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Søren Meisner

Publications and source records attributed to Søren Meisner.

9 recordsLinked to original sources
PubMed2006

[Capsule endoscopy detection of metastasis of a malignant melanoma in the small intestine].

We report a case of a 74-year-old man with a Clark's level II, 2.5 mm melanoma on his back that was excised. A post-operative PET scan found no lesions. One and a half years later, the patient developed anaemia with blood in his stool. A gastroscopy and colonoscopy found no lesions. Video capsule endoscopy, however, detected a tumour in the small intestine. At laparotomy, the tumour was removed. Histological diagnosis showed metastatic malignant melanoma. We believe that video capsule endoscopy may increase the rate of diagnosis of small-bowel melanoma metastases.

Aged↗
PubMed2006

[Can endoscopic retrograde cholangiopancreatography be made a low-risk procedure?].

Endoscopic retrograde cholangiopancreatography (ERCP) is considered a high-risk procedure. Here we report 30-day morbidity and mortality rates following ERCP in a single referral centre with experienced endoscopists and restrictive selection of patients and indications for the procedure. The specific ERCP-related morbidity rate was 6.9%, and the specific ERCP-related mortality rate was only 0.3%. We conclude that ERCP is a safe procedure in the hands of experts and with the use of selection of patients and restrictive indications for the procedure.

Adolescent↗
PubMed2006

[Treatment of colorectal obstruction with self-expanding metal stents].

INTRODUCTION: Self-expanding metal stents (SEMS) serve as a bridge to surgery in cases of acute colorectal obstruction and provide palliation without surgery in patients with severe co-morbidity or disseminated disease. We describe our experiences with the use of SEMS in colorectal obstruction. MATERIALS AND METHODS: We analysed a consecutive series of 162 SEMS procedures in 141 patients (72 men (51%)) in the period between May 1997 and September 2004. The median age of the patients was 75 years (range 28-101). In 11 patients the stricture was caused by benign pathology. The indication of the procedure was in 62 (44%) of the cases in patients with cancer acute obstruction. RESULTS: Seventeen patients needed more than one SEMS procedure. Perforation of the colon by the stent was seen in 2% of the cases, and the frequency of stent migration was 10%. The 30-day mortality rate after SEMS procedure and subsequent resection was 17% in cases of malign acute obstruction. Resection without stoma was achieved in 76% of the cases. Fifteen patients with acute obstruction received SEMS as the definitive treatment. In the group of patients who received SEMS as palliation, only 10% needed a stoma in the follow-up period. In 11 cases of benign strictures, only 4 were successful. CONCLUSION: SEMS is a safe, effective procedure in the treatment of colorectal obstruction. It reduces the mortality and morbidity rates, as well as the need for stomas. In our experience, stenting of benign strictures is ineffective and associated with higher rates of complications.

Acute Disease↗
PubMed2006

[Treatment by stent of a benign stricture of the colon complicated by a fistula].

We report on a case of a 69-year-old man with a benign stricture of the sigmoid colon due to diverticulosis, complicated by a colovesicular fistula. Due to severe co-morbidity, surgical excision of the fistula and resection of the sigmoid colon were not indicated. Instead, the stricture and the fistula were managed via the insertion of a self-expanding, uncoated metallic stent (SEMS). The clinical symptoms disappeared after insertion of the SEMS. We conclude that SEMS may be a possible therapeutic tool in selected cases of benign stricture of the colon, with or without fistula.

Humans↗
PubMed2005

[Acute treatment of colon cancer].

The primary treatment of left-sided colonic ileus due to cancer is after localisation of the tumor with water-soluble contrast enema placement of an intraluminal, self-expanding metal stent. If this treatment is unsuccessful, open resection with primary anastomosis is the treatment of choice. In the case of a perforated tumor, resection and primary anastomis may be performed if the patient s general condition is acceptable.

Acute Disease↗
PubMed2004

Self-expanding metal stents for colonic obstruction: experiences from 104 procedures in a single center.

PURPOSE: In the past, colonic obstruction caused by malignancy most often resulted in high-risk operations, usually involving two-step procedures or leaving the patient with a stoma in case of disseminated disease. METHODS: Between May 1997 and January 2003, 104 procedures with self-expanding metal stents have been performed in 96 patients at our institution. The goals of the procedure were either postponement of emergency operation or definitive palliative treatment. Surgeons with combined endoscopic and fluoroscopic technique performed all procedures. In most cases no analgesia or only slight sedation was used. Seven types of stents were used, CHOO stents and Wallstents accounting for the majority. RESULTS: A total of 96 patients were included, 44 men and 52 women, with a mean age of 78 (range, 41-100) years. Technical success was achieved in 92 percent; clinical success, in 82 percent. Thirty-eight patients presented with an acute obstruction and were treated with self-expanding metal stents. Seventeen patients later underwent an elective resection, 9 patients were not decompressed, and 12 patients had disseminated disease and were not treated further. Eight patients had benign strictures. These eight patients accounted for several of the reinterventions, and only three patients truly gained benefit from stenting. In the remaining patients disseminated disease was diagnosed and the acute stenting served as the definitive palliative treatment. Procedure-related complications were few: perforation occurred in three patients during stenting and in one instance 6 to 7 hours after. Other technical problems could mainly be overcome by introducing an additional stent. Complications seen in the group treated with self-expanding metal stents and subsequent resection [mortality N = 3 (18 percent)], anastomotic leakage [N = 3 (18 percent)], do not differ from the number of complications we usually see in our patients who undergo elective colorectal resection. CONCLUSIONS: The use of self-expanding metal stents in malignant colonic obstruction is a safe and effective procedure with a low mortality and morbidity. In our experience the stenting of benign strictures is ineffective and combined with a high rate of complications.

Adult↗
PubMed2004

Delayed ischemic cecal perforation despite optimal decompression after placement of a self-expanding metal stent: report of a case.

Endoscopic deployment of self-expanding metal stents offers an alternative to surgical intervention in rectocolonic obstructions. Reported clinical failures in the literature are all related to the site of stent placement. We report a case of serious intra-abdominal disease after technically and clinically successful stent deployment: a potentially dangerous situation of which the surgeon should be aware. A previously healthy 72-year-old female was referred to our department with symptoms of an obstructing colorectal tumor. Successful stent placement resulted in resolution of the obstructive condition. Three days after stent deployment, x-ray examinations revealed a small-bowel obstruction and emergency surgery was performed. Intraoperative findings demonstrated a segment of ileum fixated to the tumor in the small pelvis, resulting in the obstructive condition. Furthermore, a cecal perforation, probably caused by ischemic conditions developed before stent-decompression of the colon was revealed during the operation. The patient died in the postoperative course. We discuss the observation of patients treated with self-expanding metal stents based on the selection-strategy used to allocate patients to this specific treatment. We conclude that although a patient is eligible for treatment with self-expanding metal stents, large-bowel obstruction can be too "old" for stent-decompression, causing ischemic perforation of the colon. Furthermore, we underline the need to focus on the possibility of obstructions other than those being treated.

Aged↗