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CASE REPORT: RECIDIVA PELVICA DI ETP RETTO CON INFILTRAZIONE URETERALE, TRATTAMENTO E FOLLOW-UP

G. Marzocca, M. Lo Gatto, F. Varrone
  • G. Marzocca
    Dipartimento di Chirurgia Generale e Specialità Chirurgiche. Azienda Ospedaliera Universitaria Santa Maria alle Scotte, Siena, Italy | info@pagepress.org
  • M. Lo Gatto
    Dipartimento di Chirurgia Generale e Specialità Chirurgiche. Azienda Ospedaliera Universitaria Santa Maria alle Scotte, Siena, Italy
  • F. Varrone
    Dipartimento di Chirurgia Generale e Specialità Chirurgiche. Azienda Ospedaliera Universitaria Santa Maria alle Scotte, Siena, Italy

Abstract

Introduction: The authors present the clinical case of a woman subjected to anterior resection of the rectum with recurrence involving the pelvic the right ureter occurred after about 8 years from surgery. Patients and methods: M.R. woman of 79 years, came to our observation for pain type sciatica. The patient has a history of resection front of the rectum for adenocarcinoma (T3N1Mx, G2) carried out 8 years first with 5-year follow-up negative for recurrent disease. The Rx lumbosacral spine was negative, while the ultrasound of the abdomen showed an hydronephrosis second degree dependent on the right kidney. Yes therefore performs a CT abdomen demonstrating "a level sacral promontory a solid education with a diameter of 30 mm, inhomogeneous density for nodular calcification, which is located between the common iliac arteries and infiltration of the right ureter, which appears stenosis, upstream of the stenosis, there are signs of uretero-hydronephrosis. Outcomes of resection of the rectum without evidence of loco-regional recurrence or of iliac lymphadenopathy. The tumor markers are in normal limits. Assuming a radical treatment you Exploratory laparotomy: for the small pelvis is a neoformation of about 5 cm in diameter invading the distal right ureter and ileal loop. Proceed to resection stretch of ureter infiltrated by the tumor and practiced direct suture catheter type on pig-tail. Also practiced resection involved in the neoplastic process of the loop ileal. Not possible remove the entire tumor infiltrating the plan because sacral. The post-operative care is regular, the patient is resigned in XII postoperative day. Histopathological examination identifies the lesion as relapse of adenocarcinoma of the large intestine. Results: The follow-up at 12 months is negative for disease progression. Conclusion: Colorectal tumors in advanced stage (upper stage C2, III) even after treatment of resection and adjuvant chemotherapy regional recurrences may spot the medium to long term no increase in common biohumoral Markes. These recurrences may affect the urinary system requiring treatment diligent in order to prevent permanent kidney damage. Strategies therapeutic present in a clinical setting and in the literature are numerous and vary depending on the extension of recidivism. They range from simple derivatives contracts (nephropielostomy), the resection-anastomosis of ureter involved, the en bloc resection recurrence of the mass, the debulking, the pelvic exenteratio.

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Submitted: 2012-02-09 17:33:41
Published: 2012-02-09 17:49:30
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Copyright (c) 2012 G. Marzocca, M. Lo Gatto, F. Varrone

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