[Transanal excision of rectal tumors. New applications of the endo-GIA forceps]

Two new applications of the endo-GIA technique are presented for endoluminal intrarectal resection of benign or malignant tumors of the lower or middle part of the rectum. These procedures allow resection of sessile lesions with a large implantation base. Depending on the pathology and the type of implantation, resection can either be total or via the musculosa. Results have been good with this simple procedure which allows total tumor resection and an uneventful post-operative period.

[Caustic rectal stenosis. Trans-anal resection using an EEA stapler]

An original treatment of caustic rectal stenosis due to abuse of analgesic suppositories is presented. The stenosis had been excluded by distal colostomy during 2 years before reconstruction of the circuit was attempted. Anatomically, the stenosis appeared as a complete diaphragm which could be recanalized by an EEA stapler for circular anastomosis, installed in two sites: endoluminal from the colostomy and perineal. After a 2-year follow-up, the anatomical and functional results are satisfactory.

Acute Budd-Chiari syndrome with hepatic failure and obstruction of the inferior vena cava as presenting manifestations of hereditary protein C deficiency

The protein C system is essential in limiting the activation of coagulation in vivo. We report on a 29 year old woman with Budd-Chiari syndrome and occlusion of the inferior vena cava who presented with acute liver failure. She was successfully treated with an emergency mesoatrial shunt. Eight months after surgery, she has no ascites and normal liver function. She had a low concentration of plasma protein C on admission to hospital and during the follow up. Protein C deficiency subsequently was found in her father and two sisters, who were asymptomatic. Hereditary protein C deficiency should be considered in patients with Budd-Chiari syndrome.