The first transendoscopic plastic to self-expandable metal stent replacement in Serbia and Montenegro using a diagnostic duodenoscope

Studies have shown that SEMS remain patient longer with fewer associated complications compared with conventional plastic strents. Zilver stent, a nitinol zig-zag mash SEMS has a special advantage, having a thin introducer diameter of 7 Fr with a fully deployed span of 10mm. For a 48-year-old woman presented with obstructive jaundice and a diagnosis of unresectable pancreatic carcinoma with consequent stenosis of common bile duct (CBD), infiltration of local blood vessels and life expectancy longer than six months, it was decided that an endoscopic palliative drainage procedure should be performed. The technique of transendoscopic plastic to metal stent exchange is described, using a diagnostic duodenoscope. The patient lived 7 months after implementation of Zilver stent and died anicteric due to progression of a primary disease. The transendoscopic plastic to metal stent exchange is feasible palliative method which requires a basic endoscopic equipment and experienced staff and therefore is applicable in developing countries as well.

[Fournier's gangrene associated with carcinoma of the colon]

BACKGROUND

A case of Fournier's gangrene associated with colon carcinoma was reported. Fournier's gangrene is a progressive soft tissue infection of the perineal and scrotal region.

CASE REPORT

A 50-year-old man was transferred to our hospital with clinical signs of septic shock and necrotizing soft tissue infection, of the scrotal and perianal regions. Local examination revealed a communication between rectum and left ishioanal fossa, many openings in the skin with purulent discharge and crepitus. After resuscitation the patient underwent emergent operation. Surgical debridements were performed. The wounds healed well with good granulation tissue.

DISCUSSION

The majority of patients with Fournier's gangrene are immunocompromised. Malignant disease, obesity, diabetes mellitus and peripheral vascular disease have been cited as the main predisposing factors. The origin of this synergic infection is in alimentary and urinary tract. As a rule, penis, testes, bladder and rectum are spared. Conventional treatment includes repeated surgical debridement, special antibiotic regimen to cover both, aerobes and anaerobes, and intensive care treatment. Despite optimal medical and surgical management the mortality rate in Fournier's gangrene still remains high.

[Total abdominal colectomy in treatment of acute malignant obstruction of the left colon]

This paper deals with an experience of a total abdominal colectomy in acute malignant obstruction of the left sided colon. Ten patients were treated with total abdominal colectomy during 1991 with a high frequency of synchronous carcinoma (in two patients) and precancerous lesions (a big polyp in one patient) in total 30%. One patient died after the treatment (10%) and a complete dehiscence of the ileo-rectal anastomosis and reoperation on the ninth postoperative day. One patient had had an infection of the wound. Total abdominal colectomy is an operation which can have an important role in decreasing malignant reoccurrence, avoiding stoma in the postoperative period of one month in most patients. Absolute indication for total abdominal colectomy in patients with acute malignant obstruction of the left sided colon is the "closed loop" obstruction with a decompensated colon, as well as the factor of heredity in close relatives and the absence of locally spread tumors and metasthases disregarding the age of the patient and the competence of the ileocecal valvula.