Romanian Journal of Military Medicine

2

Authors: Cătălina Diaconu, Mădălina Ilie, Alexandru L. Chiotoroiu, Laura Voicu, Daniel O. Costache, Raluca S. Costache

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3

Authors: Daniela Tabacelia, Mădălina Ilie, Alina Constantin, Anca Macovei Oprescu, Gabriel Constantinescu

Caroli diseaseis a rare congenital disorder that classically causes saccular dilatation of the bile ducts. The complications of Caroli include choledochal cysts with recurrent cholangitis, abscess formation, septicaemia, intrahepatic lithiasis and amyloidosis.We report a rare case of a young female with Caroli disease pointing out the intrahepatic lithiasis as a rare complication of the disease. Learning points  Caroli disease is an uncommon condition that should be considered in the differential diagnosis of hepatic essential cysts.  Clinically, it is characterized of recurrent episodes of fever and pain. The correct and early diagnostic is important because of the different complications and treatment unlike the essential hepatic cysts.

4

Authors: Alexandra Șopu

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5

Authors: Augustin C. Dima, Teodor Artenie, Daniel Florea, Florina Bold, Paul I. Oprea

49 year-old man presented to our clinic for pain in the right hypochondrium, diarrhea, and fever. The clinical examination highlights a tumoral formation in the right side of the abdomen, with firm consistency, poorly defined margins, and present mobility in the deep structures. On biological exams, leukocytosis with neutrophilia, inflammatory syndrome, and hypoalbuminaemia were identified. The first computed tomography exam described parietal thickening of the ascending colon, with infiltrative aspect, and multiple local adenopathies, lomboaortic and interaortocave. Moreover, four nodular liver tumors, with hypodense image in native examination, were identified. The lab tests for infectious diseases were all inconclusives: three hemocultures, three stool samples, and three coproparasitological exams were all negatives. Interdisciplinary examinations, internal medicine and infectious diseases, sustained the diagnosis of colonic neoplasm with peritumoral abscess and liver pseudo-tumoral masses. The colonoscopy did not revealed any bowel lesions relevant for neoplasia. This result as well as the bio-clinical context imposed abstention from surgical intervention. Wide spectrum antibiotics and symptomatic treatment were initiated. But, ten days after hospitalization, the second computed tomography exam showed reduction of the ascending colon wall thickness associated with significant increases of the liver tumors is so revealed. The investigations for other possible etiologies were so continued.

6

Authors: Mădălina Ilie, Vasile Șandru, Cristian Nedelcu, Bogdan Popa, Gabriel Constantinescu

Introduction: Self expandable metal stents (SEMS) are developed lately, as an effective and safe, less invasive alternative of surgery for the treatment of malignant intestinal/biliary obstruction. Recently, SEMS are also introduced in benign pathology. Aim: The aim of this presentation is to report a retrospective analysis of the total number of SEMS placed for esophageal, enteral, colorectal and biliary obstruction during the last 3 years in Clinical Emergency Hospital Bucharest, as well to review the literature published on this issue. Methods: Between 2013-2015 in Clinical Emergency Hospital Bucharest, we have placed: 232 esophageal stents, 23 enteral stents, 5 colonic stents and 75 biliary stents under radiologic guidance. The main parameters followed were represented by: sex, age, grades of obstruction, stent diameter and type, immediate and late complications and survival rate. Results: Regarding the esophageal stenting, most of the indications were malignant obstruction (155 cases of esophageal cancer and 30 cases of extrinsic compression), but also for esophageal fistula, peptic stenosis and even traumatic esophageal rupture. The majority of the enteral and colonic stents were inserted for malignant obstructions, having only 2 cases with benign obstructions. This is also the case for biliary stenting, were most of the indications were represented by pancreatic cancer. Technical and clinical success rates were approximately 92% and 80%, respectively. There were no major complications of perforation, bleeding, or death. Conclusions: SEMS insertion can be performed safely, with minimal complications and hospitalization allowing the restart of oral feeding and improvement of nutritional status for the digestive obstruction or jaundice disappearance in case of biliary obstruction. It represents the first option for unresectable digestive/biliary malignant obstruction.