Rezectie recto-sigmoidiana laparoscopica pentru nodul endometriozic rectal.Prezentare de caz

Examenul RMN cu protocol de endometrioza a evidentiat:
– col uterin – nodul endometriozic de 12/11 mm, la nivelul peretelui posterior
– ingrosarea neregulata a ligamentelor utero-sacrate
– endometriom ovarian drept ce face corp comun cu uterul si colonul sigmoid; depaseste fascia rectala anterioara – 43/70/57 mm, cu infiltrarea peretelui anterior rectal
– ovar stang – marit de volum – 72/50/62 mm – endometriom ovarian de 63/50/53

Examenul colonoscopic – a evidentiat la circa 15 cm de OAE compresie extrinseca ce nu permite distensia completa a intestinului la insuflatie; la acest nivel, mucoasa este inflamata, rigida; prin transparenta mucoasei se evidentiaza o colectie lichidiana de culoare inchisa (endometriom ?); fara alte modificari patologice.

Am intervenit chirurgical – laparoscopie exploratorie – bloc tumoral aderential pelvin ce oblitereaza fundul de sac Douglas, la care participa uterul, ambele ovare tumorale (endometrioame ovariene), ambele trompe uterine (aspect normal macroscopic), colonul sigmoid, rectul superior si ambele uretere.
Dupa liza aderentelor am pus in evidenta doi noduli endometrozici de 3, respectiv 2 cm, situati la nivelul rectului superior ce comprima si obtrueaza extrinsec segmentul tubului digestiv.
Am practicat rezectia nodulilor endometriozici in bloc cu segmentul colonic afectat, urmata de anastomoza termino-terminala (stapler circular).

Evolutia postoperatorie a fost una favorabila, cu reluarea tranzitului intestinal si a mictiunilor fiziologice, pacienta fiind externata in ziua 3 post-operator.

Video interventie chirurgicala

Echipa medicala:

Dr. Matei Gabriel  – Chirurgie Generala
Dr. Mitroi Gabriel – Chirurgie Ginecologica


Tumora colo-rectala – operatie minim invaziva

I reached MedLife by mere chance.
Last summer I came to visit the family of my sister, who married in Romania.
At a certain point during the visit, I started having abdominal pain and my appetite went low.
I was also losing weight since a while, but I never paid attention to this issue.

Because I was not feeling well at all, my sister urged me to go to a doctor for a check-up. So we reached for a gastroenteorologic control.

As the doctor suspected something, he recommended me to do a colonoscopy.
I followed the procedure, but at a certain point the doctor told me that something blocked the probe, and after the first data analysed, he mentioned a tumour.

He spoke me calmly so as not to scare me and recommended me to do a CT examination. The results showed that I had an approximatively 10 cm tumour, located in the rectum, and infiltration to the uterus.

I could not wait, the pain was growing on and on so I went to Dr. Gabriel Matei, laparoscopic surgeon.
After the case evaluation, he told me that I was at risk of getting an intestinal obstruction and surgery was needed.
I talked to the oncologist and started the treatment.

After three months I made a new set of investigations – the tumour diminished significantly and then we were able to make the surgical procedure and extract it.

This intervention involved a solo-rectal surgeon (dr.Gabriel Matei) and gynaecologist surgeon.
After a month since the operation I returned for the last intervention, colostomy removal and intestinal tract reintegration.

Today I can say that I’m alive and I won because of a quickly reacting team, very professional in the approach, exactly when most needed.

Ceren, 52, Turkey

sursa: medlifeinternational.com

Dr. Gabriel Matei
Absolvent al UMF "Carol Davila" din București (2003), medic primar chirurgie generală, competență în chirurgia laparoscopică avansată.
În contact deschis cu pacienții și permanent devotat ocupației profesionale.

© Dr. Gabriel Matei 2010-2019

Scroll Up