A CASE PRESENTATION OF URETEROCELE

Presenter - Dr. Bonny Shah

Under guidance of - Dr. R G Surela (Professor Medical Supritendent &HOU)
- Dr. S M Patel (Associate Professor)
- Dr. T A Shah (Assistant Professor)
DEPARTMENT OF SURGERY, Smt. N.H.L. Municipal Medical College & Smt. Sharadaben Chimanlal Lalbhai Municipal Hospital

TheUreterocoele Surgical Options

Definition Endoscopic Ueterocoele Incision/Deroofing
Cystic dilitation of the terminal portion of the ureter draining the upper May induce upper pole reflux
pole
A temporising procedure in acute situation
Classification
Orthotopic:- lies intravesically Upper Pole Nephrectomy
Ectopic:- extends to or beyond bladder neck Upper pole is poorly functioning
Caecoureterocoele:- prolapses posterior to urethra and anterior to vagina Subsequent ureterocoele
Commonly associated with Duplications excision/reimplantation in 20%
In a single system, Orthotopic Ureterocoeles are associated with a normal
Pyelopylostomy
upper pole
In a duplex system, Upper pole dysplasia (poor functioning) occurs with Upper pole function is preserved
duplex system ureterocoeles Ureterocoele Excision and
Reimplantation
Delay in canalisation of upper Where upper pole function is
ureteric bud leads to cystic dilatation
preserved
Duplex Ureterocoele
Both ureters are conjoined and
reimplanted
MCU
1. Ureterocoele
A 40 yrs old male patient .
Presentation
Antenatal / UTI
BOO / Colicky Flank pain / Incidental
Usually well preserved upper poles
Intervene for Symptoms / Upper pole obstruction

CYSTOSCOPY
Ureterocele is seen as transluscent cyst enlarging and collapsing as urine
flows in from above. SUMMARY
Endoscopic Incision is minimally invasive useful method -
As sole therapeutic measure
As a temporizing procedure

Endoscopic Ueterocoele Incision/Deroofing

STONE IN URETEROCELE

MANAGEMENT
Duplex System Ureterocoele
Indications for Surgery
Presence of Symptoms
Reasonable function in Upper pole
Symptomatic (UTI) Lower pole Reflux
Lower pole obstruction (due to upper pole hydro.) Follow up
Bladder outflow obstruction ALRIGHT FOR SIX MONTHS,
RECURRENT UTI & PASSING CALCULI,ASYMPTOMATIC FOR LAST ONEYEAR.
Ureterocoele obstruction
 GASTRO INTESTINAL STROMAL TUMOUR (GIST)
Presenter - Dr. ANKIT PATEL
Under guidance of - Dr. R G Surela (Professor Medical Supritendent &HOU)
- Dr. S M Patel (Associate Professor)
- Dr. T A Shah (Assistant Professor)
DEPARTMENT OF SURGERY, Smt. N.H.L. Municipal Medical College & Smt. Sharadaben Chimanlal Lalbhai Municipal Hospital

INTRODUCTION CASE REPORT OF MESENTRIC GIST

w A gastrointestinal stromal tumor (GIST) is one of the most w A 43 yrs old Female patient came with c/o , abdominal pain , weakness ,
common mesenchymal tumors of the gastrointestinal tract (1-3% of all anorexia , vomiting
gastrointestinal malignancies). w All routine blood investigations done
w They are typically defined as tumors whose behavior is driven by mutations in w Radiological investigations done-CT findings suggestive of mesentric GIST
the Kit gene or PDGFRA gene, and may or may notstain positively for Kit. w SURGICAL MANAGEMENT
-resection of mesentric GIST and some part of ileum done , ileoileal
CLINICAL MENIFESTATION anastomosis done .
w Symptoms depend on the site and size of the tumor
w Include:
Abdominal pain
Dysphagia
Gastrointestinal bleeding
Symptoms of bowel obstruction
Small tumors may be asymptomatic
Weakness

INVESTIGATION
Routine blood investigations
Immuno histochemistry markers-CD 117,CD 34 CASE REPORT OF ILEAL GIST
CT scan ILEAL GIST
A 62 yrs old male patient came with c/o
1.) Characterize an abdominal mass,
abdominal pain , abdominal distension ,
2.) Evaluate its extent, +/- metastatic disease.
vomiting , weakness , constipation ,
3.) Oral as well as IV contrast should be administered to define the bowel
anorexia
margins.
All routine blood investigations done
Upper endoscopy
Radiological investigations done-CT
a.) Endoscopy may be useful to further characterize the lesion if a gastric mass
is identified. findings suggestive of ileal GIST
b.) Leiomyomas typically appear as a submucosal mass with smooth margins, SURGICAL MANAGEMENT
a normal overlying mucosa, and they may bulge into the gastric lumen. -ileal resection and ileoileal anastomosis
Central ulceration is occasionally seen. CASE REPORT OF JEJUNAL GIST
TREATMENT A 47 yrs old male patient came with c/o JEJUNAL GIST
MEDICAL MANAGEMENT abdominal pain , vomiting , weakness
Small molecule tyrosine kinase (TK) inhibitors such as imatinib and sunitinib. ,bleeding PR , constipation , anorexia
MECHANISM OF ACTION All routine blood investigations done
These agents block signaling via c-kit or PDGFRA by binding to the adenosine Radiological investigations done-CT
triphosphate-binding pocket required for phosphorylation and activation findings suggestive of jejunal GIST
of the receptor SURGICAL MANAGEMENT
SURGICAL MANAGEMENT -jejunal resection and jejunoileal
Resection of primary tumour depending upon site , size and extent of tumour anastomosis done .

CASE REPORT OF STOMACH GIST CONCLUSION

w A 52 yrs old male patient came with c/o dysphagia , abdominal pain , anorexia Stromal or mesenchymal neoplasms gastrointestinal (GI)
, vomiting 1.) The less common variety includes tumors that are iden, a.) lipomas,
w All routine blood investigations done b.) schwannomas,
w Radiological investigations done-CT findings suggestive of stomach c.) hemangiomas,
GIST d.) leiomyomas, their malignant counterparts (eg, leiomyosarcoma)
2.)The more common group consists of stromal tumors
w SURGICAL MANAGEMENT
a.) Gastrointestinal stromal tumors (GISTs).
w - Partial gastrectomy done
b.) Located in the stomach and proximal small intestine,
STOMACH GIST
c.) But can occur in any portion of the alimentary tract with smooth muscle
within its wall,
d.) Occasionally in the omentum, mesentery, and peritoneum
Constitute only 1 percent of primary GI cancers
Stomach 50-60%
Small bowel 20-30%
Large bowel 10%
Esophagus 5%
Else where in abdomen 5%