Napkin ring recurrent (persistent) bladder cancer - Forum

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forceps

Napkin ring recurrent (persistent) bladder cancer - Ärzteforum

Post#1 »

Elderly male COPD, anxiety disorder but at least as healthy as my average recent abdominal surgery patient.

Reportedly had Radiation Therapy for bladder cancer. No physical evidence of radical cystectomy. Wife thinks he had some kind of chemotherapy also.

Presented with severe constipation.

Colonoscopy shows a napkin ring extrinsic mass encircling lower rectum. I can get the colonoscope through it but I suspect it will obstruct fairly soon.

Is there any treatment that will significantly benefit him? I was considering a palliative colostomy, but would not do that if there was any chemotherapy or radical exenterative surgery that would actually help him.


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Surgeon

Re: Napkin ring recurrent (persistent) bladder cancer - Ärzteforum

Post#2 »

How far away is the stricture from the anal verge?

It could be very easy to pass through the stricture a small EEA -close it on the antimesenteric side -taking a bite of the ring and fire. This has been described for low rectal strictures. Also endoGIA could be use to take a "side bite" of the ring.

forceps

Re: Napkin ring recurrent (persistent) bladder cancer - Ärzteforum

Post#3 »

Do you think this is a good idea for this malignant (biopsy proven) stricture? I did colonoscopic (tiny biopsies) and got poorly differentiated ca of bladder origin underneath the mucosal surface as the report.

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Surgeon

Re: Napkin ring recurrent (persistent) bladder cancer - Ärzteforum

Post#4 »

I thought has been caused by the radiation.

But how far it is from the verge? You have 2 options: resect or palliate-depending on patient's condition and the extent of his disease.

People also talk now about stents.

forceps

Re: Napkin ring recurrent (persistent) bladder cancer - Ärzteforum

Post#5 »

Odder and odder: Elderly severe COPD, recent CABG (coronary artery bypass), anxiety, etc. with napkin ring low rectal lesion probable metastatic bladder ca on Path. As late as one year ago, he was still having frequent repeat cystoscopies and resection of superficial bladder cancers. Apparently, he has had Chemo or Radiation though also in past year--once again no records available right now.

Previous R hemicolectomy for polyps that couldn't be reached by scope. No recent abdominal surgery (last at least 2011 and was probably an incisional hernia repair--don't have that op report).

Decided to do sigmoid colostomy with mucous fistula, but when I got in there he had 2 upper abdominal abscesses, 1 in each upper quadrant--the right one appeared of typically GI source and was densely adherent to abdominal wall and several small bowel loops, the left one was much larger, contained thin yellow purulent fluid and was not attached to anything. I wondered if these were hernia mesh problems.

His retroperitoneum was densely fibrotic and the intestines were stuck to this retroperitoneal process.

Unfortunately, our Pathologist only works here Weds and Thursdays now, so no frozen available and I hadn't anticipated needing one.

A quick exam of the rectal lesion revealed no obvious attachment to bladder, but after this long operation, I didn't really think resecting this would be a good idea.

I could only get the distal transverse colon up as my colostomy because of the retroperitoneal fibrosis.

Today, the Pathologist called and stated there is cancer in the abscess cavity walls which most resembles breast cancer (Indian file cells). He is doing special stains. I suspect the retroperitoneal fibrosis is the same thing.

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