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We are presenting the case of a retroperitoneal urinoma, secondary to a spontaneous pelviureteral junction rupture that effused to the thigh. A 45-year-old female patient known with lithiasis history admitted emergently in our clinic for right lumbar pain, right thigh pain and edema, fever and chills. Ultrasound examination and contrast CT revealed right side grade II hydronephrosis, fluid accumulation in the perirenal fat surrounding the kidney and descending downwards to the pelvis and upper thigh. At retrograde pyelography a right pelviureteral rupture could be observed. We preferred a minimal invasive approach and placed a right retroperitoneal drainage tube and a double-J stent, combined with broad spectrum antibiotics. After few days the patient complained for right thigh pain and movement impairment. She was immediately operated openly for right thigh abscess. Three days postoperative the general status of the patient improved and blood analyses normalized. Lumbar urinoma is a rarely encountered complication of urinary tract obstruction that can spread along the psoas muscle into the thigh. Minimal invasive treatment is recommended as first approach for urinary tract ruptures. In medical literature there are few cases of retroperitoneal abscesses effused into the thigh most of them with gastrointestinal origin. [ABSTRACT FROM AUTHOR]

Liposarcomas are the most common retroperitoneal sarcomas, occurring more frequently in the age range of 40-60 years. The purpose of this article is to highlight the diagnostic and therapeutic modalities of retroperitoneal giant liposarcomas exemplifying by presenting a 41 year old patient with a large retroperitoneal tumor (29/24/12 cm) excised with difficulty to healthy tissue and following the histopathological result, it was shown to be a primitive liposarcoma with variable profile. The patient had a good post-operative evolution and refused any adjuvant treatment (radiotherapy). He developed a large local relapse associated with vertebral metastases, with reintervention having a very difficult tumor reduction but with unfavorable postoperative evolution, with multiple organic dysfunction syndrome leading to the patient's death. Analyzing the data from the literature, we concluded that complete surgical excision with the affected organs and structures is the gold standard of treatment, but tumor recurrences are frequent (especially for dedifferentiated subtypes) and lead to increased mortality rates; adjuvant or neoadjuvant radiotherapy can help to prevent such relapses (there are still many ongoing clinical studies). [ABSTRACT FROM AUTHOR]

The stone disease in a pelvic kidney is often difficult to treat due to the multiple anatomical anomalies. We have performed a laparoscopic pyelolithotomy for a large pelvic kidney stone with guided intraoperative flexible ureteroscopy. We have successfully performed a peritoneal transmesocolic laparoscopic pyelolitotomy to a 35-year old female patient with a 23 mm stone located in the collecting system of her right pelvic kidney. During the operation we also used a flexible ureteroscope to identify the stone due to an aberrant disposition of the right collecting system. Operative time was of 5 hours with no injury of major blood vessels. Postoperative recovery was four days with minimal abdominal pain, minimal abdominal drainage, no urine leakage in the peritoneal cavity and fast retrieval of gastrointestinal function. At this point the patient is stone free and the kidney has normal function demonstrated in a renal scintigraphy. Laparoscopic pyelolithotomy is a safe and efficient treatment option for stone disease with large calculi in ectopic pelvic kidney. The advantage of laparoscopic pyelolithotomy is that it has good functional results, with fast postoperative recovery, low complication rates and high stone free rate in one session. [ABSTRACT FROM AUTHOR]

Colon tumors in the elderly are often problematic regarding the differential diagnosis along with the appendicular plastron due to their low reactivity in case of tumor or inflammatory aggressions. The present paper presents the case of a 76-year-old patient, whose symptomatology indicated an appendicular plastron initially treated in a conservative manner, and then surgically approached and for which the anatomopathological result certified the diagnosis of a cecal mucinous adenocarcinoma. The discussions about this case stress the limitations of both the clinical examination and the imaging explorations such as colonoscopy and computed tomography for the differentiation of a benign inflammatory pathology of appendicular plastron from a possible malignant tumor localized at the level of the cecum. For uncertain cases, the surgical treatment of right radical ileohemicolectomy is the only means left to decide the proper diagnosis and to prevent the occurrence of severe complications specific to the neoplastic disease. [ABSTRACT FROM AUTHOR]