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Introduction Peptic ulcers account for 50% of upper gastrointestinal bleeding incidents. Bleedings from large vessels, such as the gastroduodenal artery, are associated with increased mortality. Ulcers located on the posterior wall of the duodenum show the highest risk for erosion of the gastroduodenal artery. Endoscopic management is challenging and rebleeding rates are high due to internal and external confounding factors such as anatomical variability and gastric insufflation. We aimed to correlate macroscopic and endoscopic anatomy for assessment of implications for clinical management. Material and methods The gastroduodenal artery was dissected in 10 anatomical specimens. The points of contact of the artery with the posterior wall of the duodenum were marked with needles. The endoluminal position of the needles was recorded by standardized gastroscopy and a 3-dimensional virtual reconstruction was carried out for visualization of the artery's course. Results The artery's proximal and distal points of contact with the duodenum were 27.2 mm (range 15–30 mm; SD 6.7 mm) and 15 mm (range 10–20 mm; SD 3.5 mm), respectively, from the pylorus. The gastroduodenal artery branches from the common hepatic artery within the omentum minus running adjacent to the duodenal wall to the head of the pancreas. From endoscopic perspective, the gastroduodenal artery's course was directed towards the tip of the gastroscope. Conclusion Due to the peculiar extraluminal course of the gastroduodenal artery the arterial blood flow projects into the direction of the gastroscope during endoscopic intervention. Measures for bleeding control might have to be applied aboral from the bleeding site.

Background. Paratesticular liposarcomas are almost always mistakenly diagnosed as inguinal hernias subsequently followed by inadequate operation.Methods. 14 consecutive patients with paratesticular liposarcoma were retrospectively reviewed. Preoperative management was evaluated. Disease-free and overall survival were determined.Results. In 11 patients primary and in 3 patients recurrent liposarcoma of the spermatic cord were diagnosed. Regarding primary treatment in primary surgical intervention resection was radical (R0) in 7 of 14 (50%) patients, marginal (R1) in 6 (43%) patients, and incomplete with macroscopic residual tumour (R2) in 1 (7%) patient. Primary treatment secondary surgical intervention was performed in 4 patients: resection was radical (R0) in 3 (75%) patients and marginal (R1) in 1 (25%) patient. Regarding secondary treatment in recurrent disease resection was marginal (R1) in 3 patients (100%). Final histologic margins were negative in 10 patients with primary disease (71%) and positive in 4 patients with subsequent recurrent disease. After radical resection disease-free survival rates at 3 years were 100%. Overall survival at 4.5 years (54 (18–180) months) was 64%.Conclusion. An incomplete first surgical step increases the number of positive margins leading to local recurrences and adverse prognoses. Aggressive surgery should be attempted to attain 3-dimensional negative margins.

The size of the primary tumour is considered the most important risk factor for the development of metastasis or local recurrence in case of gastrointestinal stromal tumour (GIST). Until now no prospective data are available in the literature about the role of neadjuvant therapy with Imatinib. Between 2009 and 2012 seven patients with a giant GIST 20 cm underwent a neadjuvant treatment with Imatinib, a radical operation, followed by an adjuvant therapy. These patients were controlled with regard to peri- and postoperative morbidity and disease-free survival. Two patients were considered not resectable and one patient showed liver metastasis at the time of diagnosis. RECIST responses to the neoadjuvant Imatinib were: 2/7 patients with stable disease, 3/7 partial response, 2/7 partial response with down-staging (resectable disease). Because of the following tumour localisations (6 gastric and 1 rectal), six gastrectomies (one en-bloc with left pancreas) and one Holm operation were performed. The patient with simultaneous liver metastasis developed a tumour progression during the follow-up but the others are still tumour free after 2 years. We detected a significant tumour volume regression due to the neadjuvant chemotherapy in cases of GIST 20 cm (30 %). Our series showed good results for a neadjuvant therapy in cases of giant GIST with the achievement of 100 % R0 resection without a high morbidity rate (in the literature a tumor size 10 cm and poor localisation is associated to a high risk of R1 - 2 and high morbidity). Peri- and postoperative morbidity are acceptable and the tumour free survival at 2 years is 85 %.