In the course of 2 1/2 years a 72-year-old man had five episodes of intestinal bleeding with anaemia, but no cause was at first found by routine diagnostic tests. After the fourth episode a diagnostic laparotomy was performed at which a diffusely infiltrating growing tumour was found. As it encircled the mesenteric vascular axis resection was not possible. But because of threatened ileal obstruction by the tumour a segmental ileal resection was performed, but no intraoperative diagnosis could be established.Repeated oesophago-gastro-duodenoscopies and a coloscopy all revealed blood, especially in the upper gastrointestinal tract, but no bleeding source was found. Angiography suggested bleeding in the terminal ileum. Computed tomography demonstrated a tumour in the region of the mesenteric root.At a second laparotomy because of another bleeding, which required a blood transfusion, tuberculosis was diagnosed. Triple drug treatment was initiated and the patient has been free of symptoms and bleedings since then and fully active for 1 1/2 years.This case clearly demonstrates the difficulty of diagnosis and the long delay until specific treatment, because the combination of "tumour", bleeding and stenosis of the small intestine by an infiltrative lesion at first pointed to malignant process.

Modern imaging and computer technology gain more and more importance in surgery. This is true for elective and emergency diagnosis and treatment. However integration of technology and optimization of process management is severely behind. A new diagnostic-therapeutic platform should balance this deficit. The platform is composed of a fully equipped operation room environment with integrated high end computer-tomography with navigation, a digital subtraction angiography and an OR- and imaging-table particularly developed for this set-up. The platform may be used for elective diagnosis, for diagnosis and therapy in polytraumatized patients in one and the same location (one stop shop) and for computer assisted surgery (CAS). Bringing the technology to the patient and not the patient to the technology can save time consuming and potentially dangerous transports and expensive personnel can be reduced. Navigation-technology and high quality intra-operative imaging expand the spectrum of minimally invasive surgery.

Zusammenfassung Moderne Bildgebung und Computertechnologie gewinnen innerhalb der Chirurgie einen immer höheren Stellenwert. Dies gilt sowohl für die elektive Chirurgie als auch für die Notfallbehandlung. Die Integration der Technologien und die dadurch mögliche Optimierung der Prozessabläufe hinken dieser Entwicklung jedoch stark hinterher. Eine neue diagnostisch-therapeutische Plattform soll dieses Defizit wettmachen. Die Plattform besteht aus einer voll ausgebauten Operationssaalumgebung mit integrierter navigationsfähiger Computertomographie, einer Angiographieanlage und einem speziell dafür entwickelten Patiententisch. Sie dient sowohl der elektiven Diagnostik als auch der Diagnostik und Therapie polytraumatisierter Patienten an einem Ort (“one stop shop”) und der computerassisitierten Chirurgie (CAS). Indem die Technologie zum Patienten und nicht der Patient zur Technologie gebracht wird, können zeitraubende, potenziell gefährliche Transporte und Umlagerungen sowie teures Personal eingespart werden. Navigationstechnologie und hochauflösende intraoperative Bildgebung erweitern das Spektrum der minimal invasiven Chirurgie.

HISTORY AND CLINICAL FINDINGSIn the course of 2 1/2 years a 72-year-old man had five episodes of intestinal bleeding with anaemia, but no cause was at first found by routine diagnostic tests. After the fourth episode a diagnostic laparotomy was performed at which a diffusely infiltrating growing tumour was found. As it encircled the mesenteric vascular axis resection was not possible. But because of threatened ileal obstruction by the tumour a segmental ileal resection was performed, but no intraoperative diagnosis could be established.INVESTIGATIONSRepeated oesophago-gastro-duodenoscopies and a coloscopy all revealed blood, especially in the upper gastrointestinal tract, but no bleeding source was found. Angiography suggested bleeding in the terminal ileum. Computed tomography demonstrated a tumour in the region of the mesenteric root.DIAGNOSIS, TREATMENT AND COURSEAt a second laparotomy because of another bleeding, which required a blood transfusion, tuberculosis was diagnosed. Triple drug treatment was initiated and the patient has been free of symptoms and bleedings since then and fully active for 1 1/2 years.CONCLUSIONThis case clearly demonstrates the difficulty of diagnosis and the long delay until specific treatment, because the combination of "tumour", bleeding and stenosis of the small intestine by an infiltrative lesion at first pointed to malignant process.

1965–1981 wurden 15 Patienten mit Myxom (14 linker Vorhof, 1 rechter Ventrikel) operiert. In 8 Fällen dominierte klinisch die AV-Klappen-Obstruktion, in 4 die Embolisierung, in 3 die „Myxomkrankheit”. 8 zeigten zwei Symptomenkomplexe kombiniert. Die Echokardiographie sichert heutzutage die Diagnose. Die Resektion muß dringend erfolgen. Das Myxom muß unter Excision seiner Basis entfernt werden. 1 Patient starb postoperativ an einer Hirnblutung nach präoperativer Embolie. l Rezidiv nach 7 Jahren zeigt die Notwendigkeit langfristiger Nachkontrollen.

Between 1965 and 1974 ten patients were operared on for cardiac myxoma. There was a striking variety of signs and symptoms caused by tumour embolization, haemodynamic obstruction, and auto-immunological reactions. The diagnosis should be made early before the occurrence of irreversible complications, especially cerebral embolism. Echocardiography is a simple technique for the detection of atrial myxoma but a negative result does not exclude it, and diagnosis has to be confirmed by angiocardiography. The tumour should be removed as soon as possible after diagnosis. There is danger of tumour embolization in the course of operation. Operative mortality is low in patients with only haemodynamic complications, but in patients with previous cerebral embolism the risk is higher because of possible bleeding in the infarcted areas of the brain resulting from anticoagulation during cardio-pulmonary bypass. Nonetheless, the operation is indicated in all cases. If removal of the myxoma is complete, recurrence is rate and long-term results are good.

Between 1965 and 1974 ten patients were operared on for cardiac myxoma. There was a striking variety of signs and symptoms caused by tumour embolization, haemodynamic obstruction, and auto-immunological reactions. The diagnosis should be made early before the occurrence of irreversible complications, especially cerebral embolism. Echocardiography is a simple technique for the detection of atrial myxoma but a negative result does not exclude it, and diagnosis has to be confirmed by angiocardiography. The tumour should be removed as soon as possible after diagnosis. There is danger of tumour embolization in the course of operation. Operative mortality is low in patients with only haemodynamic complications, but in patients with previous cerebral embolism the risk is higher because of possible bleeding in the infarcted areas of the brain resulting from anticoagulation during cardio-pulmonary bypass. Nonetheless, the operation is indicated in all cases. If removal of the myxoma is complete, recurrence is rate and long-term results are good.