Intestinal obstruction secondary to Brunner's glands hyperplasia.

Brunner's gland hyperplasia constitutes 10.6% of benign tumors of the duodenum, with an incidence of 0.008%. It is usually an incidental finding during endoscopy or imaging tests as they are small and asymptomatic. In the case of symptomatic tumors, resection of the lesion is indicated. In lesions ≤2 cm, endoscopic resection can be chosen, reserving surgery for larger lesions or endoscopically inaccessible ones. We present the case of a patient with a history of vomiting and hyporexia of months of evolution who presented peptic ulcer perforation and underwent surgery. During follow-up, she presented intestinal obstruction due to pyloric stenosis. Given the impossibility of ruling out a neoplastic process with certainty in diagnostic tests, surgical resection (antrectomy) was decided with an anatomopathological finding of Brunner's gland hyperplasia.

Intracholecystic papillary neoplasm: potential differential diagnosis before a gallbladder polyp.

Intracholecystic papillary neoplasia (IPN) is a rare entity rarely described in the literature, of incidental anatomopathological diagnosis in a cholecystectomy specimen that presents a premalignant behavior, with progression to carcinoma in more than 50% of cases. In the absence of an invasive component, clinical follow-up is recommended, without associating another surgical gesture, with a 5-year prognosis (90% survival). We present a case of a patient with an incidental diagnosis of NPIC after laparoscopic cholecystectomy due to presenting a gallbladder polyp.

[Adult intestinal malrotation associated with intestinal volvulus]. / Malrotación intestinal en adulto asociada a vólvulo intestinal.

BACKGROUND: Intestinal malrotation is a congenital anomaly of the intestinal rotation and fixation, and usually occurs in the neonatal age. OBJECTIVE: Description of a clinical case associated with acute occlusive symptoms. CLINICAL CASE: A case of intestinal malrotation is presented in a previously asymptomatic woman of 46 years old with an intestinal obstruction, with radiology and surgical findings showing an absence of intestinal rotation. CONCLUSIONS: Intestinal malrotation in adults is often asymptomatic, and is diagnosed as a casual finding during a radiological examination performed for other reasons. Infrequently, it can be diagnosed in adults, associated with an acute abdomen.

Neumoperitoneo masivo: el reto de no operar / Conservative management of pneumoperitoneum secondary to pneumatosis intestinalis

Background: In Cystic Pneumatosis Intestinalis, intramural gas filled cysts are formed in the gastrointestinal wall. Its pathogenesis is unknown and its clinical manifestations are variable. Case report: We report a 33 years old HIV positive woman in retroviral treatment presenting with abdominal pain and signs of peritoneal irritation. An abdominal CT scan showed intra and retroperitoneal gas and pneumatosis intestinalis in the right and transverse colon. The patient was managed conservatively with nasogastric aspiration with a favorable evolution and was discharged ten days after admission.

Introducción: Se denomina neumatosis quística intestinal (NQI) a la formación de quistes intramurales rellenos de gas ubicados en la pared del sistema gastrointestinal, de patogénesis desconocida y de manifestaciones clínicas muy variables. Caso clínico: Presentamos un caso de neumoperitoneo masivo por NQI intestinal en una paciente VIH+ que acude a urgencias por dolor y distensión abdominal y que, a pesar de las espectaculares imágenes de la radiografía simple de abdomen y la tomografía computarizada (TC), se trató conservadoramente. Este caso pone de manifiesto el reto diagnóstico y la duda que supone para el cirujano acostumbrado a "operar para curar", no operar un cuadro que hasta hace poco tiempo inexcusablemente suponía una laparotomía exploradora.

Rotura traumática del diafragma: revisión de siete casos / Traumatic diaphragmatic rupture: a review of seven cases

Introducción: la rotura traumática del diafragma es una lesión infrecuente que aparece en politraumatismos o agresiones. Predomina en los varones entre 20 y 50 años de edad, siendo los accidentes de tráfico la principal causa en Europa. El diagnóstico preoperatorio requiere alto nivel de sospecha junto con las adecuadas exploraciones radiológicas. El retraso diagnóstico se asocia con elevada morbilidad y mortalidad, constituyendo la intervención quirúrgica inmediata un factor determinante para el éxito en el tratamiento de estos pacientes. El objetivo de este informe fue analizar la incidencia y epidemiología de la rotura traumática del diafragma en nuestro medio, y exponer nuestros resultados en el diagnóstico y tratamiento de esta lesión. Material y métodos: presentamos siete casos correspondientes al periodo 1999-2005 y analizamos el motivo de ingreso, la clínica, las formas de diagnóstico, las lesiones asociadas, el tratamiento y la evolución. Conclusiones: el diagnóstico de rotura diafragmática es difícil debido a su baja frecuencia y a su sintomatología variable, no obstante, debe ser considerado en todo paciente politraumatizado. La tomografía helicoidal es la exploración radiológica de elección y la vía de abordaje más adecuada es la laparotomía media.

BACKGROUND: Traumatic diaphragmatic rupture is an infrequent lesion usually found in polytrauma cases or after violent attacks. Patients are usually males between 20 and 50 years old, and car accidents are the main causes in Europe. Preoperative diagnosis must be based on a high level of suspicion and appropriate radiological explorations. Diagnostic delay is associated with high morbidity and mortality and early surgical treatment is required for successful management. We undertook this study to analyze the epidemiology of diaphragmatic rupture and to report our results in the diagnosis and treatment of this injury. METHODS: We present seven cases from 1999 through 2005. We analyzed the reasons for admission, signs and symptoms, diagnostic approach, associated lesions, treatment and course. CONCLUSION: Diagnosis of diaphragmatic rupture is difficult due to changeable symptomatology; nevertheless, it must be considered in all polytraumatized patients. Computerized tomography is the radiological exploration of choice and the most suitable surgical approach is laparotomy.

[Traumatic diaphragmatic rupture. A review of seven cases]. / Rotura traumática del diafragma. Revisión de siete casos.

BACKGROUND: Traumatic diaphragmatic rupture is an infrequent lesion usually found in polytrauma cases or after violent attacks. Patients are usually males between 20 and 50 years old, and car accidents are the main causes in Europe. Preoperative diagnosis must be based on a high level of suspicion and appropriate radiological explorations. Diagnostic delay is associated with high morbidity and mortality and early surgical treatment is required for successful management. We undertook this study to analyze the epidemiology of diaphragmatic rupture and to report our results in the diagnosis and treatment of this injury. METHODS: We present seven cases from 1999 through 2005. We analyzed the reasons for admission, signs and symptoms, diagnostic approach, associated lesions, treatment and course. CONCLUSION: Diagnosis of diaphragmatic rupture is difficult due to changeable symptomatology; nevertheless, it must be considered in all polytraumatized patients. Computerized tomography is the radiological exploration of choice and the most suitable surgical approach is laparotomy.