[Perineal endometriosis with anal external sphincter involvement: a case-report]. / Endometrioma perianal involucrando esfínter anal externo: reporte de un caso.

The presence of perianal endometriosis involving the anal sphincter is a rare presentation of this disease, most cases are diagnosed late and few are reported in the literature despite the number of episiotomies performed today. We present a case in a female with perianal symptoms after an episiotomy 15 years ago and visualized by endoanal ultrasound. We also review the literature of this condition. The treatment of choice is wide excision of the lesion involving the anal sphincter so the sphincter defect should be repaired by sphincteroplasty. According to the literature, early diagnosis by clinical suspicion and confirmation by endoanal ultrasound, with wide excision of endometrioma gives satisfactory results regarding anal continence.

[Cholecystoenteric fistulae with giant gallstone ileus impaction.]. / Fístula bilioentéricacon impactación de lito gigante en yeyuno.

BACKGROUND: Gallstone ileus represents 0.06% of gallstone disease cases as a result of cholecystoenteric fistulae. The presentation is that of intestinal obstruction, the stone is most commonly impacted in the terminal ileum. OBJECTIVE: To present a case of a patient with intestinal obstruction due to a giant stone impacted in the proximal jejunum. CASE REPORT: A 47 year old women presented with abdominal pain, distention, nausea and vomiting.An upper endoscopy revealed a deep duodenal ulcer penetrated to the pancreas. She had partial relief with medical treatment. She was admitted to ourhospital because a new episode of abdominal pain.Physical examination revealed an abdomen with diffuse pain, low peristalsis, leukocytes of 12 000/mm3, neutrophils of 85%, plain abdominal x-ray with intestinal obstruction and pneumobilia, CT scan with intestinal obstruction, hyperdense image in the intestinal lumen and a transition level.Surgery was performed, a giant stone of 6 cm in size was found in the proximal jejunum, an enter olithotomy was performed with primary closure. CONCLUSIONS: Gallstone ileus is a rare condition ofa common disease. It is important in the differential diagnosis in elderly patients with intestinal obstruction. The aim of treatment is to relieve the intestinal obstruction by enterotomy and stone removal.