Conservative management of splenic abscess septic emboli after tooth extractions.

Splenic abscesses are rare but may be associated with high mortality. Usually they occur in patients with systemic infection related to some immunocompromised state. The symptoms are nonspecific and the diagnosis is often late, but the development of better imaging techniques has enabled better diagnosis of splenic abscess and percutaneous drainage is a valid and safe complementary treatment option. We report a case of a patient with splenic abscess secondary to septic emboli after tooth extractions, managed conservatively with antibiotics and percutaneous drainage.

Liver metastases of colorectal adenocarcinoma with intrahepatic biliary spread pattern: clinical manifestation and importance of immunohistochemical analysis.

Liver metastases of colorectal carcinoma (LMCC) with macroscopic intrabiliary ductal involvement are a rare entity that can clinically and radiologically mimic a cholangiocarcinoma. However, a thorough anatomopathologic and immunohistochemical study of biliary ductal involvement is required because of its distinctive clinical features and relatively indolent biological behavior, reflecting a better prognosis and long-term survival. We present the case of a patient who debuted with LMCC with intrahepatic biliary ductal involvement, whose definitive diagnosis was established by immunohistochemical analysis, showing a characteristic CK7 - /CK20 + pattern.

Upper Gastrointestinal Bleeding as a Debut Form of Groove Pancreatitis: A Diagnostic Challenge.

Introduction: Groove pancreatitis (GP) is an unusual subtype of chronic pancreatitis that affects the groove area. Differential diagnosis between groove pancreatitis and pancreatic carcinoma (PC) can be challenging, both clinically and radiologically. Our aim is to report the first case of GP debut with upper gastrointestinal bleeding (UGB). Case Report. A 53-year-old man with a personal history of alcohol and tobacco abuse and chronic pancreatitis was admitted to the hospital for epigastric abdominal pain. A computed tomography scan showed a locally advanced neoformative lesion in the distal stomach. The patient presented melena, arterial hypotension, and 4.4 g/dl of hemoglobin. An upper gastrointestinal endoscopy showed a neoformative ulcerated lesion at the duodenal bulb without active bleeding. Biopsies were taken, and histopathological analysis did not show malignancy. A cephalic pancreaticoduodenectomy was performed, and the postoperative period was uneventful. Histopathological analysis revealed a segmental GP. Discussion. GP is an uncommon entity, and its clinical and radiological presentation mimics PC. However, with advances in imaging tests, several radiological criteria have been described to distinguish GP from PC preoperatively. Although some authors recommend a stepwise management with initial conservative therapy, a therapeutic strategy has not yet been established. Conclusion: GP is an uncommon type of focal pancreatitis that should be considered as a differential diagnosis of PC. We report the first clinical case of GP whose debut with UGB presented a greater diagnostic and therapeutic challenge.

Retroperitoneal paraganglioma-Is pre operative embolization useful?

INTRODUCTION: Paragangliomas (PG) are rare tumors derived from chromaffin cells that are located outside the adrenal gland and are capable of producing catecholamines. The treatment is based on a surgical resection, and there is controversy regarding the usefulness of previously carrying out an embolization and what is the most adequate surgical approach. CLINICAL CASE: We will present a 17-year-old woman with a retroperitoneal tumour in contact with the aorta and the inferior vena cava, treated with embolization prior to the surgical resection via laparotomy. DISCUSSION: The PG tumors are very infrequent and originate in the extra-adrenal chromaffin cells that exist in the vicinity of the components of the autonomic nervous system. Most of them (86%) produce catecholamines, are unique, sporadic, benign and more frequent in middle-aged women. Since they are radioresistant tumors, the only possibility for a cure is by a complete surgical excision. The preoperative embolization has been described mainly as the treatment of cervical PG, although its use in abdominal PG is more controversial and is not done in a systematic manner. CONCLUSION: We can conclude that the embolization of abdominal PG is not free of risks and that it has not been demonstrated that it significantly reduces the peri-operative bleeding or the surgical time. Probably, the embolization should be reserved for intensively hypervascularized and larger PGs.

Laparoscopic treatment of retroperitoneal cystic mesothelioma. Two cases reported.

Retroperitoneal cystic mesothelioma is a very rare lesion. The pathogeny is unclear and establishing a preoperative diagnosis versus others retroperitoneal cystic lesions is difficult. Thus, with increasing experience in laparoscopic retroperitoneal surgery, the use of this approach for exploration of a retroperitoneal mass of unknown origin may provide an alternative to classic open surgery and all the benefits of laparoscopy. We present two cases treated laparoscopycally and review the literature.

Video-assisted laparoscopic débridement for retroperitoneal pancreatic collections: a reliable step-up approach.

Several minimal access routes have been implemented as a step-up approach to treat infected pancreatic necrosis. We evaluate our experience with a series of consecutive patients with pancreatic collections treated with video-assisted retroperitoneal débridement (VARD). Seven patients were consecutively treated with VARD: five patients after acute necrotizing pancreatitis, one chronic pancreatitis, and one patient with perforation after endoscopic sphincterotomy. The indication for VARD was: development of sepsis, positive direct culture of the necrosis, and compartment syndrome. The procedure was performed under general anesthesia and modified lateral decubitus. There were four left, two right, and one bilateral VARD. Mean hospital stay since admission to VARD procedure was 30 days (range, 12 to 72 days). Mean operative time was 63 minutes. There were no intraoperative complications. Two patients needed a second procedure to control sepsis. Most patients had a long intensive care unit (ICU) stay with 6.1 days (range, 2 to 22 days) mean postoperative ICU stay. One patient had a hypernatremia as a consequence of saline lavage and three patients presented pancreatic fistula that were managed with conservative treatment. There was no mortality. VARD approach is a recommended step-up approach to treat infected pancreatic necrosis, and its indication may be extended to treat other retroperitoneal collections.

Gas portal secundario a dilatación gástrica aguda no obstructiva / Portal vein gas secondary to acute non-obstructive gastric dilatation

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Manejo conservador de un absceso esplénico por émbolos sépticos tras extracciones dentarias / Conservative management of splenic abscess septic emboli after tooth extractions

Los abscesos esplénicos son poco frecuentes pero pueden asociar una mortalidad elevada. Generalmente suceden en pacientes con una infección sistémica relacionada con algún estado de compromiso inmunitario. La clínica es inespecífica y el diagnóstico suele ser tardío, aunque el desarrollo de técnicas de imagen más avanzadas ha permitido un mejor diagnóstico de los abscesos esplénicos y isponer del drenaje percutáneo como una opción terapéutica complementaria válida y segura. Presentamos un caso de un paciente con un absceso esplénico por émbolos sépticos tras extracciones dentarias, manejado conservadoramente con antibioticoterapia y drenaje percutáneo (AU)

Splenic abscesses are rare but may be associated with high mortality. Usually they occur in patients with systemic infection related to some immunocompromised state. The symptoms are nonspecific and the diagnosis is often late, but the development of better imaging techniques has enabled better diagnosis of splenic abscess and percutaneous drainage is a valid and safe complementary treatment option. We report a case of a patient with splenic abscess secondary to septic emboli after tooth extractions, managed conservatively with antibiotics and percutaneous drainage (AU)

Neurofibroma esporádico sobre unión esofagogástrica. A propósito de un caso / Sporadic neurofibroma on the esophagogastric junction. A case report

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[Complications due to spilled gallstones and surgical clips left in the abdomen during laparoscopic cholecystectomy]. / Complicaciones por cálculos y clips intraabdominales abandonados durante una colecistectomía laparoscópica.

The presence of biliary gallstones and surgical clips in the abdominal cavity after a laparoscopic cholecystectomy can cause complications, which even though they are uncommon, can be serious. We carried out a review of the various complications, their incidence, related risk factors, ways to deal with them and recommendations to reduce morbidity associated with the presence of ectopic material (gallstones and surgical clips) in the peritoneum.

[Laparoscopic splenectomy due to torsion of a wandering spleen]. / Esplenectomía laparoscópica por torsión de un bazo ectópico (wandering spleen).

Wandering spleen is an uncommon entity, characterized by the anomalous position of the spleen, caused by the absence or laxity of its suspensory ligaments. The most common symptoms are usually due to intermittent or complete torsion of the splenic pedicle with subsequent infarction. We report a case of torsion of a wandering spleen. Laparoscopic splenectomy was performed and recovery was uneventful. Although few cases of wandering spleen treated laparoscopically have been reported in the literature, laparoscopy has been demonstrated to be a safe technique for the treatment of this entity.

Mielolipoma hepático: diagnóstico y tratamiento / Hepatic myelolipoma. Diagnosis and treatment

El mielolipoma es un tumor muy poco frecuente y su localización hepática resulta excepcional. Suele cursar de forma asintomática y su diagnóstico preoperatorio puede ser complicado. A continuación se presenta un nuevo caso de mielolipoma hepático y se hace una revisión de todos los casos descritos previamente en la literatura médica, en los que se destacan las características clinicopatológicas y radiológicas de estos tumores así como las posibilidades terapéuticas (AU)

Myelolipoma is a very uncommon tumor and is extremely rare in the liver. Patients are usually asymptomatic and preoperative diagnosis is often difficult. We report a new case of hepatic myelolipoma and review all the cases previously reported in the literature. Clinicopathologic and radiologic findings, as well as therapeutic options, are discussed (AU)

Complicaciones por cálculos y clips intraabdominales abandonados durante una colecistectomía laparoscópica / Complications due to spilled gallstones and surgical clips during laparoscopic cholecystectomy

Los cálculos biliares y clips abandonados en la cavidad abdominal tras una colecistectomía laparoscópica pueden dar lugar a complicaciones que, aunque poco frecuentes, pueden ser graves. Realizamos una revisión de las distintas complicaciones, su incidencia, factores de riesgo relacionados, manejo y recomendaciones para reducir la morbilidad relacionada con material ectópico (cálculos o clips) en el peritoneo (AU)

The presence of biliary gallstones and surgical clips in the abdominal cavity after a laparoscopic cholecystectomy can cause complications, which even though they are uncommon, can be serious. We carried out a review of the various complications, their incidence, related risk factors, ways to deal with them and recommendations to reduce morbidity associated with the presence of ectopic material (gallstones and surgical clips) in the peritoneum (AU)

Esplenectomía laparoscópica por torsión de un bazo ectópico (wandering spleen) / Laparocopic splenectomy due to torsion of a wandering spleen

El bazo ectópico o errante (wandering spleen) es una anomalía muy infrecuente caracterizada por una mala posición del bazo como consecuencia de una ausencia o laxitud de los ligamentos suspensorios del bazo. Las manifestaciones clínicas suelen producirse por una torsión completa o intermitente del pedículo esplénico, con el consiguiente riesgo de isquemia del bazo. Presentamos un caso de bazo ectópico con torsión del pedículo, tratado mediante esplenectomía laparoscópica sin complicaciones. Aunque hay pocos casos comunicados en la literatura científica, la laparoscopia ha demostrado ser una técnica válida y segura en el tratamiento del bazo ectópico (AU)

Wandering spleen is an uncommon entity, characterized by the anomalous position of the spleen, caused by the absence or laxity of its suspensory ligaments. The most common symptoms are usually due to intermittent or complete torsion of the splenic pedicle with subsequent infarction. We report a case of torsion of a wandering spleen. Laparoscopic splenectomy was performed and recovery was uneventful. Although few cases of wandering spleen treated laparoscopically have been reported in the literature, laparoscopy has been demonstrated to be a safe technique for the treatment of this entity (AU)