[Jejunal diverticulitis causing an acute abdomen]. / Diverticulitis yeyunal como causa de abdomen agudo.

Jejunal diverticulosis is a rare acquired-disease which courses asymptomatic in most cases. In spite of the fact that there are some publications of this entity in pediatric patients, most symptomatic cases have been found in adults. Reported herein is the case of a patient that presented to the emergency room with signs and symptoms suggestive of an acute abdomen. After diagnostic workup and operative management, presence and complications of a jejunal diverticulum were found to be the cause of the abdominal pain.

Laparoscopic resection of gastric schwannoma: A case report.

INTRODUCTION: Gastric schwannomas are an extremely rare presentation of mesenchymal tumors originating from Schwann cells, accounting for 0.2% of all gastric tumors. Patients are usually asymptomatic, so these tumors are frequently detected incidentally. PRESENTATION OF CASE: 68-year old male patient found to have a 5 cm mass in the lesser curvature of the stomach. After a careful preoperative evaluation, complete laparoscopic resection was performed. Pathology review confirmed a completely resected gastric Schwannoma. The patient's recovery was uneventful. At a one-year follow-up he remains asymptomatic and with no evidence of disease. DISCUSSION: We present the uncommon case of a gastric schwannoma that was appropriately treated with a laparoscopic approach and present a current literature review focusing on diagnostic and treatment methods of these rare tumors. CONCLUSION: Schwannomas should be included in the differential diagnosis of gastric tumors and can be appropriately treated with a laparoscopic approach.

Major hepatic resection for hilar cholangiocarcinoma: analysis of 46 patients.

HYPOTHESIS: Major hepatectomy, bile duct resection, and regional lymphadenectomy for hilar cholangiocarcinoma are associated with actual long-term (>5 years) survival. DESIGN: Retrospective outcome study. SETTING: Single tertiary referral institution. PATIENTS: Between 1979 and 1997, 46 consecutive patients had resection of hilar cholangiocarcinoma by major hepatectomy, bile duct resection, and regional lymphadenectomy. MAIN OUTCOME MEASURES: Overall survival and tumor recurrence were correlated to clinicopathological factors, operative morbidity, and mortality. RESULTS: Twenty-five patients underwent left hepatectomy, 17 underwent right hepatectomy, and 4 had extended right hepatectomy. Eighteen patients underwent resection of segment 1. Negative (R0) resection margins were achieved in 37 patients (80%). The operative mortality rate was 9%, and the surgical morbidity rate was 52%. Actual 1-year, 3-year, and 5-year survival rates were 80%, 39%, and 26%, respectively. Factors adversely associated with patient survival rates included: male sex, lymph node metastases, tumor grade 3 or 4, elevated direct serum bilirubin level at diagnosis, elevated preoperative activated partial thromboplastin time, and more than 4 U of red blood cells transfused perioperatively. Tumor size and R0 resection approached significance for survival. Factors associated with tumor recurrence included: male sex, tumor grade 3 or 4, a low hemoglobin level both at diagnosis and preoperatively, and a low preoperative prothrombin time and low alkaline phosphatase level at diagnosis and preoperatively. Median time to recurrence was 3.6 years. Tumor recurrence was predominantly local and regional. CONCLUSIONS: The actual 5-year survival rate of 26% justifies major partial hepatectomy, bile duct resection, and regional lymphadenectomy for hilar cholangiocarcinoma. The high frequency of local and regional recurrence warrants investigation of adjuvant therapy.

[Jejunal angiodysplasia as a cause of obscure gastrointestinal bleeding]. / Angiodisplasia yeyunal como causa de sangrado de origen desconocido.

BACKGROUND: Obscure gastrointestinal bleeding secondary to jejunal angiodysplasia is uncommon. Diagnostic approach is difficult and represents a challenge for the surgeon because of the inaccessibility of the small bowel for evaluation. When the diagnostic work-up has been completed and the bleeding source has not been found, it is mandatory to perform a surgical exploration with transoperative enteroscopy in order to locate the source of the hemorrhage and for further treatment. CASE REPORT: We report the case of a 24-year-old male with massive gastrointestinal bleeding secondary to jejunal angiodysplasia in whom an intraoperative enteroscopy was done to locate the source of bleeding and subsequently resect the affected small bowel. There are actually some non-surgical therapies for patients with high risk of complications. When patients' conditions are optimal, surgical resection is mandatory to avoid recurrence of future bleeding.

Angiodisplasia yeyunal como causa de sangrado de origen desconocido / Jejunal angiodysplasia as a cause of obscure gastrointestinal bleeding

BACKGROUND: Obscure gastrointestinal bleeding secondary to jejunal angiodysplasia is uncommon. Diagnostic approach is difficult and represents a challenge for the surgeon because of the inaccessibility of the small bowel for evaluation. When the diagnostic work-up has been completed and the bleeding source has not been found, it is mandatory to perform a surgical exploration with transoperative enteroscopy in order to locate the source of the hemorrhage and for further treatment. CASE REPORT: We report the case of a 24-year-old male with massive gastrointestinal bleeding secondary to jejunal angiodysplasia in whom an intraoperative enteroscopy was done to locate the source of bleeding and subsequently resect the affected small bowel. There are actually some non-surgical therapies for patients with high risk of complications. When patients' conditions are optimal, surgical resection is mandatory to avoid recurrence of future bleeding.

Actualidades en el tratamiento de la enfermedad hemorroidal / Current concepts in the treatment of hemorrhoidal disease

La enfermedad hemorroidal es un problema común que afecta a un gran número de pacientes. Por diversas razones, el enfermo habitualmente pospone su visita al médico e intenta múltiples remedios antes de consultar al especialista; además la gran cantidad de mitos populares sobre la enfermedad hemorroidal dificulta aún más el tratamiento adecuado del paciente. A continuación se presenta una útil revisión de conceptos actualizados y relevantes en el tratamiento de pacientes con enfermedad hemorroidal

Mesenteritis esclerosante: Una enfermedad de apariencia maligna / Sclerosing mesenteritis: a disease of malignant appearance

La mesenteritis esclerosante es una enfermedad rara, de etiología desconocida, y que a pesar de su frecuente apariencia neoplásica, es benigna. En el pasado se ha utilizado múltiples términos para referirse a esta entidad que tiene una presentación clínica variable y se caracteriza morfológicamente por un engrosamiento del mesenterio. Actualmente existe poca información acerca de su epidemiología, historia natural y respuesta al tratamiento. A continuación se presenta una revisión de la literautra y se discuten brevemente conceptos relevantes para el diagnóstico y tratamiento de paciente con mesenteritis esclerosante