Hepatic portal venous gas. Should it be considered as an ominous radiologic sign?

Portal pneumatosis is considered as an ominous radiologic sign if it is associated to intestinal ischemia. If sepsis is present, mortality reaches 80-90%. However, in inflammatory disease or infections survival rates are close to 70%. With the aim to reconsider the poor prognosis associated with portal pneumatosis, we would like to present the case of a 63-years-old male who went to the emergency room with abdominal pain and peritoneal irritation. Urgent surgery was indicated, findings were: an area of transmural necrosis located in the antimesenteric sigma's face, and patchy necrosis of the colonic mucose. A Hartmann`s procedure was performed. Nowadays, the pacient underwent surgery for restoration of the continuity of the GI.

Hemoperitoneum secondary to perforated inflammatory myofibroblastic tumor: A case report of an unusual complication.

INTRODUCTION: Inflammatory myofibroblastic tumors (IMT) are rare neoplasms characterized by a proliferation of spindle-shaped cells with a stroma infiltrated by macrophages, lymphocytes and plasma cells. CASE REPORT: We report a case of 59 years old male who presented an acute abdomen due to a mass of the mesentery of the terminal ileum, which was perforated with active bleeding. Histopathology reported a low-grade TMI with clear margins. DISCUSSION: Inflammatory myofibroblastic tumors of the mesentery are rare entities whose etio-pathogenia remains unclear. It requires a histopathological diagnosis and inmunohistochemical evaluation and its treatment is based on complete resection of the tumor. These type of neoplasms require close monitoring due to local recurrence.

Preoperative parathyroid localization. Relevance of MIBI SPECT-CT in adverse scenarios.

PURPOSE: Selective parathyroidectomy, the treatment of choice for primary hyperparathyroidism, requires precise preoperative localization. Our purpose was to compare the accuracy and concordance of pre-surgical MIBI parathyroid scintigraphy and ultrasonography, as well as to assess the relevance of hybrid acquisition (SPECT/CT) in compromised circumstances: low-weight or ectopic adenomas, coexisting thyroid disease and re-interventions. METHODS: The study included 223 patients with primary hyperparathyroidism operated in a single Surgical Unit from August 2016 to March 2021. Preoperative ultrasonography and double-phase MIBI were performed with early SPECT/CT acquisition. A minimally invasive surgical approach was initially attempted, except in patients with concomitant thyroid surgery or multiglandular parathyroid disease. RESULTS: Selective parathyroidectomy was accomplished in 179 patients (80.2%); cervicotomy and/or thoracoscopy in 44. Removal of the parathyroid lesion was achieved in 211 patients (94.6%), corresponding 204 (96.7%) to adenomas (37 ectopic). The cure rate was 94.2%. Preoperative MIBI SPECT/CT showed higher sensitivity and accuracy (84%; 80%) compared to ultrasound (72%; 71%), being more precise in defining the exact anatomical location (75.8% vs 68.7%). These differences reached statistical significance in ectopic glands. The existence of concomitant thyroid pathology did not decrease the sensitivity of SPECT/CT (84.2%). Mean parathyroid weight was 692.2mg (95%CI: 443.5-941) in MIBI-negative cases and 1145.9mg (95%CI: 983.6-1308.3) in MIBI-positive (p=0.001). Re-intervention was successful in the 8 patients with previous surgery. CONCLUSION: MIBI SPECT/CT presents greater sensitivity, accuracy and anatomical precision than ultrasound for preoperative parathyroid localization, even in the case of ectopic glands or coexisting thyroid pathology. The weight of the pathological gland is a significantly limiting factor.

One-Stage vs Two-Stage Laparoscopic Roux-en-Y Gastric Bypass in Obese Patients with Body Mass Index >55 Kg/m2; 5-YEAR FOLLOW UP.

BACKGROUND: Surgical strategies in patients with BMI > 55 kg/m2 are not well established. OBJECTIVES: The objective of this study is to compare the long term results and complications of 1- vs. 2-stage laparoscopic "Roux-en-Y″ gastric bypass (LRYGB) for patients with BMI > 55 kg/m2. METHODS: Retrospective review of the complications and outcomes, between January 2007 and January 2010, for patients with a BMI > 55 kg/m2 who underwent directly a LRYGB (1-stage) or a LRYGB as a 2nd stage of a laparoscopic sleeve gastrectomy (LSG). RESULTS: Twenty-four patients were enrolled (no patient was lost during the 5-year follow-up). In the 1-stage LRYGB group, two patients had grade II complications according to Clavien-Dindo classification. In the 2-stage LRYGB group, complications of the first and the second surgery were summed. There were no differences between the two groups despite being heterogenous (more men with a higher BMI in the 2-stage group). There was a statistically significant difference in the final BMI in 1-stage LRYGB group compared to the 2-stage LRYGB group (34.46 ± 6.29 vs. 40.40 ± 3.47; p = 0.01, respectively) and in percentage of excess of BMI loss (%EBMIL; 69.80 ± 19.96 vs. 54.54 ± 13.93; p = 0.04, respectively). CONCLUSIONS: In patients with a BMI > 55 kg/m2, both 1- and 2-stage LRYGB give good long-term results. If feasible, a 1-stage LRYGB obtains a better percentage of excess of BMI loss but if not possible, the strategy of initially performing a laparoscopic sleeve gastrectomy followed by a LRYGB is safe and there were no differences in complications.

Combined Treatment of an Aortoesophageal Fistula After Aortoplasty for Aortic Stenosis.

The aortoesophageal fistula secondary to the rupture of an aneurysm is a rare entity that usually has a fatal outcome. We present the case of a young patient with an aortoesophageal fistula secondary to a thoracic aortic aneurysm successfully treated with a combination of endoscopic and surgical techniques.

Programa de cooperación quirúrgica en un hospital rural de Etiopía. ¿Podemos ofrecer cirugía de calidad? / Surgical Cooperation Program in a Rural Hospital of Ethiopia. Can we Offer Quality Surgeries?

RESUMEN Introducción: En Etiopía la asistencia quirúrgica en el medio rural es deficitaria por la falta de cirujanos y por los limitados recursos sanitarios, y este escenario subóptimo puede provocar un incremento de morbilidad y mortalidad operatoria. Objetivos: Describir las intervenciones quirúrgicas realizadas durante ocho años de cooperación en el Hospital Rural de Gambo y analizar la morbilidad y mortalidad posoperatoria. Método: Se realizó un estudio descriptivo, retrospectivo, de las intervenciones quirúrgicas practicadas en el Hospital Rural de Gambo, por un grupo de cooperación quirúrgica entre 2007-2017 en ocho campañas quirúrgicas. Se recogieron en una base de datos el sexo, edad, diagnóstico, tipo de cirugía (urgente o programada), operaciones realizadas, complicaciones posoperatorias, infecciones del sitio quirúrgico, morbilidades, reintervenciones, transfusiones de sangre y mortalidad posoperatoria. Resultados: Se operaron 587 pacientes, 389 de cirugía general, 78 de obstetricia-ginecología, 77 lesiones urológicas y 38 pacientes de traumatología. El 13 por ciento (89) pacientes fueron operados de urgencia. Se aplicó anestesia general con intubación traqueal a 143 pacientes, anestesia raquídea en 167 casos y anestesia local en 277. En cirugía mayor (310 pacientes), la mortalidad fue 2 por ciento, con 5,3 por ciento de infección del sitio quirúrgico, 3 reintervenciones (1 por ciento) y 9 (3 por ciento) transfusiones sanguíneas perioperatorias. Conclusiones: Para la cooperación quirúrgica en el entorno rural de Etiopía es necesaria una formación adicional en cirugía obstétrica-ginecológica, urología y traumatología. A pesar de los escasos medios tecnológicos del Hospital Rural de Gambo es posible realizar una cirugía mayor con seguridad, con un bajo índice de infecciones de herida, de necesidades transfusionales, reoperaciones y mortalidad(AU)

ABSTRACT Introduction: In Ethiopia, surgical assistance in rural areas is deficient due to the lack of surgeons and limited health resources. This suboptimal setting can cause an increase in morbidity and surgical mortality. Objectives: To describe the surgical interventions carried out during eight years of cooperation in Gambo Rural Hospital and analyze the postoperative morbidity and mortality. Method: A retrospective and descriptive study of the surgical interventions performed at Gambo Rural Hospital was carried out by a surgical cooperation group between 2007-2017 in eight surgical campaigns. Sex, age, diagnosis, type of surgery (urgent or scheduled), carried out operations, postoperative complications, surgical site infections, morbidities, reoperations, blood transfusions and postoperative mortality were collected in a database. Results: 587 patients were operated on: 389 for general surgery, 78 for obstetrics-gynecology, 77 urological lesions, and 38 for traumatology. 13 percent (89) patients were operated urgently. General anesthesia with tracheal intubation was applied to 143 patients, spinal anesthesia was used in 167 cases and local anesthesia was used in 277 cases. In major surgery (310 patients), mortality was 2 percent, with 5.3 percent of surgical site infection, 3 reinterventions (1 percent) and 9 (3 percent) perioperative blood transfusions. Conclusions: Additional training in obstetric-gynecological surgery, urology and traumatology is necessary for surgical cooperation in the rural setting of Ethiopia. Despite the scarce technological means of Gambo Rural Hospital, it is possible to perform major surgery safely, with a low rate of wound infections, transfusion needs, reoperations and mortality(AU)