Laparoscopy and intraoperative enteroscopy, a helpful tool in a rare tumor (inflammatory fibroid polyp) of the small bowel. A case report.

INTRODUCTION AND IMPORTANCE: Inflammatory fibroid polyps (IFPs) are rare, benign tumors that can arise throughout the gastrointestinal tract, they are usually asymptomatic, and clinical presentation depends on the site of involvement. Gastric and colon IFPs are traditionally identified incidentally, whereas small intestinal lesions are often encountered in the setting of intussusception or during imaging studies. Complete resection via endoscopy or surgery is recommended. CASE PRESENTATION: Patient is a 52-year-old male without past medical history; he had a five-month history of mild colicky abdominal pain. A mass was detected in the small bowel, and surgery was decided. Since the mass was small a cooperative approach with an intraoperative enteroscopy was needed to locate the mass and achieve complete resection. DISCUSSION: IFPs of the small bowel require complete resection. Surgery should be performed as early as possible to prevent complications like intussusceptions, ischemia, and necrosis. CONCLUSIONS: In these rare tumors, the collaboration between surgeons and endoscopists is indispensable to improve the patient's prognosis.

Duodenal perforation after percutaneous fluid drainage, a rare event: a case report.

Duodenal perforations can be caused by surgical instruments during operations. These injuries can go initially unnoticed and lead to problematic complications. While uncommon, bowel perforation after percutaneous fluid drainage can severely impact the patient's outcome. These can occur from equipment used for image-guided percutaneous drainage, a technique that has changed the way surgeons handle postoperative fluid collections and has become daily practice. Prompt recognition and timely treatment of these types of complications can minimize the consequences of this dreaded scenario. We present the case of a 29-year-old male, for whom an intra-abdominal collection was detected after laparoscopic cholecystectomy. CT-guided percutaneous drainage was performed, during which the catheter inadvertently punctured the duodenum. Surgical consultation was required and, since the patient remained asymptomatic, conservative management of the duodenal perforation was accomplished without complications. On follow-ups, the patient is doing well.

A bleeding GIST in pandemic times, a cooperative approach to a delayed complication, a case report.

INTRODUCTION: Upper gastrointestinal bleeding is one of the major manifestations of the stomach's gastrointestinal stromal tumors; when gastric GISTs bleed, they are associated with a poor prognosis and must be treated promptly to avoid dangerous complications. A worrisome side effect of the Covid-19 pandemic is the delay in surgical treatment for seriously ill patients, a rise in surgical complications due to delayed care, lack of access to the healthcare system, and patients' hesitancy to seek care due to fear of the virus. In Ecuador, where limitations were present even in the absence of a pandemic, we are yet to fully know the full extent of the damage this pandemic has caused to ourselves and our patients. PRESENTATION OF CASE: We present the case of a 51-year-old female; she presented with upper gastrointestinal bleeding, and a gastric GIST was diagnosed. Due to the size and the symptoms, surgery was planned. Nonetheless, as Ecuador was hit hard by the Covid-19 pandemic to cope with the respiratory patients, surgeries were delayed or canceled. Our patient surgery was delayed for five months until she presented with severe gastrointestinal bleeding that required urgent action and care. Thankfully, she completely recovered. DISCUSSION AND CONCLUSIONS: This case is an example of the many complications we expect due to the pandemic; delay in treatment leads to troublesome complications. In these emergencies, time is of the essence, and surgical services must rise to the challenge; in a particular way, this case also proves that if there are the necessary tools to enhance the patient's recovery, we should hesitate to use them. Complete resection of the gastric GIST in a prompt matter must be done to avoid these potentially deadly complications.

Giant ovarian mucinous cystadenoma, a challenging situation in resource-limited countries.

Mucinous cystadenomas are a common benign neoplasm of the ovaries that can grow much larger than other adnexal masses; they are recognized as precursors of ovarian cancer and may slowly transform to borderline tumors and invasive ovarian cancer. Prompt and accurate treatment is essential as these tumors can grow to massive sizes and be potentially lethal if left untreated. Health care providers must understand the patient, their expectations and their problems; without proper communication and follow-up, any treatment is destined to disappoint. We present a case of a 76-year-old female with limited access to health care. She presented with a giant cystadenoma that grew over 1 year. Complete resection was decided and the patient underwent complete recovery. On follow-up control patient is doing well.