Sigmoid colon Schwannoma simulating colon cancer.

Schwannomas tumours are uncommonly developed in the gastrointestinal tract (2-6%), located in 12% of cases in small and large intestines. An 87-year-old woman was studied due to epigastric pain and dyspepsia. CT scan and colonoscopy showed a neoplastic process in the sigmoid colon. It was performed an oncologic laparoscopic sigmoidectomy. Histological study described a schwannoma and a positive immunohistochemistry to S-100. The diagnostic challenge is that this is a submucosa lesion, therefore, endoscopy biopsy is realized only in the mucosa. This becomes the differential diagnostic very difficult in order to differentiate from another mesenchymal tumor (GIST or leiomyoma). The immunohistochemistry helps in the diagnostic if it is positive to S- 100 and negative to C-KIT, CD-34, actine and desmine (findings of GIST tumors and leiomyoma). In conclusion, schwannoma diagnostic is tough. Those are asymptomatic tumors with nonspecific radiological findings. Diagnostic confirmation is a S-100 positive immunohistochemistry in the histological study.

Cytomegalovirus colitis seems to be colon cancer. HIV debut.

Cytomegalovirus (CMV) infection is very common in immunosuppressed patients. It can y puede afectar a todo el tracto gastrointestinal, presentándose como úlceras o pseudotumores. A 43-year-old male with no personal background of interest, was studied due to constitutional syndrome. The diagnosis was neoplasia of the right colon, reported by colonoscopy and CT scan. A right hemicolectomy was performed with oncologic character. The definitive histology was CMV infectious colitis with positive immunohistochemical staining. Treatment with ganciclovir was started and the patient was diagnosed with HIV infection. The unusual finding of CMV infection as a pseudotumor can simulate, clinically and radiologically, a colonic neoplasm. It has been described in the literature in patients immunocompromised by HIV; however, the absence of risk factors means that it can be confused with a primary neoformative process.

Breast implant during orthotopic liver transplant to avoid hepatic outflow obstruction.

Donor-recipient size mismatch in liver transplantation is a recognized but uncommon situation. It can lead to a partial or complete obstruction of the inferior vena cava with subsequent hepatic outflow obstruction. Placement of a breast implant in the right upper quadrant of the abdomen during liver transplantation is a technically easy resource and can protect the liver graft from kinking or rotation.

Rectal inflammatory stenosis secondary to Chlamydia trachomatis: a case report.

The rectal inflammatory originated strictures constitute a rare cause of intestinal obstruction. We present a 30-year-old male patient with a history of HIV and protctitis caused by Chalmydia trachomatis and HSV-2, in which develops a low intestinal obstruction refractory to medical treatment. Surgery was performed with good clinical evolution. The medical treatment constitutes the fundamental basis of the therapy in these patients. Despite that, when fibrotic stenoses are not treatable medical or endoscopically, they often require surgical treatment. We must pay attention to the proctitis infectious diseases as a cause of rectal stenosis, especially by Chlamydia trachomatis, and assess surgical option in refractory cases.

Cervical ultrasound for the evaluation of the vocal cords: A pilot study in an endocrine surgery unit.

INTRODUCTION: Cervical ultrasound (CE) has emerged as a promising tool in recent years for vocal cord (VC) assessment in patients undergoing thyroid surgery. Our aim is to assess the reliability of CE once implemented in an endocrine surgery unit and performed by the surgeons themselves. MATERIAL AND METHOD: 86 participants with no history of laryngeal pathology or cervical surgery underwent CE by three independent endocrine surgeons. Laryngeal structures and specifically the VCs were analysed. To consider the examination as diagnostic, the VCs had to be visualised statically and during phonation. The time taken to perform the technique and the interobserver variability were also analysed. RESULTS: Of the 86 participants, 51.2% were male with a mean age of 43 years. The range of diagnostic examinations between surgeons was 60-68%, with substantial agreement between the 3 explorers (Fleiss's K-value = .714). Male sex and advanced age were factors associated with non-assessability of the technique. The mean procedure time was 72 s. CONCLUSIONS: CE is a fast, non-invasive, feasible bedside tool useful for the assessment of VCs prior to thyroid surgery, mainly in young women.

[Crossed renal ectopia in a patient with a complicated sigma neoplasia]. / Ectopia renal cruzada en un paciente con neoplasia de sigma complicada.

BACKGROUND: Crossed renal ectopia is a rare pathology that is often asymptomatic. Intraoperative detection with a sigma complicated neoplasia is more infrequent and requires correct management to avoid a renal ureteral injury. AIM: To present a case report of a patient with a sigma complicated neoplasia and a crossed renal ectopia detected incidentally. CASE REPORT: We present the case of a 62-year-old man that was submitted for emergency surgery for a sigma perforated neoplasm, and who presented with a previously undiagnosed left-side CRE. During surgery there was a need to insert 2-double-J stents as a guide to both ureters and to avoid any injury to them. DISCUSSION: Crossed renal ectopia is a rare, often asymptomatic entity, the diagnosis of which is usually incidental. In our case, the detection of a concomitant complicated neoplasm, required identification of both ureters due the anatomic doubt of its localization and to avoid them being injured. In conclusion, upon finding a casual crossed renal ectopia during an emergency surgery of sigma, we recommend the identification of the ureters to facilitate its location and to avoid any injury to the ureters.