Biliary cystadenoma with elevated CA 19.9.

We report a case of a large biliary cystadenoma occupying the entire peritoneal cavity, manifesting as an abdominal swelling for years and an elevation of CA 19.9 serum levels. Serum CA 19.9 levels fell to normal values after surgical excision. Recognition and management of this rare hepatic lesion is discussed.

[Obstructive jaundice as a presentation form of bronchogenic small cell carcinoma]. / Ictericia obstructiva como forma de presentación de un carcinoma microcítico broncogénico.

We report a patient having a non-diagnosed small cell lung cancer, presenting with a clinical picture comprising emaciation, hepatomegaly, progressive jaundice, bilirubinuria and clay-colored stools. Computed tomography showed intrahepatic and extrahepatic biliary duct dilatation. The cause was compression of the common bile duct by metastatic enlarged lymph nodes in the porta hepatis. Clinical suspicion arose because of a mass found on the chest X-ray film and a positive cytologic sputum examination. The definitive diagnosis was obtained by bronchoscopy and biopsy.

[Duodenal ulcer and duodenocholedochal fistula]. / Ulcus duodenal y fístula duodenocoledociana.

A new case of choledocoduodenal fistula secondary to duodenal ulcer is reported, which manifested as an ulcer complicated by haemorrhage, duodenal stenosis and cholangitis. We recommend endoendoscopy as the main diagnostic tool. Surgical treatment should consist of avoidance of the fistulous tract, cholecystectomy, cholangiography, truncal vagotomy and gastroduodenal drainage by pyloroplasty or gastroduodenostomy.

[Polysplenia with partial abdominal visceral heterotaxia and small pancreas]. / Poliesplenia con heterotaxia visceral abdominal parcial y páncreas pequeño.

Several morphological congenital abnormalities are associated in the polysplenia syndrome: partial visceral abdominal heterotaxy, levoisomerism, abdominal vascular abnormalities, cardiac and extrahepatic biliary malformations and polysplenia. The syndrome is usually apparent during childhood because of its severe outcome; its detection during adult life is rare. We present a 42-years-old patient, asymptomatic, with right sided polysplenia and stomach, intestinal malrotation, centrally located liver with both lobes of similar size, preduodenal portal vein, interruption of the inferior caval vein with continuation via the azygos vein. There were no cardiac malformations nor lung levoisomerism. The pancreas was atrophic, an occasionally described finding. CT scan may be useful for the study of this patients in order to identify every anatomic abnormality, and plan for future surgical operations.

[Congenital cysts of the choledochus]. / Quistes congénitos del colédoco.

We describe six cases of congenital choledochal cyst of the Toddani type I. All were female, with a mean age of 33.5 years (16-52). The onset of symptoms ranged 8-192 months (mean 92.8), with an unexpected finding. Ultrasound scan was performed in five patients, with two accurate diagnoses, one suspicious and two wrong results. In two cases a C.T. was performed and the diagnosis was confirmed in both. A cholelithiasis was associated in four cases. Four patients (66.4%) were treated by cyst excision, Roux-en-Y hepaticojejunostomy and cholecystectomy, three of them as a primary procedure, and one more after failure of some derivative operations. All evolved well but one, requiring sphincterotomy and Wirsungtomy. Two patients (33.6%) were treated by cholecystectomy only, with a favourable evolution. Nevertheless, we emphasize the good results achieved with cyst excision and we recommend it as the procedure of choice.

[Familial adenomatous polyposis: proctocolectomy with an ileal pouch versus rectal preservation]. / Poliposis adenomatosa familiar: proctocolectomía con reservorio ileal frente a preservación rectal.

UNLABELLED: We assess postoperative complications and functional results of surgery in familial adenomatous polyposis (FAP): Group I (n = 11): restorative proctocolectomy with ileoanal anastomosis (RPIA); Group II (n = 8): colectomy with ileorectal anastomosis (IRA): we also have evaluated the presence of malignancy in the rectum in the latter group. Group I: COMPLICATIONS: pelvic abscess (9.1%); intestinal obstruction (9.1%), both requiring reintervention. There was complete anal continence in 81.8%; only one patient needed catheter drainage of the reservoir (9.1%). There were two cases of pouchitis (16.7%). Group II: One patient suffered anastomotic leakage (12.5%) and another one a leakage of the loop ileostomy closure, with and secondary, abdominal abscess (12.5%). There was no incontinence. In spite of periodic endoscopic surveillance rectal adenocarcinoma appeared in 347 patients with complete follow-up (42.9%). Because of the risk of rectal malignancy with IRA and the good functional results of RPIA we consider the latter as the procedure of choice and also advisable the transformation of IAR into RPIA.

[Epidermoid carcinoma on Zenker's diverticulum]. / Carcinoma epidermoide sobre un divertículo de Zenker.

Carcinoma is a rare but recognized complication of pharyngoesophageal diverticulum. We report the case of a 49-year-old man operated for a Zenker's diverticulum with an epidermoid carcinoma arising in the diverticulum. Since carcinoma is an uncommon complication of this pathology, we review the literature and discuss the therapeutic options.

[Stomach volvulus in a female patient with chondrodysplasia punctata]. / Vólvulo gástrico en una paciente con condrodisplasia punctata.

The case of an 11-year-old girl with a history of chondrodysplasia punctata is reported. She presented with a clinical picture of abdominal pain and vomiting. At surgical intervention an organo-axial gastric volvulus was found and a single derotation was performed. Three weeks after discharge the patient presented abdominal distension and vomiting. In a plain abdominal X-ray film a gastric dilation was appreciated and a new volvulus was detected by means of a contrast radiogram. The diagnosis was confirmed at surgery and a gastropexy was performed without volvulus relapse.

[Gastric necrosis secondary to acute gastric dilatation in children]. / Necrosis gástrica secundaria a dilatación aguda gástrica en el niño

We present a new case of acute dilatation gastric with fundus, in a three years old girl with Beckwith Syndrome and infection respiratory disease. The diagnosis and treatment were done early we performed a Friederich of necrosis wall and simple suture. The evolution postoperative was satisfactory.

[Cancer of the gallbladder]. / Cáncer de vesícula biliar.

We present 118 cases of cancer of the gallbladder out of 4,165 operations for gallbladder disease (6.2%) compiled over a period of 18 years at the Hospital Nacional "Valdecilla". Females were predominant, 82.2%, and the mean age was 73.2 years. The most relevant clinical finding was pain in the right upper quadrant in 73.7%, and a mass at this level in 43.2%. The diagnosis was correct in 36 cases (30.5%). All patients were treated surgically; the resectability rate was 58.5% and potentially curative cholecystectomy was performed in 15.2%. The tumor was adenocarcinoma in 91.5%, one stage I of Nein, 5 stage II, 12 stage III, 33 stage IV and 67 stage V. The 5-year survival was 100% for stage I-II and 41.6% for III; stages IV-V did not survive more than a year.