"A hybrid approach for GISTs near the esophagogastric junction, a case report".

INTRODUCTION AND IMPORTANCE: Gastrointestinal stromal tumors are the most frequent mesenchymal tumors of the gastrointestinal tract. Complete resection of GISTs is the only chance of cure for patients. When these tumors are located near the esophagogastric junction, the surgical risk can cause deformity or stenosis in the gastric inlet, leading to higher complications and diminishing their quality of life. In such cases, a more sophisticated and tailored approach should be used. CASE PRESENTATION: We present the case of a 42-year-old female; she presented to our office with a 3-year history of nausea, vomiting and abdominal distension. Two GISTs were located near the EGJ, and with a combined approach we achieved complete resection. On follow-ups, the patient is doing well. CLINICAL DISCUSSION CONCLUSION: When diagnosis is confirmed, surgical resection must be the first choice for GISTs as complete surgical excision is the only permanent cure. The rise of endoscopic surgery has become a valuable tool and a critical element in surgery. Hybrid techniques that combine laparoscopic and endoscopic approaches can improve the patient's outcomes and provide better results.

Abdominal tuberculosis in Ecuador, a problem that is still not solved.

BACKGROUND: Tuberculosis (TB) in the gastrointestinal tract or peritoneum is an uncommon condition in clinical practice. Its rarity, combined with its nonspecific presentations, makes this kind of extrapulmonary tuberculosis difficult to diagnose as it can mimic other inflammatory or malignant conditions. Delays in treatment and frequent misdiagnosis can lead to hazardous complications. In countries like Ecuador where the disease is endemic, TB should always be considered in the differential diagnosis of a patients who present with nonspecific abdominal symptoms. In these scenarios, laparoscopy can be an invaluable tool when used with sufficiently high clinical awareness and adequate training. CASE PRESENTATION: We present the case of a 37-year-old female patient from Ecuador with a 1-year history of abdominal pain, nausea, intermittent vomits, night sweats, and weight loss. After clinical evaluation and a laparoscopic intervention, abdominal TB was detected and promptly treated. Antituberculosis chemotherapy was initiated, and the patient successfully recovered. CONCLUSIONS: High clinical awareness is imperative when approaching abdominal TB due to its wide spectrum of clinical symptoms and its rarity. Early detection and prompt treatment are critical to minimize the possibility of hazardous complications.

Incidental finding after laparoscopic gastric sleeve, the value of pathology.

Gastric neuroendocrine tumors (NET) are rare tumors with a broad spectrum of symptoms; in recent years, the number of cases has increased due to the growing number of upper endoscopies. Obesity has become a worldwide epidemic and bariatric surgery one of the most effective therapies to control this illness. As more surgeries are performed, the number of histopathological samples will also increase. Incidental discoveries on these histopathological specimens are difficult situations to encounter as medical plans, prognosis and therapy will have to change accordingly. We present the case of a 43-year-old patient who underwent a laparoscopic gastric sleeve. On pathology, a NET was detected, and additional surgery was required. On follow-ups, the patient is doing well.

Acute cholecystitis and residual choledocholithiasis in a situs inversus patient, successful laparoscopic approach and ERCP a case report from Ecuador.

BACKGROUND: Situs inversus totalis is a rare genetic condition characterized by the transposition of organs to the opposite side of the body, consequently, clinical syndromes show an atypical clinical picture creating a challenge for the surgery team and predisposing to delays in treatment and diagnosis. Laparoscopic cholecystectomy is the gold standard for acute cholecystitis, and in patients with situs inversus, the laparoscopic technique must be modified to accommodate the patient's anatomy. CASE PRESENTATION: We present the case of a 55-year-old male patient without any past medical history, he presented to the emergency room with abdominal pain in his upper left quadrant. After a thorough examination, acute cholecystitis and situs inversus was diagnosed. He underwent a modified laparoscopic cholecystectomy without complications. In his postoperative period, residual choledocholithiasis was identified and ERCP was done. On follow-ups, the patient is doing well. CONCLUSIONS: Although rare and technically demanding, laparoscopic cholecystectomy and ERCP in a patient with situs inversus is feasible. The altered anatomy could lead to complex procedures, therefore proper planning and careful execution of intraoperative techniques are required to treat these patients safely and effectively.

Inclusion of a Clip Inside the Cartridge and Failure of the Stapler When Performing a Laparoscopic Sleeve Gastrectomy.

The growth of the surgical industry and the development of surgical techniques have allowed us to achieve better results for patients. Laparoscopic staplers are a crucial tool in laparoscopic surgery, and despite their proven safety and efficiency, they have been associated with technical and mechanical failures on rare occasions. Adequate knowledge of the surgical instruments is critical to accomplishing optimal results and to adequately treating these rare malfunctions and their consequences. We present a case of a surgical stapler malfunction due to a titanium clip during laparoscopic sleeve gastrectomy. This mechanical failure produced a complication that was adequately resolved, and the patient completely recovered. Our brief communication shows that errors during sleeve gastrectomy can occur, and that precise surgical skills along with a close follow-up are crucial to improve the patient outcome when these rare complications arise.

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.

Lymphangioma cavernous of the small bowel mesentery, an infrequent cause of acute abdomen in adult.

Lymphangioma is a benign mass lesion characterized by numerous thin-walled lymphatic spaces that usually manifests in the first few years of life. They generally appear in the head, neck and axillary regions. Abdominal lymphangiomas have been reported however they are rare 5%. The small bowel mesentery lymphangioma has been described in <1%. Lymphangiomas may remain asymptomatic or present with complications depending on the size and location of the lesion. We present a case of a 71-year-old female, she presented to the emergency with acute abdomen and a palpable mass in the lower abdomen. Computed tomography confirmed a mass within the mesentery of the small bowel. Laparotomy was performed and a cystic mass near the root of the small bowel mesentery was found. Patient underwent full recovery. On follow-up controls, pathology described lymphangioma cavernous.