Distal Intestinal Obstruction Syndrome resolved by dissolution with Coca-Cola® via colonoscopy in a cystic fibrosis patient.

We report the case of a 37 years old woman who presented to emergency department because of a 3 days history of abdominal disconfort and distension. After physical examination and a CT scan of the abdomen she was diagnosed of Distal Intestinal Obstruction Syndrome (DIOS) in the context of her underlying cystic fibrosis. Conservative management was attempted with no improvement. A colonoscopy was performed and thick solid feces were seen filling the cecum and right colon. An attempt to dissolve the impacted stool was made by instilling one liter of Diet Coca-Cola® through the working channel of the colonoscope. After that, the condition of the resolved in the following 24 h with no more interventions.

Hepatic Epithelioid Hemangioendothelioma as a Rare Indication for Liver Transplantation.

BACKGROUND: Hepatic epithelioid hemangioendothelioma (HEHE) is a rare neoplasm of vascular origin, with nonspecific presentation and unpredictable clinical course. Several therapeutic options are available according to the literature, including chemotherapy and radiotherapy, liver resection (LR), and liver transplantation (LT). METHODS: We present 2 cases of patients with HEHE treated with liver transplantation in our center, a 30-year-old man and a 42-year-old woman, diagnosed with several lesions involving both liver lobes. RESULTS: Levels of tumor markers (carcinoembryonic antigen [CEA], cancer antigen 19.9 [Ca19.9], and alpha-fetoprotein [AFP]) were negative. Percutaneous biopsy revealed HEHE in both cases. Due to the bilobar location, liver transplantation was performed. Postoperative course was unremarkable, and no significant complications developed. At this time, 10 and 5 years' follow-up has concluded, respectively. Both patients remain alive, asymptomatic, with normal liver function and no sign of recurrence. CONCLUSIONS: HEHE is an uncommon malignant hepatic disease. Most cases present with bilobar involvement, and LT is probably the most useful treatment with favorable outcomes according to the literature and our experience. Further studies are needed to establish the optimal management of this rare entity.

Duodenectomía total con preservación pancreática como tratamiento de la poliposis duodenal / Total duodenectomy with panceratic preservation for duodenal polyposis

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Cirugía citorreductora en cáncer epitelial de ovario en estadios avanzados / Cytoreductive surgery in advanced epithelial ovarian cancer

Objetivos: analizar los resultados quirúrgicos de citorreducción primaria y de intervalo en cáncer de ovario avanzado en el Hospital Universitario Puerta de Hierro Majadahonda. Material y métodos: las pacientes incluidas en el estudio fueron mujeres tratadas en nuestro centro de carcinoma epitelial de ovario en estadios III-IV entre 2009 y 2014. Resultados: un total de 39 pacientes fueron incluidas en el estudio. En el 41,03% de los casos se realizó cirugía de citorreducción primaria y en el 58,97% cirugía de intervalo. Se encontró afectación del espacio retrohepático en el 20,5% de los casos. La citorreducción completa se pudo realizar en el 82,1% de los casos. Conclusiones: en nuestro centro conseguimos cirugía de citorreducción completa en un alto porcentaje de casos debido a la colaboración de un equipo multidisciplinar, integrado por ginecólogos y cirujanos generales, capaces de abordar la enfermedad visible, tanto en el hemiabdomen inferior como en el superior (AU)

Objective: To analyze surgical results in primary and interval cytoreductive surgery in advanced ovarian cancer in the Puerta de Hierro Majadahonda University Hospital (Madrid, Spain). Material and methods: We included women with stage III-IV epithelial ovarian cancer who underwent surgery in our centre between 2009 and 2014. Results: A total of 39 patients were included in this study. Of these, 41.03% underwent primary cytoreductive surgery and 58.97% underwent interval surgery. We found retrohepatic evidence of tumour in 20.5% of the patients. Complete cytoreductive surgery was feasible in 82.1%. Conclusions: In our centre, a high percentage of complete cytoreductive surgery was achieved due to the cooperation of a multidisciplinary team composed of gynaecologists and gastrointestinal surgeons, able to deal with visible disease, in both the lower and upper abdomen (AU)

Severe splenic rupture after colorectal endoscopic submucosal dissection.

Splenic rupture (SR) after colonoscopy is a very rare but potentially serious complication. Delayed diagnosis is common, and may increase morbidity and mortality associated. There is no clear relation between SR and difficult diagnostic or therapeutic procedures, but it has been suggested that loop formation and excessive torquing might be risk factors. This is a case of a 65-year-old woman who underwent endoscopic submucosal dissection (ESD) for lateral spreading tumor in the descending colon, and 36 h afterwards presented symptoms and signs of severe hypotension due to SR. Standard splenectomy was completed and the patient recovered uneventfully. Colorectal ESD is usually a long and position-demanding technique, implying torquing and loop formation. To our knowledge this is the first case of SR after colorectal ESD reported in the literature. Endoscopists performing colorectal ESD in the left colon must be aware of this potential complication.

Biliary cystadenoma.

The diagnosis of cystadenoma is rare, even more so when located in the extrahepatic bile duct. Unspecific clinical signs may lead this pathology to be misdiagnosed. The need for pathological anatomy in order to distinguish cystadenomas from simple biliary cysts is crucial. The most usual treatment nowadays is resection of the bile duct, together with cholecystectomy and Roux-en-Y reconstruction.