Giant stone adhered in the vaginal cavity in a female patient with type 2 diabetes mellitus: a case report.

BACKGROUND: Bladder lithiasis comprises 5% of urological lithiasis. Large bladder stones associated with vesicovaginal fistulas are rare, and the risk factors are not an isolated process. There are metabolic comorbidities associated with this pathology, including diabetes mellitus. CASE PRESENTATION: A 70-year-old Mestizo patient is presented, reporting dysuria, pollakiuria, and abdominal pain of 4 months of evolution, located in the hypogastric region, also with a sensation of a foreign body in the vaginal introitus. In her pathological history, she presented type 2 diabetes mellitus. A computed tomography scan of the abdomen and pelvis was performed, reporting a tumor lesion in the abdominal wall. Therefore, surgical intervention was performed by cystolithotomy, obtaining a giant stone adhered to the vaginal wall with a size of 10 cm × 12 cm. CONCLUSION: Early detection of this pathology should be exhaustive in patients with characteristics and comorbidities associated with stone development to avoid possible complications, such as vesicovaginal fistulas.

Endoscopic treatment of chronic pancreatitis: European Society of Gastrointestinal Endoscopy (ESGE) Guideline - Updated August 2018.

ESGE suggests endoscopic therapy and/or extracorporeal shockwave lithotripsy (ESWL) as the first-line therapy for painful uncomplicated chronic pancreatitis (CP) with an obstructed main pancreatic duct (MPD) in the head/body of the pancreas. The clinical response should be evaluated at 6 - 8 weeks; if it appears unsatisfactory, the patient's case should be discussed again in a multidisciplinary team and surgical options should be considered.Weak recommendation, low quality evidence.ESGE suggests, for the selection of patients for initial or continued endoscopic therapy and/or ESWL, taking into consideration predictive factors associated with a good long-term outcome. These include, at initial work-up, absence of MPD stricture, a short disease duration, non-severe pain, absence or cessation of cigarette smoking and of alcohol intake, and, after initial treatment, complete removal of obstructive pancreatic stones and resolution of pancreatic duct stricture with stenting.Weak recommendation, low quality evidence.ESGE recommends ESWL for the clearance of radiopaque obstructive MPD stones larger than 5 mm located in the head/body of the pancreas and endoscopic retrograde cholangiopancreatography (ERCP) for MPD stones that are radiolucent or smaller than 5 mm. Strong recommendation, moderate quality evidence.ESGE suggests restricting the use of endoscopic therapy after ESWL to patients with no spontaneous clearance of pancreatic stones after adequate fragmentation by ESWL.Weak recommendation, moderate quality evidence.ESGE suggests treating painful dominant MPD strictures with a single 10-Fr plastic stent for one uninterrupted year if symptoms improve after initial successful MPD drainage. The stent should be exchanged if necessary, based on symptoms or signs of stent dysfunction at regular pancreas imaging at least every 6 months. ESGE suggests consideration of surgery or multiple side-by-side plastic stents for symptomatic MPD strictures persisting beyond 1 year after the initial single plastic stenting, following multidisciplinary discussion. Weak recommendation, low quality evidence.ESGE recommends endoscopic drainage over percutaneous or surgical treatment for uncomplicated chronic pancreatitis (CP)-related pseudocysts that are within endoscopic reach.Strong recommendation, moderate quality evidence.ESGE recommends retrieval of transmural plastic stents at least 6 weeks after pancreatic pseudocyst regression if MPD disruption has been excluded, and long-term indwelling of transmural double-pigtail plastic stents in patients with disconnected pancreatic duct syndrome.Strong recommendation, low quality evidence.ESGE suggests the temporary insertion of multiple side-by-side plastic stents or of a fully covered self-expandable metal stent (FCSEMS) for treating CP-related benign biliary strictures.Weak recommendation, moderate quality evidence.ESGE recommends maintaining a registry of patients with biliary stents and recalling them for stent removal or exchange.Strong recommendation, low quality evidence.

Extracción endoscópica de cálculos pancreáticos en pancreatitis crónica para evitar reagudizaciones / Endoscopic extraction of pancreatic stones in chronic pancreatitis with the aim to prevent acute flares

Chronic pancreatitis (CP) is defined by chronic inflammation of the pancreas with progressive replacement by fibrosis that produces characteristic morphological changes. The clinical picture is variable, being the main problem the pain and relapses of pancreatitis with possible local complications. Over time, the result is the development of exocrine and endocrine failure. In the initial phase, flare-ups of CP can not be distinguished from recurrent acute pancreatitis (RAP). If there are intraductal stones in the duct of Wirsung, endoscopic extraction of obstructive stones may be the first step to prevent new relapses and complications. We present the case of a patient with five episodes of acute pancreatitis (AP), three of them in the past five months. The patient was referred for study and management of RAP. His recent imaging study already showed dilatation of the main pancreatic duct, calcifications and pancreatic stones, compatible with CP. Although the hypertriglyceridemia participated in the etiology of AP, the last two episodes already occurred with normal values of triglycerides. Another possible etiologic factor was not found. His laboratory results did not show endocrine or exocrine insufficiency. The patient was treated with papillotomy, pancreatic stone extraction and installation of terapeutic pancreatic stent. He has been asymptomatic, free from new episodes of AP in the past six months. In conclusion, the CP is one of the possible causes of RAP. Endoscopic treatment by obstructive stone extraction is an efficient therapy to avoid new relapse.

La pancreatitis crónica (PC) se define por la inflamación crónica del páncreas con reemplazo progresivo por fibrosis que produce cambios morfológicos característicos. El cuadro clínico es variable, siendo el principal problema el dolor, reagudizaciones de pancreatitis con eventuales complicaciones locales. Con el tiempo, el resultado final es el desarrollo de insuficiencia exocrina y endocrina. En la fase inicial, no se puede distinguir las reagudizaciones de la PC de una pancreatitis aguda recurrente (PAR). Si se encuentran cálculos intraductales en el conducto de Wirsung, la extracción endoscópica de cálculos obstructivos puede ser el primer paso para prevenir nuevas recaídas y complicaciones. Se presenta el caso de un paciente con cinco episodios de pancreatitis aguda (PA), tres de ellos en los últimos cinco meses. El paciente fue derivado para estudio y manejo de PAR. Su estudio imagenológico reciente ya demostró dilatación del conducto pancreático principal, calcificaciones y cálculos pancreáticos, compatible con PC. Aunque la hipertrigliceridemia participó en la etiología de las PA, los últimos dos episodios ocurrieron con valores normales de triglicéridos. No se encontró otro factor etiológico posible. Su estudio de laboratorio no mostró insuficiencia exocrina ni endocrina. El paciente fue tratado mediante papilotomía, extracción de cálculos pancreáticos e instalación de prótesis pancreática terapéutica. Ha estado asintomático, libre de nuevos episodios de PA en los seis meses transcurridos. En conclusión, la PC es una de las posibles causas de PAR. El tratamiento endoscópico mediante extracción de cálculos obstructivos es una terapia eficiente para evitar nuevas recaídas.

Testicular calculus: A rare case.

BACKGROUND: Testicular calculus is an extremely rare case with unknown etiology and pathogenesis. To our knowledge, here we report the third case of testicular calculus. A 31-year-old man was admitted to our clinic with painful solid mass in left testis. After diagnostic work-up for a possible testicular tumour, he underwent inguinal orchiectomy and histopathologic examination showed a testicular calculus. Case hypothesis: Solid testicular lesions in young adults generally correspond to testicular cancer. Differential diagnosis should be done carefully. Future implications: In young adults with painful and solid testicular mass with hyperechogenic appearance on scrotal ultrasonography, testicular calculus must be kept in mind in differential diagnosis. Further reports on this topic may let us do more clear recommendations about the etiology and treatment of this rare disease.

Testicular calculus: A rare case

Testicular calculus is an extremely rare case with unknown etiology and pathogenesis. To our knowledge, here we report the third case of testicular calculus. A 31-year-old man was admitted to our clinic with painful solid mass in left testis. After diagnostic work-up for a possible testicular tumour, he underwent inguinal orchiectomy and histopathologic examination showed a testicular calculus.

Testis tumor associated to microlithiasis / Tumor de testiculo asociado a la microlitiasis / Tumor de testiculo associado a microlitiase

OBJECTIVE: To discuss the relationship between testicular microlithiasis and testis tumors in children and to consider the chances of testis preserving surgery in specific cases. CASE DESCRIPTION: Pre-adolescent presenting testicular microlithiasis and a larger left testis, corresponding to a cystic testicular tumor. The tumor was excised, with ipsilateral testis preservation. Histology diagnosed a testis dermoid tumor. COMMENTS: The relationship between testis tumors and testicular microlithiasis is ill defined in children. Pediatric urologists need to develop specific follow-up protocols for pre-pubertal children. .

OBJETIVO: Discutir las implicaciones de la microlitíasis testicular en el niño con relación al riesgo oncológico implicado y la posibilidad de cirugía de preservación testicular en casos elegidos. DESCRIPCIÓN DEL CASO: Pre-adolescente presentando aumento microlitíasis testicular y aumento del testículo izquierdo, con lesión tumoral quística. La lesión fue resecada, con preservación del testículo y diagnóstico histológico de tumor dermatoide testicular. COMENTARIOS: La relación entre tumores de testículo y microlitíasis testicular es mal definida en niños y hay la necesidad de desarrollar protocolos de seguimiento específicos para esa franja de edad. .

OBJETIVO: Discutir as implicações da microlitíase testicular na criança com relação ao risco oncológico envolvido e a possibilidade de cirurgia de preservação testicular em casos escolhidos. DESCRIÇÃO DO CASO: Pré-adolescente apresentava microlitíase testicular e aumento do testículo esquerdo, correspondendo a tumor testicular cístico. Ressecou-se o tumor, com preservação do testículo. O diagnóstico histológico foi de tumor dermoide testicular. COMENTÁRIOS: A relação entre tumores de testículo e microlitíase testicular é mal definida em crianças e há a necessidade de desenvolver protocolos de seguimento específicos para essa faixa etária. .

Hepatolithiasis with secondary cholangitis and supernumerary left hepatic lobe.

We report the case of a 31-year old woman with recurrent cholangitis secondary to hepatolithiasis. The stones were composed of calcium bilirubinate. The patient also had a supernumerary hepatic lobe connected to the inferior aspect of the segment III of the liver. The role of the supernumerary hepatic lobe in the development of hepatolithiasis is unclear and may be coincidental.

Testis tumor associated to microlithiasis.

OBJECTIVE: To discuss the relationship between testicular microlithiasis and testis tumors in children and to consider the chances of testis preserving surgery in specific cases. CASE DESCRIPTION: Pre-adolescent presenting testicular microlithiasis and a larger left testis, corresponding to a cystic testicular tumor. The tumor was excised, with ipsilateral testis preservation. Histology diagnosed a testis dermoid tumor. COMMENTS: The relationship between testis tumors and testicular microlithiasis is ill defined in children. Pediatric urologists need to develop specific follow-up protocols for pre-pubertal children.

Cistolitectomia para a remoção de 2340 urólitos em cão obeso da raça Cocker Spaniel – relato de caso / Cistolitectomy for removal of 2340 uroliths in obese dog Cocker Spaniel –- a case report

Embora a urina seja uma solução complexa, na qual diversos sais podem permanecer sob condições de super saturação, existe tendência muito forte para a precipitação e formação de sólidos a partir dos sais em dissolução. Os urólitos são formados a partir da cristalização dos sais em decorrência de diversos fatores e a urolitíase não é uma doença específica primária, mas sequela de desordens subjacentes. O presente relato descreve um caso de um canino fêmea, Cocker Spaniel, nove anos de idade, pesando 19,6 Kg, na qual se realizou o diagnóstico de múltiplos cálculos vesicais e posterior tratamento através de cistotomia para a remoção de 2340 urólitos. Segundo o histórico,o canino do presente relato frequentemente eliminava pequenos cálculos durante a micção, porém não apresentava outros sinais clínicos sugestivos de afecção no trato urinário inferior como disúria, hematúria, estrangúria, polaquiúria e incontinência urinária.O presente relato demonstra que é possível tratar cirurgicamente 2340 cálculos vesicais em cães, com adequada evolução do paciente em questão, sem recidivas, pelo período de cinco meses.

While the urine is a complex in which various salts may remain under conditions of supersaturation, there is a strong tendency for precipitation and formation of solid salts from dissolving in this organ. The urolithsare formed from crystallization of salts due to several factors and it is a disease specific primary. This report describes a case of a female dog, cocker spaniel, nine years old, weighing 19,6Kg, which was held in the diagnosis of multiple bladder stones and subsequent treatment by cystotomy for removal of 2340uroliths. According to the clinical history, the dog of this report often eliminated small calculi during urination, but showed another clinical signs of disease in the lower urinary tract such as dysuria, hematury, strangury, pollakiury and urinary incontinence. The present report demonstrates the surgical removal of bladder stones impressive 2.340, and the good evolution of the same ove a period of five months.

Cistolitectomia para a remoção de 2340 urólitos em cão obeso da raça Cocker Spaniel relato de caso / Cistolitectomy for removal of 2340 uroliths in obese dog Cocker Spaniel –- a case report

Embora a urina seja uma solução complexa, na qual diversos sais podem permanecer sob condições de super saturação, existe tendência muito forte para a precipitação e formação de sólidos a partir dos sais em dissolução. Os urólitos são formados a partir da cristalização dos sais em decorrência de diversos fatores e a urolitíase não é uma doença específica primária, mas sequela de desordens subjacentes. O presente relato descreve um caso de um canino fêmea, Cocker Spaniel, nove anos de idade, pesando 19,6 Kg, na qual se realizou o diagnóstico de múltiplos cálculos vesicais e posterior tratamento através de cistotomia para a remoção de 2340 urólitos. Segundo o histórico,o canino do presente relato frequentemente eliminava pequenos cálculos durante a micção, porém não apresentava outros sinais clínicos sugestivos de afecção no trato urinário inferior como disúria, hematúria, estrangúria, polaquiúria e incontinência urinária.O presente relato demonstra que é possível tratar cirurgicamente 2340 cálculos vesicais em cães, com adequada evolução do paciente em questão, sem recidivas, pelo período de cinco meses.AU

While the urine is a complex in which various salts may remain under conditions of supersaturation, there is a strong tendency for precipitation and formation of solid salts from dissolving in this organ. The urolithsare formed from crystallization of salts due to several factors and it is a disease specific primary. This report describes a case of a female dog, cocker spaniel, nine years old, weighing 19,6Kg, which was held in the diagnosis of multiple bladder stones and subsequent treatment by cystotomy for removal of 2340uroliths. According to the clinical history, the dog of this report often eliminated small calculi during urination, but showed another clinical signs of disease in the lower urinary tract such as dysuria, hematury, strangury, pollakiury and urinary incontinence. The present report demonstrates the surgical removal of bladder stones impressive 2.340, and the good evolution of the same ove a period of five months.AU

Íleo biliar: presentación en la urgencia quirúrgica / Gallstone ileus: a surgical emergency presentation

Se presenta el caso de una paciente de 60 años de edad, con antecedentes de litiasis vesicular, que ingresó de urgencia por presentar un cuadro de dolor abdominal, vómitos y distensión en el abdomen con 2 días de evolución. De forma secundaria presentó una deshidratación moderada. En la radiografía simple de abdomen se constataron signos radiológicos de oclusión intestinal. Se corrigió el desequilibrio hidroelectrolítico y se realizó una laparotomía exploradora, en la que se encontró un cálculo grande enclavado en el íleon terminal. Se realizó una enterolitotomía con enterorrafia y resolvió el cuadro oclusivo(AU)

The case of a 60 years old female patient with a history of gallstones that was admitted as an emergency because of abdominal pain, vomiting and abdominal distension of 2 days is presented. The patient presented also secondary moderate dehydration. In a simple abdominal radiography, radiological signs of intestinal occlusion were found. Electrolyte imbalance was corrected and an exploratory laparotomy was performed. Through this procedure, a large stone was found in the terminal ileum. Enterolithotomy was performed along with enterorraphy, thus solving the occlusion(AU)

[Duodenal duplication cyst filled with enteroliths: a case report]. / Cisto de duplição do duodeno com cálculos: Apresentação de caso.

Alimentary tract duplications are very rare, especially among adults, and only in 4-12% of the cases the duodenum is the site of origin. The main symptoms are usually epigastric pain, weight loss and vomiting. We report a case of a duodenal duplication cyst filled with enteroliths in a 23-year-old female patient presenting these symptons. The computed tomography showed a mesenteric cyst and the patient underwent a surgical procedure during which the diagnosis of duplication cyst with enteroliths was made and the cyst was excised with success. The diagnosis before surgery in these cases is extremely difficult especially if one considers how rare they are. The most helpful exam is the computed to- mography and the treatment is mainly surgical, although there are recent case reports showing the possibility of endoscopic resection (still being discussed). The presence of enteroliths can be explained by stasis and food alkalinity inside the cyst.

Rhinoliths causing palatal perforation: case report and literature review.

Rhinoliths are calcified masses formed within the nasal cavity because of the solidification of mucus, debris, or foreign objects by gradual accretion of mineral salts. They are mostly asymptomatic and incidentally diagnosed, although some patients may complain of nasal discharge and obstruction. Ulceration of the nasal mucosa, facial swelling, and bone destruction are less frequently observed but bring about difficulties for differential diagnoses with several pathologic entities. This article presents a case of a 54-year-old woman with a rhinolith causing palatal perforation, focusing on the diagnostic process and histopathologic characteristics.

Complicación por fuga de cálculos en colecistectomía laparoscópica / Escape of stones as complication of laparoscopic cholecistectomy

Se presenta el caso de una paciente de 72 años que concurrió al servicio de ecografía del Hospital J. F. Muñiz, de la Ciudad de Buenos Aires, para evaluar una tumoración en la pared abdominal y descartar un derrame pleural. Presentaba como antecedente una cirugía laparoscópica, realizada 15 meses antes, y los resultados ecográficos presentaron colecciones originadas por el derrame de cálculos en la cavidad abdominal.

Complicación por fuga de cálculos en colecistectomía laparoscópica / Escape of stones as complication of laparoscopic cholecistectomy

Se presenta el caso de una paciente de 72 años que concurrió al servicio de ecografía del Hospital J. F. Muñiz, de la Ciudad de Buenos Aires, para evaluar una tumoración en la pared abdominal y descartar un derrame pleural. Presentaba como antecedente una cirugía laparoscópica, realizada 15 meses antes, y los resultados ecográficos presentaron colecciones originadas por el derrame de cálculos en la cavidad abdominal.(AU)

Litiasis intrahepática: aporte de los tratamientos percutáneos / Intrahepatic primitive lithiasis

Se presenta una serie de 82 casos de litiasis intrahepática primitiva. Esta alta cantidad rara en Occidente, se explica por tratarse en su mayoría de pacientes que han quedado con litiasis remanente y enviados para su extracción percutánea. Desde de 1964 hasta la actualidad (5.000 casos). Se analiza la etiopatogenia dando importancia capital a las estenosis prelitiásicas, presentes en el 80 por ciento, que se consiguieron dilatar en todos los casos y no recidivaron. De las 82, 16 fueron difusas, 52 del conducto hepático izquierdo y 14 del derecho. En casi todos la cirugía fue complementada con el tratamiento instrumental. Se hizo tratamiento percutáneo en 79 casos, 73 se realizaron por la vía transfistular y 6 por vía TPH. Se obtuvo un éxito global del 94 por ciento. Las complicaciones fueron del 17 por ciento y la mortalidad del 2,4 por ciento. No se realizó ninguna hepatectomía (AU)

Litiasis intrahepática: aporte de los tratamientos percutáneos / Intrahepatic primitive lithiasis

Se presenta una serie de 82 casos de litiasis intrahepática primitiva. Esta alta cantidad rara en Occidente, se explica por tratarse en su mayoría de pacientes que han quedado con litiasis remanente y enviados para su extracción percutánea. Desde de 1964 hasta la actualidad (5.000 casos). Se analiza la etiopatogenia dando importancia capital a las estenosis prelitiásicas, presentes en el 80 por ciento, que se consiguieron dilatar en todos los casos y no recidivaron. De las 82, 16 fueron difusas, 52 del conducto hepático izquierdo y 14 del derecho. En casi todos la cirugía fue complementada con el tratamiento instrumental. Se hizo tratamiento percutáneo en 79 casos, 73 se realizaron por la vía transfistular y 6 por vía TPH. Se obtuvo un éxito global del 94 por ciento. Las complicaciones fueron del 17 por ciento y la mortalidad del 2,4 por ciento. No se realizó ninguna hepatectomía