Páncreas ectópico, una posible y rara causa de hipoglucemia postprandial / Ectopic pancreas, a possible rare cause of postprandial hypoglycemia

Introducción: El páncreas ectópico es la segunda anomalía congénita pancreática más frecuente después del páncreas divisum. Fue descrito por primera vez en 1729 por Schultz y se define como la presencia de tejido pancreático que carece de comunicación anatómica o vascular con el cuerpo principal del páncreas. La localización más frecuente es en el estómago (25 - 38 por ciento), seguido de duodeno, yeyuno e íleon. El 40 por ciento de los casos son sintomáticos y es más frecuente su presentación en varones en torno a la 5ª y 6ª década de la vida. Objetivo: Presentar un caso de páncreas ectópico diagnosticado a través de un estudio histológico tras realizada la cirugía. Presentación de caso: Presentamos el caso de una paciente compatible con hipoglucemia y cuyo estudio definitivo mostró la presencia de tejido pancreático ectópico en estómago, con resolución completa de los síntomas tras tratamiento quirúrgico. La anatomía patológica mostró una lesión nodular tumoral benigna (2,5 cm), constituida por tejido pancreático heterotópico, con presencia de páncreas exocrino con acinos. Páncreas endocrino con presencia de islotes de Langerhans y componente epitelial con ductos. Afectación desde la submucosa hasta la subserosa, con una pared muscular propia con hiperplasia muscular en relación a la heterotopía pancreática. La mucosa gástrica mostraba inflamación crónica leve con escasos folículos linfoides. Conclusiones: La presencia de páncreas ectópico es una entidad poco frecuente, pero a tener en cuenta en pacientes con clínica de hipoglucemia, una vez descartadas otras causas. No existe consenso con respecto a indicaciones en el manejo de lesiones pequeñas y asintomáticas, por lo que se recomienda individualizar cada caso teniendo en cuenta el tamaño, la localización y el tipo histológico(AU)

Introduction: Ectopic pancreas is the second most frequent congenital anomaly after pancreas divisum. It was described for the first time in 1729 by Schultz and it is defined as the presence of pancreatic tissue with no anatomical or vascular communication with the main body of pancreas. The most common location is in the stomach (25-38 percent), followed by the duodenum, jejunum and ileum ones. 40 percent of the cases are symptomatic and is more frequent their presentation in males in the fifth or sixth decade of life. Objective: To present a case of ectopic pancreas diagnosed through a histological study after surgery. Case presentation: Case of a patient with clinical features compatible with hypoglycemia that after being studied showed the presence of ectopic pancreatic tissue in the stomach, with a complete solution of the symptoms after surgical treatment. The pathological anatomy showed a benign tumor nodular lesion (2.5 cm), made up of heterotopic pancreatic tissue, with the presence of exocrine pancreas with acini. Endocrine pancreas with the presence of islets of Langerhans and epithelial component with ducts. Involvement from the submucosa to the subserosa, with a proper muscular wall with muscular hyperplasia in relation to pancreatic heterotopia. The gastric mucosa showed mild chronic inflammation with few lymphoid follicles. Conclusions: The presence of ectopic pancreas is a rare condition, but it should be taken into account in patients with clinical features of hypoglycemia once ruled out other causes. There is no consensus in regards to the indications for the management of small and asymptomatic lesions, so, it is recommended to individualize each case taking into account the size, location and histological type(AU)

De Garengeot's hernia: Case report and literature review.

INTRODUCTION: De Garengeot's Hernia is a rare type of femoral hernia in which the appendix is located inside the herniated sac. Diagnosis of the condition is challenging and its treatment must be performed without delay. PRESENTATION OF CASE: We present the case of a 75-year-old patient with a femoral hernia in which an appendix with signs of inflammation was found. An appendectomy followed by hernia repair was performed under an open preperitoneal approach according to Nyhus technique. The patient did not present any complications and was discharged on the second postoperative day. DISCUSSION: This type of hernia is often unexpected and its preoperative diagnosis is difficult to perform. In most cases the clinical picture is indistinguishable from a common incarcerated hernia. Contrast-enhanced CT is the most useful complementary test, although it is not as accurate as desirable, so the diagnosis is frequently found intraoperatively. There is a wide variety of surgical options and there is no consensus on the most appropriate one. The preperitoneal approach enables the performance of an appendectomy and subsequent hernia reparation. The use of prosthesis should be considered if there are no signs of perforation or abscess. CONCLUSION: De Garengeot's hernia is a very rare entity. The diagnosis and subsequent surgical treatment must be early to prevent the disease progression. The preperitoneal approach should be considered as the first choice technique, as it allows the exploration of the herniated sac and the performance of surgical procedures on its content.

Esophageal resection and immediate reconstruction in esophageal perforations.

BACKGROUND: Esophageal perforation is a disease with high mortality. Treatment is controversial and should be individualized. Elapsed time, location and perforation all play a role in determining the treatment option: from conservative treatment to esophagectomy. We undertook this study to report on primary esophagectomy and reconstruction in esophageal perforations with expert surgeons and selected patients. It is worth noting the rare complication of perforated peptic ulcer on Barrett's esophagus presented in one of our patients. CLINICAL CASES: We report two patients with esophageal perforation (one spontaneous and another due to pneumatic esophageal dilation) treated by primary esophagectomy and reconstruction. The patient with spontaneous perforation had Barrett's esophagus with severe dysplasia and perforated peptic ulcer. CONCLUSIONS: Esophageal resection and immediate reconstruction is controversial. It was decided to resect the esophagus in both cases reported here due to the size of the perforation and esophageal disease in the second case. The primary reason for immediate reconstruction in selected cases is permanent resolution. Primary cervical esophagealgastric anastomosis has a lower risk of contamination and leaks than thoracic anastomosis, resulting in mediastinal drainage and parenteral nutrition. Spontaneous esophageal perforation due to perforated Barrett's ulcer is uncommon. Finally, we must consider the importance of early diagnosis and treatment. It is essential to consider the size of the perforation, location, previous esophageal disease, age and general status of the patient in order to undertake appropriate management. Emergency surgery should be individualized and depends on surgeon's experience.

Biopsia guiada por laparoscopia de tumoraciones intraabdominales no digestivas / Laparoscopic biopsy of non-digestive intra-abdominal masses

Introducción. La laparoscopia es un recurso diagnóstico de múltiples enfermedades que requieren biopsia de masas intraabdominales no abordables mediante punciones guiadas por imagen. Evita la morbimortalidad asociada a la laparotomía favoreciendo el tratamiento precoz de los procesos malignos. Pacientes y método. Análisis descriptivo, retrospectivo de los resultados de una serie de pacientes de nuestro hospital, que presentan nódulo intraabdominal de etiología desconocida biopsiados mediante cirugía laparoscópica desde enero de 2001 hasta mayo de 2006. Ninguno de los pacientes es candidato a punción percutánea guiada por imagen. Resultados. Realizamos 23 biopsias: 8 retroperitoneales (34,7%), 5 mesentéricas (21,7%), 5 en hilio hepático, 4 pelvianas y 1 en cadena de vena ilíaca y asociamos 5 biopsias complementarias. Se obtuvo un 100% de material suficiente para diagnóstico anatomopatológico. La duración media de la intervención fue de 71 min. El 61% tuvo un ingreso menor de 24 h. La estancia hospitalaria (mediana) fue de 1,5 días. Conclusiones. El abordaje laparoscópico permite una exposición y una revisión completa de la cavidad peritoneal. La biopsia laparoscópica es segura y efectiva con excelente recuperación del paciente permitiendo iniciar precozmente el tratamiento definitivo (AU)

Introduction. Laparoscopic surgery offers an alternative diagnostic technique in multiple diseases requiring biopsy of non-digestive intra-abdominal masses in which image-guided biopsy cannot be performed. Laparoscopic biopsy aims to reduce the surgical aggression and complications associated with laparotomy and favors the early treatment of malignancies. Patients and method. We performed a retrospective descriptive study of our results in a series of patients in our hospital with intra-abdominal masses of unknown etiology who underwent laparoscopic surgery between January 2001 and April 2006. None of the patients were candidates for image-guided percutaneous biopsy. Results. We carried out 23 biopsies: 8 retroperitoneal (34.7%), 5 mesenteric (21.7%), 5 hepatic, 4 pelvic, and 1 in the iliac chain, as well as 5 complementary biopsies. In all patients, sufficient material for histologic diagnosis was obtained. The mean operating time was 71 minutes. Length of hospital stay was less than 24 hours in 61% of the patients. The median length of hospital stay was 1.5 days. Conclusions. The laparoscopic approach allows complete visualization and examination of the entire peritoneal cavity. Laparoscopic biopsy is a safe and effective procedure with excellent patient recovery and allows early definitive treatment (AU)

Manejo diagnóstico en el tratamientoconservador del traumatismo abdominal / Diagnostic management in the conservative treatment of abdominal trauma

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The European experience with vascular injuries.

The rich and diverse heritage of the management of vascular injuries in the 45 independent European countries prevents the authors from revealing a uniform picture of the European experience, but some trends are clearly emerging. In countries with a low incidence of penetrating trauma and increasing use of interventional vascular procedures, the proportion of iatrogenic vascular trauma exceeds 40% of all vascular injuries, whereas on other parts of the continent, armed conflicts are still a major cause of vascular trauma. National vascular registries, mostly in the Scandinavian countries, produce useful, nationwide data about vascular trauma and its management but suffer still from inadequate data collection. Despite a relatively low incidence of vascular trauma in most European countries, the results are satisfactory, probably in most cases because of active and early management by surgeons on call, whether with vascular training or not, treating all kinds of vascular surgical emergencies. In some countries, attempts at developing a trauma and emergency surgical specialty, including expertise in the management of vascular injuries, are on their way.