Tricobezoar de estómago / Gastric Trichobezoar Rapunzel Syndrome

Trichobezoars are an unusual pathology that appears generally in young adolescents associated with psychiatric disorders. The clinical presentation is very varied. The diagnosis is suspected by the clinical records of teen agers with trichophagia and trichotillomania and the digestive disorders are confirmed by the results of the endoscopy, the same as with images toward the therapeutic management. Undowbtly the treatment is surgical, and continuation with the psychiatric treatment is essential to avoid a recidival of the disease. Bezoar is a concretion formed in the alimentary tract, and according to the substances forming the ball, we find trichobezoar (foodball). The Rapunzel syndrome is an unusual complication of individual bezoar. When the trichobezoar located in the stomach extends through the pylorus into the small intestine and the right colon, is known as Rapunzel syndrome, that is an extremely rare gastric condition in humans. It is a rare form of trichobezoar, occurring in psychiatric patients with the trichobezoar (hairball) located in the stomach. The syndrome is named after the long haired girl Rapunzel in the fairy tale of the brothers Grimm. Most bezoars in teen agers are trichobezoars from swallowed hair. A 28-year-old patient is presented, with abdominal pain and vomiting, on the general physical examination the patient revealed a severe weight loss. Later on, through a gastrostomy, appeared the trichobezoar, being removed with good postsurgical resullts

[Hepatoid adenocarcinoma of the stomach. A case report]. / Adénocarcinome hépatoïde de l'estomac. A propos d'un cas.

Hepatoid adenocarcinoma of the stomach is a very rare tumor with a poor prognosis. Lymph nodes involvement and/or liver metastases are frequently observed. Diagnosis should be pointed out if elevated serum level of alpha-fetoprotein (AFP) is detected with gastric tumor. Histologically, the tumor is an adenocarcinoma of intestinal type including foci of hepatoïd differenciation. Immunohistochemistry is positive for alpha-1-antitrypsin and alpha-1-antichymotripsin, and for AFP. We report a case of a 66 year-old man presenting an advanced stage of hepatoid adenocarcinoma of the stomach, treated by gastrectomy followed by chemotherapy. The patient died four months after the surgery because of progressing liver metastatic disease.

Tumores neuro-endocrinos del intestino / Neuroendocrine tumors of the small intestine

Los tumores carcinoides son neoplasias poco frecuentes en el tubo digetivo y que se desarrollan a partir de las células que forman el sistema APUD o neuroendocrinas. El objetivo es analizar la nueva nomenclatura, la incidencia en el aparato digetivo, la presentación clínica, diagnóstico y tratamiento quirúrgico

Tumores neuro-endocrinos del intestino / Neuroendocrine tumors of the small intestine

Los tumores carcinoides son neoplasias poco frecuentes en el tubo digetivo y que se desarrollan a partir de las células que forman el sistema APUD o neuroendocrinas. El objetivo es analizar la nueva nomenclatura, la incidencia en el aparato digetivo, la presentación clínica, diagnóstico y tratamiento quirúrgico

[Jejunostomy for enteral feeding in surgery. Technical contribution and experience]. / Yeyunostomía de alimentación en cirugía. Contribución técnica y experiencia.

UNLABELLED: The necessity to maintain the nutritional integrity in patients subjected to major surgery of the superior digestive tract has been broadly accepted. The enteral nutrition for yeyunostomy is accepted as more physiologic, sure and effective than the parenteral one. MATERIALS AND METHOD: 171 yeyunostomies were indicated in: 151 patients with malignant neoplasm of the superior digestive tract, 15 with infected pancreatic necrosis, 3 bile-duodenum-pancreatic traumatisms and in 1 stenosis for gastroesophagic reflux. Depending on the pathological type, a yeyunostomy using the Witzell technique was carried out with either local or general anesthesia at a 15 to 20 cm. of the Treitz angle. To facilitate the fixation of the catheter and to avoid the stenosis of the jejunum we have incorporated, as an original technical detail, the proximal serous section with cold scalpel in about 4 cm, that is to say in the sector to be tunneled. RESULTS: There was not mortality in relation to the yeyunostomy. Among the minor complications we emphasize the abdominal distension, colic pain and diarrhea, situations that were reverted, controlling the debit and the feeding characteristics. This approach could be maintained for period of 2 months and in some cases at home. CONCLUSIONS: We emphasize the great importance of the enteral feeding for yeyunostomy, for its of easy handling, security and low cost that, together with the suggested technical detail, has allowed us to obtain a deeding road almost without inherent complications.

Yeyunostomía de alimentación en cirugía. Contribución técnica y experiencia. / [Jejunostomy for enteral feeding in surgery. Technical contribution and experience]

The necessity to maintain the nutritional integrity in patients subjected to major surgery of the superior digestive tract has been broadly accepted. The enteral nutrition for yeyunostomy is accepted as more physiologic, sure and effective than the parenteral one. MATERIALS AND METHOD: 171 yeyunostomies were indicated in: 151 patients with malignant neoplasm of the superior digestive tract, 15 with infected pancreatic necrosis, 3 bile-duodenum-pancreatic traumatisms and in 1 stenosis for gastroesophagic reflux. Depending on the pathological type, a yeyunostomy using the Witzell technique was carried out with either local or general anesthesia at a 15 to 20 cm. of the Treitz angle. To facilitate the fixation of the catheter and to avoid the stenosis of the jejunum we have incorporated, as an original technical detail, the proximal serous section with cold scalpel in about 4 cm, that is to say in the sector to be tunneled. RESULTS: There was not mortality in relation to the yeyunostomy. Among the minor complications we emphasize the abdominal distension, colic pain and diarrhea, situations that were reverted, controlling the debit and the feeding characteristics. This approach could be maintained for period of 2 months and in some cases at home. CONCLUSIONS: We emphasize the great importance of the enteral feeding for yeyunostomy, for its of easy handling, security and low cost that, together with the suggested technical detail, has allowed us to obtain a deeding road almost without inherent complications.

[Zenker diverticulum: therapeutic approach]. / Diverticulo de Zenker: conducta terapéutica.

BACKGROUND: Pharyngoesophageal or Zenker diverticula are a few frequent pathology that could represent between 1 and 3% of the patients with dysphagia and their physiopathology even at present is scarcity clear. OBJECTIVE: Therapeutic procedures results about this pathology were analyzed. SETTING: Caraffa and Sucre Clinic. DESIGN: Retrospective observational study. METHOD: It analyzed 13 patients operated by Zenker diverticula 9 of which were male and 4 were female sex with an average age of 55.6 years. Dysphagia occurred in 100% of the cases. Besides clinical finding the diagnosis was made evident by esophageal X-ray with contrast medium and endoscopy. Diverticulectomy by one stage through a left cervicotomy was the surgical procedure of choice. RESULTS: There was no surgical mortality. Related with morbility 2 patients presented fistulas managed medically and in other 2 patients abscesses of surgical wound occurred. The follow-up was carried on 6 months, 4 and 7 years respectively without relapses and with a good posterior evolution. CONCLUSIONS: Based on our short experience and the results attained we think the treatment of Zenker or pharyngoesophageal diverticulum by diverticulectomy through a left cervicotomy is safe and effective procedure to control this pathology.

[Amplifying right colectomy: place in the treatment of obstructive proximal left colon cancer]. / Colectomía derecha ampliada. Lugar en el tratamiento del cáncer de colon izquierdo proximal obstructivo.

The results obtained about nineteen (19) patients operated by left colon cancer with variable grade obstruction have been analysed. Seventeen (17) patients operated due to obstructive left colon cancer situated: five (5) in distal transverse colon, other five (5) at splenic flexure and seven (7) in proximal descending colon but three of them with right synchronic neoplasias. The remaining two (2) that showed a cancer located at splenic flexure and the other one in proximal descending colon were reoperated three weeks later than a transverse colostomy had been performed owing to an obstructive condition. One patient had to be reoperated because a generalised peritonitis from a fistula with partial disruption on end to end ileo-colic anastomosis. Exteriorization of both ends was carried out with favourable evolution and subsequent reanastomosis. An exteriorized patient by splenic flexure cancer also had to be drained ten days later for a retroperitoneal abscess through a percutaneous puncture and a lesion grade 1 in lower pole of spleen was resolved with electrofulguration. No patient has showed invalidating diarrhea and all themselves have been stabilised with two or three stools daily about two month after surgery. Amplifying right colectomy is a safe procedure with low surgical morbimortality and take privileged place in the treatment of the patients undergoing synchronical neoplasias and/or carcinomas associated with polyps, specially in all those cases when a variable grade of obstruction have occurred.

Diverticulo de Zenker: conducta terapéutica. / [Zenker diverticulum: therapeutic approach]

BACKGROUND: Pharyngoesophageal or Zenker diverticula are a few frequent pathology that could represent between 1 and 3

of the patients with dysphagia and their physiopathology even at present is scarcity clear. OBJECTIVE: Therapeutic procedures results about this pathology were analyzed. SETTING: Caraffa and Sucre Clinic. DESIGN: Retrospective observational study. METHOD: It analyzed 13 patients operated by Zenker diverticula 9 of which were male and 4 were female sex with an average age of 55.6 years. Dysphagia occurred in 100

of the cases. Besides clinical finding the diagnosis was made evident by esophageal X-ray with contrast medium and endoscopy. Diverticulectomy by one stage through a left cervicotomy was the surgical procedure of choice. RESULTS: There was no surgical mortality. Related with morbility 2 patients presented fistulas managed medically and in other 2 patients abscesses of surgical wound occurred. The follow-up was carried on 6 months, 4 and 7 years respectively without relapses and with a good posterior evolution. CONCLUSIONS: Based on our short experience and the results attained we think the treatment of Zenker or pharyngoesophageal diverticulum by diverticulectomy through a left cervicotomy is safe and effective procedure to control this pathology.