Invaginación intestinal asociada a metástasis de melanoma maligno / Small-bowel intussusception secondary to metastatic melanoma

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[Wandering spleen torsion]. / Bazo ectópico torsionado.

The ectopic spleen characterizes for absence of its suspensory ligaments and a long pedicle that are predisposed to complicate it for a torsion with commitment of the venous drainage at first and arterial at a later time himself, producing increase of its volume and infarct. This anomalous situation, it can be had to a congenital malformation of the development of its suspensory elements and fall toward the inferior abdomen or else to an inferior growth of the mesodermic yolk of that this organ originates itself. The suitable treatment is the laparoscopic splenopexy, but when it exists infarction, it is no possible avoid the splenectomy.

Bazo ectópico torsionado / Wandering spleen torsion

El bazo ectópico se caracteriza por ausencia de sus ligamentos suspensorios y un pedículo largo, que le predisponen a complicarse por una torsión, con compromiso del drenaje venoso en un principio y posteriormente arterial, produciendo aumento de su volumen e infarto. Esta situación anómala puede ser debida a una malformación congénita del desarrollo de sus elementos suspensorios y caída hacia el abdomen inferior, o bien a un crecimiento inferior de la yema mesodérmica de la que se origina este órgano. El tratamiento idóneo es la esplenopexia vía laparoscópica, pero cuando existe infarto no podemos evitar la esplenectomía (AU)

The ectopic spleen characterizes for absence of its suspensory ligaments and a long pedicle that are predisposed to complicate it for a torsion with commitment of the venous drainage at first and arterial at a later time himself, producing increase of its volume and infarct. This anomalous situation, it can be had to a congenital malformation of the development of its suspensory elements and fall toward the inferior abdomen or else to an inferior growth of the mesodermic yolk of that this organ originates itself. The suitable treatment is the laparoscopic splenopexy, but when it exists infarction, it is no possible avoid the splenectomy (AU)

[Epidermoid splenic cyst--state of the art]. / Quiste esplénico epidermoide. Estado actual del problema.

In order to understand the features of splenic epidermoid cysts and their possible associated complications, four cases of splenic epidermoid cyst are presented in this report, two in children, one of them appeared in a child affected by a EBV and BH sepsis complicated with splenic abscesses due to scratch cat disease. The other two cases were adults. According to our histophatological findings, the pathogenesis may be related to a citodiferentation from mesothelium to squamous metaplasia. Our current knowledge about the role of spleen on immunological activity, mainly against capsulated germs, and the increase risk of overwhelming postesplenectomy septicemia have contributed to our conservative attitude about splenic surgery. We believe that management during the neonatal period should be conservative because cysts tend to disappear in most cases. In older children with a small cyst our recommendation is punction-aspiration and sclerotherapy, with ultrasound follow-up control.

Haemoperitoneum secondary to rupture of retroperitoneal variceal.

A 45-year-old alcoholic male patient presented with hypovolemic shock and intense anemia (Hemoglobin 04.7 g/dl), and was operated on. A bleeding retroperitoneal varix located near the right colon was responsible for the clinical picture and was sutured. After operation the patient developed haemodynamic instability and pneumonia a situation which was reverted with intensive medical therapy. The patient is now doing well.

Primary papillary psammomatous adenocarcinoma of the umbilicus.

The histological and ultrastructural features, as well as the immunoreactivity of one case of uncommon primary papillary and psammomatous adenocarcinoma of the umbilicus are studied in the present work. The observations have been undertaken in a nine-year follow-up, and have included the primitive tumour, two local recidives, and inguinal lymphatic metastasis on two occasions. Papillary structures, numerous psammoma bodies, as well as weak and focal positive reactions to CEA and cytokeratin were present in all the tumours. Since these features and their ultrastructural characteristics were identical to primary papillary serous neoplasias of the peritoneum and ovarium, the hypothesis of an origin in coelomic remnants is considered.

[Pancreatoduodenal traumatism. Apropos of 18 cases]. / Traumatismo pancreatoduodenal. A propósito de 18 casos.

We present our experience on pancreato-duodenal trauma surgically treated; we have studied the etiopathogenesis of the lesions and the severity of the condition, which is related to their anatomical relationships and to the difficulties of the early diagnosis. We emphasize the value of non invasive diagnostic methods, particularly immediate ultrasonography, CAT and exceptionally RECP. Abdominocentesis with peritoneal lavage and the insertion of a catheter through a minimal jejunostomy, for the nutritional support of the patient and to prevent complications merits special mention.

[Spiegel's hernia. Apropos of 10 cases]. / Hernia de Spiegel. A propósito de diez casos.

We present our recent experience in the last ten cases of Spiegel's hernia, studying its form of presentation and clinical manifestations. We studied emergency cases because they presented intestinal obstruction and were handled as a surgical emergency. We remark the noninvasive diagnostic methods, mainly echography. The surgical treatment for repair of the hernial defect and the material used was the same in every case. The morbi-mortality of the series was null and there was no recurrence in the period in which we studied and followed-up the series.

[Complete section of the choledochus caused by non-penetrating trauma of the abdomen. Use of minimal catheter jejunostomy]. / Sección completa del colédoco por traumatismo no penetrante de abdomen. Utilización de la yeyunostomía mínima a catéter (YMC).

A case is presented of complete section of the choledochus as the sole lesion in closed abdominal trauma. A study is made of the difficulties of an early diagnosis of this pathology, as well as techniques for intraoperative localization and repair. Emphasis is placed on the use of peritoneal lavage as a preoperative diagnostic method and Tc99m HIDA scintigraphy of the biliary tract. The surgical technique is reviewed, assuming that the most physiological and anatomic procedure is end-to-end choledochoduodenostomy using reabsorbable sutures. We recommend the use of minimal transcatheter jejunostomy (YMC) as a method for immediate replacement of bile juice and inhibition of secretion, as well as the possibility of postoperative physiological nutrition using this approach.

[Colonic lesion caused by acute pancreatitis. Use of minimal catheter jejunostomy. Apropos of 6 cases]. / Afectación colónica por pancreatitis aguda. Utilización de la yeyunostomía mínima a catéter. A propósito de seis casos.

Colonic affectation in the context of acute pancreatitis is undoubtedly a rare complication to judge from the number of cases reported in the literature, but its appearance is increasing, perhaps because it is receiving more attention. The "infrequent" complications of so-called acute pancreatitis range from massive necrosis of the colon to fistula of the transverse colon, colonic stricture as a chronic manifestation and finally, colonic varices as a sign of segmental portal hypertension due to involvement of the mesenteric portal axis. A retrospective study was made of 6 cases treated in our General and Digestive Surgery Department and the literature on this etiopathogenic situation was reviewed to study the clinical manifestations, diagnosis and treatment of these uncommon complications. We propose minimal catheter jejunostomy as a technique for the prevention and treatment of possible complications, with epidural analgesia of these patients.

[Local resection of a rectal carcinoid tumor using Mason's trans-sphincter technic]. / Resección local de tumor carcinoide rectal con la técnica transesfinteriana de Mason.

We present an infrequent clinical case of rectal carcinoid tumor in a 65-year-old male. The treatment of this tumor is always surgical and selection of the technique is determined by the patient's age, the size and location of the neoplasm and particularly by the presence of invasion of the muscular layer in the pathology study. Simple excision of tumors under 2 cm. and abdominoperineal or low anterior resection of lesions over 2 cm. are recommended. Mason's trans-sphincter approach can be indicated in cases like ours, which permits an ample excision with margins of safety and functional conservation of the anal sphincter structure.

[Hemorrhagic recurrence after operations of azygoportal disconnection]. / La recidiva hemorrágica tras las operaciones de desconexión acigoportal.

One of the main drawbacks attributed to azygoportal disconnection operations in the surgical treatment of bleeding esophageal varices is recurrence of hemorrhage. The present paper reviews the results obtained as regards hemorrhage recurrence in 4,975 patients who underwent azygoportal disconnection in 41 series published in the western literature in recent years. An analysis is also made of the factors that, according to different authors, could be related to the failure of these procedures to prevent eventual variceal hemorrhage.