Intracholecystic papillary neoplasm: potential differential diagnosis before a gallbladder polyp.

Intracholecystic papillary neoplasia (IPN) is a rare entity rarely described in the literature, of incidental anatomopathological diagnosis in a cholecystectomy specimen that presents a premalignant behavior, with progression to carcinoma in more than 50% of cases. In the absence of an invasive component, clinical follow-up is recommended, without associating another surgical gesture, with a 5-year prognosis (90% survival). We present a case of a patient with an incidental diagnosis of NPIC after laparoscopic cholecystectomy due to presenting a gallbladder polyp.

Lipomatosis perineal del ciclista / Perineal lipomatosis in cyclists / Lipomatose Perineal do Ciclista

La lipomatosis del ciclista, también llamada induración nodular perineal del ciclista, es una entidad benigna poco frecuente. Aunque desconocida por la mayoría de los cirujanos, es más conocida por especialistas en medicina del deporte y por los propios deportistas profesionales y aficionados.Consiste en una lipomatosis simétrica bilateral en la zona isquiática, que frecuentemente resulta dolorosa al tacto, lo que dificulta e incluso imposibilita la práctica deportiva.Presentamos el caso clínico de un varón de 48 años, aficionado al ciclismo, que consultó porque las molestias que le producía le imposibilitaban la práctica del ciclismo. Se realizó una exéresis quirúrgica de las dos tumoraciones, pudiendo retomar la práctica de su deporte habitual a los tres meses.El tratamiento de la lipomatosis del ciclista mediante resección quirúrgica de las tumoraciones es una técnica eficaz que permite la total recuperación del paciente

Cyclist lipomatosis, also known as cyclist perineal nodular induration, is a relatively low frequent benign disease. Although unknown for most surgeons, is well known for Sports Medicine specialists and for professional or amateur athletes. It is a bilateral symmetrical lipomatosis in the ischial area, which is often painful and makes the sport practice difficult or even impossible. We present a 48 years old patient, amateur cyclist, who attended to our outpatient clinics because the pain made impossible for him the cyclist practice. A surgical excision of the lesions was done, and he was able to cycle again three months after the surgery. Surgical excision of cyclist lipomatosis is an effective technique that allows a complete recovery of the patient

A lipomatose do ciclista, também conhecida como endurecimento nodular perineal do ciclista, é uma doença de frequência relativamente baixa e benigna. Embora desconhecida para a maioria dos cirurgiões, é mais conhecida por especialistas em medicina esportiva e por atletas profissionais ou recreativos. Consiste de uma lipomatose bilateral simétrica na região isquiática, que apresenta em muitas vezes dolorida ao toque, o que dificulta ou mesmo impossibilita a prática do esporte. Relatamos o caso de um homem de 48 anos, ciclista amador, que foi a consulta porque o desconforto que sentia impossibilitava a prática do ciclismo. Foi realizada uma remoção cirúrgica das duas lesões, sendo capaz de retomar a sua prática do esporte após tres meses. A remoção cirúrgica da lipomatose é uma técnica eficaz que permite uma completa recuperação do paciente

[Prevalence of anal diseases after Scopinaro's biliopancreatic bypass for super-obese patients]. / Prevalencia de afección anal en el paciente superobeso mórbido tras bypass biliopancreático de Scopinaro.

INTRODUCTION: Biliopancreatic diversion by Scopinaro (BD) is a mixed (malabsortive and restrictive) bariatric technique that is successful in achieving long lasting weight lost in super obese patients. In fact, the diarrhoea (steatorrhea) that is expected after any malabsortive technique can sometimes cause significant nutritional changes and anal disease: these patients are frequently referred to our coloproctology outpatient clinic due to haemorrhoids, fissures, anal sepsis and fistula basically due to changes in quality and quantity of their faeces. The aim of this paper is to find out not only the prevalence of anal disease in our series of super obese surgical patients but also to compare the incidence between the two surgical techniques we perform in our department. MATERIAL AND METHOD: We analyzed 263 consecutive patients operated on BD of Scopinaro (50-200 cm) and modified-BD (75-225 cm) in our Department. Patients who had previously suffered from anal surgery were excluded. RESULTS: There were 45 patients (18%) who suffered from anal problems of which 38 cases (84.4%) were BD-S and only 7 cases with BD-M complained of anal disorders (p < 0.05). Overall, at the 18th month review, the mean number of motions per day was 3.5 (range, 1-15). Patients with BD-S had 5 motions per day as a mean. The mean number of motions for BD-M was 2. The frequency order of anal pathology observed was: anal fissure, haemorrhoids, abscess and fistula. CONCLUSIONS: Higher incidence of anal pathology after BD of Scopinaro is another factor to take into account to avoid performing classic Scopinaro BD as opposed to modified BD for the treatment of morbid super obesity. It is mandatory to be conservative when facing anal problems in these patients, and firstly we must modify eating habits and the nutritional status. Surgery must be highly respectful to anal sphincters to avoid incontinence.

Prevalencia de afección anal en el paciente superobeso mórbido tras bypass biliopancreático de Scopinaro / Prevalence of anal diseases after Scopinaro’s biliopancreatic bypass for super-obese patients

Introducción. El bypass biliopancreático de Scopinaro es una técnica bariátrica mixta. Los efectos secundarios indeseables derivados de las diarreas y los cambios de composición cualitativa típicos de las heces esteatorreicas observados con mayor frecuencia en este tipo de pacientes son: hemorroides, fisuras, abscesos y fístulas de ano. El objetivo de esta publicación es valorar la prevalencia de afección anal en los superobesos operados, así como comparar su incidencia entre ambas variantes de bypass biliopancreático practicadas en nuestro servicio. Material y método. Analizamos la afección anal que presentaron 263 pacientes intervenidos de obesidad mórbida en nuestro servicio (1995-2005) tras bypass biliopancreático clásico (BD-C) y bypass biliopancreático modificado (BD-M). Resultados. Un 18% (n = 45) de los pacientes presentó afección anal: BD-C, 38 pacientes, y BD-M, 7 pacientes (p < 0,05). La media de deposiciones diarreicas fue de 3,5 (intervalo, 1-15) deposiciones/día. Los pacientes del grupo BD-C realizaban 5 deposiciones de media frente a 2 del grupo BD-M. Por orden de frecuencia fueron: fisura, hemorroides, absceso y fístula. Conclusiones. La mayor incidencia de afección anal tras BD-C es otro factor que nos debe hacer abandonar esta técnica a favor del BD-M para el tratamiento de la superobesidad mórbida. Además, es fundamental ser conservadores en el tratamiento de la afección anal en este grupo de pacientes; siempre se debe corregir primero las alteraciones digestivas y el estado nutricional y no olvidar que la anatomía del canal anal debe ser preservada al máximo para evitar la incontinencia (AU)

Introduction. Biliopancreatic diversion by Scopinaro (BD) is a mixed (malabsortive and restrictive) bariatric technique that is successful in achieving long lasting weight lost in super obese patients. In fact, the diarrhoea (steatorrhea) that is expected after any malabsortive technique can sometimes cause significant nutritional changes and anal disease: these patients are frequently referred to our coloproctology outpatient clinic due to haemorrhoids, fissures, anal sepsis and fistula basically due to changes in quality and quantity of their faeces. The aim of this paper is to find out not only the prevalence of anal disease in our series of super obese surgical patients but also to compare the incidence between the two surgical techniques we perform in our department. Material and method. We analyzed 263 consecutive patients operated on BD of Scopinaro (50-200 cm) and modified-BD (75-225 cm) in our Department. Patients who had previously suffered from anal surgery were excluded. Results. There were 45 patients (18%) who suffered from anal problems of which 38 cases (84.4%) were BD-S and only 7 cases with BD-M complained of anal disorders (p < 0.05). Overall, at the 18th month review, the mean number of motions per day was 3.5 (range, 1-15). Patients with BD-S had 5 motions per day as a mean. The mean number of motions for BD-M was 2. The frequency order of anal pathology observed was: anal fissure, haemorrhoids, abscess and fistula. Conclusions. Higher incidence of anal pathology after BD of Scopinaro is another factor to take into account to avoid performing classic Scopinaro BD as opposed to modified BD for the treatment of morbid super obesity. It is mandatory to be conservative when facing anal problems in these patients, and firstly we must modify eating habits and the nutritional status. Surgery must be highly respectful to anal sphincters to avoid incontinence (AU)