Surgical acute abdomen and COVID-19 vaccination.

In response to the publication "Acute appendicitis, foreign bodies and COVID-19 vaccination: correspondence", we reviewed the association between acute surgical abdomen and COVID-19 vaccination.

Uncommon causes of acute appendicitis: foreign bodies in the cecal appendix.

A 50-year-old woman with a history of hysterectomy for endometrial cancer in 2015 visited because of abdominal pain for 1 week and fever simultaneous with her third dose of the COVID-19 vaccine. Physical examination revealed a mobile mass in the right iliac fossa, and laboratory testing showed C-reactive protein at 3 mg/dL, with no further changes. Ultrasound results were consistent with an appendiceal inflammatory mass, and a CT scan revealed an appendicolith as likely cause. The patient was subjected to laparoscopy, which found inside the mass a metallic piece (dental prosthesis) that perforated the appendiceal lumen at the mid portion of the appendix. Appendectomy was completed and the patient was discharged on the third day post-procedure.

Non-oclusive mesenteric ischemia as a complication of dialysis.

We present the case of a 69-year-old male ex-smoker, whose medical background included hypertension, chronic renal failure, atrial fibrillation anticoagulation, and chronic lower limb arterial ischemia. He suffered from abdominal pain associated with nausea and vomiting after a hemodialysis session. The analysis showed C-reactive protein at 7 mg/L, 14,500 leukocytes with neutrophilia, and lactate at 2.8. A computerized axial tomography (CAT) scan was performed and portal pneumatosis as well as a distal ileum segment with intestinal pneumatosis were observed, which was compatible with non-occlusive mesenteric ischemia.

Quiloperitoneo incidental asociado a hernia de Petersen en paciente operada de bypass gástrico laparoscópico / Incidental chyloperitoneum associated with Petersen's hernia in a patient operated by laparoscopic gastric bypass

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Metástasis cutánea esternal de colangiocarcinoma hiliar / Sternal cutaneous metastasis of hilar cholangiocarcinoma

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Sternal cutaneous metastasis of hilar cholangiocarcinoma.

Subcutaneous metastasis is a rare initial manifestation of visceral tumors, and represent advanced stages with poor prognosis. We report the case of a female patient with a subcutaneous nodule over the sternum, which was ultimately found to be a metastasis of hilar cholangiocarcinoma. Only 20 cases of subcutaneous metastasis from Klatskin tumors have been reported - a rare occurrence with poor survival rates.

Esophageal perforation by a Sengstaken balloon.

Iatrogenic esophageal perforations are rare but associated with a high morbidity and mortality. Secondary to placing a Sengstaken ballon are even more extraordinary because of the infrequency which this measure is used to control upper gastrointestinal bleeding. Therefore, we think it is of interest to communicate this complication, to remember the need to check the correct placement of the Sengstaken ballon before insufflation, since it would help further decrease this complication.

Esophageal perforation by a Sengstaken balloon / Perforación esofágica por balón de Sengstaken

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Acute abdomen from duodenal diverticulitis. A case report.

Duodenal diverticula are a rare, usually asymptomatic clinical condition. When a complication arises clinical suspicion is key for the diagnosis. On occasion these patients receive a delayed diagnosis and undergo inadequate medical therapy. We report the case of a patient with evidence of duodenal diverticulitis in association with gallbladder inflammation by contiguity, as well as his diagnosis and management.

Abdomen agudo por diverticulitis duodenal. Caso clínico / Acute abdomen from duodenal diverticulitis. A case report

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[Laparoscopic cholecystectomy in a patient with situs inversus totalis]. / Colecistectomía laparoscópica en una paciente con situs inversus totalis.

OBJECTIVE: To report a case with situs inversus totalis (SIT) and chronic cholelithiasis solved by laparoscopic surgery, outlining the utility of minimal invasive surgery and specific considerations in patients with anatomic variations. CASE REPORT: A case of a 46 year-old female who presented with a six-month history of abdominal colic pain at the left hypochondrium, accompanied with nausea and vomiting, is presented. On examination she had epigastric tenderness. Blood tests, including liver function tests, were normal. Electrocardiogram showed right axis deviation and right ventricular hypertrophy, in keeping with dextrocardia. Chest-X-Ray confirmed the diagnosis of dextrocardia. An ultrasound scan of the upper abdomen identified the gallbladder containing stones in the left upper quadrant. A CT scan visualized the spleen and the gastric camera in the right upper quadrant. Barium gastrointestinal transit, barium enema and abdominal-X-Ray were used as complementary diagnostic studies. A magnetic resonance cholangiography was not performed because the patient suffered from claustrophobia. Cholecystectomy and transcystic cholangiography were performed by laparoscopic route, taking care to set-up the operating theatre in the mirror image of the normal set-up for cholecystectomy. The patient completed a successful procedure without complications and was discharged 48 hours after the procedure. Histological exam diagnosed a chronic lithiasic cholecystitis. CONCLUSIONS: Laparoscopic cholecystectomy is an adequate surgical procedure for patients with total situs inversus and cholelithiasis, having a high security range. Detailed clinical examination is important for the diagnosis of previously unknown anatomic variations. Transcystic cholangiography is mandatory when a magnetic resonance cholangiography can not be performed. Furthermore, perhaps in this situation a left-handed surgeon is better prepared than a right-handed one to comfortably carry out the procedure.