[Acute emphysematous cholecystitis. Report of a case and review of the literature]. / Colecistite aguda enfisematosa. Relato de um caso e revisão da literatura.

The authors report a case of acute emphysematous cholecystitis (AEC) operated on at the University Hospital of ABC Medical School (São Paulo), with a review of the literature. The infrequency of this finding and the participation of local ischemic factors, associated with secondary infection by gas forming bacteria are pointed out. The authors emphasize the importance of considering this entity potentially more severe than acute non-emphysematous cholecystitis (AnEC) because in AEC gallbladder gangrene is 30 times higher and perforation occurs 5 times more frequently than in AnEC. Besides, the patient with AEC may shows no clinical signs of severity, as in the case reported, where gallbladder gangrene was seen at surgery. In AEC, diagnosis is established usually when the plain abdominal X-ray shows gas within the gallbladder or in its walls. The best results are obtained with cholecystectomy and antibiotic therapy.

[Adenocarcinoma of the cecal appendix. Report of a case of the colic type]. / Adenocarcinoma do apêndice cecal. Relato de um caso do tipo cólico.

Regarding the event of an adenocarcinoma of the colic type of the cecal appendix, operated on at the ABC Medical College Hospital, the authors summarize the subject stating that, among the appendiceal carcinoma, this particular one tends to spread, by the veins or lymphatics, besides spreading by contiguity. This carcinoma hardly presents a symptomology of its own. It appears fairly often as acute appendicitis. The authors also state the difficulty for a macroscopic diagnosis. Thus, its real nature is determined, in general, only after the histologic exam of the removed part. The right hemicolectomy is the most indicated surgery and best results are obtained in the first surgery or 30 days afterwards. About the reported case the patient was operated on with the pre and intra operatory diagnosis of appendicitis and the histologic exam, on top of confirming it, pointed out the presence of neoplasm. After the indication for reoperation, the prompt spreading of the neoplastic disease offered no means to perform any other surgery disclosing its malignant potential.