Meigs syndrome: literature review of a case report

Ovarian cancer is the presence of one or multiple tumors, which appears in one or both ovaries. These tumors are usually classified as epithelial and non-epithelial. Sex cord-stromal tumors are a group of benign and malignant neoplasms that develop from the sexual cord. Many are functional and therefore have hormonal secretions. Meigs syndrome is defined by the presence of pleural effusion and ascites in association with an ovarian tumor. We present a case of a 55 years old patient who was admitted due to a pelvic tumor, exudative pleural effusion that was difficult to manage, and ascites. A benign ovarian stromal tumor associated with elevated Ca 125 was diagnosed. After the management of the effusions, a 20x20x10 cm ovarian tumor resection was performed by laparotomy, and a transoperative report of a thecoma/fibroma type stromal tumor was received. Meigs syndrome occurs in 1% of ovarian tumors, being very rare before the third decade of life, the pathogenesis of ascites and pleural effusion could be related to the imbalance of hydrostatic forces between arterial flow and lymphovenous drainage culminating in a stromal transudate. Treatment of this syndrome should be focused on tumor debulking surgery and symptomatic treatments such as chest tubes and pleurodesis.

Enterocutaneous fistulas due to stent migration. How reliable is its use on duodenal benign pathology? a case report

Duodenal stenting has been widely used on malignant pathology on selected patients with poor prognosis and advanced disease. In these last years, there has been a clear ampliation of the clinical applications of endoscopy procedures and stents. Its use on benign pathology is spreading but there is a lack of literature about the complications in this context. The incidence of stent migration is about 10-25% in self-expandable metal stent (SEMS), and 2-5% on covered self-expanding metal stents (CSEMS). We reported a clinical case of a 48 years old patient who developed a duodenal ulcer. The patient was submitted to exploratory laparotomy, with duodenal primary closure of the ulcer. Later, the patient developed a enterocutaneous fistula because of the duodenal leak. It was referred to our third level hospital to the hepatopancreatobiliary surgery service. A new exploratory laparotomy with duodenal exclusion was planned, but it was impossible to access due to frozen abdomen. CSEMS was placed in the duodenal bulb resulting in the resolution of leaking, but the stent could not be removed because of migration. The stent trajectory was followed by abdominal x ray and tomography. The patient developed multiple intestinal an fecal enterocutaneous fistulas. It was submitted to multiples endoscopies, colonoscopies and enteroscopy without any success to reaching it. It was decided to perform a right lumbotomy to extract the prothesis. The stent was surgically removed, a planned stoma was left on the right flank on the extraction site.