Íleo biliar: descripción de dos casos / Gallstone ileus: Description of two cases

Introducción. El íleo biliar es una complicación rara de la colelitiasis y su incidencia varía del 1 al 4 %. Consiste en la migración de un cálculo de la vesicular biliar al tracto gastrointestinal, generando obstrucción intestinal. Presenta síntomas inespecíficos dependiendo del nivel de la obstrucción, lo que hace que su diagnóstico no suela ser precoz, repercutiendo en el deterioro clínico del paciente. Es especialmente grave en pacientes de edad avanzada y con comorbilidades. Casos clínicos. Se reportan los casos de dos pacientes con dolor abdominal difuso, en quienes se diagnosticó íleo biliar por tomografía. Se realizó manejo quirúrgico, el primero mediante técnica abierta y estrategia de dos pasos, y el otro mediante técnica laparoscópica. Discusión. El íleo biliar es una etiología rara de obstrucción intestinal. El cálculo migra debido a una fistula colecisto-entérica y el nivel de obstrucción es con mayor frecuencia la válvula ileocecal. Los síntomas son inespecíficos y dependen del nivel de obstrucción: dolor abdominal difuso mal caracterizado, náuseas, vómito, ausencia de flatos. El diagnóstico se hace mediante tomografía abdominal, en la cual se evidencia la tríada de Rigler. El manejo es quirúrgico, con enterotomía para extraer el cálculo y resolver la obstrucción. Conclusión. El íleo biliar es una patología que debe ser considerada en el abordaje de la obstrucción intestinal, aunque sea poco frecuente. El manejo quirúrgico es clave para resolver el cuadro de obstrucción intestinal; aún así genera importante morbimortalidad en especial en pacientes de avanzada edad.

Introduction. Gallstone ileus is a rare complication of cholelithiasis, its incidence varies from 1% to 4%. It consists of the migration of a stone from the gallbladder to the gastrointestinal tract, causing intestinal obstruction. It presents with non-specific symptoms depending on the level of the obstruction, which means that its diagnosis is not usually early, with repercussions on the clinical deterioration of the patient, being serious especially in elderly patients and with comorbidities. Clinical cases. Two patients with diffuse abdominal pain are reported. A tomographic diagnosis was made showing gallstone ileus. Surgeries were performed, in the first case using an open technique and a 2-step strategy, and on the second one using a laparoscopic technique. Discussion. Gallstone ileus is a rare etiology of intestinal obstruction. Symptoms are usually poorly characterized: diffuse abdominal pain, nausea, vomiting, absence of flatus. The diagnosis is made by abdominal tomography in which Rigler's triad is evident. Management is surgical through enterotomy to remove the stone and resolve the obstruction. Conclusion. Gallstone ileus is a rare pathology that should be considered in the approach to intestinal obstruction. Surgical management is key to resolving intestinal obstruction. Even so, it generates significant morbidity and mortality, especially in elderly patients.

Terapia E-VAC como tratamiento de complicaciones en cirugía gastrointestinal en centro de referencia de gastroenterología en Colombia: Serie de casos

Las fístulas y dehiscencias anastomóticas postoperatorias gastrointestinales se presentan de forma frecuente y muchas son manejadas quirúrgicamente, sin embargo, las intervenciones endoscópicas han mostrado mejorar desenlaces de curación y tiempo de estancia hospitalaria. Se describe la experiencia de la terapia de cierre asistida por vacío (E-VAC), en el manejo de fístulas y dehiscencias anastomóticas postoperatorias, en un centro de referencia gastrointestinal en Colombia. Se realizó un estudio serie de casos en pacientes con dehiscencia de anastomosis y fístula a diferentes niveles del tracto digestivo, tratados mediante E-VAC, por el servicio de gastroenterología de la clínica universitaria Colombia, en Bogotá, durante un periodo comprendido de febrero 2019 y noviembre 2021. Se describieron variables sociodemográficas, clínicas y quirúrgicas. Se describen 6 casos, 4 de tracto digestivo inferior y 2 de tracto digestivo superior. El 83% fueron hombres, la edad media fue de 51,8 años (+/-17,5). La indicación de E-VAC fue fístula anastomótica colorrectal en el 66%, siendo la ubicación anatómica más frecuente la anastomosis colorrectal (66%), con menor frecuencia a nivel de los cardias (16%) y esófago (16%). El tamaño del defecto se describió entre el 20 y el 80% en pacientes sometidos a terapia E-VAC, siendo el tiempo promedio de hospitalización 22.5 días con un número de recambios promedio de siete por paciente. Las fugas y fístulas anastomóticas son complicaciones potencialmente mortales en pacientes llevados a intervenciones quirúrgicas gastrointestinales, en las que la terapia E-VAC ha mostrado ser eficaz y segura, promoviendo el cierre del defecto y el drenaje de colecciones presentes, igualmente disminuyendo el tiempo de estancia hospitalaria.

Gastrointestinal postoperative anastomotic leaks and fistulas occur frequently and many are managed surgically; however, endoscopic interventions have shown to improve healing outcomes and length of hospital stay. The experience of vacuum-assisted closure therapy (E-VAC) is described, in complications such as fistulasand postoperative anastomotic leaks, in a gastrointestinal reference center in Colombia. A case series study was carried out in patients with anastomotic leaks and fistulasat different levels of the digestive tract, treated by E-VAC, by the Gastroenterology Service in Colombia, during a period from February 2019 to November 2021. Sociodemographic, clinical and surgical variables were described. 6 cases are described, 4 from lower digestive tract and 2 from upper digestive tract. 83% were men; the mean age was 51.8 years (+/-17.5). The indication for E-VAC was colorectal anastomotic fistula in 66%; the most frequent anatomical location was near the anal region (66%), less frequently at the level of the cardia (16%) and esophagus (16%). The size of the defect was described between 20 and 80% in patients undergoing E-VAC therapy, with an average hospitalization length of stay of 22.5 days, with an average number of exchanges of seven per patient. Anastomotic leaks and fistulasare potentially fatal complications in gastrointestinal surgery. E-VAC therapy has shown to be effective and safe, promoting defect closure and drainage of collections present, also decreasing the length of hospital stay.

Síndrome de Mirizzi grado IV. Presentación de un caso

El Síndrome de Mirizzi es una afección derivada del impacto de un lito en el conducto cístico o infundíbulo de la vesícula biliar. La enfermedad litiásica, crónica y complicada de la vesícula biliar es un factor determinante. Se presenta el caso de un paciente con historia de íctero obstructivo, al cual se le diagnosticó inicialmente tumor periampular. Fue reevaluado y se le realizaron varias pruebas diagnósticas, hasta llegar al diagnóstico de Síndrome de Mirizzi, corroborado en el acto quirúrgico. El SM es una enfermedad rara de la vía biliar cuyo tratamiento es quirúrgico. La vía laparoscópica para la realización de la colecistectomía es la de elección para casos grado I y en casos seleccionados grado II. La colecistectomía y derivación bilioentérica (hepaticoyeyunostomía) conforman el tratamiento para el resto de los casos.

Mirizzi Syndrome is a condition derived from the impact of a stone in the cystic duct or infundibulum of the gallbladder. Chronic and complicated stone disease of the gallbladder is a determining factor. A patient with a history of obstructive jaundice, who was initially diagnosed with a periampullary tumor is presented. He was reassessed and several diagnostic tests were performed, until reaching the diagnosis of Mirizzi Syndrome, corroborated in the surgical act. MS is a rare disease of the bile duct whose treatment is surgical. The laparoscopic approach to perform cholecystectomy is the one of choice for grade I cases and in selected cases grade II. Cholecystectomy and bilioenteric bypass (hepaticojejunostomy) are the treatment for the rest of the cases.

Endoscopic negative pressure therapy for the closure of an esophagojejunal anastomosis fistula. Case report / Terapia endoscópica de presión negativa para cierre de fístula de la anastomosis esófago-yeyunal. Reporte de caso

Abstract Introduction: Post-surgical esophagojejunal anastomosis fistulas can be life-threatening. Currently, there are several treatment alternatives. In recent years, endoscopic negative pressure therapy has emerged as an innovative treatment for these fistulas, offering numerous benefits. Case presentation: A 72-year-old man diagnosed with gastric adenocarcinoma of the body and fundus underwent total gastrectomy with D2 lymphadenectomy and Roux-en-Y anastomosis with curative intent in a quaternary care hospital in Popayán, Colombia. However, in the postoperative period, he presented systemic inflammatory response syndrome and acute abdomen due to an esophagojejunal fistula. Initial management included a laparotomy, two peritoneal washings, and an abdominal drainage. Then the patient developed frozen abdomen, so it was not possible to access the esophagojejunal anastomosis. Fistula closure was attempted by inserting a self-expandable metallic stent, yet the procedure was not successful. Salvage therapy was started using an endoscopic vacuum-assisted closure (VAC) system. After 5 replacements of the VAC system, complete drainage of the intra-abdominal collection, complete closure of the peritoneal cavity, and closure of the esophagojejunal leak, with a small residual diverticular formation, were achieved. The patient's condition improved progressively, resuming oral intake 20 days after initiation of VAC therapy. In addition, no new abdominal complications were reported during the follow-up period (17 months). Conclusions: Endoscopic VAC therapy is a new safe and effective alternative to treat complex post-surgical fistulas caused by esophagojejunal anastomosis.

Resumen Introducción. Las fístulas de las anastomosis esófago-yeyunales postquirúrgicas pueden llegar a ser mortales. En la actualidad, existen varias alternativas de tratamiento, y en los últimos años la terapia endoscópica de presión negativa se ha convertido en un método innovador y con grandes ventajas para el manejo de estas fístulas. Presentación del caso. Hombre de 72 años diagnosticado con adenocarcinoma gástrico de cuerpo y fondo a quien se le realizó una gastrectomía total con linfadenectomía D2 y una anastomosis en Y de Roux con intención curativa en un hospital de cuarto nivel en Popayán, Colombia. Sin embargo, en el posoperatorio presentó síndrome de respuesta inflamatoria sistémica y abdomen agudo producto de fístula esófago-yeyunal. Se realizó manejo inicial con laparotomía, dos lavados de cavidad peritoneal y drenaje abdominal. Posteriormente, el paciente desarrolló abdomen congelado, por lo que no fue posible acceder a la anastomosis esófago-yeyunal. Se intentó cierre de fístula mediante la inserción de prótesis metálica autoexpandible, pero el procedimiento no fue exitoso. Se inició terapia de rescate mediante sistema de cierre asistido por vacío (VAC) por vía endoscópica. Luego de 5 recambios del sistema VAC, se logró el drenaje completo de la colección intraabdominal encontrada, el cierre completo de la cavidad peritoneal y el cierre de la fuga esófago-yeyunal, con una pequeña formación diverticular residual. La condición del paciente mejoró progresivamente, con reinicio de la vía oral a los 20 días del inicio de la terapia VAC. Además, no se reportaron nuevas complicaciones abdominales en el periodo de seguimiento (17 meses). Conclusión. La terapia endoscópica de VAC es una nueva alternativa segura y efectiva para el tratamiento de fístulas postquirúrgicas complejas producto de anastomosis esófago-yeyunales.

Aneurisma de aorta abdominal roto al duodeno: causa infrecuente de hemorragia digestiva masiva

Primary aortoenteric fistula is the spontaneous communication between the lumen of the aorta and a portion of the digestive tract. The most common cause is the erosion of an abdominal aortic aneurysm into the 3rd or 4th portion of the duodenum. It manifests clinically as gastrointestinal bleeding, with or without abdominal pain and a pulsatile abdominal mass on physical exam. Gastrointestinal bleeding is initially recurrent and self-limiting and progresses to fatal exsanguinating hemorrhage. Endoscopic examination diagnoses only 25% of aortoenteric fistulas because these are usually located in the distal duodenum. Contrast computed tomography of the abdomen and pelvis is diagnostic in only 60% of cases. We report three cases with this condition. A 67-year-old male presenting with an upper gastrointestinal bleeding. He was operated and a communication between an aortic aneurysm and the duodenum was found and surgically repaired. The patient is well. A 67-year-old male with an abdominal aortic aneurysm presenting with abdominal pain. He was operated and anticoagulated. In the postoperative period he had a massive gastrointestinal bleeding and a new CAT scan revealed an aorto enteric fistula that was surgically repaired. The patient is well. An 82-year-old male with an abdominal aortic aneurysm presenting with hematochezia. A CAT scan revealed a communication between the aneurysm and the third portion of the duodenum, that was surgically repaired. The patient died in the eighth postoperative day.

Clinical application research of a novel gastrointestinal occluder device for endoscopic closure of gastrobronchial fistula (with video) / 中华消化内镜杂志

To evaluate the therapeutic effectiveness and safety of a novel gastrointestinal occluder device for gastrobronchial fistula. Data of 5 patients diagnosed as having gastrobronchial fistula who received treatment by a novel gastrointestinal occluder device at the First Affiliated Hospital of Nanjing Medical University from July to August 2020 were retrospectively analyzed. The total operation time, occluding time, intraoperative and postoperative complications, postoperative hospital stay and patients′ satisfaction were reviewed. Regular follow-up was conducted, and the short-term curative effect of occluding was evaluated 1 month after operation.All patients were males with age of 58-69 years. The course of fistula ranged 3-16 months and the diameter ranged 0.3-1.0 cm. All 5 patients achieved technical success with operation time of 38-88 minutes and occluding time of 8-24 minutes. The postoperative hospital stay ranged 3-5 days and the patients′ satisfaction score was 10. No severe complications occurred during or after operation. One month after endoscopic therapy, fistula was completely occluded in 4 patients. One patient died due to severe pulmonary infection and multiple organ failure although the bucking symptom after drinking and eating recovered before. Endoscopic closure of gastrointestinal fistula by means of the novel gastrointestinal occluder device is safe and effective.

Design of Magnamosis System for Endoscopic Tissue Clamping / 中国医疗器械杂志

Based on the principle of magnetic anastomosis technique, the design of magnetic anastomosis system for endoscopic tissue clamping is proposed. The system includes a semi-ring magnet, a special structure transparent cap and a detachable push rod. With the help of the existing digestive endoscopy and endoscopic tissue gripper, the endoscopic close clamping and anastomosis of the bleeding or perforated tissue can be completed. After the anastomosis, the magnet falls off and is discharged through the digestive tract. Animal experiments showed that the system was easy to use, the fistula was clamped firmly, the magnet was discharged for 7~21 days, and there was no magnet retention and digestive tract obstruction. Further safety verification, optimization of endoscopic operation, the system can be used in clinical trial.

Primary aortoduodenal fistula: a rare cause of massive gastrointestinal hemorrhage

Aortoduodenal fistula (ADF) is the most common type of aortoenteric fistula (AEF). This is a rare entity, which produces communication between an abdominal aortic aneurysm (AAA) and the gastrointestinal tract (GIT), resulting in massive gastrointestinal bleeding. AEF/ADF is difficult to recognize clinically, with the classical triad of symptoms including a pulsating, palpable mass, abdominal pain, and GIT bleeding. AEF/ADF can be classified into primary when a communication between an AAA and the GIT develops with no history of prior aortic reconstructive surgery, and secondary, where the communication is on the background of previous aortic reconstructive surgery. Herein we present a case report of a 75-year-old Caucasian male patient with a clinical history of AAA, who presented with massive GIT bleeding and expired shortly after. An autopsy revealed communication between an atherosclerotic AAA and the lower third of the duodenum.

Sangrado de tubo digestivo alto debido a fístula colecistoduodenal: Hallazgo quirúrgico / Upper digestive bleeding due to cholecystoduodenal fístula: surgical finding

Las fístulas colecistoentéricas se forman como una complicación poco frecuente de la colelitiasis. Se presenta el caso de un paciente femenino de 64 años con diagnóstico de sangrado de tubo digestivo alto debido a una fístula colecistoduodenal. El caso representa una urgencia gastroenterológica poco común que nos recuerda que las complicaciones raras de las enfermedades comunes pueden ser fácilmente omitidas en cualquier escenario clínico..(AU)

Bilioenteric fístulas occurs as a rare complication of gallstone disease. A 64 years-old female patient with diagnosis of upper digestive bleeding due to a cholecystoduodenal fístula is presented. This clinical case represents a rare gastrointestinal emergency that remember us that rare complications of diverse diseases can be omitted in any clinical scenario..(AU)

Clinical research in the endoscopic management of digestive fistula / 中华消化内镜杂志

Objective To evaluate the therapeutic value of endoscopic jejunal tube placement, endoscopic clipping, and over the scope clip ( OTSC) for digestive fistula. Methods Data of 38 patients with digestive fistulas at the First Affiliated Hospital of Soochow University admitted from July 2015 to July 2017 were retrospectively analyzed. Treatments were chosen according to the size and the site of the fistulas. Thirteen patients underwent jejunal tube placement ( the jejunal tube group ) , 20 underwent endoscopic clipping( the endoscopic clipping group) , and 5 underwent OTSC( the OTSC group) . The technical success rate, clinical cure rate and postoperative hospital stay were analyzed. Results All patients received the endoscopic operation successfully with no significant complications. In the jejunal tube group, 4 patients′fistulas fully healed, lesion was smaller after treatment in 3 patients, lesion didn′t change in 5 patients, and 1 patient died. The complete cure rate was 30. 8％ (4/13), and the postoperative hospital stay was 47. 4± 14. 1 days. For the endoscopic clipping group, 16 patients′ fistulas fully healed, lesion was no smaller compared with that before treatment in 3 cases, and 1 patient died. The complete cure rate was 80. 0％ ( 16/20) , and the postoperative hospital stay was 17. 9 ± 8. 9 days. Total patients in the OTSC group were completely cured, with 100. 0％( 5/5) of complete cure rate. One patient with refractory esophageal fistula underwent OTSC repeatedly with endoscopic clipping, and the healing time of fistula was 102 days. The postoperative hospital stay of 4 others was 5. 3±1. 7 days. The cure rate of fistula was higher (P=0. 03, P<0. 001) and the postoperative hospital stay was shorter ( P=0. 04, P<0. 001) in the OTSC group compared with the clipping group and the jejunal tube group. Conclusion Endoscopic management is safe and effective for digestive fistulas with less trauma, easy performance and short time of healing.

Research progress of diagnosis and management of choledochoduodenal fistula / 国际外科学杂志

The common bile duct duodenal fistula (CDF) is a special type of biliary fistula.It has a low incidence and clinical manifestations.It is difficult to diagnose and is often misdiagnosed.However,the lack of diagnostic tools and clinical guidelines make it difficult for young physicians to correctly recognize this rare condition before surgery.Endoscopic retrograde cholangiopancreatography (ERCP) is the most effective method for diagnosing CDF.For those who suspect CDF,ERCP should be used for definitive diagnosis.Surgical treatment is the main treatment for CDF.This article reviews the causes,clinical manifestations,diagnosis and treatment of CDF.

A double-catheter washing and aspiration system for the treatment of gastrointestinocutaneous fistula after peritoneal cancer resection / 中华普通外科杂志

Objective To evaluate double catheterization of cannula persistent irrigation and negative pressure system to treat gastrointestinocutaneous fistula (GIF) after cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for peritoneal cancer.Methods A self-made double catheterization of cannula persistent bathe and negative pressure system was implanted into the site of fistula,to ensure efficient drainage.The patient was treated with anti-sepsis,nutrition support and other conservative measures.Results GIFs occurred in 13 patients.The negative pressure drainage system was successfully implanted into the fistula site to keep an efficient drainage.By this conservative treatment fistula healed in 8 patients after 50 days (range 12 to 84 days).In other three patients fistula output significantly reduced and general conditions greatly improved.The mortality rate was 15％ (2/13).Conclusion The double catheterization of cannula persistent bathe and negative pressure aspiration system is a simple and efficient method to treat GIF.

Clinical analysis of 25 cases of gastrointestinal fistula after surgery for gastric cancer / 中国基层医药

Objective To explore the management of perioperative period on the effect of alimentary tract fistulas after gastric cancer operation.Methods The clinical data of 25 patients with alimentary tract fistulas after gastric cancer operation were reviewed.The location and time of alimentary tract fistulas,and perioperative period of patients were analyzed.Results Of the 25 patients,13 cases(52.0％) were anastomotic fistulas,1 case(4.0％) was bile fistula,2 cases (8.0％) were pancreatic fistulas,4 cases (16.0％) were small intestinal fistulas,and 3 case (12.0％) were duodenal stump fistulas,1 case (4.0％) was anastomotic and duodenal stump fistula,1 case (4.0％) was small intestinal and duodenal stump fistula.The alimentary tract fistulas generally occurred within the first or second week after gastric cancer operation.The incidence rate of gastrointestinal leakage was 64.0％ in gastric cancer with diabetes patients,56.0％ in gastric cancer with elderly patients,40.0％ in gastric cancer with anemia patients,36.0％ in gastric cancer with hypoproteinemia patients,16.0％ in gastric cancer with multivisceral excisions.21 cases of gastrointestinal leakage were healed after conservative treatment.2 cases with gastrointestinal leakage by operation treatment were healed.2 patients died,one died of intra-abdominal hemorrhage,one case died of MODF.Conclusion Strengthening the management of patients with alimentary tract fistulas after gastric cancer operation can promote the healing of fistula in perioperative period.

Primary aortoduodenal fistula: first you should suspect it

ABSTRACT A 59 year-old patient was admitted with upper gastrointestinal bleeding. The clinical exam showed mild hypotension and blood samples revealed acute anemia (hemoglobin = 7.5 g/dl). Emergency computed tomography showed an infrarenal abdominal aortic aneurysm and extravasation of the arterial contrast material toward the digestive tract. The patient was transported to the operating room for emergency laparotomy, which showed an aortoduodenal fistula. After proximal and distal aortic vascular control, the two anatomical structures were dissected with duodenorrhaphy, patch repair of the aortic tear and omentum interposition. The postoperative recovery was uneventful, with discharge after 12 days.

Epidemiology and outcome of patients with postoperative abdominal fistula / Perfil epidemiológico, incidência e desfecho dos pacientes com fístula abdominal pós-operatória

ABSTRACT Objective: to present the epidemiological profile, incidence and outcome of patients who developing postoperative abdominal fistula. Methods: This observational, cross-sectional, prospective study evaluated patients undergoing abdominal surgery. We studied the epidemiological profile, the incidence of postoperative fistulas and their characteristics, the outcome of this complication and the predictors of mortality. Results: The sample consisted of 1,148 patients. The incidence of fistula was 5.5%. There was predominance of biliary fistula (26%), followed by colonic fistulas (22%) and stomach (15%). The average time to onset of fistula was 6.3 days. For closure, the average was 25.6 days. The mortality rate of patients with fistula was 25.4%. Predictors of mortality in patients who developed fistula were age over 60 years, presence of comorbidities, fistula closure time more than 19 days, no spontaneous closure of the fistula, malnutrition, sepsis and need for admission to the Intensive Care Unit Conclusion: abdominal postoperative fistulas are still relatively frequent and associated with significant morbidity and mortality.

RESUMO Objetivo: apresentar o perfil epidemiológico, incidência e desfecho em pacientes que evoluíram com fístula abdominal pós-operatória. Métodos: trata-se de um estudo prospectivo transversal observacional que avaliou pacientes submetidos à cirurgia abdominal. Foram estudados o perfil epidemiológico, a incidência das fístulas pós-operatórias e suas características, desfecho desta complicaçãoe fatores preditivos de mortalidade. Resultados: a amostra constou de 1148 pacientes. A incidência de fístula foi 5,5%. Houve predominância de fístulas biliares (26%), seguidas de fístulas colônicas (22%) e gástricas (15%). O tempo médio para o surgimento da fístula foi 6,3 dias. Para o fechamento, a média foi 25,6 dias. A taxa de mortalidade dos pacientes com fístula foi 25,4%. Os fatores preditivos de mortalidade nos casos que desenvolveram fístula foram idade maior do que 60 anos, presença de comorbidades, tempo de fechamento da fístula superior a 19 dias, não fechamento espontâneo da fístula, desnutrição, sepse e necessidade de admissão em Unidade de Terapia Intensiva. Conclusão: as fístulas pós-operatórias abdominais ainda são relativamente frequentes e associadas à morbidade e mortalidade significativas.

Heterotopic mesenteric ossification in a child: Case report / Osificación mesentérica heterotópica en un niño: informe del caso / Ossificação mesentérica heterotópica num menino: relatório do caso

The term heterotopic ossification refers to bone formation in normally non-ossifying tissue. It represents a benign, localized, self-limiting and well-circumscribed lesion, and the phenomenon is rather unusual in the immediate vicinity of bones. Likewise, it is very rare in soft tissues such as the gastrointestinal tract, where it is also known as heterotopic mesenteric ossification (HMO). Intra-abdominal heterotopic ossification (IHO) is also known as intra-abdominal myositis ossificans, mesenteritis ossificans, heterotopic mesenteric ossification, and heterotopic ossification of the intestinal mesentery. It is extremely rare and only approximately 30 cases have been reported in the literature since it was first described in 1983. This paper presents the case of a male 14 year-old patient diagnosed with mesenteric ossification who was treated by the pediatric surgeons. Additionally, the authors present a review of the medical literature regarding this condition.

El término osificación heterotópica se refiere a la neoformación de tejido óseo en sitios donde normalmente el tejido no se osifica. Es una condición benigna, localizada, bien definida y autolimitada; ocurre con mayor frecuencia en la vecindad inmediata de los huesos. Es muy raro que se presente en los tejidos blandos del tracto gastrointestinal, donde es conocida como osificación heterotópica del mesenterio (OHM). La osificación heterotópica intraabdominal (OHI) es además conocida como miositis osificante, mesenteritis osificante, osificación heterotópica del mesenterio y osificación heterotópica del mesenterio intestinal. Es una condición extremadamente rara, con solo 30 casos aproximadamente reportados en la literatura desde su primera descripción en 1983. Este artículo presenta el caso de un niño de 14 años con diagnóstico de mesenteritis osificante que fue tratado por un grupo de cirujanos pediátricos. Además, se presenta una revisión de la literatura médica sobre esta extraña condición.

O termo ossificação heterotópica se refere à neoformação de tecido ósseo em lugares onde normalmente o tecido não se ossifica. É uma condição benigna, localizada, bem definida e autolimitada; ocorre com maior frequência na vizinhança imediata dos ossos. É muito raro que se apresente nos tecidos macios do trato gastrointestinal, onde é conhecida como ossificação heterotópica do mesentério (OHM). A ossificação heterotópica intra-abdominal (OHI) é ademais conhecida como miosite ossificante, mesenterites ossificante, ossificação heterotópica do mesentério e ossificação heterotópica do mesentério intestinal. É uma condição extremamente rara, com só 30 casos aproximadamente reportados na literatura desde sua primeira descrição em 1983. Este artigo apresenta o caso de um menino de 14 anos com diagnóstico de mesenterites ossificante que foi tratado por um grupo de cirurgiões pediátricos. Ademais, apresenta-se uma revisão da literatura médica sobre esta estranha condição.

Tumor mucoso apendicular / Appendiceal mucous tumor

Los tumores mucosos apendiculares tienen baja incidencia y comúnmente se diagnostican en el estudio anatomo-patólogico después de la apendicectomía. Se reporta el caso de una mujer de 41 años de edad, con un cuadro clínico de ocho meses de evolución, caracterizado por dolor abdominal de tipo opresivo, difuso y de gran intensidad en el hemiabdomen inferior, acompañado de náuseas. Después de cinco meses de iniciado este cuadro clínico, se evidenció una masa en la fosa iliaca derecha; el dolor se agudizó e intensificó, y las náuseas continuaron, por lo cual fue remitida al hospital. En los exámenes practicados se observó una masa quística compleja abdomino-pélvica de origen indeterminado, y la tomografía computadorizada de abdomen fue sugestiva de mucocele apendicular. Con estos hallazgos, se optó por el tratamiento quirúrgico por laparotomía, consistente en hemicolectomía derecha, con resección parcial de íleon, epiplectomía, histerectomía y salpigooforectomía bilateral.

The clinical manifestations of an appendicular mucous tumors are non specific. The vast majority are associated with complications of intrabdominal rupture causing acute abdomen, while the spectrum associated while the associated with extrinsic compression of adjacent organic structures is exceptional. We report a case of partial intestinal obstruction caused by an appendiceal mococele fistulized to the proximal ileum.

Obstrucción intestinal parcial producida por mucocele apendicular con fístula a íleon proximal / Partial intestinal obstruction caused by appendiceal mucocele with proximal ileum fistula

Las manifestaciones clínicas de un mucocele apendicular son inespecíficas. La gran mayoría de las veces se asocian con las complicaciones de su ruptura intraabdominal, al ocasionar un cuadro clínico de abdomen agudo, mientras que el espectro de manifestaciones clínicas asociadas con la compresión extrínseca de estructuras orgánicas vecinas, es excepcional. Se presenta el caso de un síndrome de obstrucción intestinal parcial producida por un mucocele apendicular con fístula al íleon proximal.

The clinical manifestations of an appendiceal mucocele are nonspecific. The vast majority are associated with the complications of intrabdominal rupture causing an acute abdomen, while the spectrum associated with extrinsic compression of adjacent organic structures is exceptional. We present the case of a partial bowel obstruction syndrome caused by an appendiceal mucocele fistulized to the proximal ileum.

Fístula biliobrônquica como complicação do tratamento não operatório do trauma hepático / Bile bronchial fistula as a complication of the non-operative treatment of hepatic trauma

A fístula biliobrônquica (FBB) é complicação rara da doença hepática, inclusive da evolução do trauma hepático. Seu diagnóstico, na maioria dos casos, é clínico, tendo como sinal patognomônico a bilioptise. Sua abordagem surpreende e desafia o cirurgião, especialmente em relação ao seu tratamento; e, no trauma, é essencial o controle da lesão hepática, o que torna a laparotomia medida que se impõe em detrimento da toracotomia. Este relato descreve a abordagem da FBB após o trauma, com lesão hepática associada, bem como a estratégia para o seu tratamento.

Bile bronchial fistula (BBF) is a rare complication of liver disease including the evolution of liver trauma. In most cases, its diagnosis is clinical and takes bilioptisis as the pathognomonic sign. Its approach surprises and challenges the surgeon, especially in relation to its treatment; and, in trauma, it is essential to control the hepatic lesion, which makes laparotomythe measure that arises in detriment of thoracotomy. This report describes the BBF's approach after trauma, with associated hepatic lesion as well as the strategy for its treatment.