[Intestinal obstruction and peritoneal carcinomatosis after endoscopic resection of transitional carcinoma of urinary bladder]. / Obstrucción intestinal y carcinomatosis peritoneal tras reseción endoscópica de carcinoma transicional de vejiga urinaria.

Gut involvement in bladder tumours is low, even exceptional in the presence of surface, low-grade neoplasia. The authors explain their experience in the diagnosis and management of a patient treated endoscopically for a vesical surface tumour which subsequently exhibited peritoneal and gut metastatic seeding. The various mechanisms for gut dissemination of vesical neoplasias and the repercussion of their endoscopic management are discussed.

[Villous adenoma of the appendix caused acute appendicitis]. / Adenoma velloso de apéndice causante de apendicitis aguda.

Villous adenoma of the appendix is a rare pathologic entity, the treatment is controversial. We describe the case of a patient complaining of abdominal pain that was diagnosed as acute appendicitis. Pathological examination of the surgical specimen revealed a villous adenoma of the appendix. We comment the therapeutic options and we review the literature about this pathological entity.

[Carcinoma in situ of the gallbladder. The prognostic and therapeutic implications]. / Carcinoma in situ de vesícula biliar. Implicaciones pronósticas y terapéuticas.

We have studied samples from gallbladders of five patients with carcinoma in situ over a 6-year period. Two were men and three women with du age ranging between 38 and 68 years (mean age 56). The microscopic criteria employed for the diagnosis of carcinoma in situ were pseudostratification of the epithelium, nuclear crowding, loss of cell polarity, atypical mitotic divisions and absence of stromal invasion. Cholecystectomy was carried in all patients due to cholelithiasis. Signs and symptoms were those related to the presence of stones and none of the patients was the presence of carcinoma suspected clinically. All patients are alive and symptom-free 14-84 months after surgery. Authors concluded that patients with carcinoma in situ of the gallbladder usually follows a good course after cholecystectomy.

[Ogilvie syndrome. Diagnostic and therapeutic attitude]. / Síndrome de Ogilvie. Actitud diagnóstica y terapéutica.

Ogilvie's syndrome (OS) is a clinical condiction with the symptoms, signs and radiological appearances of acute bowell obstruction but without any apparent mechanical cause. Diagnosis and treatment are often delayed and many patients are still inappropriately managed which in turn results in an increase in morbidity and mortality. We have reviewed our experience in eleven patients with OS in order to establish a system for their diagnostic and therapeutic management.

[Acute abdomen in anticoagulated patients. Its assessment and the surgical indications]. / Abdomen agudo en pacientes anticoagulados. Valoración e indicaciones quirúrgicas.

Bleeding complications associated with anticoagulant drugs can development abdominal pain simulating acute surgical conditions of abdomen. We report six cases of intraabdominal spontaneous haemorrhage presenting as an acute abdomen in patients on anticoagulant therapy: two rectus sheath hematomas, a abdominal wall hematoma, a spontaneous hemoperitoneum, a retroperitoneal hematoma and an intramural hematoma of the small bowel. The article conclude that computed tomography examination provided useful information in this complications because can demonstrate the size and location of the mass and its relation to normal intra-abdominal structures. Finally, authors expose the surgical indications of the different bleeding syndromes in this patients.

[Intramural hematoma of the ileum complicating anticoagulant therapy]. / Hematoma intramural de ileon en paciente anticoagulado.

The development of abdominal pain in the patient receiving anticoagulant therapy is more likely to pose a diagnostic dilemma. A group of intra-abdominal bleeding syndromes, which are extremely rare in patients with normal haemostasis, have been described in patients on anticoagulant therapy. Theses syndromes are of particular interest to surgeons because they simulate acute surgical conditions of the abdomen. We herein report the preoperative diagnosis of a spontaneous intramural hematoma of the small bowel by computed tomography. The authors conclude that CT should be used early in the diagnostic evaluation of abdominal pain and of acute abdomen in patients receiving anticoagulant therapy. Indications for the operative management of these patients include active bleeding, pneumoperitoneum, failure to improve with conservative management within 72 hours, worsening of symptoms, and uncertain diagnosis.

[Cecovesical fistula of inflammatory origin simulating neoplasm of the cecum]. / Fístula cecovesical de origen inflamatorio simulando neoplasia de ciego.

We describe a case of a caecovesical fistula in a 60-year-old woman caused by an inflammatory tumour of a probably appendicular origin which mimicked cancer of the caecum. The patient, had a history of idiopathic peripheral polineuropathy and chronic constipation. Presented urinary tract infection and fecaluria, without symptoms of appendicitis. At operation, a solid mass including the caecum and the fundus of the bladder was found, and the appendix was not identified. In view of the neoplastic appearance and the impossibility of separating the caecum from the bladder, "en bloc" right hemicolectomy and partial cystectomy were performed. The pathologic study showed the inflammatory nature of the lesion.