Subject(s)
Humans , Aged , Carcinoma, Papillary/diagnostic imaging , Carcinoma, Papillary/surgery , Gallbladder , CholecystectomyABSTRACT
Brunner's gland hyperplasia constitutes 10.6% of benign tumors of the duodenum, with an incidence of 0.008%. It is usually an incidental finding during endoscopy or imaging tests as they are small and asymptomatic. In the case of symptomatic tumors, resection of the lesion is indicated. In lesions ≤2 cm, endoscopic resection can be chosen, reserving surgery for larger lesions or endoscopically inaccessible ones. We present the case of a patient with a history of vomiting and hyporexia of months of evolution who presented peptic ulcer perforation and underwent surgery. During follow-up, she presented intestinal obstruction due to pyloric stenosis. Given the impossibility of ruling out a neoplastic process with certainty in diagnostic tests, surgical resection (antrectomy) was decided with an anatomopathological finding of Brunner's gland hyperplasia.
Subject(s)
Brunner Glands , Duodenal Diseases , Intestinal Obstruction , Female , Humans , Hyperplasia , Brunner Glands/diagnostic imaging , Brunner Glands/surgery , Duodenal Diseases/diagnostic imaging , Duodenal Diseases/etiology , Duodenal Diseases/surgery , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , DuodenumABSTRACT
Aortoesophageal fistula (AEF) secondary to thoracic endovascular aortic repair (TEVAR) is a rare clinical entity that poses a threat to life as it causes massive digestive bleeding, and it is estimated that 60% of patients who suffer from it could die within within 6 months of the onset of their symptoms. It requires a high clinical suspicion to establish an early multidisciplinary surgical treatment. We present the cases of two patients diagnosed with aortoesophageal fistulas after TEVAR in the last 5 years (January 2018-December 2022) while reviewing the existing scientific literature on the matter.
Subject(s)
Aortic Diseases , Endovascular Procedures , Esophageal Fistula , Vascular Fistula , Humans , Endovascular Aneurysm Repair , Vascular Fistula/diagnostic imaging , Vascular Fistula/etiology , Endovascular Procedures/adverse effects , Aortic Diseases/diagnostic imaging , Aortic Diseases/etiology , Aortic Diseases/surgery , Esophageal Fistula/diagnostic imaging , Esophageal Fistula/etiology , Hemorrhage/complicationsABSTRACT
Intracholecystic papillary neoplasia (IPN) is a rare entity rarely described in the literature, of incidental anatomopathological diagnosis in a cholecystectomy specimen that presents a premalignant behavior, with progression to carcinoma in more than 50% of cases. In the absence of an invasive component, clinical follow-up is recommended, without associating another surgical gesture, with a 5-year prognosis (90% survival). We present a case of a patient with an incidental diagnosis of NPIC after laparoscopic cholecystectomy due to presenting a gallbladder polyp.
Subject(s)
Cholecystectomy, Laparoscopic , Gallbladder Diseases , Gallbladder Neoplasms , Gastrointestinal Neoplasms , Polyps , Humans , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/surgery , Diagnosis, Differential , Gallbladder Diseases/diagnostic imaging , Gallbladder Diseases/surgery , Polyps/diagnostic imaging , Polyps/surgery , Gastrointestinal Neoplasms/surgeryABSTRACT
Colonoscopy is a frequently used procedure in our environment for the diagnosis, treatment and even prevention of colorectal cancer. Despite being a routine procedure, it is not exempt from possible complications. Bleeding and perforation are the main ones, with splenic rupture being extremely infrequent as well as one of the most serious complications derived from performing a colonoscopy. We present a patient with splenic rupture secondary to colorectal cancer screening colonoscopy who required urgent surgery for acute hemorrhagic shock.
Subject(s)
Colorectal Neoplasms , Splenic Rupture , Humans , Early Detection of Cancer/adverse effects , Splenic Rupture/diagnostic imaging , Splenic Rupture/etiology , Splenic Rupture/surgery , Colonoscopy/adverse effects , Splenectomy/adverse effects , Colorectal Neoplasms/surgery , Colorectal Neoplasms/complicationsABSTRACT
Introducción. Los tumores desmoides son lesiones de los tejidos blandos, histológicamente benignas, poco frecuentes y con gran agresividad local y carencia de potencial metastásico. Se relacionan estrechamente con antecedentes traumáticos o quirúrgicos, como la cesárea, y su tratamiento generalmente es quirúrgico. Métodos. Presentamos una serie de tres pacientes intervenidas en nuestro centro durante el año 2020. Se revisan sus antecedentes y se describe su tratamiento. Resultados. En todas nuestras pacientes se encontró algún antecedente quirúrgico, dos cesáreas y una resección de un disgerminoma. El tratamiento empleado fue la resección quirúrgica con márgenes libres y reparación del defecto mediante malla. Conclusiones. El tumor desmoide es una patología poco frecuente, su diagnóstico se realiza mediante exámenes imagenológicos y se confirma con el estudio histológico; es importante hacer el diagnóstico diferencial con el sarcoma. La cirugía radical sigue siendo el tratamiento de elección, aunque algunos autores proponen el tratamiento conservador.
Introduction. Desmoid tumors are soft tissue lesions, histologically benign, rare and with great local aggressiveness and lack of metastatic potential. They are closely related to traumatic or surgical history such as caesarean section. Their treatment is generally surgical. Methods. We present a case series of three patients operated on in our center during the year 2020. Their history is reviewed and their type of treatment is presented. Results. In all our patients, surgical history was found (two caesarean sections and one resection of a dysgerminoma). The treatment used was surgical resection with free margins and mesh repair of the defect. Conclusions. Desmoid tumor is a rare pathology; its diagnosis is made by imaging studies, and confirmed by histology. It is important to make a differential diagnosis with sarcoma. Radical surgery remains the treatment of choice, although some authors propose conservative treatment.
Subject(s)
Humans , Cesarean Section , Fibromatosis, Aggressive , General Surgery , Abdominal Wall , NeoplasmsABSTRACT
Gastrointestinal Stromal Sarcomas (GIST) are mesenchymal neoplasms whose incidence accounts for 1-2% of digestive tumors, being located in the stomach (55-60%) and small intestine (30%). The advances in its knowledge and management succeeded in the last years have being spectacular. This review aims to summarize the most important of them for surgeons. We identified four areas of interest: molecular oncology, laparoscopic approach, management of GIST located at unusual locations, and management of advanced GIST. Advances in the field of molecular oncology lead to the discovery of new oncogenic mutations making the term Wil Type GIST obsolete. Moreover, these advances allow for the development of 2 new drugs: Avapritinib and Ripretinib, that added to the previous 3 commercially available drugs (imatinib, sunitinib and regorafenib) make possible the management of GIST with resistant mutations. The principles of the surgical management of primary GIST are well stablished which laparoscopic approach must accomplish. This approach is limited by 2 main factors: location and size. The diagnosis of GIST in unusual locations as esophagus, duodenum, rectum of out of the gastrointestinal tract (EGIST), implies an extraordinary therapeutic challenge, being imperative to manage them by surgeons and oncologist among others in the setting of a multidisciplinary team. The management of advanced/metastatic GIST has changed in a revolutionary fashion because surgery is now part of its treatment as adjuvant to tyrosine kinase inhibitors.
Los tumores del estroma gastrointestinal (GIST) suponen el 1-2% de los tumores digestivos, siendo su localización más frecuente el estómago (55-60%) y el intestino delgado (30%). Los avances más importantes sucedidos en los últimos años se centran en cuatro áreas: biología molecular, abordaje quirúrgico laparoscópico, manejo técnico del GIST en localizaciones inusuales y tratamiento e integración de la cirugía en el manejo del GIST avanzado. Los avances en el conocimiento de la biología molecular del GIST han dado lugar a la progresiva identificación de nueva mutaciones oncogénicas que hacen del concepto wild type obsoleto. Estos avances han permitido el desarrollo de dos nuevos fármacos, avapritinib y ripretinib, lo que permite el tratamiento de pacientes con mutaciones resistentes a las tres líneas terapéuticas clásicas. El tratamiento quirúrgico del GIST se rige por unos principios técnicos bien establecidos que el abordaje laparoscópico debe cumplir, abordaje que queda limitado por dos factores clave: localización y tamaño. El GIST de localización infrecuente (esófago, duodeno o recto, o extradigestivo) supone un reto terapéutico. Estos pacientes deben ser manejados en un contexto multidisciplinario. La cirugía queda integrada en el manejo del GIST avanzado, considerándose como adyuvante a los inhibidores de la tirosina cinasa.
Subject(s)
Gastrointestinal Neoplasms , Gastrointestinal Stromal Tumors , Gastrointestinal Neoplasms/drug therapy , Gastrointestinal Neoplasms/genetics , Gastrointestinal Neoplasms/surgery , Gastrointestinal Stromal Tumors/drug therapy , Gastrointestinal Stromal Tumors/genetics , Gastrointestinal Stromal Tumors/surgery , Humans , Imatinib Mesylate/therapeutic use , Sunitinib/therapeutic useABSTRACT
La cirugía de los sarcomas retroperitoneales debe ser compartimental «en bloque», lo que implica la resección de órganos adyacentes al tumor. Su empleo «de entrada» permite un elevado porcentaje de resecciones con márgenes negativos, lo que supone un mejor control local y mayor supervivencia en muchos pacientes. La preservación de órganos debe hacerse de forma personalizada, especialmente en la pelvis, y adaptarla a la agresividad histológica del tumor. La biopsia preoperatoria permite establecer el subtipo de sarcoma y una adecuada estrategia perioperatoria. Estos pacientes deben ser manejados por cirujanos expertos en centros de referencia, con unidades multidisciplinarias y comités oncológicos. El uso de quimioterapia y radioterapia aún no está bien definido, por lo que solo se recomienda en centros de referencia con ensayos clínicos. En la actualidad esta es la única opción para ofrecer las mejores tasas de morbimortalidad, y las posibles mejoras en la supervivencia de estos pacientes
Surgery for retroperitoneal sarcomas should be "en bloc" compartmental, which involves resection of unaffected organs. Its upfront use is key, providing a high percentage of resections with negative margins, resulting in a better local control and increased survival in many patients. Preservation of organs should be done in an individualized manner, especially in the pelvic location, and adapted to the histological aggressiveness of the tumor. Preoperative biopsy is able to establish the diagnosis of sarcoma subtype and consequently an adequate perioperative strategy. These patients should be managed by expert surgeons at referral centers with multidisciplinary units and oncology committees. The use of chemotherapy and radiotherapy is not yet well defined, so it is only recommended at referral centers with clinical trials. Currently, this is the only option to offer the best morbidity and mortality rates, as well as possible improvements in the survival of these patients
Subject(s)
Humans , Pelvic Neoplasms/therapy , Retroperitoneal Neoplasms/therapy , Sarcoma/surgery , Biopsy , Drug Therapy/methods , Drug Therapy/standards , Margins of Excision , Neoplasm Recurrence, Local/surgery , Pelvic Neoplasms/epidemiology , Pelvic Neoplasms/pathology , Preoperative Period , Prognosis , Radiotherapy/methods , Radiotherapy/standards , Retroperitoneal Neoplasms/epidemiology , Retroperitoneal Neoplasms/pathology , Sarcoma/mortality , Surgeons , Survival RateABSTRACT
Surgery for retroperitoneal sarcomas should be "en bloc" compartmental, which involves resection of unaffected organs. Its upfront use is key, providing a high percentage of resections with negative margins, resulting in a better local control and increased survival in many patients. Preservation of organs should be done in an individualized manner, especially in the pelvic location, and adapted to the histological aggressiveness of the tumor. Preoperative biopsy is able to establish the diagnosis of sarcoma subtype and consequently an adequate perioperative strategy. These patients should be managed by expert surgeons at referral centers with multidisciplinary units and oncology committees. The use of chemotherapy and radiotherapy is not yet well defined, so it is only recommended at referral centers with clinical trials. Currently, this is the only option to offer the best morbidity and mortality rates, as well as possible improvements in the survival of these patients.
Subject(s)
Patient Care Team/organization & administration , Pelvic Neoplasms/therapy , Retroperitoneal Neoplasms/therapy , Sarcoma/surgery , Biopsy , Drug Therapy/methods , Drug Therapy/standards , Humans , Margins of Excision , Neoplasm Recurrence, Local/surgery , Pelvic Neoplasms/epidemiology , Pelvic Neoplasms/pathology , Preoperative Period , Prognosis , Radiotherapy/methods , Radiotherapy/standards , Retroperitoneal Neoplasms/epidemiology , Retroperitoneal Neoplasms/pathology , Sarcoma/epidemiology , Sarcoma/mortality , Surgeons , Survival RateABSTRACT
Introducción: la rotura traumática del diafragma es una lesión infrecuente que aparece en politraumatismos o agresiones. Predomina en los varones entre 20 y 50 años de edad, siendo los accidentes de tráfico la principal causa en Europa. El diagnóstico preoperatorio requiere alto nivel de sospecha junto con las adecuadas exploraciones radiológicas. El retraso diagnóstico se asocia con elevada morbilidad y mortalidad, constituyendo la intervención quirúrgica inmediata un factor determinante para el éxito en el tratamiento de estos pacientes. El objetivo de este informe fue analizar la incidencia y epidemiología de la rotura traumática del diafragma en nuestro medio, y exponer nuestros resultados en el diagnóstico y tratamiento de esta lesión. Material y métodos: presentamos siete casos correspondientes al periodo 1999-2005 y analizamos el motivo de ingreso, la clínica, las formas de diagnóstico, las lesiones asociadas, el tratamiento y la evolución. Conclusiones: el diagnóstico de rotura diafragmática es difícil debido a su baja frecuencia y a su sintomatología variable, no obstante, debe ser considerado en todo paciente politraumatizado. La tomografía helicoidal es la exploración radiológica de elección y la vía de abordaje más adecuada es la laparotomía media.
BACKGROUND: Traumatic diaphragmatic rupture is an infrequent lesion usually found in polytrauma cases or after violent attacks. Patients are usually males between 20 and 50 years old, and car accidents are the main causes in Europe. Preoperative diagnosis must be based on a high level of suspicion and appropriate radiological explorations. Diagnostic delay is associated with high morbidity and mortality and early surgical treatment is required for successful management. We undertook this study to analyze the epidemiology of diaphragmatic rupture and to report our results in the diagnosis and treatment of this injury. METHODS: We present seven cases from 1999 through 2005. We analyzed the reasons for admission, signs and symptoms, diagnostic approach, associated lesions, treatment and course. CONCLUSION: Diagnosis of diaphragmatic rupture is difficult due to changeable symptomatology; nevertheless, it must be considered in all polytraumatized patients. Computerized tomography is the radiological exploration of choice and the most suitable surgical approach is laparotomy.
Subject(s)
Humans , Male , Adult , Middle Aged , Diaphragm/injuries , Accidents, Traffic , Abdominal Pain/etiology , Chest Pain/etiology , Wounds, Stab/diagnosis , Wounds, Stab/surgery , Liver/injuries , Fractures, Bone/complications , Hemothorax/etiology , Hernia, Diaphragmatic, Traumatic/etiology , Hernia, Diaphragmatic, Traumatic/surgery , Incidence , Laparotomy , Retrospective Studies , Rupture , Splenic Rupture/complications , Splenic Rupture/surgery , Thoracotomy , Tomography, X-Ray Computed , Multiple Trauma/complicationsABSTRACT
No disponible
Subject(s)
Humans , Specialties, Surgical/education , Digestive System Surgical Procedures/education , Professional Competence/standards , Training Support/trends , Curriculum , Internship and Residency/standards , Educational Measurement/methodsABSTRACT
BACKGROUND: Traumatic diaphragmatic rupture is an infrequent lesion usually found in polytrauma cases or after violent attacks. Patients are usually males between 20 and 50 years old, and car accidents are the main causes in Europe. Preoperative diagnosis must be based on a high level of suspicion and appropriate radiological explorations. Diagnostic delay is associated with high morbidity and mortality and early surgical treatment is required for successful management. We undertook this study to analyze the epidemiology of diaphragmatic rupture and to report our results in the diagnosis and treatment of this injury. METHODS: We present seven cases from 1999 through 2005. We analyzed the reasons for admission, signs and symptoms, diagnostic approach, associated lesions, treatment and course. CONCLUSION: Diagnosis of diaphragmatic rupture is difficult due to changeable symptomatology; nevertheless, it must be considered in all polytraumatized patients. Computerized tomography is the radiological exploration of choice and the most suitable surgical approach is laparotomy.