Coledocolitiasis primaria en paciente con situs inversus totalis / Primary cholelithiasis in a situs inversus totalis patient

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[Massive lower digestive hemorrhage caused by jejunal cavernous hemangioma detected with scintigraphy]. / Hemorragia digestiva baja masiva debida a hemangioma cavernoso yeyunal no detectado por escintigrafía.

We report the case of a patient who needed urgent surgical assistance because of massive lower gastrointestinal hemorrhage secondary to a jejunal angiodysplasia (cavernous hemangioma). These lesions are a rare cause of gastrointestinal bleeding of obscure origin. The use of preoperative diagnostic techniques such as oral fiber-optic endoscopy, barium intestinal studies and scintigraphy have little value when the origin of lower gastrointestinal bleeding is in the small bowel. The best yield is obtained with celiac or superior mesenteric angiography. There are some cases in which only an exploratory surgical laparotomy is useful for the diagnostic supported by intraoperative enteroscopy guided by the surgeon.

[Intraoperative echography of hepatic metastases]. / Ecografía intraoperatoria de las metástasis hepáticas.

In order to evaluate the usefulness of intraoperative echography in the study of liver metastases, two groups of patients were submitted to study: A consecutive series of 25 patients operated on for digestive tumours. Before operation, echography was performed to all of them. Four patients operated on for liver metastases. In the patients who were operated for digestive tumors, the authors found 8.6% of metastasis which neither the preoperative echography nor liver palpation had detected. The usefulness of the examination in the patients to whom resective hepatic surgery was going to be performed was based on: The finding of a portal thrombosis which had not been detected in the preoperative study. The possibility of connecting the intrahepatic vascularity with the lesions, in order to decide which technique to choose. The demonstration of the non-existence of other metastases.

[Intraoperative echography as an aid in the therapy of Caroli's disease. A case report]. / La ecografía intraoperatoria como ayuda en la terapéutica de la enfermedad de Caroli. Presentación de un caso.

Congenital polycystic dilatation of the intrahepatic biliary ways (Caroli's disease) is a rare disease. The "pure" type and the one associated with congenital hepatic fibrosis are accepted. Although the current exploration methods, its diagnosis is rare before the surgical procedure. Treatment of the diffuse pure types and the ones associated with hepatic fibrosis is difficult and the outcome is bad. A case of the less frequent type is communicated, in which, as a novelty, intrasurgical echography was used in its treatment.

[Appendicular endometriosis. Clinicopathologic study of 12 cases]. / Endometriosis apendicular. Estudio clinicopatológico de 12 casos.

Endometriosis of the Digestive Tract is an uncommon pathology, especially when ileocecal appendix is involved. Authors report twelve cases of appendiceal endometriosis reviewed from surgical and anatomopathological records. The preoperative diagnosis is almost impossible. The most usual clinical presentation is compatible with that of acute or chronic appendicitis. The definitive diagnosis is confirmed by anatomopathological study of the surgical specimen. The Surgical treatment consists of appendicectomy alone or associated with extirpation of other concomitant neighbouring lesions.

[Intraoperative echography during surgery for biliary lithiasis]. / Ecografía intraoperatoria en la cirugía de la litiasis biliar.

We present the experience with the use of intraoperative ultrasonography in detecting biliary calculi on 55 patients, 19 of which had lithiasis of the common bile duct. Operative ultrasonics imaging of the biliary tree and operative cholangiography had a similar accuracy when both explorations were performed. In this series, accuracy indexes of ultrasonography in diagnosing choledocholithiasis were: sensitivity, 84.21%; specificity, 100%; efficiency, 94%; predictability of a positive test, 100%; predictability of a negative test, 92%. We think ultrasonography is a better exploration in two conditions: when intrahepatic duct lithiasis exists and if calculi are at the end of choledochus, because differentiation with neoplastic changes is easier.

[Acute abdomen due to eosinophilic gastroenteritis. A study of 2 cases]. / Abdomen agudo por gastroenteritis eosinofílica. Estudio de dos casos.

Report of two cases of eosinophilic gastroenteritis. In both cases the presentation was an acute abdomen syndrome. The etiological diagnosis was postoperative, because in the preoperative period there were no data characteristic of this entity. Probably this disease is more frequent than reported and although the treatment is medical, there are some cases in which surgery is justified.

[Mesenteric venous thrombosis as a complication of surgery for portal hypertension by the Romero-Torres technic. Apropos a case]. / Trombosis venosa mesentérica como complicación de la cirugía de la hipertensión portal según la técnica de Romero-Torres. A propósito de un caso.

A case is presented of mesenteric venous thrombosis which affects about 30 cm of small intestine in a patient operated one month before for portal hypertension and bleeding from esophagogastric varices, in which an interruption of the portal-azygous venous circulation was made with splenectomy, using the Romero-Torres procedure. We consider that postsplenectomy thrombocytosis has been the first pathogenic factor in the mesenteric venous thrombosis.