[Use of pneumoperitoneum in the repair of giant abdominal hernias]. / Neumoperitoneo en el tratamiento de hernias gigantes.

The preoperative use of progressive pneumoperitoneum has been demonstrated to be safe and effective in the treatment of large hernias. The indications for this technique include massive hernias, hernias in patients with high surgical risk, and large recurrent hernias. We describe four patients in whom progressive pneumoperitoneum was carried out under local anesthesia and sedation between 1 and 3 weeks before surgery. All four hernias were closed with a preperitoneal mesh. Insufflation was performed on an inpatient basis in two patients and in the ambulatory setting in one. No postoperative complications were detected. No evidence of recurrence was found during follow-up (10 months-11 years).

Neumoperitoneo en el tratamiento de hernias gigantes / Use of pneumoperitoneum in the repair of giant abdominal hernias

El uso del neumoperitoneo preoperatorio progresivo ha demostrado ser una técnica útil y eficaz para el tratamiento de grandes defectos de la pared abdominal. Está indicado en hernias gigantes, pacientes de alto riesgo quirúrgico y grandes defectos recidivados. Se describe a 4 pacientes en los que se empleó neumoperitoneo progresivo realizado bajo anestesia local y sedación entre 1 y 3 semanas antes de la cirugía, seguido del tratamiento del defecto herniario con malla preperitoneal. Dos pacientes en régimen ambulatorio y 2 hospitalizados. No se detectaron complicaciones postoperatorias. Durante el seguimiento (10 meses-11 años) no hubo evidencias de recidiva (AU)

The preoperative use of progressive pneumoperitoneum has been demonstrated to be safe and effective in the treatment of large hernias. The indications for this technique include massive hernias, hernias in patients with high surgical risk, and large recurrent hernias. We describe four patients in whom progressive pneumoperitoneum was carried out under local anesthesia and sedation between 1 and 3 weeks before surgery. All four hernias were closed with a preperitoneal mesh. Insufflation was performed on an inpatient basis in two patients and in the ambulatory setting in one. No postoperative complications were detected. No evidence of recurrence was found during follow-up (10 months-11 years) (AU)

[Intestinal linitis plastica: late metastasis from gastric signet ring cell adenocarcinoma]. / Linitis plástica intestinal: metástasis tardía de adenocarcinoma gástrico en anillo de sello.

Linitis plastica is a malignant disease that usually occurs in the stomach, although it can affect any segment of the alimentary tract. Typically, this entity shows slow progression and insidious clinical course. We present the case of a patient with a previous diagnosis of signet ring cell cancer of the stomach that had been treated with curative intent 12 years before the clinical onset of small and large bowel linitis plastica. The diagnosis was obtained as an incidental pathological finding after urgent surgery for intestinal obstruction. No gastric mass was found. Linitis plastica should be considered in the differential diagnosis of patients with symptoms of obstruction after resection of a gastric carcinoma, especially if there are macroscopic surgical findings of circumferential narrowing. A long interval after diagnosis and treatment of the primary disease does not allow malignancy to be ruled out.

Linitis plástica intestinal: metástasis tardía de adenocarcinoma gástrico en anillo de sello / Intestinal linitis plastica: late metastasis from gastric signet ring cell adenocarcinoma

La linitis plástica es una entidad maligna típica de tumores gástricos, aunque puede afectar a cualquier segmento del tubo digestivo. Característicamente presenta progresión lenta y clínica insidiosa. Se presenta el caso de un paciente con antecedente de adenocarcinoma gástrico con células en anillo de sello, diagnosticado y tratado con intención curativa 12 años antes del inicio clínico de una linitis plástica de intestino delgado e intestino grueso. El diagnóstico fue obtenido como hallazgo anatomopatológico casual tras cirugía urgente de obstrucción intestinal. No se encontró masa gástrica. La linitis plástica debe ser tenida en cuenta entre los diagnósticos diferenciales, en pacientes intervenidos previamente de neoplasias malignas de estómago que presentan cuadros obstructivos, sobre todo ante hallazgos operatorios macroscópicos de estenosis circunferencial. El largo tiempo de evolución transcurrido desde el diagnóstico y el tratamiento de la enfermedad primaria no permite descartar la naturaleza maligna de la lesión (AU)

Linitis plastica is a malignant disease that usually occurs in the stomach, although it can affect any segment of the alimentary tract. Typically, this entity shows slow progression and insidious clinical course. We present the case of a patient with a previous diagnosis of signet ring cell cancer of the stomach that had been treated with curative intent 12 years before the clinical onset of small and large bowel linitis plastica. The diagnosis was obtained as an incidental pathological finding after urgent surgery for intestinal obstruction. No gastric mass was found. Linitis plastica should be considered in the differential diagnosis of patients with symptoms of obstruction after resection of a gastric carcinoma, especially if there are macroscopic surgical findings of circumferential narrowing. A long interval after diagnosis and treatment of the primary disease does not allow malignancy to be ruled out (AU)