Stump appendicitis after laparoscopic appendectomy; laparoscopic management and literature review.

INTRODUCTION: Appendectomy is one of the most common surgical procedures performed worldwide There are different etiologies for acute appendicitis such as obstruction of the appendiceal lumen by fecalith, lymphoid hyperplasia, or neoplasm. Laparoscopic appendectomy has become the treatment of choice for both complicated and uncomplicated appendicitis; common postoperative complications include wound infection, bleeding, intraabdominal abscess. Stump appendicitis is defined as the interval repeated inflammation of remaining residual appendiceal tissue after an appendectomy. PRESENTATION OF CASE: 38-Year-old female patient with a history of laparoscopic appendectomy performed in 2016 for acute uncomplicated appendicitis. She arrived to the emergency room due to abdominal pain 7 out of 10, located in the periumbilical region, later with migration to the right lower quadrant, abdominal CT scan evidenced the presence of a cecal and pericecal inflammatory process as well as the base and residual proximal portion of the cecal appendix laparoscopic stump appendectomy was performed. DISCUSSION: Stump appendicitis (SA) is defined as the inflammation of the remnant of the cecal appendix after an appendectomy, whether due to impaction of a fecalith or secondary to an ischemic process, the probability of developing SA is estimated to be about 1/50,000 cases throughout life. The most frequently used treatment is exploratory laparotomy to complete the previous appendectomy; however, there are 5 reported cases of stump appendicitis, where surgical resolution was performed through laparoscopic surgery. CONCLUSIONS: It is important to keep this entity in mind when evaluating a patient with acute abdomen with previous history of appendectomy, since the delay in diagnosis and treatment increases morbidity and mortality; laparoscopic stump appendectomy has been shown to be a safe treatment (Agha et al., 2020 [14]).1.

Foreign modeling agent reaction; managed with two staged surgical reconstruction. Case report and review of literature.

INTRODUCTION: In Mexico, body modeling with injectable biomaterials such as liquid silicone is a common practice in non-certified clinics by non-medical personnel; These materials produces a series of complications described as Foreign modeling agent reaction (FMAR) with variable spectrum of severity. CASE PRESENTATION: 38-year-old female with history of biomaterial injection in a non-certified cosmetic clinic 10 years prior to evaluation. Presents with intermittent symptoms characterized by fever, erythema, induration and pain in the gluteal region. An exhaustive debridement and resection with primary closure was performed. Thereafter, reconstruction was done using a combined technique with gluteal implants and autologous fat graft, evolving without complications. DISCUSSION: The use of biomaterials has been widely documented throughout history; liquid silicone being one of the protagonists. Used for aesthetic purposes and modeling areas such as buttocks and breasts. They have been associated with an assortment of early or late onset complications, sometimes resulting in fatal outcomes. Various treatment modalities have been described depending on the severity of presentation, from conservative to surgical management. CONCLUSION: There is a shortage of treatment guidelines regarding FMAR due to its wide variety of presentation, treatment must be individualized to obtain adequate results. Although conservative treatment has shown good results, the anatomical alterations usually condition dissatisfaction that should be addressed with reconstructive techniques [10].

Adrenal schwannoma in a female patient; A rare benign neoplasm: Case report and literature review.

INTRODUCTION: Schwannomas are rare, slow-growing, usually benign tumors that originate from myelin-producing Schwann cells. Adrenal schwannomas are an exceptionally rare subset of these tumors, with few cases reported in the literature. PRESENTATION OF CASE: We present the case of a 44-year old female patient being evaluated for chronic abdominal pain at the outpatient clinic. Clinical and laboratory workup was unremarkable. An abdominal CT scan was performed, revealing a left suprarenal solid mass (5 × 6 cm). Surgical resection of the adrenal gland was performed, given the patient's symptoms, the size of the tumor, and its malignant potential. The patient completed the postoperative period satisfactorily, and her symptoms improved. Histopathological findings were compatible with a benign adrenal schwannoma. DISCUSSION: Schwannomas generally appear in the head, neck and extremities, with the vestibulocochlear nerve being the most frequently involved site. Retroperitoneal schwannomas account for 1-5% of retroperitoneal masses and comprise only 1-3% of all schwannomas. Their incidence increases with age, from 4% in the general population, reaching 7% in patients over 70 years of age. CONCLUSION: Adrenal incidentalomas represent a diagnostic challenge. Because of the malignant potential of large (> 4 cm) adrenal masses and the lack of characteristic findings using conventional imaging techniques and laboratory diagnostic tools, surgical excision with histopathology and immunohistochemistry analysis are required for definitive diagnosis and optimal management.

Conversion from mini bypass to laparoscopic Roux en Y gastric bypass in an emergency setting: Case report and literature review.

INTRODUCTION: It has been demonstrated that certain technique endpoints are key to the success for the OAGB and RYGB procedures but only a few texts in which post-operative complications are documented. PRESENTATION OF CASE: 42-year-old male patient admitted to the emergency department for presenting abdominal pain located in the epigastrium for 4 days, melenic evacuations and syncope on one occasion. Two years prior to admission, the patient underwent a single anastomosis bypass for grade III obesity.Gastric bypass mini revision surgery was performed an antecolic and antegastric gastrointestinal anastomosis was made with a 3 cm latero-lateral anastomosis; an intestinal-intestinal anastomosis was performed 60 cm from the gastric anastomosis. The length of the biliopancreatic loop (120 cm) and the feeding loop (60 cm) are reviewed. DISCUSSION: Performing an "en bloc" resection of the anastomosis is essential since bile reflux is one of the irritation mechanisms of the anastomosis but not the only one. The size of the gastric pouch directly influences the frequency of marginal ulcers, so during the OAGBP revision, the gastro-jejunal junction must be resected to remodel it, reducing the size of the gastric reservoir that allows to perform the new anastomosis in less inflamed tissue. Roux-en-Y reconstruction should be performed once the length of the biliopancreatic loop is verified and it does not exceed 150 cm and a short alimentary loop to avoid nutritional complications.Complications arising from bariatric procedures are varied, infrequent in well-trained surgeons, but severe in inexpert hands, leading to an increase in mortality rates. CONCLUSIONS: We propose the laparoscopic conversion of OAGB to RYGB as a safe method, and feasible in hemodynamically unstable patients.

Midgut volvulus caused by intestinal malrotation; A rare cause of acute abdomen in adults. Case report.

INTRODUCTION: Acute abdomen due to midgut volvulus with intestinal malrotation is rare event with only only few cases in the literature Butterworth et al. (2018). Intestinal malrotation presented in the adulthood is reported in 0.2-0.5 %, of cases; with only 15 % f them presenting as midgut volvulus Butterworth et al. (2018). Intestinal malrotation is casued by an alteration in embryonic development between 10-12 weeks of gestation. The main alteration is anomalous position of the bowel with the small intestine residing on the right side of the abdomen, while the colon and cecum remain on the left side due to malposition of the Treitz ligament. Additionally, the ascending colon remains attached to the abdominal wall by fibrous peritoneal bands known as Ladd bands, this being a cause of midgut volvulus and intestinal obstruction. PRESENTATION OF CASE: We present a 25-year-old male with failure to thrive who arrives at the ED with clinical signs and symptoms of intestinal occlusion and acute abdomen, initial resuscitation is made in ED and is transferred to OR, an exploratory laparoscopy evidencing intestinal malrotation with cecal volvulus and a Ladd procedure is made openly without PO complications. DISCUSSION: The gold standard for diagnosis of intestinal malrotation is the upper gastrointestinal series. However, in patients with acute abdomen associated with this pathology where is suspected intestinal ischemia and hemodynamic instability, it is essential that an emergency laparotomy be performed. CONCLUSIONS: The diagnosis of intestinal malrotation is difficult, since many patients are asymptomatic in adulthood or present with variable GI symptoms. Therefore, it is imperative to have a high index of suspicion in patients with compatible clinical characteristics in order to perform the best therapy in time and manner.

Gallbladder osteoma in a 66-year-old female; Case report and review of literature.

INTRODUCTION: Gallbladder mesenchymal tumours are rare. The more common include fibroma, lipoma or haemangioma. A gallbladder osteoma is very rare indeed there is only one other case reported in medical literature). We report a new case. PRESENTATION OF CASE: A 66-year-old female presented to the emergency department complaining of colicky epigastric pain and generalised abdominal discomfort for 1 month. The pain was scored 5/10 but there were no associated symptoms of fever, nausea or vomiting. Vital signs were normal as were all laboratory parameters. An abdominal ultrasound revealed a thin walled gallbladder with a solitary 3 mm polyp. Motility studies confirmed gallbladder dyskinesia. Laboratory studies were ordered reporting normal findings. Abdominal ultrasound was ordered reporting an image suggesting a gallbladder polyp and gallbladder dyskinesia. Cholecystectomy was done without any incidents and the gallbladder was sent to pathology. Pathology reported mature bone tissue in the stromal gallbladder tissue. Due to the rareness of the presence of mature bone tissue in the gallbladder we decided to report the case for the medical community. DISCUSSION: Osteomas are mesenchymal cell tumors derived from the mesoderm; the gallbladder may be the primary site of numerous types of mesenchymal tumors, although these tumors are common the location is not. CONCLUSIONS: We report only the second case of gallbladder osteoma. These mesenchymal tumours are common but this location is not. This case report will serve to remind readers of both benign osteomas and unusual conditions causing gallbladder disease.

Necrotizing soft tissue infection after liposculpture; Case report.

INTRODUCTION: Liposculpture procedures have a complication rate of 5%, with the majority being minor complications. Infections in isolated liposuction procedures are as low as 0.1 % of cases. Necrotizing infections can occur after major traumatic injuries, as well as after minor breaches of the skin or mucosa. Here we present a case of a 53-year-old female patient who underwent cosmetic surgery and developed a necrotizing soft tissue infection and we will discuss the importance of early diagnosis, risk factors and preventive measures, treatment options and our management of this particular case. PRESENTATION OF CASE: 53-year-old female patient with a history of multiple cosmetic surgeries, with no significant past medical history, she presented fever and disabling pain at the surgical site with extensive bullae formation; during her fourth post operative day, she presented septic shock that required vasopressor support and mechanical ventilation, accompanied by acute renal failure which required admission to the intensive care unit. The patient's relatives requested air transportation to bring the patient to our center. The patient remained hospitalized for 42 days in which 15 surgical interventions were performed including multiple surgical wound cleansing and debridement as well as placement of a negative pressure wound therapy system, flaps advancement, lesions reconstruction, graft procurements and insertions. DISCUSSION: Antibiotic prophylaxis is recommended preferably with a second-generation cephalosporin, one hour prior to surgery and should be continued for 5-6 days afterwards. Likewise, prophylaxis with Flucloxacillin or gentamicin is recommended in the case of liposuction and or abdominoplasty. The microorganisms most frequently isolated in post-liposuction infections are Staphylococcus aureus, Streptococcus group A, Streptococcous pyogenes, and synergistic infections with anaerobes and facultative pathogens. Among the most severe complications of liposuction is necrotizing soft tissue infection (NSTI), which is an infection of the subcutaneous tissue that spreads to the underlying dermis and sometimes beyond including the fascia and muscle. CONCLUSION: Rapid recognition of NSTI is life-saving and urgent, extensive debridement and prophylactic antibiotics are the mainstay treatment for this condition, multiple debridement procedures may be necessary for successful treatment.

Bilateral carotid body tumor resection in a female patient.

INTRODUCTION: Carotid body tumors also called carotid paragangliomas are rare neuroendocrine neoplasms derived from neural crest cells, approximately 3% of all paragangliomas occur in the head and neck area (Xiao and She, 2015); although they represent 65% of the head and neck paragangliomas (Georgiadis et al., 2008). PRESENTATION OF CASE: We present the therapeutic management of a 65-year-old woman with bilateral carotid body tumors. The patient presented to medical clinic for unrelated signs and symptoms of weight loss, dyspepsia, and epigastric pain. Physical examination showed bilateral non-tender neck masses for which imaging studies were ordered resulting in the diagnosis of bilateral carotid tumor. Surgical resection was staged with one week of distance between each tumor resection. DISCUSSION: Carotid Body Tumors can arise from the paraganglia located within the adventitia of the medial aspect of the carotid bifurcation.Resection is the only curative treatment. Carotid body tumors resection represents a special challenge due to potential neurovascular complications. CONCLUSIONS: Surgical resection of carotid body tumors represents a special challenge to the surgeon because of the complex anatomical location of the tumor, including close relationship with the cranial nerves, involvement of the carotid vessels and large vascularization of the tumor. With the advance of diagnosis and improvement in surgical techniques as well as the understanding of biological behavior of tumors, surgical treatment has become a safer alternative for treating these tumors.

[Equity, public health and genomics: the legal, social and biotechnology challenge in México]. / Equidad, salud pública y genómica: el reto jurídico, social y biotecnológico en México.

Mexico has entered an era where health research is enriched by the study of genetic variants that determinate how the different human populations are differentially susceptible to diseases. The objective is to design new strategies in health care and services based on medical genomics. However, to ensure universal access to these products, we should rethink the legal aspects that facilitate the design of health policies, based on the principle of equity. Intrinsic factors of the Mexican health system as inequity, poverty and low investment in health research, are challenges that add to the development of appropriate distribution strategies for the use of new genomic products for health. This article discusses these challenges and establish the basis to design policies and appropriate use of these new genomic-based health care services.

[Partial laparoscopic nephrectomy: treatment for hydrocalicosis due to infundibular stenosis]. / Nefrectomía parcial laparoscópica: tratamiento de hidrocalicosis por estenosis infundibular.

BACKGROUND: This report describes a partial nephrectomy with a minimally invasive approach, carried out laparoscopically as a treatment for a hydrocalicosis caused by a congenital infundibular stenosis. CLINICAL CASE: The patient presented a clinical background of one year of evolution, manifested as recurrent urinary tract infections caused by urine accumulation in the adjacent collecting tubules which were compressed by the superior hydrocalicosis. This procedure was made using a transperitoneal access, making a superior pole resection of the right kidney and respecting the adrenal gland. CONCLUSIONS: In our opinion, to widen the usage of the laparoscopic surgery in urology can benefit patients to reduce post-surgery complications and hospitalization time, with a more comfortable recovery.