[Intestinal intussusception secondary to myofibroblastic tumor in an elderly patient. Case report]. / Intususcepción intestinal secundaria a tumor miofibroblástico en un adulto mayor. Reporte de caso.

BACKGROUND: Intussusception is defined as a segment of the gastrointestinal tract and mesentery within the lumen of an adjacent segment. It is a rare condition in adults that can occur anywhere in the gastrointestinal tract from the stomach to the rectum. Only 5% of all intussusceptions are presented in adults, and in 1-5% of all cases of intestinal obstruction. Inflammatory myofibroblastic tumour is rare, and is usually found in the lung, and rarely detected in some intestinal portions. It causes a variety of non-specific symptoms, with those that present as an intussusception being uncommon. CLINICAL CASE: A female of 69 years with partial bowel obstruction secondary to intestinal intussusception due to an inflammatory myofibroblastic tumour, a rarely diagnosed condition and never published before. DISCUSSION: Inflammatory myofibroblastic tumours are rare, and in this case with an atypical presentation that was surgically resolved satisfactorily. These entities are difficult to diagnose, with histopathology giving the definitive diagnosis. A literature review was performed to gather recent information about their diagnosis and treatment. CONCLUSIONS: Inflammatory myofibroblastic tumours require a high level of suspicion, as diagnosis prior to surgery is difficult. Surgery is considered the treatment of choice, requiring leaving free surgical edges to prevent recurrences.

[Hepatic angiosarcoma and liver transplantation: case report and literature review]. / Angiosarcoma hepático y trasplante hepático: reporte de caso y revisión de bibliografía.

BACKGROUND: Hepatic angiosarcoma is a rare vascular malignancy that accounts for 2% of all hepatic primary tumours. The diagnosis is difficult, especially if the patient does not have history of exposure to carcinogens, which are considered as risk factors. The diagnosis is made by histopathology, but in a considerable percentage it can only be accomplished by autopsy. The performing of fine needle aspiration biopsy can lead to bleeding, with limitations in its use. CLINICAL CASE: A 41 year-old male, with no history of exposure to carcinogens, who developed abdominal pain secondary to a haemoperitoneum due to tumour rupture, was diagnosed by imaging methods with a giant cavernous hepatic haemangioma. He was initially treated with embolisation, and later with a liver transplant. After six months he developed haemoptysis secondary to lung metastasis. The autopsy reported metastatic hepatic angiosarcoma. DISCUSSION: This condition has been related to carcinogen exposure, with malignant transformation from a benign vascular neoplasia being proposed as a hypothesis. The differential diagnosis can be achieved with imaging studies such as CT scan, and the definitive diagnosis is made by histopathology with immunohistochemistry tests, with 35%-100% being made in the autopsy. CONCLUSION: Hepatic angiosarcoma is a malignant vascular neoplasia, the potential curative option is surgery with tumour free margins. Liver transplantation remains controversial because of its poor prognosis in the short term.

[Allogeneic parathyroid: 2-year follow-up]. / Alotrasplante de paratiroides: seguimiento a 2 años.

BACKGROUND: Hypoparathyroidism is one of the most frequent complications of neck surgery. The treatment is currently medical; however this involves several complications secondary to high doses of calcium and vitamin D, thus making parathyroid allotransplantation a good management option. MATERIAL AND METHODS: Patients with hypoparathyroidism were selected in the April-December period of 2011 in the general surgical clinic. They were between 16 and 65 years, and ingested high doses of calcium. The donors were patients with primary and secondary hyperparathyroidism, and the transplants were performed in relation to blood group and human leucocyte antigen. RESULTS: Five parathyroid allografts were performed. All the patients had iatrogenic hypoparathyroidism, all women with a mean age of 49.8 years. The graft was implanted under local anaesthesia in the non-dominant forearm. Four of the patients are so far considered functional due to the increase in paratohormone, and demonstrating its function by scintigraphy with sestamibi. One of the patients showed no increase in paratohormone or imaging studies that demonstrate its functionality. After a two year follow up the graft remains functional but with with oral calcium intake at a lower dose than before transplantation. None of the patients had immunosuppression side effects. CONCLUSIONS: In this study, allogeneic unrelated living parathyroid transplant with an immunosuppressive regimen of six months has proven to be a safe alternative treatment to improve quality of life by decreasing the excessive calcium intake and improving physical activity with adequate graft survival at 24 months follow up.

[Gastric perforation by MALT lymphoma. Case report]. / Perforación gástrica por linfoma MALT. Reporte de caso.

BACKGROUND: Gastric non-Hodgkin lymphoma is a rare tumour that represents approximately 7% of all stomach cancers and 2% of all lymphomas. The most frequent location of gastric MALT (mucosa associated lymphoid tissue) lymphomas is in the antrum in 41% of the cases, and 33% can be multifocal. The risk of spontaneous perforation of a gastric MALT lymphoma is 4-10%. CLINICAL CASE: 24 year old male patient carrying the Human Immunodeficiency Virus, who began with signs and symptoms of acute abdomen and fever 72 hours before arriving in the emergency room. A computed tomography was performed that showed free fluid in the cavity, and gastric wall thickening. The patient underwent a laparotomy, finding absence of the anterior wall of the stomach, sealed with the left lobe of the liver, colon and omentum. Total gastrectomy, with oesophagosty and jejunostomy tube, was performed. CONCLUSIONS: Gastric perforation secondary to a MALT lymphoma is rare, with high mortality. There is limited information reported of this complication and should be highly suspected in order to provide appropriate treatment for a complication of this type.

[Pedicled gastric lipoma. Case report]. / Lipoma gástrico pediculado. Reporte de caso.

BACKGROUND: The gastrointestinal tract lipomas are a rare, benign, slow-growth condition and can be a diagnostic challenge, they are more frequent in the colon. The gastric lipoma occurs in fewer than 5% of cases, and represents less than 1% of all gastric tumors, usually their finding is incidental and the initial presentation may be obstruction, bleeding and intussusception. The purpose of presenting this case for its rarity, the few symptoms that the patient present and collect the most current information about the diagnosis and treatment. CLINICAL CASE: We report the case of a 59 years-old male patient who after having suffered acute pancreatitis a tomography control was made looking for complications it found a pylorus-duodenal intussusception, an endoscopy was performed and a tumor about 6 cm was found and biopsies without confirm diagnosis, so it was decided to perform a partial gastrectomy, histopathology study confirmed the diagnosis of gastric lipoma as well as disease free margins. Was maintained with adequate postoperative evolution currently asymptomatic. CONCLUSIONS: The gastric lipoma is a rare benign entity that can mimic a malignancy, in our case an incidental finding which was managed by partial gastrectomy with satisfactory postoperative results.

[Adenocarcinoma mucoproductor in Meckel's diverticulum. Case report and review]. / Adenocarcinoma mucoproductor en un divertículo de Meckel. Reporte de caso y revisión del tema.

BACKGROUND: Meckel's diverticulum is the most common congenital anomaly in the small intestine, which results from incomplete obliteration omphalomesenteric duct, usually the diagnosis is incidental, rarely reaching with bleeding, obstruction, diverticulitis or in rare cases a neoplasm. Clinic case: 67 year old woman that started her condition with urinary symptoms (dysuria, frequency, bladder tenesmus and pushing), within the study protocol a cystogram was performed and demonstrated a defect in the bladder dome edges with compression effect, the computed tomography reported a bladder infiltrating hypodense lesion, which is decided to resect finding Meckel's diverticulum with a tumor that infiltrates the bladder dome, the histopathological confirmed the diagnosis shown free edges but insufficient, which need a reintervention to increase margins; all the extension studies shown without tumor activity. CONCLUSIONS: Mucoproductor adenocarcinoma derived from a Meckel's diverticulum is a clinical entity that because of its nonspecific symptomatology and variability of presentation, is diagnosed incidentally on radiological images. The disease has a high mortality rate and a low prevalence.

Antecedentes: el divertículo de Meckel es la anomalía congénita más frecuente en el intestino delgado, que resulta de la obliteración incompleta del conducto onfalomesentérico; su diagnóstico suele ser incidental, pocas veces con sangrado, obstrucción, diverticulitis o en casos raros una neoplasia. Caso clínico: paciente femenina de 67 años de edad, que inició su padecimiento con síntomas urinarios (disuria, polaquiuria, pujo y tenesmo vesical). El cistograma demostró: defecto en el domo de la vejiga, bordes irregulares y efecto de compresión. La tomografía computada reportó: vejiga con lesión hipodensa infiltrante en el domo vesical, al resecarla se encontró un divertículo de Meckel con un tumor infiltrante; el estudio histopatológico confirmó el diagnóstico y demostró los bordes libres; todos los estudios de extensión resultaron sin actividad tumoral. Conclusiones: el adenocarcinoma mucoproductor derivado de un divertículo de Meckel es una entidad clínica que debido a sus síntomas inespecíficos y variabilidad de presentación sólo se diagnostica por lo que se aprecia en las imágenes radiológicas. Este adenocarcinoma tiene un alto índice de mortalidad pero baja prevalencia.

Fractura crónica de hueso hioides / Chronic hyoid fracture

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