["Candy cane" Roux syndrome in laparoscopic gastric by-pass]. / Síndrome del "bastón de caramelo" en derivación gástrica por laparoscopia.

BACKGROUND: With the worldwide epidemic of obesity, there has been an increase in the numbers of procedures of bariatric surgery such as the Roux-en-Y gastric bypass. Nevertheless, this type of surgery is not exempt from complications such as those described as "candy cane" Roux syndrome. CLINICAL CASE: We present the case of a 34-year-old female with previous diagnosis of morbid obesity (BMI 38.5 kg/m(2)) who underwent laparoscopic Roux-en-Y gastric bypass 2 years previously. Six months ago the patient presented intermittent epigastric pain of moderate intensity radiating towards the left hypochondrium. The patient reported no limitations of activities of daily living. Pain was associated with ingestion of carbonated beverages and ventral decubitus position. Upper gastrointestinal (GI) series was done, observing a blind, dilated jejunal loop adjacent to the gastrojejunal anastomosis. Suspicion of "candy cane" Roux syndrome was established. Exploratory laparoscopy and resection of the blind jejunal loop with stapler was done. Nine months later the patient is asymptomatic. CONCLUSIONS: Symptoms of these patients are nonspecific, and a high level of suspicion is required. The best study to evaluate this clinical entity is the upper GI series. The recommendation for bariatric surgeons is to minimize the length of the blind loop in the gastrojejunal anastomosis and to place it towards the right side to favor its drainage by gravity and eliminate problems in the jejuno-jejuno anastomosis that cause a retrograde expansion of the Roux-en-Y limb. Therefore, laparoscopic resection is the best method for the treatment of this syndrome.

Solid pseudopapillary tumor of the pancreas: case report and literature review.

BACKGROUND: Solid pseudopapillary tumor of the pancreas is an epithelial tumor of low malignancy that primarily affects young women and represents approximately 1-2% of all pancreatic neoplasms. We present a case of this type of tumor treated in the General Hospital of Tijuana, Mexico, as well as a review of the literature. CLINICAL CASE: We present the case of a 37-year-old female with symptomatology of early satiety and abdominal distension. During open cholecystectomy we found a tumor in the body of the pancreas. Biopsy was done, establishing the diagnosis of solid pseudopapillary tumor of the pancreas. The patient was treated successfully with distal pancreatectomy and splenectomy. DISCUSSION: Solid pseudopapillary tumor of the pancreas is a rare neoplasm. It is more frequent in young women and has an unknown etiology. Clinical manifestations include abdominal pain, sensation of plenitude or early satiety, abdominal mass, nausea and vomiting. Laboratory tests are usually normal. Computerized axial tomography may show a large encapsulated heterogeneous mass. Diagnosis is established through biopsy and surgery is the best treatment for this pathological entity. CONCLUSIONS: One may conclude that the solid pseudopapillary tumor is a differential diagnosis in the presence of pancreatic tumors, although due to its rarity it is not the first option to discard. Surgery represents the best treatment for this pathological entity and should be attempted in all cases, independent of the size of the pancreatic injury.

Tumor sólido pseudopapilar de páncreas: presentación de un caso y revisión de la literatura / Solid pseudopapillary tumor of the pancreas: case report and literature review

Introducción: El tumor sólido pseudopapilar del páncreas es un tumor epitelial de baja malignidad que afecta a mujeres jóvenes y corresponde de 1 a 2 % de todas las neoplasias del páncreas. Presentamos un caso tratado en el Hospital General de Tijuana, y revisión de la literatura. Caso clínico: Mujer de 37 años de edad, con síntomas de saciedad temprana y distensión abdominal. Durante una colecistectomía abierta se identificó un tumor en el cuerpo del páncreas, se tomó biopsia y estableció el diagnóstico de tumor sólido pseudopapilar páncreas. Fue tratada con pancreatectomía distal y esplenectomía. Conclusiones: El tumor sólido pseudopapilar del páncreas es la neoplasia de etiología desconocida más frecuente en mujeres jóvenes, de diagnóstico diferencial ante tumor en páncreas, aunque por su rareza no debe ser la primera opción a descartar. Las manifestaciones clínicas incluyen dolor abdominal, sensación de plenitud o saciedad temprana, masa abdominal, náusea y vómito, entre otras. Los exámenes de laboratorio por lo general son normales. La tomografía axial computarizada puede revelar masa heterogénea grande con una cápsula. El diagnóstico se realiza mediante biopsia y la cirugía por sí sola tiene un nivel de curación excelente y se debe intentar en todos los casos.

BACKGROUND: Solid pseudopapillary tumor of the pancreas is an epithelial tumor of low malignancy that primarily affects young women and represents approximately 1-2% of all pancreatic neoplasms. We present a case of this type of tumor treated in the General Hospital of Tijuana, Mexico, as well as a review of the literature. CLINICAL CASE: We present the case of a 37-year-old female with symptomatology of early satiety and abdominal distension. During open cholecystectomy we found a tumor in the body of the pancreas. Biopsy was done, establishing the diagnosis of solid pseudopapillary tumor of the pancreas. The patient was treated successfully with distal pancreatectomy and splenectomy. DISCUSSION: Solid pseudopapillary tumor of the pancreas is a rare neoplasm. It is more frequent in young women and has an unknown etiology. Clinical manifestations include abdominal pain, sensation of plenitude or early satiety, abdominal mass, nausea and vomiting. Laboratory tests are usually normal. Computerized axial tomography may show a large encapsulated heterogeneous mass. Diagnosis is established through biopsy and surgery is the best treatment for this pathological entity. CONCLUSIONS: One may conclude that the solid pseudopapillary tumor is a differential diagnosis in the presence of pancreatic tumors, although due to its rarity it is not the first option to discard. Surgery represents the best treatment for this pathological entity and should be attempted in all cases, independent of the size of the pancreatic injury.