Mesenteric root pseudocyst: finding in an asymptomatic patient-a case report.

BACKGROUND: Mesenteric cysts are one of the rarest abdominal tumor masses, representing a little-studied pathology. In turn, the variability and non-specificity of clinical manifestations make diagnosis difficult, as it can be reached by imaging findings due to another cause or by non-specific abdominal pain. CASE PRESENTATION: This article describes the case report of an asymptomatic 28-year-old patient who presented a 6-cm abdominal cystic mass with mixed density, which was found incidentally by computed tomography. Exploratory laparoscopy was performed followed by conversion to conventional surgery to extract the tumor mass. The anatomical pathology diagnosis was pseudocyst of the mesentery root. Mesenteric cysts are one of the rarest abdominal tumor masses, representing a little-studied pathology. In turn, the variability and non-specificity of clinical manifestations make diagnosis difficult, as it can be reached by imaging findings due to another cause or by non-specific abdominal pain. CONCLUSIONS: Mesenteric cysts are rare, and their nonspecific symptoms often lead to diagnosis based on imaging findings. Complete laparoscopic enucleation is the standard treatment.

Pseudoquiste mesentérico: reporte de un caso

Introducción: Los quistes mesentéricos se pueden encontrar a lo largo de todo el mesenterio del intestino. Los pseudoquistes de mesenterio se caracterizan por carecer de revestimiento endotelial. Generalmente son asintomáticos y el diagnóstico se realiza mediante estudios de imagen. Material y Método: Reporte de un caso clínico Resultados: Presentamos el caso de una mujer de 50 años sana que consulta por tumoración indolora en flanco izquierdo. Se solicita TC y RNM donde se visualiza tumoración quistica de paredes finas, homogenea de 88mm de diámetro mayor con septos y tabiques. Se realiza abordaje laparoscópico identificando masa de 12cm que se protruye a nivel del mesenterio de la segunda asa yeyunal, se reseca in incidentes. La anatomía patológica informó pseudoquiste mesentérico, sin elementos de malignidad. Buena evolución posterior. Conclusiones: Los quistes mesentéricos son extremadamente infrecuentes. General-mente se localizan en el mesenterio del intestino delgado como en el caso presentado. Teniendo en cuenta las características histopatológicas, se clasifican en seis grupos. Si bien es excepcional su transformación maligna, el tratamiento consiste siempre en su resección quirúrgica. Se prefiere la laparoscopía por sus conocidos beneficios.

Introduction: Mesenteric cysts can be found throughout the entire intestine mesentery. Mesenteric pseudocysts are characterized by lack of endothelial lining. They are generally asymptomatic and the diagnosis can be made by imaging studies. Material and Method: Report of a clinical case Results: We present the case of a healthy 50-year-old woman consulted for a painless tumor on the left flank. She requested a CT and MRI where a thin-walled, homogeneous cystic tumor of 88mm in greatest diameter with septa and partitions was visualized. A laparoscopic approach was performed identifying a 12cm mass that protruded at the level of the mesentery of the second jejunal loop, it was resected without incident. The pathological anatomy reported a mesenteric pseudocyst, without elements of malignancy. Good subsequent evolution. Conclusions: Mesenteric cysts are extremely rare. They are generally located in the mesentery of the small intestine, as in the case presented. Taking into account the histopathological characteristics, they are classified into six groups. Although its malignant transformation is exceptional, the treatment always consists of its surgical resection. Laparoscopy is preferred for its well-known benefits.

Solitary mesenteric fibromatosis in a male patient: clinical case report.

Mesenteric fibromatosis is a rare tumor that grows slowly and asymptomatically and is more frequent among men. The risk factors described in the literature may not be present in all cases. The clinical presentation is variable and depends on the localization of the tumor and the involvement of surrounding structures. Imaging studies such as abdominal computed tomography and magnetic resonance imaging are the preferred methods for the diagnosis of this tumor. However, a definitive diagnosis is made based on histopathology and immunohistochemistry results. Surgical resection remains the preferred option for the treatment of mesenteric fibromatosis. This report presents a clinical case of mesenteric fibromatosis in a male patient who presented with partial abdominal obstruction and the absence of risk factors for mesenteric fibromatosis.

Giant paratubal cyst: report of a case in second level public hospital.

BACKGROUND: Giant paratubal cysts are mostly benign tumors, with an incidence of 10%. The incidence rate of neoplasms is 2% to 3%, including papillary carcinoma and serous papillary neoplasms. CASE REPORT: A 35-year-old woman who began her current condition 3 years after her pregnancy, with urgency when urinating, abdominal pain and sensation of abdominal mass, who was diagnosed and protocolized in a second public level hospital of the State of Mexico, treated with open surgery, and good postoperative evolution.

ANTECEDENTES: Los quistes paratubáricos gigantes son en su mayoría tumores benignos, con una incidencia del 10%. La tasa de incidencia de neoplasias es del 2 al 3%, incluyendo carcinoma papilar y neoplasias papilares serosas. CASO CLÍNICO: Mujer de 35 años que comenzó su condición actual 3 años después de un embarazo, con urgencia al orinar, dolor abdominal y sensación de masa abdominal, que fue diagnosticada y protocolizada en un hospital público de segundo nivel del Estado de México, tratada con cirugía abierta y con buena evolución posoperatoria.

Feline gastrointestinal eosinophilic sclerosing fibroplasia

A female Persian cat arrives for clinical assessment with a 3-month history of weight loss and sporadic vomiting. The clinical and paraclinical findings were hypodynamia cachexia, leukocytosis and presence of a mass in duodenum. Histopathological evaluation revealed a non-neoplastic tumor proliferation, which was organized into dense, sclerotic-like connective tissue trabeculae that anastomosed, with cells of spindle-shaped morphology, elongated and rounded nuclei with prominent nucleoli and fine granular chromatin. These cells were intermingled with abundant eosinophils and in smaller proportion lymphocytes, macrophages, plasma cells, with transmural distribution. Masson's trichrome differential staining trabeculae of collagen fibers. Based on the clinical and microscopic findings, the diagnosis of feline eosinophilic sclerosing fibroplasia is established, being this pathology's first documented report in Colombia.(AU)

Pseudotumor toraco-abdominal asociado a Bartonella henselae y Eikenella corrodens en un paciente pediátrico inmunocompetente / Thoraco-abdominal pseudotumor associated with Bartonella henselae and Eikenella corrodens in an immunocompetent patient

Resumen Los pseudotumores inflamatorios son poco frecuentes y escasamente descritos en la literatura y han sido asociados a infecciones polimicrobianas. Se presenta el caso de un niño de 9 años, procedente de Bolivia, quien consultó por dolor abdominal, baja de peso y vómitos, diagnosticándose un pseudotumor tóraco-abdominal. El laboratorio clínico, mediante el estudio de biología molecular en tejido, permitió la identificación de uno de los probables agentes etiológicos.

Abstract Inflammatory pseudotumors are a rare pathology and scarcely reported in the literature and have been associated with polymicrobial infections. Here, we present the case of a 9 years old boy from Bolivia, who presented with abdominal pain, weight loss and vomiting, who was diagnosed with a thoraco-abdominal pseudotumor. The micro-biology and molecular laboratories in tissue allowed the identification of one of the probable etiological agents.

El reto del aneurisma de la aorta abdominal para especialistas en medicina general integral e internistas / The challenge of abdominal aortic aneurysm for general practitioners and internists

El aneurisma de la aorta abdominal es una enfermedad asintomática, frecuente en los adultos mayores del sexo masculino. Su aparición está asociada a enfermedades crónicas no transmisibles como la hipertensión arterial, la enfermedad arterial periférica, la diabetes mellitus, entre otras. A nivel comunitario constituye un problema de salud el diagnóstico tardío de la entidad en pacientes con factores de riesgo, por lo que se decide realizar el artículo de revisión con el objetivo de actualizar los aspectos de diagnóstico clínico, imagenológico, terapéutico y la conducta a seguir ante un paciente con sospecha de aneurisma de la aorta. Se realizó una revisión exhaustiva del tema en bases de datos como SciELO, MEDISAN, Revistas de Angiología y Cirugía Cardiovascular. Para lograr mejores resultados en el diagnóstico precoz y la atención a los pacientes con aneurisma de la aorta abdominal, es necesario mantener la actualización del tema, el uso del método clínico y el trabajo en conjunto de la atención primaria con el nivel secundario(AU)

Abdominal aortic aneurysm is an asymptomatic disease, common in older males. Its appearance is associated with chronic non-communicable diseases such as arterial hypertension, peripheral arterial disease, diabetes mellitus, among others. At the community level, the late diagnosis of the entity in patients with risk factors constitutes a health problem, so it was decided to carry out the review article with the aim of updating the clinical, imaging and therapeutic aspects of diagnosis and the behavior to be followed in a patient with suspected aortic aneurysm. We conducted an exhaustive review of the subject in databases such as SciELO, Medisan, Magazines of Angiology and Cardiovascular Surgery. To achieve better results in the early diagnosis and care of patients with abdominal aortic aneurysm, it is necessary to keep up-to-date on the subject, the use of the clinical method, and the joint work of primary care with the secondary level(AU)

Mesenteric cyst presenting with acute abdomen pain and bowel obstruction: Case report and brief literature review.

Mesenteric cysts were first described in 1507 and since then remain as a rare intraabdominal pathology. The etiology of this kind of tumor is still unclear and the classification remains controversial. They are usually asymptomatic, but can also cause acute abdominal pain and sometimes need emergency surgical approach. Clinical history, physical exam and complementary tests do not always provide diagnosis, which in many cases is made after surgery. Surgical management with complete excision of the cyst is the gold standard treatment. Laparoscopy technique should be preferred whenever is possible. The knowledge of these rare tumors is important for considering the correct approach. The goals of this article is to describe a case report of mesenteric cyst presented with acute abdominal pain at the emergency and do a brief literature review about this entity.

Duplicación intestinal en la primera porción del duodeno en neonato / Intestinal Duplication in the First Portion of the Neonatal Duodenum

RESUMEN Se denomina duplicación intestinal a un grupo de malformaciones congénitas de la vía digestiva, de estructuras diverticulares, quísticas o tubulares, que presentan paredes de músculo liso como las del intestino y un revestimiento mucoso de tipo gastrointestinal. Se localiza en cualquier segmento del tubo digestivo, desde la boca hasta el ano. La zona más afectada es el íleon y constituye la causa más frecuente de masa abdominal en el periodo neonatal. El diagnóstico puede ser prenatal a través, de ecografía o resonancia. En el periodo posnatal es la clínica la que establece los indicios para realizar exámenes complementarios, que pueden ir desde ecografía hasta estudios con Tecnecio 99. En la porción duodenal esta enfermedad representa el 5 por ciento de todas las duplicaciones intestinales. La descripción de casos en la primera porción es excepcional, por lo que la consideramos para tener en cuenta como diagnóstico diferencial en las enfermedades tumorales neonatales de origen abdominal(AU)

ABSTRACT Intestinal duplication defines a group of congenital malformations of the digestive tract, of diverticular, cystic or tubular structures, which have smooth muscle walls such as those of the intestine and a gastrointestinal-type mucous lining. It is located in any segment of the digestive tract, from the mouth to the anus. The most affected area is the ileum, while the condition constitutes the most frequent cause of abdominal mass in the neonatal period. The diagnosis can be prenatal through either ultrasound or resonance. In the postnatal period, the clinical indications establish, based on the signs, whether complementary tests are required, which can range from ultrasound to studies with technetium-99. In the duodenal portion, this disease represents 5 percent of all intestinal duplications. The description of cases in the first portion is exceptional, which is the reason why we consider it as a differential diagnosis in neonatal tumor diseases of abdominal origin(AU)

Neuroblastoma infantil: características clínicas, tratamento e prognóstico / Infant neuroblastoma: clinical characteristics, treatment and prognosis

Introdução: O neuroblastoma é a mais prevalente neoplasia abdominal pediátrica com um impacto de 15% da mortalidade total por causa oncológica nessa população. Este trabalho tem como objetivo estabelecer os critérios que levam à suspeição, diagnóstico e tratamento deste tumor. Métodos: Elaborado estudo de revisão bibliográfica entre as principais fontes científicas, realizando uma análise comparativa entre os artigos estudados, desconsiderando informações defasadas ou artigos com baixo impacto científico. Resultados: Este trabalho conseguiu reunir as principais informações acerca do neuroblastoma, possibilitando que este artigo sirva como fonte de estudo para profissionais da saúde. Conclusão: Deve-se suspeitar do diagnóstico de neuroblastoma quando a anamnese e o exame físico estiverem associados ao efeito de massa e a síndromes paraneoplásicas. Apesar do neuroblastoma ser uma doença de métodos diagnósticos e tratamento há muito estabelecidos, novos protocolos de estadiamento têm surgido, aderindo novas informações acerca de fatores de risco e predisposições genéticas.

Introduction: Neuroblastoma is the most prevalent abdominal neoplasia among pediatric patients, with an impact of 15% of total mortality of oncologic causes in this population. This article aims to identify the criteria that leads to the suspicion, diagnosis and treatment of the tumor. Methods: We reviewed works in several databases, while doing a comparative analysis of the chosen articles, excluding outdated or with low scientific impact information. Results: This article has managed to summarize the main information about neuroblastoma, allowing it to serve as a go-to source for health professionals. Conclusion: The diagnosis of neuroblastoma should be suspected when anamnesis and physical examination are associated with mass effect and paraneoplastic syndromes. Despite neuroblastoma being a disease with diagnostic methods and treatment long established, new protocol of staging have been emerging, adding new information about risk factors and genetic predispositions.

An unusual abdominal wall mass in a child

ABSTRACT Abdominal tumors are one of the most common types of pediatric cancer. Therefore, they should always be included in the differential diagnosis of abdominal masses. Here, we present the case of a child whose initial hypothesis of diagnosis contemplated this possibility. Later, it was demonstrated that the abdominal mass found was secondary to a common parasitosis. A 2-year old, moderately malnourished and pale white boy was referred with a history of a rapidly growing, well-limited, middle abdominal mass. The mass was 10 by 3 cm, hard and poorly movable, apparently involving both abdominal rectus muscles. A complete resection was performed, revealing an abdominal wall abscess, with intense eosinophilic proliferation, secondary to a local and intense reaction to innumerous Ascaris lumbricoides eggs. Extra luminal infestations with Ascaris, that usually form peritoneal granulomas have been previously described. However, neither external trauma nor fistula, that could explain the superficial presence of the eggs, was found. This description reinforces the relevance of infectious diseases within the differential diagnosis of abdominal masses, particularly in areas with high prevalence of parasitic infestations.

Estudio de una masa abdominal en pediatría: revisión de la literatura / Study of an abdominal mass in pediatrics: review of the literature

Alrededor del 20 por ciento de los tumores diagnosticados en pediatría corresponden a masas intraabdominales y de ellos, el 20 por ciento son tumores malignos, por lo que un alto índice de sospecha asociado a un diagnóstico precoz pueden incidir positivamente en el pronóstico de los pacientes. El objetivo de este trabajo fue realizar una revisión actualizada de la literatura disponible sobre el estudio de una masa abdominal en pediatría, enfocado principalmente en la epidemiología y orientación diagnóstica que debería seguir el médico al enfrentarse a un paciente con este hallazgo. La forma de presentación clínica de una masa abdominal es variable. En un número importante de pacientes será de forma asintomática, lo que dificulta el diagnóstico precoz, por lo que es necesario mantener un alto índice de sospecha frente esta patología. Como herramientas para la evaluación de una masa abdominal contamos cada vez más con exámenes radiológicos, marcadores tumorales e histología, sin embargo, los exámenes deben realizarse orientados a comprobar la sospecha diagnóstica que obtengamos de una completa anamnesis y examen físico.

About 20 percent of the tumors diagnosed in pediatric patients correspond to intraabdominal masses. These can correspond to both benign and malignant pathology. Moreover, 20 percent of solid malignant tumors are located in the abdomen, so a high index of suspicion associated with an early diagnosis can positively affect the prognosis of these patients. The clinical presentation of an abdominal mass is variable. A significant number of patients will be asymptomatic, which makes early diagnosis difficult. This is why it is necessary to maintain a high index of suspicion in this pathology. As tools for the evaluation of an abdominal mass, we are increasingly counting on radiological examinations, tumor markers and histology. However, the examinations must be carried out in order to verify the diagnostic suspicion that we obtain from a complete anamnesis and physical examination. The objective of this work was to perform an updated review of the available literature on the study of abdominal mass in pediatrics, focused mainly on the epidemiology and diagnostic orientation that should be followed by the physician when confronting a patient with this finding.

Tumores del estroma gastrointestinal: revisión de nuestra experiencia / Surgery of gastrointestinal stromal tumors: review of our experience in the last five years

Objective: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract. Surgical resection is the standard treatment for localized primary GISTs. The aim of the study is to present our 5-year surgical experience, as well as the results obtained in terms of survival and disease progression. Material and Method: We conducted a descriptive, retrospective study of primary GISTs treated in our center between 2009-2013. We analyze the most relevant variables, criteria of risk of progression according Fletcher's classification from National Institutes of Health and the Miettinem's classification from the Armed Forces Institute of Pathology, as well as analysis of relapse-free survival (RFS) with Kaplan-Meier survival curves. Results: We present a series of 30 patients. Mean age 65 years (40-84 years). The most common location was the stomach (n = 14, 46.6 percent). The surgery was R0 in 23 cases of 30. The mean tumor diameter was 5.3 cm (0.5-18). 14 patients received adjuvant treatment with Imatinib. After an average follow-up of 31.2 months (6-62 months), it was found relapse in 4 patients, progression and exitus in 1, exitus in 3 and exitus in the immediate postoperative period in 1. RFS at one year was 96.7 percent, and 89.2 percent at 4 years. Mean survival time was 56.2 months (95 percent CI 51.8-60.6). Conclusion: The recommended attitude after radical surgery is follow-up. In selected patients with risk of relapse, adjuvant treatment with Imatinib delays the progression of the disease and increases the survival.

Objetivo: Los tumores del estroma gastrointestinal son las neoplasias mesenquimales más frecuentes del tubo digestivo. La resección quirúrgica es el tratamiento estándar en los GISTs primarios localizados. El objetivo del estudio es presentar nuestra experiencia quirúrgica en 5 años, así como los resultados obtenidos en cuanto supervivencia y progresión de la enfermedad. Material y Método: Serie de casos, estudio observacional descriptivo retrospectivo, que analiza los resultados obtenidos en cuanto al tratamiento quirúrgico de GIST primarios sometidos a resección quirúrgica en nuestro centro entre 2009-2013. Todas las intervenciones fueron realizadas por personal del Staff y dentro de los protocolos de las unidades de cirugía hepato-biliar y esófago-gástrica. Se analizan las variables de mayor relevancia, criterios de riesgo de progresión según la clasificación de Fletcher del National Institutes of Health y la clasificación de Miettinem del Armed Forces Institute of Pathology, así como análisis de la supervivencia libre de recaída (SLR) con curvas de Kaplan-Meier. Resultados: Presentamos una serie de 30 pacientes. Edad media de 65 años (40-84 años). La localización más frecuente fue estómago (n = 14, 46,6 por ciento). La cirugía fue R0 en 23 de los 30 pacientes. El diámetro tumoral medio fue de 5,3 cm (0,5-18, con una mediana de 4 cm. Catorce pacientes recibieron tratamiento adyuvante con Imatinib. Tras un seguimiento medio 31,2 meses (6-62 meses), se detectó recaída en 4 pacientes, progresión y exitus en 1, exitus en 3 y exitus en el postoperatorio inmediato en 1. La SLR al año fue del 96,7 por ciento, siendo del 89,2 por ciento a los 4 años. El tiempo medio de supervivencia fue de 56,2 meses (IC 95 por ciento 51,8-60,6). Conclusiones: La actitud recomendada tras una cirugía radical es el seguimiento. En pacientes seleccionados con riesgo de recaída el tratamiento adyuvante con Imatinib retrasa la progresión de la enfermedad y aumenta la supervivencia.

[Abdominal wall actinomycosis. A report of a case]. / Actinomicosis de pared abdominal. A propósito de un caso.

BACKGROUND: Abdominal wall Actinomycosis is a rare disease associated with the use of intrauterine device and as a complication of abdominal surgery. Diagnosis is difficult because it is unusual and behaves like a malignant neoplasm. AIM: A case report is presented of a patient who had used an intrauterine device for four years and developed a stony tumour in the abdominal wall associated with a set of symptoms that, clinically and radiologically, was simulating a peritoneal carcinomatosis associated with paraneoplastic syndrome, even in the course of an exploratory laparotomy. CLINICAL CASE: The patient attended our hospital with a two-month history of abdominal pain and symptoms that mimic a paraneoplastic syndrome. The diagnosis of abdominal actinomycosis was suspected by the finding of the microorganism in cervical cytology together with other cultures and Actinomyces negative in pathological studies, confirming the suspicion of a complete cure with empirical treatment with penicillin. CONCLUSIONS: Actinomycosis should be considered in patients with pelvic mass or abdominal wall mass that mimics a malignancy. Antibiotic therapy is the first treatment choice and makes a more invasive surgical management unnecessary.

Quiste gigante de mesenterio en un recién nacido: Reporte de un caso / Giant mesenteric cyst in a newborn: Report of a case

Se reporta el caso de una recién nacida, quien fuera ingresada al Servicio de Urgencia por distensión abdominal, dolor y vómito. Inicialmente se le dio manejo médico, pero posteriormente le fue identificada una masa en el hemiabdomen derecho que desplazaba a las vísceras. Es por ello que el Servicio de Cirugía Pediátrica decidió realizar intervención quirúrgica. En la cirugía, se encontró una tumoración a expensas del quiste de mesenterio, que posteriormente fue drenado en el transquirúrgico. El postoperatorio fue satisfactorio. El objetivo de este artículo es informar el caso de un neonato con un quiste de mesenterio y efectuar la revisión de la patología con la finalidad de establecer el abordaje diagnóstico y terapéutico. El quiste del mesenterio es una patología muy poco frecuente, el cual se define como cualquier lesión quística localizada en el mesenterio y se subdivide, según su origen, en tumores linfáticos, mesoteliales, urogenitales, dermoides, entéricos y pseudoquísticos. Los casos más frecuentes son los linfangiomas benignos producidos por la proliferación de tejido linfático ectópico. Generalmente se presentan en el mesenterio del intestino delgado o en el epiplón. Respecto al abordaje-diagnóstico, los estudios de imagen, para que sean de mayor utilidad, deben estar orientados con base en la historia clínica y la exploración física, siguiendo un orden en la realización de los mismos. El manejo definitivo es la exéresis o el drenaje, aun en casos asintomáticos.

We report the case of a newborn who was admitted for emergency service due to abdominal pain, distension and vomit. Initially medical treatment was given, but subsequently an abdominal mass was identified, so the pediatric surgery service decided to carry out a surgical intervention. At surgery a mass at the expense of mesenteric cyst was found. The cyst was drained in the trans-surgical. The postoperative course was satisfactory. The objective of the paper is to report the case of a newborn with a mesenteric cyst and review this pathology in order to establish the diagnosis and therapeutic approach. Mesenteric cyst is a rare disease defined as any cystic lesion in the mesentery. It is divided according to their origin in lymphoid tumors, mesothelial, urogenital, dermoid, and enteric pseudocystic. The most frequent cases are benign lymphangiomas produced by the proliferation of ectopic lymphoid tissue. Usually occur in small bowel mesentery or omentum. Regarding the diagnostic approach, the imaging studies should be oriented on the basis of clinical history and physical examination, following an order in conducting such studies. The definitive management is the excision or drainage, even in asymptomatic cases.

Autoimmune pancreatitis / Pancreatitis autoinmunitaria

We report the case of a 70-year-old male with chronic abdominal pain, who presented with increased intensity of the pain, and was initially diagnosed and treated for acute biliary pancreatitis. However, the symptoms persisted after hospital discharge, and he was subsequently studied with cholangio-MRI, abdominal CT scan, and ERCP, which revealed dilation of the biliary tract and a mass in the head of the pancreas. An excisional biopsy of the lesion showed chronic inflammation with severe sclerosing fibrosis and a lymphoplasmacytic infiltrate. A diagnosis of autoimmune pancreatitis was made, and the patient was initiated on azathioprine with good clinical response.

Presentamos el caso de un varón de 70 años con dolor abdominal crónico, que se presenta con aumento de este; se le diagnostica y se lo trata inicialmente como cuadro de pancreatitis biliar. A pesar del manejo inicial, los síntomas persisten después de la primera hospitalización, y se estudia con tomografía computarizada de abdomen, colangiorresonancia y colangiopancreatografía retrograda endoscópica, estudios en los cuales se detecta dilatación de la vía biliar y masa en la cabeza del páncreas. Se llevó a cabo biopsia excisional, que demuestra inflamación crónica con intensa fibrosis e infiltrado linfocitario. Se hace diagnóstico de pancreatitis autoimmunitaria y se inicia azatioprina, con adecuada respuesta.

Pseudoaneurisma de la arteria pancreaticoduodenal. Presentación de caso / Pduodenal pancreatic artery pseudoaneurysm. Case report

Introducción: el pseudoaneurisma es una lesión que puede afectar la pared de una arteria o del corazón .Se produce como resultado de inflamación, trauma o iatrogenia. Su diagnóstico es cada vez más frecuente con la introducción de técnicas imagenológicas como la Ecografía Doppler, la Angio tomografía, la imagen por Resonancia magnética (IRM) y la Angiografía por sustracción digital. Objetivos: enfatizar en el diagnóstico del pseudoaneurisma arterial basado en los hallazgos clínicos de una masa abdominal palpable asociada a dolor abdominal difuso y resaltar los estudios imagenológicos que contribuyeron al diagnóstico y tratamiento. Presentación del caso: en este reporte se presenta un caso de una paciente de 72 años quien acude a la Sala de Emergencias con dolor abdominal difuso y se constata una masa abdominal palpable. Conclusiones: la combinación de varios estudios imagenológicos fue muy útil para definir el diagnóstico.

Introduction: pseudoaneurysms arise from a disruption in arterial or heart wall continuity resulting from inflammation, trauma, or iatrogenic causes such as surgical procedures. The advent of new radiologic techniques, such as Doppler echography, angyo tomography, magnetic resonance imaging (MRI) and subtraction digital angiography, with a greater sensitivity for asymptomatic disease has allowed more frequent diagnosis of pseudo aneurysms. Objectives: to emphasize in the diagnosis of arterial pseudo aneurysms based on the clinical findings of an abdominal mass associated with generalized abdominal pain and to enhance the imagenologic studies that contributed to the diagnosis and treatment. Case report: this report presents a case of a 72 year old patient who came to the emergency room with generalized abdominal pain. It was identified a palpable hemiabdominal mass. Conclusions: the combination of imaging studies was helpful in establishing the diagnosis.

Tumor miofibroblastico inflamatorio: presentación de dos casos pediátricos / Inflammatory myofibroblastic tumor: presentatiom of two pediatric cases

El tumor miofibroblástico inflamatorio tiene un comportamiento predominantemente benigno pero en ocasiones puede mostrar grados variables de agresividad. Se localiza en diferentes órganos, el pulmón es el sitio más frecuente, seguido por la cavidad abdominal. Se presentan 2 casos con tumor miofibroblástico inflamatorio. Caso N° 1 femenino de 5 años con palidez cutáneo mucosa, hiporexia, dolor abdominal, fiebre, soplo cardíaco y hepatoesplenomegalia. Ultrasonido, tomografía y estudio radiológico contrastado: tumor en cuerpo gástrico con engrosamiento de sus paredes sugestivo de enfermedad linfoproliferativa. Estudio endoscópico: lesión verrugosa, en curvatura mayor y cuerpo alto. Biopsia: no concluyente. Caso N° 2 femenino de 14 años con estreñimiento agudo, dolor abdominal, masa palpable en mesogastrio e hipogastrio. Ultrasonido y tomografía: lesión ocupante de espacio en mesenterio, quística. Las dos pacientes presentaron anemia severa, leucocitosis y trombocitosis. Se realizó laparotomía exploradora en ambas, caso N° 1: tumor sólido en curvatura mayor gástrica, se hizo resección completa mediante gastrectomía parcial. Caso N° 2: tumor que surge del mesocolon transverso, quístico, ocupando todo el abdomen, 90% fue resecado. Diagnosticó histopatológico: tumor miofibroblástico inflamatorio. Evolución satisfactoria en ambos casos. Esta neoplasia debe sospecharse en niños para evitar terapias radicales, la cirugía conservadora es suficiente como tratamiento en la mayoría de los casos

The inflammatory myofibroblastic tumor behaves predominantly benign but can sometimes show varying degrees of aggressiveness. It is located in different organs, the lung is the most frequent, followed by the abdominal cavity. We present 2 cases of inflammatory myofibroblastic tumor. Case No. 1 female 5 years old with pale skin mucosa, anorexia, abdominal pain, fever, heart murmur, and hepatosplenomegaly. Ultrasound, CT and contrast radiological study: tumor in the stomach with thickening of their walls suggestive of lymphoproliferative disease. Endoscopic Study: warty lesion on greater curvature and high body. Biopsy inconclusive. Case No. 2 female 14 years with severe constipation, dominal pain, palpable mass in mesogastrium and hypogastric. Ultrasound and CT: space-occupying lesion in the mesentery, cystic. The two patients had severe anemia, leukocytosis and thrombocytosis. Laparotomy was performed in both Case No. 1: solid tumor greater curvature gastric resection was completed by partial gastrectomy. Case No. 2: tumor that arises from the transverse mesocolon, cystic, occupying the entire abdomen, 90% were resected. Pathological diagnosis: inflammatory myofibroblastic tumor. Satisfactory in both cases. This neoplasm should be suspected in children to prevent radical therapies, surgery, conservative treatment is sufficient in most cases

Actinomycosis of the colon with invasion of the abdominal wall: An uncommon presentation of a colonic tumour.

Actinomycosis is an uncommon chronic suppurative infectious disease that is caused by Actinomycetes organisms, which are gram-positive, microaerophilic, anaerobic bacteria. The most common type causing disease in humans is Actinomyces israelii. This organism is a commensal of the human mouth and is seldom pathogenic. When it does cause disease, however, three main clinical types of involvement are recognized including cervico-facial, thoracic and abdominal actinomycosis.Herein, we present the case of a 79-year-old male patient who underwent surgical exploration following presentation with abdominal pain and an abdominal mass, initially thought to be a malignancy. Pathologic examination confirmed this as a case of abdominal actinomycosis. This diagnosis should always be included in the differential diagnosis of patients who present with an infiltrative abdominal mass.

Secuestro pulmonar infradiafragmático asociado a malformación adenomatoidea quística congénita / Infradiaphragmatic pulmonary sequestration combined with cystic adenomatoid malformation

El secuestro pulmonar (SP) es raro, es la presencia de tejido pulmonar no unido al resto del pulmón pudiendo ser intralobar o extralobar (más común). El diagnóstico definitivo de una masa abdominal superior fetal sólo puede hacerse después del nacimiento, tras una serie de revisiones ultrasonográficas o de imágenes. Presentamos caso clínico de primigesta, 34 años. Ecografía en la 17ª semana: imagen multiquística de 15 mm de diámetro en polo superior del riñón izquierdo fetal. Cariotipo fetal tras amniocentesis: 46 XX. Ecografía en la 20ª semana: ausencia de otras alteraciones estructurales. Ecografía en la 33ª semana: imagen multiquística de 20 mm de diámetro, independiente del riñón. Se sugiere diagnóstico de neuroblastoma suprarrenal izquierdo. En la 39ª semana: nacido de 3160 gramos, Apgar de 9/10, sin complicaciones. Ecografía neonatal: tumoración mixta de predominio líquido de 3 cm de diámetro sobre el riñón izquierdo pero independiente. Resonancia magnética: masa adrenal izquierda compatible con neuroblastoma. Al 36º día de vida: laparotomía subcostal izquierda, riñón y glándulas suprarrenales izquierdas normales, comprimidos por tumor quístico de 3 x 2,5 cm, semisólido, adherido al diafragma. Extirpación completa. Diagnóstico anatomopatológico: secuestro pulmonar infradiafragmático con cambios de malformación adenomatoidea congénita de tipo II. Los tumores abdominales constituyen el 5 % de las anormalidades detectadas en ecografía prenatal. El diagnóstico diferencial incluye neuroblastoma, hemorragia adrenal, tumores renales, teratomas y secuestro pulmonar extralobar intraabdominal (SPEI). El SPEI constituye el 2 a 5 % de los secuestros pulmonares y tiene una alta incidencia de coexistencia con MAQC tipo II.

The pulmonary sequestration (SP) is rare and characterized by the presence of pulmonary tissue not joined to the rest of the normal lung. It could be intralobar or more commonly extralobar. The definite diagnosis of a fetal upper abdominal mass can be made only after birth and following a series of ultrasonographic or image exams. We present the clinical case of a primipara of 34 years old. A 17th week ultrasound showed a multicystic image of 15 mm diameter in the upper pole of the fetal left kidney. The fetal cariotype after amniocentesis was 46 XX. The 20th week ultrasound showed the absence of other structure alterations. The 33th week ultrasound showed a multicystic image of 20mm diameter separated from the kidney. A diagnosis of left adrenal neuroblastoma is suggested. The labor occurred at 39th week with a newborn of 3,160 grams, Apgar of 9/10 without complications. The neonatal ultrasound revealed a mixed tumor of liquid predominance of 3 cm diameter above but independent from the left kidney. A magnetic resonance imaging showed a left adrenal mass compatible with a neuroblastoma. At the 36th day of life, a left subcostal laparotomy showed a normal left kidney and left suprarenal glandules compressed by a semisolid cystic tumor of 3 x 2.5 cm adhered to diaphragm. A complete extirpation was carried out and the anatomopathological diagnosis showed an infradiaphragmatic pulmonary sequestration combined with a type II cystic adenomatoid malformation. Abdominal tumors represent 5 % of the abnormalities detected in prenatal ultrasound. The differential diagnosis includes neuroblastoma, adrenal hemorrhage, kidney tumors, teratomas and intraabdominal pulmonary sequestration (IPS). The IPS constitutes 2 to 5 % of the pulmonary sequestration and has a high frequency of coexistence with type II cystic adenomatoid malformation.