[Teres ligament hemangioma: laparoscopic approach]. / Hemangioma del ligamento redondo: resección laparoscópica.

Hemangiomas are benign vascular tumors, whose origin comes from the embryonic mesodermal tissue remains. The liver is the most common location. Its location in the teres ligament is extremely rare. This is a 59 years old male admitted because of episodes of epigastric pain for six months. A CT scan and MRI demostrated a 2 cm diameter lesion located near the Teres ligament. Laparoscopic resection was performed. Hemangiomas are the most common benign solid tumors located in the liver. They represents 73% of all benign liver tumors. MRI is the imaging of greater certainty for diagnosis. The Teres ligament (ligamentum teres hepatis) is a fibrous cord resulting in obliteration of the umbilical vein. The location of hemangiomas in this region is extremely rare but should be considered and should make the differential diagnosis with a pedicled hepatic hemangioma or gastointestinal stromal tumors.

Most common robotic bariatric procedures: review and technical aspects.

Since its appear in the year 1997, when Drs. Cadiere and Himpens did the first robotic cholecystectomy in Brussels, not long after the first cholecystectomy, they performed the first robotic bariatric procedure. It is believed that robotically-assisted surgery's most notable contributions are reflected in its ability to extend the benefits of minimally invasive surgery to procedures not routinely performed using minimal access techniques. We describe the 3 most common bariatric procedures done by robot. The main advantages of the robotic system applied to the gastric bypass appear to be better control of stoma size, avoidance of stapler costs, elimination of the potential for oropharyngeal and esophageal trauma, and a potential decrease in wound infection. While in the sleeve gastrectomy and adjustable gastric banding its utility is more debatable, giving a bigger advantage during surgery on patients with a very large BMI or revisional cases.

[Gastric Bypass versus Sleeve gastrectomy: comparison between type 2 Diabetes weight loss and complications. Review of randomized control trails]. / Bypass gástrico vs manga gástrica: comparación de resultados sobre diabetes tipo 2, descenso de peso y complicaciones. Revisión de ensayos clínicos controlados aleatorizados.

INTRODUCTION: Obesity today is a major health problem worldwide and the leading health problem in Western countries because it is associated with multiple comorbidities that increase the mortality of these patients. MATERIAL AND METHODS: A review of the literature was done in PubMed (Medline) and Cochrane Library of randomized controlled trials comparing gastric bypass with sleeve gastrectomy in the treatment of obesity and type 2 diabetes mellitus (T2DM). Eighteen papers were found, of which eleven met the initial inclusion criteria. DISCUSSION: The variables analyzed to determine the superiority of one technique over the other were: the percentage ofexcess BMI lost (% EIMCP), the percentage of excess weight loss (% EPP), BMI at the end of the study, lost Kg and the percentage of weight lost. Regarding the control of T2DM fasting glycemia, the glycosylated hemoglobin (HbAlc), whether or not oral agents or insulin were considered. CONCLUSION: No highlighting differences in results that can be obtained with RYGB and MG to control obesity and T2DM. Either method achieves excellent results, even surpassing those obtained with dietary, pharmacological and behavioral treatment.

Late surgical complications after gastric by-pass: a literature review.

INTRODUCTION: Gastric bypass is today the most frequently performed bariatric procedure, but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the late ones. METHOD: Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English. RESULTS: There were selected 35 studies that matched the headings. Late complications were considered as: anastomotic strictures, marginal ulceration and gastrogastric fistula. CONCLUSION: Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.

Late surgical complications after gastric by-pass: a literature review / Complicações cirúrgicas tardias após bypass gástrico: revisão da literatura

INTRODUCTION: Gastric bypass is today the most frequently performed bariatric procedure, but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the late ones. METHOD: Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English. RESULTS: There were selected 35 studies that matched the headings. Late complications were considered as: anastomotic strictures, marginal ulceration and gastrogastric fistula. CONCLUSION: Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention. .

INTRODUÇÃO: O bypass gástrico é hoje o procedimento bariátrico mais realizado, mas, apesar disso, várias complicações podem ocorrer com variada morbimortalidade. Provavelmente todos os cirurgiões bariátricos conhecem essas complicações, mas como a cirurgia bariátrica continua a se espalhar, o cirurgião geral deve estar familiarizado com essas complicações e seu manuseio. As complicações do bypass gástrico podem ser divididas em dois grupos: as precoces e tardias, tendo em conta o período de duas semanas após a operação. Este artigo irá focar as tardias. MÉTODO: Foi realizada revisão da literatura utilizando as bases Medline/PubMed, Cochrane Library, SciELO, e informações adicionais sobre sites institucionais de interesse cruzando os descritores: bypass gástrico AND complicações; seguimento AND complicações; complicações pós-operatórias AND anastomose, Roux-en-Y; obesidade AND complicações pós-operatórias. A língua usada para a busca foi o inglês. RESULTADOS: Foram selecionados 35 estudos que combinavam com os descritores. As complicações tardias foram consideradas como: estenose de anastomose, ulceração marginal e fístula gastrogástrica. CONCLUSÃO: O conhecimento sobre as estratégias de como reduzir o risco e incidência das complicações deve ser adquirido ao longo do tempo, e cada cirurgião deve estar familiarizado com essas complicações, a fim de reconhecê-las precocemente e realizar a melhor intervenção. .

Early surgical complications after gastric by-pass: a literature review.

INTRODUCTION: Gastric bypass is today the most frequently performed bariatric procedure,but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the early ones. METHOD: Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English. RESULTS: There were selected 26 studies that matched the headings. Early complications included: anastomotic or staple line leaks, gastrointestinal bleeding, intestinal obstruction and incorrect Roux limb reconstruction. CONCLUSION: Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention.

Total gastrectomy due to ferric chloride intoxication.

INTRODUCTION: The ferric chloride intoxication is frequently caused by accident. Its toxicity is generally underrated, which can lead to fatal evolution or irreversible consequences. In this case, the caustic condition of the substance is related to the toxic properties of iron. CASE PRESENTATION: A 36-year-old male patient arrives by ambulance indicating sensory deterioration. He presents erosive injuries in the buccal cavity and in the oropharynx, brownish teeth and metabolic acidosis. Toxicology tests and ferritin blood dosage are requested, which show a result from 1400 mg/dl. The symptoms are interpreted as acute iron intoxication. Due to the unfavorable evolution of his condition, an abdominal and pelvic CT scan are performed, which show extensive pneumoperitoneum and free fluid in the abdominal cavity. An exploratory laparotomy, a total gastrectomy with esophagostomy and feeding jejunostomy, washing and drainage due to perforated gastric necrosis caused by caustic ingestion are performed. DISCUSSION: In our country, there is a high rate of intoxication caused by iron compounds, although it is not statistically measured. Nevertheless, the ferric chloride intoxication is extremely infrequent. The ingestion of this product leads to complications, which are associated with the iron concentration and its condition as a caustic agent. CONCLUSIONS: The surgical indications in the presence of intoxication caused by iron compounds are: stomach evacuation of iron, gastric necrosis, perforation or peritonitis and stenosis. Early or prophylactic gastrectomy is contraindicated. However, if complications that require immediate surgical intervention arise, there should be no hesitation and the corresponding procedure should be performed.

Early surgical complications after gastric by-pass: a literature review / Complicações cirúrgicas precoces após bypass gástrico: revisão da literatura

INTRODUCTION: Gastric bypass is today the most frequently performed bariatric procedure,but, despite of it, several complications can occur with varied morbimortality. Probably all bariatric surgeons know these complications, but, as bariatric surgery continues to spread, general surgeon must be familiarized to it and its management. Gastric bypass complications can be divided into two groups: early and late complications, taking into account the two weeks period after the surgery. This paper will focus the early ones. METHOD: Literature review was carried out using Medline/PubMed, Cochrane Library, SciELO, and additional information on institutional sites of interest crossing the headings: gastric bypass AND complications; follow-up studies AND complications; postoperative complications AND anastomosis, Roux-en-Y; obesity AND postoperative complications. Search language was English. RESULTS: There were selected 26 studies that matched the headings. Early complications included: anastomotic or staple line leaks, gastrointestinal bleeding, intestinal obstruction and incorrect Roux limb reconstruction. CONCLUSION: Knowledge on strategies on how to reduce the risk and incidence of complications must be acquired, and every surgeon must be familiar with these complications in order to achieve an earlier recognition and perform the best intervention. .

INTRODUÇÃO: O bypass gástrico é hoje o procedimento bariátrico mais realizado, mas, apesar disso, várias complicações podem ocorrer com variada morbimortalidade. Provavelmente todos os cirurgiões bariátricos conhecem essas complicações, mas como a cirurgia bariátrica continua a se espalhar, o cirurgião geral deve estar familiarizado com essas complicações e seu manuseio. As complicações do bypass gástrico podem ser divididas em dois grupos: as precoces e tardias, tendo em conta o período de duas semanas após a operação. Este artigo irá focar as precoces. MÉTODO: Foi realizada revisão da literatura utilizando as bases Medline/PubMed, Cochrane Library, SciELO, e informações adicionais sobre sites institucionais de interesse cruzando os descritores: bypass gástrico AND complicações; seguimento AND complicações; complicações pós-operatórias AND anastomose, Roux-en-Y; obesidade AND complicações pós-operatórias. A língua usada para a busca foi o inglês. RESULTADOS: Foram selecionados 26 artigos que combinavam com os descritores. As complicações imediatas foram: fístula na linha de grampeamento, sangramento gastrointestinal, obstrução intestinal e reconstrução incorreta da alça em Roux. CONCLUSÃO: O conhecimento sobre as estratégias de como reduzir o risco e incidência das complicações deve ser adquirido ao longo do tempo, e cada cirurgião deve estar familiarizado com essas complicações, a fim de reconhecê-las precocemente e realizar a melhor intervenção. .

Mediastinitis necrotizante descendente: dieciseis años de experiencia / The descending necrotizing mediastinitis

Antecedentes: La mediastinitis necrotizante descendente es una entidad poco frecuente de alta mortalidad que se origina en procesos sépticos orofaríngeos o cervicales mal drenados. El pasaje de material infectado se realiza a través del espacio parafaríngeo, y de allí por el espacio retrovisceral hacia el mediastino posterior.Objetivos: Definir los parámetros para diagnosticar en forma temprana esta afección y lograr así instaurar rápidamente la conducta quirúrgica agresiva que nos permita disminuir la elevada tasa de mortalidad de esta severa complicación. Lugar de aplicación: Hospital nacional universitario. Diseño: Retrospectivo y descriptivo. Población: Práctica hospitalaria. Material y método: Entre 1995 y 2011 fueron tratados 12 pacientes con mediastinitis necrotizante (7 hombres y 5 mujeres). El foco fue absceso dentario en 9 y absceso amidgalino, absceso pos-fractura de maxilar y mastoiditis, en 1 caso respectivamente. Todos presentaron edema cervical, fiebre y dolor y fueron estudiados con radiología convencional y TAC cervicotorácica de inicio. El tiempo de demora entrela primera consulta y la atención en nuestro hospital fue de más de 72 hs en el 75% de los pacientes. Todos fueron operados por un doble abordaje, cervical y torácico. A 4 pacientes se les realizó abordaje torácico bilateral.Resultados: Las complicaciones fueron: distres respiratorio en 7, bronconeumonía en 3, hemorragia cervical e infección urinaria en1. Fueron reoperados 4 paciente. La mortalidad fue del 33% (4 de 12 pacientes).Conclusión: Si bien la mediastinitis necrotizante descendente es una entidad rara, su gravedad obliga a considerarla como complicaciónante todo absceso cervical no drenado. La TAC cervicotorácica en estos pacientes, sumada a una conducta terapéutica quirúrgica agresivason las claves para un diagnostico precoz y un tratamiento efectivo.

Mediastinitis necrotizante descendente: Dieciséis años de experiencia

Antecedentes: La mediastinitis necrotizante descendente es una entidad poco frecuente de alta mortalidad que se origina en procesos sépticos orofaríngeos o cervicales mal drenados. El pasaje de material infectado se realiza a través del espacio parafaríngeo, y de allí por el espacio retrovisceral hacia el mediastino posterior. Objetivos: Definir los parámetros para diagnosticar en forma temprana esta afección y lograr así instaurar rápidamente la conducta quirúrgica agresiva que nos permita disminuir la elevada tasa de mortalidad de esta severa complicación. Lugar de aplicación: Hospital nacional universitario. Diseño: Retrospectivo y descriptivo. Población: Práctica hospitalaria. Material y método: Entre 1995 y 2011 fueron tratados 12 pacientes con mediastinitis necrotizante (7 hombres y 5 mujeres). El foco fue absceso dentario en 9 y absceso amidgalino, absceso pos-fractura de maxilar y mastoiditis, en 1 caso respectivamente. Todos presentaron edema cervical, fiebre y dolor y fueron estudiados con radiología convencional y TAC cervicotorácica de inicio. El tiempo de demora entre la primera consulta y la atención en nuestro hospital fue de más de 72 hs en el 75% de los pacientes. Todos fueron operados por un doble abordaje, cervical y torácico. A 4 pacientes se les realizó abordaje torácico bilateral. Resultados: Las complicaciones fueron: distres respiratorio en 7, bronconeumonía en 3, hemorragia cervical e infección urinaria en 1. Fueron reoperados 4 paciente. La mortalidad fue del 33% (4 de 12 pacientes). Conclusión: Si bien la mediastinitis necrotizante descendente es una entidad rara, su gravedad obliga a considerarla como complicación ante todo absceso cervical no drenado. La TAC cervicotorácica en estos pacientes, sumada a una conducta terapéutica quirúrgica agresiva son las claves para un diagnostico precoz y un tratamiento efectivo.(AU)

Background: The descending necrotizing mediastinitis is a slightly frequent entity of high mortality that originates itself in septic oropharyngeal processes or poorly drained cervicals. The passage of infected material is realized across the parapharyngeal area and hence for the retrovisceral area towards the back mediastinum. Objective: To define the diagnostic parameters to recognize prematurely this affection and to select rapidly the effective surgical treatment which help us diminish the high rate of mortality of this severe complication. Setting: University Nacional Hospital. Design: Retrospective and descriptive. Population: Hospital practice. Material and method: Between 1995 and 2011, 12 patients, including seven men and five women were treated with necrotizing mediastinitis. The critical area was an abscess toothwort for 9 and tonsil abscess for 2, abscess post-fractures of maxillary and mastoiditis in 1 respectively. They all presented cervical edema, fever and pain and they were studied by conventional radiology and cervicothoracic TAC in the beginning. The time of delay between the first consult and the visit in our hospital was over 72 h. in 75% of the cases. They all were treated with double medical approach, both cervical and thoracic. On the other hand, 4 patients faced only thoracic bilateral medical approach. Results: The medical complications arised were: respiratory distress in 7, bronchopneumonia in 3, cervical hemorrhage and urinary infection in 1. 4 were re-operated. The mortality was 33% (4 out of 12 patients). Conclusion: Though the descending necrotizing mediastinitis is a rare entity, its seriuosness forces us to consider it as a critical medical issue while tackling any cervical abscess not drained. Under these circumstances the cervicothoracic TAC, along with an aggressive therapeutic surgery, is the key factor to obtain a precocious diagnosis and an effective treatment.(AU)

Vesícula de porcelana. Caso clínico y revisión de la literatura / Porcelain gallbladder: a clinical case and a review of the literature

Vesícula en porcelana se define como la calcificación de la pared de la vesícula biliar. Es una rara entidad que se observa en el 0,06 a 0,8% de las colecistectomías. Su etiología sigue siendo desconocida. Reportamos dos casos de pacientes con vesícula en porcelana. Un caso es un paciente masculino de 60 años que consulta por sintomatología biliar, se realiza el diagnóstico mediante ecografía y tomografía computada y es intervenido quirúrgicamente realizándose colecistectomía parcial con anatomía patológica que informa: pared vesicular con esclerohialinosis y focos de calcificación distrófica. El otro caso es una paciente femenina de 98 años, cuya forma de presentación fue incidental dado que cursaba con cuadro de oclusión intestinal, se realizó colecistectomía con buena evolución postoperatoria. Series publicadas entre los años 1950 y 1960 avalan que la vesícula en porcelana puede observarse con frecuencia en pacientes con cáncer de vesícula, aunque recientemente se ha desestimando este tipo de relación. El motivo por el cual se presentan estos casos es su baja frecuencia y su controversia en lo que al tratamiento se refiere por su relación con el cáncer de vesícula (AU)

Porcelain bladder is defined as calcification of the gallbladder wall. It is a rare condition and is seen in 0.06% to 0.8% of cholecystectomies. It origin is still unknown. We report two cases of patients with a porcelain gallbladder. One case is a 60 year-old male patient who was seen due to having biliary symptoms. The diagnosis was made by ultrasound and computed tomography, and he was surgically intervened by performing apartial cholecystectomy. The histopathology reported a gallbladder wall with sclerohyalinosis and dystrophic calcification foci. The other case is a 98 year-old female patient, whose form of presentation was incidental given that she suffered from symptoms of an intestinal obstruction. A cholecystectomy was performed with a good post-surgical outcome. A series published in between 1950 and 1960 show that the porcelain bladder can be frequently observed in patients with cancer of the gallbladder, although this relationship is currently being rejected. The reason why these cases are being presented is because of their (AU)

[Porcelain gallbladder: a clinical case and a review of the literature]. / Vesícula de porcelana. Caso clínico y revisión de la literatura.

Porcelain bladder is defined as calcification of the gallbladder wall. It is a rare condition and is seen in 0.06% to 0.8% of cholecystectomies. It origin is still unknown. We report two cases of patients with a porcelain gallbladder. One case is a 60 year-old male patient who was seen due to having biliary symptoms. The diagnosis was made by ultrasound and computed tomography, and he was surgically intervened by performing a partial cholecystectomy. The histopathology reported a gallbladder wall with sclerohyalinosis and dystrophic calcification foci. The other case is a 98 year-old female patient, whose form of presentation was incidental given that she suffered from symptoms of an intestinal obstruction. A cholecystectomy was performed with a good post-surgical outcome. A series published in between 1950 and 1960 show that the porcelain bladder can be frequently observed in patients with cancer of the gallbladder, although this relationship is currently being rejected. The reason why these cases are being presented is because of their low incidence and the controversy over what treatment to use, due to its association with gallbladder cancer.

Tumor de Evans perineal / Evans perineal tumor

INTRODUCCION. El tumor de Evans es un sarcoma fibromixoide de bajo grado, poco común, originado en los tejidos blandos. La recurrencia local es habitual y las metástasis a distancia muy poco frecuentes. La localización perineal es extremadamente rara. La mayoría de los datos sobre ellos provienen de comunicaciones individuales y no se conoce mucho sobre su etiología, patogenia y pronóstico. Se presenta un caso de sarcoma de Evans perineal, con revisión de la literatura. LUGAR DE APLICACIÓN. Hospital Nacional Profesor Alejandro Posadas, Buenos Aires, Argentina. CASO CLINICO: Mujer de 49 años. En 1993 durante parto vaginal se palpa tumoración vulvoperineal; la paciente abandona el seguimiento. Concurre en 2008 a nuestro servicio presentando una gran tumoración perineal abscedada. Se realizan estudios imagenológicos confirmando su localización extrarectal. Se realizan biopsias no significativas. Se realiza exéresis tumoral por vía perineal con reparación esfinteriana y colostomía sigmoidea de protección. Evoluciono sin complicaciones. RESULTADOS. El protocolo de la anatomía patológica informó sarcoma fibromixoide de bajo grado (Tumor de Evans). A dos años de seguimiento sin signos de recidiva local ni metástasis a distancia. CONCLUSIONES. El tumor de Evans es una neoplasia extremadamente rara y más aun la localización perineal. El tratamiento de elección es la exéresis quirúrgica. El pronostico parecería estar determinado por la recidiva local.

BACKGROUND: Evans tumor is a rare, low-grade fibromyxoid tumor which originates in the soft tissues. Local recurrence is common and distant metastases are infrequent. Perineal localization is extremely rare. Most of the data about them are individual case reports and not much is known about their etiology, pathogenesis and prognosis. A case of a perineal Evans tumor is presented, together with a literature review. CASE REPORT: A 49 year old woman, in whom in 1993 during a vaginal delivery a vulvoperineal mass is palpated; the patient is lost in the follow-up. In 2008 she comes to our Department presenting a large perineal tumor and abscess. Imaging studies are carried out confirming its extra-rectal localization. Biopsies are taken and are indeterminate. The tumor is excised through the perineal route. The patient had no complications. RESULTS: The pathology report informs low grade fibromyxoid sarcoma (Evans tumor). She is two years in follow-up without signs of neither local recurrence nor distant metastases. CONCLUSIONS: An Evans tumor is an extremely rare neoplasm, and furthers more in a perineal localization. The treatment of choice is surgical excision. The prognosis is apparently determined by local recurrence.