Absceso isquiorrectal con extensión intra y preperitoneal / Isquiorectal abscess with intra and preperitoneal dissemination

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Úlcera gástrica penetrante en el hígado / Gastric ulcer penetrating the liver

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A clinical model for predicting lymph node metastasis in submucosal invasive (T1) colorectal cancer.

BACKGROUND: No single histopathological feature of submucosal invasive colorectal cancer (T1-CRC) can reliably predict the risk for lymph node metastasis (LNM). AIM: The purpose of the study was to develop a prediction model of LNM in T1-CRC. METHODS: Ninety-seven surgically resected T1-CRC at our institution were retrospectively evaluated. Morphology, localization, grading, mode of growth, presence of background adenoma, lymphoid infiltration, angiolymphatic invasion, budding, and depth of invasion were assessed. Mortality and morbidity related to surgery were also evaluated. Benefit-risk balance was assessed according to the presence of severe complications and to the presence of LNM. RESULTS: Fourteen cases had LNM (14%). Eight patients (8%) presented severe surgical complications and there were two deaths (2 %). Infiltrative growth pattern (OR 31.91, 95% CI 2.37-428.36; p = 0.009) and the absence of lymphoid infiltrate (OR 28.75; 95% CI 2.13-388.37; p = 0.011) were the only variables independently associated with LNM in the multivariate analysis. Both variables were included in the prediction model together with sessile morphology (OR 4.88; 95% CI 0.81-29.3; p = 0.083) and poorly differentiated carcinoma (OR 11.77; 95% CI 0.77-179.83; p = 0.076). A 0-100 score was developed (infiltrative growth pattern: no = 0, yes = 33; lymphoid infiltrate: no = 29, yes = 0; sessile morphology: no = 0, yes = 15; poorly differentiated: no = 0, yes = 23). Cutoff point to indicate additional surgery was set in 35 points (i.e., 10% risk LNM). Discrimination of the prediction model was excellent (AUC 0.90; 95% CI 0.81-0.99). CONCLUSION: Combined evaluation of infiltrative growth pattern, lymphoid infiltration, poorly differentiated carcinoma, and sessile appearance showed good performance for discriminating T1-CRC patients with LNM. The benefit-risk balance was in favor of surgery when at least two of these criteria were present.

[Role of laparoscopic surgery in the treatment of achalasia: an analysis of 50 cases]. / Papel del tratamiento quirúrgico por vía laparoscópica de la achalasia de cardias: análisis de 50 casos.

UNLABELLED: Achalasia is an uncommon oesophageal motor disorder, with a controversial therapeutic management. AIM: The aim of our study was to analyse our experience in the management of achalasia, assessing the impact of minimally invasive surgery, its complications and its outcomes in the short and medium term. METHODS: A retrospective and descriptive study was designed, including all patients operated on between 1999 and 2010 with the diagnosis of achalasia. Previous diagnostic tests, duration of symptoms, previous non-surgical treatment, surgical approach, associated antireflux intervention, surgical time and perioperative complications were analysed. RESULTS: A total of 50 patients, 24 males and 26 females, with a mean age of 47 years underwent laparoscopic surgery. The mean duration of the disease was 2 years. Eleven (22%) patients had received endoscopic treatment (1-4 sessions) prior to the surgery, with 100% of symptomatic recurrence. The surgery was accompanied by a Dor fundoplication in 48 patients, and Toupet fundoplication in the remaining two. The mean surgical time was 123 minutes. There were 9 intraoperative complications (5 gastric mucosal perforations, 2 bleeding, 1 liver injury and 1 aspiration); 4 postoperative complications (3 scapular pain and 1 sub-phrenic collection) were reported. The long-term subjective symptomatic response was excellent/good in 84% of patients, intermediate in 12% and a poor response in 4%. The mean follow-up was 28 months. CONCLUSIONS: Heller cardiomyotomy should be the treatment of choice in selected Achalasia patients, because of its short and long term outcomes, and its low morbidity.

Percutaneous endoscopic suturing is an alternative treatment for persistent gastrocutaneous post-PEG fistula / La sutura endoscópico-percutánea es una alternativa terapéutica en la fístula gastrocutánea persistente post-PEG

Persistent gastrocutaneous fistula after the removal of a gastrostomy tube is an unusual complication associated with percutaneous endoscopic gastrostomy (PEG). Surgical closure has been usually the treatment of choice. Several endoscopic methods have been previously attempted to close the fistula, usually with poor results. We report a successful case of percutaneous endoscopic suturing of a persistent gastrocutaneous post-PEG fistula, using a monofilament absorbable suture. A biopsy forceps was used to deepithelialize both ends of the fistulous tract to promote granulation tissue formation. The gastrocutaneous fistula closed completely after the procedure and there were no complications during the follow-up(AU)

[Adenocarcinoma arising in Meckel's diverticulum: a case report and literature review]. / Adenocarcinoma sobre divertículo de Meckel: presentación de un caso y revisión de la literatura.

Meckel's diverticulum is the most common congenital anomaly of the gastrointestinal tract. The presence of malignant lesions arising in the diverticulum is very rare, the most common malignant lesion being sarcoma, followed by carcinoid tumors, and less frequently by adenocarcinomas. We present the case of an 86-year-old man who developed acute abdomen. Surgery revealed a perforated Meckel's diverticulum. Histology identified a poorly-differentiated adenocarcinoma arising in Meckel's diverticulum. We provide a review of the literature.

Adenocarcinoma sobre divertículo de Meckel: presentación de un caso y revisión de la literatura / Adenocarcinoma arising in Meckel’s diverticulum: a case report and literature review

Resumen El divertículo de Meckel es la anomalía congénita más común del tracto gastrointestinal. La presencia de lesiones malignas sobre el divertículo es muy infrecuente, la más común corresponde a los sarcomas, seguidas del tumor carcinoide y, por último, de los adenocarcinomas. Presentamos el caso de un paciente de 86 años intervenido por un cuadro de abdomen agudo; en la cirugía se identificó un divertículo de Meckel perforado, la histología demostró un adenocarcinoma pobremente diferenciado. Finalmente se ha realizado una revisión de la literatura médica relacionada (AU)

Abstract Meckel’s diverticulum is the most common congenital anomaly of the gastrointestinaltract. The presence of malignant lesions arising in the diverticulum is very rare, themost common malignant lesion being sarcoma, followed by carcinoid tumors, and less frequentlyby adenocarcinomas. We present the case of an 86-year-old man who developed acuteabdomen. Surgery revealed a perforated Meckel’s diverticulum. Histology identified a poorly differentiated adenocarcinoma arising in Meckel’s diverticulum. We provide a review of theliterature