Aneurisma de la arteria hepática común con compromiso de la arteria esplénica: causa infrecuente de dolor abdominal / No disponible

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A common hepatic artery aneurysm with splenic artery involvement: an unusual cause of abdominal pain.

Forty-eight year old man with epigastric pain. CT scan shows a common hepatic artery aneurysm (HAA) of 4,6 cm in size with permeable portal vein. Angiography demonstrates that it affects from the beginning of the celiac trunk until hepatic arteries bifurcation, producing a proximal splenic artery stenosis. Proximal and distal embolization is done achieving a complete aneurysm occlusion. A stent is placed in celiac trunk in order to maintain splenic flow. Permeability of distal hepatic artery through choledochal arteries is observed in a month follow-up CT scan. HAA are infrequent but potentially lethal. Endovascular techniques should be considered of choice currently. HAA embolization has an elevated risk of hepatic ischemia.

Is obesity a factor of surgical difficulty in transanal endoscopic surgery?

BACKGROUND: The aim of this study is to assess the feasibility of transanal endoscopic surgery (TES) in obese patients. METHODS: Observational descriptive study evaluating the feasibility of TES in obese rectal tumors between June 2004 and January 2019. Patients were assigned to two groups: body mass index (BMI) < 30 kg/m2 and BMI ≥30 kg/m2, the latter defined as obese. RESULTS: From 775 patients, 681 were enrolled in the study, 145 (21.3%) of them obese. No statistically significant differences between groups were found with respect to overall morbidity (27, 18.6%).The obese patients presented trends towards shorter mean surgical time (65 min, IQR 48 min), less perforation in the peritoneal cavity (eight, 5.5%), and 133 (91.7%) presented a lower rate of lesion fragmentation. CONCLUSION: There were no significant differences in postoperative outcomes in obese patients (BMI ≥30 kg/m2). TES in those obese patients does not represent a factor of surgical difficulty.