[Carcinoma of the Vater's ampulla and colonic carcinoma with synchronous onset]. / Carcinoma de ampolla de Vater y carcinoma colónico de aparición sincrónica.

We report the case of a female patient who presented with a very unusual association: an early invasive adenocarcinoma of the ampulla of Vater and a synchronous carcinoma of the right colon, in the absence of familial polyposis coli. Six years before a hysterectomy was performed because of uterine leiomyomata. The treatment was a Whipple's resection and, after three months, a right colectomy.

[Hepatic actinomycosis]. / Actinomicosis hepática.

We present a case of primary liver actinomycosis in a patient who was operated on for a duodenal ulcus seven years before. A gastrectomy was performed. His gallbladder was also removed two years before. After the surgical treatment, followed by antibiotic and chemotherapeutic treatment, with the result of a pretended success, the patient developed a liver pyogenic abscess and portal hypertension. Authors emphasise the seriousness of the illness as well as its rarity even with an accurate treatment.

[Massive lower digestive hemorrhage caused by jejunal cavernous hemangioma detected with scintigraphy]. / Hemorragia digestiva baja masiva debida a hemangioma cavernoso yeyunal no detectado por escintigrafía.

We report the case of a patient who needed urgent surgical assistance because of massive lower gastrointestinal hemorrhage secondary to a jejunal angiodysplasia (cavernous hemangioma). These lesions are a rare cause of gastrointestinal bleeding of obscure origin. The use of preoperative diagnostic techniques such as oral fiber-optic endoscopy, barium intestinal studies and scintigraphy have little value when the origin of lower gastrointestinal bleeding is in the small bowel. The best yield is obtained with celiac or superior mesenteric angiography. There are some cases in which only an exploratory surgical laparotomy is useful for the diagnostic supported by intraoperative enteroscopy guided by the surgeon.

[Intraoperative echography of hepatic metastases]. / Ecografía intraoperatoria de las metástasis hepáticas.

In order to evaluate the usefulness of intraoperative echography in the study of liver metastases, two groups of patients were submitted to study: A consecutive series of 25 patients operated on for digestive tumours. Before operation, echography was performed to all of them. Four patients operated on for liver metastases. In the patients who were operated for digestive tumors, the authors found 8.6% of metastasis which neither the preoperative echography nor liver palpation had detected. The usefulness of the examination in the patients to whom resective hepatic surgery was going to be performed was based on: The finding of a portal thrombosis which had not been detected in the preoperative study. The possibility of connecting the intrahepatic vascularity with the lesions, in order to decide which technique to choose. The demonstration of the non-existence of other metastases.

[Intraoperative echography as an aid in the therapy of Caroli's disease. A case report]. / La ecografía intraoperatoria como ayuda en la terapéutica de la enfermedad de Caroli. Presentación de un caso.

Congenital polycystic dilatation of the intrahepatic biliary ways (Caroli's disease) is a rare disease. The "pure" type and the one associated with congenital hepatic fibrosis are accepted. Although the current exploration methods, its diagnosis is rare before the surgical procedure. Treatment of the diffuse pure types and the ones associated with hepatic fibrosis is difficult and the outcome is bad. A case of the less frequent type is communicated, in which, as a novelty, intrasurgical echography was used in its treatment.

[Appendicular endometriosis. Clinicopathologic study of 12 cases]. / Endometriosis apendicular. Estudio clinicopatológico de 12 casos.

Endometriosis of the Digestive Tract is an uncommon pathology, especially when ileocecal appendix is involved. Authors report twelve cases of appendiceal endometriosis reviewed from surgical and anatomopathological records. The preoperative diagnosis is almost impossible. The most usual clinical presentation is compatible with that of acute or chronic appendicitis. The definitive diagnosis is confirmed by anatomopathological study of the surgical specimen. The Surgical treatment consists of appendicectomy alone or associated with extirpation of other concomitant neighbouring lesions.

[Intraoperative echography in the diagnosis of obstructive jaundice of undetermined cause]. / Aportación de la ecografía intraoperatoria en el diagnóstico de las ictericias obstructivas de causa no filiada.

Intraoperative ultrasonography was performed in a consecutive series of 11 patients with obstructive jaundice. On two occasions, the examination modified the preoperative diagnosis, diagnosing liver metastasis in a patient with hydatid cysts and in another by detecting gallstones in the main biliary duct in which ERCP was suggestive of an ampullary tumor. Ultrasound made a definitive diagnosis of choledocholithiasis in one case, and pancreatic carcinoma in three cases all of which had a preoperative diagnosis of biliary obstruction of undetermined cause. The examination defined accurately the level of obstruction and the extent of a carcinoma of the bile ducts in two patients and it helped in obtaining cytological samples from a pancreatic tumor mass. Its use is recommended when the cause of biliary obstruction cannot be accurately diagnosed preoperatively.

[Acute abdomen due to eosinophilic gastroenteritis. A study of 2 cases]. / Abdomen agudo por gastroenteritis eosinofílica. Estudio de dos casos.

Report of two cases of eosinophilic gastroenteritis. In both cases the presentation was an acute abdomen syndrome. The etiological diagnosis was postoperative, because in the preoperative period there were no data characteristic of this entity. Probably this disease is more frequent than reported and although the treatment is medical, there are some cases in which surgery is justified.

[Mesenteric venous thrombosis as a complication of surgery for portal hypertension by the Romero-Torres technic. Apropos a case]. / Trombosis venosa mesentérica como complicación de la cirugía de la hipertensión portal según la técnica de Romero-Torres. A propósito de un caso.

A case is presented of mesenteric venous thrombosis which affects about 30 cm of small intestine in a patient operated one month before for portal hypertension and bleeding from esophagogastric varices, in which an interruption of the portal-azygous venous circulation was made with splenectomy, using the Romero-Torres procedure. We consider that postsplenectomy thrombocytosis has been the first pathogenic factor in the mesenteric venous thrombosis.