[Developmental cysts in the presacral space in adults]. / Quistes del desarrollo en el espacio presacro en el adulto.

Localization of primitive neoplasms the retrorectal or presacral space is rare in adults as most of these tumors are congenital. Developmental cysts are included within the group of retrorectal congenital cystic neoplasms and are slowly-progressive cystic neoplasms. Because of their localization, their manifestation is delayed, despite their congenital nature. Their form of presentation is varied and is caused by compression of the surrounding organs or infectious complications of the cyst.We describe two cases of presacral developmental cysts (one epidermoid cyst and one dermoid cyst) that presented in adulthood. Special attention is paid to the classification, and diagnostic and therapeutic problems of these tumors.

Idiopathic megacolon associated with oesophageal achalasia.

We report a rare case of achalasia coexistent with megacolon. The patient, a 25-year-old woman, presented at our hospital with a history of abdominal pain with distension, and was finally operated on for a megacolon. Five months later she presented symptoms of progressive dysphagia and heartburn. Oesophageal manometry of the upper and lower oesophageal sphincter and X-ray studies showed images compatible with achalasia. Oesophagomyotomy of the oesophagogastric junction (Heller procedure with Dor haemifundoplication technique) was performed. In the specimens taken for biopsy, neither pathology of the myenteric plexuses, nor atrophy of the muscle fibres was evident. Chagas' disease serological diagnosis for Trypanosoma cruzii, neurological disease, diabetes and all the pathological events related with neuromuscular disorders of the gastrointestinal tract proved negative. We believe that the pathological findings are related to a dysfunction of the physiological mediators of the upper and lower digestive tract motility. The present case is extraordinary and, to our knowledge, extremely rare. The association of the two pathological diseases is questionable, and the literature is reviewed.

[Insulinoma. Apropos of a new case]. / El insulinoma. A propósito de un nuevo caso.

Insulinomas are rare tumors whose difficult diagnosis is usually delayed with respect to appearance of the first symptoms. The Whipple triad (symptoms of hypoglycemia, low blood glucose and rapid alleviation of symptoms after glucose administration) associated with an increase in plasma immunoreactive insulin (IRI) and low blood glucose levels constitute the diagnostic basis of insulinoma as the cause of organic hypoglycemia. Curative treatment entails surgery and its success will depend on the location of the tumor. Selective arteriography and, more recently, percutaneous transhepatic insulin determination (IRI) in the splenoportal axis have a diagnostic rate of 90%. Nevertheless, none of these topographic diagnostic methods replaces meticulous intraoperative exploration of the pancreas, which in our case was definitive for cure.