Case report: Closed-loop bowel obstruction secondary to a double gallstone ileus.

INTRODUCTION AND IMPORTANCE: In this paper, we report an unusual case of a closed-loop bowel obstruction secondary to a double gallstone ileus. This type of pathology constitutes an emergency, and requires prompt surgical intervention to prevent further complications. PRESENTATION OF CASE: The patient was a 90-year-old female who came to our emergency room with a clinical picture compatible with an acute abdomen. Imaging tests performed included a plain radiograph and abdominal CT-scan, which confirmed the diagnosis. The patient was then transferred to the operating room, and an open double enterolithotomy was performed, extracting two cylindrical gallstones with a diameter of over 2.5 cm. No treatment was given for either the gallbladder nor the biliary-enteric fistula due to the patient's physical status. CLINICAL DISCUSSION: Gallstone ileus is a rare entity, but must be taken into consideration when a patient with an abdominal obstruction arrives to the emergency department, especially when signs such as pneumobilia or visualization of the stones are detected by imaging tests. Early surgical intervention is required to avoid complications. However, addressing the biliary-enteric fistula at the same time is a sensitive procedure that may not be advisable, depending on the status of the patient. This report includes a bibliographic review of existing cases of gallstone ileus and the specifics of its diagnosis and management. CONCLUSION: This pathology can lead to serious complications if not managed properly. Prompt diagnosis and surgical intervention are essential to avoid complications such as intestinal gangrene and perforation. Inspecting the entire intestine during surgery is crucial for removing any additional gallstones that may be present to prevent the reappearance of symptoms.

De Garengeot's hernia: Case report and literature review.

INTRODUCTION: De Garengeot's Hernia is a rare type of femoral hernia in which the appendix is located inside the herniated sac. Diagnosis of the condition is challenging and its treatment must be performed without delay. PRESENTATION OF CASE: We present the case of a 75-year-old patient with a femoral hernia in which an appendix with signs of inflammation was found. An appendectomy followed by hernia repair was performed under an open preperitoneal approach according to Nyhus technique. The patient did not present any complications and was discharged on the second postoperative day. DISCUSSION: This type of hernia is often unexpected and its preoperative diagnosis is difficult to perform. In most cases the clinical picture is indistinguishable from a common incarcerated hernia. Contrast-enhanced CT is the most useful complementary test, although it is not as accurate as desirable, so the diagnosis is frequently found intraoperatively. There is a wide variety of surgical options and there is no consensus on the most appropriate one. The preperitoneal approach enables the performance of an appendectomy and subsequent hernia reparation. The use of prosthesis should be considered if there are no signs of perforation or abscess. CONCLUSION: De Garengeot's hernia is a very rare entity. The diagnosis and subsequent surgical treatment must be early to prevent the disease progression. The preperitoneal approach should be considered as the first choice technique, as it allows the exploration of the herniated sac and the performance of surgical procedures on its content.

¿Qué hacer ante una neoplasia mucinosa papilar intraductal de páncreas? Nuestra experiencia / What to do with an intraductal papilary mucinous pancreatic neoplasm? Our experience

INTRODUCCIÓN: Las neoplasias quísticas pancreáticas representan un grupo heterogéneo de enfermedades, donde la neoplasia mucinosa papilar intraductal está alcanzando protagonismo. El objetivo del estudio es revisar nuestra serie de neoplasias quísticas pancreáticas intervenidas y valorar la concordancia con las recomendaciones de Fukuoka. MÉTODOS: Revisamos de forma retrospectiva nuestra experiencia analizando los datos clínicos y radiológicos, la indicación quirúrgica y el estudio histológico de los 11 pacientes intervenidos en nuestro centro desde julio de 2011 a julio de 2015 por esta enfermedad, con el objetivo de valorar la concordancia con los consensos actuales. RESULTADOS: En nuestra serie la mayoría de los casos (7/11) presentaban síntomas al diagnóstico. El diagnóstico preoperatorio se alcanzó en 10 pacientes mediante radiología y/o ecoendoscopia. Las indicaciones quirúrgicas fueron presencia de síntomas, datos radiológicos de sospecha de malignidad y neoplasia de rama secundaria asintomática mayor a 30mm. Los hallazgos en estudio histológico fueron de malignidad en 6/11 (2 neoplasia invasiva, 4 displasia de alto grado), displasia moderada en 2/11, displasia de bajo grado en 2/11 y ausencia de displasia en un paciente. CONCLUSIONES: La indicación quirúrgica de las neoplasias mucinosas papilares intraductales de páncreas depende de los síntomas asociados, dimensiones, localización, riesgo y sospecha de malignidad

INTRODUCTION: Cystic pancreatic neoplasms are a heterogeneous group of pathology, and intraductal papillary mucinous neoplasia is becoming more common. The aim of this study is to review our series of cystic pancreatic neoplasms that underwent surgery and to evaluate the similarities with Fukuoka recommendations. METHODS: Retrospective review of our experience analyzing clinical and radiological data, indication for surgery and pathology study of 11 patients operated on in our centre from july 2011 to july 2015, aiming to evaluate the degree of agreement with the current consensus. RESULTS: In our series the majority of cases (7/11) had symptoms at diagnosis. Preoperative diagnosis was achieved in 10 patients using radiology and/or endoscopy. Indications for surgery were the presence of symptoms, radiological data suspicious of malignancy, and secondary branch neoplasia over 30mm. Pathological findings were malignancy in 6/11 cases (2 invasive neoplasia, 4 high grade dysplasia), moderate dysplasia in 2/11, low-grade dysplasia in 2/11 and no dysplasia in one patient. CONCLUSIONS: Surgical indication of intraductal mucinous pancreatic neoplasms depends on the associated symptoms, size, location, risk and suspicion of malignancy

What to do with an intraductal papilary mucinous pancreatic neoplasm? Our experience. / ¿Qué hacer ante una neoplasia mucinosa papilar intraductal de páncreas? Nuestra experiencia.

INTRODUCTION: Cystic pancreatic neoplasms are a heterogeneous group of pathology, and intraductal papillary mucinous neoplasia is becoming more common. The aim of this study is to review our series of cystic pancreatic neoplasms that underwent surgery and to evaluate the similarities with Fukuoka recommendations. METHODS: Retrospective review of our experience analyzing clinical and radiological data, indication for surgery and pathology study of 11 patients operated on in our centre from july 2011 to july 2015, aiming to evaluate the degree of agreement with the current consensus. RESULTS: In our series the majority of cases (7/11) had symptoms at diagnosis. Preoperative diagnosis was achieved in 10 patients using radiology and/or endoscopy. Indications for surgery were the presence of symptoms, radiological data suspicious of malignancy, and secondary branch neoplasia over 30mm. Pathological findings were malignancy in 6/11 cases (2 invasive neoplasia, 4 high grade dysplasia), moderate dysplasia in 2/11, low-grade dysplasia in 2/11 and no dysplasia in one patient. CONCLUSIONS: Surgical indication of intraductal mucinous pancreatic neoplasms depends on the associated symptoms, size, location, risk and suspicion of malignancy.

Rotura de absceso hepático piógeno: una causa rara de neumoperitoneo / Rupture of a pyogenic liver abscess: A rare cause of pneumoperitoneum

La presencia de neumoperitoneo espontáneo es un hallazgo común en pacientes con enfermedad abdominal. En el 90% de las ocasiones es consecuencia de una perforación de víscera hueca1. La rotura de un absceso hepático piógeno es una complicación infrecuente que acontece entre el 5 y el 15% de los casos, y es una causa extremadamente rara de neumoperitoneo. Existen muy pocos casos descritos en la literatura médica al respecto.Debido a su elevado interés clínico, presentamos el caso de una paciente con neumoperitoneo espontáneo secundario a la rotura de un absceso hepático piógeno(AU)

Spontaneous pneumoperitoneum is a common finding in patients with abdominal disorders. In 90% of cases, this entity results from hollow viscera perforation. Rupture of a pyogenic liver abscess is an infrequent complication occurring in 5 to 15% of cases. Pneumoperitoneum secondary to intraperitoneal rupture of an abscess is extremely rare and very few cases have been reported in the literature. Given its clinical interest, we report a case of pneumoperitoneum due to spontaneous rupture of a gas-containing pyogenic liver abscess (AU)

[Rupture of a pyogenic liver abscess: a rare cause of pneumoperitoneum]. / Rotura de absceso hepático piógeno: una causa rara de neumoperitoneo.

Spontaneous pneumoperitoneum is a common finding in patients with abdominal disorders. In 90% of cases, this entity results from hollow viscera perforation. Rupture of a pyogenic liver abscess is an infrequent complication occurring in 5 to 15% of cases. Pneumoperitoneum secondary to intraperitoneal rupture of an abscess is extremely rare and very few cases have been reported in the literature. Given its clinical interest, we report a case of pneumoperitoneum due to spontaneous rupture of a gas-containing pyogenic liver abscess.

La cirugía que se avecina. La cirugía mujer / The surgery to come. The feminization of surgery

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