A needle in the colon, the risk of ingested foreign objects: a case report.

Ingestion of foreign bodies is often found in clinical practice; however, intestinal perforation due to ingestion of foreign bodies is rare. Sharp and metallic objects are usually the ones that cause most complications. Preoperative diagnosis is difficult since the clinical presentation is vague and nonspecific presentation can simulate many abdominal pathologies. Patients are rarely aware of foreign body ingestion, and a high index of suspicion is required to make a timely diagnosis. In addition, treatment demands prompt surgery to avoid dangerous complications. We present the case of a 19-year-old tailor; he inadvertently swallowed a needle and presented to the emergency department with a colonic perforation. Surgery was required, and he recovered completely.

Bochdalek hernia in a young adult successfully treated with a laparoscopic approach, a case report.

BACKGROUND: Bochdalek hernias are a rare form of diaphragmatic hernias; they are frequently found in children; however, they have been discovered in completely asymptomatic adults in exceptional situations. Being such a unique pathology, they can be easily confused and misdiagnose, exposing patients to unnecessary treatments. CASE REPORT: Patient is an otherwise healthy 30-year-old patient without past medical history; after vigorous physical activity, a Bochdalek hernia was discovered and successfully treated; on follow-ups, he is doing well without signs of recurrence. CONCLUSIONS: In adults, Bochdalek hernia is an uncommon form of diaphragmatic hernia. As most cases are asymptomatic, a high index of suspicion is needed since diagnosis is challenging. Modern surgical techniques can improve patient recovery and short hospital stay with minimal morbidity or mortality.

Laparoscopy and intraoperative enteroscopy, a helpful tool in a rare tumor (inflammatory fibroid polyp) of the small bowel. A case report.

INTRODUCTION AND IMPORTANCE: Inflammatory fibroid polyps (IFPs) are rare, benign tumors that can arise throughout the gastrointestinal tract, they are usually asymptomatic, and clinical presentation depends on the site of involvement. Gastric and colon IFPs are traditionally identified incidentally, whereas small intestinal lesions are often encountered in the setting of intussusception or during imaging studies. Complete resection via endoscopy or surgery is recommended. CASE PRESENTATION: Patient is a 52-year-old male without past medical history; he had a five-month history of mild colicky abdominal pain. A mass was detected in the small bowel, and surgery was decided. Since the mass was small a cooperative approach with an intraoperative enteroscopy was needed to locate the mass and achieve complete resection. DISCUSSION: IFPs of the small bowel require complete resection. Surgery should be performed as early as possible to prevent complications like intussusceptions, ischemia, and necrosis. CONCLUSIONS: In these rare tumors, the collaboration between surgeons and endoscopists is indispensable to improve the patient's prognosis.

Pneumoperitoneum and Pneumatosis cystoides intestinalis, a dangerous mixture. A case report.

BACKGROUND: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by gas infiltration into the intestine wall. When gas is seen in the intestinal wall, it is usually a sign of bowel wall infarction and a surgical emergency; therefore, an adequate differentiation of benign and urgent conditions of pneumatosis intestinalis is necessary to prevent misdiagnosis and inadequate therapies. CASE PRESENTATION: We present the case of a 79-year-old male with past medical history of Alzheimer's, cholecystectomy, and umbilical hernia. PCI was identified, and conservative therapy was started. Since the patient's pain persisted, a complication was suspected, and surgery was decided. After successful treatment, the patient completely recovered. CONCLUSION: There are many benign and life-threatening causes of pneumatosis intestinalis, the imaging appearance of both may look very similar. Therefore, clinical history, physical examination, and laboratory test results are the best indicators of whether it is due to a benign or life-threatening cause. PCI must be managed with a multidisciplinary team of clinicians, radiologists, and surgeons to achieve better results for our patients.

Giant ovarian mucinous cystadenoma, a challenging situation in resource-limited countries.

Mucinous cystadenomas are a common benign neoplasm of the ovaries that can grow much larger than other adnexal masses; they are recognized as precursors of ovarian cancer and may slowly transform to borderline tumors and invasive ovarian cancer. Prompt and accurate treatment is essential as these tumors can grow to massive sizes and be potentially lethal if left untreated. Health care providers must understand the patient, their expectations and their problems; without proper communication and follow-up, any treatment is destined to disappoint. We present a case of a 76-year-old female with limited access to health care. She presented with a giant cystadenoma that grew over 1 year. Complete resection was decided and the patient underwent complete recovery. On follow-up control patient is doing well.

Giant ovarian cystadenocarcinoma in an adult patient, a rare finding in modern times.

Ovarian cancer (OC) is one of the most commonly diagnosed cancers among women. Regretfully due to its a broad spectrum of clinical behavior and challenging diagnosis most cases are diagnosed at a late stage. On rare occasions, these tumors can grow to massive sizes if left untreated, worsening the prognosis of the patient. Thanks to the advancement of medicine and diagnostic techniques, these rare cases are less frequent. Timely detection and surgery could avoid all these potentially troublesome scenarios. We report the case of a 64-year-old female with a giant 13 kg high-grade papillary serous ovarian cystadenocarcinoma, the tumor grew during a four year period and was adequately treated with surgery and is under close follow up with the oncologist. To our knowledge, this is the first case of a giant ovarian cystadenocarcinoma ever reported in Ecuador.

Subcapsular liver hematoma after extracorporeal shock wave lithotripsy, a rare complication.

Extracorporeal shock wave lithotripsy (ESLW) is a common and relatively safe procedure, with a high success rate and low adverse effects. Complications of this procedure are usually limited to the kidneys and almost always resolve spontaneously. However, on rare occasions, a frightening complication, as a hematoma of a parenchymatous organ, such as the liver can appear. Abdominal pain is usually the only manifestation when a liver hematoma develops, and should always be investigated, as this dreaded complication can put the patient's life at risk. Conservative treatment is usually the treatment of choice, nevertheless, on severe cases that do not respond to conservative measures, surgery or embolization is necessary. We report the case of a 38-year-old male who underwent ESWL, 12 h after the procedure he presented to the emergency room with severe abdominal pain, after complementary exams a liver hematoma was detected. Following conservative management, the patient fully recovered.

Gastric mixed adenoneuroendocrine carcinoma case report.

Mixed adenoneuroendocrine carcinomas are rare tumors that contain both an exocrine and an endocrine component. Since the latest classification by the World Health Organization and with the aid of immunostaining, more mixed adenoneuroendocrine carcinomas are now identified and diagnosed. Nonetheless, our knowledge of these tumors is still limited, notably concerning gastric variants, as the cases reported in the literature are very limited. The clinical and surgical treatment, including the chemotherapy schemes, the prognosis, and recurrence still represent challenges for the medical teams. We present the case of a 62-year-old woman. After an upper endoscopy revealed multiple polyps and a low-grade neuroendocrine tumor, a D2 radical gastrectomy was performed. A low output esophageal anastomotic leak was discovered in the postoperative period and successfully managed. Pathology revealed a gastric mixed adenoneuroendocrine carcinoma, the first case of this kind reported in Ecuador. Patient is doing well and under constant surveillance up until her 13th postoperative month.

Massive retroperitoneal dedifferentiated liposarcoma in a young patient.

Liposarcomas are rare malignant tumors that mostly develop in the retroperitoneum. They have a broad behavioral spectrum, from small masses of tissue to highly aggressive tumors. The dedifferentiation process occurs in up to 10% and it's most likely to occur in the retroperitoneum, a process that not only changes its components but also its prognosis. These tumors can grow to a massive size since most of them do not give any symptoms until they invade the adjacent structures. Timely detection and surgery could avoid all these potentially lethal scenarios. We present a case of a 34-year-old patient, who reported a growing mass in her abdomen that reached massive proportions but remained untreated due to lack of sufficient access to healthcare facilities in her geographic location. After complete removal of the mass the patient underwent complete recovery, dedifferentiated liposarcoma was the final diagnosis.

Laparoscopic approach to non-communicating intestinal duplication cyst in adult.

Intestinal duplication is rare congenital pathology generally diagnosed in infancy or early childhood. Presentation in adults is extremely rare. We present a case of a 36-year-old otherwise healthy female patient without any past medical history. She presented with a month of lower abdominal pain, clinical examination revealed pain and a palpable mass in the lower abdomen. CT scan confirmed a cystic mass dependent of the cecum wall and colonoscopy showed an extrinsic compression of the lateral wall of the ascending colon. However, the mucosa and the rest of the colon appeared normal. Since pain became more intense laparoscopy was performed and a cystic mass dependent on the cecum was discovered. Laparoscopic hemicolectomy was performed. Patient underwent full recovery. On follow up controls, pathology described intestinal cystic duplication of the colonic wall.

Estudio de factores de riesgo para transmisión de leishmaniosis cutánea americana en una área endémica de la Provincia de Pichincha / Study of risk factors for transmission of American cutaneous leishmaniasis in an endemic area of ​​the Province of Pichincha

Contexto: En Ecuador, la leishmaniosis cutánea americana se reporta en 20 de 22 provincias, con una incidencia anual de 3.000 a 4.500 casos. En la Provincia de Pichincha, esta forma clínica de leishmaniosis se ha expandido a las zonas tropicales del noroeste y el conocimiento epidemiológico es exiguo. Objetivos: investigar el perfil epidemiológico y factores de riesgo de leishmaniosis cutánea americana. Material y métodos: el estudio efectuado en la Provincia de Pichincha vinculó a 1081 individuos mediante la aplicación de una encuesta con variables epidemiológicas relacionadas al parásito, evaluación de actitudes, conocimientos y prácticas de la población sobre la enfermedad. Resultados: el 15,7% de los encuestados sufrieron leishmaniosis cutánea americana en el pasado. Se observó la presencia de cánidos (56,4%) y aves de corral (37%) en las inmediaciones de las viviendas. La recolección de basura beneficia al 86,7% de inmuebles, donde el 87,7% de habitantes permanecen entre 18 a 22 horas diarias. El 51,9% de encuestados usan habitualmente insecticidas para el control de vectores. El 70,4% conocen sobre la leishmaniosis cutánea americana y el 25,6% saben cómo prevenirla mediante control químico (12%), control físico (18,9%), limpieza peridomiciliaria (11,7%) y selección adecuada del sitio para edificar viviendas distantes de vegetaciones (2,2%). Conclusión: es mandatorio iniciar campañas educativas para mejorar conocimientos, actitudes y prácticas sobre prevención. (AU)

Context: In Ecuador, American cutaneous leishmaniasis is reported in 20 of 22 provinces, with an annual incidence of 3,000 to 4,500 cases. In the Province of Pichincha, this clinical form of leishmaniasis has spread to the tropical zones of the northwest and the epidemiological knowledge is meager. Objective: to investigate the epidemiological profile and risk factors of American cutaneous leishmaniasis. Material and methods: The study carried out in the Province of Pichincha involved 1081 individuals, through the application of a survey with epidemiological variables related to the parasite, evaluation of attitudes, knowledge and practices of the population about the disease. Results: 15.7% of the respondents suffered from American cutaneous leishmaniasis in the past. The presence of canids (56.4%) and poultry (37%) were observed in the immediate vicinity of the dwellings. Garbage collection benefits 86.7% of properties, where 87.7% of inhabitants remain between 18 to 22 hours a day. 51.9% of respondents routinely use insecticides for vector control. 70.4% know about American cutaneous leishmaniasis and 25.6% know how to prevent it by chemical control (12%), physical control (18.9%), peridomiciliary cleaning (11.7%) and adequate site selection to build houses far from vegetation (2.2%). Conclusion: It is mandatory to initiate educational campaigns to improve knowledge, attitudes and prevention practices. (AU)