Gallstone ileus presenting in an elderly patient: A case report.

INTRODUCTION AND IMPORTANCE: Biliary ileus is a rare yet significant cause of mechanical intestinal obstruction, which occurs when a gallstone enters the gastrointestinal tract through a bilioenteric fistula, leading to intestinal blockage. This condition primarily affects elderly patients and is associated with high morbidity and mortality if not diagnosed and treated promptly. CASE PRESENTATION: We present the case of a 94-year-old female with a history of hypertension and chronic venous insufficiency. The patient was admitted with severe abdominal pain, nausea, and vomiting, with clinical findings suggestive of intestinal obstruction. Computed tomography revealed Rigler's triad, confirming the diagnosis of biliary ileus. An exploratory laparotomy was performed, identifying three gallstones in the small intestine. The patient underwent enterotomy for stone extraction and had a favorable immediate postoperative outcome. CLINICAL DISCUSSION: Biliary ileus presents a diagnostic challenge due to its nonspecific symptoms. While Rigler's triad (pneumobilia, intestinal obstruction, and ectopic gallstone) is diagnostic, it is not always apparent in imaging. Surgical intervention remains the standard of care for resolving the obstruction, though appropriate preoperative management and timely surgery are crucial for improving outcomes. CONCLUSION: This case emphasizes the importance of considering biliary ileus in the differential diagnosis of intestinal obstruction, particularly in elderly patients. Early surgical intervention is essential to prevent severe complications. Evidence based medicine ranking: Level IV.

Hybrid Laparo-Endoscopic Resection of Submucosal Cardial Tumors Assisted by Flexible Articulated Instruments.

We report a new surgical method in 10 patients who underwent hybrid laparo-endoscopic resection (HLER) of submucosal tumors with the combination of flexible articulated laparoscopic instruments (FALI). We have assessed technical reproducibility, safety, and morbidity. Resection was completed in all cases. Mean surgical time was 60 min (30-85). Median tumor size was 16 mm (12-30). The more frequent location was the gastroesophageal junction. No complications were observed during the procedure. Length of stay was 1 day in all cases. We have found HLER to be a safe procedure allowing margin resection and organ preservation. The addition of FALI added ease of performance in hard-to-reach tumor locations.

Gastric adenocarcinoma in the excluded stomach 18 years after bariatric surgery: a case report.

Gastric cancer (GC) ranks fourth in overall cancer mortality. Bariatric surgical procedures, especially the gastric bypass surgery (GBS), raise a concern about the risk of GC in the excluded stomach (ES). Diagnosis of GC in the ES is challenging due to anatomical changes and impossibility of endoscopic access to the ES. There are few reports of GC after GBS, and it occurs more in the gastric stump than in the ES. We report a case of a 54-year-old female with GC in the ES 18 years after GBS. The increasing number of GBS and the aggressiveness of the GC show how relevant this case is to emphasize the need to consider this diagnosis in patients who develop upper abdominal symptoms, anemia or weight loss.

First day postoperative values of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein as complication predictors following gastric oncologic surgery.

INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) level are simple laboratory test parameters that can provide us with information on the inflammatory status of the organism. CRP has been shown to be a predictor of postoperative complications, whereas NLR and PLR have shown greater usefulness in the prognosis of oncologic pathologies. AIM: To evaluate the associations of NLR and PLR with postoperative complications following gastric oncologic surgery and compare them with CRP. MATERIALS AND METHODS: A prospective study was conducted on 66 patients that underwent oncologic gastric surgery, within the time frame of January 2014 and March 2019. The variables analyzed were sociodemographic data, surgical technique, tumor extension, and NLR, PLR, and CRP levels from the first day after surgery, as well as postoperative complications. RESULTS: Seventeen patients (25.8%) presented with grade III-V complications, utilizing the Clavien-Dindo classification system. Mean NLR value was 11.30 and was associated with the appearance of major complications, with statistical significance (p = 0.009). Mean PLR was266.05 and was not significantly associated with complications (p = 0.149). Fifty-four patients had a mean CRP level of 143.24 and it was not related to the appearance of major complications (p = 0.164). CONCLUSIONS: The NLR is a simple and inexpensive parameter, which measured on postoperative day one, predicted the appearance of major postoperative complications in our study sample and appears to be a better predictive parameter than CRP for said complications. Further studies to confirm that trend need to be carried out.

Intususcepción yeyunogástrica retrógrada en un paciente con historia de gastroyeyunostomía hace 20 años: reporte de caso y revisión de la literatura / Retrograde jejunogastric intussusception in a patient with underlying history of gastrojejunostomy 20 years ago: Case report and literature review

Resumen La intususcepción yeyunogástrica es una complicación rara, pero potencialmente fatal de acuerdo con el momento de su diagnóstico e intervención. Debido a su baja incidencia, se requiere de una alta sospecha diagnóstica, basada en la clínica y los antecedentes quirúrgicos. En el presente reporte se expone el caso de un paciente de 74 años, con historia de gastroyeyunostomía y cerclaje duodenal realizados como parte del manejo de úlcera duodenal 20 años atrás. Se presentó por urgencias luego de 7 días de inicio de los síntomas caracterizados por dolor, intolerancia a la vía oral y hematemesis. Su diagnóstico se realizó mediante endoscopia de vías digestivas altas y su manejo definitivo, mediante gastrectomía subtotal y reconstrucción en Y de Roux transmesocólica por laparotomía.

Abstract Retrograde jejunogastric intussusception is a rare but potentially fatal complication, according to the time of diagnosis and intervention. Due to its low incidence, a high diagnostic suspicion is required, based on the clinical and surgical history. This study presents the case of a patient of 74 years old with a history of gastrojejunostomy and duodenal cerclage performed as part of duodenal ulcer treatment 20 years ago. The patient was admitted to the emergency unit, after 7 days of having symptoms such as pain, intolerance to oral intake, and hematemesis. Diagnosis was performed by upper digestive tract endoscopy and the final treatment by subtotal gastrectomy and transmesocolic Roux-en-Y reconstruction by laparotomy.

First day postoperative values of the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and C-reactive protein as complication predictors following gastric oncologic surgery. / Valor del Ratio Neutrófilo-Linfocito, Ratio Plaqueta-Linfocito y Proteína C Reactiva del primer día como predictores de complicaciones postoperatorias tras cirugía oncológica gástrica.

INTRODUCTION: The neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and C-reactive protein (CRP) level are simple laboratory test parameters that can provide us with information on the inflammatory status of the organism. CRP has been shown to be a predictor of postoperative complications, whereas NLR and PLR have shown greater usefulness in the prognosis of oncologic pathologies. AIM: To evaluate the associations of NLR and PLR with postoperative complications following gastric oncologic surgery and compare them with CRP. MATERIALS AND METHODS: A prospective study was conducted on 66 patients that underwent oncologic gastric surgery, within the time frame of January 2014 and March 2019. The variables analyzed were sociodemographic data, surgical technique, tumor extension, and NLR, PLR, and CRP levels from the first day after surgery, as well as postoperative complications. RESULTS: Seventeen patients (25.8%) presented with grade III-V complications, utilizing the Clavien-Dindo classification system. Mean NLR value was 11.30 and was associated with the appearance of major complications, with statistical significance (p = 0.009). Mean PLR was 266.05 and was not significantly associated with complications (p = 0.149). Fifty-four patients had a mean CRP level of 143.24 and it was not related to the appearance of major complications (p = 0.164). CONCLUSIONS: The NLR is a simple and inexpensive parameter, which measured on postoperative day one, predicted the appearance of major postoperative complications in our study sample and appears to be a better predictive parameter than CRP for said complications. Further studies to confirm that trend need to be carried out.

Jejum Pré-Operatório: Consensos e Controvérsias / Preoperative fasting: consensuses and controversie

Introdução: A prática do jejum pré-operatório se consolidou no século XX e prosseguiu praticamente inalterada até os anos 80, onde passou a ser reestruturada. Diante disso, o presente artigo tem o intuito de realizar uma revisão sobre o jejum pré operatório orientado na literatura comparando-o com o que é encontrado dentro da realidade brasileira. Metodologia: Trata-se de um estudo de revisão da literatura, de natureza exploratória, realizada por meio de pesquisa de artigos científicos, dissertações e teses disponíveis nas bases de dados online. Resultados: a American Society of Anesthesiologists desenvolveu a Task "Force on Preoperative Fasting" que estabelece para líquidos claros um jejum mínimo de 2 horas e para dieta leve de 6 horas. No Brasil, um estudo com 3.175 pacientes revelou que 46% deles jejuaram por um período superior a 12 horas. Discussão: Além de não aumentar a possibilidade de danos, observa-se que a redução do tempo de jejum pré-operatório está associada a benefícios no processo de recuperação do paciente. Dentre as causas para o jejum prolongado nas instituições de saúde do Brasil estão o atraso nas operações, a transferência de horário e de período ou o seu adiamento para o próximo dia. Conclusão: o aprimoramento do jejum pré-operatório é necessário, tendo como estratégia a melhor comunicação entre equipes médicas e de enfermagem e o paciente atendido nas instituições hospitalares. (AU)

Background: The practice of preoperative fasting was consolidated in the twentieth century and remained unchanged until the 1980s, when it was questioned. Therefore, the present article aims to review the preoperative fasting oriented in the literature comparing it with what is found in Brazilian reality. Methods: This is an exploratory literature review study, conducted through research of scientific articles, dissertations and theses available in online databases. Results: The American Society of Anesthesiologists has developed the Task Force on Preoperative Fasting, which establishes for clear liquids a minimum fasting of 2 hours and 6 hours for a light diet. In Brazil, a study with 3,175 patients revealed that 46% of them fasted for more than 12 hours. Discussion: In addition to not increasing the possibility of damage, it is observed that the reduction of preoperative fasting time is associated with benefits in patient's recovery process. Causes of prolonged fasting in Brazilian health institutions include delayed operations, changes on time and period, or postponement to the next day. Conclusions: the improvement of preoperative fasting is necessary, having as strategy a better communication between medical and nursing teams and the patients treated at hospitals. (AU)

Large primary hepatic gastrinoma in young patient treated with trisegmentectomy: A case report and review of the literature.

Primary hepatic gastrinoma is a rare disease, with fewer than 40 cases reported in the medical literature. Because it is located in an organ in which metastases are common, its diagnosis is difficult. We report a case of a 19 years old male patient with a history of gastric ulcers since the age of nine. Following gastric surgery, an antrectomy and a vagotomy, there was some alleviation of symptoms. Subsequently, the patient reported various intermittent episodes of diarrhea, diffuse abdominal pain, and vomiting. The patient underwent tomography, which revealed the presence of a hepatic mass measuring 19.5 cm × 12.5 cm × 17 cm. Primary hepatic gastrinoma was diagnosed based on laboratory examinations that indicated hypergastrinemia and a positron emission tomography/magnetic resonance study with somatostatin analogue that confirmed the liver as the primary site. After hepatic trisegmentectomy (II, III, IV, V, VIII), the patient's symptoms improved. The case is notable for the presence of a rare tumor with uncommon dimensions.

Intuscepção anterógrada jejuno-jejunal no pós-operatório de gastrectomia parcial com Billroth II causando síndrome da alça aferente / Anterograde jejunojejunal intussusception in the post operatively of a parcial gastrectomy Billroth II causing afferent loop syndrome

Apresenta-se o caso de um homem, 57 anos, submetido a uma antrectomia com reconstrução a Billroth II devido a uma úlcera péptica sangrante, que evoluiu no quarto dia de pós-operatório com intuscepção anterógrada jejuno-jejunal, causando síndrome da alça aferente.

Its reported a case of a 57-year-old male, who underwent an antrectomy with Billroth II reconstruction because of an bleeding peptic ulcer, that evolved in the fourth day postoperatively with a anterograde jejunojejunal intussusception causing afferent loop syndrome.