Revista Chilena De Cirugia最新文献

Retroperitoneal neoplasias may be a diagnostic and therapeutic challenge for the clinician.

Case report

A 56 year old male with prior history of type 2 diabetes consults with right inferior limb edema and paresthesias. He was diagnosed of deep vein thrombosis and lymph node conglomerate by ultrasound. A CT scan was performed, observing great retro peritoneal mass enclosing vascular and nervous structures. An initial histological diagnosis of hamartoma was made. Surgery was scheduled to remove the tumour, ligation of thrombosed external iliac vein and the external iliac artery was preserved. Intraoperative histological findings suggested sarcoma, definite studies showed presence of high grade liposarcoma. Two weeks after the intervention, the patient presents in hypovolemic shock due to rupture of the right external iliac artery. Emergent ligation of the artery and femorofemoral bypass was performed, with adequate postoperatory recovery. The patient was discharged and continued adjuvant oncology treatment and was exitus six months later.

Discussion

Sarcomas are the most frequent primary retroperitoneal tumours. They are difficult to diagnose and often have untimely treatment. Sarcomas tend to be asymptomatic, or present with local compression symptoms, affecting vascular and nervous structures. CT scan is the gold standard for diagnostic imaging. Treatment requires a multidisciplinary approach, surgical resection as the main therapy; radio and chemotherapy represents a solution for irresectable or high grade malignancies.

Background

Described almost 100 years ago, the Hartmann procedure is still valid, being the classical behavior adopted for the management of the left colon in the emergency room. The restitution of the intestinal transit provides an important improvement in the quality of life of the patients, nevertheless given the high morbimortality, only half is reconstructed. Laparoscopic Hartmann restitution offers all the advantages of minimally invasive procedures with morbidity and mortality comparable to conventional surgery.

Objectives

Analyze surgical technique and the results of a series of patients in whom laparoscopic Hartmann restitution was performed.

Material and methods

Retrospective review was conducted between March 2002 and January 2017. The population belongs to the Surgical Clinics of the Maciel Hospital (‘Q2’ and ‘Q3’), UDELAR Medical School, Montevideo, Uruguay.

Results

Twenty-nine patients were operated: 10 women and 19 men. The most frequent pathologies that determined the Hartmann were linked to diverticular pathology (37.93%) or oncological (34.48%). The minimum time elapsed between the Hartmann and the reconstruction was 4 months. The operative times ranged from 107 to 240 min. The conversion rate was 24.1%. Major complications occurred in 6.90% and minor complications in 13.79%. There was no anastomotic leak. The hospital stay was 5.57 days. The mortality rate was 3.45%.

Conclusions

Our results are consistent with the international literature, laparoscopic Hartmann restitution is a demanding but feasible, safe procedure that gives the patient the benefits of minimally invasive surgery.

Objective

To determine BISAP as a predictor of mortality in acute pancreatitis in the Emergency Service.

Materials and methods

A cohort study in acute pancreatitis in emergency service, two groups were formed according to BISAP score, low risk (0-2) and high risk (3-5). The total sample for each group was 23.76, nevertheless it was worked with 111 patients of low risk and 23 of high risk. The sampling technique was non-randomized by quota. Mortality was measured at 24 h and at 7 days. Statistical analysis included logistic regression and probability calculation.

Results

When the BISAP score is high risk the probability of dying at 24 h is 22.7% and 76.5% at 7 days (Chi² = 13.91, P = .002).

Discussion and conclusion

The BISAP score allows predicting the probability of dying at 24 h and at 7 days.

Objective

To present a case of strangulated Littré femoral hernia.

Clinical case

86 years old man with 4 days of post-traumatic periumbilical abdominal pain accompanied by vomiting and absence of stools with gas transit preserved. Examination highlighted a painful and indurated mass of 3 cm in diameter that it was not reducible below right inguinal arch. A femoral hernia repair with preperitoneal approach was performed by identifying a strangulated Littré hernia performing bowel resection and tissue repair of the hernia defect.

Conclusion

Littré femoral hernias are an extremely rare entity and optimal surgical management is not established.

Introduction

Perivascular Epithelioid Cell Neoplasms (PEComas) are uncommon tumors of mesenchymal origin. These ones include the epithelioid angiomyolipoma (EAML), a tumor with malignant potential and whose simultaneous presentation with thyroid cancer is quite rare.

Presentation of case

Forty years old man with fast-growing mass in relation to lower right thyroid pole and tracheal infiltration. Abdominopelvic contrast-enhanced CT shows multiple renal masses with dominant mass in the left upper pole. Thyroid histopathology showed a lesion in right lobe corresponding to tall cell variant of papillary thyroid cancer (PTC) and a second neoplasm in the contralateral lobe corresponding to classical variant of moderately differentiated PTC. In the kidney was found a tumor corresponding to EAML with epithelioid aspect cells equivalent to 40%.

Discussion

This article corresponds to the first in the literature to describe the simultaneous presentation of EAML with synchronous bilateral PTC (SBiPTC) and its possible association. A common molecular pathway corresponding to the TSC/mTOR pathway is described, as well as SBiPTC prevalence and immunohistochemical markers for EAML diagnosis.

Introduction

In patients with long Barrett esophagus we have suggested to perform fundoplication with antrectomy, vagotomy and Roux-en-Y duodenal diversion however it could be associated with complications and side effects.

Objective

The objective of this study is to compare open versus laparoscopic surgery for early and early postoperative complications, mortality and distant outcomes.

Material and method

We compare 2 cohorts of patients, 73 patients with open surgery and 53 patients, who underwent laparoscopic surgery using the same technique. Only patients with Long Barrett were included. They are clinically monitored in the early and late postoperative period, with endoscopy and histology at long term follow-up (3-5 years). The results were evaluated in terms of early and late complications, the quality of life and patient satisfaction were analyzed. For the analysis we used t-student considering a P < .05 as significant.

Results

As for early complications, there were no significant differences in both groups. There was no postoperative mortality. In the late complications, the total complications are not significantly different between the two groups (only their causes and characteristics changed) neither in terms of Visick's classification and the quality of life score

Conclusion

The fundoplication, with laparoscopic acid suppression and duodenal diversion, presents similar short-term and long-term results than open surgery, with the benefits of a mini-invasive procedure.