Elena Martín-Pérez

Cystic lymphangioma of the lesser omentum in an adult.

Abdominal lymphangiomas are uncommon congenital benign tumors that occur mainly in children. The authors report the case of a 37-year-old woman with a cystic lymphangioma of the lesser omentum. The lesion was removed surgically with a complete resection. The histologic diagnosis was omental lymphangioma. Complete surgical resection with negative surgical margins is the treatment of choice, and the results are excellent. Incomplete resection may lead to recurrence.

Colloid Carcinoma of the Pancreas: A Distinct Pancreatic Neoplasm with Good Prognosis. Report of a Case

CONTEXT Colloid carcinoma is considered a distinct type of pancreatic neoplasia with specific histopathological and molecular features, and a better prognosis. CASE REPORT We present the case of a patient with a 15 cm locally invasive colloid carcinoma of the pancreas, in which an aggressive surgical approach achieved no evidence of disease 24 months after surgery. CONCLUSIONS If an accurate diagnostic approach and surgical resection are performed, the 5-year survival rate can reach 60%. Presence of invasive intraductal papillary mucinous neoplasm has been reported, and this can affect the prognosis. Adjuvant therapy has not demonstrated improvement of survival in surgically-resected patients.

Nonfunctional Metastatic Parathyroid Carcinoma in the Setting of Multiple Endocrine Neoplasia Type 2A Syndrome.

Parathyroid carcinoma is a very rare malignancy. It has been associated with hyperparathyroidism-jaw tumour syndrome, familial isolated primary hyperparathyroidism, and multiple endocrine neoplasia type 1 (MEN-1) and 2A (MEN-2A) syndromes. We report a 54-year-old man with a MEN-2A which presents with a nonfunctional metastatic parathyroid carcinoma and a pheochromocytoma in the absence of medullary thyroid carcinoma. Only a few cases of parathyroid carcinoma have been reported in the literature associated with this syndrome.

Meckel's diverticulum in the adult: surgical treatment

Abstract Introduction: Management of asymptomatic Meckel’s diverticulum (MD) incidentally discovered in adults remains controversial. The aim of this study was to determine if incidental diverticula should be removed. Materials and methods: We reviewed a consecutive series of patients surgically managed from January 1994 to December 2016. Patients were divided into two groups according to symptomatic or asymptomatic diverticula, and characteristics were compared. Results: The study included 66 patients: 30 in the symptomatic group (45%) and 36 in the incidental group (55%). We found 12 females (18.2%), and the ratio male:female was higher in the symptomatic group (14:1 vs. 2.6:1). Patients in the symptomatic group were significantly younger: 41.7 ± 18.1 vs. 54.7 ± 19.8 years (p = .007). MD in the symptomatic group tended to be longer (3.8 ± 1.9 vs. 2.6 ± 0.9 cm; p = .003). A MD-associated malignancy was present in three patients (4.5%), all neuroendocrine tumours. Major postoperative complications occurred in 6.6% of symptomatic patients and 0% within the incidental group, without specific morbidity related to prophylactic surgery. No mortality was observed. Conclusion: Resection of incidentally found Meckel’s diverticulum can be made because of benefits outweigh the risks in this high-risk area for cancer.

Intra-abdominal abscess due to fish bone perforation of small bowel

A 74-year-old woman without history of abdominal complaints presented to the emergency room with lower left abdominal pain for the last four weeks. She also referred hyporexia and fever up to 38.5 C during five days. On examination the patient had localized peritonism in the left iliac fossa and there was the clinical impression of a mass in this location. Laboratory tests revealed a white blood cell count of 9.8 10/L (neutrophils 80%). Based on an initial clinical impression of acute diverticulitis, a computed tomography (CT) was performed. CT (Figures 1 and 2) demonstrated an inflammatory mass of 6.5 3 cm between small bowel and left abdominal wall, without pneumoperitoneum. The mass contained a linear hyperdense object inside, compatible with an intraabdominal abscess related with a jejunal perforation by a fish bone. The patient was unaware of having ingested a foreign body (FB) previously. She was managed with an intravenous broad-spectrum antibiotic (piperacilin/tazobactam) and a percutaneous drainage. The culture of fluid collection was negative. During the admission the clinical condition was improved and she was treated orally with amoxicillin/clavulanic acid after the third day. The patient had an uneventful recovery and was discharged after ten days. At one year follow-up, she was asymptomatic. FB ingestion is a common clinical problem seen in the emergency room, but it is underreported [1]. Gastrointestinal perforation is rare, occurring in less than 1% of patients. They are usually fish and chicken bones, and fish bones are the most commonly cause of FB perforation [2]. The ileum (39%) and jejunum (27%) are the sites most frequently perforated [1]. The inability to obtain a history of FB ingestion and its nonspecific clinical presentation make diagnosis extremely difficult. Moreover, initial presentation occasionally can mimic other abdominal entities: acute appendicitis, diverticulitis or peptic ulcer [1,3,4]. CT is the most useful diagnostic tool with a sensitivity reported as 71.4% for initial images, and this improved to 100% on retrospective review of CT scans [2]. The region of perforation typically appears as a linear calcified lesion surrounded by an area of inflammation, as in this case. Figure 1. Computed tomography (CT) demonstrated an inflammatory mass of 6.5 3 cm between small bowel and left abdominal wall, without pneumoperitoneum.

Síndrome compartimental abdominal secundario a pancreatitis aguda necrotizante

Severe acute pancreatitis occurs in around 20% of patients and is associated with mortality rates between 8-40%. Abdominal compartment syndrome is a fatal complication that is associated with new organ failure or acute worsening of existing organ failure and has an associated mortality of around 60%. Intra-abdominal pressure measurements are recommended in patients with risk factors for intra-abdominal hypertension or abdominal compartment syndrome. Management should be based on a step-up method and surgical intervention may be indicated when conservative treatment fails.

Acute pancreatitis secondary to periampullary duodenal diverticulitis.

The patient is a 93-year-old woman with a history of recurrent acute cholecystitis and pancreatitis who came to the ER with epigastric abdominal pain radiating towards the back and nausea. Lab work showed normal inflammatory parameters, amylase 1261 U/L, and hepatic profile without alterations. Computed tomography scan demonstrated multiple duodenal diverticula and detected a periampullary diverticulum with signs of local inflammation pressing on the intrapancreatic common bile duct (Figs. 1 and 2). The extrahepatic bile duct showed no alterations, although the pancreas had mild atrophy and the Wirsung duct presented moderate dilatation. The patient was hospitalized and managed conservatively; her progress was favorable and she was discharged one week later.

Absceso hepático post-colangiopancreatografía retrógrada endoscópica con presencia de Actinomyces naeslundii

Departamento de Cirugı́a, Ginecologı́a, Obstetricia y Pediatrı́a, Universidad de Murcia, Murcia, Spain Servicio de Cirugı́a General y del Aparato Digestivo, Hospital Clı́nico Universitario Virgen de la Arrixaca, Servicio Murciano de Salud, El Palmar, Murcia, Spain Instituto Murciano de Investigación Biosanitaria Virgen de la Arrixaca (IMIB-Arrixaca), Murcia, Spain Universidad de Sonora, Sonora, Mexico

Hidatidosis hepática gigante

Paciente varón de 83 años, con antecedentes de hipertensión arterial y hernia de hiato, acude a urgencias por presentar cuadro de febrı́cula y dolor abdominal. A la exploración destaca un efecto masa doloroso en hipocondrio derecho. Se realiza una colangiorresonancia magnética en la que se aprecian 2 quistes hidatı́dicos con mú ltiples vesı́culas en su interior, localizados en los segmentos VIII y entre los segmentos V y VI, que miden 12 11 cm y 19 12 cm, respectivamente (fig. 1). Se identifica una interrupción de la periquística con formación de vesı́culas adyacentes, que se extienden hacia el segmento IV. Diagnóstico: quiste hidatídico gigante. c i r e s p . 2 0 1 5 ; 9 3 ( 2 ) : e 1 1

Giant Hepatic Hydatidosis

Paciente varon de 83 anos, con antecedentes de hipertension arterial y hernia de hiato, acude a urgencias por presentar cuadro de febricula y dolor abdominal. A la exploracion destaca un efecto masa doloroso en hipocondrio derecho. Se realiza una colangiorresonancia magnetica en la que se aprecian 2 quistes hidatidicos con mu ltiples vesiculas en su interior, localizados en los segmentos VIII y entre los segmentos V y VI, que miden 12 11 cm y 19 12 cm, respectivamente (fig. 1). Se identifica una interrupcion de la periquistica con formacion de vesiculas adyacentes, que se extienden hacia el segmento IV. Diagnostico: quiste hidatidico gigante. c i r e s p . 2 0 1 5 ; 9 3 ( 2 ) : e 1 1