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Background: Several guidelines have put forward recommendations about the perioperative process of cholecystectomy. Despite the recommendations, controversy remains concerning several topics, especially in low- and middle-income countries. The aim of this study was to develop uniform recommendations for perioperative practices in cholecystectomy in Mexico to standardize this process and save public health system resources., Methods: A modified Delphi method was used. An expert panel of 23 surgeons anonymously completed two rounds of responses to a 29-item questionnaire with 110 possible answers. The consensus was assessed using the percentage of responders agreeing on each question., Results: From the 29 questions, the study generated 27 recommendations based on 20 (69.0%) questions reaching consensus, one that was considered uncertain (3.4%), and six (20.7%) items that remained open questions. In two (6.9%) cases, no consensus was reached, and no recommendation could be made., Conclusions: This study provides recommendations for the perioperative management of cholecystectomy in public hospitals in Mexico. As a guide for public institutions in low- and middle-income countries, the study identifies recommendations for perioperative tests and evaluations, perioperative decision making, postoperative interventions and institutional investment, that might ensure the safe practice of cholecystectomy and contribute to conserving resources., (Copyright © 2020 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)

We present the unique case of a young female woman with an infected left liver hematoma as a complication of a previous endoscopic retrograde cholangiopancreatography for a choledocolithiasis. Urgent liver resections are rarely indicated and are usually performed in cases of important liver trauma. To our knowledge this is the first case of an urgent liver resection for the rare indication of late hepatic infected hematoma after an ERCP.

Hepatic mucinous cystic neoplasms represent a challenging pathology due to their very low frequency, insidious presentation and unclear demography due to the limited cases reported to date. Surgical treatment is mandatory when possible to prevent recurrence and malignant transformation. The case presented herein has a peculiarity, mainly an increased level of CA 19-9 which has not been previously reported.

We present the very unusual case of a 38-year-old woman with acute appendicitis and intestinal obstruction. During surgery, a 2.5 cm gallstone impacted at the base of the cecal appendix was found as the cause of a gangrenous appendicitis and obstruction; a choledochal-duodenal fistula was found during the same surgery with no gallstones remaining in the gallbladder or elsewhere. The case was managed by appendectomy with retrieval of the gallstones and no other procedure was performed for the gallbladder or the fistula, since no other gallstone was found on examination. Previously, she was found to have a round, radio-opaque image on the right iliac fossa on imaging, initially identified as an appendicolith, but after pathological examination it turned out to contain cholesterol and calcium bilirubinate. Gallstone ileus as the cause of an obstructive gangrenous appendicitis is a very unusual disease presentation that should be kept in mind when finding an unusual appendicolith presentation in or out the appendix.

Foreign bodies are a common problem in the daily endoscopic practice. Nevertheless, long objects as toothbrushes, sometimes pose a special problem when trying to remove them from the stomach, due to the difficulty of passing through the hiatus. Endoscopic retrieval of toothbrushes has seldom be reported.

Background: Vaginal evisceration is a rare event associated to be associated with several factors. In premenopausal women it is often associated with trauma during intercourse, rape, iatrogenic injury and introduction of foreign objects. In postmenopausal women 73% of cases are associated with previous vaginal surgery or hysterectomy., Case Report: Here we present the case of a female patient who had a vaginal evisceration six days after an abdominal hysterectomy. The patient underwent an abdominal reduction of the small bowel, but due to irreversible vascular compromise it was resected. The vaginal cuff was closed with interrupted non-absorbable sutures., Conclusion: Vaginal evisceration is a rare disease associated with pelvic surgery. When it happens, it should be addressed as an emergency. The abdominal approach is the choice when there is trauma or intestinal ischemia, while the combined vaginal with laparoscopic approach is a good option in selected patients.