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Eleven patients with cicatricial stenosis in the junction area of hepatic ducts were evaluated. In all patients the injury occurred during cholescystectomy and no operative cholangiography was performed. In 3 patients the injury was recognized during the initial cholecistectomy. Ten patients had been operated on at least one time to correct the injury in other Services. Four cases had duct or peritoneal drainage. There was an attempt of reanastomosis in two cases. Five patients had a bilio-digestive anastomosis performed in variable occasions. Two patients were reoperated 5 times, one patient 3 times. The others were submitted to one or 2 reoperations. There were a period of 1 to 72 months between the injury and last reoperation. Jaundice was the most common presenting manifestation since it appeared in all patient except one. Five patients had biliary cirrhosis. Roux-en-Y hepaticojejunostomy was carried out in all cases after enlarging the biliar stoma by longitudinal section on the left hepatic duct and performing a termino-terminal anastomosis. The 10 or 12 caliber Kehr drain used was taken out after the control cholangiography, carried around the second postoperative week. Concerning the long term results, one patient died of recurrent cholangitis six months after the 6th reoperation and one patient 14 months after the 4th reoperation of liver failure. Both had biliary cirrhosis. Two patients, remained assymptomatic for 60 months and 3 patients for 24, 37 and 56 months. The importance of preventing this severe complication is stressed by the authors. Patients with such lesions need be referred to specialized centers where well trained surgeons are available. The technique herein presented seems us to be a good option.

Jejunal leiomyoblastoma was first described in 1960, and since then many reviews were made because its histological particularity, biological behavior, and rarity. Gastric localization is most common, and only 6 jejunal cases were described. A case of a 48 years old man with tumoral mass localized only on a proximal jejunum loop was operated because of intestinal obstruction due to intussusception of a jejunal leiomyoblastoma. Although the presence of some malignant criteria like lymphnodes and peripancreatic tissue metastasis after one year of follow-up, no sign of disease was present.

The detection of Bowen's disease, a very rare condition in an unusual extension--literally covering the anogenital area--and the successful more conservative way of handling the lesions, through surgical separate steps, prompted the authors to review the literature and to report the case.

The authors report three cases of cystadenoma of the pancreas. Two cases were serouscystadenoma and one case was mucouscystadenoma. The best diagnostic procedures were computed axial tomography and ultrasonography. Decisions regarding operation depend on three factors: the patient's general conditions, site of the tumor and hystologic pattern. In the first case the elderly patient had the tumor in the head of the pancreas which had led to biliary obstruction. To establish satisfactory biliary drainage a biliodigestive anastomosis was used. The other two cases were younger patients with large protruding abdominal mass in the epigastrium and mesogastrium by a tumor of the body and tail of the pancreas. In these cases we opted for body pancreatectomy and splenectomy. Since the serouscystadenoma doesn't have the malignant potential that the mucouscystadenoma has, the surgical procedure can be different from the surgical resection used for the treatment of pancreatic cystadenoma.

In order to relieve complete obstruction of the thoracic esophagus due to spinocellular carcinoma, thirteen patients, all of them in good or at least regular general conditions were submitted to a bypass using a isoperistaltic gastric tube. The disease itself was treated by radiotherapy after surgery. Only one patient died at the hospital due to an error in the radiotherapy schedule. Cervical fistula was observed in six patients seven days after surgery; local treatment was enough for complete healing in five out of six. In one patient surgery was performed in order to repair the anastomotic area. Stenosis was observed in three patients but in all cases it was possible to overcome it by endoscopy. With the progress of the disease other complications were observed such as hemoptysis and respiratory distress. The survival rate was nine months (running between five and sixteen) but it should be noted that swallow capacity was maintained until death. The employed of a bypass of isoperistaltic gastric tube seems to be a desirable alternative in the treatment of esophageal cancer because it allows the reestablishment of deglutition before any treatment such as radiotherapy alone or combined with surgery.

The authors report one case of peritoneal splenosis. The patient submitted to a gastrectomy had a past history of traumatic rupture of the spleen. The morphologic and immunologic aspects of splenosis are discussed. The value of imaging splenic tissue by scynthscanning are pointed out in basis of infection prophylaxis.

The authors report a case of acute emphysematous cholecystitis (AEC) operated on at the University Hospital of ABC Medical School (São Paulo), with a review of the literature. The infrequency of this finding and the participation of local ischemic factors, associated with secondary infection by gas forming bacteria are pointed out. The authors emphasize the importance of considering this entity potentially more severe than acute non-emphysematous cholecystitis (AnEC) because in AEC gallbladder gangrene is 30 times higher and perforation occurs 5 times more frequently than in AnEC. Besides, the patient with AEC may shows no clinical signs of severity, as in the case reported, where gallbladder gangrene was seen at surgery. In AEC, diagnosis is established usually when the plain abdominal X-ray shows gas within the gallbladder or in its walls. The best results are obtained with cholecystectomy and antibiotic therapy.

The authors report upon 5 cases of biliary-enteric fistulas, all of them detected preoperatively in a General Surgery Service during a relatively short period of time (6 months). Two cholecysto-duodenal and one cholecysto-ileal fistula were complications of a pre-existent cholelithiasis. A choledocho-duodenal fistula was caused by a penetrating peptic ulcer and a choledocho-colonic fistula was a iatrogenic traumatic one. The review of the literature demonstrates generally a lower incidence of this pathology in different surgical centers, one or two cases a year. More than 50 per cent of the biliary-enteric fistulas were unexpectedly found during operations on the biliary tract or stomach. This forces the surgeon to change his programmed surgical procedure without adequate preoperative preparation. The consequence is a higher morbidity rate in such operations. The continuing refinement of diagnostical procedures have led to a progressive and more frequent preoperative assessment of these fistulas. Adequate diagnostic methods and surgical procedures adopted in different cases of biliary enteric fistulas are discussed, emphasizing the good results obtained and the lower morbidity.

Squamous cell carcinoma of the esophagus, with isolated metastasis to the terminal ileum, is a rare finding. Only 18 of such cases have been reported in the medical literature, all of them found at necropsies. The accurate examination of the abdominal cavity, after performing a gastrostomy, showed a neoplastic lesion in the terminal ileum, which was then resected. The histopathological examination revealed the metastatic nature of the lesion. The authors emphasize the importance of a complete and accurate revision of the abdominal cavity on patients with esophagus squamous cell carcinoma.