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Introduction: When primary ventral hernia and simultaneous diastasis recti are diagnosed, there is no consensus among the surgical community on the surgical treatment regarding indications or surgi...

ResumenAntecedentesLa obstrucción intestinal en colon, como consecuencia de un cálculo biliar, es una enfermedad extremadamente rara, que suele desarrollarse en muy pocas ocasiones.Caso clínicoPresentamos el caso de una paciente de 87 años, que acude al servicio de urgencias por cuadro compatible con obstrucción intestinal de varios días de evolución, como consecuencia de un cálculo impactado en colon sigmoide.ConclusiónEl íleo biliar colónico es una enfermedad muy rara, que ocurre generalmente en pacientes de edad avanzada, como consecuencia del paso del cálculo de gran tamaño desde la vesícula al colon, a través de una fístula colecisto-cólica, siendo una enfermedad con una elevada morbimortalidad.AbstractBackgroundA gallstone colonic ileus is a very rare condition.Clinical caseThe case is reported of an 87 year-old patient who came to the Emergency Department due to an intestinal obstruction of several days onset, which was caused by a gallstone affected sigmoid colon.ConclusionColonic gallstone ileus is a rare disease that usually occurs in older patients due to the passage of large gallstone directly from the gallbladder to colon, through a cholecystocolonic fistula. It has a high morbidity and mortality.

Background Large vessel sarcomas are rare tumours. Leiomyosarcoma of the inferior vena cava is the most common. About 300 cases have been reported in the literature. They tend to be large, and not develop metastasis. The prognosis of these tumours is poor. Clinical case An 81-year-old woman who complained of pain in the right flank, with no other symptoms. Abdominal computed tomography showed a large retroperitoneal mass, which affected the inferior vena cava, with signs of thrombosis inside. It also encompassed the right renal vein and the right kidney. Excision of the tumour was performed in block, performing an autologous saphenous vein bypass between left the renal vein and proximal segment of inferior vena cava. Discussion Leiomyosarcomas of the inferior vena cava are classified according to their relationship with adjacent structures. The clinical signs and symptoms are generally non-specific. Diagnosis is made using computed tomography or magnetic resonance imaging, and biopsy of the retroperitoneal mass. Surgery is the only treatment capable of providing prolonged survival. The surgical management is determined by: the level of involvement, the extension, and the presence or absence of collateral veins. The role of adjuvant therapy is controversial. Conclusions Inferior vena cava leiomyosarcomas remain a challenge for surgeons. At present, radical resection with negative margins, offers the highest survival rate. The best results are obtained with a multidisciplinary approach by experienced teams in the management of these tumours.

ResumenAntecedentesLos sarcomas de grandes vasos son tumores raros; el leiomiosarcoma de cava inferior es el más frecuente de ellos, del que existen unos 300 casos descritos. Tienden a presentar gran tamaño sin causar metástasis. El pronóstico de estos tumores es malo.Caso clínicoMujer de 81 años que consulta por dolor en fosa renal derecha, sin otra sintomatología. La tomografía computada abdominal muestra una gran masa retroperitoneal, que compromete a la vena cava inferior, con signos de trombosis en su interior; igualmente, engloba a la vena renal derecha y al riñón derecho. Se realizó exéresis de la tumoración en bloque, con un bypass autógeno, con safena entre vena renal izquierda y segmento proximal de vena cava inferior.DiscusiónLos leiomiosarcomas de vena cava inferior se clasifican en función de su relación con las estructuras vecinas. La clínica suele ser inespecífica. El diagnóstico se realiza por tomografía computada o resonancia magnética nuclear y biopsia de la masa retroperitoneal. La cirugía es el único tratamiento capaz de proporcionar supervivencias prolongadas. El manejo quirúrgico se determina por: el nivel de afectación, la extensión y la presencia o ausencia de venas colaterales. El papel del tratamiento adyuvante es controvertido.ConclusionesLos leiomiosarcomas de vena cava inferior continúan siendo un desafío para los cirujanos. En la actualidad, la resección radical con márgenes negativos ofrece la mayor tasa de supervivencia. Los mejores resultados se obtienen con un abordaje multidisciplinario por parte de equipos experimentados en el manejo de estos tumores.AbstractBackgroundLarge vessel sarcomas are rare tumours. Leiomyosarcoma of the inferior vena cava is the most common. About 300 cases have been reported in the literature. They tend to be large, and not develop metastasis. The prognosis of these tumours is poor.Clinical caseAn 81 year-old woman who complained of pain in the right flank, with no other symptoms. Abdominal computed tomography showed a large retroperitoneal mass, which affected the inferior vena cava, with signs of thrombosis inside. It also encompassed the right renal vein and the right kidney. Excision of the tumour was performed in block, performing an autologous saphenous vein bypass between left the renal vein and proximal segment of inferior vena cava.DiscussionLeiomyosarcomas of the inferior vena cava are classified according to their relationship with adjacent structures. The clinical signs and symptoms are generally non-specific. Diagnosis is made using computed tomography or magnetic resonance imaging, and biopsy of the retroperitoneal mass. Surgery is the only treatment capable of providing prolonged survival. The surgical management is determined by: the level of involvement, the extension, and the presence or absence of collateral veins. The role of adjuvant therapy is controversial.ConclusionsInferior vena cava leiomyosarcomas remain a challenge for surgeons. At present, radical resection with negative margins, offers the highest survival rate. The best results are obtained with a multidisciplinary approach by experienced teams in the management of these tumours.

Resumen Objetivo Presentar nuestra experiencia en la implantacion periestomal de malla de polipropileno en espacio preperitoneal como profilaxis de hernia paraestomal en colostomias terminales en pacientes intervenidos por neoplasia rectal. Metodos Desde enero de 2010 hasta marzo de 2014, 45 pacientes consecutivos afectados de neoplasia de recto que requirieron implantacion de colostomia terminal definitiva fueron intervenidos y analizados. En todos ellos se implanto una malla de polipropileno profilactica en espacio preperitoneal periestomal. Analizamos variables demograficas, aspectos tecnicos y efectividad de la tecnica asi como complicaciones consecuentes. Resultados Se implanto malla profilactica en 45 pacientes, 35 varones y 10 mujeres, con una media edad de 66,2 anos (47-88) y un indice de masa corporal de 29,1 (20,4-40,6). Se intervinieron de manera programada y con identico protocolo 7 adenocarcinomas de recto medio, 36 de recto bajo, un melanoma de recto y un carcinoma de celulas escamosas de ano; realizandose una amputacion abdominoperineal en 38 pacientes y reseccion anterior baja con colostomia terminal en 7 pacientes. La via de abordaje fue laparotomica en 39 casos y laparoscopica en 6 casos, 2 de los cuales se convirtieron a laparotomia. La mediana del tiempo de seguimiento fue de 22 meses (2,1-53). Se evidenciaron 3 hernias paraestomales (6,6%), siendo un hallazgo radiologico durante tomografia computarizada de control. No hubo complicaciones asociadas a la colostomia ni a la implantacion de la malla. Conclusiones La colocacion de una malla de polipropileno en localizacion paraestomal preperitoneal es facilmente reproducible, disminuyendo la incidencia de hernia paraestomal sin aumentar la morbilidad ni la mortalidad.

Objective: To show our results with the use of a polypropylene mesh at the stoma site, as prophylaxis of parastomal hernias in patients with rectal cancer when a terminal colostomy is performed. Methods: From January 2010 until March 2014, 45 consecutive patients with rectal cancer, underwent surgical treatment with the need of a terminal colostomy. A prophylactic mesh was placed in a sublay position at the stoma site in all cases. We analyse Demographics, technical issues and effectiveness of the procedure, as well as subsequent complications. Results: A prophylactic mesh was placed in 45 patients, 35 male and 10 females, mean age of 66.2 (47–88) and Body Mass Index 29.1 (20.4–40.6). A total of 7 middle rectal carcinoma, 36 low rectal carcinoma, one rectal melanoma and one squamous cell anal carcinoma were electively treated with identical protocol. Abdominoperineal resection was performed in 38 patients, and low anterior resection with terminal colostomy in 7. An open approach was elected in 39 patients and laparoscopy in 6, with 2 conversions to open surgery. Medium follow up was 22 months (2.1–53). Overall, 3 parastomal hernias (6.66%) were found, one of which was a radiological finding with no clinical significance. No complications related to the mesh or the colostomy was found. Conclusions: The use of a prophylactic polypropylene mesh placed in a sublay position at the stoma site is a safe and feasible technique. It lowers the incidence of parastomal hernias with no increased morbidity. Objetivo: Presentar nuestra experiencia en la implantación periestomal de malla de polipropileno en espacio preperitoneal como profilaxis de hernia paraestomal en colostomías terminales en pacientes intervenidos por neoplasia rectal. Métodos: Desde enero de 2010 hasta marzo de 2014, 45 pacientes consecutivos afectados de neoplasia de recto que requirieron mplantación de colostomía terminal definitiva fueron intervenidos y analizados. En todos ellos se implantó una malla de polipropileno profiláctica en espacio preperitoneal periestomal. Analizamos variables demográficas, aspectos técnicos y efectividad de la técnica así como complicaciones onsecuentes. Resultados: Se implantó malla profiáctica en 45 pacientes, 35 varones y 10 mujeres, con una media edad de 66,2 años (47–88) y un índice Masa Corporal de 29,19 (20,4–40,6). Se intervinieron de manera programada y con idéntico protocolo 7 adenocarcinomas de recto medio,36 de recto bajo, un melanoma de recto y un carcinoma de células escamosas de ano; realizándose una amputación abdominoperineal en 38 pacientes y resección anterior baja con colostomía terminal en 7 pacientes. La vía de abordaje fue laparotómica en 39 casos y laparoscópica en 6 casos, 2 de los cuales se convirtieron a laparotomía. La mediana del tiempo de seguimiento fue de 22 meses (2,1–53). Se evidenciaron 3 hernias paraestomales (6,6%), siendo un hallazgo radiológico durante tomografía computarizada de control. No hubo complicaciones asociadas a la colostomía ni a la implantación de la malla. Conclusiones: La colocación de una malla de polipropileno en localización paraestomal preperitoneal es fácilmente reproducible, disminuyendo la incidencia de hernia paraestomal sin aumentar la morbilidad ni la ortalidad.

Carcinoid tumors of the ampulla of Vater grow slowly and have an excellent prognosis after complete resection of local disease. Histopathological diagnosis is definitive, and the Whipple's procedure is performed as a standard at the present time, although more novel minimally-invasive techniques may be highly useful for selected patients. While tumor size is not a reliable marker of tumor aggression, it is nonetheless related to lymphatic invasion, hence an accurate diagnosis is important if the patient is to be offered the best option available for the treatment of their disease. Endoscopic ultrasound (EUS) is the technique of choice for presurgical assessment and endocopic excision, as it may rule out vascular and nodal involvement, and establish whether submucosal invasion is present, which precludes endoscopic resection. Local resection has been shown to obtain similar results as compared to CDP in terms of overall survival in patients with small periampullary NETs, with the advantage of significantly lower morbidity in selected cases.

Background A gallstone colonic ileus is a very rare condition. Clinical case The case is reported of an 87 year-old patient who came to the Emergency Department due to an intestinal obstruction of several days onset, which was caused by a gallstone affected sigmoid colon. Conclusion Colonic gallstone ileus is a rare disease that usually occurs in older patients due to the passage of large gallstone directly from the gallbladder to colon, through a cholecystocolonic fistula. It has a high morbidity and mortality.

Resumen Objetivo La aplicacion de la tecnica laparoscopica en la colecistitis aguda es aun hoy un tema controvertido. El objetivo del estudio es valorar la aplicabilidad, seguridad, beneficios y complicaciones del abordaje laparoscopico en pacientes con colecistitis aguda, asi como la evolucion y desarrollo de dicha via en la unidad de cirugia de urgencias de un hospital de tercer nivel, en comparacion con la laparotomica. Material y metodo El estudio consta de 354 pacientes con cuadros de colecistitis aguda intervenidos por via abierta o laparoscopica desde 2006 a 2009. Resultados Se han intervenido 253 pacientes por via laparoscopica, 101 por via abierta, apreciandose un predominio del sexo masculino (57,67%) y una edad media de 62,83 anos. El numero de colecistectomia laparoscopica ha pasado del 60% en el 2006, al 79% en 2009. La estancia media (englobando complicadas y no complicadas) hablan a favor del abordaje laparoscopico frente al abierto (mostrando una diferencia de aproximadamente 6 al dia). Las complicaciones postoperatorias a lo largo de estos cuatro anos en la via laparoscopica han experimentado un descenso, pasando de un 21,42 a un 11,3%. Las complicaciones locales y globales se correlacionaron significativamente con el tiempo transcurrido entre el inicio de los sintomas agudos y la cirugia, asi como con el estado anatomopatologico de la vesicula biliar. Conclusiones El abordaje laparoscopico va adquiriendo un papel cada vez mas primordial en el tratamiento de esta dolencia, convirtiendose en nuestro hospital en la principal opcion quirurgica.

The application of the laparoscopic technique in acute cholecystitis is still subject to controversy. The aim of this study is to asses the applicability, safety, benefits and complications of the laparoscopic approach in patients with acute cholecystitis, as well as the development of this technique in the emergency surgery department of a tertiary hospital, compared to laparotomy.The study consisted of 354 patients with acute cholecystitis syndromes operated either by open or laparoscopic surgery, during the years 2006 to 2009.The laparoscopic method was used in 253 patients, and 101 by the open route, with the slight majority being male (57.67%) and with a mean age of 62.83 years. The number of laparoscopic cholecystectomies increased from 60% in 2006, to 79% in 2009. The mean hospital stay (including those with and without complications) was shorter using the laparoscopic approach, compared to open surgery (showing a difference of approximately 6 days). The postoperative complications in laparoscopy during the four years studied decreased from 21.42 to 11.3%. The local and general complications were significantly associated with time since the start of the acute symptoms and the surgery, as well as the histopathological state of the gall bladder.The laparoscopic approach continues to play an increasing role in the treatment of this disease, becoming the main surgical option in our hospital.

Hirschsprung's disease is characterized by absence of ganglion cells in submucosal and myenteric plexus of distal bowel. Most cases become manifest during the neonatal period, but in rare instances, this disease is initially diagnosed in adult age. It usually presents as severe constipation with colonic dilatation proximal to the aganglionic segment. The treatment is surgical, removing the aganglionic segment and restoring continuity of digestive tract. The disease rarely presents as an acute intestinal obstruction. We report a case not previously diagnosed, which presented as a massive colonic dilatation with a maximum diameter of 44 cm, with imminent risk of drilling that forced to perform an emergency surgery. We include a review of existing literature.