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Background: The gastrointestinal stromal tumours (GIST) are the most common soft tissue sarcomas of the digestive tract. They are usually found in the stomach (60-70%) and small intestine (25-30%) and, less commonly, in the oesophagus, mesentery, colon, or rectum. The symptoms present at diagnosis are, gastrointestinal bleeding, abdominal pain, abdominal mass, or intestinal obstruction. The type of symptomatology will depend on the location and size of the tumour. The definitive diagnosis is histopathological, with 95% of the tumours being positive for CD117., Clinical Cases: This is an observational and descriptive study of 5cases of small intestinal GIST that presented with gastrointestinal bleeding as the main symptom. The period from the initial symptom to the diagnosis varied from 1 to 84 months. The endoscopy was inconclusive in all of the patients, and the diagnosis was made using computed tomography and angiography. Treatment included resection in all patients. The histopathological results are also described., Conclusion: GIST can have multiple clinical pictures and unusual symptoms, such as obscure gastrointestinal bleeding. The use of computed tomography and angiography has shown to be an important tool in the diagnosis with patients with small intestine GISTs., (Copyright © 2016. Publicado por Masson Doyma México S.A.)

Background: Choledochal cysts are rare. They usually present during childhood in women, but it can also be seen during pregnancy. Clinical signs and symptoms are obscured during this time, thus it can complicate the diagnosis and represent a life threatening complication for both the mother and the child., Objective: To communicate the case of 3 pregnant patients with choledochal cyst., Clinical Cases: Three pregnant women in which choledochal cyst were diagnosed. Two developed signs of cholangitis. The first one underwent a hepatic-jejunostomy, but had an abortion and died on postoperative day 10. The second one had a preterm caesarean operation due to foetal distress and underwent a hepatic-jejunostomy 4 weeks later; during her recovery she had a gastric perforation and died of septic complications. The third one did not develop cholangitis or jaundice. She had an uneventful pregnancy and had a hepatic-jejunostomy 4 weeks later with good results., Conclusions: Management of choledochal cysts during pregnancy is related to the presence of cholangitis. When they do not respond to medical treatment, decompression of the biliary tree is indicated. Definitive treatment should be performed after resolution of the pregnancy., (Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.)

Introduction: Achalasia is a primary esophageal motor disorder. The most common symptoms are: dysphagia, chest pain, reflux and weight loss. The esophageal manometry is the standard for diagnosis. The aim of this paper is to determine the effectiveness of the surgical management in patients with achalasia in a tertiary care hospital., Methods: A case series consisting of achalasia patients, treated surgically between January and December of 2011. Clinical charts were reviewed to obtain data and registries of the type of surgical procedure, morbidity and mortality., Results: Fourteen patients were identified, with an average age of 49.1 years. The most common symptoms were: dysphagia, vomiting, weight loss and pyrosis. Eight open approaches were performed and six by laparoscopy, with an average length of cardiomyotomy of 9.4 cm. Eleven patients received an antireflux procedure. The effectiveness of procedures performed was 85.7 %., Conclusions: Surgical management offered at this tertiary care hospital does not differ from that reported in other case series, giving effectiveness and safety for patients with achalasia.

Background: Hepatic pseudoaneurysm is rare and potentially fatal. It occurs as a consequence of injury to the vascular wall, erosion diathermy through clips, biliary leakage and secondary infection. The main symptom is intra-abdominal bleeding., Objective: To communicate the case of two patients with hepatic pseudoaneurysm., Clinical Cases: Case 1: We present a 43 year-old male with a history of grade IV liver injury due to blunt abdominal trauma and managed surgically. Case 2: A 67 year-old man with bile duct injury after laparoscopic cholecystectomy. Both patients presented with biliary leakage, abdominal sepsis and late intra-abdominal bleeding. Tomographic studies showed the lesion. Superselective embolization was performed proximal and distal to the lesion with good results. During follow-up, none of them showed signs of recurrent bleeding., Conclusions: Hepatic artery pseudoaneurysm is rare and usually secondary to bile duct injury associated with vascular injury after cholecystectomy or liver trauma. Arteriography with embolization is the best diagnostic and therapeutic procedure. Surgery is indicated for hemodynamically unstable patients, embolization failure or rebleeding. Early diagnosis reduces morbidity and mortality of this complication.

Background: The afferent syndrome loop is a mechanic obstruction of the afferent limb before a Billroth II or Roux-Y reconstruction, secondary in most of case to distal or subtotal gastrectomy. Clinical case: Male 76 years old, with antecedent of cholecystectomy, gastric adenocarcinoma six years ago, with subtotal gastrectomy and Roux-Y reconstruction. Beginning a several abdominal pain, nausea and vomiting, abdominal distension, without peritoneal irritation sings. Amylase 1246 U/L, lipase 3381 U/L. Computed Tomography with thickness wall and dilatation of afferent loop, pancreas with diffuse enlargement diagnostic of acute pancreatitis secondary an afferent loop syndrome., Conclusion: The afferent loop syndrome is presented in 0.3%-1% in all cases with Billroth II reconstruction, with a mortality of up to 57%, the obstruction lead accumulation of bile, pancreatic and intestinal secretions, increasing the pressure and resulting in afferent limb, bile conduct and Wirsung conduct dilatation, triggering an inflammatory response that culminates in pancreatic inflammation. The severity of the presentation is related to the degree and duration of the blockage.

Background: Biliary ileus is present in 0.06% of patients with gallstones as an outcome of a cholecystoenteric fistula, most frequently presenting as an intestinal obstruction. It is a clinic entity occasionally diagnosed, which translates into a significant margin of complications and mortality ranging from 12 to 27%. Our objective is to report the experience in the treatment of this pathology in a tertiary care hospital., Methods: We carried out a retrospective study in patients with a diagnosis of biliary ileus during a 10-year period., Results: thirteen patients were included in the study, nine males (69%) and four females (31%) with a mean age of 57 years. All patients had intestinal occlusion symptoms. Preoperative diagnosis was achieved in three patients (23%). The most common surgery was intestinal resection with anastomosis (54%). One patient from the study group died (8%). Hospitalization length was a mean of 15 days and average follow-up was 11 months., Conclusions: Bilary ileus is a pathology of patients of advanced age and must be suspected when symptoms of occlusion are present, regardless of gender. Early diagnosis can mean earlier intervention and potentially less traumatic surgery. Treatment is focused on urgent laparotomy and resolution of the intestinal occlusion, leaving management of the biliary fistula to only selected cases.

Background: Pancreatic cystic lesions (PCL) are identified in 1 % of patients who undergo abdominal computed tomography scans, because it is difficult to discriminate clinically between benign and malignant PCL. The PCL must be distinguished from inflammatory pseudocysts, which can have a similar radiographic appearance. The aim of this study was to review the incidence of PCL during 10 years., Methods: Nineteen consecutive patients who underwent surgical resection of a cystic lesion of the pancreas during a 10-year period were reviewed., Results: From 1998, 434 patients underwent to pancreatic surgery, 103 (25.75%) resulted with neoplasm of the pancreas and a PCL was diagnosed in 19 of them (18.44%). They were more common in women (n=15, 79%). The pathologic diagnosis was mucinous cystadenoma (n=6, 31.5%) followed by serous cystadenoma and solid cystic papilar tumor (n=4, 21%). Mucinous cystadenocarcinoma was diagnosed in a 77 year-old man and a serous cystadenocarcinoma was diagnosed in a 53 years-old woman; cystic degeneration of two insulinomas were diagnosed in a 71 year-old woman and a 32 year-old man (5.26%)., Conclusions: PCLs represent a spectrum of associated diseases. The incidence of serous cystadenoma is lower in our experience.

Retroperitoneal cystic lymphangyoma is a benign lesion, extremely rare in adults. In most cases is asymptomatic. The objective of this report is to present the case of an 82 year old woman who presented abdominal pain, food intolerance and a palpable abdominal mass located toward the upper right quadrant. The abdominal CT scan showed a cystic lesion below the liver which extended to the retroperitoneum. The patient underwent laparotomy achieving complete resection of the lesion and she was discharged soon after. After six months of follow up, she has not presented recurrence. The presentation of this lesion is very rare, generally as a consequence of congenital malformations of the lymphatic vessels. These lesions must be considered as part of the differential diagnosis of the cystic type tumors. The ultrasound and abdominal CT scan are useful for diagnosis. Surgical resection is the only therapeutic option.

Background: splenectomy has been elected surgical procedure for multiple hematologic diseases, specially for Idiopathic Thrombocytopenic Purpura. The aim of this study was to compare the incidence of splenectomies in two different periods of time and to show decrease tendency during the most recent years., Methods: it was a retrospectively reviewed study from medical records of patients who underwent splenectomy at the Hospital de Especialidades Siglo XXI, between 1986 to 1990 and 1995 to 1999., Results: during the first period of time, the incidence of splenectomies for hospital admissions was 0.52%, and in the second 0.19%., Conclusions: the incidence of splenectomies performed at the Hospital de Especialidades Siglo XXI decreased in the second period of time, probably because there are new available treatments for hematologic diseases.

Introduction: We report here a case of a patient with pseudotumor cerebri (PTC) associated with morbid obesity. PTC, also called benign intracranial hypertension, is a known complication of morbid obesity with resolution by reduction of obesity., Clinical Case: A 42-year-old female with morbid obesity and secondary PTC underwent a modified jejunocolonostomy., Results: The patient has lost 43% of excess body weight and the intracranial pressure is normal., Conclusions: PTC is a benign pathology, and the cause may be morbid obesity. Bariatric surgery is useful in the management of these patients for the resolution of this disease.

Objective: The objective of this report is to describe the existence of a rare tumor that must be taken into consideration when studying the diagnosis of pancreatic tumors., Case Report: A 20-year-old female with abdominal pain as an only manifestation was seen. The diagnosis of a pancreatic head and body tumor was made. During surgery, we found a tumor in the head and body of the pancreas that measured approximately 10 x 7 cm; histopathologic study revealed a solid and cystic papillary epithelial neoplasm of the pancreas., Discussion: Frantz-Gruber tumor is a rare pancreatic tumor suspected during the evaluation of a young female with abdominal pain and confirmed during surgery. It is important to consider the existence of this tumor in the evaluation of patients with these characteristics; even if the tumor's biological behavior is benign Frantz-Gruber tumor is considered a low-grade malignant tumor

Since 1905, the abdominal cavity has been used for absorption of cerebrospinal fluid in patients with hydrocephalus. Among complications in its use is formation of abdominal pseudocysts. We describe the case of a patient with hydrocephalus who developed an abdominal pseudocyst. The main complaint of the patient was abdominal pain and fever. During physical examination, a 15-cm abdominal tumor was detected. The patient underwent abdominal surgery for excision of the pseudocyst and peritoneal shunt was relocated to right atrium. Recovery was uneventful. Incidence of abdominal pseudocyst ranges from 1-4.5%. Principal symptoms are related with intracranial hypertension. The patient usually requires surgical exploration to resolve the illness, and in presence of infection the shunt should be changed.

Intestinal obstruction is one of the most frequently abdominal problems that concern general surgeons. One of the infrequent causes of mechanical obstruction is sclerosing encapsulating peritonitis (SEP); this entity causes intense fibrosis of the components in the peritoneal layer, resulting in adhesion of abdominal organs. SEP can be primary or secondary; both are a type of peritoneal fibrosclerosis that causes intestinal obstruction with difficult resolution and a great number of complications. In terms of frequency and etiology, there are few data, and the problem is considerated a multifactorial disease with association to neoplasms, toxics, drugs, and idiopathic form. This article presents three cases of sclerosing encapsulating peritonitis and the possible factors that play an important role in the development of this infrequent entity.

Background Data: Surgery stays as the only effective therapy against gastric cancer. Several factors have been postulated to influence morbidity and mortality risk in gastric cancer surgery., Objective: Determine morbidity and mortality of gastric cancer surgery and establish risk factors., Method: We reviewed the charts of patients who underwent surgery for gastric adenocarcinoma. Morbidity and mortality is reported. Demographic factors, preoperative physical evaluation, biochemical parameters, surgical technique and tumor biology were analyzed as risk factors for morbidity and mortality., Results: During a seven year period, 120 patients were operated for gastric cancer. Median age was 58.07 years. Subtotal gastrectomy was the most common surgical procedure in 51 patients (42.5%). Morbidity was 26.66% (n = 32). Medical most common complication was renal failure (n = 6, 14.63%) and surgical most common complication was wound infection (n = 7, 17.07%). Mortality was 13.33% (n = 16). Statistically significant risk factors for morbidity were age, ECOG status, Goldman Cardiac Risk Index and a total lymphocyte count. Statistically significant risk factors for mortality were Goldman Cardiac Risk Index, albumin, creatinine, and total lymphocyte count., Conclusions: Morbidity and mortality after gastric cancer surgery is influenced by preoperative conditions of patients.

The objective of the present study was to determine the type, frequency and severity of the side effects of a low-molecular-weight heparin (LMWH) during the prophylaxis of thromboembolic disease (TED) after abdominal surgery. The study was prospective, comparative, longitudinal, and open. The setting was at the surgical and hematology services of a teaching hospital. There were 57 patients (27 males, 30 females) with risk factors for TED, including gastrointestinal malignancies. Seventeen patients (Group A) received LMWH, 20 mg/day; 20 (Group B) standard heparin (SH), 5,000 U/12 h, and 20 (Group C) formed the control group. LMWH or SH were administered 2 h before surgery and then, when patients assumed complete ambulatory status, at the end of their hospital stay or for a maximum of ten days. There were no significant differences among the groups in relation with age, anthropometric variables, type and duration of surgery, nor in the extent of the surgical bleeding, days to full ambulatory status nor length of postoperative hospital stay. A similar number of erythrocyte transfusions were used on the three groups. Eighty-three percent of the patients were 50 years of age or older. None developed TED. Postoperatively in group "A" a significant increase in platelets (p = 0.01) was found, as was the shortening of the activated partial thromboplastin time (P = 0.007); other adverse effects did not occur during the administration of LMWH. These findings allowed us to conclude that LMWH constitutes a safe, reliable and comfortable alternative for prophylaxis of TED in this type of surgical patients.