Tratamento de cisto mesentérico quiloso Mesenteric chylous cyst treatment

INTRODUÇÃO: Cistos mesentéricos são tumores abdominais raros, que podem acometer pacientes de todas as faixas etárias, sendo mais comuns em mulheres na quarta década de vida. Essas neoplasias são geralmente assintomáticas e diagnosticadas por acaso. Seu tratamento é baseado na retirada do cisto, por laparotomia ou laparoscopia, embora em alguns casos possa ser necessária a ressecção de segmento intestinal. O prognóstico é bom e a recorrência é baixa. RELATO DO CASO: Mulher de 40 anos de idade, obesa, hipertensa e diabética, apresentou história de dor abdominal contínua de pouca intensidade no hipocôndrio esquerdo e epigástrio, sem irradiações, durante cerca de três meses. Após um mês do início dos sintomas percebeu massa em andar superior do abdome palpável desde o epigástrio até o flanco esquerdo, de consistência endurecida, pouco móvel, superfície regular e dolorosa. A tomografia computadorizada de abdome evidenciou formação cística de paredes finas e lisas, medindo 12,9 x 11,6 x 9,9 cm, situada em flanco esquerdo, em região mesentérica, deslocando estruturas adjacentes, sugestiva de cisto mesentérico. À laparotomia evidenciou-se massa cística, com aproximadamente 10 cm de diâmetro, de parede fina e lisa, cor amarelada, com vasos tortuosos na superfície, sem aderência à estruturas adjacentes, localizada no mesojejuno a cerca de 50 cm da flexura duodenojejunal. O cisto foi completamente retirado e seu conteúdo era líquido brancacento e inodor, sugestivo de quilo. O exame anatomopatológico revelou cisto mesotelial benigno mesentérico. CONCLUSÃO: O tratamento desses cistos consiste basicamente na sua retirada ou descapsulação, que pode ser realizado de preferência por via laparoscópica.<br>INTRODUCTION: Mesenteric cysts are rare abdominal tumors that may occur in patients at any age and are more common in women at the age of forty. They are generally free of symptoms and incidentally found. The treatment is based on cyst ressection, by laparotomy or laparoscopy, although the enterectomy may be necessary. The prognosis is usually good and the recurrence is rare. CASE REPORT: Women 40 years of age, obese, hypertensive and diabetic, had a history of continuous abdominal pain of low intensity in the left hypochondrium and epigastrium, without irradiation, for about three months. After a month of onset of symptoms noticed a mass in the upper abdomen palpable from the epigastrium to the left flank with a hard consistency, little mobility, smooth surface and painful. Computed tomography of the abdomen showed cystic formation with thin smooth wall, measuring 12.9 x 11.6 x 9.9 cm, located on the left flank in the mesenteric region, displacing adjacent structures, suggestive of mesenteric cyst. At laparotomy a cystic mass was found, with approximately 10 cm in diameter, yellowish, with tortuous vessels on the surface, without adherence to adjacent structures, located in mesojejunum about 50 cm from the duodenojejunal flexure. The cyst was completely removed and its content was whitish and odorless liquid, suggesting a chylo. Pathology revealed benign mesothelial mesenteric cyst. CONCLUSION: - The treatment of these cysts consists basically of their withdrawal or decapsulization, which can preferably be achieved by laparoscopy

Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence

Abstract We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3–0.9%) 12 months and 1.8% (95%CI 1.1–2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1–0.3%) 12 months and 0.6% (95%CI 0.5–0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3–82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure