Epidemiological profile of esophageal cancer mortality in Rio Grande do Sul and its health Regions

Introduction: Malignant esophageal neoplasia is a rare tumor, but it has high morbidity and mortality. Early diagnosis and intensive treatment associated with surgical approach remains the best treatment for the disease. Its epidemiology is extremely diverse in the world, even in the same country.Methodology: This was a retrospective analysis made from 2000-2015, analyzing the mortality rates of malignant esophageal neoplasia in the state of Rio Grande do Sul (RS) in its 30 Health Regions and in Brazil. The mortality data were collected in the Mortality Information System (SIM) and the population data in the Brazilian Institute of Geography and Statistics (IBGE).Results: The esophageal cancer mortality rate was 8.61 (95% CI, 8.49-8.73) per 100,000 inhabitants in RS, while the national rate was 3.66 (95% CI, 3, 49- 3.82), with a significant difference (p <0.0001). The regional distribution was variable, and the West Border region presented the highest rate, 12.91 (95% CI, 12.05-13.77). However, even regions with lower mortality presented twice as much deaths than the national rate. Mortality increased with aging, with the oldest age groups (≥80 years) presenting 69.62 (95% CI, 64.9-74) deaths per 100,000 inhabitants. Conclusion: Esophageal neoplasia is still a very serious condition in the state of RS, being associated with an almost 3-fold higher mortality rate compared to the national rate. Even within the state different epidemiological patterns are found.Keywords: Esophageal cancer; epidemiology; mortalit

Incarcerated right-sided diaphragmatic hernia in a patient undergoing Roux-en-Y gastric bypass

Bochdalek hernia is the most common congenital diaphragmatic hernia. Its symptoms are normally diagnosed and treated during the neonatal period. Conversely, in adults it is usually asymptomatic and, as a consequence, this group is misdiagnosed. A case of a 64-year-old female patient with an uncommon incarcerated right-sided diaphragmatic hernia formed three years after a Roux-en-Y gastric bypass and a significant weight loss is reported. The importance of this abnormality as a complication of the bariatric surgery should be considered.Key words: Diaphragmatic hernia; gastric bypass; bariatric surgery

Mucinous cystic neoplasm of the liver

A 55-year-old woman was investigated for occasional epigastric pain and weight loss. T2-weighted abdominal magnetic resonance imaging and magnetic resonance cholangiography revealed a multilocular cyst with multiple septa and a solid component in the liver, measuring 6.1 x 4.8 x 6.5 cm. Given the patient’s symptoms and malignant potential, a laparoscopic segmentectomy with partial resection of segments IV B and V was performed to completely remove the cystic lesion, associated with cholecystectomy. Histopathology demonstrated a cyst lined by columnar mucinous epithelium. Therefore, the diagnosis was mucinous cystic neoplasm of the liver. This article presents a case report and literature review of this entity.A 55-year-old woman was investigated for occasional epigastric pain and weight loss. T2-weighted abdominal magnetic resonance imaging and magnetic resonance cholangiography revealed a multilocular cyst with multiple septa and a solid component in the liver, measuring 6.1 x 4.8 x 6.5 cm. Given the patient’s symptoms and malignant potential, a laparoscopic segmentectomy with partial resection of segments IV B and V was performed to completely remove the cystic lesion, associated with cholecystectomy. Histopathology demonstrated a cyst lined by columnar mucinous epithelium. Therefore, the diagnosis was mucinous cystic neoplasm of the liver. This article presents a case report and literature review of this entity

Cisto Epidermóide de Baço em Paciente Previamente Hígido

Paciente feminina, 14 anos, previamente hígida, com queixa de dor lombar e em flanco esquerdo há seis meses. Apresentava também plenitude pós-prandial, de início concomitante aos outros sintomas. À palpação abdominal, percebia-se massa em hipocôndrio esquerdo e elevação do gradil costal do mesmo lado. A ultrassonografia evidenciou lesão esplênica bem delimitada, cística e unilocular. Hemograma, função hepática e renal estavam dentro da normalidade. A sorologia para hidatidose foi negativa. A tomografia contrastada revelou um processo expansivo hipodenso (Figura 1), medindo 16,3 X 12,5 cm, sugerindo cisto esplênico simples ou epidermóide. A paciente foi então submetida à esplenectomia videolaparoscópica (Figura 2), com aspiração do conteúdo do cisto e retirada da peça cirúrgica por uma incisão de Pfannenstiel. Não houve complicações pós-operatórias. O exame anatomopatológico mostrou baço de 415 g, exibindo cisto revestido por epitélio escamoso (cisto epidermóide)

Innovative hybrid technique of bile duct exploration in the treatment of Choledocolithiasis

Common bile stone disease (CBDS) is frequent and has potentially severe complications, such as acute biliary pancreatitis and cholangitis. Unnecessary and unplanned procedures must be avoided, so before choosing the best treatment of common bile duct lithiasis it is essential to have a proper diagnose. CBDS is currently treated by therapeutic endoscopic retrograde cholangiopancreatography (ERCP) or laparoscopic bile duct exploration (LCBDE). The aim of this article is to present a innovative hybrid technique of common bile duct exploration, on account of one option in those cases where the laparoscopic approach is not resolutive, avoiding the need of conversion to open approach technique. The hybrid technique has the same benefits of open and laparoscopic techniques, but without increasing costs with material and with good resolutivity in complex cases of common bile duct stones.                                                  Keywords: Choledocholithiasis; laparoscopic common bile duct exploration; LCBDE; open common bile duct exploratio

Incarcerated right-sided diaphragmatic hernia in a patient undergoing Roux-en-Y gastric bypass

Bochdalek hernia is the most common congenital diaphragmatic hernia. Its symptoms are normally diagnosed and treated during the neonatal period. Conversely, in adults it is usually asymptomatic and, as a consequence, this group is misdiagnosed. A case of a 64-year-old female patient with an uncommon incarcerated right-sided diaphragmatic hernia formed three years after a Roux-en-Y gastric bypass and a significant weight loss is reported. The importance of this abnormality as a complication of the bariatric surgery should be considered. Key words: Diaphragmatic hernia; gastric bypass; bariatric surgery

Mirizzi Syndrome Type IV: A challenging diagnosis

Mirizzi Syndrome type IV is an extremely rare condition, which is confused with the diagnosis of cholangiocarcinoma in many cases. This report describes a case of a forty-three-year old patient, who was forwarded to our department of general surgery with a high suspicion of a choledochal neoplasic lesion. During the hospitalization he was diagnosed with Mirizzi Syndrome type IV. We concisely describe the case and the literature review about this pathology

Effect of Roux-en-Y gastric bypass in the control of erosive esophagitis

Background: Gastroesophageal reflux disease (GERD) is a multifactorial disease associated with environmental and genetic factors. Obesity is among the risk factors for its development, which also correlates with an increase in severity of clinical presentation and a higher incidence of complications associated with reflux.Aims: To evaluate the impact of Roux-en-Y gastric bypass on the control of erosive esophagitis and metabolic and anthropometric parameters related to obesity.Methods: This historical cohort study included a sample of 249 patients who had undergone bariatric surgery using the Roux-en-Y gastric bypass technique at the Hospital São Vicente de Paulo, Passo Fundo, southern Brazil, from January 2014 to December 2015. Results: Of 249 patients, 77.9% (190 patients) were female and the mean age was 38 years. The occurrence of reflux esophagitis was 81.1% (196 patients) in the preoperative period and 31.3% (75 patients) in the postoperative period. With regard to bariatric treatment response to control moderate and severe esophagitis (grades B, C and D), there was a reduction in prevalence from 62 (25%) to 12 (5%) patients (p<0.05).  Conclusion: Bariatric surgery using the Roux-en-Y gastric bypass technique is effective in the control of reflux esophagitis. Regression is observed mainly in cases of moderate and severe esophagitis.Keywords: Erosive esophagitis; GERD; bariatric surgery; obesity; comorbidit

Justapapillar Duodenal Gastrointestinal Stromal Tumor (gist) Local Resection: A Case Report

Introduction: Gastrointestinal stromal tumors (GISTs) are the most frequent non-epithelial tumors of the gastrointestinal tract (GIT). The most common location is the stomach, followed by small intestine, being very rare the cases of duodenal origin, where it can cause digestive bleeding and anemia. The surgical resection of the tumor is the gold-standard treatment and the definitive diagnosis is based on immunohistochemical analysis of the surgical specimen.Case presentation: A case of exophytic and endophytic GIST located in the second portion of the duodenum, one centimeter below the duodenal papilla, was reported in a 33-year-old female patient.Conclusion: The gold-standard treatment is surgical resection of the tumor with negative margins (R0), with no need for lymphadenectomy. Local lesion resection or duodenopancreatectomy can be performed. Duodenopancreatectomy, unlike local resection of the lesion, is associated with increased length of hospital stay and longer intraoperative time. Therefore, it should be reserved for lesions that cannot be resected locally. Fortunately, a local resection was performed, which have a more favorable prognosis

Treatment of posterior gastric wall gastrointestinal stromal tumor with gastric sleeve: A case report

Gastrointestinal stromal tumors (GISTs) are the most common non-epithelial tumors of the gastrointestinal tract1. The most usual location is the stomach, followed by the small intestine, where it may cause digestive bleeding and anemia6. Surgical resection of the tumor is the gold standard treatment, and definitive diagnosis is based on immunohistochemical analysis of the surgical specimen8. We report the case of a 53-year-old man with gastric GIST presenting with endophytic and exophytic growth, located at the posterior wall of the stomach, in the antrum-body transitional zone, treated with gastric sleeve.Keywords: Gastrointestinal stromal tumors; gastrointestinal neoplasms; gastric sleeve; diagnosis; prognosis; treatmen