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

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

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

Laparospic Resection of Gastrointestinal Stromal Tumors (GIST) of Small Intestine: A case report

Although gastrointestinal stromal tumors (GISTs) are a rare type of cancer, they are the commonest mesenchymal tumors of the gastrointestinal tract (GIT). GISTs can affect any segment of the GIT, but the usual location is the stomach, followed by the small intestine. Surgical resection of the tumor is the gold standard treatment for localized GISTs, and in patients with inoperable and metastatic disease, imatinib mesylate is the standard treatment. Pathological diagnosis is based on morphology and immunohistochemical findings. We report the case of a 55-year-old man with jejunal GIST presenting with endophytic and exophytic growth, located in the proximal jejunum. He had history of melena, anemia and one episode of enterorrhagia, and was treated with surgical resection of the lesion.Keywords: Gastrointestinal stromal tumor; gastrointestinal neoplasm

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

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

Mesenteric desmoid tumor after bariatric surgery: a case report

We report the case of a 37-year-old woman investigated for left flank pain, 1 year after bariatric surgery (Roux-en-Y gastric bypass). Abdominal computed tomography (CT) revealed a solid, heterogeneous and expansive intra-abdominal lesion, measuring 9.3x9.4x10.4cm, compressing adjacent structures with no signs of invasion. The main diagnostic hypothesis considered was desmoid tumor/Schwannoma and a ileocolectomy with partial mesenteric resection was performed. A histopathological and immunohistochemical analysis confirmed the diagnosis of mesenteric desmoid tumor