INTRODUCTION

Sacrococcygeal pilonidal disease is a common inflammatory process affecting young adults. This is mostly seen in sacrococcygeal region. There are multiple factors, which can basically be divided into mainly two, as congenital (such as a result of fusion failure, deeper localized natal cleft) and acquired (such as local infection) factors¹^,⁸. Non-operative and operative strategies are mainly used in management. Local flap use is accepted as the favorite surgical closure method with high success rates, once the lesion is excised. On the other hand, surgical approach occasionally may fail and so several complications are seen such as infection, hemorrhage and flap dehiscence¹^,⁴.

When a complication occurs, a precise wound care is needed to manage the wound properly. Herein we present a case with flap dehiscence and infection following a local flap closure in the management of a recurrence of a pilonidal disease usıng a negative pressure wound therapy (NPWT).

INTRODUCTION

Brunner gland adenoma (Brunerroma or hamartoma) is a rare, benign lesion of the Brunner's glands, accounting for 10.6% of benign duodenal tumors¹⁰. It is predominantly seen in the 5^th to 6^th decades and with no gender predilection¹³. It is often an incidental finding during esophagogastroduodenoscopy or imaging studies. In symptomatic patients, clinical manifestations include gastrointestinal bleeding, duodenal obstruction, abdominal pain, ampullary obstruction, or intussusception⁸^,⁹. Given their potential to be mistaken as cancer, it is important to consider it in the differential diagnosis of duodenal masses¹⁴. As there have been reports of focal cellular atypia and adenocarcinoma within the lesion, resection, whether endoscopic or surgical is recommended for suspected Brunneromas³.

We report here a case of Brunneroma, which presented as gastrointestinal stromal tumor (GIST) with intussusception on radiological and endoscopic studies and brief review of literature.

INTRODUCTION

Adult Polycystic Liver Disease (APLD) is a rare affection characterized by multiple cystic lesions of the liver. It may be associated with kidney cysts too and is frequently diagnosed accidentally in images studies as a non symptomatic condition. However, some patients can develop symptoms due to mass effect of multiple and big sized cyst such as abdominal pain, gastric compression, palpable mass and biliary obstruction¹^,²

Surgical treatment is the only option available in order to resolve those symptoms and could varies from minimally-invasive surgery to liver transplantation. Once diagnosis is made, surgical strategy and timing to operation can be a challenging situation^3,4,5.

INTRODUCTION

Desmoid tumors are a rare entity, histologically benign (fibroblastic proliferation) but with an infiltrative growth that gives them a local aggressive behavior¹. The sporadic have an annual incidence of 2.4-4.6 per million inhabitants¹, but their incidence increases in patients affected by familial adenomatous polyposis or Gardner’s syndrome. They are more frequent in women, and can be extra or intra-abdominal, the latter being the most frequent.

They affect the abdominal wall by 50%, retroperitoneum by 9% and the mesentery by 40%². The description of tumors that depend on the intestinal wall is exceptional in the literature based on an exhaustive search in Pubmed and Cochrane with the key word “desmoid tumor small bowell” evidencing sporadic cases².

INTRODUCTION

When finishing a continuous suture, often a thread segment is too short to be tied. In this situation, the knots are made with the aid of needle holders or hemostatic forceps, but the result may be unsatisfactory¹^,²^,³. Another option is to fix it with another thread, which is tied with the short thread, increasing the cost of the operation.

The use of an auxiliary thread to facilitate the making the end knot of a continuous short-threaded suture has been used by the author for over 40 years with good results. It is likely that other surgeons have also discovered this tactic and use it, but the author has not found published information and has only disclosed it personally during the operative acts.

HEADINGS:
Sutures, Suture techniques, Suture anchors,

INTRODUCTION

Colorectal adenocarcinoma is a common malignancy around the world and synchronous or metachronous liver metastases will be observed in about 50% of these patients. Hepatic resection is a potentially curative treatment for metastases from colorectal cancer^1,2. However, only about 20% of the patients are suitable for resection, and recurrence occur in the majority of these patients and they are candidates for palliative chemotherapy. Liver transplant has been performed for liver tumors in well selected patients, mainly hepatocellular carcinoma, liver metastases from neuroendocrine tumors and peri-hilar cholangiocarcinoma emerging the concept of transplant oncology. Complete surgical resection is the treatment of choice for patients with liver metastases, but in a large proportion it is not possible to obtain a complete R0 resection. In 2006 the Oslo group started the first trial on liver transplant for patients with colorectal liver metastases (SECA I study). The inclusion criteria were R0 primary colorectal resection, unresectable liver metastases, no extrahepatic disease, at least six weeks of chemotherapy and an Eastern Cooperative Oncology Group (ECOG) performance status 0-1^2,3. Twenty-one patients with unresectable colorectal liver metastases (u-CRLM) were included. The overall survival rate at five years was 60% with a median survival time of 27 months. Notwithstanding the disease free survival rate was 35% at one year and all patients got relapse if observed up to three years, mainly in the form of lung metastases which were slow growing and most often resectable. Some factors were identified as related to worse prognosis (the Oslo Criteria) and include: 1) time from primary cancer surgery <2 years; 2) progressive disease on chemotherapy; 3) maximum tumor diameter >5.5 cm; and 4) CEA levels >80 μg/l. Beside Norway, liver transplant for colorectal liver metastasis have been performed in Japan, France, Canada, Portugal, Turkey, and Germany^2,4,5. Very recently the Oslo group reported the preliminary results of SECA II trial, indicating that a five year overall survival of about 80% may be obtained if stricter selection criteria for liver transplant in this patient cohort are used⁶. Nowadays, the majority of liver transplant reported for u-CRLM utilize deceased donor liver transplant (DDLT). In Brazil DDLT is not possible due to organ shortage problem and living donor liver transplant (LDLT) seems to be the only available alternative.

INTRODUCTION

The management of the traumatic perforation of the esophagus constitutes challenging situation, since that is unusual condition; the diagnosis is hindered by the nonspecific or discrete symptomatology and the treatment standardization is also hindered by the variety of the causes and its consequences^3,4,6,10

INTRODUCTION

Small bowel is a difficult area to visualize with endoscopy. While ileo-colonoscopy can help visualize the terminal few centimeters of the ileum, esophagogastroduodenoscopy is usually utilized to view the gastrointestinal tract till the proximal duodenum. The visualization of distal duodenum, jejunum and ileum requires advanced techniques. While capsule endoscopy can provide the visualization of the entire small bowel, it is costly and cannot be used to obtain tissue for histology or for therapeutic purpose. Enteroscopic techniques like the push enteroscopy, spiral enteroscopy and single or double balloon enteroscopy are used to diagnose and treat small bowel lesions¹. However, these are costly and their availability is scarce as is the expertise in their use. The accessories for their use are different and add to the cost of therapy. Previously the use of pediatric colonoscopes has been reported for push enteroscopy². However, the more readily available adult colonoscope may not be helpful because of the larger diameter. We hypothesized that the gastroscope may be used to access the proximal jejunal lesions.

INTRODUCTION

Foreign body ingestion is an important problem in adult with psychological disorders. In literature ingestion such as fish bone, fork and several metallic elements were reported. The first attempt, after diagnosis, is endoscopic removal¹. Surgical approach is necessary in it´s failure. In this paper is presented a successful endoscopic removal of a wristwatch which was ingested by a deaf patient.

INTRODUCTION

Acute pancreatitis is an inflammatory condition of the pancreas which can lead to morbidity. Formation of pancreatic pseudocyst is one of the well-known complication. While small pseudocyts are asymptomatic, large ones can become symptomatic and cause several complications including infection, rupture, bleeding, biliary complications and portal hypertension¹^,².

Various interventions are available for the management of symptomatic pancreatic pseudocysts. Endoscopic ultrasound (EUS) guided cystogastrostomy is a choice for treatment of large pseudocyts, witch bulge into gastric lumen^2,3. In this paper we present a case of large sized who was managed with argon plasma coagulation probe and without endoscopic ultrasonography.