Scrotal collections: pictorial essay correlating sonographic with magnetic resonance imaging findings

The present study is aimed at describing scrotal collections observed at ultrasonography and magnetic resonance imaging. The authors describe the main features of hydrocele, hematocele and pyocele, as well as the most common causes, clinical manifestations and associated diseases, with a brief review of the embryology and anatomy of the scrotum. Collections are frequently found in the evaluation of the scrotum, which is often performed on an emergency basis, and in most cases can be differentiated by means of imaging studies. With the consolidation of magnetic resonance imaging as the method of choice complementary with ultrasonography, the authors also describe magnetic resonance imaging findings of scrotal collections as well as the situations where such method is indicated.

Perfuração gástrica secundária a tricobezoar gigante: descrição de caso e revisão da literatura

Gastric bezoars are impactations offoreign material in lhe stomach. When they are caused by hail; they are named tricho- bezoars. The complications oftrichobezoars are very rare. In this papel; we describe a case of a 16-year-old girl that had a previous history oftricophagia, and had an acute abdominal pain with a pneumoperitoneum in the abdomen radiography. An operation was performed and a gastric perforation was founded associated with a giant trichobezoa7: The trichobezoar was removed by traction through a gastrostomy which was performed in order to remove lhe trichobezoa7: Some fragments of the ulcer were obtained to histological study. The gastrostomy was treated by a gastrorraphy confection. In lhe post- operative period a left subfrenic abscess was revealed and has been drained by laparatomy 15 days after the fisrt operation. After the second surgical procedure the patient had a good evolution, and left the hospital in good health conditions.

Apendicite em hérnia femoral com formação de fístula estercoral

The presentation of acute appendicitis in femoral hernia is rare. The gastrointestinal symptons are overshadowed by the local findings. This may lead to delayed diagnosis and complications such as formation of fistula. The authors report a case of a 76-year-old female patient which presented with stercoral fistula after drainage of a right groin abscess ten months earlier.

Tuberculose hepática pseudotumoral

Tuberculous involvement of the liver is usually a diffuse process, associated with miliary tuberculosis. However localized tuberculosis of the liver producing a macronodular tuberculoma or an abscess is rare. The authors present a case of pseudotumoral hepatic tuberculosis in a 34-year old woman. This patient presented a 2 month history of fever weight loss of 4Kg and right upper quadrant abdominal pain. She denied jaundice, choluria, or acholia. Laboratory investigation, including renal and liver function tests. revealed normal levels. Chest X-ray was normal. Abdominal ultrasonography demonstrated a hypoechoic nodule in the right hepatic lobe. CT scan showed hypodense areas in the same place and no retroperitoneal lymphadenopathy. Due to the inespecificity of the signs, symptoms and image findings, a diagnostic laparoscopy was performed, it was however inconclusive. Then, the patient was submitted to a laparotomy with ressection of the lesion. Histological examination revealed a tuberculoid granulomatous lesion with caseous necrosis. Postoperatively, the patient was placed on antituberculous chemotherapy with rifampin, isoniazid and pyrazinamide. Eight months later the patient is asymptomatic.

Fístula pieloduodenal espontânea

Authors present two cases of spontaneous pyeloduodenal fistulas associated to suppurative kidney disease. In both cases the fistulas developed from pyonephrosis and perirenal abscesso Diagnosis was made through intravenous or retrograde pyelogram and two patients were successfully treated by nephrectomy and primary duodenorraphy. Authors present a literature review concluding that 72 additional cases of pyeloduodenal fistulas have been described.

Abscesso hepático piogênico associado à esquistossomose mansônica

The authors report a case of the 15 year old young man, from endemic zone of schistosomiasis and with a chronic schistosomiasis, was admitted complaining of continuous pain in the right upper quadrant, spreaded to epigastrium and right lower quadrant which, began 10 days before. It was associated to fever, anorexia, hepatomegaly, esplenomegaly and signs of peritoneal irritation without clinical improvement. At laparotomy multiple liver microabscesses were found. Excluded the classic etiology, a liver biopsy was done and showed Schistossoma mansoni eggs. surrounded by the same inflamatory cells of microabscesses. This suggested that they have been the predisposing cause for the formation of liver abscesses, as shown in the literature. Schistosomiasis can be complicated with pylephlebitis, immunodepression and granulomatous reaction, centrallobular necrosis and a raise in the infection risk. The described data suggest the schistosomiasis as the etiology of hepatic microabscesses, mainly in endemic zones.

Peritonite por bário

We report a case of a 49 years-old man who underwent a barium meal examination for an epigastric pain. A perforated gastric ulcer with barium extravasation into peritoneal cavity was seen on X-rays. During an emergency laparotomy, a perforated pyloric ulcer was noted, along with barium contamination in the peritoneal cavity. The ulcer was closed with an omental patch and an extensive peritoneal lavage with saline was performed. During the postoperative period, the patient developed signs of peritonitis and underwent a new laparotomy was at the 9th day showing a subfrenic abscess with a large barium contamination. The patient presented septic shock and multiple organ failure. dying on the 21th day.

Abscesso esplênico

Splenic abscess is a rare disease usually associated with immunosuppressed states. Its diagnosis may be difficult due to non-specific symptoms . The authors report a case of a healthy woman, 42 years old, bearer of splenic and renal abscesses , treated with antibiotics and splenectomy. A review of the literature is presented with emphasis on the diagnosis and treatment.

Tumor estromal gastrointestinal de intestino delgado

Stromal tumors of the gastrointestinal tract (gists) represent relatively rare lesions that arise from connective tissue elements located along the entire length of the gut. They were initially identified by immunohistochemical investigation, proving their origin from nondifferentiated mesenchymal cells. Only a minority of this lesions, mainly those confined to the esophagus and rectum, have been shown to correspond to mature, well-differentiated types of neoplasms such as leiomyoma or leiomyosarcoma. The majority of gists corresponds to a heterogeneous group of lesions that have as their common denominator an immature proliferation of epithelioid or spindle cells arising from its muscle layers, or between them, showing partial or incomplete myoide, neural, ganglionic, or mixed features of differentiation. This case report intends to show a gist of small bowel in a male, 46 years old, with a two-year of evolution.

Tríade de Carney

The authors present a case of an incomplete form of Carney's Triad .They emphasize the use of immunohistochemistry to classify gastrointestinal stromal tumors and policy of long term follow-up .

Abscesso hepático piogênico por corpo estranho

Pyogenic hepatic abscess by a foreign body is a rare disease and its diagnosis is habitually made during necropsy. The authors present a case of a woman operated because of a pyogenic hepatic abscess, in the interior of which bristle made of material of vegetable origin were encountered and identified in the laboratory as the principal rib of a leaf, known in Brazil as piaçava. The hepatic abscess was drained and the patient was discharged. The probable mechanism for the formation of the hepatic abscess consisted of the accidental ingestion, perforation of the intestines and penetration in the liver.

Tumor estromal do trato gastrintestinal primário da papila duodenal

The majority gastrointestinal wall tumors previously considered leiomyomas or leiomyosarcomas were reclassified into Gastrointestinal Stromal Tumours because of typical imunohistochemic, genetic and biologic behaviors findings. We present a case report of Gastrointestinal Stromal Tumor primary of the duodenal papilla causing digestive haemorrage that was submitted to surgical treatment.

Drenagem endoscópica de abscesso pancreático

Surgical drainage is still considered the gold standard treatment of pancreatic abscess. Patients with high surgical risk, however, require alternative therapy. The authors report three cases of pancreatic abscess that were treated endoscopically. In patients who met endoscopic drainage criteria, treatment was effective, though one case did require surgical intervention as a result of gastric puncture point bleeding. After this initial experience, we believe that endoscopic drainage should be considered in selected cases.

Abscesso intrabdominal tardio pós colecistectomia laparoscópica

Perforation of the gallbladder during laparoscopic cholecystectomy may be associated with intraperitoneal gallstone spillage. Several complications secondary to lost gallstones in the abdominal cavity have been described. We report a rare complication of abdominal abscess secondary to two gallstones left in the abdominal cavity. A 75-year-old female presented with spontaneous drainage of pus through the umbilicus five years after laparoscopic cholecystectomy. An ultrasonographic evaluation of the abdomen revealed a solid mass of 56x26 mm of diameter, with acoustic shadow, localized distal to the umbilicus. At laparotomy, an abscess with two biliary calculi was drained. The patient had good recovery, with no complication.

Atualização em GIST

Gastrointestinal stromal tumor (GIST) has been recently the subject of considerable clinical and experimental interest. This focus is based on insights gained during the past years concerning its identification as a distinct clinical entity and the advances in knowledge about the diagnosis and management. Historically, surgery has been considered the most effective treatment in spite of its limitations. Others therapeutic approaches have been tryng without success, until the introduction of imatinib. This drug provided hopeful results in the treatment of this neoplasia. The idea that imatinib could improve surgical outcome have led to some clinical trials with the hope that this association (imatinib & surgery) could achieve good results.