Leiomioma do esôfago removido por videolaparoscopia

This report describes a leiomyoma of the inferior third section of the esophagus removed during laparoscopic cholecystectomy. The patient is a woman 55-years-age, carrying esophageal myoma of 40 mm in diameter wide, situated in the posterior wall of the lower esophagus. Indications for surgery were based mainly on the growth of the mass (6 mm when discovered 7 years previously, increased to 40 mm). Recently the patient returned suffering from pain, which could be attributed to his litiasic cholecystopaty. A small degree of low disphagia could also be observed. Radiologic imaging, direct endoscopic examination and endoscopic ultrasound showed that the mioma protruded on to the oesophagic lumen, discreetly diminishing there. A laparoscopic esophageal myomectomy was indicated at the same session of the laparoscopic cholecystectomy. Once the pneunoperitoneum was installed, five ports were placed as if for a hiatus hernia surgery. The cholecystectomy was uneventful. Next, an esophagoscopy was performed so as to determine the precise area covering the base of the tumour; at the right-lateral site. Longitudinal and circular fibres of the esophagus was severed over the lesion and the enucleation of the tumour was performed alternating the monopolar dissection, bipolar and hidrodisection. Control-endoscopy was carried out to verify mucosa integrity. Four suture points with poliglactine 3-0 string so as to close the musculature followed this. One suture was placed in for diminution of the size of the esophagean hiatus. Total time of intervention: two hours (30m for the cholecystectomy and one hour and thirty minutes for the myomectomy). Postoperative period: uneventful. Disappearance of the disphagia was observed. Radiologic transit control with water-soluble contrast at 4th post-operative day: good passage. Diagnosis from laboratory of pathology: conjunctive tumour formed by muscle non-striated cells: leiomyoma. The patient was re-examined on the two-month postoperative follow-up. General conditions were good and there were no complain of dysphagia. Neither there were any symptoms of gastro-esophageal reflux.

Estenose esofagiana congênita por coristoma

Oesophageal choristomas are a very uncommon cause of congenital oesophageal stenosis. A high index of suspection is necessary for differential diagnosis with commoner causes of oesophageal suboclusion in childhood, mainly acquired oesophageal obstruction caused by gastroesophageal reflux. We present a case report and review the clinical, endoscopic and radiologic features of the disease and consider the need for padronization of surgical techniques to treat this condition, which is still controversial.

Adenomioma da papila de vater em adulto jovem

The authors report a case of adenomyoma of papilla of Vater in a young adult, a rare pathology in this age and site. The commonest clinical findings are abdominal pain, dyspepsia and jaundice, as in this case in which the patient referred these symptoms for several months. The diagnosis is usually difficult before surgery, because the radiological and endoscopic appearances are difficult to interpret, since they may only show obstruction and enlargement of the biliary tract; in this way, the endoscopic biopsy may be useful. In the present case the computed tomography, abdominal scan and intraoperative cholangiography only demonstrated obstruction and enlargement of the biliary tract, without the presence of gallstones. The treatment is usually lesion resection according to its size, performing the total resection in those cases of extensive involvement of the digestive tract, as it was performed in this case, due to the dimension of the lesion and its malignant appearance. The patient was discharged from hospital on the thirteenth postoperative day, with a histological diagnosis of adenomyoma of papilla of Vater. Three months after the procedure the patient was asymptomatic.

Migração de clipe metálico para úlcera duodenal após colecistectomia videolaparoscópica: Ligaclip migration into a duodenal ulcer following laparoscopic cholecystectomy

We report a rare cause of pyloric stenosis caused by migration of surgical clips into a duodenal ulcer following laparoscopic cholecystectomy. Even after endoscopic removal of the clips the inflammatory reaction during the healing process caused a stenosis of the pylorus that eventually required a truncal vagotomy and gastroenterostomy.

Extração de fitobezoar gástrico por videolaparoscopia: considerações técnicas originais

Videolaparoscopic surgery has been used for treatment of almost all surgical abdominal diseases, mainly where there are no large ressections, or operative field is limited. In these situations, laparoscopic surgery has the advantages of less morbidity, quick recovery and good cosmetic results. Bezoars removal, or its mobilization, is probably included in these possible proceedings. Three non-laparotomic procedures were described: 1. endoscopic-laparoscopic; 2. videolaparoscopy and mobilization of intestinal bezoar to the cecum; 3. laparoscopy and gastrotomy for bezoar removal, through suprapubic incision or the umbilical punction. There have been only two publications describing the videolaparoscopic method for bezoar removal, and the methods applied can be complications or morbidity related. We describe one case where the applied technique is simple and easy to perform, time saving and probably less complications-related. This technique, with four trocars, utilized a plastic bag besides the stomach to be opened, followed by gastrotomy, bezoar removal and immediate introduction in the plastic bag, suture of gastrotomy and removal through the left subcostal trocar. This technique was feasible and easy to perform, with short operative time, and there were no intra or post-operative complications; the patient was discharged in the second post-operative day, and is without further problems after one year follow-up. We believe that this could be an adequate technique to perform laparoscopic gastric bezoar removal, and the rigid sequence of operative events allows a quick procedure, with minimal contamination. The videolaparoscopy seems to be an adequate access to surgical treatment of gastro-intestinal bezoars, with or without obstruction, and should be the ellected the procedure of choice to begin the surgical treatment, with convertion to laparotomy in case of any intra-operative adversity.

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.

Nova técnica de alimentação enteral em fístulas esôfago-jejunais

BACKGROUND: A new procedure for the treatment of esophageal fistula, mainly associated to the ebb esophagojejunal in patients submitted to the total gastrectomy and reconstruction with loop jejunal Rouxen-Y anastomosis is present. METHODS: The method is based in the use of "probe standard enteral prolongated with drain to laminate adapted in extremity", which results in advanced positioning inside the jejunum, making the administration of enteral nutrition possible and impeding ebb esophagojejunal. RESULTS: The authors discuss the theoretical advantages of the procedure and they suggest that the treatment of esofagic fistula with probe prolonged enteral would be suitable in the treatment of the fistula esophagojejunal by preventing the ebb esophagojejunal, which would result in smaller period of duration of the fistula esophagojejunal and it would prevent the high mortality rate. CONCLUSIONS: Preliminary studies demonstrated that this is a technically easy, low cost procedure through the endoscopic use. A prospective evaluation for morbility and mortality related to the method is needed.

Simpatectomia lombar retroperitoneal endoscópica

In the last few years, there has been an increase in the indication of lumbar sympathectomy for plantar hyperhidroses. There are few reports of the laparoscopic access for this operation, even when it seems to be a very apropriate method. A case of a left lumbar sympathectomy through the retroperitoneal endoscopic approach is presented. The total control of left plantar hiperhidroses was achieved, showing the effectiveness of this operation, completely feasible through extraperitoneal endoscopic route.

Duplicação uretral em homem adulto

Urethral duplication is a rare congenital anomaly. The clinical presentation and treatment varies because of the different anatomical patterns of this abnormality. We report a case of this entity in the adult male patient. The clinical, radiological and endoscopic findings, as well as the treatment are discussed.

Sump syndrome: relato de caso

Sump Syndrome after choledochoduodenostomy is becoming rare, mainly because endoscopic procedures are replacing this surgery. We report a case of this syndrome where the only symptom was pain. The diagnosis was made after 3 years and many doctors attended the patient. The treatment was endoscopic and the result was excellent.

Aspectos endoscópicos no manejo da úlcera péptica gastroduodenal

Bleeding remains a common and a potential lethal complication for peptic ulcer disease. Multidisciplinary approach by endoscopists, surgeons and intensive care physicians is necessary to improve results for this severe complication. In this article we intend to introduce surgeons and intensive care physicians to endoscopic concepts and maneuvers commonly used in the treatment of bleeding peptic ulcer disease. Early clinical assessment and endoscopic evaluation are helpful to classify the severity of the bleeding episode. Two major achievements have changed the management of this complication: combined endoscopic therapy and proton pump inhibitors. The former consists of combining two different endoscopic methods to stop bleeding or prevent re-bleeding (e.g., injection of a sclerosing substance and thermal coagulation). Surgical treatment for peptic ulcer bleeding is indicated when endoscopic therapy fails or to prevent re-bleeding in high risk patients who presents with a spurting bleeding ulcer and shock. For the remaining situations, there are consistent evidences that a second endoscopic therapy should be attempted when re-bleeding occurs. Keywords: endoscopic hemostasis, recurrent bleeding, peptic ulcer bleeding, proton-pump inhibitor, non-variceal gastrointestinal bleeding.

Cirurgia endoscópica transluminal por orifícios naturais: realidade atual

Natural orifice transluminal endoscopic surgery (NOTES) is an emerging experimental alternative to conventional surgery that eliminates abdominal incisions and incision-related complications by combining endoscopic and laparoscopic techniques to diagnose and treat abdominal pathology. Natural orifice transluminal endoscopic surgery refers to the method of accessing the abdominal cavity through a natural orifice under endoscopic visualization. Since its introduction in 2004, numerous reports have been published describing different surgical interventions. Recently, a group of expert laparoscopic surgeons and endoscopists outlined the limitations of this approach and issued recommendations for progress toward human trials. Transluminal surgery is a new method for accessing the abdomen under direct endoscopic visualization. Preliminary studies have demonstrated the feasibility of this technique in animal models; however, further research is warranted to validate its safety in humans.

Utilização da jejunostomia para extração endoscópica de Ascaris lumbricoides da via biliar principal em paciente com doença de Caroli

Grumbach-Auvert disease represents a type of Obstructive Disease of the Intrahepatic Biliary Tree. We presents a case report of a patient with hepatic abscess caused by Ascaris which ascended into hepatic parenquima through hepaticojejunostomy, resolved by endoscopic extraction of it after the jejunostomy of permanent access was opened.

Síndrome de Plummer-Vinson: relato de caso

We present a case of Plummer-Vinson syndrome, which is a rare condition nowadays. The diagnosis was made after years of the disease, many doctors having attended the patient. The treatment consisted of oral supplementation of iron and endoscopic dilatations. The patient is asymptomatic.

Síndrome de estenose pilórica por adenocarcinoma de piloro

We present a case of primary malignant pylorus neoplasia, emphasizing its rarity, the difficulty of diagnosis and the importance of an adequate prepare before the endoscopic procedure. Literature shows that tumors compromising the first, third and fourth segments of duodenum are rare, especially those of the pyloric area, representing only 0.35% of all malignant tumors of the gastrointestinal tract. Adenocarcinoma is the most common histological type, representing 50% of all malignant neoplasias at this site. The most common symptoms are weight loss, nausea, vomiting, abdominal pain, abdominal mass, sudden changes in intestinal habits and iron deficiency anemia secondary to chronic intestinal hemorrhage. Survival after five years is only 18%. We report a case of a seventy-one year-old male referring early satiety, epigastric pain, retrosternal burning and dyspepsia, with unspecific results in complementary exams, since complete gastric emptying was not achieved. As symptoms worsened, the patient was submitted to laparotomy, with identification of gastric dilation and severe pyloric stenosis, macroscopically suggesting malignancy. The chosen procedure was a subtotal gastrectomy. Adjuvant radiotherapy and chemotherapy were not used. The patient is been followed-up without tumor recurrence so far.