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We present an adolescent boy with unilateral supernumerary breast. It was a V type by Leung Clasification. Despite the average occurence between 0.22% and 6% in a normal population we have not had other cases in the last 20 years. The patient was an asthenic boy of sixteen in the IV stage of puberty. Sometimes he felt swelling and tenderness in this breast tissue two years ago. These symptoms became worse two months ago. At the admission he was symptom free. In the right hypochondrium inferomedially he had a nipple and areola with a small part of the glandular tissue. The axilla was empty. After an excision we got a 15 x 10 x 8 mm specimen. Pathohistological report described incompletely formed mammary lobule with smooth muscles and lactiferous ducts of nipple in dermis. This was consistent with the diagnosis of ectopic breast tissue. He wanted it removed for esthetic reasons. His hormonal state was normal. All blood checks were normal. Kidney ultrasound was normal. His grandmother had pyelon duplex and frequent uroinfections. As it is known, there is an association between supernumerary breast tissue and renal malformations. Since he did not have it, we think that a routine screening of the uropoetic system should be performed in any patient with supernumerary breast.
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Mama/anomalías , Adolescente , Humanos , MasculinoRESUMEN
Article presents a laparoscopic cystogastrostomy of pancreatic pseudocysts. Pancreatic pseudocyst is a common complication of acute or chronic pancreatitis. It is treated by drainage. Until the development of laparoscopic method, the only surgical type of treatment was a drainage of pseudocyst into the stomach or intestine by the open surgery. In a recent years, a new procedures of laparoscopic treating of pseudocysts pancreatic were published. Despite of the small number of cases it is legible that this certain method of operative treatment has clear benefits for the patient. Herewith, we present a laparoscopic transgastric cystogastrostomy of the 44-year old woman who was admitted because of acute biliary pancreatitis. She was operated six months after the acute attack.
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Gastrostomía , Laparoscopía , Seudoquiste Pancreático/cirugía , Adulto , Drenaje/métodos , Femenino , Humanos , Seudoquiste Pancreático/complicaciones , Pancreatitis Aguda Necrotizante/complicaciones , Pancreatitis Aguda Necrotizante/cirugíaRESUMEN
UNLABELLED: In 10-15% of the patients that underwent cholecystectomy, common bile duct stones were found either during the preoperative, intraoperative or postoperative evaluation. Their treatment traditionally was based on open approach and extraction of calculi, with development of endoscopic procedures we have ERCP with endoscopic sphincterotomy, but due to rapid development of laparoscopic procedures now-days we have other therapeutic options such as laparoscopic transcystic extraction and laparoscopic choledohotomy. METHODS: During the period between 2007-2009 we treated 168 patients with common bile duct stones. Age range was 21-78 years, 105 female and 63 male patients. We have performed 47 open explorations, 9 laparoscopic transcystic exploration, as well as 112 ERCP and ES. We monitored the rate of success (%), intra- and postoperative complications. RESULTS: The success rate of the cases of open exploration was 95%, in 2 cases postoperative cholangiogram showed concrement residues that were successfully treated later on with ERCP+ES. Out of 9 transcystic LCBDE we have performed, in 4 cases extraction was successful, 3 patients underwent conversion into open exploration, and 2 patients were successfully treated with postoperative ERCP. A total of 69 patients were treated with ERCP and ES with the 82% success rate of stone extraction. CONCLUSION: Even though laparoscopic and endoscopic procedures have revolutionized treatment of common bile duct stones, the role of ERCP is not changed. Treatment in general hospital settings largely depends on availability of endoscopic and laparoscopic equipment and expertise, and must be individualized according to methods that are available. In our settings we have found that best summary of these demands are achieved by ERCP and laparoscopic approach.
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Colangiopancreatografia Retrógrada Endoscópica , Cálculos Biliares/cirugía , Adulto , Anciano , Femenino , Cálculos Biliares/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Adulto JovenRESUMEN
Diaphragm injuries are diagnosed in the acute phase of blunt trauma only in 10% of cases--more often they are presented as hernia. Traumatic diaphragmatic hernia presents unique obstacles to a minimal invasive approach. However, with the proper training and equipment, most of these hernias are amenable to laparoscopic approach. These patients can expect the same well-known benefits of laparoscopic approach. We report here the case of a 56-year-old man, admitted to hospital with symptoms of vomiting, abdominal pain and dispnea who sustained blunt abdominal trauma in a high speed motor vehicle accident nine months ago. X-ray and CT scans confirmed suspected strangulated diaphragmatic hernia which contained stomach, colon, majoromentum and spleen in left hemithorax. The urgent laparoscopic procedure was performed--omentum, colon and stomach were taken backthrough diaphragmatic defect but the spleen was tightly fixed in thoracal cavity and splenectomy was performed. The diaphragmatic defect was repaired with interruptured sutures. This case proves that laparoscopic repair of diaphragmatic hernia is effective, but this should be carried out with caution, sometimes it needs additional complex procedure in emergency setting like splenectomy in this case.
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Hernia Diafragmática Traumática/cirugía , Laparoscopía , Humanos , MasculinoRESUMEN
There are increasing reports about laparoscopic splenectomy being performed even in blunt trauma patients, especially when conservative treatment has failed, but there are very rare reports involving pregnant patients operated laparoscopically due to a blunt trauma. The fear of possible injury of the fetus and effects on the course of the pregnancy limited the use of laparoscopic surgery in pregnant trauma patients. We report here a case of the laparoscopic splenectomy performed in a pregnant patient who sustained a blunt abdominal trauma, with grade V splenic injury. After diagnostic laparoscopy, which revealed the presence of a large amount of free fluid in the abdomen and a lesion on hilum of the spleen, laparoscopic splenectomy was performed with vascular staple. The patient had an uneventful recovery and was discharged with no discernible effects on the course of the pregnancy. This case shows that laparoscopic splenectomy is feasible and a safe procedure in pregnant patients who sustained a blunt abdominal trauma, but it requires adequate experience in elective laparoscopic surgery of spleen, continuous monitoring of fetal vitality is required.