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INTRODUCCIÓN: Los quistes mesentéricos son tumores intra-abdominales definidos como cualquier quiste en el mesenterio del tracto gastrointestinal, ubicándose más frecuentemente en intestino delgado (íleon 60%) cuya incidencia es de tan solo 1 en 350.000 casos, haciendo relevante la publicación de los casos identificados para ampliar el conocimiento y conducta que se debe tener frente a los mismos. CASO CLÍNICO: Se trata de una paciente femenina de 36 años de edad, que acudió con cuadro de dolor abdominal acompañado de importante aumento del diámetro abdominal de un año de evolución, agudizado hace 4 días, por lo que se realizó ecografía abdominal donde se observó una masa quística de aproximadamente 7554ml, completando con estudio tomográfico donde no se observó aparente compromiso de grandes vasos, identificándose quirúrgicamente masa quística dependiente de mesenterio que comprometía la tercera y cuarta porción del duodeno, por lo que requirió resección de las mismas con anastomosis primaria, tras lo cual paciente mostró adecuada respuesta tras el procedimiento. DISCUSIÓN: El tratamiento de elección frente a un quiste mesentérico es la resección del mismo, debido a que otros métodos han mostrado altas tazas de recurrencia, sin embargo, el abordaje quirúrgico varía de acuerdo al cuadro clínico, teniendo como primera opción la resolución laparoscópica, no obstante, se optó por la realizar una laparotomía dado el gran volumen del quiste evidenciado en estudios de imagen. CONCLUSIONES: Los quistes mesentéricos tienen buen pronóstico una vez que son resecados completamente, sin embargo, es importante tomar en cuenta que el riesgo de compromiso vascular se vincula con el tamaño del mismo, algo que se puede confirmar solo durante el procedimiento quirúrgico, es por ello que se debe anticipar estas situaciones y tomar las medidas para reducir las consecuencias del mismo.

INTRODUCTION: Mesenteric cysts are intra-abdominal tumors defined as any cyst in the me-sentery of the gastrointestinal tract, most frequently located in the small intestine (ileum 60%) whose incidence is only 1 in 350,000 cases, making the publication of the cases relevant. iden-tified to expand the knowledge and behavior that must be followed regarding them. CLINICAL CASE: This is a 36-year-old female patient who presented with abdominal pain accompanied by a significant increase in abdominal diameter for one year, exacerbated 4 days ago, so an abdominal ultrasound was performed where a cystic mass of approximately 7554 ml, completed with a tomographic study where no apparent involvement of the great vessels was observed, surgically identifying a cystic mass dependent on the mesentery that compromised the third and fourth portions of the duodenum, which required resection of the same with primary anastomosis, after which the patient showed an adequate response after the procedure. DISCUSSION: The treatment of choice for a mesenteric cyst is its resection, because other methods have shown high rates of recurrence; however, the surgical approach varies according to the clinical picture, with laparoscopic resolution being the first option; however, it was decided to perform a laparo-tomy given the large volume of the cyst evident in imaging studies. CONCLUSION: Mesenteric cysts have a good prognosis once they are completely resected, however, it is important to take into account that the risk of vascular compromise is linked to its size, something that can be confirmed only during the surgical procedure, which is why These situations must be anticipated and measures taken to reduce their consequences

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BACKGROUND: Achalasia is an autoimmune disease whose probable causal agent is a neurotropic virus that chronically infects the myenteric plexus of the esophagus and induces the disease in a genetically susceptible host. The association between achalasia and coronaviruses has not been reported. AIMS: To evaluate the presence of the SARS-CoV-2 virus, the ACE2 expression, the tissue architecture, and immune response in the lower esophageal sphincter muscle (LESm) of achalasia patients who posteriorly had SARS-CoV-2 (achalasia-COVID-19) infection before laparoscopic Heller myotomy (LHM) and compare the findings with type II achalasia patients and transplant donors (controls) without COVID-19. METHODS: The LESm of 7 achalasia-COVID-19 patients (diagnosed by PCR), ten achalasia patients, and ten controls without COVID-19 were included. The presence of the virus was evaluated by in situ PCR and immunohistochemistry. ACE2 receptor expression and effector CD4 T cell and regulatory subsets were determined by immunohistochemistry. KEY RESULTS: Coronavirus was detected in 6/7 patients-COVID-19. The SARS-CoV-2 was undetectable in the LESm of the achalasia patients and controls. ACE2 receptor was expressed in all the patients and controls. One patient developed achalasia type II post-COVID-19. The percentage of Th22/Th17/Th1/pDCreg was higher in achalasia and achalasia-COVID-19 pre-HLM vs. controls. The Th2/Treg/Breg cell percentages were higher only in achalasia vs. controls. CONCLUSION & INFERENCES: SARS-CoV2 and its receptor expression in the LESm of achalasia patients who posteriorly had COVID-19 but not in the controls suggests that it could affect the myenteric plexus. Unlike achalasia, patients-COVID-19 have an imbalance between effector CD4 T cells and the regulatory mechanisms.

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Background: Episodic angina-like retrosternal pain is a prevalent symptom for achalasia patients pre- and post-treatment. The cause of postoperative chest pain remains poorly understood. Moreover, there are no reports on their predictive value for chest pain in the long-term post-treatment. The effect of laparoscopic Heller myotomy (LHM) and fundoplication techniques (Dor vs. Toupet) is unclear. Methods: We analyzed a cohort of 129 achalasia cases treated with LHM and randomly assigned fundoplication technique. All the patients were diagnosed with achalasia by high-resolution manometry (HRM). Patients were followed up at 1-, 6-, 12-, and 24-month post-treatment. We implemented unadjusted and adjusted logistic regression analyses to evaluate the predictive significance of pre- and post-operative clinical factors. Results: Preoperative chest pain with every meal was associated with an increased risk of occasional postoperative chest pain [unadjusted model: odds ratio (OR) = 12, 95% CI: 2.2-63.9, P = 0.006; adjusted model: OR = 26, 95% CI: 2.6-259.1, P = 0.005]. In type II achalasia, hypercontraction was also associated with an increased risk of chest pain (unadjusted model: OR = 2.6 e9 in all the patients). No significant differences were associated with age, type of achalasia, dysphagia, esophageal shape, and integrated relaxation pressure (IRP) with an increased risk of occasional postoperative chest pain. Also, there was no significant difference between fundoplication techniques or surgical approaches (e.g., length of myotomy). Conclusion: Preoperative chest pain with every meal was associated with a higher risk of occasionally postoperative chest pain.

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Las lesiones contusas de la arteria carótida tienen el potencial de provocar graves complicaciones neurológicas debido a eventos cerebrovasculares isquémicos. Presentación del caso Un paciente masculino de 41 años sufrió un trauma en el cuello, luego de impactar contra un cable atravesado en la vía pública, mientras conducía una motocicleta. El paciente desarrolló un hematoma expansivo en el cuello pero no presentó alteraciones neurológicas. La puntuación de la escala de coma de Glasgow fue 15/15. Ante la sospecha de una lesión de la arteria carótida se realizó angiotomografía contrastada que demostró una lesión de la íntima carotidea. El manejo quirúrgico incluyó trombectomía in-situ y arteriorrafa. Conclusión La lesión traumática de la arteria carótida es una condición poco común que requiere una alta sospecha clínica para su diagnóstico. El manejo comprende resolución quirúrgica y anticoagulación para prevenir complicaciones de orden neurológico.

Blunt carotid arterial injuries have the potential for cause severe neurological complications due to stroke Case Report A 41 year old male patient suffered a neck trauma by an impact with a wire across the road, while he was driving a motorcycle. The patient developed an expansive hematoma in the neck but do not showed neurological disorders. The score of the Glasgow coma scale was 15/15. Suspecting an injury in the carotid artery a CT angiography with contrast was performed which showed a carotid damage. Surgical management included thrombectomy and suture of the artery. Conclusion Traumatic injury to the carotid artery is a rare condition that requires a high clinical suspicion for diagnosis. Treatment consists in an adequate surgical procedure and anticoagulation to prevent neurological complications.

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