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We report the case of a patient who needed urgent surgical assistance because of massive lower gastrointestinal hemorrhage secondary to a jejunal angiodysplasia (cavernous hemangioma). These lesions are a rare cause of gastrointestinal bleeding of obscure origin. The use of preoperative diagnostic techniques such as oral fiber-optic endoscopy, barium intestinal studies and scintigraphy have little value when the origin of lower gastrointestinal bleeding is in the small bowel. The best yield is obtained with celiac or superior mesenteric angiography. There are some cases in which only an exploratory surgical laparotomy is useful for the diagnostic supported by intraoperative enteroscopy guided by the surgeon.

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In order to evaluate the usefulness of intraoperative echography in the study of liver metastases, two groups of patients were submitted to study: A consecutive series of 25 patients operated on for digestive tumours. Before operation, echography was performed to all of them. Four patients operated on for liver metastases. In the patients who were operated for digestive tumors, the authors found 8.6% of metastasis which neither the preoperative echography nor liver palpation had detected. The usefulness of the examination in the patients to whom resective hepatic surgery was going to be performed was based on: The finding of a portal thrombosis which had not been detected in the preoperative study. The possibility of connecting the intrahepatic vascularity with the lesions, in order to decide which technique to choose. The demonstration of the non-existence of other metastases.

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Congenital polycystic dilatation of the intrahepatic biliary ways (Caroli's disease) is a rare disease. The "pure" type and the one associated with congenital hepatic fibrosis are accepted. Although the current exploration methods, its diagnosis is rare before the surgical procedure. Treatment of the diffuse pure types and the ones associated with hepatic fibrosis is difficult and the outcome is bad. A case of the less frequent type is communicated, in which, as a novelty, intrasurgical echography was used in its treatment.

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Endometriosis of the Digestive Tract is an uncommon pathology, especially when ileocecal appendix is involved. Authors report twelve cases of appendiceal endometriosis reviewed from surgical and anatomopathological records. The preoperative diagnosis is almost impossible. The most usual clinical presentation is compatible with that of acute or chronic appendicitis. The definitive diagnosis is confirmed by anatomopathological study of the surgical specimen. The Surgical treatment consists of appendicectomy alone or associated with extirpation of other concomitant neighbouring lesions.

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Intraoperative ultrasonography was performed in a consecutive series of 11 patients with obstructive jaundice. On two occasions, the examination modified the preoperative diagnosis, diagnosing liver metastasis in a patient with hydatid cysts and in another by detecting gallstones in the main biliary duct in which ERCP was suggestive of an ampullary tumor. Ultrasound made a definitive diagnosis of choledocholithiasis in one case, and pancreatic carcinoma in three cases all of which had a preoperative diagnosis of biliary obstruction of undetermined cause. The examination defined accurately the level of obstruction and the extent of a carcinoma of the bile ducts in two patients and it helped in obtaining cytological samples from a pancreatic tumor mass. Its use is recommended when the cause of biliary obstruction cannot be accurately diagnosed preoperatively.

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We present the experience with the use of intraoperative ultrasonography in detecting biliary calculi on 55 patients, 19 of which had lithiasis of the common bile duct. Operative ultrasonics imaging of the biliary tree and operative cholangiography had a similar accuracy when both explorations were performed. In this series, accuracy indexes of ultrasonography in diagnosing choledocholithiasis were: sensitivity, 84.21%; specificity, 100%; efficiency, 94%; predictability of a positive test, 100%; predictability of a negative test, 92%. We think ultrasonography is a better exploration in two conditions: when intrahepatic duct lithiasis exists and if calculi are at the end of choledochus, because differentiation with neoplastic changes is easier.

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Report of two cases of eosinophilic gastroenteritis. In both cases the presentation was an acute abdomen syndrome. The etiological diagnosis was postoperative, because in the preoperative period there were no data characteristic of this entity. Probably this disease is more frequent than reported and although the treatment is medical, there are some cases in which surgery is justified.

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A case is presented of mesenteric venous thrombosis which affects about 30 cm of small intestine in a patient operated one month before for portal hypertension and bleeding from esophagogastric varices, in which an interruption of the portal-azygous venous circulation was made with splenectomy, using the Romero-Torres procedure. We consider that postsplenectomy thrombocytosis has been the first pathogenic factor in the mesenteric venous thrombosis.

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The authors present two cases of hepatic echinococcus cyst with destruction of the biliary confluent. The severity of this exceptional lesion requires uncommon treatment. Experience with treatment of biliary fistulas when there is a residual cystic cavity, provides arguments for and against primary suture of these fistulas. In these cases, the required treatment consists in reconstruction of the hepatic biliary ducts destroyed (right, left and common) by using the pericystic envelope itself as a plastic neoformative element. The result has demonstrated its efficacy after many years of use, as we have indicated in this article. "Echinococcus granulosus" itself is only rarely a problem in the host, but a hepatic echinococcus cyst does not only pose a spatial problem, except insofar as it often involves the biliary tree. In the cases reported here, the hepatic echinococcus cyst causes biliary problems in over 60% of the cases (1). These biliary problems were as follows: Compression of the common bile duct by the cys; More often, compression of the intrahepatic bile ducts causes the cyst to open inside the biliary duct and to fissure, leading to a biliocystic fistula.

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