LA is related to shorter hospital stay, faster return to daily activities, and shorter time to first flatus. LA appears to be as safe and effective as OA in pregnant patients without increasing adverse perinatal outcomes.

Background: Intraoperative testing of gastrointestinal anastomosis effectively ensures anastomotic integrity. this study investigated whether the routine use of methylene blue intraoperatively identified leaks to reduce the postoperative proportion of clinical leaks.Methods: this study retrospectively analyzed consecutive total gastrectomies performed from january 2007 to December 2014 in a university hospital setting by a general surgical group that exclusively used the methylene blue test. all surgeries were performed for gastric or junctional cancers (n = 198). all reconstructions (roux-en y esophagojejunostomy) were performed using a stapler. the methylene blue test was used in 108 cases (group 1) via a nasojejunal tube. no test was performed for the other 90 cases (group 2). Intraoperative leakage rate, postoperative clinical leakage rate, length of hospitalization, and mortality rate were the outcome measures.Results: the intraoperative leakage rate was 7.4% in group 1. the postoperative clinical leakage rate was 8.6%. the postoperative clinical leakage rate was 3.7% in group 1 and 14.4% in group 2 (p = 0.007). there were no postoperative clinical leaks when an intraoperative leak led to concomitant intraoperative repair. the median length of hospital stay was 6 days in group 1 and 8 days in group 2 (p < 0.001). one death occurred in each group. no test-related complications were observed.Conclusion: the methylene blue test for esophagojejunostomy is a safe and reliable method for the assessment of anastomosis integrity, especially in cases with difficult esophagojejunostomic construction.

ArAs A et Al. 622rev assoC med bras 2016; 62(7):622-627 ORIGINAL ARTICLEThe diagnosis of acute appendicitis in pregnant versus non-pregnant women: A comparative study Objective: To investigate whether the diagnosis of acute appendicitis is affected by pregnancy or not. Method: A retrospective study with the analysis of the medical records of all women suspected of having appendicitis who underwent appendectomy at our hospital between June 2010 and March 2015 were reviewed. The patients were divided into two groups according to whether they were pregnant or not during the surgery: group I, pregnant women, and group II, non-pregnant women.Results: During the study period, 38 pregnant women and 169 non-pregnant women underwent appendectomy. The time from admission to the operation was not statistically different (2.17±1.47 days in group I vs. 1.98±1.66 day in group II; p=0.288). The pregnant group had longer hospital stay than the nonpregnant group (p=0.04). Ultrasonography (USG) was used as the first diagnostic modality in 36/38 patients in group I and 161/169 in group II. The non-visualized appendix on ultrasound was seen in 17 patients in group I and 51 patients in group II, which was not statistically different. Sensitivity and specificity of USG in diagnosis of acute appendicitis were 61.29 and 80.00% in group I, and 93.0 and 31.6% in group II, respectively. Conclusion: Although the diagnosis of appendicitis in pregnant women is not delayed, careful assessment of these patients suspected of having appendicitis should be encouraged when USG examination is normal or nondiagnostic.

BACKGROUND:The aim of the present study was to review cases that required surgical intervention to remove ingested foreign bodies.

Torsion of a wandering spleen is a rare disease. The symptoms and signs of this condition are only present when the splenic pedicle torts. The etiological factors are the congenital absence of the ligaments that hold the spleen in its normal anatomic position, or the relaxation of these ligaments resulting from conditions like trauma and abdominal surgery. We aimed to present a rare case with torsion of wandering spleen that consequently developed thrombosis of portal vein and its branches, taking into consideration the relevant literature.

The aim of this study was to describe our experience in patients treated with the diagnosis of colonoscopic perforation. A retrospective institutional computer-based search of the patients treated with the diagnosis of colonoscopic perforation between July 2009 and May 2014 was undertaken. Our study included 16 patients. In 9 (56%) patients, perforations occurred during the diagnostic colonoscopy. Snare polypectomy was the causative factor in 5 patients associated with therapeutic colonoscopy. The perforation was significantly higher in patients who underwent therapeutic colonoscopy than those had diagnostic colonoscopy (P<0.007). The sigmoid colon was the most common perforation site (62.5%). Twelve patients (75%) were treated by surgically, 3 (19%) patients by conservatively, and 1 (6%) by endoscopic clipping. Early recognition of the perforation is critical. Therefore, a high index of suspicion is essential for the prompt and accurate diagnosis.

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