La infección por citomegalovirus es poco frecuente, afecta sobre todo a sujetos inmunocomprometidos y los pacientes de este grupo tienen una alta morbilidad y mortalidad. La clínica de la reactivación o reinfección del virus puede variar desde formas asintomáticas hasta complicaciones graves específicas de órgano, como la hemorragia del tracto gastrointestinal masiva. Es de vital importancia un tratamiento adecuado con antivirales; la opción quirúrgica se reserva para las complicaciones gastrointestinales de acuerdo con la situación clínica del paciente. Se presentan los casos de dos pacientes inmunocomprometidas que luego presentar episodios de rectorragia se diagnostican con colitis por citomegalovirus que exige tratamiento quirúrgico.
Aim: Description of a patient with an elevation of CA 19-9 levels caused by a giant benign splenic cyst, which was completely laparoscopically resected through a single port, despite the large size of the lesion. An increase in CA 19-9 in this type of cystic tumors does not indicate malignancy. Background: The cystic tumors of the spleen are rare diseases that may present a CA 19-9 increase, without indicating malignancy. There is a tendency to perform surgical intervention as less invasive and aggressive as possible. The current trend in the management of splenic cysts with a CA 19-9 increase and benign radiological characteristics, is a minimally invasive surgery, whenever possible. Case description: We present a case of a young patient with a giant splenic cyst of 20.5 × 14.5 × 23 cm and elevated CA 19-9 levels. Spleen was completely laparoscopically resected through a single port after the cyst puncture and aspiration, using the advantages of laparoscopic surgery and single port. Had a favorably postoperative course with resolution of the symptoms up to the current date.
Conclusion:There is an actual tendency to perform minimally invasive surgical interventions. In pathologies such as the clinical case provided, we should try to make a surgical intervention as less invasive as possible, despite the large size of the lesion. In our case, we successfully performed the resection of a giant splenic cyst, using the advantages of laparoscopic surgery and the single port, which helped us in the extraction of the piece. Clinical significance: When facing this pathology, we must bear in mind that benign epithelial and mesothelial cysts can produce an increase of CA 19-9 blood levels, without indicating malignancy. So, we should try to make a surgical intervention as less invasive as possible.
This paper reports a case of Petersen's space hernia after mini gastric bypass. This is an anecdotal post-operative complication in the mini gastric bypass technique, with an estimated rate of 1/5000 cases. Similar cases described in the literature were treated by the surgical hernia reduction and the closure of the mesenteric defect. Our patient had a unique management, performing a conversion to Roux-en-Y gastric bypass with dissection of the biliopancreatic limb at the anastomosis and creation of a variable foot-point anastomosis with excellent mid-term post-operative results. This should provide better long-term results as compared to simple mesenteric closure, avoiding the complications of mini gastric bypass technique.
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