BackgroundSubxiphoid incisional hernia occurs as a complication following median sternotomy and are difficult to repair. We present recent data of a standardized technique for correction of subxiphoid incisional hernias, and discuss possible anatomical and surgical factors related to recurrence of the hernia.MethodsA retrospective study with medical records analysis of patients submitted to surgical correction of subxiphoid incisional hernias through standardized treatment between July 2014 and September 2016. All procedures were carried out using the same standardized technique, surgical materials (threads and meshes) and pre- and post-operative care.ResultsAll of the surgical procedures carried out were elective. The hernia defect varied between 5 cm and 16 cm (mean of 7.4 cm); the procedure lasted between 32 and 75 min; the mean time of hospital stay was 2.2 days (range from 1 to 5 days). In five patients the correction of subxiphoid incisional hernia was carried out concurrently with another procedure. No death occurred as a result of the operations. Five patients had minor postoperative complications. Follow up time was between 7 and 33 months, with a recurrence rate of 0% at the time of writing.ConclusionsDespite the limitations of a short follow up period, the surgical technique described presented low rates of early recurrence by closing the hernia defect, using relaxing incisions in the musculature and aponeurosis and surgical mesh.

Primary hepatic gastrinoma is a rare disease, with fewer than 40 cases reported in the medical literature. Because it is located in an organ in which metastases are common, its diagnosis is difficult. We report a case of a 19 years old male patient with a history of gastric ulcers since the age of nine. Following gastric surgery, an antrectomy and a vagotomy, there was some alleviation of symptoms. Subsequently, the patient reported various intermittent episodes of diarrhea, diffuse abdominal pain, and vomiting. The patient underwent tomography, which revealed the presence of a hepatic mass measuring 19.5 cm × 12.5 cm × 17 cm. Primary hepatic gastrinoma was diagnosed based on laboratory examinations that indicated hypergastrinemia and a positron emission tomography/magnetic resonance study with somatostatin analogue that confirmed the liver as the primary site. After hepatic trisegmentectomy (II, III, IV, V, VIII), the patient’s symptoms improved. The case is notable for the presence of a rare tumor with uncommon dimensions.

Background We are reporting a rare case of MUTYH-associated polyposis, a colorectal cancer hereditary syndrome, diagnosticated after an intussusception. Colorectal cancer is an important cause of cancer related mortality that can be manifested by an intussusception, a rare occurrence in adults and almost always related to tumors. Approximately 5% of colorectal cancers can be attributed to syndromes known to cause hereditary colorectal cancer, such as MUTYH-associated polyposis, autosomal genetic syndrome associated with this disease. Case presentation We present the case of a 44 years old male, that sought medical consultation with a complaint of abdominal discomfort, that after five days changed its characteristics. The patient was sent to the emergency department were a CT-scan revealed intestinal sub-occlusion by ileocolic invagination. Right colectomy was carried out. The anatomic-pathological examination revealed a moderately differentiated mucinous adenocarcinoma and multiples sessile polyps, which led to the suspicion of a genetic syndrome. In the genetics analysis two mutations were observed in the MUTYH gene, and MUTYH-associated polyposis was diagnosticated. Conclusion This case demonstrates the importance of meticulous analysis of the patient examinations results to identify possible discrete alterations that can lead to improved understanding of disease.

HighlightsTransplantation patients presents associated risk factors that make appearance of incisional hernia more likely.Several aspects of the closure of large hernia defects following liver transplatation remain controversial.A successful approach for selected patient group for whom there is no established standard treatment is described.

Background: Ventral hernias are prevalent results in abdominal surgeries and may represent a surgical challenge in complex cases, mainly due to tension in the abdominal wall musculature. The failure of surgical correction may lead to a more morbid treatment for the patient, in addition to a considerable socioeconomic impact. In order to have a lower risk of complications, the use of Botulinum Toxin A (BTA), may be a preoperative alternative to reduce abdominal wall tension by causing sustained and reversible paralysis. This critical review of the literature proposes to evaluate the adjacent use of BTA in surgical corrections of ventral hernias.Methods: Using the PubMed database, the keywords 'ventral hernia', and 'botulinum toxin' were searched using the Boolean operator AND. Articles were selected based on their relevance and updated information. The outcomes of interest included the change in ventral hernia defect width and in lateral abdominal wall muscle length, pain, hernia recurrence and complications.Results: A total of 20 articles from 2009 to 2018 were found. We excluded some articles due to irrelevant technique, use of animal models and lack of outcome data. Reduction of the abdominal wall thickness increasing it`s length, less perioperative pain, hernia reduction and the correction with less tension were observed after the use of BTA injection. No complications occurred during applications. Conclusion:The use of BTA seems to be a promising alternative in the management of ventral hernias due to the capacity of reducing tension in the abdominal wall. Given the complexity of such cases, however, more studies are necessary to determine the efficacy of this method.