HighlightsIntussusception is rare cause of chronic abdominal pain in adults.Colo-colonic intussusceptions caused by large submucous lipoma.Adults intusseption is rarely caused by idiopathic condition.Main causes are inflammatory diseases, benign or malignant tumors, adhesions and other mechanical conditions impairing peristalsis leading to chronic diarrhea.Inflammatory diseases, tumors, adhesions or mechanical conditions may lead to this patology.Colonoscopy contributes to diagnosis given that it provides direct visualization and biopsy.

IntroductionThe French surgeon Rene Jacques Croissant de Garengeot first described the finding of the Appendix inside a femoral hernia sac in 1731. The De Garengeot’s hernia is a rare entity, comprehending only 0.5–5% of the femoral hernias. The pathogenesis of this entity is still controversial, and in the same way, there are different theories to explain the occurrence of appendicitis inside the De Garengeot’s hernia. There is no standard technique in the treatment of this entity.Presentation of caseW.P.S., 84, female, admited for medical assistance due to claims of edema and flogistic signs in the right inguinal region, noted four days prior. There was no abdominal pain, discomfort, or other symptoms. The physical examination showed hard edema and bulging on the right inguinal region, colaborating for the hipotesis of incarcerated hernia. Patient was then submitted to inguinotomy and the vermiform Appendix was discovered inside the femoral hernia without signs of appendicitis. The case was conducted using the De Oliveira’s technique to femoral hernia repair and Liechenstein for the inguinal hernia repair.DiscussionThe De Garengeot’s hernia is a rare entity, comprehending only 0.5–5% of the femoral hernias2, it represents an unusual finding and is, in the majority of cases, diagnosed intraoperatively. It’s pathogenesis is yet matter of discution. There is no standard approach for this hernia, possibly by the few numbers and variability of presentation of cases described.ConclusionThis paper presents a case of a 84yo female with De Garengeot’s hernia that was submitted to a correction using the De Oliveira’s technic. A low cost technic with great results without use of polypropylene mesh.

Comparative study of intraperitoneal adhesions related to light-weight polypropylene mesh and type I polymerized and purified bovine collagen coated light-weight polypropylene mesh in rabbits 1 2-Experimental SurgeryActa Cir Bras. 2017;32(11):903-912 AbstractPurpose: To compare the effectiveness of light-weight polypropylene mesh coated with polymerized and purified bovine type I collagen (Surgidry HNB) in the treatment of abdominal wall defect and the degree of adhesion formation. Methods: Two types of polypropylene mesh were implanted after creation of defect measuring 6.0cm X 5.5cm in the anterior abdominal wall of 32 male New Zealand breed rabbits, divided in two groups (n = 32): (1) light-weigh macroporous polypropylene, (2) type I polymerized and purified bovine collagen coated light-weigh macroporous polypropylene. These animals were further accessed for adhesions, histological evaluation of inflammation and wall's thickness. Results:The percentage of the area adhered in group 1 (62.31 ± 16.6) was higher compared to group 2 (22.19 ± 14.57) (p <0.05). There was an association between the percentage of the covered area by adhesions and the type of adhesion, toughness and the scores obtained by the adhesion score by correlation analysis (p <0.05). There was no difference between the groups in any variables in relation to the degree of inflammation. Conclusion:The purified type I bovine collagen coated light-weigh polypropylene mesh showed to be effective in the repair of abdominal wall defects and reducing adhesion formation. 903Comparative study of intraperitoneal adhesions related to light-weight polypropylene mesh and type I polymerized and purified bovine collagen coated light-weight polypropylene mesh in rabbits Garcia DPC et al. Acta Cir Bras. 2017;32(11):903-912

Little is known about soft tissue sarcomas (STS) in Brazil, once the federal statistics regarding estimates on incidence and mortality of the most common cancers that affect the Brazilian population currently do not include STS. This study aims to perform a broad evaluation and description of the epidemiological profile, access to treatment and main clinical outcomes of the Brazilian STS patient. A population-based cohort study of 66,825 patients who underwent procedures related to STS treatment registered in the Brazilian public health system (Sistema Único de Saúde, SUS) databases. Median age was 57 years, 30% of them older than 65 years and 50.7% of the cohort was female. The majority, 50,383 patients (75.4%), was diagnosed between 2008 and 2015. Most prevalent anatomic sites were upper and lower limbs (12.6%) and the registry of sarcomas without a specific location comprehended 29.7% of the cohort. The majority of patients resided in the Northeast (40.2% of the patients). Surgery was the first treatment modality in 77.7% of the cases. For survival analysis, only patients with stage and histological grade information were included. The 1-, 5- and 10-year survival rate of the patients was, respectively, 75.4% (95% CI = 74.1–76.7%), 43.4% (95% CI = 41.5–45.5%) and 18.6% (95% CI = 14.8–23.3%).

Intellectual and scientific content of the study, design the protocol, provided guidelines for the surgical interventions, supervised all phases of the study. ABSTRACT PURPOSE:To develop an experimental model for incisional hernias and to compare morphological and functional aspects of hernia repairs by suture, polypropylene mesh and collagen mesh. METHODS:A defect measuring 7cm x 2cm was created in the anterior abdominal of 28 New Zealand male rabbits, divided into four groups (n = 7): (1) control, (2) suture of the anterior sheath of the rectus abdominal muscle, (3) setting of polypropylene mesh, and (4) setting of collagen mesh. On the 90th postoperative day, the animals were examined to verify the presence of incisional hernia. Samples of abdominal wall and scar were collected for histological study. RESULTS:Incisional hernia was identified in 85.7% of the control group, 57.1% of the suture group, 42.9% of the collagen mesh group, and none in the polypropylene mesh group (p = 0.015). Mesh exposure could be identified in 71.4% of the animals in group 3 and in no animal in group 4 (p = 0.021). The polypropylene mesh is effective in the treatment of abdominal wall defects, causing an intense inflammatory reaction. CONCLUSION:The collagen mesh is biocompatible, producing a minimal inflammatory reaction, but fails in the treatment of abdominal wall defects.

Introduction: Little is known about soft tissue sarcomas (STS) in Brazil, once the federal statistics regarding estimates on incidence and mortality of the most common cancers that affect the Brazilian population currently do not include STS. This study aims to perform a broad evaluation and description of the epidemiological profile, access to treatment and main clinical outcomes of the Brazilian STS patient.Methods: A population-based cohort study of 66,825 patients who underwent procedures related to STS treatment registered in the Brazilian public health system (Sistema Único de Saúde, SUS) databases. Results: Median age was 57 years, 30% of them older than 65 years and 50.7% of the cohort was female. The majority, 50,383 patients (75.4%), was diagnosed between 2008 and 2015. Most prevalent anatomic sites were head and neck (13.6%) and upper and lower limbs (12.6%). The registry of sarcomas without a specific location comprehended 29.7% of the cohort. The majority of patients resided in the Northeast (40.2% of the patients). Surgery was the first treatment modality in 77.7% of the cases. The 1-, 5- and 10-year survival rate of the patients was, respectively, 82.3% (95% CI = 82%-82,7%), 57.4% (95% CI = 56.9%-58%) and 42% (95% CI = 41.2%-42.9%).

IntroductionAmong the many techniques available for bariatric surgery, the Mini Gastric Bypass is a safe, technically simple and effective option. However, it may present with postoperative complications, being the perforated gastric ulcer one of the most relevant ones.Presentation of caseA female patient of 41 years of age, with past medical history of a laparoscopic MGB performed 2 year before, presented with 12 hours of sharp and abruptly initiated abdominal pain, with diffuse presentation with suspected perforated acute abdomen after initial medical assessment and examination. Imaging propaedeutic was performed and confirmed a small pneumoperitoneum the patient was submitted to a laparoscopy with closure of the leak and omental patch (Graham's patch) after a thorough abdominal irrigation with saline solution. The patient was discharged from the hospital on the fourth day after surgery.DiscussionOne of the most common complications after and MGB surgery is the occurrence of gastric ulcers and main manifestation of the anastomotic marginal ulcers (MU) is the perforation. The treatment of the perforated peptic ulcer can be performed via laparoscopic or laparotomic approach. The main objective, regardless of the method used to access the abdominal cavity, is to identify and close the perforation.ConclusionThe perforated gastric ulcer is a complication of the mini bariatric bypasses, and the laparoscopic treatment of the perforation associated with thorough irrigation for of the abdominal cavity and omentoplasty present good results for management of this complication.