Pancreaticobiliary reflux is a common phenomenon in patients with gallstones and an uncommon phenomenon in patients with healthy gallbladders without gallstone disease.

Purpose To compare the performance for the prediction of perforated appendicitis of total bilirubin versus C-reactive protein (CRP), white blood cell count, the time period of symptoms' evolution, and systemic infl ammatory response syndrome (SIRS).Methods Prospective observational study, applying receiver operating characteristics curve analysis to compare the sensitivity and specifi city of the tested variables. ResultsThe period of symptom's evolution was prolonged (105.2 ± 79.3 hours vs. 38.6 ± 17.5 hours), and CRP levels were higher in perforated appendicitis (176 ± 82.6 mg/l vs. 80 ± 76 mg/l). Most patients with perforated appendicitis had a SIRS score higher than 3 points. CRP (>76.7 mg/l), the time period of symptoms' evolution (>34.5 hours), and SIRS (3 points or more), were the best cutoff values to predict perforated appendicitis.Conclusions Perforated appendicitis may be suspected based on CRP, SIRS and the time period of symptoms' evolution. We do not recommend the use of total bilirubin to predict perforation in appendicitis.

The incidence of incidental pathology found during laparoscopic bariatric surgery has been estimated to be around 2%, and gastric gastrointestinal stromal tumors (GISTs) have been found in 0.8% of patients, constituting a rather uncommon finding. Safe laparoscopic resection of gastric GISTs is an established procedure and has been described associated to gastric Roux-en-Y bypass for morbid obesity. We discuss one case of a gastric GIST incidentally discovered during laparoscopic sleeve gastrectomy for morbid obesity. The procedure was performed via laparoscopy, and the patient recovered without any complication. Currently, the patient has lost weight according to what was expected, is asymptomatic, and free of disease.

(Rev Méd Chile 2009; 137: 1597-601).

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Gastrointestinal duplications are uncommon developmentalE l adenocarcinoma primario del intestino delgado es una neoplasia infrecuente, representa entre 1% y 5% de todos los tumores gastrointestinales 1,2 , constituye un desafío para el clínico debido a su rareza asociada a síntomas inespecífi-cos que retrasan el diagnóstico y tratamiento oportuno, lo que lleva a un pronóstico muy malo con una tasa de supervivencia a 5 años que varía entre 20% y 30% 1-3 . Frecuentemente, estos tumores son hallazgos en cirugía de urgencia por complicaciones propias del tumor como obstrucción intestinal, perforación o hemorragia 4,5 . En nuestra experiencia con una supervivencia menor a 1 año 4 . Las duplicaciones gastrointestinales son

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