0.05). CONCLUSION: Colocolonic anastomosis without previous bowel preparation was shown to be safe and efficacious, suggesting it is not an indispensable procedure in colorectal anastomosis surgery.]]>

RESUMO Objetivo: analisar, comparativamente, a incidência de câncer incidental de vesícula biliar em colecistectomias de urgência versus colecistectomias eletivas realizadas em hospitais públicos de Teresina-PI. Métodos: estudo observacional descritivo, quantitativo, com delineamento transversal, cujo cenário foram dois hospitais públicos de Teresina-PI. Foram analisados 6.329 prontuários de pacientes submetidos à colecistectomia, entre janeiro de 2011 e dezembro de 2017. Os dados coletados foram divididos em dois grupos e confrontados estatisticamente através do teste Z para diferença entre proporções. Resultados: detectou-se câncer incidental da vesícula biliar em 6,53% das colecistectomias de urgência e em 0,38% das eletivas. Quanto ao sexo, observou-se que, na cirurgia de urgência, 69% eram mulheres e 31%, homens, enquanto no procedimento eletivo, 78% eram mulheres e 22%, homens. Quanto à idade, a maioria dos pacientes possuía mais de 60 anos e, entre estes, 69,3% submetidos à colecistectomias de urgência e 82,6%, à eletivas. O tipo histopatológico "adenocarcinoma" foi encontrado em 84,6% das cirurgias de urgência e 100% das eletivas. Conclusão: câncer incidental de vesícula biliar foi mais frequente em colecistectomias de urgência em comparação às eletivas. O perfil dos pacientes com essa doença maligna nos dois tipos de procedimento foi do sexo feminino, maiores de 60 anos de idade e com diagnóstico histopatológico de adenocarcinoma.

Introduction: Cancer of the gallbladder is described as one of the most important and deadly disease that affects the biliary tract occupying the 5th place among malignant diseases of the digestive system. The aim of the study was to determine the incidence of cancer in elective cholecystectomies performed in the hospital of Teresina, Piauí in 2012. Methods: Documentary research, retrospective, descriptive and quantitative approach. Data collection occurred by reviewing the histopathological records of patients undergoing elective cholecystectomy. The parameters evaluated were gender, age and histological type. HGV authorized by the ethics committee. Results: Of the 948 patients there was an incidence of 0.8% (8 patients) with gallbladder cancer, 93.8% (889 patients) with chronic calculous cholecystitis, 3.2% (30 patients) with chronic cholecystitis, 2.1% (20 patients) with acute exacerbation chronic cholecystitis and only 0.1% (1 patient) with mucosal polyps. Of patients with bladder cancer 87.5% (7 patients) were female and 12.5% (1 patient) were male, aged 49e82 years, mean 66 years. As for the histological pattern, we found that 6 cases were well-differentiated type of adenocarcinoma (75%), 1 mucinous type (12.5%) and 1 biliary malignancy metastatic poorly differentiated (12.5%). Conclusion: The prevalence of gallbladder cancer in elective cholecystectomy was 0.8% in the study, the most prevalent histological type was adenocarcinoma. Thus the outpatient follow-up with the appreciation of the histopathological after discharge is extremely important for the prognosis of the disease.

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Objective Evaluate healing response of colo-colic anastomosis by invagination vs. single-layer suture. Methods Sixty dogs were randomly distributed in two groups and anastomosed with single-layer suture (G-I, control) or by invagination and cardinal sutures (G-II, study). In the end, the animals were euthanized (10 from each group on POD7 and 20 on POD21) and the anastomosed segment was retrieved for histology and immunohistochemistry. Parameters included body weight, adhesions, edema, vasoproliferation, type I and III collagen, myeloperoxidase and nitric oxide. Findings were analyzed with Student's t test and the Mann–Whitney test. Results No animal died prior to euthanasia. The groups were similar with regard to all parameters: median weight 10.86 kg (G-I) and 9.98 kg (G-II) on POD7 (p = 0.41) and 11.86 kg (G-I) and 11.55 kg (G-II) on POD21 (p = 0.71); abdominal adhesions (p = 0.7383 POD7; p = 0.5685 POD21), level of edema (p = 0.3006 POD7; p = 0.7990 POD21), vasoproliferation (p = 0.1191 POD7; p = 0.0758 POD21), type I collagen (p = 0.4591 POD7; p = 0.3357 POD21), type III collagen (p = 0.2166 POD7; p = 0.2712 POD21), nitric oxide (p = 0.3980 POD7; p = 0.4796 POD21) and myeloperoxidase (p = 0.580 POD7; p = 0.755 POD21). Conclusion No significant difference in healing response was observed between the two anastomosis techniques (single-layer suture and invagination).

human) successfully. The patient was discharged on the 8th PO uneventful. The patient presented positive serology for hepatitis B and histopathology showed hepatocellular carcinoma and the patient was referred for liver transplantation center. Conclusion: The diagnosis is very difficult in emergency treatment and sets a challenge to the surgeon. The evolution of hemostatic agents has enabled greater security in the control of bleeding during surgery.

a history of oral contraceptive use. The malignant transformation of HCA in Hepatocellular Carcinoma (HCC) is still unclear. We review the literature and summarize what is currently believed to be the possible pathway of malignant transformation. We also describe a well-documented case of asymptomatic 63 years old men with initial diagnosis of HCA that after 4 years and 3 months of follow-up had a right hepatectomy for hepatocellular carcinoma.Background: Well-differentiated hepatocellular carcinomas (HCCs) are considered as early form of HCCs in hepatocarcinogenesis and the average diameter is less than 20mm. Among the benign liver lesions, angiomyolipoma (AML) is a rare mesenchymal tumor which is composed of smooth muscle cells, adipose tissues and blood vessels.Here we report a case of large well-differentiated HCC mimicking AML preoperatively. Case: An 84-year old man presented with dyspepsia for several weeks. He was known hepatitis B carrier and had subtotal gastrectomy for gastric cancer 20 years ago. Serum alpha-fetoprotein and PIVKA II level were 3.72 ng/ml and 2055 mAU/ml. Abdominal CT scans found 10cm sized fatcontaining hypervascular heterogeneous mass that showed irregular enhancement without wash-out in portal and venous phases. Needle biopsy showed coagulation necrosis without cancer cell. Hepatic tumor was considered as benign AML. 4 months later, follow-up abdominal CT scans showed increase in tumor size to 11.7cm and he underwent left lateral sectionectomy. Gross findings showed expanding nodular patterned bulging mass with large amount of necrosis. Microscopic findings were atypical cells with trabecular patterns and pseudoglandular structures which were compatible with well-differentiated HCC. In contrast to preoperative imaging studies, fat component was less than 1% of the tumor. Conclusions: Large well-differentiated fat-containing HCCs are very rare. In our case, preoperative imaging studies showed a large heterogeneous hepatic tumor with fatty component which showed irregular enhancement in delayed phases that differ from typical features of HCCs. Because preoperative diagnosis of AML is difficult, we should consider proper treatment for large hepatic tumors.

Conclusion:The tactic of two preservations and reperfusion because of technical problems during LT is feasible for the recovery of the grafts.