Resumo em Português:

Ruptura dos órgãos que constituem o tubo digestório pode ocorrer em presença de aumento tensórico intraluminar ou quando sua parede estiver enfraquecida. É possível que as diferenças histológicas entre as diversas partes desse tubo interfiram na pressão necessária para que ocorra sua ruptura. Acredita-se que o uso prolongado de corticosteróides possa diminuir a resistência da parede digestória. Com o objetivo de se avaliarem as pressões de ruptura dos órgãos pertencentes ao tubo digestório, realizou-se o presente trabalho. Foram utilizados 20 camundongos de ambos os sexos, com peso variando entre 38 e 52 g, divididos aleatoriamente em dois grupos (n=10): grupo sem corticóide e grupo com administração subcutânea de hidrocortisona (1mg/kg/dia) durante 28 dias. Após esse período, os camundongos foram mortos e, em seguida, foram retirados os diversos segmentos do tubo digestório correspondentes a seus órgãos para avaliação da tensão de ruptura. Não houve diferença significativa entre os grupos com e sem corticóide. As tensões de ruptura do esôfago e do cólon foram maiores do que a do estômago, duodeno, jejuno e íleo (p<0,05). Concluindo, a administração de corticosteróide durante 28 dias não altera a resistência à ruptura do tubo digestório íntegro. O esôfago e o cólon apresentaram maior resistência à ruptura que os demais segmentos digestórios. A resistência do esôfago é significativamente maior que a do cólon.

Resumo em Inglês:

Rupture of digestive tract organs may be due to an increased intraluminal pressure or to a weakened wall. The histological characteristics of each part of the digestive tract seems to play an important role in the tension required to cause a rupture. It has been reports suggesting that the intestinal wall resistance may be lowered by the use of steroids. The present study has the purpose to assess the rupture pressure of distinct segments of the digestive tract. Twenty mice of both sexes, weighing between 38 and 52 g were randomly assigned two groups; the first (n=10) without corticosteroid and the second (n=10) with the administration of subcutaneous hydrocortisone (1 mg/kg/day) during 28 days. After this period, all organs of the digestive tract were removed and submitted to an intraluminal hypertension until rupture was achieved. There was no significant difference between groups. Rupture resistances at the esophagus and colon were greater than that at the stomach, duodenum, jejunum and ileum (p<0,05). In conclusion, steroid administration during 28 days does not alter the resistance of an intact digestive tract. The esophagus and the colon have higher resistances than the rest of the digestive tract. The esophagical resistance is significantly higher than the colonic.

Resumo em Português:

Vinte e oito porcos foram aleatoriamente separados em dois grupos de 14 animais (A e B). Operados, o diâmetro anatômico das respectivas cárdias foi moldado e medido por um balonete de látex distendido por injeção de alginato, seguida de seção esofagogástrica. As anastomoses do grupo "A" foram realizadas ponto a ponto com fio de poliglactina 910-"000" e as do "B"com grampeadores "ILS". Sete animais dos subgrupos "A1"e"B1" foram reoperados e estudados após sete dias e outros sete porcos, dos subgrupos "A 2" e "B 2", foram no 14º dia. As peças anatômicas foram macroscopicamente examinadas, submetidas à prova pressórica, histologicamente estudadas, e os moldes, identificados e aferidos. Realizou-se estudo comparativo, prospectivo e randomizado da diferença percentual média de estenose ("delta P"), obtida pela média dos diâmetros da cárdia antes e após sutura manual e mecânica. A análise estatística demonstrou insignificante variação na diferença de estenoses e dos tempos operatórios ("deltas Ps"). Na sutura manual, o "delta P" foi 25,44% no sétimo dia pós-operatório e 15,88% no 14º dia e na mecânica, os percentuais do grupo de sete e 14 dias, respectivamente, foram 22,80% e 23,04%. As estenoses não prejudicaram o trânsito alimentar esofagogástrico. Macroscopicamente não houve vazamentos em cavidade livre apesar da microscopia ter evidenciado deiscências parciais bloqueadas em três animais. As aderências foram mais incidentes no grupo de sutura manual e a má coaptação das bordas viscerais, em alguns grampeamentos, resultou em cicatrização fibrótica com estenose mais acentuada. A sutura manual causou maior reação flogística perianastomótica e o grampeamento comprometeu mais intensamente a mucosa e a neo-angiogenêse. O trabalho parece ter demonstrado que as suturas manual e mecânica, se não são ideais, são satisfatórias e de considerável qualidade quando realizadas com mínimo traumatismo, boa hemostasia, preservação do aporte sangüíneo, controle de infeção, escolha do fio ou do grampeador apropriado e a adequada coaptação das margens viscerais.

Resumo em Inglês:

Twenty eight pigs were randomly distributed to two groups of 14 animals ("A" and "B"). Cardia's anatomic diameter was mouldred and measured with a small latex balloon filled with alginato injection. The animals were then submitted to an esophagogastric section. In group "A", anastomosis was performed with separated sutures using 910 poliglactina "000" and in the group "B" the suture was performed with ILS stapler. Seven pigs, from both subgroups "A1" and "B1", were submitted to a new operation and evaluated after seven days while two other sub-groups from seven animals each ("A2" and "B2") had the operation on the 14th day. The anatomic parts were macroscopically examined, followed by a pressure test, histological study and the identification and measurement moulds. The medial percentual difference of stenosis (delta P), was evaluated by the media of the cardias' diameter before and after manual and mechanics suture. Statistical analysis showed that there is no significant percentual media difference of stenosis and operative time ("deltas Ps"). The "delta P" stenosis in the manual suture was 25,44% at the 7th postoperative day and 15,88% at the 14th postoperative day. In the mechanics suture the percentual on the 7th and 14th day were 22,80% and 23,04%. The stenosis did not cause any trouble to the esophagogastric alimentary transit. Macroscopically, there were no free leakage observed in the abdominal cavity, although the microscopic evaluation showed a blocked partial suture ruptures in three animals. Adesions were more prevalent with manual sutures. A bad coaptation between visceral edges of the anastomosis in a few clippings resulted in a fibriform reparation with areater stenosis. Regarding hand made sutures, more perianastomotic inflamatory changes were observed in this subset of animals, while the stapling of the anastomosis lowered angiogenesis. The present study may have demonstrated that manual and mechanical sutures, if not ideal are at least, satisfactory and have considerable quality when they are performed with minimal trauma, good hemostasis, preservation of the blood irrigation, infection control, choice of the appropiated suture material or the most suitable stapler with good coaptation of the visceral edges.

Resumo em Português:

Este estudo experimental em ratos avalia a influência da irrigação da cavidade peritoneal com solução salina isotônica (0,9 %), em diferentes temperaturas, na formação de aderências peritoneais e prevenção de hipotermia após pneumoperitônio. Foram utilizados 80 ratos divididos em quatro grupos de 20 animais: grupo controle (G1) sem irrigação, grupos com irrigação a temperatura ambiente 22,0°C (G2), a 35,0°C (G3) e a 45,0°C (G4). A análise da hipotermia foi realizada através da monitorização da temperatura retal em três diferentes momentos: após a anestesia (T1), cinco minutos depois da insuflação de dióxido de carbono (T2) e cinco minutos após a irrigação com solução salina (T3). Os animais foram sacrificados no 28º dia de pós-operatório. Observaram-se aderências nos grupos com irrigação, sendo que, com salina à temperatura de 45,0ºC houve maior formação de aderências (30,0%) , porém, esta diferença não foi significante. No G2 ocorreu uma queda significante na temperatura média retal quando comparada aos demais grupos, demonstrando que a hipotermia na cirurgia laparoscópica pode ser reduzida com o uso de solução salina aquecida.

Resumo em Inglês:

Adhesions following abdominal surgery have plagued surgeons for years. Intra-operative irrigation of the peritoneal cavity with isotonic saline solution is a common procedure in gastrointestinal surgery. Although warm saline is often recommended to prevent hypothermia, accurate temperature control is rarely observed. Recent experimental studies are correlating saline temperature with adhesion formation and it has been shown that when saline temperature exceeds 37,0ºC it increases the possibilities of adhesions. Hypothermia is frequent during laparoscopy due to the insufflation of cold carbon dioxide to induce pneumoperitoneum. Most laparoscopic procedures also use irrigation with physiologic solutions, such as normal saline. Our purpose was to evaluate the influence of intraperitoneal isotonic saline solution irrigation, at different temperatures, on adhesion formation and hypothermia prevention after pneumoperitoneum. Eighty rats were divided in four groups of 20 animals each: control group (G1) with no irrigation, G2 group with irrigation at ambient temperature - 22,0°C, G2 at 35,0ºC and G4 at 45,0ºC. Temperature analysis was accomplished through a rectal probe in three different moments: after anesthesia (T1), five minutes after carbon dioxide insuflation (T2) and five minutes after saline irrigation (T3). The animals were sacrificed in the 28th day of postoperative. Adhesions were observed in all groups with irrigation and a greate adherence formation (30%) was observed at 45,0ºC. Even so, this difference was not significant. In the G2 a significant fall occurred in the rectum average temperature when compared with the other groups demonstrating that the hypothermia can be avoided with the use of warmed saline solution in laparoscopic surgery.

Resumo em Português:

Foram avaliados retrospectivamente 107 pacientes com metástases cervicais de tumor primário oculto, atendidos entre 1977 e 1995 no Hospital Heliópolis. Considerou-se a influência de fatores epidemiológicos e características clínicas na recorrência da doença e sobrevida. O carcinoma epidermóide foi o tipo histológico mais freqüente, acometendo predominantemente as cadeias júgulo-carotídeas alta e média (níveis II e III). Noventa e três por cento dos pacientes apresentavam doença avançada (estadiamento N2 ou N3). A sobrevida livre de doença (SLD) aos 5 anos foi de 24%, sendo 40% para os pacientes com 55 anos ou menos e 8% para aqueles com mais de 55 anos (p = 0,01). Todos os pacientes com doença na cadeia júgulo-carotídea baixa (nível IV) apresentaram recidiva nos primeiros 12 meses após o tratamento. Os tumores indiferenciados apresentaram recidiva mais precocemente. Na análise multivariada os fatores idade, tipo de tratamento e estadiamento foram significativos (p<0,05).

Resumo em Inglês:

A retrospective outcome analysis of 107 patients with neck metastasis from an occult primary tumor, was performed at the Head and Neck Service of Heliópolis Hospital, São Paulo, Brazil from 1977 to 1995, being the squamous-cell carcinoma, the more frequent neoplasia. Ninety three percent of patients had advanced disease (stage N2 or N3). The 5-year free of disease survival was 24%, forty percent for patients up to 55 years old and 8% for patients more than 55 years (p = 0,01). Patients with undifferentiated tumors and those with disease at level IV had an earlier relapse of disease. The treatment, stage and age were significant in multivariate analysis (p < 0,05).

Resumo em Português:

São apresentados os resultados de 1772 colecistectomias videolaparoscópicas, sendo 1.700 consecutivas sem mortalidade e baixa morbidade e rápida recuperação pós-operatória. Salienta-se a importância da sistematização técnica adotada para tais resultados, bem como do uso de instrumentos especiais de dissecção. É apresentada a estruturação de um modelo de trabalho para formação do cirurgião em cirurgia laparoscópica do aparelho digestivo, de maneira progressiva e sistematizada. O modelo implantado de formação e preparo do cirurgião, com rigor, profundidade e seriedade, é certamente responsável pelos resultados do nível de excelência obtidos.

Resumo em Inglês:

The authors showed the results of 1772 laparoscopic cholecystectomies, 1700 of them consecutevely without mortality and low morbidity and fast post-operative recovery. From the 1772 patients, 12,4% were over 70 years old; 49% of them had associated diseases. Surgical risk were evaluated from ASA I to IV. Chronic cholecystitis were present in 94,8% of the patients while, 3,6% had acute cholecystitis, and 0,2% gallblader cancer. Intraoperative cholangiography was performed in 83% of the cases. There were 67 patients with choledocolithiasis, 29 of them with no pre-operative clinical suspection. Conversion rate was less than 1%. Operative technique was standartized, beginning with the patient position in operative bed, trocars positioning, gallblader presentation with the graspers, as well as the timing of the structures dissection. The importance of the technical sistematization utilized is underlined, as well as the use of special instruments for dissection. It is presented a working model for surgical formation on alimentary tract laparoscopic surgery, in a progressive and sistematized way. It begins with the organization of a motivated surgical team, working together in order to improve the laparoscopic surgery methodology. The model for surgical formation of is responsible for the excellent results obtained.

Resumo em Português:

Avaliou-se, retrospectivamente, a evolução pós-operatória das varizes esofagogástricas em 40 pacientes submetidos a um dos seguintes procedimentos cirúrgicos: a (n=27) derivação esplenorrenal distal (ERD) e B (n=13) derivação esplenorrenal proximal (ERP). Todos os pacientes tinham hipertensão porta esquistossomótica com diagnóstico prévio de varizes do esôfago, presentes ou não no estômago, com um ou mais episódios de sangramento. Os pacientes foram submetidos a um dos procedimentos cirúrgicos de acordo com a preferência do cirurgião assistente. Foram realizadas, nesses pacientes, endoscopias no período pré-operatório e aos seis, 12 e 18 meses no pós-operatório. Os dados de cada endoscopia foram coletados e comparados entre os grupos, verificando-se a presença de varizes do esôfago e estômago nos diferentes períodos, comparando esses achados através do teste do qui-quadrado, com significância para p<0,05. Os resultados obtidos não mostraram casos de ressangramento até o 18º mês pós-operatório, nem casos de encefalopatia. Foram diagnosticadas varizes esofágicas, no pré-operatório, em 100% dos pacientes nos dois grupos. No período pós-operatório, houve redução significativa das varizes do esôfago, quando estudados os dois grupos conjuntamente, para 40% no sexto mês (p = 0,0002), 30% no 12º mês (p = 0,003) e 27,5% no 18º mês (p = 0,003). No sexto mês pós-operatório, a incidência de varizes do esôfago foi maior nos pacientes com ERD quando comparados àqueles com ERP (51,9% vs. 15,4%, p = 0,03). Quando estudadas as varizes aos 12 e 18 meses não foi observada diferença significativa entre pacientes submetidos a ERD ou ERP (12º mês, 37% vs. 15,4%; 18º mês, 25,9% vs. 30,8%). Foram vistas varizes gástricas em 37,5% dos pacientes, com redução significativa no sexto mês (2,5%, p = 0,005). Entretanto, quando comparada com a freqüência do sexto mês, houve aumento significativo no 12º mês (5%, p = 0,00001) e 18º mês (7,5%, p = 0,02). Quando comparados os grupos, no período pré-operatório, estas varizes estiveram presentes mais freqüentemente no grupo submetido a ERP (69,2% vs. 26%, p = 0,0005), sem diferença significativa no período pós-operatório (6º mês, 16,6% vs. 0%; 12º mês, 33,3% vs. 0%; 18º mês, 33,3% vs. 11,1%). Este trabalho demonstrou que os dois tipos de cirurgia têm resultado semelhante em relação à resolução das varizes do esôfago e estômago no 18º mês, mas os resultados indicam que a redução na incidência das varizes do esôfago se acompanha de aumento das varizes gástricas, provavelmente devido à abertura de novas vias colaterais de drenagem em casos de persistência de uma pressão porta aumentada ou mau funcionamento da derivação esplenorrenal.

Resumo em Inglês:

Bleeding due to esophagogastric varices is the major cause of death in patients with hepatic disease. The most frequent treatment of these varices in elective conditions are based in mechanisms that interrupt the connection between splancnic and systemic venous bed. Surgical procedures are divided into portosystemic shunts (selective and non-selective) and disconnection. In portasystemic shunt, the purpose is to derive the splancnic flux, diminishing the esophagogastric varices and prevent re-bleeding. But literature is controversial about the index of re-bleeding and hepatic encephalophaty after proximal or distal splenorenal shunts. We performed this study to evaluate the evolution of esophagogastric varices after proximal splenorenal (PS) or distal splenorenal (DS) shunt. Postoperative outcome of oesophageal and gastric varices were retrospectively evaluated in forty patients submitted to one of two following procedures: A (n=27), distal splenorenal shunt (DS), and B (n=13), proximal splenorenal shunt (PS). All patients had portal hypertension with oesophageal or gastric varices due to schistosomiasis, and a pre-operative history of variceal bleeding. Patients were submitted to the surgical procedure according to personal preference of the assistant surgeon, and preoperatively and after endoscopy was performed six, twelve and eighteen months after surgery. Endoscopy data were collected and compared bet were the two groups according the presence or absence of gastric and oesophageal varices in pre and postoperative period. Results showed no rebleeding in this group, and no of encephalopathy. The incidence of oesophageal varices was 100% in pre-operative period in two groups. There was a significative decrease in oesophageal varices after six (40%, p = 0,0002), twelve (30%, p = 0,003) and eighteen months (27.5%, p = 0,003). In the six months period, the incidence of oesophageal varices was higher in DS group, when compared with PS group (51.9% vs. 15.4%, p = 0,03). In twelve and eighteen months periods, there was no difference among these two groups in relation to the presence of oesophageal varices (twelve months, 37% vs. 15.4%; eighteen months, 25.9 vs. 30.8%). In relation to the gastric varices, there was an higher incidence of this type of varices in PS group in preoperative period when compared with DS group (26% vs. 69.2%, p = 0,005). However, in the six months period there was no difference between the groups (16,6% vs. 0%), which is also observed in twelve months period (33.3% vs. 0%) or in the eighteen months period (33.3% vs. 11.1%). The overall incidence of gastric varices was 37.5%, with a significative reduction in the six month period (2.5%, p=0.005), but with an increase in twelve month period (5%, p=0.00001) and eighteen month period (7.5%, p=0.02). In conclusion we observed both surgical techniques make similar results in relation to resolution of oesophageal and gastric varices after 18 months, but the results suggest that the decrease in oesophageal varices in both groups is accompanied by an increase in gastric varices, probably due to overture of new collateral vessels in cases of persistence of a higher portal pressure or splenorenal shunt failure.

Resumo em Português:

A ressecção do esôfago sem toracotomia vem sendo utilizada com maior freqüência, nos últimos anos, para as afecções benignas, sobretudo no megaesôfago avançado. A vantagem dessa via de acesso é a de evitar o comprometimento da dinâmica pulmonar, mas, entretanto, podendo haver abertura da pleura, com o conseqüente hemopneumotórax, além da potencial agressão a outros órgãos mediastinais com morbidade pós-operatória muitas vezes expressiva. Por sua vez, no megaesôfago avançado, a esofagite de estase predispõe à instalação de carcinoma. Com base nessas considerações, foi proposta, previamente em animais e cadáver humano, a retirada da mucosa-submucosa do esôfago, mediante sua invaginação completa, sem toracotomia. Os resultados satisfatórios estimularam a continuação nessa linha de pesquisa, iniciando-se a experiência na área clínica. Assim, o presente trabalho teve por objetivo demonstrar o resultado do pós-operatório imediato, a técnica de retirada da mucosa do esôfago pelo descolamento submucoso, conservando a túnica muscular intacta no mediastino. O procedimento foi realizado pela via cervicoabdominal em 60 pacientes portadores de megaesôfago graus III ou IV. Efetuou-se a reconstrução do trânsito grastrintestinal transpondo o estômago pelo mediastino posterior, por dentro da túnica muscular esofágica ou pela via retroesternal. O estudo permitiu concluir: 1) a ressecção da mucosa pelo plano submucoso, mediante a invaginação, mostrou ser de execução simples e viável em 98,4% dos casos; 2) ausência de sangramento, no intra ou no pós-operatório imediato, cuja origem fosse do leito da túnica muscular esofágica remanescente ao nível mediastinal; 3) baixa incidência de complicações pleuropulmonares - 5,0%.

Resumo em Inglês:

Partial ou total esophagectomy without thoracotomy has been used with greater frequency for the last few years to treat benign affections, specially advanced megaesophagus. Although this procedure presents the advantages of avoiding compromise of lung dynamics, it is not free complications. Among these, we have to emphasize the opening of pleura with hemopneumothorax, together with the potential aggression to other organs in the mediastinum, with a significant postoperative morbidity. On the other hand, in advanced megaesophagus, stasis esophagitis may lead to carcinoma. Based on these considerations, it was proposed, previously in animals and human beings, mucosal and submucosal removal by complete invagination, without thoracotomy. These results were satisfactory in experimental surgery and encouraged the beginning of the clinical experience area. Thus, the aim of the present work is to show, by a detailed analysis, the tecnique of esophageal mucosal and submucosa removal from the muscular layer, main taining it complete at the mediastinum. This procedure was performed by a cervicoabdominal approach in 60 patients with grade III and IV megaesophagus. The reconstruction of the gastrointestinal tract by the stomach transposition was performed through the posterior mediastinum inside the muscular layer or by retrosternal route. The study allowed us the following conclusions: 1) the mucosa removal by the submucosa, through invagination proved to be simple and seasible in 98,4% of the cases; 2) the absence of bleeding from the bed layer muscular esophagus, during or at immediate postoperative period; 3) The incidence of pleura and lung complications - (5,0%.) is low.

Resumo em Português:

Muitas substâncias têm sido utilizadas após hepatectomias parciais com o fim de se saber como elas atuam no processo de regeneração. Entre elas encontra-se o hormônio de crescimento. Visando conhecer a influência deste hormônio, 50 ratos Wistar, machos, com idade de 170 dias e peso médio de 380g, foram divididos em dois grupos de 25 animais, respectivamente experimento e controle. Sob anestesia inalatória de éter etílico sofreram laparotomia mediana e hepatectomia de aproximadamente 70%, ressecando-se os lobos mediano e lateral esquerdo que eram pesados e em seguida fazia-se a laparorrafia. Os ratos do grupo experimento receberam hormônio de crescimento através de injeção diária, subcutânea, de 0,4U/kg num volume de 0,12 ml. Os animais do controle receberam igual volume de água destilada pela mesma via. Sacrificados em lotes de cinco animais de cada grupo com 36, 72, 168, 240 e 336 horas. Avaliava-se o peso do animal e o peso total do fígado. Através da fórmula de Kwon et al. a regeneração hepática foi calculada. No estudo microscópico conhecia-se as figuras de mitose em 20 campos. O percentual de regeneração do peso da víscera mostrou-se maior no grupo tratado com hormônio de crescimento nas aferições de 168h (p = 0,011), 240 h (p = 0,011) e 336h (p < 0,0001). Nos animais do grupo experimento a regeneração foi completa a partir de 168h enquanto que no controle não atingira 100% com 336h. As figuras de mitose estiveram presentes no grupo experimento até 240h sendo significativamente maior no grupo experimento nas aferições de 36h (p < 0,001) e 72h (p < 0,01). Concluiu-se que o hormônio de crescimento leva à regeneração mais rápida do fígado após hepatectomia, em ratos.

Resumo em Inglês:

Many substances have been used after partial hepatectomy in order to determine their effect on the regeneration process. One of them is growth hormone. We divided 50 male Wistar rats aged 170 days and weighing on average 380g into two groups of 25 animals each (experimental and control groups) to determine the effect of this growth hormone. The animals were anesthetized with ethyl ether and submitted to median laparotomy and a 70% hepatectomy, by medium and left lateral lobes resection. The removed lobes were weighed and the abdomen closed. The rats in the experimental group received growth hormone by daily subcutaneus injection of a 0,4 U/Kg dose, in a volume of 0,12 ml. Control animals received an equal volume of distilled water, injected by the same route. Five animals from each groups were then sacrificed after 36, 72, 168, 240 and 336 hours, and the weight of each animal and of the liver was determined. Hepatic regeneration was calculated by the formula of Kwon et al. and mitotic figures observed in 20 histological fields by light microscopy. Percentage weight of the regenerated liver was higher in the animals treated with growth hormone at 168 h (p=0,011), 250 h (p=0,011) and 336 (p<0,0001). In the experimental group, regeneration was complete starting at 168 h, whereas in controls did not reached 100% after 336 h. Mitotic figures were present in the experimental group up to 240 hs, and were present in significantly higher numbers in the experimental group at 36 h (p<0,001) and 72 h (p<0,01). We conclude that growth hormone leads to a more rapid regeneration of the liver after hepatectomy in rats.

Resumo em Português:

A videolaparoscopia (VL) vem contribuindo de forma crescente, para diagnóstico e terapêutica de várias afecções cirúrgicas abdominais, introduzindo profundas mudanças na cirurgia contemporânea. Esse avanço incorporou-se também às urgências traumáticas, fazendo parte da avaliação diagnóstica e, às vezes, da terapêutica do trauma abdominal. Os autores apresentam uma revisão concisa da literatura sobre a VL no trauma, atualizando o tema e discutindo os aspectos mais relevantes das indicações, limitações e complicações do método.

Resumo em Inglês:

Videolaparoscopy has been contributing for the diagnostic and therapeutic approach in the abdominal surgical diseases in the last years. Representing real modification in the conventional elective and traumatic abdominal surgery. Its has been recognized as a safe procedure for the diagnosis and treatment of abdominal trauma. Diagnostic predictive values, sensibility and specificity are greater than when obtained by the other diagnostic methods such as peritoneal lavage, ultrasonography and computed tomography. Despite their limitations, when indicated for selected patients seems to reduce non terapeutic laparotomies, postoperative morbidity, hospital stay and costs. The authors present a review of the literature regarding videolaparoscopy in the abdominal trauma, its limitations and complications. Based an a complex protocol for the indications of videolaparoscopy for abdominal trauma, the authors sugested their exclusive use by level trauma centers.

Resumo em Inglês:

A 21-year-old girl presents with a 15-day history of epigastric pain and vomiting. Ten days later, constipation and abdominal distension followed. The patient reported similar epigastric pain and vomiting for 6 days last year. A painless epigastric 12-by-8-centimeter tumor was observed on abdominal palpation, and rectal examination revealed an extrinsic tumor compressing anterior rectal wall. Upper digestive endoscopy showed a trichobezoar. Upon laparotomy, one gastric and one duodenal trichobezoar were removed through an anterior gastrotomy. Another one was found 40 centimeters proximal to the ileo-cecal valve and removed through a proximal ileotomy. Trichobezoar is an unspecific disease, which diagnosis is made upon suspicion. Early recognition of bezoars is important because morbidity and mortality rise considerably once complications occur. We illustrate this case to emphasize the need for early recognition and surgical management in order to reduce morbimortality.

Resumo em Inglês:

The Superior Mesenteric Syndrome is a rare and controversial disease. The compression of the duodenum by the mesenteric artery and aorta causes an intermitent obstruction. Preoperative diagnosis is very difficult.We present one case of this syndrome in a pacient with severe weight loss and signs of high intestinal obstruction. The diagnosis was based on clinical and radiologic findings. A duodenojejunostomy was performed after medical treatment failure.This patient died on the 20th posoperative day due to cardiac complications. This syndrome must be remembered in cases of high obstruction in chronic ill patients.

Resumo em Inglês:

Spontaneous perforation of the common bile duct is rare. It happens predominantly in children and it is related to obstructive disease of the biliary tract. We present a case of an 18 year-old male patient, with ulcerative rectocolitis associated with malignant tumor of the head of pancreas. The patient developed an acute abdomen syndrome and laparotomy, a spontaneous perforation of common bile duct was evidenced. The authors make a revision of the clinical aspects of that pathology.

Resumo em Inglês:

Mesenteric cyst is a rare intra abdominal pathology. The incidence ranges from 1/100,000 to 1/250,000 hospital admissions. The authors present a case of a female patient, 20 years old, with abdominal pain for four months which three days had an acute onset of abdominal pain, and ultrasound revealed a cyst of mesentery within a dense fluid. The patient had been submitted to a laparotomy, and resection of the cyst. We emphasized the clinical symptoms, diagnostic evaluation and the therapeutic of this condition.

Resumo em Inglês:

The authors report a case of adenomyoma of papilla of Vater in a young adult, a rare pathology in this age and site. The commonest clinical findings are abdominal pain, dyspepsia and jaundice, as in this case in which the patient referred these symptoms for several months. The diagnosis is usually difficult before surgery, because the radiological and endoscopic appearances are difficult to interpret, since they may only show obstruction and enlargement of the biliary tract; in this way, the endoscopic biopsy may be useful. In the present case the computed tomography, abdominal scan and intraoperative cholangiography only demonstrated obstruction and enlargement of the biliary tract, without the presence of gallstones. The treatment is usually lesion resection according to its size, performing the total resection in those cases of extensive involvement of the digestive tract, as it was performed in this case, due to the dimension of the lesion and its malignant appearance. The patient was discharged from hospital on the thirteenth postoperative day, with a histological diagnosis of adenomyoma of papilla of Vater. Three months after the procedure the patient was asymptomatic.