Revista Portuguesa de Cirurgia
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Apesentação de um Caso Clínico de GIST pancreático
No full textGastrointestinal stromal tumors are clinical entities not very frequent, and if we considerer that cases of pancreatic presentation, they are rare. The authors present a case report, treated in our Surgical Department, because there are few cases published. This patient presents with an abdominal mass of pancreatic localization, which was surgically treated. After histopathological characterization we concluded to be a gastrointestinal stromal tumor. A brief review of gastrointestinal stromal tumors was done.Os tumores do estroma gastrointestinal (G.I.S.T.) são entidades clínicas pouco frequentes, e se considerarmos os casos de apresentação pancreática, são raros. Os autores pretendem assim fazer a apresentação de um caso clínico, que surgiu no nosso Serviço, atendendo a que são poucos os casos relatados em artigos científicos. Este é um caso de uma doente de 70 anos, com uma volumosa massa abdominal, de localização pancreática, submetida a ressecção cirúrgica. Após caracterização histopatológica concluiu tratar-se de um tumor do estroma gastrointestinal. No final do trabalho é feito um breve enquadramento teórico sobre os tumores do estroma gastrointestinal. Palavras-chave: Gastrointestinal stromal tumor (GIST); Pâncreas;
Micro-Laparoscopia – Uma Alternativa ou um Complemento às Técnicas de Video-Cirurgia por Porta Única?
Get PDFAs a text support for the presentation of a video clip showing the technique of cholecystectomy by Micro-laparoscopy, this text gives a summarized introduction to the use of the so called “needlescopy”, to its technological evolution, to the details of the technique performed and to the results the author has obtained. In the final part the author gives his comments on the use of this approach, as an alternative and as a complement to the “Single Port” techniques. Como suporte da apresentação de um vídeo que mostra a técnica da colecistectomia através da Micro-laparoscopia, este texto sumaria a introdução à utilização da chamada “needlescopy”, a sua evolução tecnológica, os detalhes da técnica executada e os resultados obtidos pelo autor. No final são feitas considerações relativas à utilização desta abordagem, seja como alternativa, seja como complemento das técnicas de “Porta Única”
Paniculite Pancreática – caso clínico
Get PDFA 65-years-old female admitted on general surgery with acute pancreatitis, complicated with painful, erythematous and subcutaneous nodules, located on the legs, followed by poliarthritis. The combination of clinical and laboratory data as well as the results of skin biopsy confirmed the diagnosis of pancreatic panniculitis. The patient was treated with conservative therapy only led to her underlying pathology. A successful outcome and disappearance of the lesions were registered. Pancreatic panniculitis is a rare disorder that affects a small number of patients with pancreatic disorders, particularly pancreatitis (acute and chronic) and carcinoma of the pancreas. The disease is characterized by necrosis of subcutaneous adipose tissue and manifests itself usually by subcutaneous, erythematous and painful nodules, located preferentially on the lower limbs, and in more than half of the cases, there is inflammation of the periarticular fat. In the most cases, histopathology reveals lobular panniculitis and fat cells without nuclei (ghost cells). Treatment is conservative, aimed at the underlying pathology. Keywords: acute pancreatitis, pancreatic carcinoma, panniculitis, ghost cells. Doente do sexo feminino, de 65 anos, internada no serviço de Cirurgia Geral por quadro de pancreatite aguda, complicado de nódulos subcutâneos, eritematosos, dolorosos, localizados nas pernas, acompanhados de poliartralgias. A conjugação dos dados clínicos e analíticos com o resultado da biópsia cutânea permitiu estabelecer o diagnóstico definitivo de paniculite pancreática. A paciente beneficiou apenas de terapêutica conservadora dirigida à patologia de base. Registou-se evolução clínica favorável com desaparecimento total das lesões. A paniculite pancreática é uma entidade clínica rara que afecta um número reduzido de doentes com distúrbio pancreático, particularmente pancreatite (aguda e crónica) e carcinoma do pâncreas. A doença caracteriza-se por necrose do tecido adiposo subcutâneo e manifesta-se, geralmente, por nódulos subcutâneos, eritematosos, dolorosos, localizados preferencialmente aos membros inferiores e, em mais de metade dos casos, verifica-se inflamação da gordura periarticular. O exame histopatológico, na maioria das vezes, revela paniculite lobular e adipócitos anucleados (“ghost cells”). O tratamento é conservador e direccionado à patologia de base. Palavras-chave: pancreatite aguda; carcinoma pancreático; paniculite; “ghost cells”.
Technique of double incision laparoscopic cholecystectomy (DILCH) as an alternative to SILS
Get PDFBackground. Single incisions laparoscopic surgery (SILS) applied for cholecystectomy can ensure a good cosmetic effect expecting without no visible scarring cosmetic effect after surgical procedures, but needrequires implementation of special ports, as well as articulating and banked instruments to be more comfortable for the surgeon. The aim of this paper is to present three three-ports cholecystectomy through two well hidden incisions – umbilical and suprapubic, – performed by with typical laparoscopic instruments. Methods. Ten consecutive elective patients with typical, symptomatic cholelithiasis were qualified for DILS cholecystectomy. All acute cases were excluded from intervention. Typical CO2 pneumoperitoneum was done after umbilical skin incision. Two ports, 5 mm and 11 mm, were inserted in the maximum external edges of this incision. The second incision for 11 mm optical trocar for optic was performed in the suprapubic median line, just in the hairy zonewithin the hair line, to hidden conceal himit. Results. DILCH were performed without any conversions to classical LCH or open cholecystectomy. Each procedure was different according to technical improvement of access and manipulation of instruments manipulations. Time of interventions ranged between from 2 hours for the first patients to 1 hour for the last according to the learning curve. No complications were observed and all patients were discharged as after conventional LCH. Conclusions. DILCH as a three three-port laparoscopic intervention, performed with typical laparoscopic instruments, is more convenient for the surgeon than single incision LCH. Transfer of the optic from the umbilical port site to hidden the concealed suprapubic hairy region gives thereprovides more space for instruments but didn’t did not spoil theed good cosmetic effect of intervention. This procedure is easy to learn and in case of technical problems we can always apply additional ports like foras in typical LCH. Background. Single incisions laparoscopic surgery (SILS) applied for cholecystectomy can ensure a good cosmetic effect expecting without no visible scarring cosmetic effect after surgical procedures, but needrequires implementation of special ports, as well as artic- ulating and banked instruments to be more comfortable for the surgeon. The aim of this paper is to present three three-ports chole- cystectomy through two well hidden incisions – umbilical and suprapubic, – performed by with typical laparoscopic instruments. Methods. Ten consecutive elective patients with typical, symptomatic cholelithiasis were qualified for DILS cholecystectomy. All acute cases were excluded from intervention. Typical CO2 pneumoperitoneum was done after umbilical skin incision. Two ports, 5 mm and 11 mm, were inserted in the maximum external edges of this incision. The second incision for 11 mm optical trocar for optic was per- formed in the suprapubic median line, just in the hairy zonewithin the hair line, to hidden conceal himit. Results. DILCH were performed without any conversions to classical LCH or open cholecystectomy. Each procedure was different according to technical improvement of access and manipulation of instruments manipulations. Time of interventions ranged between from 2 hours for the first patients to 1 hour for the last according to the learning curve. No complications were observed and all patients were discharged as after conventional LCH. Conclusions. DILCH as a three three-port laparoscopic intervention, performed with typical laparoscopic instruments, is more convenient for the surgeon than single incision LCH. Transfer of the optic from the umbilical port site to hidden the concealed supra- pubic hairy region gives thereprovides more space for instruments but didn’t did not spoil theed good cosmetic effect of intervention. This procedure is easy to learn and in case of technical problems we can always apply additional ports like foras in typical LCH.
Carcinoma Papilar da Tiróide em Quisto do Canal Tiroglosso: um caso clínico
Get PDFWe report a case of a woman who underwent Sistrunk operation for Thyroglossal Duct Cyst. Pathology revealed papillary thyroid carcinoma in duct walls and a total thyroidectomy was performed. Final pathology showed multiple papillary carcinoma foci in thyroid gland. Although ectopic thyroidal tissue is common in thyroglossal duct cyst wall, the presence of carcinoma is rare. Diagnosis is usually postoperative. Treatment consists in radical cyst excision, while complementary total thyroidectomy remains controversial. Keywords: Thyroglossal duct cyst; papillary thyroid carcinoma Apresentamos o caso clínico de uma doente com um Quisto do Canal Tiroglosso, submetida a operação de Sistrunk. O exame histológico revela carcinoma papilar na parede do quisto, tendo-se decidido proceder a tiroidectomia total. A peça histológica revela vários focos de carcinoma papilar na tiróide. É comum a presença de tecido tiroideu ectópico na parede do Quisto do Canal Tiroglosso, mas rara a incidência de carcinoma. O diagnóstico é quase sempre pós-operatório. O tratamento consiste na excisão radical do quisto, sendo controversa a necessidade de tiroidectomia complementar. Palavras-chave: Quisto do canal tiroglosso, carcinoma papilar da tiróide