RESUMO
Resumen Objetivo Reportar el caso clínico de un quiste de duplicación gástrica en un paciente adulto. Materiales y Método Paciente de sexo masculino de 70 años con una tumoración quística supramesocólica, con síntomas digestivos inespecíficos. La imagenología solicitada no determinó la etiología ni origen de la misma planteándose múltiples diagnósticos diferenciales. Se realizó una laparotomía exploradora. Resultados La laparotomía confirmó el origen gástrico de la tumoración. Se realizó la resección completa de la misma con resección gástrica en forma de gastrectomía atípica. El estudio anatomopatológico de la pieza confirmó un quiste de duplicación gástrica. Discusión Los quistes de duplicación gástrica son una enfermedad congénita rara, se diagnostican principalmente en la etapa neonatal, siendo raro en el adulto. La mayoría son lesiones únicas, no comunicantes, asintomáticas y de difícil diagnóstico preoperatorio siendo habitual el diagnostico definitivo en el intraoperatorio y con el estudio histológico de la pieza. Conclusión El quiste de duplicación gástrica debe tenerse en cuenta en los diagnósticos diferenciales de toda lesión quística supramesocólica. Son lesiones potencialmente malignas siendo la resección completa la que brinda el diagnóstico y tratamiento definitivo.
Aim To report the clinical case of a gastric duplication cyst in an adult patient. Materials and Method 70 year old male patient with a symptomatic supramesocolic cystic lesion. Preoperative imagenology was not able to determine the exact origin or etiology. Several differential diagnosis were made and finally an exploratory laparotomy was performed. Results The laparotomy determined the gastric origin and a complete resection including gastric wall was done. The anatomopathological study confirmed it was a gastric duplication cyst. Discussion Gastric duplication cysts are a rare congenital disease, diagnosed mainly in the neonatal stage, with rare presentation in the adult stage. Most of these lesions are unique, non-communicating, usually asymptomatic and difficult to diagnose preoperatively, with definitive diagnosis being common in intraoperative and histological study of the piece. Conclusion The gastric duplication cyst must be taken into account in the differential diagnosis of any supramesocolic cystic lesion. They are potentially malignant lesions, and complete resection provides the definitive diagnosis and treatment.
Assuntos
Humanos , Masculino , Idoso , Estômago/anormalidades , Cistos/diagnóstico por imagem , Anormalidades do Sistema Digestório/diagnóstico por imagem , Imageamento por Ressonância Magnética , Ultrassonografia , Cistos/congênitoRESUMO
INTRODUCTION: The choice of immediate or delayed surgery in patients with common bile duct calculi without severity criteria is controversial. Studies of patients with common bile duct calculi show that in a considerable percentage of these patients there is spontaneous passage of these stones without the need for surgery. AIM: To compare the percentage of common bile duct stones found at surgery between patients with impacted common bile duct stones undergoing immediate and delayed surgery. PATIENTS AND METHOD: Patients admitted to the Hospital de Clínicas Manuel Quintela with a diagnosis of impacted common bile duct stones were retrospectively reviewed. The patients were classified into two groups: those who underwent exploratory common bile duct surgery within 48 hours of admission (immediate surgery) and those who underwent surgery after the first 48 hours of admission (delayed surgery). The number of patients with a finding of common bile duct stones in each group was analyzed. RESULTS: Seventy patients (37 in the immediate surgery group and 33 in the delayed surgery group) were analyzed. Among the patients who underwent immediate surgery, 92% showed common bile duct stones on cholangiography or another instrumental procedure. In the group that underwent delayed surgery, this percentage was 64% (P< .004). Three factors predicting the absence of spontaneous passage of stones after 48 hours of admission were identified: age more than 70 years, jaundice of 7 days' duration or more and common bile duct stones visible by imaging techniques. CONCLUSIONS: The results of this study suggest that delayed surgery of impacted common bile duct stones reduces the number of patients requiring common bile duct surgery as well as the number of patients requiring biliary drainage. Patients aged more than 70 years old, with jaundice of more than 7 days' duration and with common bile duct stones visible by imaging techniques do not benefit from delayed surgery.