Cholecystocolonic fistula (CCF) is a rare complication of cholelithiasis. They are often asymptomatic, difficult to diagnose preoperatively, it despite radiological support, and they are discovered incidentally perioperatively. We present the case of a woman with acute cholecystitis, who was operated by laparoscopy, and a CCF was evidenced, it was resolved by conversion to open surgery. FCC can be complicated and simulate acute abdominal symptoms. It should be taken into account in older adults with a history of cholelithiasis and scleroatrophic vesicles with adhesions. Very few cases have been described in the literature, and none in our country. We present a case of FCC that was admitted as acute cholecystitis, and the diagnosis and treatment of it were during her surgery.

Indirect inguinal hernia (IHH) is the most frequent congenital anomaly in infancy and childhood. In girls, the sliding IIHs contain mainly the ovary with or without a fallopian tube. We present the case of a 6-month-old girl who was presented with an irreducible left inguinal tumor associated with vomiting. She was operated of emergency with a diagnosis of complicated left indirect inguinal hernia containing gangrenous fallopian tube and left ovary. This type of hernia has a higher incidence in prematures and females under one year of age. Preoperative ultrasound may be helpful for diagnosis. The repair procedure is the classic herniorrhaphy with high ligation of the hernia sac, through an inguinal approach.

Acute appendicitis is the most frequent surgical emergency instance in young adults; and its association with parasitic infections is rare. Of these particular cases, appendix location of hydatid cyst is extremely rare; and there have been published reports of such cases only in Iran, India, Tunisia, and Peru. We present the case of a 52-year old male subject born in Puno, with no relevant past medical history, who was admitted with a clinical condition typically consistent with acute appendicitis. When this patient underwent surgery, the appendix was found showing a cystic mass, compatible with complicated Echinococcus granulosus hydatid cyst. Later on, three additional intraabdominal hydatid cysts were identified. There was no surgical or trauma past history, so it was concluded this condition corresponded to disseminated primary intraabdominal location of hydatid disease, including th...

The pancreatic disorders, as acute pancreatitis, of biliary etiology are rare in pediatrics, even more the pancreatic pseudocysts. They are liquid collections surrounded of a fibrous capsule without epithelium, secondary to acute pancreatitis. We present the case of a 14-year-old female patient with a history of acute pancreatitis because of biliary etiology, 10 months prior. She complained of intermittent abdominal pain and a palpable mass in the epigastrium. The Imaging studies showed a pancreatic pseudocyst and cholelithiasis. The laparoscopy was chosen because the technical and esthetic benefits for this population. Therefore, a laparoscopic cystogastro-ostomy-anastomosis and cholecystectomy were performed, with good progress. We affirm this technique is a safe and effective method for the management of this pathology in pediatric patients, and it should be considered as the first op...

Chylous ascites (CA) is a rare condition, and it can present as a peritoneal reaction named acute chylous peritonitis (ACP). We report the case of a 26-year old male who developed acute abdomen. He underwent surgery and turbid milky fluid was found in his abdominal cavity. A prophylactic appendectomy was performed, as well as aspiration and lavage of the abdominal cavity. Drainage tubes were placed. Studies of the fluid revealed increased triglyceride and amylase contents. Gram-staining and cultures were negative. A computed tomography scan revealed acute pancreatitis (Balthazar C), so a diagnosis of chylous ascites secondary to pancreatitis was confirmed. The patient did well, he received hydration, analgesics, and oral diet according to tolerance. Very few cases of ACP have been reported in the literature, and its association with acute pancreatitis is very unusual. This condition may ...

Xanthogranulomatous cholecystitis (CXG) and Adenomyomatosis (VA) are rare, with few reports in our setting. The preoperative and intraoperative differentiation is difficult because it presents radiological and macroscopic characteristics, similar to cancer. It often presents as acute cholecystitis. And the diagnosis is established by the presence of fibrosis, foamy histiocytes, and Rokitansky-Aschoff sinuses, respectively. We present the case of a woman who came in for abdominal pain, nausea and vomiting. The tomography revealed a subcapsular liver collection. Surgery was performed and a hepatic abscess blocked by the omentum was evidenced, with multiple adhesions; and thickened-walled vesicle perforated in bacinete. Patient receives antibiotic therapy, progresses well, and histopathology concludes CXG and VA. CXG and VA are rare diseases associated with cholelithiasis. In our case, its ...

Hemorrhagic cholecystitis is a rare complication of acute cholecystitis, but with high mortality. Clinically it is identical to acute cholecystitis, and it does not usually present with gastrointestinal bleeding. We present the case of a 57-year-old man, with no history or use of anticoagulants, referred to our hospital for a "gallbladder tumor", after tomographic and cholangioresonance studies, associated with a drop in serum hemoglobin, suspicion of him is defined. He enters the operating room and a gangrenous gallbladder is evident, containing clots and stones. Confirming his diagnosis with histopathological study. Due to its clinical similarity, it should be considered in patients with a history of anticoagulant therapy, trauma, malignancy, or findings consistent with acalculous cholecystitis. But it can occur in patients with no history and be associated with cholelithiasis. Early d...

Gallstone ileus (BI) is defined as intraluminal mechanical intestinal obstruction by one or more gallstones; who have emigrated through a biliodigestive fistula, established as a complication of cholelithiasis. We present the case of a 59-year-old woman with a history of arterial hypertension, with a preoperative tomographic diagnosis of intestinal obstruction due to biliary ileus (Rigler's triad), for which she underwent emergency surgery, deciding to perform an enterolithotomy and schedule her second intervention in two months. BI is an uncommon cause of intestinal obstruction in elderly patients, with high morbidity and mortality. It requires a high index of suspicion in the presence of intermittent intestinal obstruction and a history of biliary colic. Rigler's triad is only present in a third of patients, for which tomography is the study of choice. Treatment is controversial, but t...

Acute appendicitis is the most frequent surgical emergency instance in young adults; and its association with parasitic infections is rare. Of these particular cases, appendix location of hydatid cyst is extremely rare; and there have been published reports of such cases only in Iran, India, Tunisia, and Peru. We present the case of a 52-year old male subject born in Puno, with no relevant past medical history, who was admitted with a clinical condition typically consistent with acute appendicitis. When this patient underwent surgery, the appendix was found showing a cystic mass, compatible with complicated Echinococcus granulosus hydatid cyst. Later on, three additional intraabdominal hydatid cysts were identified. There was no surgical or trauma past history, so it was concluded this condition corresponded to disseminated primary intraabdominal location of hydatid disease, including th...

The pancreatic disorders, as acute pancreatitis, of biliary etiology are rare in pediatrics, even more the pancreatic pseudocysts. They are liquid collections surrounded of a fibrous capsule without epithelium, secondary to acute pancreatitis. We present the case of a 14-year-old female patient with a history of acute pancreatitis because of biliary etiology, 10 months prior. She complained of intermittent abdominal pain and a palpable mass in the epigastrium. The Imaging studies showed a pancreatic pseudocyst and cholelithiasis. The laparoscopy was chosen because the technical and esthetic benefits for this population. Therefore, a laparoscopic cystogastro-ostomy-anastomosis and cholecystectomy were performed, with good progress. We affirm this technique is a safe and effective method for the management of this pathology in pediatric patients, and it should be considered as the first op...

Traumatic Abdominal Wall Hernia (TAH) is secondary to Closed Abdominal Trauma (TAbC). Defined as a herniathrough a musculofacial defect, without skin penetration, and without evidence of a previous hernia. We present the case of a 48-year-old man who suffered a traffic accident, diagnosed with PAHT and wall fasciitis by means of tomography, who died despite surgical treatment. PAHT is rare, it is the most severe form of abdominal wall injury, and it is associated with Intra-Abdominal Injuries (LIA). The diagnosis can be difficult, and the tomography is the most useful study of imagen. Management generally involves urgent surgical intervention to resolve LIAs; however, the treatment and closure of the defect must be adapted to each patient and the circumstances.

Peru is one of the countries with the greatest regional distribution of human fascioliasis caused by F. hepatica in the world, it was considered an emerging disease and can have high morbidity. We present the case of a 41-year-old woman who presented with abdominal pain. Ultrasound showed cholelithiasis and choledocholithiasis; and the cholangioresonance study showed bile duct dilation and distal stenosis. A retrograde endoscopic cholangiopancreatography was made and we removed two parasites similar to hepatic flukes. Subsequently, the cholecystectomy could not be performed due to delay and request for voluntary discharge. In our environment, even today, there is a need to suspect fascioliasis, in the case of a compatible clinical of choledocholithiasis in patients from endemic regions. Therefore, knowing the best study alternatives and appropriate treatment according to the phase of the...

Chylous ascites (CA) is a rare condition, and it can present as a peritoneal reaction named acute chylous peritonitis (ACP). We report the case of a 26-year old male who developed acute abdomen. He underwent surgery and turbid milky fluid was found in his abdominal cavity. A prophylactic appendectomy was performed, as well as aspiration and lavage of the abdominal cavity. Drainage tubes were placed. Studies of the fluid revealed increased triglyceride and amylase contents. Gram-staining and cultures were negative. A computed tomography scan revealed acute pancreatitis (Balthazar C), so a diagnosis of chylous ascites secondary to pancreatitis was confirmed. The patient did well, he received hydration, analgesics, and oral diet according to tolerance. Very few cases of ACP have been reported in the literature, and its association with acute pancreatitis is very unusual. This condition may ...

Xanthogranulomatous cholecystitis (CXG) and Adenomyomatosis (VA) are rare, with few reports in our setting. The preoperative and intraoperative differentiation is difficult because it presents radiological and macroscopic characteristics, similar to cancer. It often presents as acute cholecystitis. And the diagnosis is established by the presence of fibrosis, foamy histiocytes, and Rokitansky-Aschoff sinuses, respectively. We present the case of a woman who came in for abdominal pain, nausea and vomiting. The tomography revealed a subcapsular liver collection. Surgery was performed and a hepatic abscess blocked by the omentum was evidenced, with multiple adhesions; and thickened-walled vesicle perforated in bacinete. Patient receives antibiotic therapy, progresses well, and histopathology concludes CXG and VA. CXG and VA are rare diseases associated with cholelithiasis. In our case, its ...

La colecistitis hemorrágica es una complicación rara de la colecistitis aguda, pero con alta mortalidad. Clínicamente es idéntica a la colecistitis aguda, y no suele presentarse con hemorragia gastrointestinal. Presentamos el caso de un varón 57 años, sin antecedentes, ni uso de anticoagulantes, referido a nuestro hospital por una “tumoración vesicular”, tras los estudios tomográficos y de colangioresonancia, asociado a la caída de hemoglobina sérica, se define su sospecha. Ingresa a sala de operaciones y se evidencia una vesícula gangrenada, conteniendo coágulos y cálculos. Confirmando su diagnóstico con el estudio histopatológico. Debido a su similitud clínica, debe considerarse en pacientes con antecedentes de terapia anticoagulante, trauma, malignidad, o hallazgos compatibles con colecistitis alitiásica. Pero puede presentarse en pacientes sin antecedentes y esta...

Gallstone ileus (BI) is defined as intraluminal mechanical intestinal obstruction by one or more gallstones; who have emigrated through a biliodigestive fistula, established as a complication of cholelithiasis. We present the case of a 59-year-old woman with a history of arterial hypertension, with a preoperative tomographic diagnosis of intestinal obstruction due to biliary ileus (Rigler's triad), for which she underwent emergency surgery, deciding to perform an enterolithotomy and schedule her second intervention in two months. BI is an uncommon cause of intestinal obstruction in elderly patients, with high morbidity and mortality. It requires a high index of suspicion in the presence of intermittent intestinal obstruction and a history of biliary colic. Rigler's triad is only present in a third of patients, for which tomography is the study of choice. Treatment is controversial, but t...

El síndrome de NARP (neuropatía, ataxia, retinitis pigmentosa) es una encefalomielopatía de herencia ligada al cromosoma X, asociada a una mutación en el gen mitocondrial ATP6 que consiste en el cambio de una tiamina por guanina en la posición 8993 del genoma mitocondrial, determinando la sustitución del aminoácido leucina por arginina y produciendo proteínas anormales con alteración de la energía mitocondrial. El grado de severidad de los síntomas, depende del porcentaje de mitocondrias que portan la mutación y el tejido en el que se encuentre el mayor número de mitocondrias mutadas. Se presenta el caso de un paciente varón de 18 meses de edad, natural y procedente de Arequipa, quien presentó hipotonía desde el nacimiento, retraso del desarrollo psicomotor y ataxia. La sospecha diagnóstica se planteó por el proceso neurodegenativo y la encefalomielopatía que manifesta...

Hemobilia (HB) is the presence of blood in or through the biliary tract. Its most common causes are iatrogenic, traumatic, neoplasms, and cholangiovenous or arterio-biliary fistulas. Also, gallstones account for 5-15% of such cases. We present the case of a 28-year-old woman, with no remarkable history or anticoagulant use, who was initially diagnosed with acute cholecystitis, and required emergency open cholecystectomy. During the operation, a clot adhered to the gallbladder lumen and two calculi were evidenced. The diagnosis was confirmed with histopathological findings. Due to its clinical similarity, HB should be considered in patients with a history of anticoagulant therapy, trauma, malignancy, or with findings consistent with alithiasic cholecystitis. HB may also occur in patients with no remarkable history, and it be associated with cholelithiasis. Treatment depends on the patient...

The retroperitoneal abscess can be secondary to retrocecal appendicitis. We present the case of a 66 years old male, obese and diabetic, who presented with pain and lumbar mass, and a previous history of abdominal pain. A tomography showed a retroperitoneal abscess with soft tissue and a right scrotal bag. He was admitted to the operating room and a retrocecal appendix with distal end digested was evidenced, and when we opening the retroperitoneum and making a right lumbar and inguinal incision the pus leakage was showed too. The patient received antibiotic therapy and cures, and had a good evolution. Retroperitoneal abscess secondary to acute appendicitis is a rare and serious surgical infection, and it causes necrotizing fasciitis is exceptional. Therefore, it should be included within the diagnostic possibilities in allimmunosuppressed patients with low back pain and a history of abdo...

Intussusception as a cause of intestinal obstruction in adults is a very rare entity, the majority is secondary to a benign or malignant neoplasm of the small intestine. Lipomas are rare benign tumors, considered neoplasms of mature adipose tissue without pleomorphism that are found in the gastrointestinal tract as well-demarcated tumors of the submucosa, and are most often found within the wall of the small intestine. We present the case of a 72-year-old man who underwent surgery for intestinal obstruction, and an intraoperative diagnosis of small bowel intussusception secondary to a submucosal angiolipoma according to pathology. Intussusception in adults is rare, and the fact that it is due to another unusual benign entity is even rarer. Tomographic study is useful, but most are diagnosed intraoperatively. The resection "in block", is the most recommended due to the suspicion of malign...