BACKGROUND: Tumors are rare in neonatal age. Congenital mesoblastic nephroma (CMN) is a usually benign renal tumor observed at birth, or in the first months of life. It may also be identified prenatally and associated with polyhydramnios leading to preterm delivery. Effective treatment is surgical in most cases, consisting in total nephrectomy. In literature, very few studies report on the neonatal management of such a rare disease, and even less are those describing its uncommon complications.
METHODS: We report on two single-center newborns affected with CMN. The first patient is a preterm female baby, born at 30+ 1 weeks of gestation (WG) due to premature labor, with prenatal (25 WG) identification of an intra-abdominal fetal mass associated with polyhydramnios. Once obtained the clinical stability, weight gain, instrumental (computed tomography, CT, showing a 4.8 × 3.3 cm left renal neoformation) and histological/molecular characterization of the lesion (renal needle biopsy picture of classic CMN with ETV6-NTRK3 translocation), a left nephrectomy was performed at 5 weeks of chronological age. The following clinical course was complicated by intestinal obstruction due to bowel adherences formation, then by an enterocutaneous fistula, requiring multiple surgical approaches including transitory ileo- and colostomy, before the conclusive anastomoses intervention. The second patient is a 17-day-old male term baby, coming to our observation due to postnatal evidence of palpable left abdominal mass (soon defined through CT, showing a 7.5 × 6.5 cm neoformation in the left renal lodge), feeding difficulties and poor weight gain. An intravenous diuretic treatment was needed due to the developed hypertension and hypercalcemia, which regressed after the nephrectomy (histological diagnosis of cellular CMN with ETV6-NTRK3 fusion) performed at day 26. In neither case was chemotherapy added. Both patients have been included in multidisciplinary follow-up, they presently show regular growth and neuromotor development, normal renal function and no local/systemic recurrences or other gastrointestinal/urinary disorders.
CONCLUSIONS: The finding of a fetal abdominal mass should prompt suspicion of CMN, especially if it is associated with polyhydramnios; it should also alert obstetricians and neonatologists to the risk of preterm delivery. Although being a usually benign condition, CMN may be associated with neonatal systemic-metabolic or postoperative complications. High-level surgical expertise, careful neonatological intensive care and histopathological/cytogenetic-molecular definition are the cornerstones for the optimal management of patients. This should also include an individualized follow-up, oriented to the early detection of any possible recurrences or associated anomalies and to a better quality of life of children and their families.

OBJECTIVE: The aim of this study was to compare the likelihood of bowel obstruction according to the placement of the mesh (either intraperitoneal or extraperitoneal) in ventral hernia repairs.
METHODS: Patients were divided into two groups, an intraperitoneal (IP) group (mesh placed by laparoscopy or with an open approach) and an extraperitoneal (EP) group, all operated on in the Digestive Surgery Department at the Dijon University Hospital. The primary outcome was the occurrence of an episode of bowel obstruction requiring hospitalization and confirmed by abdominal CT scan.
RESULTS: Between March 2008 and July 2021, 318 patients were included, with 99 patients in the EP group (71 meshes placed preperitoneally and 28 placed retromuscularly) and 219 patients in the IP group (175 patients operated on laparoscopically versus 44 patients by direct approach). Three patients presented an episode of acute intestinal obstruction, with no difference between the two groups (p = 0.245), although all bowel obstructions occurred in the IP group and with the laparoscopic approach (1.7% of patients operated on by laparoscopy). The occlusive events occurred at 1 month, 2 years, and 3 years. There was no difference in terms of recurrence or postoperative chronic pain. There were more seroma and mesh infections in the EP group (p < 0.05). Two patients operated on by laparoscopy had undetected bowel injuries, prompting emergent surgery for peritonitis.
CONCLUSIONS: No statistically significant difference was found in terms of bowel obstruction between the intraperitoneal and the extraperitoneal position, but all cases of obstruction happened in the intraperitoneal mesh group. Visceral lesions remain a major complication of the laparoscopic approach that should not be neglected.

Recurrent gallstone ileus has a recurrence of 2-8.2% with a mortality of 12-20%, secondary to an enteric or cholecystic gallstone. A male patient with a diagnosis of intestinal occlusion secondary to biliary ileus and cholecystoduodenal fistula, performing enterotomy and closure in two planes with drainage placement. Two months after presenting the clinical of intestinal occlusion, medical management began and an abdominal tomography was performed, finding an image suggestive of recurrent gallstone ileus, treated with laparotomy.
El íleo biliar recurrente tiene una frecuencia del 2-8.2% y una mortalidad del 12-20%, que se presenta de forma secundaria a un cálculo biliar entérico o colecístico. Varón que cursa con diagnóstico de oclusión intestinal secundaria a íleo biliar y fístula colecistoduodenal. Se realiza enterotomía y cierre en dos planos con colocación de drenaje. Dos meses después, el paciente presenta un cuadro clínico de oclusión intestinal, por lo que se inicia manejo médico y se realiza la correspondiente tomografía computarizada abdominal, encontrando una imagen sugestiva de íleo biliar recurrente, con manejo por laparotomía.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It affects ~5-10% of women in their reproductive years. When it affects the intestine, it tends to be confused clinically with a wide variety of affections, which is why it has sometimes been called \"the great simulator\". A review of the literature shows that intestinal localization is rare and that obstruction secondary to this cause is even more unusual, with preoperative diagnosis being a challenge for surgeons. With the purpose of highlighting clinical and diagnostic imaging characteristics that help the preoperative suspicion of this entity, so rare in routine practice, we present two cases of women who underwent emergency surgery, without a previous diagnosis of endometriosis and with intestinal occlusion as the first manifestation of the disease. Treatment of intestinal occlusion by endometriosis consists of intestinal resection of the affected sector and primary anastomosis. Diagnosis of intestinal occlusion secondary to ileal endometriosis is based on a high index of suspicion and should be considered in women of childbearing age, without a history of disease and with a history of painful menstruation.
La endometriosis se define como la presencia de tejido endometrial fuera de la cavidad uterina. Ocurre en aproximadamente 5 a 10% de las mujeres en edad fértil. Cuando afecta al intestino tiende a confundirse clínicamente con una gran variedad de afecciones por lo cual en algunas oportunidades se le ha llamado también \"la gran simuladora\". La revisión de la literatura muestra que la localización intestinal es poco frecuente y que la obstrucción secundaria a esta causa es aún más inusual, siendo el diagnóstico preoperatorio un desafío para los cirujanos. Con el propósito de resaltar características clínicas y de estudio por imágenes que ayuden a la sospecha preoperatoria de esta entidad tan infrecuente en la práctica habitual, se presentan dos casos de mujeres operadas de urgencia, sin diagnóstico previo de endometriosis y con oclusión intestinal como primera manifestación de la enfermedad. El tratamiento consiste en la resección intestinal del sector afectado y anastomosis primaria. El diagnóstico se basa en un alto índice de sospecha y debería ser considerado en mujeres en edad fértil, sin antecedentes patológicos y con historia de menstruaciones dolorosas.

Meckel\'s diverticulum (MD) is a remnant of omphalomesenteric channel. It is often asymptomatic but it can be responsible for various clinical complications and variable clinical status especially in children. We conducted a retrospective study on complications of MD among children hospitalized in the division of Paediatric Surgery at the University Hospital Hassan II, Fez, Morocco. The study aimed to describe the clinical, radiological and therapeutic features of MD. The study was conducted over a period of 10 years (January 2009 - December 2018) and involved 18 children (15 boys and 3 girls) aged 1 day - 15 years (with an average age of 5 years) who had undergone surgery for complications of MD. Acute intussusception and intestinal occlusion were the most frequent complications. Other complications included: infection of the MD (1 case) and digestive hemorrhage (2 cases). Two rare types of neonatal Meckel\'s diverticulum were described (neonatal occlusion and fistula associated with omphalocele). In no case, abdominal X-ray without treatment, ultrasound and CT scan showed MD. Scintigraphy was performed in 2 patients with hematochezia and it helped to make the diagnosis of MD in one case. Three patients underwent laparoscopic surgery with resection of the MD and intestinal anastomosis with laparoscopy. The other patients underwent laparotomy. Ileostomy was performed in one case, followed by secondary recovery. Patient\'s outcome was good, except for one case of anastomotic leakage. Anatomopathological examination showed two cases of heterotopia.

Exposure and infections by Trypanosoma cruzi are the fourth cause of loss of potential life years between parasitic and infectious diseases. We describe the case of a 11-year-old patient with intestinal occlusion, surgically treated with intestinal volvulus, the surgical specimen is sent to histopathology reporting Chagasic megacolon. The age range of presentation is a challenge in the absence of nonspecific symptoms. There is no pediatric statistical data that define trypanosomiasis in a latent or chronic state and will be diagnosed in adult stages due to the physiopathological alterations that they will present.
La exposición y las infecciones por Trypanosoma cruzi ocupan el cuarto lugar entre las causas de pérdida de años de vida potenciales por enfermedades parasitarias e infecciosas. Se describe el caso de un niño de 11 años, con cuadro de oclusión intestinal, intervenido quirúrgicamente con datos de vólvulo intestinal. La pieza quirúrgica se envió a histopatología, que reportó megacolon chagásico. El rango de edad de presentación es un reto ante la falta de síntomas inespecíficos. No se cuenta con datos estadísticos pediátricos que definan la tripanosomiasis en estado latente o crónico, y estos niños serán diagnosticados en la etapa adulta por las alteraciones fisiopatológicas que presentarán.

UNASSIGNED: Gallstone ileus (GI) represents a rare cause of mechanical intestinal occlusion, which is caused by the impaction of a gallstones at the gastrointestinal tract, being most frequently the terminal ileum; its etiology is due to the passage of a calculum through a biliary-enteric fistula. Due to its low incidence, diagnostic suspicion and adequate initial surgical treatment are essential for an adequate clinical evolution.
UNASSIGNED: A bibliographic review on the current surgical management of GI was carried out and exemplified by the presentation a clinical case.
UNASSIGNED: 78-year-old male with bowel obstruction, upon undergoing a CT scan, a gallstone at the level of distal ileum is displayed, therefore, an exploratory laparotomy (ex lap) is performed with enterotomy and extraction of the calculus. The patient bestowed adequate postoperative clinical evolution, and the presence of a cholecystoduodenal fistula is documented by an upper endoscopy.
UNASSIGNED: GI represents an uncommon pathology, however, there is discrepancy in the literature regarding the initial surgical management, especially in whether or not a biliary procedure should be associated with emergency enterolithotomy.
UNASSIGNED: GI is associated with complications secondary to diagnostic delay and its late surgical resolution, although the initial treatment is aimed at resolving the intestinal obstruction through enterotomy and gallstone extraction, there is controversy regarding the preferred time for cholecystectomy and repair of biliary-enteric fistula, being the two-stage surgery the surgical procedure of choice, especially in patients with a high risk of complications.
UNASSIGNED: El íleo biliar (IB) es una causa poco frecuente de oclusión intestinal mecánica, causado por la impactación de un cálculo biliar en el tubo digestivo, siendo la localización más frecuente el íleon terminal; se debe al paso de un cálculo a través de una fístula bilioentérica. Debido a su baja incidencia, la sospecha diagnóstica y el tratamiento quirúrgico inicial adecuado son de gran importancia para la evolución clínica.
UNASSIGNED: Realizar una revisión bibliográfica sobre el manejo quirúrgico actual del IB y ejemplificarlo mediante la presentación de un caso clínico.
UNASSIGNED: Varón de 78 años con cuadro de oclusión intestinal, con presencia de cálculo biliar en el íleon distal por tomografía. Se realiza laparotomía exploradora con enterotomía y extracción del cálculo. Cursa con adecuada evolución posquirúrgica, documentándose fístula colecistoduodenal por panendoscopia.
UNASSIGNED: El IB es una patología poco común, por lo cual existe discrepancia en cuanto al tipo de manejo quirúrgico ideal, sobre todo en si se debe o no asociar un procedimiento biliar a la enterolitotomía de urgencia.
UNASSIGNED: El IB se asocia a complicaciones secundarias al retraso diagnóstico y a una mala elección de la técnica quirúrgica inicial. Si bien el tratamiento está encaminado a resolver la obstrucción intestinal mediante enterotomía y extracción del cálculo biliar, existe controversia en cuanto al tiempo preferido para realizar la colecistectomía y la reparación de la fístula bilioentérica, siendo la cirugía en dos tiempos el procedimiento quirúrgico de elección, sobre todo en pacientes con alto riesgo de complicaciones.

The cecum is the second part of the colon that is most commonly affected by the volvulus after sigmoid colon and before left corner and the transverse colon. This condition occurs in patients with abnormally mobile cecum. Volvulus is characterized by torsion or tilt. Clinically, it appears as bowel obstruction due to acute strangulation. Abdominal x-ray without treatment and abdominal CT scan are the radiological procedures of choice in the diagnosis of volvulus of the cecum. Treatment is based on emergency surgical excision of the cecum and of the terminal ileum. We report two cases of patients with volvulus of the cecum admitted to the emergency department with acute intestinal obstruction. In both patients, the diagnosis was confirmed by abdomino-pelvic CT scan and the treatment was based on ileocolic resection with immediate restoration of the intestinal continuity. The postoperative course was uneventful.

BACKGROUND: A Giant Hiatal Paraesophageal Hernia (GPEH) is a Hiatal Hernia (HH) that includes more than 30% of the stomach in the thorax. The gold standard form of repair today is the laparoscopic abdominal approach in elective scenarios. Laparoscopic HH repair advantages include, less postoperative pain, small incisions, reduced postoperative respiratory complications are reduced, shorter hospital stay. The objective of this paper is to describe a patient undergoing with upper intestinal obstruction and a GPEH Type IV, approached laparoscopically.
METHODS: We received a female patient 59 years old, she came with symptoms abdominal pain, emesis of intestinal characteristics and obstipation, with an evolution of 5 days. She also referred dyspnea; she went to another institution where made a CAT scan finding a GPEH. We decided to realize the procedure laparoscopically. We follow the principal objectives, reducing the hernia, dissecting al de hernia sac excision, Hiatal reparation with no mesh, and Nissen type fundoplication without Collis Gastroplasty. The patient stayed for seven days for surveillance and when the leukocyte and LDH went to a regular rate patient was discharged. With no complications with normal intestinal function and nearly no pain.
CONCLUSIONS: We present a GPEH case associated with upper intestinal obstruction, with clinical findings that suggested ischemia. The approach of the treatment was abdominal laparoscopy.
CONCLUSIONS: In elective patients Laparoscopy is superior than abdominal approach. Randomized trials comparing laparoscopic versus open approach are needed to conclude that laparoscopic approach is superior to open approach, in potentially GPEH complicated patients.

BACKGROUND: Renal cell carcinoma is the most frequent malignant neoplasia of the kidney accounting for 90 % of all renal solid tumors. Metastases from renal cell carcinoma are rarely located in the small bowel and generally their clinical presentation includes bleeding and obstruction. Intussusception in adults is an extremely rare pathological condition and only 30 to 35 % of small bowel intussusceptions are derived from malignant lesions.
METHODS: We report here a clinical case of a 75-year-old white man hospitalized for anemia and subocclusion. An abdominal ultrasound and computed tomography showed a small bowel intussusception. During a surgical exploration, a polypoid lesion was found to be the lead point of the intussusception. His small intestine was resected and a functional side-to-side anastomosis was performed. The histological features of the surgical specimen confirmed the diagnosis of metastatic renal cell carcinoma.
CONCLUSIONS: Small bowel intussusception from renal cell carcinoma metastasis should always be considered in the setting of unexplained intestinal subocclusion in patients with a history of renal cell carcinoma.