the trauma registry provides a clear picture of the points to be improved in trauma patient care, however, there are specific peculiarities for implementing this tool in the Brazilian milieu.

Introduction: According to the Brazilian National Institute of Cancer, gastric cancer is the third leading cause of death among men and the fifth among women in Brazil. Surgical resection is the only potentially curative treatment. The most serious complications associated with surgery are fistulas and dehiscence of the jejunal-esophageal anastomosis. Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy. Case Report: A 76-year-old man was diagnosed with intestinal-type gastric adenocarcinoma. He underwent a total laparoscopic-assisted gastrectomy and D2 lymphadenectomy on May 19, 2015. The pathology revealed a pT4pN3 gastric adenocarcinoma. The patient became clinically stable and was discharged 10 days after surgery. He was subsequently started on adjuvant FOLFOX chemotherapy; however, 9 days after the second cycle, he was brought to the emergency room with nausea and severe epigastric pain. A CT scan revealed a hiatal hernia with signs of strangulation. The patient underwent emergent repair of the hernia and suffered no postoperative complications. He was discharged from the hospital 9 days after surgery. Conclusion: Hiatal hernia is not well documented, and its occurrence in the context of gastrectomy is an infrequent complication.

Splenic tumors are not frequent. Blood vessel neoplasms are a rare category of tumors and have an extremely low incidence in the spleen. This case report aims to describe a 57-year-old woman in whom a routine imaging examination had shown splenic cysts. During her follow-up, the cysts became larger and increased in number. A diagnostic splenectomy was performed and its analysis showed a rare splenic angiosarcoma.

Abstract:Despite rare, metastatic anal carcinoma confers a poor prognosis. Systemic chemotherapy is the mainstay of treatment for advanced disease while the role of biologics and/or surgical resection of metastatic disease are anecdotal. Compared to isolated liver colorectal or neuroendocrine cancer liver metastases, there is far less experience with resection or nonsurgical local ablative procedures for patients with metastatic anal carcinoma to the liver. We report the case of a 67-year-old woman with metastatic anal carcinoma to the liver who was successfully treated with liver resection and remains free of relapse more than one year later. pelvis, which showed a 5.1-cm anal canal lesion as well as enlarged bilateral inguinal lymph nodes (2.0 cm), consistent with a clinical stage IIIB. At that time, the patient was treated with standard chemoradiation (CRT) consisting of mitomycin C (12 mg/m 2 , given on day 1) and Capecitabine (825 mg/m 2 twice daily during the days of radiotherapy). KeywordsThe total radiation therapy dose was 54 Gy in 27 fractions. During CRT, she developed grade 3 cutaneous radiation dermatitis and grade 3 diarrhea. Clinical examination four weeks after finishing CRT revealed complete regression of the anal tumor with no palpable inguinal lymphadenopathy. Nevertheless, 4 months after the completion of CRT, she developed at least three metastatic liver lesions in segments V and VI, measuring approximately 3.6 cm each. She was treated with 6 cycles of weekly Paclitaxel (80 mg/m²) and Cetuximab (400 mg/m² in the first cycle followed by 250 mg/m²). A repeat CT scan as well as a PET-CT scan revealed considerable increase in the size of the larger liver mass, which measured 13.1 cm × 10.7 cm × 10.6 cm, without new metastases (Figures 1 and 2). At that point, the patient was complaining of intense fatigue, anorexia, as well as upper abdominal pain. She was confined to bed with an extremely poor quality of life. Her lactate dehydrogenase (LDH) level was 1,045 U/L (normal values: 180-460 U/L). After extensive discussion with the patient and her family, it was decided to proceed with right hepatectomy. The postoperative period was uncomplicated and the patient was discharged home six days later. Histological findings of the resected specimen demonstrated metastatic squamous cell carcinoma with extensive necrosis, consistent with the known primary tumor of the anal canal, with free margins. Thirteen months after surgery, the patient remains remarkably well and free of recurrence (Figures 3 and 4). DiscussionIn patients with primary tumors of the gastrointestinal tract (especially colorectal adenocarcinoma and small intestine neuroendocrine tumors), the most likely mode of spread to the liver is through portal venous drainage or via direct intra-abdominal lymphatic channels. For other primary malignancies, metastases commonly reach the liver via systemic circulation, implying that extra-hepatic sites may have the same probability of being involved. Based on this rationale, hepatic resection of non-co...

and tail. 74% of sensory fibres were localized in the pancreatic head, 19% in the corpus and 7% in the tail. Conclusions: Murine pancreatic head has the highest density of pancreatic nerves. Overall, due to its intraperitoneal and perilymphoid localization, the mouse pancreas bears a substantially different structural innervation pattern when compared to the human pancreas.