This report presents two cases of young males who developed the rare idiopathic form of sclerosing encapsulating peritonitis (SEP) presented as partial bowel obstruction, both diagnosed during surgical treatment, with satisfactory outcomes. Sclerosing encapsulating peritonitis is a rare and enigmatic condition, characterized by intraperitoneal fibrosclerosis, which causes intestinal obstruction. It is a chronic entity with a poorly elucidated pathophysiology, leading to the constitution of a thick white nacreous fibrosis membrane that wraps the bowel in a concertina-like fashion with some adhesions configuring an intra-abdominal cocoon. Sclerosing encapsulating peritonitis is reported in a wide variety of patients, including those who have undergone peritoneal dialysis, young adolescent girls, cirrhotic patients after peritoneal-venous shunting, and patients treated with β-blockers. Nevertheless, the etiology of SEP remains obscure. This entity presents many difficulties in preoperative diagnosis because of its peculiar characteristics. Recognition of the SEP results in proper management and prevents unnecessary bowel resection. Regardless of cause, the treatment of the obstruction is surgical, with dissection of the encasing membrane from the intestine and separation of adherent loops of small bowel until they are laid free and returned to their normal configuration. The prognosis after appropriate surgical therapy is good, but depends on coexisting diseases.

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Objective: This study aimed to present seven cases of avascular necrosis of the sesamoid and report the role of bone scintigraphy in the diagnosis of these patients. Methods: Seven patients with clinical suspicion of avascular necrosis of the sesamoid underwent three-phase bone scintigraphy with 30 mCi of 99mTc-MDP. Results: Most of the patients were young female adults with complaints of limiting pain in the forefoot, who were making use of inappropriate footwear and/or had a history of injury with or without fracture. There was no predominance of either of the feet or between the femoral or tibial sesamoid. Two patients (28.57%) had a bipartite tibial sesamoid and one (14.29%) had splitting of the tibial and fibular sesamoids. In 100% of the patients, three-phase bone scintigraphy, combined with other propaedeutic methods, proved to be crucial for the diagnosis. The initial procedure in all cases was conservative. In four cases (57.14%), there was no remission of symptoms, and surgical excision of the necrotized sesamoid tissue was performed. In all the patients, the therapy used was effective, with complete remission of symptoms, without complications or deformities of the forefoot. Conclusions: Three-phase bone scintigraphy becomes a cornerstone of the propaedeutics when avascular necrosis of the sesamoid is suspected, through contributing towards early and accurate diagnosis and enabling allowing appropriate specialized treatment.

Introdução: a linfocintilografia de membros inferiores (LMMII) é método eficaz para avaliar a drenagem linfática. Objetivo: apresentar 154 pacientes submetidos à LMMII entre março/2009 e junho/2010. Métodos: foram adquiridas imagens da pelve e MMII após administração intradérmica simultânea de 1,0 mCi de 99mTc-Dextran 500 em 0,1 mL no espaço interdigital do primeiro e segundo pododáctilos bilateralmente. Resultados: foram examinadas 129 (83,77%) mulheres; média de 51,48 anos de idade; 32 (20,78%) na faixa etária entre 40 e 49 anos; 58 (37,66%) com índice de massa corporal entre 25 e 30 kg/m 2 ; 92 (59,74%) com edema, linfedema ou inchaço como motivo do exame; 93 (60,39%) não submetidos a cirurgia ou procedimento vascular prévios; 108 (70,13%) sem processo inflamatório, erisipela ou trauma prévios; 103 (66,88%) com edema bilateral ao exame; 48 (31,17%) com piora do edema no período noturno; 77 (50%) com evolução há mais de um ano; 31 (20,13%) hipertensos. Achados cintilográficos: 149 (96,75%) com alguma alteração ao exame; 38 com atraso bilateral acentuado no tempo de trânsito linfático; 85 (55,19%) com cadeias linfonodais normofuncionantes; 62 com drenagem do radiotraçador via safena parva bilateralmente; 84 (54,55%) sem vasos colaterais; 92 (59,74%) sem retenção linfática; 85 (55,19%) sem refluxo dérmico; 15 (9,74%) com linfonodos em região poplítea. Conclusões: a LMMII é método disponível para detecção do linfedema e alterações na drenagem linfática, sendo importante para triagem inicial investigativa, avaliação de edemas em fases iniciais e monitoramento de intervenções terapêuticas, clínicas ou cirúrgicas.

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