Heterotopic pregnancy (HP) is defined as the simultaneous development of an intra- and an extra uterine gestation. The occurrence of a spontaneous triplet HP is an exceptionally rare medical condition. We report the case of a young woman with spontaneous heterotopic triplets at 8 weeks of gestation, with a misdiagnosis of topic twins and acute appendicitis. The ectopic tubal pregnancy was ruptured and a salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed uneventfully. The two healthy babies were delivery by cesarean section at 36 ± 2 weeks of gestation. Heterotopic triplets with ruptured tubal ectopic pregnancy represent a special diagnostic and therapeutic challenge for the obstetrician. A high rate of clinical suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.

Background: Studies related to obesity have shown association with metabolic syndrome. Data showing that obesity is capable to cause low grade chronic inflammation, without its classic signs and symptoms, call attention to researches to study different cells types and the mechanism of the inflammatory process. Aim: To evaluate the variation of glycated hemoglobin (HbA1c) and the pro-inflammatory cytokine interleukin-6 (IL6) in diabetic patients with BMI <35 kg/m2 in the pre and postoperative of partial duodenal switch. Method: Nine patients were studied before and one year after the operation and the variation of the serum IL6 was measured by Elisa. The changes of HbA1c were also registered. Results: The pre-operative IL6 levels reached 65,50436±2,911993 pg/ml and one year after de operation 39,47739±3,410057 and the HbA1c average of 10,67 and 5.8 in the same period. Conclusion: The partial duodenal switch was efficient to control one year after the procedure the chronic inflammatory process caused by the diabetes mellitus type 2 with BMI <35 by dropping the IL6 levels and bringing the HbA1c to normal.

Introdução: Fístula colovesical é uma comunicação patológica entre a bexiga e o cólon. Pode originar de neoplasia colônica, radioterapia, doenças inflamatórias intestinais, iatrogênese, mas é mais frequente como complicação de doença diverticular do cólon sigmóide. Fístula colovesical secundária, a doença diverticular do cólon sigmoíde, tem apresentado aumento em sua incidência devido ao aumento da expectativa de vida da população, e da mudança de hábito alimentar. Relato do caso: Apresentamos seis casos de fístula sigmoidovesical complicando doença diverticular do cólon sigmóide tratados cirurgicamente com ressecção do cólon. Três casos eletivos foram tratados com ressecção e anastomose primária, um deles por laparoscopia e os casos complicados com cirurgia de Hartmann e reconstrução tardia do trânsito intestinal em dois de três pacientes. Conclusão: De maneira geral, os resultados foram favoráveis em todos os pacientes operados.

Adult intussusception is a rare condition. But coloanal intussusception is an exception. Malignant lesions are the most common cause of colonic intussusception, and in this aspect, differ from childhood intussusception. We present a case wherein the patient had a lipoma of the sigmoid colon that caused an immense prolapse through the anus. Very few cases of coloanal intussusception are reported in adults, and we discuss the diagnostic tools and the management of this rare surgical entity.

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