Introduction and importance Pheochromocytomas are rare tumors (0.1–2% of incidence), arising from the chromaffin cells in the sympathoadrenal system. Approximately 85% of the times are localized in the adrenal medulla; therefore, could be placed extra adrenal in 15% of the population. 10–30% of the cases could be asymptomatic. Classic symptoms vary from palpitations, tachycardia, hypertension. Case presentation Case report of a 37-year-old female patient presented with diffuse abdominal pain, with any associated symptoms. Contrast computed tomography was performed; a retroperitoneal mass was found, contacting the third portion of the duodenum. Intraoperative hypertensive crisis was documented with the manipulation of the mass. Octreotide infusion was administered with the normalization of the clinical condition. Patients do not present any postoperative morbidity after 90 days. Pathology reports chromaffin cells concluding pheochromocytoma. Discussion Pheochromocytomas are rare tumors with an annual incidence between 3 and 8 cases per million population per year in some series of cases. In general terms prevalence rounds 0.1–0.6% of patients with hypertension. Surgical management is the definitive treatment for pheochromocytoma benign or malign. Morbidity described in literature reaches 40% with 20% of mortality in some series of cases. In our patient we do not present postoperative complications. Conclusion Intraoperative hypertension is a clinical and surgical challenge, not only for the surgeon, also anesthesiology. Pheochromocytoma it's a complex entity and could be silent in until 30% of the cases, should be suspected in all neuroendocrine retroperitoneal tumors. Multidisciplinary approach with anesthesia, endocrinology and surgery department is mandatory to have good postoperative outcomes.

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Background COVID-19 pandemic has led to changes in the presentation and treatment of surgical pathologies. Therefore, we aim to describe the influence of the COVID-19 pandemic on the clinical presentation and management of acute appendicitis (AAp) and its surgical outcomes. Study design A multicenter cohort study with prospectively collected databases. Three high-volume centers were included and all patients over 18 years of age who underwent appendectomy for AAp were included. Multiple logistic regression and multinomial logistic regression were performed, and odds ratio, relative risk, and B-coefficient were reported when appropriate, statistical significance was reached with p-values < 0.05. Results 1.468 patients were included (709 in the pre-pandemic group and 759 in the COVID-19 group). Female patients constituted 51.84%. Mean age was 38.13 ± 16.96 years. Mean Alvarado’s score was 7.01 ± 1.59 points. Open surgical approach was preferred in 90.12%. Conversion rate of 1.29%. Mortality rate was 0.75%. There was an increase of perforated and localized peritonitis (p 0.01) in the COVID-19 group. Presence of any postoperative complication (p 0.00), requirement of right colectomy and ileostomy (p 0.00), and mortality (p 0.04) were higher in the COVID-19 group. Patients in the pre-pandemic group have a lesser risk of mortality (OR 0.14, p 0.02, 95% CI 0.02–0.81) and a lesser relative risk of having complicated appendicitis (RR 0.68, p 0.00, 95% CI 0.54–0.86). Conclusion Complicated appendicitis was an unexpected consequence of the COVID-19 pandemic, due to surgical consultation delay, increased rates of morbidity, associated procedures, and mortality, influencing the clinical course and surgical outcomes of patients with AAp.

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Background: Hemosuccus pancreaticus is a rare cause of upper gastrointestinal bleeding (1/1500) and represents the loss of blood through the main pancreatic duct and its exteriorization through the major duodenal papilla. It can lead to massive bleeding, which is potentially life-threatening. This condition most commonly follows pseudoaneurysm formation secondary to acute or chronic pancreatitis. As a result of its infrequency, it is difficult to diagnose, and the mortality rate remains high. To our knowledge this is the first case report of Latin-American population. Case presentation: A 70-year-old male patient presented with diffuse severe abdominal pain associated with melenas. Angiotomography was performed, ruling out mesenteric ischemia, with evidence of pancreatic head tumor with liver metastases. Sandblom's triad was present and the diagnosis of hemosuccus pancreaticus was confirmed. Multiple arteriograms were performed, with pseudoaneurysm of gastroduodenal artery findings. Therefore, endovascular coil embolization was performed in two opportunities to control the bleeding. Conclusion: Upper gastrointestinal bleeding is a clinical challenge for the surgeon and emergency medicine. It’s a complex entity with high mortality that should be suspected in patients with acute or chronic pancreatitis and periampullary tumors with non-established sources of bleeding. Clinically manifested by Sandblom's triad. Its diagnosis gold standard is the arteriography plus embolization which is also therapeutic. Surgery is related to higher mortality and reserved for specific situations.