Merkel cell carcinoma. Report of one caseMerkel cell carcinoma is a rare neuroendocrine tumor typically found on sun-exposed areas such as face and extremities. We report a 57 years old male presenting with a tumor in the left perianal region that prior to surgery was catalogued as a perianal teratoma. The pathological study informed a Merkel cell tumor. It was locally excised and a cutaneous flap was made. Two years after surgery, the patient had pulmonary metastases and chemotherapy was started. Due to lack of response, it was discontinued after four cycles.Key words: Merkel cell tumor, local excision, pulmonary metastases. ResumenLos tumores de células de Merkel, son raros tumores neuroendocrinos que típicamente son encontrados en zonas expuestas al sol como cara y extremidades. Describimos un caso de un paciente de 57 años de edad con una tumoración en la región perianal que inicialmente se catalogó como un teratoma, cuya histopatología informó un tumor de células de Merkel. Se manejo con resección local amplia y colgajo cutáneo. Después de 2 años de la cirugía, el paciente evolucionó con claros signos de enfermedad metastásica pulmonar y actualmente se encuentra en manejo paliativo con quimioterapia.Palabras clave: Tumor de células de Merkel, resección local, enfermedad metastásica. IntroducciónEl carcinoma de células de Merkel o carcinoma neuroendocrino cutáneo es un tumor poco frecuente y agresivo, asociado a una elevada tendencia a invasión ganglionar, recurrencia y metástasis a distancia. La etiología de éste, así como en muchos de los tumores cutáneos descritos, es desconocida. La hipótesis más aceptada es aquella que describe el efecto oncogénico de las radiaciones solares aso- CASOS CLÍNICOS

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Artificial bowel sphincter for anorectal reconstruction. Preliminary report and review of surgical technique Introduction: The artificial sphincter (ABS) has been proposed as an option for the treatment for severe refractory fecal incontinence. We have witnessed a great discussion on systematic reviews regarding the short-and long-term results of ABS, assessing its real benefit. Objective: To analyze the surgical outcomes of patients undergoing artificial sphincter implantation and review of surgical technique. Material and Methods: Between 2003 and 2007, the ABS system was introduced in four patients. The mean age was 34 years (13 to 54 years). Two patients were admitted for rectal agenesis, a severe anorectal trauma and abdominoperineal resection for a low rectal cancer. Results: Follow-up time was 12 to 60 months. We performed the explantation of the device for perineal wound infection in one case. All patients had mild incontinence ABS showed a decrease an average of 3.5 points to 12 months of follow-up on the Wexner Scale. Conclusions: The installation of the artificial sphincter is a feasible and safe alternative for anorectal reconstruction in selected patients. The morbidity and explantation of the series is similar to other international reports.

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