Extragastrointestinal stromal tumors are rare mesenchymal neoplasms that can occur in the omentum and mesentery. A clinical case of an elderly person from Cuenca is presented, the patient has symptoms like: pain, abdominal distension, lack of elimination of gases and feces of 24 hours of evolution, the physical examination showed a distended abdomen, diffuse palpation pain, increased hydro noise.

BACKGROUND: Laparoscopic cholecystectomy is one of the most frequently performed surgical procedures, which has gradually evolved to become one of the safest surgeries. However, no procedure is without risk; in this context, biliary duct injury (BDI) is the most important intraoperative complication during cholecystectomy. Common bile duct injury reaches a variable incidence between 0.4 to 1.4%, which is associated with significant long-term morbidity, including stenosis and recurrent cholangitis, significant limitations in the life quality of the patient [1]. In order to reduce the incidence of BDI, several alternative procedures can be performed during a difficult cholecystectomy, among which we can list: cholecystostomy, subtotal cholecystectomy and/or conversion to open cholecystectomy. Subtotal cholecystectomy, according to several meta-analyses, minimizes the possibility of bile duct injury, however, it is associated with the persistence or development of symptomatic gallstones in the remnant of the gallbladder or cystic duct; when this occurs, it is necessary to reoperate on symptomatic patients [1,2]. It is estimated that between 5-40% of patients who have previously undergone cholecystectomy, may present episodes of abdominal pain like those that initially motivated the surgical indication, grouped under the term "post-cholecystectomy syndrome" (PCS) [3]. PCS is mainly caused by residual lithiasis, which represents approximately 21.3% of readmissions [4]; other causes of PCS include: stenosis or bile leak, neuroma in the scar tissue, biliary dyskinesia, Oddi sphincter dysfunction. It is also worth highlighting, within the causes, the cystic duct remnant syndrome defined as "presence of a residual cystic duct greater than 1 cm that produces symptoms as a consequence of the lithiasis inside it", with a prevalence of less than 2.5% among patients that underwent cholecystectomy; however, a high index of suspicion will allow us to recognize it in the immediate postoperative period or even several years later [3,4]. The age range of onset of cystic duct remnant syndrome is from 21 to 90 years. The female preponderance of gallstones is the probable reason for greater frequency of the syndrome in this gender. Clinically, the main reason for consultation is abdominal pain in the right hypochondrium and epigastrium, which occurs in 77% of the patients; accompanied by nausea, in 44% of patients; vomiting in 31% and fever in 19% of patients [5]. Magnetic resonance cholangiopancreatography is the non-invasive technique of choice for evaluating the biliary tree, relegating endoscopic retrograde cholangiopancreatography (ERCP) as a strictly therapeutic technique. In addition, ERCP with sphincterotomy and possible placement of a stent to aid drainage of the main bile duct can be performed, along with definitive surgical treatment, by gallbladder and/or cystic remnant resection [3]. This case report details an experience of surgical reintervention in a patient with a remnant gallbladder and cystic duct with lithiasis.

Introducción: una hernia incisional constituye una protrusión anormal del peritoneo a través de la cicatriz patológica de una herida quirúrgica o traumática, cuya frecuencia oscila entre el 12% al 15% de todas las laparotomías efectuadas. Caso clínico: paciente obesa de 55 años con una hernia incisional de gran tamaño de dos años de evolución que acude al servicio de consulta externa del Hospital Básico de Paute. Entre sus antecedentes se destaca la presencia de Linfoma no Hodgkin hace 11 años. La tomografía de abdomen evidencia una voluminosa hernia incisional en pared abdominal anterior con anillo herniario de aproximadamente 10 cm por donde protruye epiplón y contenido de asas intestinales sin signos de incarceración. Se procede a reparación del defecto herniario vía laparoscópica mediante la técnica IPOM-plus (Intra Peritoneal Onlay Mesh - plus). La paciente permaneció hospitalizada por 48 horas luego de lo cual fue dada de alta en buenas condiciones. Conclusión: la técnica IPOM-plus es una excelente alternativa en pacientes con hernias incisionales y ventrales ya que generan mínimo sangrado, corta estancia hospitalaria y escaso uso de antibióticos, por ello se reafirma la importancia clínica de este informe.

Introducción: el Tumor de Frantz, representa 0.2 - 2.7% de la totalidad de tumores pancreáticos. Afecta con mayor frecuencia a mujeres, entre 18 - 35 años, tiene bajo grado de malignidad; sin embargo, es localmente agresivo. Caso clínico: mujer, 22 años, antecedentes de pancreatitis a repetición, presentó dolor crónico exacerbado con la palpación en hemi-abdomen superior y mesogastrio. Tras estudios complementarios se determinó la presencia de una masa con patrón mixto en cuerpo de páncreas. Se realizó una pancreatectomía corpo-caudal, histopatológicamente compatible con neoplasia sólida pseudopapilar, márgenes libres e inmunohistoquímica positiva para: b-catenina, CD10 y progesterona. Permaneció hospitalizada 8 dias, presentando fistula pancreática de bajo debito que se manejó de forma conservadora y ambulatoriamente, siendo dada de alta definitiva al dia 21 post quirúrgico. Conclusión: las neoplasias sólidas pseudopapilares representan un reto para el cirujano, quien debe individualizar el abordaje, tanto diagnóstico como terapéutico, para lograr mínimas complicaciones con bajo índice de recurrencia.