Rationale: Although rare, pancreatic neoplasms can occur during pregnancy, both in benign and malignant forms. Mucinous cystic neoplasms (MCNs) of the pancreas, a type of these neoplasms, are precursor lesions to invasive pancreatic cancer. The presence of the ovarian-type stroma is a defining feature. Patient concerns: The first case was a 38-year-old woman in her 18th week of pregnancy with abdominal pain that worsens a few weeks later. The second case was a 30-year-old woman in her 17th week of pregnancy with abdominal pain in the left hypochondrium. Diagnosis: The patients were under clinical examination and laboratory test including carbohydrate antigen 19-9 (CA 19-9) and carcinoembryonic antigen (CEA). Both patients had magnetic resonance imaging (MRI). The diagnosis of a MCNs of the pancreas was done preoperatively in the 2 cases. Interventions: Both patients underwent distal pancreatectomy during pregnancy. One of them was an emergency laparotomy because of a ruptured MCN. Outcomes: Both patients were completely recovered from distal pancreatectomy and continued to full term, delivering a healthy baby by Caesarean section. After 6 years of follow-up, the first patient underwent a total gastrectomy, because of a gastric cancer with carcinomatosis. Currently the 2 patients are still alive after 8 years and 5 years of follow-up, respectively. Lessons: Surgical resection of MCNs during pregnancy should be considered during the second trimester given common distal pancreas location, rapid growth, risk of spontaneous rupture, and malignant potential.

OBJETIVO: Determinar los tiempos de latencia de las ondas electrococleográficas en pacientes normales en nuestro medio. MÉTODOS: El estudio se realizó en el Servicio de Otorrinolaringología del Centro Médico Naval, Callao - Perú, durante 23 meses. Se evaluó 98 personas (50 hombres y 48 mujeres) tomando un solo oído sano de cada uno. RESULTADOS: Los tiempos de latencia promedio encontrados en los exámenes de electrococleografía realizados en los 98 pacientes fueron compatibles con los valores hallados en otros países. En los pacientes menores de 15 años (6,1%) los tiempos de latencia se encontraron más prolongados que en el promedio. Los tiempos de latencia de acuerdo al oído examinado y según sexo no muestran diferencia significativa. CONCLUSIONES: Los valores de latencia en la electrococleografía dependen directamente del grado de mielinización o madurez neurológica de la vía auditiva.

ResumenSe presenta un caso de duodenopancreatectomía laparoscópica mano asistida exitosa, por neoplasia duodenal. Se muestra los aspectos técnicos de dicho procedimiento y se revisa la bibliografía en relación al tema.Palabras clave: Pancreaticoduodenectomía; neoplasmas duodenales; laparoscopia. Laparoscopic duodenopancreatectomy. Case report AbstractA case of successful hand-assisted laparoscopic duodenopancreatectomy for duodenal neoplasia is presented. Technical aspects of such procedure is presented as well as pertinent bibliography.

La pancreatitis crónica calcificante (PCC) es la forma más común de pancreatitis crónica a nivel mundial y está relacionada a dolor crónico incapacitante e insuficiencia pancreática. El manejo del dolor abdominal crónico en PCC representa un reto, siendo habitual el uso de opiáceos que generan tolerancia y dependencia. Por esta razón se propone un tratamiento escalonado, progresando desde tratamiento médico y endoscópico hasta el quirúrgico con el fin de aliviar el dolor y conservar la función pancreática. La pancreatoyeyunostomia lateral (PYL) o procedimiento de Partington Rochelle, es la técnica de elección más frecuente en pacientes con dolor crónico producto de la PCC refractario a tratamiento médico y endoscópico, asociado a dilatación del conducto pancreático principal. Reportamos el caso de un paciente con diagnóstico de PCC sometido a PYL laparoscópica, siendo el primer reporte en el Perú, describimos la técnica empleada y la complicación tratada con éxito. Se revisa la literatura pertinente.

Introduction: Choledochal cyst (CC) is a rare disease in western countries that presents in adults and is considered a premalignant lesion. A series of unusual presentations and complex management and some very infrequent situations are presented. Methods: We performed a case review of CC cases operated at Guillermo Almenara Hospital, Lima, Peru from 2008 to 2017. Cases of complex management due to their rare presentation were included. Ten cases of CC are described. Results: Case #1: CC associated with hepatic hydatid cyst. Case #2: CC associated with intracystic fasciola hepatica. Case #3: CC associated with a medusa-shaped arterial malformation at the cyst. Case #4: Jaundice after laparoscopic cholecystectomy. Video was reviewed and it is noticed that cholecystectomy and a resection of a CC, mistaken for the infundibulum, was performed. Case #5 and #6: Very distal resections of CC a few millimeters from the ampulla. Case #7: Same as cases #5 and #6 but presented in pancreas divisum. Case #8: Previously treated CC with a cysto-duodenal anastomosis underwent resection of the cyst and Roux-en-Y anastomosis. Case #9: Previously CC case treated with cysto-jejunal Roux-en-Y anastomosis. A complete resection of the cyst was performed laparoscopically. Case #10: Previously resected CC presented with abnormal pancreas head. Pancreaticoduodenectomy is performed. Conclusion: Choledochal cysts can have complex presentations and surgical management should be tailored for each individual case.