Intranodal schawnomas are extremely rare. Just a few cases have been described before. Clinical presentation comprises not only symptomatic mass in several anatomical body parts, but also, they can be found during analysis of surgical specimens resected for other reasons. The report is based on the case of an 80-year-old patient who underwent to right hemicolectomy for an adenocarcinoma. The histopathologic analysis revealed one mesenteric intranodal schwannoma in the surgical specimen. The diagnosis was confirmed by immunohistochemistry with positive result for vimentin and S100 protein. Less than 12 cases have been reported in the literature before. The findings pointed out our patient as, one of these few reported with such diagnosis.

BACKGROUND: Pain management after hemorrhoidectomy continues to be challenging. OBJECTIVE:The aim of this study was to evaluate the effectiveness of infiltration of bupivacaine hydrochloride and triamcinolone acetonide in surgical wounds of Milligan-Morgan hemorrhoidectomy for postoperative pain relief. DESIGN:A double-blind randomized controlled clinical trial was conducted between May 2015 and June 2019. SETTINGS:This study was carried out in a secondary referral hospital center in Spain. PATIENTS:Patients who underwent an elective Milligan-Morgan hemorrhoidectomy for grade III-IV hemorrhoids were included. INTERVENTIONS:Patients allocated in the intervention group received a single infiltration of bupivacaine and triamcinolone and patients allocated in the control group did not receive any intervention. MAIN OUTCOMES MEASURES:The primary end point was the median of maximum pain by visual analog scale during the 48 hours of hospital stay. Secondary end points were pain at follow-up, pain during defecation, analgesic requirements, wound healing rate, and complications.RESULTS: A total of 128 patients were randomly assigned (64 in each group). The median of maximum pain score at 48 hours was 3 points in the intervention group and 6 points in the control group, which was significantly different (p < 0.05). No differences were observed regarding pain during defecation. Morphine requirements were significant lower in the intervention group (6.3% vs 21.9% patients; p = 0.01; 5 vs 23 cumulative doses; p = 0.01). Wound healing and complication rates were similar in both groups.LIMITATIONS: Use of placebo was not considered in the control group ("intervention group" vs "control group" clinical trial). Data regarding pain or other complications at 48 hours postoperatively were pooled and expressed as median of values. CONCLUSIONS: Infiltration of surgical wounds with bupivacaine and triamcinolone decreases postoperativeFunding/Support: This was an investigator-initiated study supported by internal funding.

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