Smooth muscle tumors are rare tumors with a low worldwide incidence, which is a diagnostic and therapeutic challenge for doctors, within these, leiomyosarcomas are tumors that occur more frequently in the uterus or abdominal cavity, however, another presentation called leiomyosarcomas peripheral which are subdivided into cutaneous or subcutaneous which tend to appear in the extremities of the lower limbs. The presentation of a clinical case of a patient of the eighth decade of life who presents a giant tumor of the ulcerative abdominal wall and hemorrhage that conditions anemia syndrome and hemorrhagic shock is made, for which an emergency surgical resection is performed. The treatment of leiomyosarcoma consists of surgical removal, however the margins are not clearly defined and regularly require a multidisciplinary team that includes an oncological surgeon and a plastic and reconstructive surgeon. In advanced cases and selected patients, medical treatment with chemotherapy can be granted.

Umbilical hernia is a defect of the abdominal fascia that allows the protrusion of the intestinal content through the umbilical ring, in adults these hernias are associated with increased intra-abdominal pressure caused by obesity, abdominal distension, and abdominal distension. We presented the clinical case of a 38-year-old female patient who presented a giant umbilical hernia with contents of the transverse colon and necrotic ascending colon, performing abdominal wall plasty with separation of components. Treatment of patients with giant hernias is a challenge. The presence of non-viable bowel should not be considered a contraindication for mesh repair. Giant umbilical hernias are an uncommon pathology which requires knowledge of the different techniques of abdominal wall repair as well as their possible complications.

Central vascular accesses are very useful tools for the treatment and diagnosis of various medical conditions such as the administration of drugs and solutions, chemotherapy, hemodialysis, hemodynamic monitoring. A review of the clinical record of a 59-year-old patient treated at a tertiary hospital was performed. We presented the case of a patient with vascular lesion of the brachiocephalic truncus arteriosus derived from the placement of a dialysis catheter. Vascular access placement is a routine procedure in many critical patient services, however it is important to know in detail the vascular anatomy and surgical technique to reduce the risk of complications.

A giant paraesophageal hernia is defined when at least 30% of the stomach has moved to the thorax or the presence of another intra-abdominal organ.  We describe the presentation of a clinical case of a giant hiatal hernia with perforated gastric ulcer in a 52-year-old man who presented to the emergency department with pain in the inguinal region developing obstructive shock. Presentation of hiatal hernias is usually asymptomatic and in some cases with atypical signs and symptoms involving cardiovascular and respiratory disorders. In patients with a history of gastroesophageal reflux disease/ with atypical thoracic symptoms, hiatal hernia and its complications should be ruled out.