A intussuscepção representa a invaginação de um segmento intestinal sobre outro que, apesar de relativamente comum entre as crianças, raramente acomete os adultos. Nestes, a invaginação intestinal apresenta uma causa bem definida na maioria dos casos e seu quadro clínico costuma ser bastante variável, contudo, poucos deles são diagnosticados no período pré-operatório. Um tratamento padrão ainda não pôde ser estabelecido e sua abordagem terapêutica deve ser individualizada, porém frequentemente resulta em ressecções dos segmentos intestinais envolvidos. Este artigo relata o tratamento cirúrgico de um caso de obstrução intestinal em mulher idosa, causada por intussuscepção íleo-cólica. O agente etiológico correspondia a um tumor polipóide em íleo terminal, para a qual a utilização de imuno-histoquímica foi necessária na realização de seu diagnóstico diferencial com GIST.

Whereas intussusception is relatively common in children, it is clinically rare in adults and requires a high index of suspicion. Controversy remains regarding the optimal management of this problem in the adult patient, but its treatment usually requires resection of the involved intestinal segment because of the frequency of neoplasms and bowel ischemia. This article reports one uncommon case of intestinal obstruction due to ileocolic intussusception in an older woman treated by surgical approach.

OBJETIVO: Nos últimos anos, evidências de associação entre Helicobacter pylori e câncer gástrico têm sido relatadas por inúmeros estudos. Este trabalho objetiva investigar a prevalência da infecção por este microorganismo em pacientes com câncer gástrico, oriundos do Hospital de Câncer Napoleão Laureano (João Pessoa - PB) e determinar o risco relativo para o desenvolvimento desta neoplasia nos pacientes infectados. MÉTODO: Com esta finalidade, 16 pacientes com diagnóstico confirmado de adenocarcinoma gástrico foram submetidos à endoscopia digestiva alta para coleta de fragmentos da mucosa gástrica, para realização do teste da urease, sendo então, pareados com um grupo de 16 controles com exames endoscópicos normais. RESULTADOS: Dos 16 portadores de câncer, 28,1% estavam infectados, versus 25% para os do grupo controle. Nos indivíduos infectados, houve maior prevalência da infecção nos portadores de lesões gástricas distais (43,8%), nos tumores Borrmann III (37,6%), e moderadamente diferenciados (37,6%). Houve associação estatisticamente significante entre o grau de diferenciação e a presença da infecção pelo H. pylori (p<0,10). O risco relativo estimado para a associação entre câncer gástrico e infecção pelo H. pylori foi de 1,28% (odds ratio = 1,28%). CONCLUSÃO: Estes resultados permitem concluir que a infecção pelo H. pylori é um fator de risco relativo para o desenvolvimento do adenocarcinoma gástrico.

BACKGROUND: In recent years evidence of the association between Helicobacter pylori and gastric cancer has been related by many studies. This work aims both at investigating the prevalence of infection by this micro-organism in patients with gastric cancer from Cancer Hospital Napoleão Laureano (João Pessoa - PB) and at determining the relative risk to the development of this neoplasm in infected patients. METHODS: Sixteen patients with confirmed diagnostic of gastric adenocarcinoma were submited to a high digestive endoscopy so that fragments of the stomach were paired with a group of sixteen controls with normal endoscopic exams. RESULTS: Of the sixteen patients with cancer, 28,1% were infected versus 25% of the control group. Within infected patients, H. pylori was more prevalent among those with distal gastric lesions (43,8%), in Borrmann III (37,6%) and moderately differentiated tumors(37,6%). There was a statistically significant association between the degree of differentiation and the presence of the infection by the H. Pylori (p < 0,10). The estimated relative risk of the association between gastric cancer and H. Pylori infection was 1,28% (odds ratio = 1,28%). CONCLUSION: Based on these results we can conclude that H. Pylori infection is a factor of relative risk for the development of gastric adenocarcinoma.

The rectum is the second most common location of the carcinoid tumors of the gastrointestinal tract. It represents approximately one or two per cent of the rectal neoplasms. Metastases are less frequent and it presents a better prognosis than carcinoid tumors found in the digestive tract. Treatment is surgical and the technique to be used depends fundamentally on the size of the tumor and the degree of in the intestinal wall penetration. Lesions which are greater than one centimeter have been treated with local excision, while the ones greater than two centimeters have been submitted to a radical resection. This article presents a case of rectal carcinoid diagnosed and treated initially as adenocarcinoma by abdominal rectossigmoidectomy. There were no signs of recurrence after a period of five years and six months of post-surgical follow-up. Nowadays the validity of radical resection in the treatment of rectal carcinoids has been much questioned due to the fact that it has not shown a significant raise in survival rate when compared with patients who were submitted to a local resection.

Traumatic diaphragmatic hernia is defined as a laceration of the diaphragm with an abdominal viscera herniation into the thorax. It is usually asymptomatic, with the exception of the cases with obstruction, strangulation, necrosis or perforation of the herniaded viscera. It is classified as acute, latent or chronic, in accordance with the evolutive period. At the latent phase, symptoms are indefinite and the radiological signals, which are suggestive of thoracic affections, are frequent and can induce a diagnosis error, leading to inadequate treatment.This article presents a case of chronic traumatic diaphragmatic hernia which was complicated by a gastricpleuralcutaneous fistula, due to an inadequate thoracic drainage. Considering that this is a chronic affection with an unquestionable surgical indication, due to the complications risk, it is essential to have a detailed diagnostic investigation, which aims at both avoiding an intempestive or inadequate therapeutics behaviour and reducing the affection morbimortality. Recently, the videolaparoscopic approach has proved to be more precise when compared to the other diagnostic methods, by direct visualization of the diaphragmatic laceration, allowing its correction by an immediate suture.

Os tumores do intestino delgado são raros e a maioria das lesões neoplásicas sintomáticas é maligna.Os neoplasmas benignos são um pouco mais freqüentes e ambos estão relacionados a um diagnóstico difícil, pois determinam queixas abdominais inespecíficas, comuns a uma grande variedade de afecções digestivas. Exames de imagem e endoscópicos podem ser úteis para o diagnóstico, mas freqüentemente não são conclusivos. Para os blastomas primários, a ressecção cirúrgica é a opção de escolha, porém, para os metastáticos, a terapêutica operatória deve ser reservada para os casos complicados por obstrução, hemorragia ou perfuração. O presente estudo tem por finalidade analisar retrospectivamente 13 casos de lesões malignas do intestino delgado, num período de 28 anos. Verificou-se maior incidência de tumores primários (69,2%) e de linfomas (30,7%). Entre os secundários, as mestástases por adenocarcinoma foram as mais freqüentes (15,4%). Enterectomia segmentar foi o procedimento cirúrgico mais realizado (84,6%) e a mortalidade hospitalar foi de 15,4%. A sobrevida de cinco anos foi nula para os pacientes portadores de metástases, enquanto que para os primários foi de 44,4%, sugerindo um melhor prognóstico para as neoplasias primitivas, independentemente do tipo histológico da neoplasia.

Small bowel tumors are rare, and the majority of symptomatic lesions are malign. Benign tumors are a more frequent. Both benig and maligmant mors are associated with difficult diagnosis, because of atipic abdominal complaints, common to a large variety of digestives affections. Endoscopic and imaging examination may have diagnostic, but frequently are inconclusives. For primary tumors, the surgical resection is the treatment of choice, but for metastatic, tumors surgical resection has to be reserved for the cases complicated by obstruction, bleeding or perforation. This study has aim to analyse retrospectively 13 cases of small bowel maligns tumors in a period of 28 years. A higher incidence of primary tumors (69,2%), and linfomas (30,7%) were observed. Among metastatic tumors, the adenocarcinoma was the most frequent (15,4%). Segmental enterectomy was the most common surgical procedure (84,6%), and hospital mortality was 15,4%. Survival rate within five years was zero for metastatic tumors, while for primary lesions was 44,4%, suggesting a better prognostis for primary lesions, independently from the histologic type of neoplasms.

São analisados os resultados do tratamento cirúrgico em cinco casos de melanoma maligno anorretal (MMAR). Um paciente encontrava-se no estádio clínico I, dois no estádio clínico II e dois no estádio III. Todos os pacientes foram operados, sendo quatro submetidos a excisão local do tumor, e um a amputação abdômino-perineal do reto. Este último sobreviveu por apenas sete meses, enquanto uma paciente, estádio clínico II e submetida apenas à excisão local, sobreviveu por 168 meses. Os autores questionam a validade do estadiamento clínico I (tumores localizados) como fator prognóstico, já que desconsidera o grau de penetração do tumor na parede anorretal. Sugerem ainda a realização de estudos multicêntricos, para que se possa estabelecer uma uniformidade terapêutica para o MMAR.

In spite of being rare, the anorectal region is the third most frequent localization of the melanoma, following the skin and eyes. The results of treatment are conflictant, with variable averange survival of 2,7 months until 30 months in patients submitted to surgical treatment. In this study, the results of surgical treatment in five cases of malignant anorectal melanoma are presented. One patient was in clinical staging I, two in II and two in III. All of them have been operated, four submitted to local excision of the tumor and one to abdominoperineal amputation of the retum. Two patients were submitted to adjuvant chemiotherapy and one to radiotherapy and inespecific imunotherapy with oral BCG. The unique patients in the stage I had a survival of 13 months, similar to the patients III (average survival = 14 months), and inferior to the patients II ( average survival = 87,5 months ). The authors question the validity of the clinical stage I ( localizated tumours ) like a prognostic factor, because it desconsider lhe penetration grade of the tumour in tha anorectal wall. The still suggest the realization of multicentric studies to allow the establishment of a therapeutic uniformity to the malignant anorectal melanoma.