Abstract Introduction After the diagnosis of neoplasm of the middle and distal rectum, patients are often submitted to oncological treatment by neoadjuvant therapy. At the end of this treatment, those patients who show complete clinical response can choose, together with their physician, to adopt the watch-and-wait strategy; although it implies lower morbidity for the patient, this strategy is dependent on strict adherence to treatment follow-up for the early identification of any future local injury. Materials and Methods Survey of data from medical records and description, and discussion of case reports with a literature review in books and databases. Results We report the case of a 73-year-old patient diagnosed with moderately differentiated adenocarcinoma of the middle rectum, Stage II (cT3bN0M0), who presented complete clinical response after undergoing treatment with neoadjuvant therapy. Together with the assistant team, the watch-and-wait strategy was chosen. During the follow-up, an endoscopic examination showed a vegetating at the proximal limit of the tumor scar. We chose to perform submucosal endoscopic dissection. The report of the anatomopathological examination evidenced a serrated adenoma with narrow margins free of neoplasia. Conclusion Patient adherence to cancer treatment using the watch-and-wait strategy is essential for the early identification of new local lesions. After resection of the lesion identified in the tumor scar site as a neoplasm-free lesion, it is consistent to think that this lesion would be the origin of the neoplasm, given the adenomatous origin. rectum therapy choose physician watchandwait watch wait followup follow up injury description databases 73yearold yearold 73 year old cT3bN0M0, cT3bN0M0 cTbNM , cT bN M (cT3bN0M0) team chosen followup, up, dissection neoplasia lesions neoplasmfree 7 cT3bN0M (cT3bN0M0 (cT3bN0M

ABSTRACT Intrahepatic biliary stone disease is a difficult condition to treat, due to anatomical complexity of biliary tract, association with colestasis, and high recurrence rates, with potential short- and long-term complications, such as cholangitis and secondary biliary cirrhosis. Removal of biliary stones via intraductal access can be achieved endoscopically or percutaneously, with preference for cholangioscopy-guided laser lithotripsy in complex cases. The surgical approach, despite its prolonged results, is a more invasive and risky procedure. The authors present a case of cholangioscopy with percutaneous laser biliary lithotripsy as an option for the treatment of intrahepatic biliary stone disease associated with biliary stricture following biliodigestive anastomosis due to bile duct injury following cholecystectomy, a safe and effective alternative with low morbidity and satisfactory outcomes in follow-up. treat tract colestasis rates short longterm long term complications cirrhosis percutaneously cholangioscopyguided guided cases approach results procedure cholecystectomy followup. followup follow up. up follow-up

RESUMO A litíase biliar intra-hepática é uma condição de difícil tratamento, pela complexidade anatômica, pela associação à estase biliar e pelas altas taxas de recidiva, com potenciais complicações a curto e a longo prazo, como quadros de colangite de repetição e cirrose biliar secundária. A remoção de cálculos biliares por acesso intraductal pode ser obtida por via endoscópica ou percutânea, com preferência por litotripsia a laser por colangioscopia em casos complexos. A cirurgia, apesar de apresentar resultados prolongados, apresenta o contraponto de ser mais invasiva e com maiores riscos. Os autores apresentam um caso, e suas imagens, de colangioscopia com litotripsia biliar percutânea a laser como opção para tratamento de litíase biliar intra-hepática associado a estenose biliar secundária a anastomose biliodigestiva por lesão de via biliar pós colecistectomia, uma alternativa segura e eficaz, com baixa morbidade e um resultado satisfatório no seguimento. intrahepática intra hepática anatômica recidiva prazo complexos cirurgia prolongados riscos caso imagens colecistectomia eficaz seguimento