Revista Científica do Hospital e Maternidade José Martiniano Alencar

Peer-based learning: application in the surgical education of students

Mon, 29 Sep 2025 00:00:00 +0000

Peer-based learning promotes knowledge exchange and enhances medical education. In surgical training, student organizations help fill gaps in undergraduate education by integrating theory and practice. The "Surgery and Emergency Immersion Month" (MICE), organized by a student organization, offered 40 hours of theoretical and practical classes with specialists and trained students. The event had strong participation and received positive feedback, highlighting the importance of practical learning. This experience reinforces the impact of peer-based learning in preparing better-trained doctors, encouraging similar initiatives in surgical education.

Hepatic adenoma with rupture: an unusual presentation with literature review and case report

Mon, 29 Sep 2025 00:00:00 +0000

Os Adenomas Hepáticos são tumores hepáticos benignos, porém com potencial significativo de complicações, incluindo a rotura espontânea, que por sua vez pode levar a um estado de choque hemorrágico. O presente estudo tem como objetivo revisar a apresentação clínica, o manejo e os desfechos destes Adenomas Hepáticos, além de relatar um caso observado em um hospital terciário no Ceará. Foi realizada uma revisão de literatura nas bases de dados PubMed, Lilacs e Cochrane, utilizando descritores relacionados ao adenoma hepático roto e seus desfechos. Foram incluídos 9 estudos que abordam as características dos pacientes, as abordagens terapêuticas (cirúrgicas e não cirúrgicas) e os principais desfechos clínicos. O caso relatado envolve uma paciente de 38 anos com adenoma hepático roto, que apresentou complicações hemorrágicas e foi submetida a múltiplas intervenções cirúrgicas. A revisão e o relato de caso reforçam a necessidade de uma abordagem individualizada para o manejo do adenoma hepático roto, considerando os riscos de complicações graves e a importância do monitoramento pós-operatório.

Ileocolic intussusception caused by lipoma: case report and literature review

Mon, 29 Sep 2025 00:00:00 +0000

Intestinal intussusception is a rare cause of intestinal obstruction in adults, accounting for less than 1% of cases of mechanical obstruction. Intestinal lipomas are uncommon benign lesions that can present asymptomatically but may rarely act as a point of intestinal invagination. This article reports the case of a 58-year-old patient with ileocolic intestinal obstruction and a postoperative diagnosis of intestinal lipoma, highlighting the importance of early imaging diagnosis followed by appropriate surgical management for patient care.

Minor Surgery Process for Rural Patients

Mon, 29 Sep 2025 00:00:00 +0000

Ambulatory surgeries are short-duration procedures with a low risk of complications, essential for treating elective medical conditions that affect patient’s quality of life. However, the high demand in the public healthcare system and limited resources result in long waiting lists, making access to these services difficult. Small surgery campaigns emerge as an effective strategy to provide fast and safe care. This study reports on a campaign organized by the Academic League of General Surgery at the University of Fortaleza, during which 39 patients were treated and 51 procedures were performed, reducing the demand on the public healthcare system and providing practical learning opportunities for students. Despite challenges related to patient screening and resource acquisition, the high patient satisfaction highlights the campaign’s effectiveness and positive impact.

Mucinous cystic neoplasm of the liver: case report and literature review

Mon, 29 Sep 2025 00:00:00 +0000

Mucinous cystic neoplasia of the liver and biliary tract represents a rare entity characterized by peculiar morphology, most commonly found in adults, particularly women between 40 and 50 years of age. Clinically, these tumors may cause abdominal pain, compressive symptoms, and jaundice. In 85% of cases, the lesion develops in the liver, while involvement of the extrahepatic bile ducts and gallbladder is even rarer. The differential diagnosis between cystadenoma and cystadenocarcinoma is challenging in the preoperative setting; therefore, surgical resection with margins is recommended due to the risk of malignancy.

Non-recurrent laryngeal nerve: a case report

Mon, 29 Sep 2025 00:00:00 +0000

Introduction: One of the fundamental steps faced by surgeons during thyroidectomy lies in the identification and preservation of the laryngeal nerves, in particular the recurrent laryngeal nerve (RLN), and its anatomical variation, the non-recurrent nerve. Case report: Woman, 39 years old, who presented with dysphagia, dyspnea on physical exertion and dysphonia. A solid nodule was detected on thyroid USG. She then underwent thyroidectomy and, during the dissection to identify the right recurrent laryngeal nerve, it was observed that it was emerging directly from the vagus nerve to the larynx. Discussion: Although the presence of anatomical variants of NLI has been associated with an increased risk of iatrogenic injuries during surgeries in the head and upper chest region, it has not yet been proven that the systematic application of preoperative imaging studies can effectively reduce this risk. Conclusion: The presence of non-recurrent highlights the importance of systematic dissection of the inferior laryngeal nerve during surgery.

Comparative and temporal analysis of anorectal fistulas treatment in Brazil over the last 10 years: related to Covid-19?

Mon, 29 Sep 2025 00:00:00 +0000

Introduction: Anorectal fistulas, often stemming from perianal abscess drainage, are connections between the anorectal canal and the perianal region, with an average incidence of 8.6 per 100,000 inhabitants. Patients usually present with draining fistulae accompanied by severe symptoms, necessitating surgical intervention to prevent recurrence and incontinence. During the COVID-19 pandemic, proctological disorders have lost priority, leading to expedited diagnoses and treatments. Objectives: To conduct a temporal analysis of anorectal fistula treatment in Brazil over the past decade and identify its relationship with the pandemic. Method: A cross-sectional, documentary, and quantitative study with a sample of 102,666 procedures for closure of rectal fistula and anal fistulectomy/fistulotomy reported in the SIH/SUS between 2014-2023, available from the Department of SUS Statistics. Variables were evaluated based on the number of approved Hospital Admission Authorizations (AIH) and the nature of the care provided. Results: The number of procedures reached its minimum in 2020 (6,583), 44.9% fewer than in 2019 (11,955), attributed to reduced demand for elective care during the pandemic. Despite the overall decrease, the proportion of urgent procedures increased from 14.8% in 2019 to 25.3% in 2021, possibly due to worsening cases resulting from delayed diagnoses, without demonstrating to be a risk factor for disease recurrence. Conclusion: There was a significant reduction in the number of anorectal fistula treatments in the first two years of the pandemic, with a relative increase in the number of these procedures in urgent situations, indicating greater severity of cases at the time of intervention.

Incidental gallbladder neoplasia after elective cholecystectomy: a retrospective analysis

Mon, 29 Sep 2025 00:00:00 +0000

Objectives: To report the incidence of incidental gallbladder cancer after elective cholecystectomies in a secondary SUS hospital, comparing it with the literature and reviewing the risk factors and management related to this condition. Material and Methods: Unicentric, retrospective, non-randomized and observational study of patients who underwent cholecystectomy surgery from January to December 2024 at Hospital José Martiniano de Alencar, Fortaleza, Ceará. Patients who returned for postoperative evaluation of the surgical specimen were included and those who were lost to follow-up were excluded. Results: Of the 1078 eligible patients, 934 were female and 144 were male, all of whom underwent surgery for symptomatic cholelithiasis. Four cases of incident gallbladder cancer were diagnosed, representing an incidence of 0.37%. Three of these cases were classified as low-grade intraepithelial neoplasia, all in female patients, with a mean age of 53 years and without the need for additional surgery. The fourth case was identified in a young male, operated on for a 1cm polyp, but a mass was found intra-operatively, with histopathology confirming pt2a neoplasia and cystic duct involvement, who underwent rescue surgery at 3 weeks, but with evidence of metastatic disease. a factor that must be taken into consideration in the study is the high rate of 11.05% loss to follow-up of patients who did not return for postoperative evaluation. Conclusions: The incidence of incidental cancer found in elective cholecystectomies was low, but we emphasize that its diagnosis is of great importance due to the prognosis of the disease and for adequate postoperative management. Attention to risk factors such as advanced age, cholelithiasis and polyps greater than or equal to 1 cm can help identify patients with a greater chance of developing this condition. The management of incidental biliary cancer must be individualized, based on the clinical and pathological characteristics of each case.

Epidemiological profile of patients undergoing colorectal surgeries and analysis of the incidence of anastomotic fistulas in a secondary hospital - from 2019 to 2024

Mon, 29 Sep 2025 00:00:00 +0000

Objectives: Anastomotic fistula is one of the most severe complications in colorectal surgery. This study aimed to outline the profile of patients undergoing colorectal surgeries and identify the risk factors associated with the occurrence of fistulas. Methods: A review of medical records from 114 patients who underwent colorectal surgeries was conducted, analyzing data related to sex, age, underlying pathology, type of surgery, surgical approach, incidence of anastomotic fistulas, classification and management, morbidity and mortality. Results: The overall incidence of fistulas was 10.5%, and the factors associated with anastomotic fistulas were male sex (RR=1.89; 95% CI: 0.54–6.59), history of acute diverticulitis (RR=2.03; 95% CI: 0.51–6.09), laparotomic surgery (RR=2.5; 95% CI: 0.8–8.3), and anastomosis involving the rectum (RR=2.8; 95% CI: 0.8–9.8). Conservative treatment was the primary approach (50%), followed by surgical reintervention (41.7%), while a smaller proportion was managed with percutaneous drainage (8.3%). Mortality and lethality rates were 0.87% and 8.3%, respectively. Conclusions: Data analysis suggests that male sex, history of acute diverticulitis, low anastomosis, and laparotomic surgery are the factors most associated with the development of anastomotic fistulas, though without statistical significance. The overall incidence of fistulas is slightly lower than values reported in the global literature, while mortality is well below expected levels, highlighting the excellence and expertise of this service in performing such surgeries. Conservative treatment was sufficient in most cases.

Training of resident doctors of the general and digestive surgery service at a tertiary care center in Fortaleza, Ceará

Mon, 29 Sep 2025 00:00:00 +0000

Collecting data on surgical procedures performed is essential to analyze the entity's social benefit, the quality of resident training and to better allocate resources. The study analyzes the training of resident doctors in General and Digestive Surgery at a tertiary care center in Fortaleza, Ceará, between March 2022 and January 2023. Eight residents participated, acting as first surgical assistant or most active member in 1334 procedures elective surgeries, excluding canceled and urgent surgeries and inadequate data. Resident training was divided into Basic Surgery (2 years) and General Surgery (3 years), according to CBC and MEC guidelines. Medium complexity procedures predominated, especially laparoscopic cholecystectomies and inguinal hernioplasties. Each 2-year resident performed an average of 362 procedures and the 3-year resident performed 545 procedures. Training is comprehensive, but better planning is needed for appendectomies and splenectomies.

Editorial

Manoel de Jesus Rodrigues Mello — Mon, 29 Sep 2025 00:00:00 +0000