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To report our results with local excision by transanal endoscopic microsurgery (TEM) to treat 42 cases of rectal lesions (29 adenomas and 13 carcinomas).Prospective, descriptive study. Sex distribution: 55% men, 45% women, mean age 65 years (range: 17-84 years).rectal bleeding 67%, diarrhea 23%.mucosectomy 6 cases, full-thickness excision 36 cases. Average follow-up: 11 months (range: 1-36 months).We analyzed operating time (average 85 min; range: 25-180 min), bleeding (average 100 ml, range 10-350 ml), distance of the tumor from the anal verge (lower tumor margin: mean, 8.8 cm; range, 1-20 cm; distal tumor margin: mean, 12.9 cm; range, 5-22 cm), tumor size (mean, 3.9 cm; range, 2-10 cm), postoperative hospital stay (average, 4 days; range, 2-15 days), morbidity (hemorrhage 1 case; perforation, 1 case), mortality (0) and follow-up (temporary incontinence to flatus in 6 cases, 1 recurrence of carcinoma treated with abdominoperineal resection, 2 recurrences of adenoma and 2 new adenomas).TEM is a safe technique for the treatment of rectal lesions. Low morbidity and recurrence rates and short hospital stays make TEM a procedure of choice when local rectal surgery is indicated.

To describe two cases of adrenal pseudocyst that presented as acute abdomen and shock.Two cases of adrenal pseudocyst are presented: one patient was a 69-year-old woman who presented with shock and pain in the left hypochondrium and the other was a 23-year-old woman who complained of dizziness and pain in the left hypochondrium.US and CT evaluation showed a heterogeneous cystic mass. Blood analysis showed low hematocrit and hemoglobin levels. Surgical resection of the retroperitoneal cystic mass was performed. The pathological analysis disclosed an adrenal pseudocyst.Adrenal pseudocyst is an uncommon lesion that infrequently causes symptoms and rarely presents as acute abdomen. Ultrasound and CT are the most useful diagnostic imaging methods. Treatment is by surgery if the lesion is large and symptomatic, if it cannot be clearly distinguished from a tumor, and if massive hemorrhage occurs.

endorectal ultrasound (EUS) is currently accepted as the best technique for the preoperative study of patients with rectal tumors, and surgical decisions depend increasingly on EUS staging. The main pitfalls in staging rectal tumors are over- or understaging as well as errors in imaging lymph nodes. Being aware of such errors and their causes may help to improve the overall results. The aim of the present study was to evaluate the accuracy of EUS in staging rectal neoplasms, and to study potential sources of error.from May 1996 to December 1998, 120 patients with rectal tumors were studied preoperatively by EUS. The uTNM classification described by Hildebrandt and coworkers was used. The EUS findings were compared prospectively with the results of pathological examination. When there was no correlation, both the specimen and the EUS findings were carefully reviewed to look for potential sources of error.41 out of 120 patients were classified as uT1, 10 as uT2, 60 as uT3 and 9 out of 120 as uT4. 31 patients had positive lymph nodes (uN1). On comparing these data with the results of the pathological report, we found 90% accuracy in staging rectal wall penetration, and 70% accuracy in the diagnosis of lymph nodes. Errors were due basically to technical problems, characteristics of the tumor itself, and difficulties in staging lymph nodes.it is important to identify the potential source of errors as well as the current limitations of EUS to improve the overall results with this technique.