Laura Antônia Vicenzi Souza

Objective: To describe ileal obstruction caused by a phytobezoar in an older adult and the diagnostic and postoperative challenges. Methodology: A descriptive single-patient case report presenting clinical findings, imaging, operative and pathological findings, treatment, and follow-up, with a narrative discussion of the literature. Results: An 80-year-old woman presented with severe abdominal pain and three days without stool or flatus. Examination revealed abdominal distension, marked tympany, and diffuse tenderness. C-reactive protein was 125 mg/L, with sodium and potassium within reference ranges. Computed tomography showed focal ileal narrowing, upstream dilatation, proximal ileal fecalization, and intraperitoneal fluid. Nasogastric decompression did not resolve the obstruction. Same-day laparotomy identified a phytobezoar with an estimated volume of 50 mL, which was removed through an enterotomy without ileal resection. Serosal injury 40 cm proximal to the ileocecal valve was repaired. Pathological examination identified material consistent with plant fibers. Postoperative ileus and acute pulmonary edema were managed medically. Bowel function returned on postoperative day six, and discharge occurred on day seven. At follow-up 20 days after discharge, the patient was asymptomatic. Conclusion: Phytobezoar should be considered despite the absence of previous surgery. Reassessment of persistent obstruction and careful adjustment of hydration and oral intake are important during postoperative recovery.

Goals: To analyze temporal trends in mortality from liver cancer in adults in the southern states of Brazil from 2000 to 2019. Method: An ecological time series study was conducted. All records regarding mortality from liver cancer in the southern states of Brazil in the period between 2000 and 2019 were analyzed. Mortality rates were calculated and standardized by sex, age by sex and state. Simple linear regression was performed to estimate the trend of mortality. The result obtained is statistically significant (p<0.05). Results: A trend of increase in mortality rates from liver cancer in the South region (p<0.001) was identified. The same was observed for both sexes (p<0.01). The male age group between 60 and 79 years old showed the highest average annual increase. There was a trend towards reduction in rates for the female age groups between 60-69 years old and 80 years or older (p<0.05). In the three states, the upward trend continued: Santa Catarina with an average rate of 11.54/100,000 inhabitants, followed by Rio Grande do Sul with an average rate of 15.53/100,000 inhabitants and Paraná with an average rate of 12.53/100,000 inhabitants. Conclusion: The current study demonstrated an upward trend of liver cancer occurrence in the South region of Brazil.