ABSTRACT
Introducción: actualmente no existe una técnica gold standard para el tratamiento definitivo de la enfermedad pilonidal crónica. Las técnicas empleadas en nuestro servicio son la técnica de Karydakis, Colgajo Romboidal y una variante de la técnica de Soll y col. a la que denominamos Técnica de preservación cutánea. Objetivo: evaluar y comparar la eficacia de las técnicas de Karydakis (TK), Colgajo de Limberg (CL) y de Preservación cutánea (PC) en el tratamiento de la enfermedad pilonidal crónica. Material y Métodos: estudio retrospectivo sobre 136 pacientes operados por enfermedad pilonidal crónica en el Sanatorio Allende, entre Enero del 2006 y Septiembre del 2013, basado en revisión de historias clínicas y entrevista telefónica. Se incluyeron 125 pacientes, 38 operados mediante CL, 50 con TK, y 37 con PC. Se excluyeron 11 pacientes por enfermedad pilonidal supurada. Las variables de evaluación primarias fueron el tiempo operatorio, complicaciones postoperatorias, tasa de recidiva; y las secundarias fueron el tiempo de reincorporación a actividades normales y deportivas, y el grado de satisfacción del paciente. Los test estadísticos empleados fueron el análisis de varianza, el postest de Tukey y Chi-cuadrado. Resultados: el tiempo quirúrgico fue menor en el grupo TK (37 min) en comparación con el grupo CL (53 min) (p0.05) aunque la reincorporación a actividades deportivas fue más prolongada en el grupo TK (43 días) respecto de los otros dos grupos (32 días) (p=0,042)...
Introduction: actually, there is no consensus as to the optimal surgical operation for sacrococcygeal pilonidal disease. The techniques used in our institution are Karydakis flap reconstruction, Limberg flap transposition, and a modified Soll et al procedure, which includes sinusectomy with primary closure called Cutaneous preservation technique. Objectives: to evaluate and to compare the efficacy and morbidity of Karydakis flap reconstruction (KF), Limberg flap transposition (LF) and Cutaneous preservation technique (CP) in the treatment of chronic pilonidal sinus disease. Patients and methods: a retrospective study was performed in 136 consecutive patients operated for chronic pilonidal sinus disease at Sanatorio Allende between January 2006 and September 2013, using KF, LF and CP procedures. Eleven patients were excluded for presenting suppurated pilonidal disease. One hundred and twenty five patients were included, 50 in the KF, 38 in LF and 37 in the CP group. Primary endpoints included operation time, complications and recurrence rates. Secondary end-points were healing time, return to normal and sports activities and degree of patients satisfaction. Data was obtained via a revision of digital clinical history and a standardized telephone interview. Statistical tests used were Anova with Tukeypost test and Chi-square test. Results: operating time was shorter in the KT group (37 min) compared with LF group (53min) (p0.05). However, return to sports activities was delayed in KF group (43 days), compared with LF and PC group (32 days) (p=0,042)...
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Chronic Disease , Pilonidal Sinus/surgery , Surgical Procedures, Operative/methods , Postoperative Complications , Recurrence , Retrospective Studies , Surgical Flaps , Suture TechniquesABSTRACT
La hernia obturatriz (HO) es poco frecuente y representa del 0.05 al 0.4 por ciento del total de hernias. Debido a su rareza y a su presentación inespecífica, el diagnóstico es por lo general tardío y las tasas de mortalidad elevadas (12-70 por ciento). Se presenta un caso típico de HO diagnosticada en el preoperatorio mediante TC Multi-corte con RMP y tratado mediante laparotomía de urgencia con buen resultado. El empleo de TC Multicorte con RMP de abdomen y pelvis, en cuadros de obstrucción intestinal en mujeres añosas, sin antecedente de cirugías previas ni hernias objetivables, tiene gran valor para el diagnóstico preoperatorio precoz de HO y podría contribuir a reducir las elevadas tasas de morbilidad y mortalidad.
Abstract. The obturator hernia (OH) is rare and accounts for 0.05 to 0.4% of all hernias. Because of its rarity and its nonspecific presentation, diagnosis is usually late and has high mortality rates (12-70%). A typical case of OH diagnosed preoperatively by Multislice CT with MPR and treated using emergency laparotomy with good results, is presented. The use of Multislice CT with MPR of the abdomen and pelvis, in symptoms of intestinal obstruction in elderly women with no history of previous surgery or objectified hernias, has great value for early preoperative diagnosis of OH and could help reduce the high rates of morbidity and mortality.
Subject(s)
Humans , Female , Aged, 80 and over , Hernia, Obturator , Tomography, X-Ray Computed/methods , Early Diagnosis , Hernia, Obturator/surgeryABSTRACT
Mesenteric panniculitis is a rare entity of benign features that affects the intestinal mesenteric fat tissue and can progress in different ways, from spontaneous resolution to fibrosis. The etiology is still uncertain, probably caused by trauma, infection or surgery. We report a case of a 64-year-old male patient who suddenly began with abdominal pain and leukocytosis. Diagnosis of mesenteric panniculitis was made by a CT scan and the patient evolved with spontaneous resolution within two months.
Subject(s)
Mesentery/diagnostic imaging , Panniculitis, Peritoneal/diagnostic imaging , Humans , Male , Middle Aged , Tomography, X-Ray ComputedABSTRACT
La compresión axilar por el uso de muletas es una causa infrecuente y subdiagnosticada de isquemia arterial aguda del miembro superior. Se presenta el caso de un paciente con isquemia aguda debido a trauma en la confluencia de las arterias axilar y humeral inducido por el uso de muletas. Dicha lesión fue el foco de microembolias que ocluyeron el arco palmar y la arteria humeral. Se diagnosticó con una arteriografía selectiva de la arteria axilar, y se tratómediante un bypass axilo-humeral con prótesis de PTFE anillado de 6 mm, con resultado satisfactorio en el seguimiento clínico a cinco años del postoperatorio.
A compressão axilar devido ao uso de muletas é uma causa pouco frequente e subdiagnosticada de isquemia arterial aguda do membro superior. Apresenta-se o caso de um paciente com isquemia aguda por trauma da confluência das artérias axilar e femoral induzido pormuletas. Esta lesão foi o foco de microembolias que provocaram a oclusão do arco palmar e da artéria femoral. Foi diagnosticado com uma arteriografia seletiva da artéria axilar, e tratado com um bypass axilo-femoral com prótese de capas de PTFE de 6 mm, com resultado satisfatório no seguimento clínico, cinco anos depois do pós operatório.
Crutch induced axillary trauma represents an infrequent but underdiagnosed cause of acuteischemia to the upper limb. We present a case of acute arterial ischemia caused by trauma of the confluence of the axillary and brachial arteries induced by the use of crutches. This lesion was the origin of microembolisms that occluded both the palmar arch and the brachialartery. The diagnosis was made by a selective arteriography of the axillary artery. An axillobrachial bypass with a 6 mm ringed PTFE prosthesis was performed showing satisfactory resultson his 5 year postoperative clinical follow up.
Subject(s)
Humans , Male , Aged , Axillary Artery/injuries , Axillary Artery , Brachial Artery/injuries , Embolism/etiology , Upper Extremity/blood supply , Crutches/adverse effects , Angiography , Arterial Occlusive Diseases/etiology , Arterial Occlusive Diseases , Ischemia , Thrombosis/etiologyABSTRACT
We report a case of acute small bowel obstruction occurring secondary to endometriosis of the terminal ileum. Ileal endometriosis is a rare condition that can cause acute small bowel obstruction. As this cse and others in the literture highlight, establishing a preoperative diagnosis is very difficult due to the vagueness of symptoms and similarity in presentation to other causes of obstruction, and is based on a high index of suspicion. However, this disorder should be considered in the differential diagnosis of women of child-bearing age who present with symptoms of obstruction. The definiteve treatment includes resection of the involved segment with primary anastomosis, and adjuvant hormonal therapy may prevent recurrence. VATER association is an acronym for the fllowing non-random association of defects: Vertebral defects, Anal atresia, tracheoesophageal fistula with Esophageal atresia, and Renal or Radial defects. VACTERL association is an expanded acronym to include Cardiac defects and Limb defects. Diagnosis of VACTERL association is made if theree out of seven above defects are present in an infant. The incidence is estimated to be 1.6 cases in 10,000 live births.
Subject(s)
Humans , Female , Adult , Abdominal Pain , Umbilical Arteries/abnormalities , Diagnosis, Differential , Endometriosis/diagnosis , Endometriosis/pathology , Endometriosis , Intestinal Obstruction/surgery , Pancreas/pathologyABSTRACT
Introducción: el duodeno representa el segundo sitio más común de desarrollo de divertículos, después del colon. Se encuentran generalmente a 2,5 cm de la ampolla de Vater o en la primera porción duodenal, en casos relativamente raros, se presentan en la tercera y cuarta porción duodenal. Objetivo: presentación de un caso de divertículo en tercera porción duodenal, así como también la metodología diagnóstica y terapéutica para resolverlo. Discusión: el diagnóstico clínico de los divertículos duodenales presenta dificultad debido a que no existe una presentación clínica característica. Sólo el 10% y 25% de los pacientes son sintomáticos. Las manifestaciones clínicas se desarrollan por las complicaciones de las diverticulitis. El diagnóstico se basa en los estudios contrastados como las seriadas esofagogastroduodenales, TAC multicorte, así como también, la realización de una endoscopía, deben contribuir a un diagnóstico acertado. El tratamiento quirúrgico de los divertículos asintomático en pacientes adultos no está justificado, mientras que en el paciente con síntomas el criterio es quirúrgico para evitar complicaciones como: hemorragia, perforación, diverticulitis, pancreatitis y obstrucción. Conclusión: el tratamiento de los divertículos duodenales varía según el tipo, localización y extensión del proceso inflamatorio. La cirugía se encuentra reservada en un 1 al 3% de los pacientes con divertículos duodenales en tercera porción, considerando aquellos enfermos con dolor abdominal persistente o complicaciones asociadas a la diverticulitis.
Introduction: The duodenum is the second most common site of diverticula development after the colon. They are usually found to 2.5 cm of the ampulla of Vater or the first part of the duodenum, in relatively rare cases, occur in the third and fourth duodenal portion. Objective: A case of duodenal diverticulum in the third portion, as well as diagnostic and therapeutic methodology to solve it. Discussion: The diagnosis of duodenal diverticula have difficulty because there is no characteristic clinical presentation. Only 10% and 25% of patients are symptomatic. The clinical manifestatiions are developed by the complications of diverticulitis. The diagnosis is bases on serial contrast studies such as upper GI, multislice CT, and also carrying out an endoscopy, should contribute to an accurate diagnosis. Surgical treatment of asymptomatic diverticula in adult patients is not justified, whereas in patients with symptoms on surgical approach is to avoid complications such as bleeding, perforation, diverticulitis, pancreatitis and obstruction. Conclusion: The treatment of duodenal diverticula varies according to the type, location and extent of the inflammatory process. Surgery is reserved on a 1 to 3% of patients with duodenal diverticula in the third portin, whereas those patients with persistent abdominal pain or complications associated with diverticulitis.