Embarazo con miomatosis uterina complicado con isquemia intestinal: reporte de un caso / Pregnancy with uterine myomatosis complicated by intestinal ischemia: case report

Resumen Los miomas uterinos, también conocidos como fibromas o leiomiomas, son los tumores uterinos benignos más prevalentes. Afectan a las mujeres principalmente durante sus años reproductivos y se diagnostican hasta en un 70% de las mujeres blancas y en más del 80% de las mujeres de ascendencia africana durante su vida, con una prevalencia durante el embarazo del 2% al 10%. Pueden ser asintomáticos hasta en un 70% de las pacientes, y se estima que pueden ocurrir complicaciones en aproximadamente una de cada 10 mujeres embarazadas. Se han asociado a complicaciones y resultados adversos del embarazo, según su tamaño y ubicación en el útero, y pueden manifestarse de diferentes formas. Presentamos el caso de una mujer de 30 años, con embarazo en el tercer trimestre, quien consultó por dolor abdominal, con ecografías obstétricas durante su control prenatal que reportaban miomatosis uterina, quien presentó isquemia intestinal por un vólvulo de intestino delgado versus compresión extrínseca.

Abstract Uterine fibroids, also known as fibroids or leiomyomas, are the most prevalent benign uterine tumors, affecting women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African descent during their lifetime, with a prevalence during pregnancy of 2% to 10%; they may be asymptomatic in up to 70% of patients, and it is estimated that complications may occur in approximately one in 10 pregnant women. They have been associated with complications and adverse pregnancy outcomes, depending on their size and location in the uterus, they can manifest in different ways. We present the case of a 30-year-old woman, pregnant in the third trimester, who consulted for abdominal pain, with obstetric ultrasound scans during her prenatal check-up reporting uterine myomatosis, who presented intestinal ischemia due to small bowel volvulus versus extrinsic compression.

Primary hydatid cyst of the mesentery presenting as a small bowel volvulus

Hydatid disease mostly caused by Echinococcus granulosus (dog tape worm) is a common parasitic disease in pastoral areas. It produces cysts in the human body. Human is an accidental intermediate host. Most common sites are liver and lungs. Intraperitoneal hydatid cyst occurs sometimes and it is usually secondary to rupture of primary hepatic hydatid cyst. Primary intraperitoneal hydatid cyst is rare (2%). Primary hydatid cyst in mesentery is very rare. Small bowel volvulus is rare but documented complication of tumours of the mesentery, including cysts. In this article, the authors present a case of primary mesenteric hydatid cyst with acute intestinal obstruction secondary to volvulus.

Signo del remolino: cirugía de urgencia o falacia ad populum / Whirpool sign: emergency surgery or Falacia ad populum

Introducción: Las pruebas de diagnóstico por imagen se han convertido en una pieza crucial en el diagnóstico del abdomen agudo en la urgencia, sin embargo, la conducta médica deberá basarse en los hallazgos iconográficos contextualizados. El signo tomográfico del remolino constituye un paradigma por su asociación con el vólvulo intestinal. Objetivos: Registrar pacientes con diagnóstico de abdomen agudo en busca del "signo del remolino" en la tomografía computada e identificar quiénes requirieron intervención quirúrgica. Métodos: Estudio analítico de corte transversal evaluándose 115 tomografías computadas de abdomen agudo obstructivo en búsqueda del signo del remolino. Resultados: 15 tomografías fueron excluidas por tratarse de estudios solicitados en posoperatorios. El signo del remolino se presentó en el 5%. Los diagnósticos fueron de mal rotación intestinal (2%), vólvulo de intestino delgado (1%), vólvulo de sigma (1%) y enterocolitis (1%). Sólo el 60% de los pacientes requirieron cirugía. Discusión: La presencia del signo del remolino no siempre obedece a una resolución quirúrgica. No es patognomónico de una sola entidad puntual, pudiendo representar un hallazgo en el contexto de otra patología aguda, por lo que se debería reconocer sus variantes para instaurar el tratamiento adecuado, sea quirúrgico o médico.

Introduction: The imaging test have become an important piece on the diagnosis of the acute abdomen in emergency, nevertheless medical conduct should be based on contextualized iconographic findings. The tomographic "whirlpool sign" establishes a surgical paradigm for its association with the bowel volvulus. Objetive: To register patients with diagnosis of acute abdomen looking for the "whirlpool sign" in the computed tomography and identify who needed surgical intervention. Methods: Analytical cross-sectional study. 115 tomographies of acute obstructive abdomen have being evaluated. Results: 15 tomographies were excluded. The prevalence of the whirlpool sign was 5%. Diagnoses were intestinal malrotation (2%), midgut volvulus (1%), sigmoid volvulus (1%) and enterocolitis (1%). Only 60% of the patients required surgery. Discussion: The presence of the "whirlpool sign" not always determines a surgical resolution. It is not a pathognomonic sign of a punctual entity; it could represent an ordinary finding in the context of several pathologies. To apply the correct treatment, surgical or medical, for these patients it was important to recognize "whirlpool sign" variants.

Intestinal rupture due to small bowel volvulus in a captive American black bear (Ursus americanus)

Intestinal rupture caused by small bowel volvulus was diagnosed in a captive 13-year-old male American black bear. The animal presented with decreased appetite, depression, lethargy, and mild abdominal distention for 3 days. The animal was treated with antibiotics, hypermetabolites, and digestive medicine daily; however, it died on the third day of treatment. The clinical symptoms included hemorrhagic ascites, gaseous extension of the small intestine, and intestinal rupture caused by small bowel volvulus. Hemorrhagic signs were observed in the lungs and heart. This is the first case to describe small bowel volvulus in mammals of the family Ursidae.

Small Bowel Volvulus in Adults: A case report

Small bowel volvulus in adults is very rare and occasionally occurs due to congenital midgut malrotation. The most common cause of small bowel volvulus is adhesions (74%), and other causes are Crohn's disease (7%), neoplasia (5%), hernia (2%), radiation (1%), and miscellaneous (11%). Presenting symptoms may be acute or present periodically during a longer period of time with a condition that is intermittent or recurrent because of spontaneous detorsion of the volvulus. Diagnostic imaging studies are plain abdominal film, ultrasonography, abdominal CT, and angiography. Abdominal CT is the most accurate. The most frequent CT finding is "Whirlpool sign." Other findings are bowel-loop dilatation, bowel-wall thickening, beak signs, mesenteric alterations, and extraluminal fluid. The mortality rate associated with small bowel volvulus in adults is 10~67%. We report a case of small bowel volvulus in adults.