Evaluación de pacientes adultos mayores con diagnóstico de abdomen agudo quirúrgico. Estudio prospectivo, descriptivo, no experimental / Evaluation of elderly patients with a diagnosis of acute surgical abdomen. Prospective, descriptive, non-experimental study

Se ha observado que la población mayor de 65 años requiere con mayor frecuencia procedimientos quirúrgicos y en ellos las presentaciones clínicas de las entidades responsables de un abdomen agudo son atípicas. En situaciones de emergencia, el diagnóstico resulta más difícil que en el adulto debido a diversos factores. Objetivo: Evaluar características clínicas, edad y sexo de pacientes adultos mayores con diagnóstico de abdomen agudo quirúrgico en el Hospital Universitario "Dr. Manuel Núñez Tovar" de Maturín, estado Monagas, período enero-septiembre 2019. Método: Se realizó un tipo de investigación no experimental, prospectiva, descriptiva, transversal, de campo, donde se estudiaron a todos los pacientes mayores de 60 años con diagnóstico de abdomen agudo quirúrgico según criterios clínicos, en el servicio de Cirugía General, con una muestra de 53 pacientes que cumplieron los criterios de inclusión. Resultados: Se evaluaron 790 pacientes adultos, con diagnóstico de abdomen agudo quirúrgico en el período señalado, de los cuales 53 pacientes correspondían a adultos mayores, 30 pacientes (56.60%) de sexo femenino con una edad promedio general de 71.33 años. La principal causa de abdomen agudo quirúrgico en adultos mayores fue la obstrucción intestinal con 26 pacientes (49.06%). La principal comorbilidad fue la hipertensión arterial (41.50%). Un 16.98% de los pacientes se complicaron con sepsis (complicación más frecuente) con mortalidad de 15.09% y más de la mitad (54.71%) ameritaron más de 4 días de hospitalización incluyendo a los complicados (90%)(AU)

It has been observed that the population over 65 years of age requires more and more surgical procedures and in them the clinical presentations of the entities responsible for an acute abdomen are atypical. In emergency situations, diagnosis is more difficult than in adults due to various factors. Objectives: Evaluate clinical characteristics, age and sex of older adult patients with diagnosis of acute surgical abdomen at the "Dr. Manuel Núñez Tovar" Hospital from Maturín, Monagas state, January-September 2019 period. Method: A non-experimental type, prospective descriptive, cross-sectional, field research was carried out, where all patients older than 60 years with a diagnosis of acute surgical abdomen according to clinical criteria, in the General Surgery service, with a sample of 53 patients who met the inclusion criteria. Results: 790 adult patients were evaluated, with a diagnosis of acute surgical abdomen in the indicated period, of which 53 patients corresponded to older adults, 30 female patients (56.60%) with a general average age of 71.33 years. The main cause of acute surgical abdomen in older adults was intestinal obstruction with 26 patients (49.06%). The main comorbidity was arterial hypertension (41.50%). 16.98% of the patients were complicated by sepsis (the most frequent complication) with mortality of 15.09% and more than half (54.71%)(AU)

Hematoma disecante del esófago a causa de abdomen agudo quirúrgico / Dissecting Hematoma of the Esophagus due to Acute Surgical Abdomen

RESUMEN El hematoma disecante del esófago es poco frecuente y solo existen pocos casos registrados en la literatura. Generalmente, se presenta después de un trauma asociado a procedimientos endoscópicos o de forma espontánea. Se describe clínicamente con la triada clásica de dolor torácico, odinofagia, disfagia o hematemesis. Se ha relacionado con un aumento rápido de la presión intraesofágica o un mecanismo de deglución anómala particularmente en presencia de trastornos de la hemostasia. La mayoría de los pacientes tienen un buen pronóstico pues resuelven con tratamiento conservador. Presentamos el caso clínico de un paciente con diagnóstico de hematoma disecante de esófago con ruptura a cavidad abdominal que causó hemoperitoneo importante. Se realiza una revisión del tema(AU)

ABSTRACT Dissecting hematoma of the esophagus is a rare condition and there are only few cases reported by the literature. Generally, it occurs after trauma associated with endoscopic procedures or spontaneously. It is described clinically with the classic triad of chest pain, odynophagia, dysphagia or hematemesis. It has been associated with a rapid increase in intra-esophageal pressure or an abnormal swallowing mechanism particularly in the presence of haemostasis disorders. Most patients have a good prognosis because they obtain a solution by means of a conservative treatment. We present the clinical case of a patient with a diagnosis of dissecting hematoma of the esophagus with rupture to the abdominal cavity causing significant hemoperitoneum. A review of the subject is carried out(AU)

Comportamiento de la presión intrabdominal en el abdomen agudo quirúrgico / Behavior of intrabdominal pressure in the acute surgical abdomen

Introducción: la presión intrabdominal se define como el resultado de la tensión presente dentro del espacio anatómico abdominal y es un elemento clave en todos los procesos fisiopatológicos que se desarrollan en el abdomen agudo o en sus complicaciones. Objetivo: evaluar el comportamiento de la presión intrabdominal medida por vía transvesical en los pacientes con abdomen agudo quirúrgico. Método: se realizó una investigación de carácter cuasiexperimental del comportamiento de la presión intrabdominal, en 200 enfermos con cuadros de abdomen agudo quirúrgico, atendidos en el Hospital General Docente Comandante Pinares, durante el periodo comprendido de abril 2011 a octubre 2015. Se controlaron variables como la edad, sexo, presión intrabdominal, frecuencia respiratoria y cardiaca, así como diagnóstico etiológico. Resultados: la mayor incidencia de pacientes pertenece al sexo masculino, predominando las edades 40 - 49 años. El diagnóstico etiológico que más se presentó fue la apendicitis aguda con un valor de presión intrabdominal normal, entre 1 y 9 cm de agua. El incremento de la PIA modificó la frecuencia respiratoria (polipnea) y la frecuencia cardiaca (taquicardia). Después de realizar la laparotomía y descompresión abdominal la PIA regresa a valores normales en el postoperatorio. Conclusiones: la medición de la presión intrabdominal constituye una herramienta más para el diagnóstico del abdomen agudo quirúrgico y sus complicaciones(AU)

Introduction: intrabdominal pressure is defined as the result of the tension present within the abdominal anatomical space and is a key element in all the pathophysiological processes developed in the acute abdomen or in its complications. Objective: to evaluate the behavior of intrabdominal pressure measured by the transvesical approach in patients with acute surgical abdomen. Method: a quasiexperimental investigation was performed on the behavior of intrabdominal pressure in 200 patients with surgical acute abdomen, cared at Comandante Pinares General Teaching Hospital, during the period from April 2011 to October 2015. Some variables were controlled, such as age, sex, intrabdominal pressure, respiratory and cardiac frequency, as well as etiological diagnosis. Results: the highest incidence of patients belongs to the male sex, with ages ranging from 40 to 49 years old. The most frequent etiologic diagnosis was acute appendicitis with normal intrabdominal pressure, between 1 and 9 cm of water. The increase of intrabdominal pressure altered respiratory rate (polypnea) and heart rate (tachycardia). After performing abdominal laparotomy and decompression the intrabdominal pressure returned to normal postoperative values. Conclusions: the measurement of intrabdominal pressure is one more tool for the diagnosis of acute surgical abdomen and its complications(AU)

Caracterización clínica de pacientes con urgencias quirúrgicas abdominales operados por cirugía videolaparoscópica / Clinical characterization of patients with abdominal surgical emergencies operated by videolaparoscopic surgery

Introducción: el abdomen agudo quirúrgico justifica el mayor porcentaje de intervenciones de urgencia a nivel mundial. El empleo de la cirugía videolaparoscópica en este tipo de afecciones es cada vez más frecuente. Objetivo: caracterizar a los pacientes operados de urgencia con esta modalidad. Métodos: estudio descriptivo y transversal de una serie constituida por 534 pacientes operados de urgencia con enfermedades abdominales agudas por cirugía videolaparoscópica en el Hospital Dr. Joaquín Castillo Duany de Santiago de Cuba, desde el primero de enero de 2013 hasta el 31 de diciembre de 2015. Las principales variables utilizadas fueron: diagnóstico operatorio, tiempo quirúrgico, tiempo de hospitalización, complicaciones, reintervención, causa de reintervención y estado al egreso. Se emplearon medidas de resumen como número, porcentaje y media aritmética. Resultados: las mujeres y los grupos etarios jóvenes fueron los porcentajes más representativos de la serie estudiada (55, 8 por ciento y 46, 6 por ciento respectivamente). La enfermedad más frecuente fue la apendicitis aguda) con 40,3 por ciento. El tiempo quirúrgico promedio fue de 34 minutos. Se egresó al 61,4 por ciento antes de las 24 horas y 1,8 por ciento de los pacientes presentaron complicaciones posoperatorias. Conclusiones: los porcentajes de complicaciones, corta estancia hospitalaria y baja letalidad, son similares a los referentes teóricos internacionales, indicando que la cirugía videolaparoscópica de urgencia es una alternativa útil en los pacientes con abdomen agudo quirúrgico(AU)

Introduction: Acute surgical abdomen justifies the highest percentage of emergency interventions worldwide. The use of videolaparoscopic surgery in these types of conditions is becoming more frequent. Objective: To characterize the emergency operated patients with this modality. Methods: Descriptive and cross-sectional study of a series consisting of 534 patients operated on with acute abdominal diseases by videolaparoscopic surgery at the Hospital Dr. Joaquín Castillo Duany from Santiago de Cuba, from January 1, 2013 to December 31, 2015. The main variables used were: operative diagnosis, surgical time, hospitalization time, complications, reoperation, cause of reoperation and state at discharge. Results: Women and younger age groups represented the most representative percentages of the series studied (55.8 percent and 46.6 percent respectively). The most frequent disease was acute appendicitis) with 40.3 percent. The average surgical time was 34.0 minutes. It was discharged the 61.4 percent before 24 hours and 1.8 percent of patients presented postoperative complications. Conclusions: The percentage of complications, short hospital stay and low lethality, are similar to the international theoretical references, indicating that emergency videolaparoscopic surgery is a useful alternative in patients with acute surgical abdomen(AU)

Oclusión intestinal por duplicación intestinal: diagnóstico y tratamiento en urgencias / Intestinal occlusion by intestinal duplication: diagnosis and treatment in the emergency

Las duplicaciones intestinales son anomalías congénitas; se han descrito a lo largo de todo el tracto digestivo con una presentación clínica inespecífica. Reportamos el caso clínico de un paciente de 83 años intervenido quirúrgicamente por una oclusión intestinal por duplicación intestinal del íleon terminal. Discutimos la presentación clínica, estudios de imagen, procedimiento quirúrgico y resultados del tratamiento. Revisamos la literatura actual pertinente por ser un hallazgo etiológico de oclusión intestinal poco frecuente.

The intestinal duplication are congenital abnormalities; have been described throughout the digestive tract with a nonspecific clinical presentation. We report the clinical case of a patient of 83 years underwent surgery for an intestinal occlusion by intestinal duplication of the terminal ileum. We discuss the clinical presentation, image studies, surgical procedure and results of treatment. We review the current literature relevant to be a finding etiological diagnosis of intestinal occlusion rare.

Criterio de los estudiantes de medicina y de expertos sobre el diagnóstico del abdomen agudo quirúrgico en el anciano / Criteria of the medical students and of experts on the diagnosis of the acute surgical abdomen in the elderly

Introducción: en Cuba, la expectativa de vida de la población se ha elevado considerablemente lo que hace necesaria la capacitación para un mejor desempeño de los profesionales de la salud. Objetivo: valorar los conocimientos adquiridos para el tratamiento del abdomen agudo quirúrgico en el adulto mayor en la carrera de Medicina. Métodos: se evaluaron grupos representativos con estudiantes de Medicina y docentes de la Facultad General Calixto García, mediante entrevistas de profundidad. Resultados: los estudiantes evaluaron de excelente o bien los conocimientos adquiridos sobre los síndromes abdominales agudos durante su rotación por cirugía, el 69,4 por ciento consideró que el programa de la asignatura incluye contenidos que posibilitan evaluar la urgencia abdominal del adulto mayor, el 18,4 por ciento entendió que el programa no brinda esa posibilidad y un 12,2 por ciento desconocía este hecho, el 90,8 por ciento de los estudiantes consideró que es necesaria una propuesta de modificación de los temas relacionados con el abdomen agudo en la asignatura Cirugía General, el 66,7 por ciento de los docentes opinaron que son insuficientes los contenidos impartidos en la asignatura relacionados con el tratamiento quirúrgico del abdomen agudo del anciano, para lograr las habilidades necesarias en los futuros profesionales, el 33,3 por ciento consideran que los contenidos son suficientes. Conclusión: el envejecimiento poblacional exige un mejor desempeño de los profesionales de la salud para elevar la calidad de vida del adulto mayor. El programa de la asignatura Cirugía General, que se imparte en la carrera de Medicina necesita una revisión curricular de acuerdo al contexto actual.

Introduction: life expectancy of the Cuban population has considerably risen, so the training of the health professionals is necessary to improve their performance. Objective: to assess the knowledge on treatment of acute surgical abdomen in the older adult in the medical studies. Methods: Representative groups of medical students and professors from Calixto Garcia medical school were evaluated through in-depth interviews. Results: the evaluation given by students about the acquired knowledge on the acute abdominal syndromes during their rotation in the surgery service was excellent or good. In the group, 69.4 percent stated that the subject curriculum included the elements that make the evaluation of abdominal emergency possible in the older adult whereas 18.4 percent did not and 12.2 percent ignored this fact; 90.8 percent of students deemed necessary a proposal of changing topics related to acute abdomen treatment in the general surgery subject and 66.7 percent of the professors expressed that in the present surgery curriculum, the contents taught as to the surgical treatment of the acute abdomen in the elderly was not enough for the future medical professionals to attain the necessary skills, but 33.3 percent considered these same contents as adequate. Conclusions: population aging demands better performance of health professionals to raise the quality of life of the older adult. The General Surgery subject curriculum taught in the medical studies needs to be revised in line with the present context.

Omental Torsion: A Review of Literature and Case Report.

Eitel first described omental torsion in 1899. Omental torsion is rarely diagnosed preoperatively, knowledge of this pathology is important to the surgeon as it mimics common acute surgical abdomen. For this reason in the absence of diagnosed preexisting abdominal pathology including cyst, tumors, foci of intra-abdominal inflammation, postsurgical wounds or scarring and hernia sacs, omental torsion can present a surprise. Exploratory laparotomy represents the diagnostic and definitive therapeutic procedure, presently laparoscopy is the first choice procedure.

Hepatoblastoma: causa inusual de abdomen quirúrgico agudo / Hepatoblastoma: unusual cause of acute surgical abdomen

Presentamos el caso clínico de un escolar de 6 años y 3 meses con hepatoblastoma y que se manifestó como un abdomen agudo quirúrgico, que es una presentación poco frecuente dentro de la incidencia de este tumor.

We present the clinical case of a school for 6 years and 3 months with hepatoblastoma and which manifested itself as a surgical acute abdomen, which is a rare presentation within the incidence of this tumor.

Multivariate Analysis of Physical and Laboratory Factors for Acute Abdomen Detection in Young Women Visiting the Emergency Department due to Non-Traumatic Abdominal Pain

PURPOSE: One of the most challenging groups of patients to diagnose that visit an emergency department (ED) is the female with acute abdominal pain. The causes of acute abdominal pain range from minor, self-limiting conditions to life-threatening disorders. Differential diagnosis for these patients is extensive and frequently requires multiple examinations and tests. This study analyzed the effectiveness of surgical abdomen detection using various physical examination and clinical laboratory methods, for young women reporting non-traumatic abdominal pain. METHODS: This study reviewed computed tomography (CT) reports for 232 women, aged 21~35 years old, who visited our ED for nontraumatic abdominal pain from July 2009 to June 2010. Bivariate analyses relating physical and laboratory methods used to detect surgical abdomen were conducted. A multivariate logistic regression model was then derived, with all variables in the final model significant at p<0.05. RESULTS: The number of patients who required surgical intervention was 88, while the number who did not require surgery was 144. Significant predictive methods for identifying surgical abdomen were maximal tenderness site (p=0.019), rebound tenderness (p=0.037), white blood cell count (p=0.012) and urine blood (p=0.037). The bootstrap result was identical in 1000 samples with a 95% confidence interval. CONCLUSION: Maximal tenderness site, rebound tenderness, and results indicating leukocytosis and hematuria were found to be independently valid factors for detection of surgical abdomen in young women evaluated in our ED due for nontraumatic abdominal pain.

Brazilian guidelines for the diagnosis and treatment of hereditary angioedema

Hereditary angioedema is an autosomal dominant disease characterized by edema attacks with multiple organ involvement. It is caused by a quantitative or functional deficiency of the C1 inhibitor, which is a member of the serine protease inhibitor family. Hereditary angioedema is unknown to many health professionals and is therefore an underdiagnosed disease. The causes of death from hereditary angioedema include laryngeal edema with asphyxia. The estimated mortality rate in patients in whom the disease goes undetected and who are therefore incorrectly treated is 25-40 percent. In addition to edema of the glottis, hereditary angioedema often results in edema of the gastrointestinal tract, which can be incapacitating. Patients with hereditary angioedema may undergo unnecessary surgical interventions because the digestive tract can be the primary or only organ system involved, thus mimicking acute surgical abdomen. It is estimated that patients with hereditary angioedema experience some degree of disability 20-100 days per year. The Experts in Clinical Immunology and Allergy of the "Associação Brasileira de Alergia e Imunopatologia -ASBAI" developed these guidelines for the diagnosis, therapy, and management of hereditary angioedema.