Vólvulo cecal: reporte de un caso / Cecal volvulus: a case report

El vólvulo cecal es una causa rara de abdomen oclusivo agudo. Cada año, aproximadamente 2,8-7,1 personas por millón se ven afectadas por esta patología. Se estima que el vólvulo cecal representa el 25-40% de todo el vólvulo del colon. Causa alrededor del 1-1,5% de las oclusiones intestinales en adultos. La mayoría de los pacientes presentan síntomas de hinchazón, estreñimiento, náuseas y vómitos. Hasta el 50% puede tener síntomas intermitentes antes de la torsión. Su baja prevalencia dificulta su diagnóstico preoperatorio, siendo diagnosticado frecuentemente durante la cirugía. Presentamos el caso de un hombre de 66 años que ingresa por dolor abdominal, cuyos métodos de imagen complementarios iniciales fueron diagnósticos de abdomen agudo oclusivo y finalmente durante la cirugía se observó un vólvulo cecal

The cecal volvulus is a rare cause of an acute occlusive abdomen. Each year, approximately 2.8-7.1 people per million are affected by this pathology. It is estimated that the cecal volvulus represents 25-40% of all the colon volvulus. Causing about 1-1.5% of intestinal occlusions in adults. Most patients have symptoms of bloating, constipation, nausea, and vomiting. Up to 50% may have intermittent symptoms before torsion. Its low prevalence hinders its preoperative diagnosis, being frequently diagnosed during surgery. We present a case of a 66-year-old man admitted for abdominal pain, whose initial complementary imaging methods were diagnostic of acute occlusive abdomen and finally a cecal volvulus was observed during surgery

Neumoperitoneo secundario a neumatosis intestinal masiva: un reporte de caso / Pneumoperitoneum secondary to massive intestinal pneumatosis: a case report

Introducción. La neumatosis intestinal se define como la presencia de quistes aéreos en la pared del tracto digestivo, a nivel submucoso o subseroso, que comprometen principalmente el intestino delgado. Las manifestaciones clínicas son inespecíficas y los hallazgos imagenológicos son fundamentales en el enfoque diagnóstico. El manejo puede ser médico o quirúrgico, dependiendo del compromiso intestinal y las complicaciones asociadas. Caso clínico. Hombre de 78 años, que ingresó por cuadro de dolor abdominal crónico, con hallazgos imagenológicos de neumoperitoneo. Al ser llevado a intervención quirúrgica se encontró neumatosis intestinal masiva del íleon, requiriendo resección intestinal. Resultado. El paciente presentó una evolución postoperatoria satisfactoria y fue dado de alta, sin complicaciones. Conclusión. La neumatosis intestinal es una enfermedad poco frecuente, que se presenta principalmente en hombres. La sospecha diagnóstica se confirma con imágenes tomográficas. Los pacientes candidatos para el manejo médico deben presentar causas con curso benigno, sin compromiso hemodinámico ni complicaciones. El manejo quirúrgico se reserva para pacientes con abdomen agudo o signos de sepsis.

Introduction. Intestinal pneumatosis is defined as the presence of air cysts in the wall of the digestive tract at the submucosal or subserosal level, mainly compromising the small intestine. The clinical manifestations of the disease are nonspecific, and the imaging findings are essential in the diagnostic approach. Management can be conservative and/or surgical depending on the intestinal compromise and associated complications. Clinical case. The following is the case of a 78-year-old man, who was admitted due to chronic abdominal pain with imaging findings of pneumoperitoneum. Patient underwent surgery and a massive ileum pneumatosis was found, requiring intestinal resection. Results. The patient ́s postoperative course was uneventful, and he was discharged without further complications. Conclusions. Intestinal pneumatosis is an uncommon disease, which mostly affect men population. Clinical suspicion of this condition should be confirmed with abdominal tomography. Candidates for medical management are those with benign course pathologies without hemodynamic compromise and/or complications. Surgical management should be reserved for patients with acute abdomen or sepsis.

Síndrome de Rapunzel asociado a perforación intestinal. Caso clínico / Rapunzel syndrome associated with intestinal perforation. Clinical case

Introducción. Los tricobezoares ocurren de forma frecuente en niñas y adolescentes, y se asocian a trastornos psicológicos como depresión, tricotilomanía o tricofagia. Caso clínico. Se presenta una paciente adolescente con síndrome de Rapunzel, con hallazgo adicional de perforación yeyunal debido al tricobezoar. Discusión. Dentro de las complicaciones de los tricobezoares se reporta invaginación intestinal (principalmente de yeyuno), apendicitis, obstrucción biliar, neumonía, pancreatitis secundaria y perforación, esta última como ocurrió en nuestra paciente. Conclusión. En pacientes mujeres adolescentes con dolor abdominal o abdomen agudo, se debe tener en cuenta el diagnóstico de síndrome de Rapunzel, así como sus probables complicaciones

Introduction. Trichobezoars occur frequently in young and adolescent girls, and are associated with psychological disorders such as depression, trichotillomania, or trichophagia. Clinical case. An adolescent patient with Rapunzel syndrome is presented, with an additional finding of jejunal perforation due to the trichobezoar. Discussion. Among the complications of trichobezoars, intussusception is reported (mainly of the jejunum), appendicitis, biliary obstruction, pneumonia, secondary pancreatitis, and perforation, the latter as occurred in our patient. Conclusion. In adolescent female patients with abdominal pain or acute abdomen, the diagnosis of Rapunzel syndrome should be taken into account, as well as its probable complications

Torsión primaria segmentaria del omento mayor: una causa infrecuente de abdomen agudo quirúrgico / Primary segmental torsion of the greater omentum: an uncommon cause of acute surgical abdomen

El abdomen agudo comprende un amplio grupo de enfermedades con alta incidencia en la práctica quirúrgica habitual. Se presenta el caso de un paciente masculino, de 23 años, con cuadro abdominal agudo, cuyo diagnóstico preoperatorio fue compatible con una apendicitis aguda; al efectuar la laparotomía exploratoria se constató torsión primaria y segmentaria del omento mayor. Esta es una afección de difícil diagnóstico preoperatorio, generalmente diagnosticada durante el acto quirúrgico porque fácilmente se confunde con otras enfermedades del abdomen agudo quirúrgico. Lo indicado en estos pacientes es la remoción del segmento involucrado por lo que se realizó omentectomía parcial y apendicectomía complementaria; el paciente presentó una evolución clínica favorable.

Acute abdomen comprises a wide group of diseases with a high incidence in routine surgical practice. We present a 23-year-old male patient with acute abdominal symptoms, whose preoperative diagnosis was compatible with acute appendicitis; primary and segmental torsion of the greater omentum was found when performing the exploratory laparotomy. This condition is difficult to diagnose preoperatively; it is generally evident during surgery because it is confused with other diseases of the acute surgical abdomen. The removal of the involved segment is indicated in these patients that is why partial omentectomy and complementary appendectomy were performed; the patient had a favourable clinical evolution.

Pancreatitis aguda: Puntos clave. Revisión argumentativa de la literatura / Acute pancreatitis: Key points. Argumentative review of the literature

Introducción. La pancreatitis aguda es una condición gastrointestinal común que se asocia a una importante morbimortalidad. Se estima que su incidencia es de 34 por cada 100.000 habitantes, afecta principalmente a adultos a partir de la sexta década de la vida y en nuestra región es debida en la mayoría de los casos a cálculos biliares. Métodos. Se hizo una revisión de los aspectos fundamentales de esta patología, común y potencialmente mortal. Resultados. El diagnóstico requiere del hallazgo de manifestaciones clínicas, aumento de las enzimas pancreáticas en suero y, en ocasiones, el uso de imágenes diagnósticas. Se puede clasificar en leve, moderada y severa, lo cual es fundamental para determinar la necesidad de tratamiento y vigilancia en una unidad de cuidados intensivos. Conclusión. En la actualidad los pilares de manejo de la pancreatitis aguda son la terapia temprana con líquidos, tratamiento del dolor, inicio precoz de la vía oral y resolución del factor etiológico desencadenante. En presencia de complicaciones o un curso severo de enfermedad, pueden requerirse manejo antibiótico e intervenciones invasivas

Introduction. Acute pancreatitis is a common gastrointestinal condition that is associated with significant morbidity and mortality. It is estimated that its incidence is 34 per 100,000 inhabitants, it mainly affects adults from the sixth decade of life, and in our region, most of the cases are secondary to gallbladder stones. Methods. We present a review of the fundamental aspects of this disease, common and potentially fatal. Results. Diagnosis requires finding clinical manifestations, increased serum pancreatic enzymes, and sometimes the use of diagnostic imaging. It can be classified as mild, moderate and severe, which is essential to determine the need for treatment and monitoring in an intensive care unit. Conclusion. Currently, the pillars of management of acute pancreatitis are early fluid therapy, pain management, early oral food intake, and resolution of the etiology. In the presence of complications or a severe course of the disease, antibiotic management and invasive interventions may be required

Apendicitis aguda en inicio de trabajo de parto. Reporte de caso / Acute appendicitis atthe onset of labor.A Case Report

Apendicitis aguda es la secuencia de inflamación, perforación, formación de absceso y peritonitis, causado con mayor frecuencia por obstrucción del lumen apendicular. La apendicitis es la patología quirúrgica no obstétrica más frecuente en el embarazo. Su incidencia puede ser variable y se presenta con mayor proporción durante el primer y segundo trimestre de gestación. Se presenta el caso de una paciente de 34 años de edad, con 36 semanas de gestación. Se diagnostica abdomen agudo quirúrgico y posible apendicitis aguda complicada. En sala de operaciones se confirma diagnóstico de apendicitis aguda complicada, revelando un plastrón apendicular y evolución favorable. Durante la gestación el diagnóstico de la apendicitis es difícil debido a los cambios anatómicos y fisiológicos que se producen, por lo que recalcamos la importancia de describir esta condición en el embarazo. Palabras Clave: apendicitis; embarazo; abdomen agudo.

Acute appendicitis is the sequence of inflammation, perforation, abscess formation and peritonitis, most frequently caused by obstruction of the appendicular lumen. Appendicitis is the most frequent non-obstetric surgical pathology in pregnancy. Its incidence can be variable and occurs with a greater proportion during the first and second trimester of pregnancy. The case of a 34-year-old patient with 36 weeks of gestation is presented. Surgical acute abdomen and possible complicated acute appendicitis are diagnosed. In the operating room, the diagnosis of acute appendicitis was confirmed, revealingan appendiceal plastron and favorable evolution. During pregnancy, the diagnosis of appendicitis is difficult due to the anatomical and physiological changes thatoccur, so we emphasize the importance of describing this condition during pregnancy. Key Words:appendicitis; pregnancy; acute abdomen.

Sensibilidad y especificidad de las escalas diagnósticas en la apendicitis aguda. Estudio prospectivo / Sensitivity and specificity of the diagnostic scales in acute appendicitis. Prospective study

La Apendicitis Aguda se manifiesta cuando existe inflamación del apéndice cecal, representando una de las más notables causas de abdomen agudo con pronóstico quirúrgico en el mundo. Existen sistemas de puntuaciones que se han generado para su comprobación, mediante técnicas no invasivas, de fácil aplicación y reproducción; destacando entre ellas las escalas de ALVARADO, RIPASA, AIR, entre otras. Objetivo: Comparar la sensibilidad y especificidad de las escalas AIR Vs. RIPASA para el diagnóstico de la Apendicitis Aguda en el Hospital General Nacional "Dr. Ángel Larralde", período enero 2020 ­ diciembre 2022. Materiales: Estudio observacional, descriptivo y evaluativo, prospectivo y de corte transversal. Muestra fue intencional no probabilística, cumpliendo con los criterios de inclusión. Para la recolección de datos, se empleó la observación directa como técnica y como instrumentos las escalas AIR y RIPASA. Resultados: Muestra conformada por 192 pacientes, sin predisposición de géneros. Sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo y exactitud diagnóstica AIR: 70%; 58,33%; 73,68%; 53,84%; 65,62%; RIPASA: 88,88%; 42,85%; 66,66%; 75%; 68,75%. Conclusiones: La exactitud diagnóstica para la escala de RIPASA fue ligeramente mayor que para AIR (68,75% vs. 65,62%), permitiendo afirmar que, en el grupo de estudio, resultó más conveniente la aplicación de la escala de RIPASA en pacientes sanos para el diagnóstico correcto de Apendicitis Aguda(AU)

Acute Appendicitis manifests when there is inflammation of the cecal appendix, representing one of the most notable causes of acute abdomen with surgical prognosis in the world. There are scoring systems that have been generated for verification, using non-invasive techniques that are easy to apply and reproduce; highlighting among them the scales of ALVARADO, RIPASA, AIR, among others.Objective : To compare the sensitivity and specificity of the AIR Vs. RIPASA scales for the diagnosis of Acute Appendicitis at the National General Hospital "Dr. Ángel Larralde", period January 2020 ­ December 2022. Materials: Observational, descriptive and evaluative, prospective and cross-sectional study. Sample was intentional, non-probabilistic, meeting the inclusion criteria. For data collection, direct observation was used as a technique and the AIR and RIPASA scales as instruments.Results : Sample made up of 192 patients, with no gender predisposition. Sensitivity, specificity, positive predictive value, negative predictive value, and AIR diagnostic accuracy: 70%; 58.33%; 73.68%; 53.84%; 65.62%; RIPASE: 88.88%; 42.85%; 66.66%; 75%; 68.75%.Conclusions : The diagnostic accuracy for the RIPASA scale was slightly higher than for AIR (68.75% vs. 65.62%), allowing us to affirm that, in the study group, the application of the RIPASA scale was more convenient in healthy patients for the correct diagnosis of Acute Appendicitis(AU)

Obstrucción intestinal por vólvulo de ciego en paciente con malrotación intestinal asociado a situs ambiguous / Intestinal obstruction due to volvulus of the cecum in a patient with intestinal malrotation associated with situs ambiguous

Introducción. La oclusión intestinal, completa o incompleta, es uno de los cuadros de abdomen agudo más frecuentes. Constituye entre 20 % y 35 % de los ingresos urgentes en las áreas quirúrgicas hospitalarias. Caso clínico. Se presenta el caso de un paciente con antecedente de carcinoma de próstata, que consultó con un cuadro de obstrucción intestinal y abdomen agudo. Se le diagnosticó vólvulo de ciego, mal rotación intestinal y situs ambiguous. El tratamiento quirúrgico del paciente fue exitoso. Conclusión. El conocimiento de estas condiciones patológicas es imprescindible para poder brindarle un correcto tratamiento quirúrgico y disminuir la mortalidad que pueden acarrear

Introduction. Complete or incomplete intestinal obstruction is one of the most frequent acute abdomen conditions. It constitutes between 20% and 35% of the urgent admissions of hospital surgical areas. Clinical case. We present a case of a patient with a history of prostate carcinoma, who began with clinical symptoms of intestinal obstruction and acute abdomen. He was diagnosed with volvulus of the cecum, intestinal malrotation, and situs ambiguous. Surgical treatment of the patient was successful. Conclusion. Knowledge of these pathological conditions is essential to be able to provide correct surgical treatment and reduce the mortality that these can lead to

Gravedad de colecistitis aguda en paciente lúpica con COVID-19 / Severity of acute cholecystitis in a lupus patient with COVID-19

Las enfermedades reumáticas constituyen un grupo de afecciones cuyo mecanismo patogénico se enfoca en la persistencia de un proceso inflamatorio que origina manifestaciones articulares y sistémicas. Aunque no es frecuente, en ocasiones el proceso inflamatorio genera complicaciones graves que requieren intervención quirúrgica como es el caso de la colecistitis aguda. Se presenta el caso de una paciente femenina de 36 años de edad, con diagnóstico de lupus eritematoso sistémico de 5 años de evolución que ingresa con COVID-19 y a los 6 días de hospitalización comienza con un cuadro franco de abdomen agudo que requirió intervención quirúrgica de urgencia. Se presenta el cuadro por la coexistencia de la enfermedad reumática, la infección por COVID-19 y el evento agudo secundario al proceso inflamatorio que causan ambas afecciones(AU)

Rheumatic diseases constitute a group of conditions whose etiopathogenic mechanism focuses on the persistence of an inflammatory process that generates joint and systemic manifestations. Although it is not frequent, sometimes the inflammatory process generates serious complications that require surgical intervention, as is the case with acute cholecystitis. The case of a 36-year-old female patient is presented, with a diagnosis of systemic lupus erythematosus of 5 years of evolution who was admitted due to symptoms compatible with COVID-19 and after 6 days of hospitalization she began with a clear picture of acute abdomen that required emergency surgical intervention. The picture is presented due to the coexistence of rheumatic disease, COVID-19 infection and the acute event secondary to the inflammatory process that both conditions generate(AU)

Bezoar. A propósito de un caso / Bezoar. A case report

Introducción: la obstrucción del intestino delgado (SBO) es una presentación común en cualquier unidad de cirugía general. Sin embargo, su diagnóstico y manejo preoperatorio a menudo pueden ser difíciles debido a sus múltiples causas. La obstrucción intestinal pequeña secundaria a la impactación de bezoar es considerablemente infrecuente, con una frecuencia reportada de aproximadamente 0.4% a 4%. La incidencia de bezoar como causa de obstrucción intestinal es baja. El método complementario con la mayor sensibilidad y especificidad continúa siendo CT del abdomen y la pelvis con contraste oral e intravenoso. El tratamiento debe ser quirúrgico. Modificar la dieta junto con el manejo de los trastornos es la mejor forma de prevención.

Introduction: Small Bowel Obstruction (SBO) is a common presentation in any general surgery unit. However, its diagnosis and preoperative management can often be difficult due to its multiple causes. Small bowel obstruction secondary to bezoar impaction is considerably uncommon, with a reported frequency of about 0.4% to 4%. The incidence of bezoar as a cause of intestinal obstruction is low. The complementary method with the highest sensitivity and specificity continues to be CT of the abdomen and pelvis with oral and intravenous contrast. Treatment must be surgical. Modifying the diet along with managing the disorders is the best form of prevention

Apendicitis aguda traumática. Reporte de caso / Traumatic acute appendicitis. A case report

RESUMEN Se presenta el caso de un hombre de 37 años sin antecedentes de dolor abdominal, o padecimiento de alguna enfermedad, que recibió un golpe directo con objeto romo (bate de béisbol) en el cuadrante inferior derecho del abdomen. Asistió a consulta con dolor abdominal selectivo en fosa ilíaca derecha, de aproximadamente 29 horas de evolución, que comenzó después de un trauma abdominal cerrado. Al examen físico se constata signo de Blumberg positivo, punto de McBurney doloroso con hiperestesia cutánea y cierto grado de defensa muscular. En los exámenes complementarios se comprueba leucocitosis y predominio de neutrófilos, con desviación a la izquierda. Se decidió realizar laparotomía exploratoria y se constató en el transoperatorio apendicitis aguda flegmonosa. La etiología traumática en la apendicitis aguda es un diagnóstico por exclusión que debe ser considerado en condiciones específicas.

ABSTRACT We present a 37 year-old man with no antecedents of abdominal pain, or suffering from other illnesses who received a direct blow with a blunt object (baseball bat) in the right lower quadrant of the abdomen. The patient was seen in consultation with a selective abdominal pain in his right iliac fossa, with approximately 29 hours of evolution that began after a closed abdominal trauma. A positive Blumberg sign, a painful McBurney's point with cutaneous hyperesthesia and certain grade of muscular defense were verified on physical exam. Leukocytosis and prevalence of neutrophils with left deviation were proven on complementary exams. An exploratory laparotomy was decided and a phlegmonous acute appendicitis was verified during the periprocedural period. Traumatic etiology in acute appendicitis is a diagnosis for exclusion that should be considered under specific conditions.

Apendagitis epiploica en paciente con la COVID-19 / Epiploic appendagitis in a COVID-19 patient

Introducción: La apendagitis epiploica es un proceso inflamatorio producido por daño estructural debido a torsión que genera zonas hemorrágicas o isquémicas, o bien por una inflamación circundante que afecta los apéndices y genera infarto o necrosis grasa. Objetivo: Describir las características clínico-imagenológicas de un paciente con diagnóstico de apendangitis epiploica en el curso de su infección por COVID-19. Caso clínico: Paciente blanco, masculino de 48 años, con diagnóstico de COVID-19, que comenzó con cuadro de dolor abdominal difuso de 8 días de evolución, que se intensificó en las últimas 24 horas a nivel de la fosa iliaca derecha, acompañado de fiebre, estado nauseabundo y toma del estado general. Se le realiza rayos X de abdomen simple encontrándose íleo regional y tomografía axial computarizada con doble contraste, se halló el signo del halo hiperdenso compatible con apendangitis epiploica. Se decide tratamiento conservador. Se tiene en cuenta la comorbilidad con la COVID-19. Se le realizó seguimiento clínico-imagenológico con evolución favorable con la terapéutica impuesta. Desarrollo: La apendagitis epiploica es una causa de dolor abdominal infrecuente, que puede simular un cuadro de abdomen agudo. La evolución de esta enfermedad puede ser autolimitada por lo que se recomienda el manejo conservador. Conclusiones: Con la presente investigación se exponen los hallazgos clínicos-imagenológicos de la apendagitis epiploica, entidad poco conocida, que puede imitar un abdomen agudo quirúrgico y conllevar a una innecesaria intervención quirúrgica(AU)

Introduction: Epiploic appendagitis is an inflammatory process caused by structural damage due to torsion that generates hemorrhagic or ischemic areas, or by surrounding inflammation that affects the appendages and generates infarction or fat necrosis. Objective: describe the clinical-imaging characteristics of a patient diagnosed with epiploic appendangitis in the course of his COVID-19 infection. Clinical case report: We report the case of a white, 48-year-old male patient, diagnosed with COVID-19, who began with an 8-day history of diffuse abdominal pain, which intensified in the last 24 hours at the level of the right iliac fossa, accompanied by fever, nauseous state and taking of the general state. Simple abdominal X-rays were performed, finding regional ileus and computed tomography with double contrast, a hyperdense halo sign compatible with epiploic appendangitis was found. Conservative treatment is decided. Comorbidity with COVID-19 is taken into account. Clinical-imaging follow-up was carried out with favorable evolution with the imposed therapy. Development: Epiploic appendagitis is an infrequent cause of abdominal pain, which can simulate an acute abdomen. The evolution of this disease can be self-limited, so conservative management is recommended. Conclusions: This research disclosures the clinical-imaging findings of epiploic appendagitis, a little-known entity that can mimic an acute surgical abdomen and lead to unnecessary surgical intervention(AU)

Surgical approach of megacecum secondary to descending colon tumor / Abordagem cirúrgica de megaceco secundário a tumor de cólon descendente

Intestinal obstruction is the most frequent clinical manifestation of colon tumors, most of which are located in the descending and recto-sigmoid colon. Emergency bowel obstruction surgery is associated with high mortality and morbidity risks and the ideal approach remains controversial. Multi-stage procedures and the use of stents as bridges for surgery are promising options. A case of a 61-year-old patient with an acute obstructive abdomen secondary to colorectal neoplasm is presented, with emphasis on its diagnosis and treatmen (AU)

Obstrução intestinal é a manifestação clínica mais frequente de tumores de cólon sendo esses, em sua maioria, localizados no cólon descendente e reto-sigmoide. A cirurgia de emergência para obstrução intestinal é associada a altos riscos de mortalidade e de morbidade e a abordagem ideal permanece controversa. Procedimentos em vários estágios e o uso de stents como ponte para cirurgia são opções promissoras. É apresentado um caso de paciente de 61 anos, com abdome agudo obstrutivo secundário à neoplasia colorretal, com ênfase em seu diagnóstico e tratamento (AU)

Infarto omental como causa inusual de dolor abdominal: un reporte de caso / Omental infarction as an unusual cause of abdominal pain: a case report

Resumen El infarto omental es una causa infrecuente de abdomen agudo y de etiología no muy conocida, su presentación clínica inespecífica puede simular otras patologías más comunes, lo que hace su diagnóstico un reto clínico. Se presenta el caso de una mujer de 33 años que asiste a urgencias con clínica de dolor abdominal agudo, atípico, con hallazgos ecográficos sugestivos de apendicitis aguda, sin embargo, por la clínica inusual se realizó tomografía axial computarizada (TAC) de abdomen, con reporte sugestivo de diverticulitis. Ante la no concordancia clínica ni imagenológica, la paciente fue llevada a laparoscopia diagnóstica, como hallazgo intraoperatorio se evidenció isquemia del epiplón como único hallazgo, por lo cual se realizó omentectomía parcial. Siendo este un caso de importancia clínica debido a que el infarto omental debe considerarse entre los diagnósticos diferenciales de dolor abdominal agudo, en especial cuando la presentación es atípica y se han excluido las patologías más frecuentes. MÉD.UIS.2022;35(1): 43-8.

Abstract Omental infarction is an uncommon cause of acute abdomen and its etiology is not well known. Its nonspecific clinical presentation can simulate bibr more common pathologies which makes its diagnosis a clinical challenge. We present the case of a 33-year-old woman who attends the emergency room with symptoms of acute, atypical abdominal pain, ultrasound findings were suggestive of acute appendicitis, however, due to unusual symptoms, a computerized axial tomography (CT) of the abdomen was performed, with a suggestive report of diverticulitis. Given the clinical and imagenologycal findings mismatch, the patient underwent to diagnostic laparoscopy where omentum ischemia was evidenced as the only finding, partial omentectomy was performed. This is a case of clinical importance because the omental infarction should be considered among the differential diagnoses of acute abdominal pain, especially when the presentation is atypical and the most frequent pathologies have been excluded. MÉD.UIS.2022;35(1): 43-8.

Terapia de presión negativa para el manejo de abdomen catastrófico secundario a íleo biliar / Negative Pressure Therapy for Managing Catastrophic Abdomen following Gallstone Ileus

Introducción: El abdomen catastrófico o abdomen hostil es una entidad quirúrgica de gran importancia por la pérdida de los distintos espacios entre los órganos de la cavidad abdominal y las estructuras de la cavidad abdominal. Estas alteraciones producen cambios anatómicos grandes por un síndrome adherencial severo. Objetivo: Demostrar la presentación de un abdomen catastrófico posterior a manejo de íleo biliar en un paciente adulto. Caso clínico: Paciente masculino de 43 años que producto de un abdomen agudo obstructivo por íleo biliar evolucionó tórpidamente en otra casa asistencial. Se realizaron 3 intervenciones quirúrgicas, hasta llegar a nuestra casa asistencial donde se le trata de manera multidisciplinaria e integral. Estuvo 120 días hospitalizado y se le realizó 5 intervenciones quirúrgicas para aplicación y recambio de terapia de presión negativa abdominal abierta (ABThera). Durante la última intervención al encontrar una cavidad limpia y sin fugas se realiza gastroentero anastomosis en Y de Roux con una buena evolución clínico-quirúrgica hasta el alta, con seguimiento dos meses posteriores por consulta externa. Conclusiones: El abdomen catastrófico es un reto para el manejo por los cirujanos porque se requiere aparte de un vasto conocimiento también el apoyo de otras especialidades para poder combatir esta entidad(AU)

Introduction: Catastrophic abdomen or hostile abdomen is a surgical entity of great significance due to the loss of the different spaces between organs and the structures of the abdominal cavity. These alterations produce major anatomical changes due to a severe adhesive syndrome. Objective: To show the presentation of a catastrophic abdomen following gallstone ileus management in an adult patient. Clinical case: A 43-year-old male patient who, as a consequence of an acute obstructive abdomen due to gallstone ileus, had a torpid evolution into another care facility. Three surgical interventions were performed before he arrived at our care facility, where he was treated in a multidisciplinary and comprehensive way. He was hospitalized for 120 days and underwent five surgical interventions for application and replacement of the open abdomen negative pressure therapy (ABThera). During the last intervention, upon finding a clean cavity without leaks, a Roux-en-Y gastroenteric anastomosis was performed, with a good clinical-surgical evolution until discharge and follow-up of two months thereafter in the outpatient clinic. Conclusions: Catastrophic abdomen is a challenge to be managed by surgeons because it requires, apart from vast knowledge, the support of other specialties to combat this entity(AU)

Abordagem cirúrgica de megaceco secundário a tumor de cólon descendente / Surgical approach of megacecum secondary to descending colon tumor

RESUMO: Obstrução intestinal é a manifestação clínica mais frequente de tumores de cólon sendo esses, em sua maioria, localizados no cólon descendente e reto-sigmoide. A cirurgia de emergência para obstrução intestinal é associada a altos riscos de mortalidade e de morbidade e a abordagem ideal permanece controversa. Procedimentos em vários estágios e o uso de stents como ponte para cirurgia são opções promissoras. É apresentado um caso de paciente de 61 anos, com abdome agudo obstrutivo secundário à neoplasia colorretal, com ênfase em seu diagnóstico e tratamento. (AU)

ABSTRACT: Intestinal obstruction is the most frequent clinical manifestation of colon tumors, most of which are located in the descending and recto-sigmoid colon. Emergency bowel obstruction surgery is associated with high mortality and morbidity risks and the ideal approach remains controversial. Multi-stage procedures and the use of stents as bridges for surgery are promising options. A case of a 61-year-old patient with an acute obstructive abdomen secondary to colorectal neoplasm is presented, with emphasis on its diagnosis and treatment. (AU)

Effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen: a prospective randomized controlled study / 中国当代儿科杂志

OBJECTIVES@#To study the effect of somatostatin on postoperative gastrointestinal function and stress level in children with acute abdomen.@*METHODS@#A total of 102 children with acute abdomen who underwent surgery in Xuzhou Children's Hospital from August 2019 to June 2021 were enrolled as subjects and were randomly divided into an observation group and a control group, with 51 children in each group. The children in the control group were given conventional treatment such as hemostasis and anti-infective therapy after surgery, and those in the observation group were given somatostatin in addition to conventional treatment. Peripheral blood samples were collected from both groups before surgery and on days 1 and 5 after surgery. The two groups were compared in terms of the serum levels of endothelin-1 (ET-1), adrenocorticotropic hormone (ACTH), cortisol, gastrin, and motilin, postoperative recovery, and the incidence rate of complications.@*RESULTS@#There was no significant difference in the serum levels of ET-1, ACTH, cortisol, gastrin, and motilin between the two groups before surgery (P>0.05). Compared with the control group, the observation group had significantly lower serum levels of ET-1, ACTH, and cortisol on days 1 and 5 after surgery (P<0.05) and significantly higher levels of motilin and gastrin on day 5 after surgery (P<0.05). Compared with the control group, the observation group had significantly shorter time to first passage of flatus, first bowel sounds, and first defecation after surgery, as well as a significantly shorter length of hospital stay (P<0.05). The incidence rate of complications in the observation group was significantly lower than that in the control group (6% vs 24%, P<0.05).@*CONCLUSIONS@#In children with acute abdomen, somatostatin can significantly reduce postoperative stress response, improve gastrointestinal function, and reduce the incidence rate of complications, thereby helping to achieve a good prognosis.

Etiology of ascites in 165 children / 中国当代儿科杂志

OBJECTIVES@#To study the etiology and clinical features of children with ascites, so as to provide a basis for the diagnosis and treatment of ascites in children.@*METHODS@#The medical data of the children with ascites, who were hospitalized from January 1, 2010 to December 31, 2019, were retrospectively reviewed.@*RESULTS@#Among the 165 children with ascites, the male/female ratio was 1.53:1, and the mean age of onset was (6±4) years. The causes of ascites included surgical acute abdomen (39 children, 23.6%), infectious diseases (39 children, 23.6%), neoplastic diseases (27 children, 16.4%), hepatogenic diseases (18 children, 10.9%), pancreatitis (10 children, 6.1%), cardiogenic diseases (8 children, 4.8%), rheumatic immune diseases (6 children, 3.6%), and nephrogenic diseases (5 children, 3.0%). According to the age of onset, there were 33 infants, 24 young children, 30 preschool children, 41 school-aged children, and 37 adolescents. Surgical acute abdomen and hepatogenic diseases were the main causes of ascites in infants (P<0.05). Neoplastic disease was the leading cause in young children (P<0.05). Infectious diseases were the most common cause in adolescents (P<0.05).@*CONCLUSIONS@#Surgical acute abdomen, infectious diseases, neoplastic diseases, and hepatogenic diseases are the common causes of ascites in children, and there are some differences in the leading cause of ascites between different age groups.