Reporte de caso. Abdomen agudo nutricional en el adulto mayor: apendagitis epiploica / Case report. Acute nutritional abdomen in the elderly: epiloic appendagitis

Se presentó un paciente de sexo masculino de 71 años de edad que consultó por un cuadro compatible con abdomen agudo médico de comienzo brusco. Refirió antecedentes de diabetes mellitus tipo 2, obesidad, dislipemia e hipertensión arterial. Al examen físico se encontró: afebril, presión arterial (PA) 128/75 mmHg; a la palpación del abdomen se halló un abdomen globoso, blando, depresible, doloroso en ambas fosas iliacas, signo de Mc Burney negativo, sin signos de re-acción peritoneal, catarsis y diuresis conservadas. Se solicitó una tomografía computada (TC) abdominal con con-traste oral y endovenoso (EV). La TC informó, a nivel del sigma sobre el borde antimesentérico, una imagen nodular de densi-dad grasa con halo hiperintenso y alteración tomodensitometría de la grasa adyacente, además de imágenes diverticulares no complicadas. Con el cuadro clínico del paciente y los hallazgos tomográficos se arribó al diagnóstico de apendagitis epiploica. Se inició tratamiento conservador con abordaje nutricional.

Colonic basidiobolomycosis with liver involvement masquerading as gastrointestinal lymphoma: a case report and literature review

Abstract Basidiobolomycosis is an unusual fungal skin infection that rarely involves the gastrointestinal tract. This study reported a 5-year-old boy with gastrointestinal basidiobolomycosis that had been misdiagnosed as gastrointestinal lymphoma. He was treated by surgical resection and a combination of posaconazole and amphotericin B deoxycholate with an acceptable response and no recurrence.

Pancreatico-Colonic Fistula-Demonstrated by Multidetector-Row CT

No abstract available.

Síndrome de Chilaiditi / Chilaiditi´s syndrome

A interposição permanente ou temporária do cólon, intestino delgado ou estômago no espaço hepatodiafragmático é conhecido como sinal de Chilaiditi, sendo geralmente assintomático. É evidenciado normalmente em um exame radiológico de rotina. A sua incidência é de 0,025% nos exames radiológicos em todas as idades, aumentando levemente nos pacientes maiores de 60 anos, sendo mais comuns em homens do que em mulheres, com uma relação de 4:1. A associação do sinal de Chilaiditi com sintomas como dor abdominal, náuseas, volvo intestinal, dor retroesternal, sintomas respiratórios, vômitos, distensão abdominal, obstrução ou suboclusão intestinal caracteriza a síndrome de Chilaiditi. No presente estudo, apresentamos um novo caso do sinal de Chilaiditi observado ocasionalmente ao exame radiológico de abdome (AU)

The permanent or temporary interposition of the colon, small intestine or stomach in between the liver and the diaphragm is known as Chilaiditi's sign, usually being asymptomatic. The condition is usually diagnosed in routine X-rays. Its incidence is 0.025% in radiological scans in all age groups, with a slight increase in patients over 60. It is more common in males than females in a ratio of 4:1. The association of Chilaiditi's sign with symptoms of abdominal pain, nausea, intestinal volvus, retrosternal pain, respiratory symptoms, vomiting, abdominal distension, intestinal obstruction or sub-occlusion characterizes the Chilaiditi syndrome. Here we report the case of Chilaiditi's sign as detected in abdominal X-rays (AU)

Colonoscopía virtual: realidad en un hospital público / Virtual colonoscopy: reality in a public hospital

Colon cancer is the third cause of death by cancer in Chile. Virtual CT colonoscopy (VC) is a non-invasive imaging technique in development. The most common indications of VC are screening of colonic polyp, incomplete conventional colonoscopy and staging of colorectal tumors. The objective of our study is to show our experience with this method in the Radiology Unit of Hospital Padre Hurtado. We reviewed 15 VC, corresponding to 15 patients (10 female and 5 male), with ages between 18 and 75. Six exams showed no significant findings (40%), 4 diverticular diseases (26,6%), 3 colon cancers (20%), and 2 familial polyposis (13,3%). VC proved to be an accesible method, well tolerated by the patients, less invasive than conventional colonoscopy and with no complications in our series. It also constitutes for us an excellent study method in patients where conventional colonoscopy is incomplete. We obtained an adecuate correlation with conventional colonosocopy, when this method was performed. Evaluation of the data obtained from VC requires a trained radiologist and, in some occasions, prolonged time for analysis and interpretation of the results.

El cáncer de colon es la tercera causa de muerte por cáncer en Chile. La colonoscopía virtual (CV) es una técnica de imagen no invasiva en desarrollo. Sus indicaciones habituales son: screening y detección de pólipos en el colon, colonoscopía convencional fallida o incompleta y, etapificación de tumores colorrectales. El objetivo de nuestro trabajo fue mostrar nuestra experiencia con este método diagnóstico en el Servicio de Imagenología del Hospital Padre Hurtado. Se revisaron 15 exámenes de CV que correspondieron a 15 pacientes (10 mujeres y 5 hombres), con edades entre 18 y 75 años. Los estudios mostraron 6 casos sin hallazgos patológicos significativos (40%), 4 enfermedades diverticulares (26,6%), 3 neoplasias de colon (20%) y 2 poliposis familiares (13,3%). La colonoscopía por TC resultó ser una técnica accesible, bien tolerada por los pacientes, menos invasiva que la fibrocolonoscopía y sin complicaciones. Además, para nosotros constituye un excelente método de estudio, sobretodo en aquellos pacientes en los cuales la fibrocolonoscopía resultó fallida o incompleta. Se obtuvo una buena correlación con colonoscopía convencional, cuando ésta se pudo realizar. El post-proceso de los datos requiere de entrenamiento del radiólogo y, algunas veces, tiempo prolongado para el análisis e interpretación de los resultados.

Chronic Recurrent Volvulus of the Colonic Splenic Flexure Associated with the Eventration of Left Diaphragm / 대한소화기학회지

The eventration of diaphragm is usually found incidentally on chest X-ray or sometimes presented as acute gastric volvulus. However, colonic volvulus on splenic flexure area complicated by diaphragmatic eventration is extremely rare. A 25 year old man complained of upper abdominal pain for three days. He had a history of brain injury during infant period, and had epilepsy and mental retardation. Plain chest X-ray showed left diaphragmatic eventration and marked dilatation of colon on splenic flexure area which had not been changed for last three years. Barium enema showed bird beak appearance on distal colon near the splenic flexure. Colonoscopic reduction failed. After decompression with rectal and nasogastric tubes, colonic volvulus was relieved. To prevent the recurrence of volvulus, we performed segmental resection of left colon including splenic flexure area and repaired the left diaphragmatic eventration. After the operation, the patient had no further recurrent episode of volvulus although ileus persisted.

Hérnia diafragmática congênita simulando tumor de cólon em paciente adulto jovem / Congenital diaphragmatic hernia simulating a colon tumor in young adult patient

Os autores apresentam um caso de hérnia diafragmática congênita diagnosticada em paciente adulto jovem durante transoperatório de laparotomia exploradora. Esta, realizada visando a esclarecer quadro clínico sugestivo de obstrução colônica por etiologia neoplásica. É apresentada, ainda, uma revisão sobre o tópico, avaliando-se as semelhanças entre o caso em questão e as informações de literatura (AU)

The authors present a case of congenital diaphragmatic hernia diagnosed in a young adult patient during exploratory laparotomy. Surgery was performed to elucidate clinical findings sugestive of large bowel obstruction due to colonic neoplasia. It Is still presented a review about this subject, evaluating the similarities between the case and the literature informations (AU)

Pneumobilia--clue to an unusual cause of diarrhea.

A 65-year lady presented with diarrhea and weight loss of six months duration. Initial evaluation suggested that malabsorption was the possible underlying mechanism for the diarrhea. Work up for the common etiologies of malabsorption was non-contributory. Presence of pneumobilia raised the suspicion of a bilio-enteric fistula, which was subsequently confirmed on barium enema and endoscopic cholangio-pancreaticography to be a cholecystocolic fistula. At surgery, a fistulous tract from the fundus of the gallbladder was found to be communicating with the hepatic flexure. Fistulectomy with cholecystectomy resulted in prompt relief of symptoms. Cholecystocolic fistula (CCF) is a rare biliary fistula with diverse presentation.

The Efficacy of Metallic Stent Placement in the Treatment of Colorectal Obstruction

DBJECTIVE: To evaluate the efficacy of newly designed covered and non-covered coated colorectal stents for colonic decompression. MATERIALS AND METHODS: Twenty-six patients, (15 palliative cases and 11 preoperative) underwent treatment for the relief of colorectal obstruction using metallic stents positioned under fluoroscopic guidance. In 24 of the 26, primary colorectal carcinoma was diagnosed, and in the remaining two, recurrent colorectal carcinoma. Twenty-one patients were randomly selected to receive either a type A or type B stent; for the remaining five, type C was used. Type A, an uncovered nitinol wire stent, was lightly coated to ensure structural integrity. Type B (flare type) and C (shoulder type) stents were polyurethane covered and their diameter was 24 and 26mm, respectively. The rates of technical success, clinical success, and complications were analyzed using the chi-square test, and to analyse the mean period of patency, the Kaplan-Meier method was used. RESULTS: Thirty of 31 attempted placements in 26 patients were successful, with a technical success rate of 96.8% (30/31) and a clinical success rate of 80.0% (24/30). After clinically successful stent placement, bowel decompression occurred within 1-4 (mean, 1.58+/-0.9) days. Five of six clinical failures involved stent migration and one stent did not expand after successful placement. In the preoperative group, 11 stents, one of which migrated, were placed in ten patients, in all of whom bowel preparation was successful. In the palliative group, 19 stents were placed in 15 patients. The mean period of patency was 96.25+/-105.12 days: 146.25+/-112.93 for type-A, 78.82+/-112.26 for type-B, and 94.25+/-84.21 for type-C. Complications associated with this procedure were migration (n=6, 20%), pain (n=4, 13.3%), minor bleeding (n=5, 16.7%), incomplete expansion (n=1, 3.3%), and tumor ingrowth (n=1, 3.3%). The migration rate was significantly higher in the type-B group than in other groups (p=0.038). CONCLUSION: Newly designed covered and non-covered metallic stents of a larger diameter are effective for the treatment of colorectal obstruction. The migration rate of covered stents with flaring is higher than that of other types. For evaluation of the ideal stent configuration for the relief of colorectal obstruction, a clinical study involving a larger patient group is warranted.

Volvulus of the splenic flexure of the colon

The definition of volvulus is an axial twist of a portion of the gastrointestinal tract along its mesentery. The involved bowel is obstructed partially or completely with a variable degree of arterial and venous occlusion. The colon is the most common site for volvulus. The splenic flexure is the least common site of colonic volvulus. We experienced a case of the volvulus of the splenic flexure. It will be the 30th case of the volvulus involving the splenic flexure in the English literature, to our knowledge. A 30-year-old woman was admitted due to abdominal pain and distention with vomiting. An emergency barium study revealed characteristic "bird beak" sign. Surgery was performed resecting the involved colon of splenic flexure. The result was excellent.

A case of pancreatico-colo-cutaneous fistula; management guided by endoscopic retrograde cholangio-pancreatography

A report of a 67-year-old man, who had been suffering from an enterocutaneous fistula after a left hemicolectomy due to colon cancer is presented. He had sudden intermittent upper abdominal pain and a high amylase level in the drainage fluid. The fistulogram showed a colocutaneous fistula with an abnormal cavity in the left upper quadrant. ERCP was performed to demonstrate the relationship between the pancreatic duct and the colocutaneous fistula connected with the abnormal cavity, and showed a pancreatico-colo fistula which was connected with the abnormal cavity. From the results of the above two studies, a diagnosis of the pancreatico-colocutaneous fistula could be drained, and a distal pancreatectomy, splenectomy and closing of the colonic opening were performed. After the operation, the patient was discharged without problem. We report herein a case of pancreaticocolocutaneous fistula which was confirmed by ERCP preoperatively and surgically treated successfully.