Tuberculosis abdominal en pediatría: presentación de un caso / Abdominal tuberculosis in pediatrics: A case report

La tuberculosis es una enfermedad infectocontagiosa cuya forma de presentación más frecuente es la pulmonar; la afectación abdominal es poco frecuente, por lo que su diagnóstico continúa siendo un desafío. Las manifestaciones clínicas de la tuberculosis abdominal así como sus hallazgos en el examen físico suelen ser inespecíficos y, en muchas ocasiones, similares a los de otras patologías, por lo que es fundamental considerarla entre los diagnósticos diferenciales. Se presenta el caso clínico de un paciente de sexo masculino, de 15 años de edad, hospitalizado por un síndrome febril prolongado asociado a dolor abdominal, diarrea, sudoración nocturna y pérdida de peso

Tuberculosis is an infectious disease which most commonly compromises the respiratory system, whereas abdominal involvement is rare, thus its diagnosis is a challenge. The clinical manifestations of abdominal tuberculosis as well as its physical examination findings are usually non-specific and, frequently, similar to those of other diseases, so it is critical to consider abdominal tuberculosis among the differential diagnoses. Here we report the clinical case of a 15-year-old male patient hospitalized for a prolonged febrile syndrome associated with abdominal pain, diarrhea, night sweats, and weight loss.

Causa rara de dolor abdominal recurrente; coexistencia del síndrome de Wilkie y el síndrome del cascanueces / A rare cause of recurrent abdominal pain; the coexistence of Wilkie's syndrome and nutcracker syndrome

El síndrome del cascanueces es un síndrome que presenta síntomas clínicos como hematuria, proteinuria ortostática, congestión pélvica, varicocele del lado izquierdo, hipertensión y dolor en fosa renal. Estos síntomas se producen por la compresión de la vena renal izquierda entre la aorta y la arteria mesentérica superior. En el síndrome de Wilkie, la tercera porción del duodeno está comprimida entre la arteria mesentérica superior y la aorta abdominal, lo que provoca diversos síntomas gastrointestinales. La coexistencia de estos dos síndromes constituye una afección rara y se incluye como casos clínicos en la bibliografía. En este artículo, se presentan los resultados clínicos y radiológicos de un paciente de 17 años que presentaba dolor abdominal recurrente debido al síndrome de Wilkie, acompañado del síndrome del cascanueces que le provocaba proteinuria, por lo que el paciente fue derivado a los consultorios externos de reumatología pediátrica con un diagnóstico preliminar de fiebre mediterránea familiar.

Nutcracker syndrome is a syndrome that has clinical symptoms such as hematuria, orthostatic proteinuria, pelvic congestion, left-sided varicocele, hypertension, and flank pain. These symptoms occur because of the compression of the left renal vein between the aorta and the superior mesenteric artery. In Wilkie's syndrome, the third part of the duodenum is compressed between the superior mesenteric artery and the abdominal aorta, causing various gastrointestinal symptoms. The coexistence of these two syndromes is a rare condition and is included as case reports in the literature. This article presents the clinical and radiological results of a 17-year-old male patient who had recurrent abdominal pain due to Wilkie's syndrome, which was accompanied by nutcracker syndrome that caused proteinuria, and for this reason, the patient was referred to the Pediatric Rheumatology outpatient clinic with a preliminary diagnosis of familial Mediterranean fever.

Oclusión intestinal mecánica secundaria a hernia de Littré / Mechanical Intestinal Occlusion Secondary to Littré's Hernia

Introducción: La hernia de Littré se define como la presencia de un divertículo de Meckel en cualquier orificio herniario. Se han reportados muy pocos casos en la literatura por su frecuencia tan baja referida al 2 por ciento de la población general. Objetivo: Reportar y compartir el tratamiento exitoso de un caso clínico poco frecuente de oclusión intestinal mecánica por hernia de Littré. Caso clínico: Se trata de un paciente masculino, de 69 años de edad, raza blanca y con antecedentes de hipertensión arterial hace siete años, para lo que lleva tratamiento regular con captopril. Acudió al Servicio de Urgencias de Cirugía general del Hospital Clínico Quirúrgico Docente "Lucía Íñiguez Landín" por presentar dolor abdominal tipo cólico localizado difusamente, de moderada intensidad, sin irradiación precisa y acompañado de dos vómitos biliosos de poca cantidad, además de parada de la emisión de gases y heces fecales dos días antes, por lo que se ingresó para tratamiento quirúrgico urgente con diagnóstico de oclusión intestinal mecánica. Conclusiones: El diagnóstico preoperatorio de la hernia de Littré es poco probable, sobre todo si se acompaña de oclusión intestinal por lo que casi siempre es transoperatorio. El tratamiento quirúrgico del divertículo depende del estado inflamatorio y vascular(AU)

Introduction: Littré's hernia is defined as the presence of a Meckel's diverticulum in any hernial orifice. Very few cases have been reported in the literature because of its very low frequency, referred to as of 2 percent of the general population. Objective: To report and share the successful management of a rare clinical case of mechanical intestinal occlusion due to Littré's hernia. Clinical case: This is the case of a 69-year-old white male patient with a history of arterial hypertension for seven years, for which he has been receiving regular treatment with captopril. He went to the general surgery emergency department of Lucía Íñiguez Landín Clinical Surgical Teaching Hospital for presenting diffusely localized colicky abdominal pain, of moderate intensity, without precise irradiation and accompanied by two small amounts of bilious vomiting, in addition to stopping gas and stool emission two days earlier, for which he was admitted for urgent surgical treatment with a diagnosis of mechanical intestinal occlusion. Conclusions: The preoperative diagnosis of Littré's hernia is unlikely, especially if accompanied by intestinal occlusion, a reason why it is almost always transoperative. The surgical treatment of the diverticulum depends on the inflammatory and vascular status(AU)

Resolución laparoscópica de un caso de "candy cane" en un postoperatorio de by pass gástrico / Laparoscopic resolution of a case of "candy cane" in a postoperative period of gastric bypass / Resolução laparoscópica de um caso de "candy cane" em pós-operatório de bypass gástrico

El by pass gástrico (BPG) es una técnica de cirugía bariátrica de probada eficacia en el control de la obesidad y la resolución de enfermedades asociadas, como diabetes e hipertensión. El dolor abdominal en el postoperatorio alejado del BPG es un verdadero desafío, y exige para su diagnóstico etiológico comprender la técnica quirúrgica y las posibles causas que originan el dolor. Las principales causas de dolor son la úlcera de neoboca, las hernias internas (por el espacio de Petersen o la brecha mesentérica), la litiasis vesicular sintomática y el síndrome del "bastón de caramelo" (o "Candy Cane syndrome" por su nombre anglosajón). El mismo resulta de una excesiva longitud del cabo yeyunal ciego del asa alimentaria, luego de la anastomosis gastro yeyunal. Cuando mide más de 4 cm puede llenarse de alimentos, actuando como una bolsa o reservorio, generando dolor, náuseas o vómitos. El diagnóstico surge de la clínica y un estudio contrastado que demuestre la longitud excesiva del extremo del asa alimentaria. El tratamiento es quirúrgico y la desaparición de los síntomas confirma el diagnóstico.

Acute Hepatitis in a Pediatric Patient with COVID -19: Case Report / Hepatitis Aguda en un paciente pediátrico con COVID-19

COVID-19 typically courses with mild clinical manifestations; however, a pediatric patient might get severe sequelae and complications when there is an infection. There is no information about liver complications due to COVID-19 in children in Mexico. This case report will set a precedent about timely diagnosis for hepatitis as a complication for COVID-19 disease in young patients in Mexico. Clinical case: A 12-years-old man has intermittent generalized abdominal pain misdiagnosed and treated for irritable bowel syndrome 3 days prior. The abdominal pain stayed, and a day after the patient vomited 3 times (each one after every meal). The patient started with orangish urine, weakness, fatigue and hyporexia 1 day prior to admission. The day of the admittance, a COVID-19 RT-PCR test was performed, giving a positive result. Once he was admitted, laboratory tests were made, showing an increase of liver enzyme levels, showing liver disease as a complication for the viral infection. Conclusion: Pediatrics patients might get Hepatitis due to COVID-19. In a patient with abdominal pain or other liver disease symptoms while coursing with the virus or even after the infection, further investigation must be made.

El COVID-19 típicamente cursa con manifestaciones clínicas leves, sin embargo, un paciente pediátrico puede presentar secuelas y complicaciones graves cuando existe una infección. No hay información sobre complicaciones hepáticas por COVID-19 en niños en México. Este reporte de caso sentará un precedente sobre el diagnóstico oportuno de hepatitis como complicación de la enfermedad COVID-19 en pacientes jóvenes en México. Caso clínico: Varón de 12 años con dolor abdominal generalizado intermitente mal diagnosticado y tratado por colon irritable 3 días antes. El dolor abdominal se mantuvo, y al día siguiente el paciente vomitó 3 veces (cada una después de cada comida). El paciente comenzó con orina anaranjada, debilidad, fatiga e hiporexia 1 día antes de su ingreso. El día del ingreso se le realizó una prueba de RT-PCR de COVID-19 dando positivo. Una vez que ingresó, se realizaron exámenes de laboratorio que mostraron un aumento de los niveles de enzimas hepáticas, lo que mostró una enfermedad hepática como complicación de la infección viral. Conclusión: Los pacientes pediátricos pueden contraer hepatitis por COVID-19. En un paciente con dolor abdominal u otros síntomas de enfermedad hepática mientras cursa con el virus o incluso después de la infección, se debe realizar una investigación adicional.

Teratoma ovariano como causa de dor abdominal em criança na idade pré-escolar / Ovarian teratoma as a cause of abdominal pain in preschool children

Introdução: Os tumores ovarianos, raros na infância, apresentam maior incidência entre 8 e 9 anos, tendo pico aos 19 anos. A sintomatologia principal manifesta-se por dor abdominal, massa palpável, febre, constipação e mais raramente polaciúria e disúria. Os teratomas ovarianos maduros embora sejam neoplasias majoritariamente benignas, se malconduzidas, podem evoluir para emergências cirúrgicas. Objetivo: Analisar o teratoma ovariano maduro como possível etiologia de dor abdominal crônica em pacientes pediátricos. Relato de Caso: Criança, 2 anos e 9 meses, levada ao atendimento médico com relato de dor abdominal crônica, 3 meses de evolução, com períodos de agudização, de forte intensidade, associada à disúria e polaciúria conduzida como principal suspeita infecção do trato urinário (ITU). A partir da clínica compatível, associado a leucocitúrias, mesmo não havendo crescimento bacteriano nas culturas, devido à recorrência do quadro, seguiu-se a propedêutica adequada de investigação de ITU de repetição, através do rastreio de má formações das vias urinárias. O ultrassom abdominal total com dinâmica do trato urinário constatou presença de volumosa formação expansiva originada provavelmente em ovário esquerdo. Estendida a pesquisa diagnóstica foi realizada tomografia computadorizada do abdome e pelve com achados sugestivos de teratoma ovariano esquerdo, exercendo comportamento expansivo local com desvio e compressão de estruturas anatômicas circunvizinhas. Com a hipótese diagnóstica evidenciada foi encaminhada à cirurgia pediátrica e oncologia para tratamento adequado, com realização de ooforectomia e seguimento clínico. Conclusão: Importância da propedêutica adequada para casos de dor abdominal crônica em pacientes pediátricos devido à extensão de possíveis diagnósticos diferenciais.

Introduction: Ovarian tumors, rare in childhood, have a higher incidence between 8 and 9 years, peaking at 19 years. The main symptomatology is manifested by abdominal pain, palpable mass, fever, constipation, and more rarely polaciuria and dysuria. Mature ovarian teratomas although they are mostly benign neoplasms, if poorly conducted, they can progress to surgical emergencies. Objective: To analyze mature ovarian teratoma as a possible etiology of chronic abdominal pain in pediatric patients. Case Report: Child, 2 years and 9 months, taken to medical care with report of chronic abdominal pain, three months of evolution, with periods of sharpness, of strong intensity, associated with dysuria and polaciuria and primary suspected urinary tract infection (UTI). From the compatible clinic, associated with leukocytes, though there is no bacterial growth in the cultures, due to the recurrence of the condition, appropriate propaedeutic investigation of repeat UTI was followed by screening for urinary pathway malformations. Total abdominal ultrasound with urinary tract dynamics was requested, which that found the presence of a large expansive formation probably originating in the left ovary. Extended diagnostic research, the computed tomography of the abdomen and pelvis was performed with findings suggestive of left ovarian teratoma exerting local expansive behavior with deviation and compression of surrounding anatomical structures. With the diagnostic hypothesis evidenced, she was referred to pediatric surgery and oncology for appropriate treatment with oophorectomy and clinical follow-up. Conclusion: Importance of adequate propaedeutics for cases of chronic abdominal pain in pediatric patients due to the extent of possible differential diagnoses.

Application of ultrasound-guided endoscopic retrograde appendicitis therapy in children with appendix-related chronic abdominal pain / 中国当代儿科杂志

OBJECTIVES@#To study the clinical efficacy of ultrasound-guided endoscopic retrograde appendicitis therapy in children with appendix-related chronic abdominal pain.@*METHODS@#A retrospective analysis was performed on the medical data of 30 children with the chief complaint of chronic abdominal pain who were admitted from August 2019 to May 2021. All the children were found to have inflammation of the appendix or intracavitary stool and fecalith by ultrasound and underwent ultrasound-guided endoscopic retrograde appendicitis therapy. The medical data for analysis included clinical manifestations, endoscopic findings, white blood cell count, neutrophil percentage, length of hospital stay, and cure rate.@*RESULTS@#Among the 30 children with chronic abdominal pain, there were 13 boys (43%) and 17 girls (57%), with a mean age of (9±3) years (range 3-15 years) at diagnosis. The median duration of the disease was 12 months, and the median length of hospital stay was 3 days. The children had a median white blood cell count of 6.7×109/L and a neutrophil percentage of 50%±13%. Fecalith and a large amount of feces were flushed out of the appendix cavity for 21 children (70%) during surgery. The follow-up rate was 97% (29/30), and the median follow-up time was 11 months (range 5-26 months). Of the 29 children, abdominal pain completely disappeared in 27 children (93%).@*CONCLUSIONS@#Ultrasound-guided endoscopic retrograde appendicitis therapy is effective in children with chronic abdominal pain caused by feces or fecalith in the appendix cavity.

Quiste hepático gigante complicado por rotura traumática / Giant Hepatic Cyst Complicated by Traumatic Rupture

Introducción: Quistes hepáticos son formaciones de contenido líquido-seroso rodeado de parénquima hepático normal y sin comunicación con la vía biliar intrahepática. Mayor incidencia en adultos mayores de 50 años, con una relación mujer / hombre de 1.5: 1. Son asintomáticos. Los síntomas se presentan debido a su tamaño o bien por la presencia de complicaciones como la hemorragia, la rotura, la infección intraquística, o la compresión de estructuras adyacentes. Objetivo: Caracterizar a una paciente que presenta quiste hepático gigante complicado por rotura traumática. Caso clínico: Paciente femenino de 81 años, acudió a emergencia luego de haber presentado caída impactándose sobre superficie dura a nivel de parrilla costal e hipocondrio derecho, presentó dolor abdominal intenso acompañado de nausea y vómito. Al examen físico mostró signos claros de irritación peritoneal. Se realizó tomografía axial computarizada que reporta rotura de la pared de quiste hepático y aproximadamente 600 ml de líquido libre en cavidad. Se efectúo tratamiento quirúrgico de emergencia al realizar destechamiento del quiste y lavado de la cavidad. Conclusiones: Los quistes hepáticos, debido a su tamaño o complicaciones pueden poner en peligro la vida de los pacientes. Es necesario que dentro del arsenal diagnóstico del cirujano esté presente el conocimiento de esta patología(AU)

Introduction: Hepatic cysts are formations with liquid-serous content surrounded by normal liver parenchyma and without communication with the intrahepatic bile duct. It is reported with higher incidence in adults over fifty years of age, with a women/men ratio of 1.5: 1. They are asymptomatic; symptoms appear due to either their size or the presence of complications such as hemorrhage, rupture, intracystic infection, or compression of adjacent structures. Objective: To characterize a patient with a giant hepatic cyst complicated by traumatic rupture. Clinical case: A 81-year-old female patient went to the emergency room after falling and subsequently impacting herself on a hard surface at the level of the rib cage and right hypochondrium; she presented intense abdominal pain accompanied by nausea and vomiting. The physical examination showed clear signs of peritoneal irritation. A computerized axial tomography was performed, reporting rupture of the hepatic cyst wall and approximately 600 mL of free fluid within the cavity. Emergency surgical treatment was performed after cyst unroofing and cavity washing. Conclusions: Hepatic cysts, due to their size or complications, can endanger the patients' lives. It is necessary for the surgeon to consider knowledge of this condition as part of his or her diagnostic resources(AU)

Enfrentamiento del paciente con dolor abdominal / Approach to the patient with abdominal pain

El dolor abdominal es una causa frecuente de consulta ambulatoria, sus causas son múltiples e incluyen patologías de riesgo vital u otras de bajo riesgo que requieren principalmente tratamiento y no requieren mayores estudios. La historia clínica y el examen físico son las herramientas principales para poder sospechar la etiología de la enfermedad que está causando el dolor abdominal. Es por esto que realizar una historia completa, haciendo preguntas dirigidas a confirmar o descartar sospechas diagnósticas, asociado a un examen físico completo y sistemático, es la principal forma de orientar el diagnóstico y estudio posterior del paciente. Conocer el cuadro clínico de las enfermedades que dentro de sus síntomas pueden presentar dolor abdominal, especialmente aquellas que son de riesgo vital permite poder diagnosticarlas con la rapidez que se requiere. Así mismo, es necesario reconocer aquellas enfermedades que son más frecuentes y que no requieren mayores estudios sino tratamiento básico, habitualmente ambulatorio. Existen personas que, por sus condiciones de salud o edad, pueden tener presentaciones atípicas de cuadros habituales o mayores riesgos de tener enfermedades infrecuentes o de mayor riesgo vital, que es importante reconocer al momento de la evaluación.

Abdominal pain is a common complaint in ambulatory medicine. It has multiples causes,including lifethreatening pathologies and other benign in which the need in treatment and no other tests. The clinical history and physical examination are the key to suspect the etiology of the underlying disease. A complete history includes make direct questions to confirm or discard the diagnostic suspects and with a complete and systematic physical examination are the main way to get the diagnosis and treatment of the patient. The clinician must know the syndromes which includes abdominal pain, especially those life-threatening which requires urgent treatment or surgery. Also needs to know the frequent benign syndromes that can be safely treated symptomatically with no further investigation. Older adults or patients with comorbidities may present with unusual causes of abdominal pain or may have an atypical presentation of common disorders. Also, may present more frequent serious etiologies that may require urgent interventions.

Enterite mesentérica como complicação rara do lúpus eritematoso sistêmico / Mesenteric enteritis as a rare complication of systemic lupus erythematosus

A dor abdominal no paciente com lúpus eritematoso sistêmico tem amplo espectro clínico, variando desde condições inespecí- ficas, como diarreia e vômitos, até eventos de importante morbi- mortalidade, como o abdome agudo inflamatório e/ou perfura- tivo. A seguir, descreve-se um caso de paciente do sexo feminino, de 23 anos, internada por dor abdominal associada a vômitos e à diarreia crônica e progressiva. Foi diagnosticada com lúpus eritematoso sistêmico há 2 anos. Durante a internação, evoluiu com quadro de abdome agudo, e foi realizada tomografia compu- tadorizada de abdome, revelando importante edema de parede intestinal difuso. Isso, somado a alterações clínico-laboratoriais, permitiu o diagnóstico de enterite lúpica. Foi realizado tratamen- to conservador, com corticoterapia e terapia de suporte com correção de distúrbios eletrolíticos severos, sendo iniciado ciclo- fosfamida, com resolução dos sintomas gastrintestinais.

Abdominal pain in patients with systemic lupus erythematosus has a broad clinical spectrum, ranging from nonspecific symp- toms, such as diarrhea and vomiting, to events of significant morbidity and mortality, such as acute inflammatory and/or per- forating abdomen. This article describes a case of a 23-year-old female patient hospitalized for abdominal pain, associated with vomiting and progressive chronic diarrhea. She was diagnosed with systemic lupus erythematosus 2 years ago. During hospita- lization, the patient progressed with acute abdomen, and an ab- dominal computed tomography scan was performed, revealing major diffuse intestinal wall edema. This, added to clinical and laboratories alterations, allowed the diagnosis of lupus enteritis. A conservative treatment with corticotherapy and supportive therapy with correction of severe electrolyte disturbances were initiated, as well as the prescription of cyclophosphamide, with resolution of gastrointestinal symptoms.

Absceso periostomal secundario a perforación intestinal por cuerpo extraño: presentación de un caso / Periostomal abscess secondary to bowel perforation due to foreign body ingestion: a case report

Resumen Objetivo: Reportar un caso de absceso periostomal, su diagnóstico clínico e imagenológico y manejo. Materiales y Método: Paciente de 77 años usuaria de colostomía con dolor abdominal asociado a aumento de volumen y enrojecimiento de la piel alrededor de la colostomía. Una tomografía computada de abdomen muestra un cuerpo extraño perforante de la pared colónica ostomizada, asociado a formación de un absceso. Resultados: Se practica una incisión de la colección, dando salida a gran cantidad de pus y cuerpo extraño correspondiente a tibia de ave. Se inicia cobertura antibiótica y se instala drenaje Penrose. Controles posteriores muestran regresión del absceso y drenaje sin débito. Discusión: 80%-90% de los cuerpos extraños ingeridos son eliminados sin complicación y < 1% producen perforación. Esto es más común en segmentos intestinales angulados o intervenidos quirúrgicamente. La clínica es inespecífica y el diagnóstico requiere una imagen que identifique signos sugerentes. Conclusión: Un absceso periostomal y la perforación intestinal por cuerpo extraño son cuadros infrecuentes. La alta sospecha diagnóstica y una evaluación imagenológica pueden dar una respuesta precisa. Además del manejo quirúrgico, debe asociarse cobertura antibiótica para enteropatógenos y generalmente un sistema de drenaje.

Aim: To report a case of periostomal abscess, its clinical and imaging diagnosis and management. Materials and Method: 77-year-old patient, user of a colostomy with abdominal pain associated to swelling and redness of the skin next to the colostomy. A computed tomography of the abdomen showed a foreign body perforating the ostomized bowel associated to the formation of an abscess. Results: An incision of the gathering was performed, giving out a great quantity of pus and the foreign body, which corresponded to a bird's tibia. Antibiotic therapy was given, and a Penrose drainage installed. Further controls showed regression of the abscess and no flux from drainage. Discussion: 80%-90% of ingested foreign bodies are eliminated without complications and < 1% produce perforation. This is more common in angled intestinal segments or surgically intervened ones. Clinical features are unspecific, and diagnosis requires suggesting imaging signs. Conclusion: Periostomal abscesses and bowel perforation due to foreign body are infrequent. High diagnostic suspicion and an imaging evaluation may give a precise answer. Besides surgical management, antibiotic coverage for enteropathogens must be associated and a drainage system too in most cases.

Especificidades clínico-epidemiológicas y diagnósticas del cáncer de colon con metástasis hepáticas sincrónicas / Clinical-Epidemiological Specificities of Colon Cancer Diagnosed with Synchronic Metastasis

Introducción: El cáncer de colon se erige como la neoplasia del tubo digestivo más frecuente en la presente centuria. Objetivo: Identificar algunos factores clínicos, epidemiológicos y diagnósticos en pacientes operados de cáncer de colon con metástasis hepática sincrónica. Métodos: Se realizó un estudio observacional, descriptivo y transversal de una muestra de 31 pacientes operados con diagnóstico definitivo de cáncer de colon con metástasis hepática sincrónica, en el servicio de Cirugía General del Hospital Provincial Docente "Saturnino Lora" de Santiago de Cuba durante el periodo comprendido entre 2010 y 2019. Resultados: La edad promedio fue de 63,2 años. Existió predominio de la enfermedad inflamatoria intestinal como antecedente patológico personal, y del alcoholismo como factor de riesgo. La sintomatología predominante fue dolor abdominal y cambios del hábito intestinal, así como el tumor palpable al examen físico del abdomen. La ecografía abdominal y el colon por enema fueron los procederes de diagnóstico más utilizados. Prevalecieron los tumores en el colon izquierdo a nivel del descendente. Todos los tumores malignos fueron adenocarcinomas a predominio de los moderadamente diferenciados. Conclusiones: Las edades avanzadas de la vida, así como la presencia de tabaquismo y alcoholismo son factores epidemiológicos característicos de la población de enfermos aquejados de cáncer de colon con metástasis hepática. Los elementos clínicos identificados constituyeron los habitualmente descritos en la literatura médica, aunque los estudios imaginológicos utilizados preoperatoriamente resultaron limitados para el diagnóstico del cáncer de colon con metástasis hepática sincrónica, precisándose el hallazgo de las lesiones metastásicas durante la intervención quirúrgica(AU)

Introduction: Colon cancer is the most frequent digestive-tract neoplasm in the present century. Objective: To identify some clinical, epidemiological and diagnostic factors in patients operated on for colon cancer and synchronic hepatic metastasis. Methods: An observational, descriptive and cross-sectional study was carried out in a sample of 31 patients operated on with a definitive diagnosis of colon cancer and synchronic hepatic metastasis, in the general surgery service of Saturnino Provincial Teaching Hospital in Santiago de Cuba, during the period between 2010 and 2019. Results: The average age was 63.2 years. There was a predominance of inflammatory intestinal disease as a personal pathological antecedent, as well as alcoholism as a risk factor. The predominant symptoms were abdominal pain and changes in intestinal habits, as well as a tumor palpable on physical abdominal examination. Abdominal ultrasound and lower barium enema were the most used diagnostic procedures. Tumors prevailed at the level of the left descending colon. All malignant tumors were adenocarcinomas, predominantly moderately differentiated ones. Conclusions: Advanced ages of life, as well as smoking and alcoholism are characteristic epidemiological factors among the population of patients suffering from colon cancer with hepatic metastases. The clinical elements identified were those usually described in the medical literature, although the imaging studies used preoperatively were limited for the diagnosis of colon cancer with synchronic hepatic metastasis, a fact that required finding metastatic lesions during surgery(AU)

Recurrent abdominal pain, peritoneal effusion, and eosinophilia in a boy aged 17 years / 中国当代儿科杂志

A boy, aged 17 years, was admitted again due to abdominal pain, diarrhea, and eosinophilia for 3 years, which worsened for 3 days. Three years ago, the boy suffered from abdominal pain and diarrhea after eating yogurt; color Doppler ultrasound showed a large amount of peritoneal effusion, and routine blood test, bone marrow cell morphology, and ascites histological examination showed a large number of eosinophils. Three days ago, he was admitted again due to abdominal pain and diarrhea. The gastrointestinal endoscopy showed eosinophil infiltration in the angle of stomach. The boy was diagnosed with eosinophilic gastrointestinal disease (eosinophilic gastroenteritis). He was improved after the treatment with glucocorticoids and dietary avoidance, and no recurrence was observed during the one-year follow-up. It is concluded that for children who attend the hospital due to gastrointestinal symptoms such as abdominal pain and diarrhea, if there is an increase in peripheral blood eosinophils, it is necessary to consider the possibility of eosinophilic gastrointestinal disease, and eosinophil infiltration and abnormal eosinophil count in gastrointestinal tissue based on endoscopic biopsy may be the key to diagnosis.

Resultados del tratamiento quirúrgico de la perforación intestinal causada por ingestión de mondadientes: aportación de 3 casos / Results of surgical treatment of intestinal perforation caused by toothpick ingestion: contribution of 3 cases

RESUMEN: La ingestión de mondadientes (IM) constituye un evento poco frecuente (se han publicado alrededor de 157 casos a nivel mundial), pero puede causar perforaciones intestinales (PI), con peritonitis, sepsis e incluso muerte. Este hecho, determina la necesidad de intervenir quirúrgicamente a la mayoría de estos pacientes. El objetivo de este manuscrito fue informar resultados del tratamiento quirúrgico de 3 casos de PI por IM. Caso 1: hombre de 52 años, con perforación duodenal y de la vesícula biliar. Caso 2: Mujer de 54 años con perforación cecal. Caso 3: hombre de 72 años, con perforación de colon izquierdo y lesión esplénica. Todos fueron hospitalizados por dolor abdominal y fiebre. En dos casos el diagnóstico se verificó por tomografía y en uno por ecotomografía. Los tres casos fueron intervenidos quirúrgicamente a través de laparotomía. Intervenciones: Caso 1: se realizó colecistectomía y sutura duodenal. Caso 2: se realizó hemicolectomía derecha e ileotransverso anastomosis. Caso 3: se realizó hemicolectomía izquierda y esplenectomía. En todos los casos se encontró el mondadientes. Todos los pacientes evolucionaron de forma satisfactoria, sin complicaciones postoperatorias. La IPD es una emergencia quirúrgica. Las PI son comunes y la peritonitis asociada es frecuente. El pronóstico depende de un diagnóstico precoz y un tratamiento oportuno.

SUMMARY: Toothpick ingestion (TPI) is a rare event, but can cause intestinal perforation (IP), peritonitis, sepsis, and even death (approximately 157 cases have been published worldwide). This fact determines the need for surgical intervention in most of these patients. The aim of this manuscript was to report the results of the surgical treatment in 3 cases of IP by TPI. The report involves the following: Case 1: A 52-year-old man, with duodenal and gallbladder perforation. Case 2: A 54-year-old woman with cecal perforation. Case 3: A 72-year-old man, with perforation of the left colon and splenic rupture. All were hospitalized for abdominal pain and fever. In two of the cases the diagnosis was verified by tomography and in one by ultrasound. All three patients underwent laparotomy. In the first case (1), cholecystectomy and duodenal suture were performed; in the second case (2) right hemicolectomy and ileo-transverse anastomosis were performed, and in the third case (3), Left hemicolectomy and splenectomy were performed. Toothpick was found in all cases. The patients in this report all evolved satisfactorily without postoperative complications. In conclusion, TPI is a surgical emergency. IP are common and the associated peritonitis is high. Prognosis depends on early diagnosis and timely treatment.

Tumor miofibroblástico inflamatorio del colon / Inflammatory Myofibroblastic Tumor of the Colon

RESUMEN Introducción: Los tumores miofibroblásticos son tumores benignos de origen mesenquimal, de etiología incierta, y frecuente en niños y jóvenes. Objetivo: Describir un nuevo caso de tumor miofibroblástico abdominal. Caso clínico: Se presenta una paciente de 20 años con antecedentes de salud con dolor en abdomen derecho, se realiza tomografía de abdomen contrastada que informa una masa hiperdensa no homogénea en flanco derecho. Se realiza resección quirúrgica del tumor y el estudio anatomopatológico informa un tumor miofibroblástico inflamatorio. Su pronóstico es favorable porque es una entidad benigna y no metastiza. Conclusiones: Los tumores miofibroblásticos de colon son infrecuentes, benignos, que al diagnosticarlos deben resecarse ampliamente para evitar la recidiva(AU)

ABSTRACT Introduction: Myofibroblastic tumors are benign tumors of mesenchymal origin, of uncertain etiology, and frequent in children and young people. Objective: To describe a new case of abdominal myofibroblastic tumor. Clinical case: The case is presented of a 20-year-old female patient with a health history and pain in the right abdomen. Contrasted abdominal tomography is performed, which shows an inhomogeneous hyperdense mass in the right flank. Surgical resection of the tumor was performed. The pathological study reported an inflammatory myofibroblastic tumor. Its prognosis is favorable because it is a benign entity that does not metastasize. Conclusions: Colon myofibroblastic tumors are infrequent, benign, and when diagnosed, they must be widely removed to avoid recurrence(AU)

Ascaris lumbricoides, causa de la colecistitis aguda en el servicio de emergencia del Hospital "Alfredo Noboa Montenegro", 2018 / Ascaris lumbricoides, cause of acute cholecystitis in the emergency service of the "Alfredo Noboa Montenegro" Hospital, 2018

Ascaris lumbricoides provoca una de las helmintiasis más frecuentes en los países tropicales, pudiendo producir efectos patológicos en cualquier parte del organismo, siendo los conductos biliales uno de los sitios recurrentes provocando una colecistitis aguda. La CA es una de las principales causas de ingreso al servicio de Emergencia, es una inflamación de la vesícula cuyo diagnóstico oportuno es de vital importancia para la prevención de complicaciones. Por tal razón, determinar la frecuencia de las variables clínicas, de laboratorio y ecográficas, su relación con las comorbilidades asociadas a las características demográficas de los pacientes y el nivel de severidad de la colecistitis aguda causada por la A. lumbricoides de las Guías de Tokio 2018 del Servicio de Emergencia del Hospital Alfredo Noboa Montenegro durante el periodo junio - diciembre 2018, para la elaboración de un esquema diagnóstico. La metodología de investigación fue cuantitativa descriptiva de corte transversal. Dentro de los principales hallazgos, el CA aparece con prevalencia en el género femenino en un 69,41%, promedio de edad de 32 a 45 años, el 10% de 170 pacientes presentaron en su ecografía una forma parasitaria compatible con A. Lumbricoides, los resultados clínicos arrojaron presencia de dolor (67,34%), fiebre (68,65%), náuseas (45,93%); en los laboratorio la Proteína C Reactiva estuvo aumenta en el 94,18% de los casos, en imagenología se refleja presencia de líquido pericolecistico en un 78,82% y un engrosamiento de pared vesicular en un 34,12%. El nivel de severidad registrado según los criterios de las guías de Tokio 2018 fue grado I 35,3%, grado II 47,1% y grado III 17,6%. Se recomienda la estructuración de un esquema diagnóstico oportuno de colecistitis aguda causada por A. Lumbricoides(AU)

Ascaris lumbricoides causes one of the most frequent helminthiases in tropical countries, being able to produce pathological effects in any part of the body, being the bile ducts one of the recurrent sites causing acute cholecystitis. AC is one of the main causes of admission to the Emergency service, it is an inflammation of the gallbladder whose timely diagnosis is of vital importance for the prevention of complications. signs and symptoms, the timely diagnosis is of vital importance for the prevention of complications. For this reason, determine the frequency of clinical, laboratory and ultrasound variables, their relationship with the comorbidities associated with the demographic characteristics of the patients and the level of severity of acute cholecystitis cause of A. lumbricoides of the Tokyo Guidelines 2018 of the Hospital Emergency Service Alfredo Noboa Montenegro during the period June - December 2018, for the elaboration of a diagnostic scheme. The research methodology was quantitative cross-sectional descriptive. Among the main findings that were prevailed in the female gender in 69,41%, average age from 32 to 45 years, 10% of 170 patients presented in their ultrasound a parasitic form compatible with A. lumbricoides, clinical results that prevailed was presence of pain (67.34%), fever (68.65%), nausea (45.93%); in the laboratory findings the C Reactive Protein was increased in 94,18% of cases, in imaging the presence of pericolecist fluid is reflected in 78,82% and a thickening of the vesicular wall in 34,12%. The severity level recorded according to the criteria of the Tokyo 2018 guidelines was grade I 43,53%, grade II 48,24% and grade III 8,24%. The structuring of a timely diagnostic scheme for acute cholecystitis cause of A. lumbricoides is recommended(AU)

Migraña Abdominal: variaciones en el diagnóstico y tratamiento entre gastroenterólogos y neurólogos pediatras / Abdominal migraines: variations in diagnosis and care between pediatric gastroenterologists and neurologists

Resumen: Introducción: La migraña abdominal (MA) es infrecuente y poco estudiada. Nuestro objetivo fue investigar el diagnóstico y tratamiento de niños y adolescentes con MA y compararlos entre gastroen terólogos y neurólogos pediatras. Pacientes y Método: Todos los cuadros de MA (1-18 años) de un hospital de EE. UU, con diagnóstico de MA o sus variantes (ICD-9 346.2 o IC-10 G43.D, G43.D0, G43.D1) entre 2011-2017 fueron revisados. La información sobre diagnóstico, intervalo desde inicio de síntomas, criterios diagnósticos, pruebas diagnósticas, tratamiento y resultado se analizaron. Re sultados: Sesenta y nueve historias médicas fueron identificadas. La edad media al diagnóstico fue 9,7 años. El 48% de los pacientes fueron del sexo femenino. Cincuenta (72,4%) pacientes fueron tratados solo por gastroenterólogos pediatras, y 10/69 (14,5%) por neurológos pediatras exclusivamente. 6/69 (8,7%) fueron inicialmente evaluados por gastroenterología y posteriormente referidos a neurología, y 2/69 (2,9%) fueron inicialmente evaluados por neurología y luego referidos a gastroenterología. 3/10 (30%) de las MA diagnosticadas por neurólogos no mencionaban que el paciente tuviera dolor abdominal, sin embargo, todos los diagnósticos realizados por gastroenterólogos presentaron dicho síntoma (p=0,0035). 5/50 (10%) de las historias médicas de gastroenterología y ninguna de las histo rias de neurología mencionaban los criterios de Roma. Conclusiones: La mayoría de los niños fueron diagnosticados por pediatras gastroenterólogos. Los gastroenterólogos rara vez utilizaron los criterios de Roma. Pacientes evaluados por neurología son frecuentemente diagnosticados con MA, incluso sin presentar dolor abdominal (criterio necesario para el diagnóstico). Se recomienda educación para el correcto y oportuno diagnóstico de la migraña abdominal.

Abstract: Introduction: Abdominal migraine (AM) is uncommon and understudied. Our objective was to investigate the diagnosis and treatment of children and adolescents with AM and compare with that of pediatric gastroenterologists and neurologists. Patients and Method: All AM cases (1-18 years) from a USA hospital with diagnosis of abdominal migraine or its variants (ICD-9 346.2 or IC-10 G43.D, G43.D0, G43.D1) between 2011 and 2017 were reviewed. Information on diagnosis, interval from onset of symptoms, diagnostic criteria, diagnostic tests, treatment, and outcome were analyzed. Results: 69 medical records were identified. The mean age at diagnosis was 9.7 years, and 48% of patients were female. 50/69 (72.4%) patients were exclusively treated by a pediatric gastroenterologist and 10/69 (14.5%) exclusively by a pediatric neurologist. 6/69 (8.7%) were initially evaluated by gas troenterology and referred to neurology, and 2/69 (2.9%) were initially evaluated by neurology and then referred to gastroenterology. 3/10 (30%) of the AM diagnosed by neurologists did no report ab dominal pain (AP), however, all diagnoses made by gastroenterologists did (p = 0.0035). 5/50 (10%) of the gastroenterology medical records and no neurology medical records mentioned Rome criteria. Conclusions: Most of the children were diagnosed by pediatric gastroenterologists. Gastroenterolo gists rarely use the Rome criteria. Patients evaluated by neurologists are frequently diagnosed with AM even without AP (a criterion that is required for its diagnosis). Education is recommended for the correct and timely diagnosis of AM.

Family COVID-19 cluster analysis of an infant without respiratory symptoms

Abstract Diagnosing cases of coronavirus disease (COVID-19) with only non-respiratory symptoms has been challenging. We reported the diagnosis of a child who tested positive for COVID-19 with abdominal pain/diarrhea and tracked his family cluster. One member of the family tested positive for COVID-19 on real-time reverse-transcription polymerase chain reaction assay and three other family members had anti-SARS-CoV-2 antibodies.

Effectiveness of the superior hypogastric plexus neurolytic block in the management of pelvic abdominal pain in adult patients diagnosed with cancer: A systematic literature review / Efectividad del bloqueo neurolítico del plexo hipogástrico superior en el manejo del dolor abdominopélvico en pacientes adultos con diagnóstico de cáncer. Revisión sistemática de la literatura

INTRODUCTION: Severe oncological pain occurs in up to 60% of pelvic abdominal cáncer patients, being refractory to medical management in up to 30% of cases. In 1990, the superior hypogastric plexus neurolytic block (SHPB) was described for the control of pain in these patients. This study aimed to evaluate the effectiveness of this technique for the control of oncological pain. METHODOLY: Studies that evaluated the effectiveness of the SHPB using the classic or transdiscal approach in adult patients with oncological abdominal-pelvic pain were systematically reviewed. A search was conducted in PubMed, EMBASE and Scopus from January 1, 1990, to August 31, 2019, without a language restriction. The visual analog scale (VAS), morphine milligram equivalents (MME) per day, quality of life and presence of complications were recorded. The quality of the studies was evaluated using the Jadad and Ottawa-Newcastle scales. RESULTS: Eight studies met the inclusión criteria: 6 were descriptivo longitudinal studies, and 2 were controlled clinical trials, comprising 316 patients (75% female and 25% male; average age 53.2 years); the most frequent diagnoses were gynecological (65%) cancer. An average VAS reduction of 55%-60.8% was obtained as well as a MME reduction of 40%-60%. Three studies evaluated the quality of life using the (QLQ-C30), (PSS) and Zubrod scale all with positive results. Complications were reported in 18% of cases, pain related to the puncture was the most frequent. CONCLUSIONS: The SHPB may be an effective for the control of severe oncological abdominal-pelvic pain, decreasing the VAS and MME and improving the quality of life of patients.

INTRODUCCIÓN: El dolor oncológico severo se presenta hasta en el 60% de los pacientes con cáncer abdominopélvico, siendo refractario al manejo médico hasta en el 30% de los casos. En 1990, se describió el bloqueo del plexo hipogástrico superior (BPHS) para el control de dolor en estos pacientes. Nuestro objetivo en este estudio fue evaluar la efectividad de esta técnica. METODOLOGÍA: Se realizó una revisión sistemática de estudios que evaluaron la efectividad del BPHS técnicas guiadas por fluoroscopio en pacientes adultos con dolor oncológico abdominopélvico. Se realizó una búsqueda en Pubmed, EMBASE y Scopus desde el 1de enero de 1990 hasta el 31 de agosto de 2019, sin restricción de idioma. Se evaluó la escala visual análoga, el consumo de opioides: dosis equivalente de morfina día, calidad de vida, presencia de complicaciones y se evaluó la calidad de los estudios mediante escalas Jadad y Ottawa- Newcastle. RESULTADOS: Ocho estudios cumplieron los criterios de inclusión, 6 fueron longitudinales descriptivos y 2 ensayos clínicos controlados, con un total de 316 pacientes, 75% femenino y 25% masculino; edad promedio 53,2 años; diagnóstico más frecuente: Cáncer ginecológico (65%). Se logró una reducción de la escala visual análoga (EVA) de 55%-60,8% y reducción de la dosis equivalente de miligramos de morfina oral día (DEMO) del 40%-60%. Tres estudios evaluaron la calidad de vida con las escalas QLQ-C30, PSS y Zubrod, mostrando mejoría en todas. Se reportaron complicaciones en 18% de los casos, siendo el dolor en el sitio de punción la más frecuente.CONCLUSIONES: El BPHS puede ser efectivo en el control de dolor oncológico de origen abdominopélvico, disminuyendo escala visual análoga (EVA), dosis equivalente de miligramos de morfina oral día (DEMO) y mejorando la calidad de vida. Sin embargo, se requieren de estudios adicionales para dar una recomendación con alta calidad de evidencia.