Divertículo de Meckel. A propósito de un caso / Meckel's diverticulum. Apropos of a case

RESUMEN El divertículo de Meckel es una evaginación en dedo de guante del borde antimesentérico del íleon, constituido por sus capas, debido a una persistencia embriológica del extremo proximal del conducto onfalomesentérico. Forma una bolsa a manera de tubo y que puede extenderse hasta la región umbilical, su inflamación (diverticulitis) produce un cuadro clínico semejante al de la apendicitis aguda, por lo que su diagnóstico preoperatorio es raro. Por lo infrecuente, los médicos no piensan seriamente en esta patología y su diagnóstico definitivo se realiza durante el transoperatorio. Se presentó un caso por lo infrecuente que resulta lo cual aporta conocimiento a la comunidad médica sobre el tema. Paciente de 68 años, acude al centro con dolor tipo cólico, taquicardia y fiebre de 38.5C°, con 24 h de evolución. Refiere que el dolor se le hizo fijo hacia fosa iliaca derecha, el cual se fue intensificando. Se decidió su ingreso para tratamiento quirúrgico. Se realizó apendicectomia y resección y anastomosis en la zona del divertículo. Se recibió biopsia informando diverticulitis de Meckel.

ABSTRACT Meckel's diverticulum is an evagination resembling a glove finger of the ileum anti-mesenteric edge, formed by layers due to an embryologic persistence of the proximal end of omphalo-mesenteric duct. It forms a sac like a tube that may extend up to the umbilical region; its inflammation (diverticulitis) has clinical characteristics similar to the acute appendicitis ones, making its pre-surgery diagnosis very unusual. Due to its frequency, doctors often do not take this disease into account, and it is definitely diagnosed during the trans-operative. The case was presented due to its infrequency, bringing knowledge on the theme to medical community. A patient aged 68 years assisted the hospital with a colic-like pain, tachycardia and fiver of 38.5oC after 24 hours of evolution. He refers that the pain became fixed in the right iliac fosse and got more intensity. The decision was entering him for surgical treatment. Appendectomy, resection and anastomosis were carried out in the area of the diverticulum. The received biopsy informed Meckel's diverticulum.

Doença ulcerosa péptica: realmente é possível identificá-la por meio das características da dor epigástrica? / Peptic ulcer disease: is it really possible to identify it through the characteristics of epigastric pain?

OBJETIVO: Determinar se características da dor epigástrica são capazes de identificar pacientes com doença ulcerosa péptica. MÉTODOS: Estudo caso-controle, com coleta de dados de setembro de 2014 a junho de 2016. Foram incluídos pacientes com mais de 18 anos com dispepsia que realizaram endoscopia digestiva alta ambulatorialmente. Os pacientes foram abordados antes de realizar a endoscopia digestiva alta, verificando, em suas guias, a presença de dispepsia, tendo sido convidados a responder um questionário, e, posteriormente, o prontuário de cada entrevistado foi avaliado para verificação do diagnóstico, sendo, então, divididos entre o Grupo Doença Ulcerosa Péptica (casos), com 32 pacientes, e o Grupo Controle, com 44 pacientes com dispepsia atribuída a outras causas. RESULTADOS: Dos pacientes com dispepsia não ulcerosa, 52,27% caracterizaram a dor como em queimação, sendo 47,72% moderada e que piorava com alimentação. Dentre os demais sintomas, 45,45% relataram náuseas e 25% desconforto pós-prandial, com 52,27% relatando histórico familiar negativo de doença ulcerosa péptica. Em contrapartida, dos pacientes com doença ulcerosa péptica, 53,12% referiram dor em queimação e de moderada intensidade, e 50% relataram piora com alimentação. Dentre os demais sintomas, prevaleceram também náuseas (53,12%) e desconforto pós-prandial (40,62%). A maioria (81,25%) relatou histórico familiar de doença ulcerosa péptica. Observou-se diferença estatística em dor noturna, predominando na doença ulcerosa péptica (p=0,0225) e dor em cólica na dispepsia não ulcerosa (p=0,0308), assim como na ausência de histórico familiar entre os pacientes com dispepsia não ulcerosa (p=0,0195). CONCLUSÃO: A dispepsia relacionada à doença ulcerosa péptica relaciona-se, principalmente, à piora noturna, sendo que a intensidade da dor, a relação com alimentação e os sintomas associados não auxiliaram na diferenciação da dispepsia não ulcerosa, diferentemente do que a literatura tradicionalmente informa. (AU)

To determine whether it is possible to identify Peptic Ulcer Disease through the characteristics of epigastric pain. METHODS: This is a case-control study with data collected between September 2014 and June 2016 including patients over 18 years of age with dyspepsia who underwent upper gastrointestinal endoscopy as outpatients. The patients were approached before the upper gastrointestinal endoscopy when their test requisition form indicated the presence of dyspepsia. The subjects were invited to answer a questionnaire and, afterwards, the records of all interviewees were evaluated to check for the diagnosis. Then, they were divided into a peptic ulcer disease group (cases), with 32 patients, and a control group, with 44 patients with dyspepsia from other causes. RESULTS: Among non-ulcer dyspepsia patients, 52.27% described the pain as a "burning pain", with 47.72% reporting it as moderate and aggravated by food intake. As for other symptoms, 45.45% of subjects reported nausea, and 25% reported postprandial discomfort; 52.27% had no family history of peptic ulcer disease. In contrast, 53.12% of peptic ulcer disease patients reported "burning" and moderate pain, and 50% said the pain was aggravated by eating. As for the other symptoms, nausea (53.12%) and postprandial discomfort (40.62%) prevailed; most of the patients (81.25%) had family history of peptic ulcer disease. There was a statistical difference in night pain, which was more prevalent in peptic ulcer disease (p=0.0225), and colicky pain, which was more frequent in nonulcer dyspepsia (p=0.0308), as well as absence of family history in non-ulcer dyspepsia patients (p=0.0195). CONCLUSION: Dyspepsia caused by peptic ulcer disease is mainly related to night worsening, and pain intensity, the relationship with food intake, and associated symptoms did not help differentiate nonulcer dyspepsia, differently from what the medical literature traditionally suggests. (AU)

Excessive crying in infants / Excessive crying in infants

ABSTRACT Objective: Review the literature on excessive crying in young infants, also known as infantile colic, and its effects on family dynamics, its pathophysiology, and new treatment interventions. Data source: The literature review was carried out in the Medline, PsycINFO, LILACS, SciELO, and Cochrane Library databases, using the terms “excessive crying,” and “infantile colic,” as well technical books and technical reports on child development, selecting the most relevant articles on the subject, with emphasis on recent literature published in the last five years. Summary of the findings: Excessive crying is a common symptom in the first 3 months of life and leads to approximately 20% of pediatric consultations. Different prevalence rates of excessive crying have been reported, ranging from 14% to approximately 30% in infants up to 3 months of age. There is evidence linking excessive crying early in life with adaptive problems in the preschool period, as well as with early weaning, maternal anxiety and depression, attention deficit hyperactivity disorder, and other behavioral problems. Several pathophysiological mechanisms can explain these symptoms, such as circadian rhythm alterations, central nervous system immaturity, and alterations in the intestinal microbiota. Several treatment alternatives have been described, including behavioral measures, manipulation techniques, use of medication, and acupuncture, with controversial results and effectiveness. Conclusion: Excessive crying in the early months is a prevalent symptom; the pediatrician's attention is necessary to understand and adequately manage the problem and offer support to exhausted parents. The prescription of drugs of questionable action and with potential side effects is not a recommended treatment, except in extreme situations. The effectiveness of dietary treatments and use of probiotics still require confirmation. There is incomplete evidence regarding alternative treatments such as manipulation techniques, acupuncture, and use of the herbal supplements and behavioral interventions.

RESUMO Objetivo: Revisar a literatura sobre choro excessivo em bebês pequenos e cólicas infantis e suas repercussões na família e a fisiopatologia e as estratégias de tratamento. Fonte dos dados: Revisadas as principais bases de dados, Medline, PsycINFO, Lilacs e SciELO e Cochrane Library com o uso das expressões “choro excessivo do lactente” e “cólicas do lactente”. Foram selecionadas as publicações mais relevantes com ênfase nos últimos cinco anos. Síntese dos dados: É um sintoma comum nos primeiros meses de vida e é motivo de cerca de 20% das consultas pediátricas. As prevalências de choro excessivo variam de 14 a 30% nesses lactentes. Existem evidências que ligam o choro excessivo nos primeiros meses de vida com problemas futuros, bem como ao desmame precoce, à ansiedade, à depressão materna, ao transtorno do déficit de atenção/hiperatividade (TDAH) e a outros problemas comportamentais. Distintos mecanismos fisiopatológicos podem explicar esse quadro clínico, como alterações no ritmo circadiano, imaturidade do SNC e alterações na microbiota intestinal. São descritas opções de tratamento, desde medidas comportamentais, técnicas manipulativas e uso de medicação até acupuntura, com resultados e eficácia controversos. Conclusão: Para o choro excessivo nos primeiros meses é necessária a atenção do pediatra para o entendimento e manejo do problema e oferecer apoio para pais em exaustão. A prescrição de drogas de efeitos duvidosos e potenciais efeitos colaterais não é terapêutica preconizada, a não ser em situações extremas. A eficácia dos tratamentos dietéticos e o uso de probióticos ainda necessitam de confirmação. Existem evidências incompletas a respeito de tratamentos opcionais, como técnicas manipulativas, acupuntura, uso de suplemento à base de ervas e intervenções comportamentais.

Avaliação física e ultrassonográfica da cicatriz em 12 equinos submetidos à celiotomia mediana com fio de poliéster para tratamento de cólica / Physical and ultrasonographic assessment of scar from celiorrhaphy with polyester thread in horses undergoing treatment of acute abdominal colic / Evaluación física y ecografia de cicatriz en 12 equinos sometidos a celiotomia mediana con hilo de poliéster para tratamiento del cólico

Foi realizado um levantamento das complicações incisionais em 12 equinos submetidos à celiotomia mediana seguida de celiorrafia com fio de poliéster. Os animais foram submetidos a exame clínico e complementar. O exame clínico consistiu na inspeção e palpação da linha média. O método de exame complementar foi a ultrassonografia da linha media na área referente à cicatriz abdominal. Foram encontrados complicações incisionais em sete animais (58,3%). As complicações incisionais encontradas foram fibrose (41,6%), reação ao fio de sutura (41,6%), fístulas (16,6%), edema peri-incisional (25%), infecção incisional (16,6%), drenagem incisional (16,6%). No exame indireto foi observado edema pós-operatório, pequenas áreas focais de líquido ao redor do fio de sutura. Mesmo com as complicações incisionais encontradas e o número de animais examinados, o fio de poliéster mostrou-se resistente e seguro podendo ser utilizado na laparorrafia mediana em equinos.

A survey on the incisional complications in twelve horses submitted to median celiotomy followed with celiorrhaphy with polyester suture was performed. The animals were submitted to clinical and complementary examination. Inspection and palpation of the midline for clinical evaluation was performed. Ultrasonography of the abdominal scar of the midline area was used as an indirect test. Seven animals presented incisional complications (58.3%), such as fibrosis (41.6%), suture material reaction (41.6%), fistulas (16.6%), peri-incisional edema (25%), wound infection (16.6%), and incisional drainage (16.6%). In indirect evaluation, post-operative edema was observed, as well as small focal areas with fluid around the suture. Despite the incisional complications found and the small number of animals examined, it was concluded that polyester suture proved to be resilient and safe, and can be used in median celiorrhaphy in horses.

Una encuesta sobre las complicaciones incisionales en 12 equinos sujetados a una celiotomía mediana seguida de una celiorrafia con hilo de poliéster. Los animales fueron sometidos a exámenes clínicos y complementarios. El examen clínico incluyó la inspección y palpación de la línea mediana. Otro método evaluativo fue la ecografía de la línea media en la zona referente a la cicatriz abdominal. Complicaciones incisionales fueron encontradas en siete animales (58,3%). Las complicaciones incisionales encontradas fueron fibrosis (41,6%), reacción al hilo de sutura (41,6%), fístulas (16,6%), edema perincisional (25%), infecciones incisionales (16,6%) y drenaje incisional (16,6%). En el examen indirecto se ha observado edema postoperatorio, pequeñas áreas focales de líquido alrededor del hilo de sutura. A pesar de las complicaciones incisionales encontradas y el número de animales examinados, el hilo de poliéster demostró resistencia, seguridad y puede ser utilizado en celiorrafia mediana en equinos.

What caused hemolytic anemia and colicky abdominal pain? Lead!

No abstract available.

Abdômen agudo em equídeos no semiárido da região nordeste do Brasil / Acute abdomen in equidae in the semiarid of the Brazilian Northeast

Foram revisados os casos de abdômen agudo de origem gastrintestinal em equídeos atendidos no Hospital Veterinário da Universidade Federal de Campina Grande, em Patos, Paraíba. No período de janeiro de 2001 a dezembro de 2010. Setenta (4,5%) do total de 1542 equídeos atendidos no período apresentaram quadro clínico de cólica, sendo 60 equinos, cinco muares e cinco asininos. A compactação de cólon maior foi a causa mais frequente de cólica, diagnosticada em 37,14% dos casos, seguida por compactação de cólon menor (10%) e corpo estranho de cólon menor (7,14%). Em quatro casos as cólicas foram causadas pela presença de fitobezoares no intestino grosso, sendo dois deles associados ao consumo de vagens de Prosopis juliflora. Em cinco casos foi observada a presença de corpos estranhos no cólon menor e em um caso os corposestranhos foram encontrados no cólon maior, sendo principalmente sacos plásticos. As lesões estrangulantes do intestino delgado foram observadas em quatro casos. Outras causas foram cólica espasmódica (dois casos por parasitose e dois por ingestão de resíduos domiciliares), sobrecarga gástrica (três casos) e deslocamento de cólon maior que foi diagnosticado em dois animais. Laceração de cólon menor, torção de ceco, compactação de ceco e timpanismo por consumo de Manihot esculenta foram diagnosticados em uma única ocasião. O principal fator de risco para o desenvolvimento de cólicas foi o consumo de Pennisetum purpureum, Brachiaria decumbens, Sorghum spp. ou Echinochloa polystachya picados manualmente ou em picotadeira ou triturados em forrageira (OR=4,03; P=0,007). Como resultado da baixa qualidade dos alimentos ingeridos, a frequência dos atendimentos de equídeos portadores de cólica foi significativamente maior no segundo semestre (época da seca na região estudada) (OR=2,61; P<0,01). Concluiu-se que a oferta de volumoso de baixa qualidade na seca contribui para a alta frequência de casos de cólica e que o manejo alimentar tem um papel importante na ocorrência da doença e, por isso, a sua melhoria pode influenciar positivamente na redução do número de casos de cólica em equídeos no semiárido nordestino.

The cases of equidae acute abdomen diagnosed in the Veterinary Hospital of the Federal University of Campina Grande, in the semiarid of the Brazilian Northeast were reviewed. From January 2001 to December 2011, 70 (4.5%) equidae out of 1542 were affected by colic, including 60 horses, 4 mules, and 6 donkeys. Large colon impaction diagnosed in 37.14% of the cases was the most frequent cause of colic, followed by small colon impaction (10%) and foreign body in the small colon (7.14%). In four cases, colics were caused by phytobezoars in the large gut, two of which were associated with the ingestion of large amounts of fresh Prosopis juliflora pods. Six cases of colic by foreign bodies, mainly plastic bags, were observed, five located in the small colon and one in the large colon. Strangulating small intestinal lesions were observed in four cases. Other causes of colic were spasmodic colic (two cases due to gastrointestinal parasites and two due to consumption of home residues), and gastric impaction (three cases). Large colon displacement was diagnosed twice. Laceration of the small colon, cecal torsion, and bloat by ingestion of Manihot esculenta were diagnosed once. The main risk factor for the occurrence of colic was the ingestion of choped Pennisetum purpureum, Brachiaria spp., Sorghum spp. or Echinochloa polystachya (OR=4.03; P=0.007). As a result of the low quality of the foods the frequency of colic was significantly higher during the dry season (second semester) (OR=2.61; P<0.01). It is concluded that feeding with low quality forages during the dry season contributes with the high frequency of cases of colic in the Brazilian semiarid, and that is necessary to improve food quality and food management to try to decrease the frequency of this syndrome in the region.

Características celulares e bioquímicas do líquido peritoneal de equinos submetidos à obstrução experimental do duodeno, íleo e cólon maior / Cellular and biochemical characteristics of peritoneal fluid of equines submitted to experimental obstruction of duodenum, ileum, and large colon

Estudaram-se as características macroscópicas, bioquímicas e citológicas do líquido peritoneal de equinos submetidos a um modelo experimental de obstrução intestinal em 24 animais, distribuídos em grupos: de controle instrumentado (GI), de obstrução do duodeno (GII), de obstrução do íleo (GIII) e de obstrução do cólon maior (GIV). As amostras de líquido peritoneal foram colhidas antes da cirurgia (T0), durante as obstruções (T60i-T180i) e após as desobstruções (T60ri-T7º ). Durante o período obstrutivo, não foram observadas alterações significativas nos parâmetros bioquímicos e citológicos avaliados no líquido peritoneal dos animais. Após as desobstruções, apenas os animais de GII e GIII apresentaram resposta inflamatória mais intensa, caracterizada por maior contagem global e diferencial de leucócitos e dos valores de proteína total, fibrinogênio, lactato e fósforo inorgânico. As alterações laboratoriais não foram associadas a sinais clínicos indicativos da presença de processo inflamatório abdominal, demonstrando que os resultados da análise do líquido peritoneal, apesar de auxiliarem no acompanhamento da evolução do processo de cura, não devem ser utilizados isoladamente na elaboração do diagnóstico e do prognóstico de complicações no pós-operatório de equinos com cólica.

The macroscopic, biochemical, and cytological characteristics of peritoneal fluid of equines submitted to intestinal obstruction using an experimental model were evaluated. Twenty-four animals were distributed in four groups: instrumented control (GI), duodenum obstruction (GII), ileum obstruction (GIII), and large colon obstruction (GIV). Peritoneal fluid samples were collected before the surgery (T0), during the obstruction (T60i-T180i), and after unblocking procedures (T60ri-T7º ). During obstructive period, significant alterations were not observed in biochemical and cytological examination of peritoneal fluid of all animals. After unblocking procedure, animals from GII and GIII presented intense inflammatory response characterized by higher global and differential leukocytes counts, as well as in fibrinogen and total protein concentrations; lactate and inorganic phosphorus concentrations in peritoneal fluid were also increased. The laboratory alterations were not associated with clinical signs, indicative of the abdominal inflammatory process presence. Results showed that analyses of peritoneal fluids can be used as support in the evolution of healing process. However, they can not be isolated used for a diagnosis and prognosis of equine postoperative complications.

Estrangulação de intestino delgado devido a divertículo de Meckel e banda mesodiverticular em égua gestante – relato de caso / Strangulation of the small intestine by Meckel´s diverticulum and mesodiverticular band in a pregnant mare – Case Report

O objetivo deste trabalho é descrever a ocorrência de cólica por estrangulação intestinal ocasionada por banda mesodiverticular (BMD) e divertículo de Meckel (DM) em uma égua no terço final de gestação com histórico de 20 horas de cólica moderada contínua sem resposta à administração de analgésicos. Pela celiotomia constatou-se a presença de BMD e DM medindo 15cm a partir da borda anti-mesentérica, ocasionando estrangulação intestinal distante 150cm do orifício ileocecal. Realizaramse enterectomia de 290cm de alça necrosada, drenagem do conteúdo enegrecido e fétido do intestino remanescente, seguida de by pass do ceco por jejuno-colonostomia. Durante o pós-operatório, o quadro se manteve refratário à terapia intensiva instituída. O animal voltou a ter refluxo pela sonda nasogástrica e ocorreu abortamento após seis dias, sendo praticada a eutanásia após 24 horas. A BMD e o DM são estruturas remanescentes dos componentes onfalomesentéricos vitelinos, e sua ressecção deve ser considerada sempre que essas estruturas forem diagnosticadas durante a cirurgia abdominal em equinos. A égua deste relato viveu cinco anos sem consequências aparentes, até que tais alterações provocaram a estrangulação intestinal.

The objective of this report is to describe the occurrence of intestinal strangulation caused by mesodiverticular band (MDB) and Meckel´s diverticulum (MD) in a mare at the latter third of gestation with a 20 hours history of moderate colic unresponsive to analgesic medication. The celiotomy revealed the presence of 5.9 inches long MD and MDB causing intestinal strangulation 59 inches from the ileocecal valve. It was performed an enterectomy of 115 inches of necrotic loop, drainage of the dark and fetid content of the remaining intestine, followed by cecum bypass through jejunocolostomy. Despite the intensive therapy established during postoperative, the gastric reflux through the nasogastric tube came back, the mare suffered abortion after six days, and the euthanasia was performed after 24 hours. MDB and MD are remaining structures of vitelline omphalomesenteric components and their resection should be considered whenever these structures are diagnosed during abdominal surgery in equines. The mare on this report lived five years without apparent consequences; until the moment these alterations caused intestinal strangulation.

Alternate and incidental diagnoses on noncontrast-enhanced spiral computed tomography for acute flank pain

Our aim was to determine the incidence and spectrum of significant alternate or incidental diagnoses established or suggested on spiral computed tomography [CT] in a large series of patients with suspected renal colic. Records of all patients that had undergone spiral CT [5-mm to 7-mm slice thickness] for acute flank pain during a 5-year period were reviewed. The radiological diagnoses of urinary calculi and obstruction as well as clinical entities not suspected otherwise were analyzed. A total of 4000 CT's had been performed in the evaluation of acute flank pain. Urinary calculi had been identified in 3120 patients [78%]. There were 398 patients [9.9%] who had an alternate cause of flank pain or an incidentally detected condition on CT. Of these patients, 102 [25.6%] had more than one additional finding. A total of 153 clinical conditions had been identified mimicking flank pain secondary to calculus and obstruction. In 47 patients [1.2%], incidental solid masses had been detected. Spiral CT is a valuable technique in the evaluation of acute flank pain with uncertain clinical diagnosis. A wide spectrum of alternate and additional diagnoses including abdominal solid organ tumors and other significant abdominal conditions such as pancreatitis can be established or suggested on spiral CT performed for suspected acute urinary colic

Cáncer de próstata metastático a hígado: presentación clínica infrecuente: reporte de un caso / Metastatic prostate cancer of liver: an infrequent clinical presentation: case report

El cáncer de próstata constituye la neoplasia más frecuentemente diagnosticada en la población masculina. Ocupa el segundo lugar en mortalidad con respecto a todas las neoplasias estando relacionadas la mayoría de las muertes con enfermedad metastásica, siendo el lugar de metástasis más frecuente hueso seguido de otros órganos como pulmón, pleura e hígado. Descripción de caso clínico y revisión de literatura. Caso clínico: masculino de 71 años quien ingresa al Hospital Uyapar por presentar distensión, dolor abdominal y la ausencia de evacuaciones, al examen físico abdomen, distendido, doloroso, timpanizado, escasos ruidos hidroaéreos, tacto rectal: próstata aumentada de tamaño, superficie irregular, consistencia pétrea, laboratorios sin alteraciones. Se plantea el diagnóstico de obstrucción intestinal parcial. Recibe tratamiento médico y 2 días posterior a su ingreso, debido a exacerbación de sintomatología se realiza laparotomía exploradora evidenciando perforación de ciego y colon transverso, tumor en recto superior de 5 cm x 5 cm aproximadamente y lesiones blanquecinas en segmentos hepáticos VI, VIII y X, se realiza hemicolectomía derecha ampliada, se toman muestras de ganglios hepáticos y mesentéricos, y de lesiones hepáticas, cuyas biopsias reportan lesiones metastásicas de probable origen prostático a los cuales se realiza estudio inmunohistoquímica corroborando diagnóstico de adenocarcinoma prostático. Se presenta caso clínico debido a lo infrecuente de encontrar metástasis hepáticas en pacientes con cáncer de próstata. Así mismo, en la literatura revisada no se encontraron casos de cáncer prostático que se presenten clínicamente como obstrucción intestinal.

The prostate cancer is the most frequently diagnosed neoplasia in the male population. This neoplasia is in second place about mortality respect all of cancers. The majority of dead are common cause of metastases disease. Bone is the most commonly involved organ by metastasis disease followed by lungs, pleura and the liver. A clinical case description and literature review is presented. The clinical case: male of 71 years old who entranced at Uyapar Hospital for presented abdominal pain, distention and constipation. Physical examination: distended and painful abdomen, bowel sounds decreased, rectal examination: prostate gland enlarged, irregular with rock hard consistency. No altered laboratory findings. The established diagnosis was partial obstruction of the large intestine. Two days after receiving medical treatment, due to worsen symptoms, exploratory laparotomy was done. The surgical findings were cecum and transverse colon perforation, an upper rectum´s tumor of 5 x 5 cm and whitish lesions of VI, VIII and X hepatic segments. A right extended colostomy was done. Samples of hepatic and mesenteric lymph nodes and hepatic lesions were taken and sent to biopsy which reported metastasis lesions of probable prostate origin and these biopsies were analyzed with inmunohistochemical method that verified diagnosis of prostate adenocarcinoma. This clinical case is presented due to the infrequent liver metastases in patients with prostate cancer. Furthermore, there were no cases of prostate cancer clinically presented like partial obstruction of large intestine in the literature reviewed.

Tomografia computadorizada sem contraste na avaliação de pacientes com cólica renal / Unenhanced computed tomography in patients with renal colic

Este artigo faz uma revisão sobre o papel da tomografia computadorizada (TC) sem contraste em pacientes que apresentam cólica renal e ressalta as vantagens apresentads por esse método, o qual é considerado atualmente o exame-padrão ouro para diagnosticar nefrolitíase. Para tal, primeiramente, é feita uma breve revisão sobre esta entidade clínica e sobre os diferentes métodos de imagem utilizados em sua confirmação diagnóstica.

Treatment of Fraley’s syndrome by upper-pole nephrectomy

CONTEXT: Fraley’s syndrome is characterized by vascular compression on the superior infundibulum with secondary dilatation of the upper pole calyx, mostly located on the right side. CASE REPORT: We present the case of a 22-year-old woman with vascular compression of the upper-pole infundibulocalyceal system (Fraley’s syndrome). The patient had a history of frequent hospitalizations for emergency care due to lumbar pain over the past twelve months. The diagnosis was obtained following renal arteriography. Since the surgical treatment by means of upper-pole nephrectomy, the patient has not had any further symptoms.

CONTEXTO: A síndrome de Fraley é caracterizada por impressão vascular do infundíbulo superior com dilatação secundária do pólo caliceal superior. É geralmente localizada no lado direito. RELATO DE CASO: Nós apresentamos o caso de uma mulher com 22 anos de idade com compressão vascular do sistema infundibulocaliceal do pólo superior (síndrome de Fraley). A paciente trazia história de hospitalizações freqüentes em emergências nos últimos 12 meses devido a cólicas renais. O diagnóstico foi obtido após arteriografia renal. Depois do tratamento cirúrgico por meio de nefrectomia polar superior, a paciente não apresentou mais sintomas.

Abdomen agudo médico / Acute abdominal pain

El dolor abdominal agudo es un síntoma habitual y muchas veces severo en la práctica médica. En ocasiones puede aparecer como un cuadro dramático asociado a numerosas enfermedades médicas o quirúrgicas. Al asistir a un paciente con dolor abdominal agudo el médico está obligado a establecer con premura un diagnóstico presuntivo y a elegir el tratamiento apropiado. El objetivo de este artículo es enunciar y clasificar las numerosas enfermedades médicas que pueden presentar dolor abdominal agudo como síntoma principal.

Renal colic: pathophysiology, diagnosis and management

Renal colic not only leads to significant morbidity, but also imposes a financial burden on society in that it decreases productivity and increases healthcare costs. A review of medical literature regarding reno - urethral colic was performed using MEDLINE and on-line publications, like European Association of Urology [EAU] Guidelines. Clinical presentation of renal colic, mechanisms of urethral peristalsis and pathophysiology of renal colic were studied. An overview of available medical treatments was presented. The classic presentation of acute renal colic is sudden onset of severe pain in flank, primarily caused by acute urethral obstruction. The pain associated with urethral obstruction is caused by a rise in intra luminal pressure which produces an increase in urethral smooth muscle tension. The diagnosis is often made on clinical symptoms. The objectives of therapy at this stage are to eliminate pain, preserve renal function and eliminate the obstruction. Many drugs have been used in the treatment of renal colic, such as NSAIDs, opioid analgesics, and even loco-regional anesthesia and acupuncture. Nonetheless, the safest and most effective treatment has not yet been clearly defined. An accurate understanding of the pathophysiology of reno- urethral colic allows the physician to tailor the best treatment for each patient. Although many drugs have been suggested for treating renal colic, it seems that the first line medications should be NSAIDs, mostly in oral form. Fluid intake is encouraged and chemical analysis of stone should be performed whenever possible

Exploración laparoscópica de la vía biliar: primera experiencia en el Hospital Universitario de Caracas / Laparoscopic exploration of the biliary tract: first experience at the Hospital Universitario de Caracas

El objetivo de este trabajo es presentar la experiencia inicial en la exploración laparoscópica de la vía biliar en pacientes con coledocolitiasis. Se evalúan cuatro casos de pacientes con coledocolitiasis a quienes se les realizó exploración de vía biliar por laparoscopia. Servicio de Cirugía III. Hospital Universitario de Caracas. El ultrasonido y las pruebas de funcionalismo hepático hicieron sospechar la presencia de cálculos en la vía biliar. En todos los casos se realizó colangiografía intraoperatoria, la cual constató la presencia de coledocolitiasis. Posteriormente se realizó exploración de la vía biliar por laparoscopia, por vía transcística con cesta de Dormia bajo control fluoroscópico, siendo esta vía efectiva en el 50 por ciento de los casos, el resto de los casos requirió realización de coledocotomía y uno de ellos se convirtió por la presencia de cálculo enclavado en la ampolla y dificultades técnicas. El tiempo operatorio promedio para la exploración transcística y transcoledociana fue de 105 y 210 minutos respectivamente. La única complicación asociada al procedimiento correspondió a un caso de diarrea postoperatoria. La evolución postoperatoria fue satisfactoria en todos los casos. La exploración laparoscópica de la vía biliar parece ser un procedimiento seguro y efectivo para el tratamiento de la coledocolitiasis, sin embargo, es importante tomar en cuenta la experiencia del equipo quirúrgico y la disponibilidad del instrumental para realizar el procedimiento. Es necesario proseguir con el estudio para continuar con el desarrollo de la técnica y establecer conclusiones definitivas.

role of unenhanced helical computed tomography scan in the diagnosis of acute renal colic

Patients presenting in the emergency room [ER] with flank pain suggestive of renal or ureteric stones may have alternative underlying conditions mimicking urolithiasis. An early diagnosis and appropriate treatment for urolithiasis and other causes of flank pain is important. The majority of centers around the world are increasingly using un-enhanced helical CT [UHCT] for evaluation of renal colic. This study was conducted to define the importance of UHCT as an alternative to US and IVP in cases of acute renal colic with suspected renal or ureteric stones as a cause of pain and to define the incidence and spectrum of significant incidental diagnosis other than renal or ureteric stones. 43patients presented at ER with acute loin pain were reviewed with UHCT for suspected renal or/ureteral stones. Radiological diagnosis of clinical entities not suspected otherwise was analyzed. All other relevant radiological, biochemical and serological investigations and per-operative findings were also noted. Renal stones were identified in 11 patients [25.6%], ureteral calculi were identified in 16 patients [37.2%], findings of recent passage of calculi in 2 patients [4.7%] and no calculi in 14 patients [32.5%]. Overall the incidental findings [additional or alternative diagnosis] were found in 3 [6.9%] CT scans of all patients; and [21%] of nonurinary calcular patients. Diagnosis was confirmed by peri-operative findings, and other radiological and biochemical investigations or on clinical follow up. UHCT is more beneficial than US and IVP in ER for accurate and rapid management of cases of acute renal colic as a wide spectrum of significant incidental diagnosis - other than stones - can be identified on UHCT performed for suspected renallureteral stones. In the present series of 43 CT examinations, Urolithiasis was appeared in 67.5% of cases. The incidence of incidental diagnosis of pathologies other than urolithiasis was 6.9% of all patients 21% of patients with no calculi