Malrotación intestinal en el adulto: cirugía de Ladd laparoscópica / Intestinal Malrotation in Adults: laparoscopic Ladd's Surgery

Las malrotaciones por bandas de Ladd son un subtipo de anormalidades de la embriogénesis consistentes en prolongaciones fibrosas, producto de una fijación anómala del mesenterio. Se extienden desde el ciego mal rotado hacia el retroperitoneo, pudiendo producir compresión extrínseca del duodeno. En el 90% de los casos la presentación clínica tiene lugar dentro del primer año de vida como un cuadro agudo, en forma de oclusión duodenal o vólvulo de intestino delgado con la consecuente isquemia de este o hernia interna. En la edad adulta, las formas de presentación son menos específicas. Los métodos de referencia ("gold standard") utilizados para el diagnóstico son la seriada gastroduodenal y la tomografía computarizada. El tratamiento quirúrgico consiste en la cirugía de Ladd, cuyo abordaje convencional fue descripto en 1936 por William Ladd. Presentamos el caso de un paciente adulto con un cuadro oclusivo, causado por dicha anomalía, diagnosticado de forma oportuna y resuelto de manera segura por vía laparoscópica. (AU)

Ladd's band malrotations are a subtype of abnormalities of embryogenesis consisting of fibrous extensions, product of abnormal fixation of the mesentery, that goes from the poorly rotated cecum towards the retroperitoneum, which can cause extrinsic compression of the duodenum. In 90% of cases, the clinical presentation takes place within the first year of life, as an acute condition, like duodenal occlusion or small bowel volvulus with its consequent ischemia or internal hernia. In adulthood, the forms of presentation are less specific. The gold standard methods used for diagnosis are gastroduodenal series and computed tomography. Surgical treatment consists of Ladd's surgery, whose conventional approach was described in 1936 by William Ladd. We present ta case of an adult patient with an occlusive presentation, given by this anomaly, diagnosed in a timely manner and safely resolved by laparoscopic approach. (AU)

Perioperative management and operative treatment of malignant tumor of anal canal merging severe abdominal protuberance / 中华胃肠外科杂志

Objective: To report the perioperative management and robot-assisted minimally invasive surgery results of one case with malignant tumor of anal canal combined with severe abdominal distention. Methods: A 66-year-old male suffer from adenocarcinoma of anal canal (T3N0M0) with megacolon, megabladder and scoliosis. The extreme distention of the colon and bladder result in severe abdominal distention. The left diaphragm moved up markedly and the heart was moved to the right side of the thoracic cavity. Moreover, there was also anal stenosis with incomplete intestinal obstruction. Preoperative preparation: fluid diet, intravenous nutrition and repeated enema to void feces and gas in the large intestine 1 week before operation. Foley catheter was placed three days before surgery and irrigated with saline. After relief of abdominal distention, robotic-assisted abdominoperineal resection+ subtotal colectomy+colostomy was performed. Results: Water intake within 6 hours post-operatively; ambulance on Day 1; anal passage of gas on Day 2; semi-fluid diet on Day 3; safely discharged on Day 6. Conclusion: Robotic-assisted minimally invasive surgery is safe and feasible for patients with malignant tumor of anal canal combined with severe abdominal distention after appropriate and effective preoperative preparation to relieve abdominal distention.

Excepcional variación anatómica del confluente biliar superior / Exceptional anatomical variation of the upper biliary confluence / Variação anatômica excepcional da confluência biliar superior

Las variaciones de la formación del confluente biliar superior y su frecuencia deben ser conocidas para asegurar óptimos resultados en la cirugía hepática y evitar lesiones quirúrgicas biliares.

Incidencia y características de los pacientes portadores de defectos congénitos en el Servicio de Neonatología del Centro Hospitalario Pereira Rossell 2016-2020: 5 años de experiencia / Incidence and characteristics of patients with congenital defects at the Pereira Rossell Hospital's Neonatology Department in 2016-2020: 5 years experience / Incidência e características dos pacientes com defeitos congênitos no Serviço de Neonatologia do Centro Hospitalar Pereira Rossell 2016-2020: 5 anos de experiencia

Los defectos congénitos son alteraciones morfológicas que se originan durante la vida intrauterina que se presentan hasta en un 5% de los recién nacidos vivos. Tienen múltiples etiologías, siendo esta multifactorial en el 90% de los casos. Se realizó un estudio observacional, prospectivo, descriptivo incluyendo a todos los recién nacidos portadores de defectos congénitos en el período 2016-2020. El objetivo de este trabajo es determinar la incidencia de defectos congénitos en recién nacidos del Centro Hospitalario Pereira Rossell en el período mencionado, así como conocer su distribución por aparatos y sistemas, las características demográficas de esta población, la prevalencia de diagnóstico prenatal y la exposición materna a factores de riesgo durante la organogénesis. Se obtuvo una incidencia de 1,7% (423 recién nacidos afectados en 24.870 nacimientos), de los cuales el 34,98% contaba con diagnóstico prenatal. El sistema cardiovascular fue el que presentó una mayor frecuencia de alteraciones, y el defecto congénito más frecuentemente observado individualmente fue la gastrosquisis, con una incidencia de 15,28 cada 10.000 nacidos vivos. La diabetes gestacional se presentó en el 17,25% de las gestantes. Este trabajo nos permitió conocer la incidencia de defectos congénitos, así como su distribución por aparatos y sistemas. Este tipo de sistemas de vigilancia resultan fundamentales para identificar elementos a mejorar, que permitan disminuir la morbilidad y mortalidad de estos pacientes y también identificar precozmente factores de riesgo que aumenten estas patologías de forma significativa.

Congenital birth defects are morphological disturbances originated during gestation and present in up to 5% of live births. They have multiple etiologies, in 90% of cases of multifactorial origin. A longitudinal, prospective, observational study was carried out and it included all patients with congenital birth defects in 2016-2020. The main objective of this study was to determine the incidence of newborns with congenital birth defects between 2016 and 2020, to determine their distribution by organ, to describe their demographic characteristics, to calculate the prevalence of prenatal diagnosis and to identify maternal risk factors. We obtained an incidence of 1,7% (423 affected newborns in 24870 live births), 34,98% had prenatal diagnoses. The cardiovascular system was the most frequently affected and when classified by individual birth defect, the most frequently observed was gastroschisis with 15.28 cases in 10,000 live births. Gestational diabetes was the maternal risk factor most frequently observed with 17, 25%. This study enabled us to know the incidence of congenital birth defects and their distribution by different organs at our center. These surveillance systems are key to identify areas of potential improvement that might enable us to mitigate morbidity and mortality in this group of patients.

Os defeitos congênitos são alterações morfológicas que se originam durante a vida intrauterina e ocorrem em até 5% dos recém-nascidos vivos. Possuem múltiplas etiologias, sendo multifatoriais em 90% dos casos. Realizou-se um estudo observacional, prospectivo e descritivo incluindo todos os recém-nascidos com defeitos congênitos no período 2016-2020. O objetivo deste trabalho foi determinar a incidência de defeitos congênitos em recém-nascidos do Centro Hospitalar Pereira Rossell no período 2016-2020, bem como conhecer sua distribuição por órgãos e sistemas, as características demográficas dessa população, a prevalência de diagnóstico pré-natal e exposição materna a fatores de risco durante a organogênese. Obteve-se uma incidência de 1,7% (423 recém-nascidos afetados em 24.870 nascimentos), dos quais 34,98% tiveram diagnóstico pré-natal. O sistema cardiovascular foi o que apresentou maior frequência de alterações, e o defeito congênito mais observado individualmente foi a gastrosquise com incidência de 15,28 em cada 10.000 nascidos vivos. O diabetes gestacional ocorreu em 17,25% das gestantes. Este paper permitiu conhecer a incidência de defeitos congênitos, bem como sua distribuição por órgãos e sistemas. Estes tipos de sistemas de vigilância são essenciais para identificar elementos a melhorar, que permitam reduzir a morbilidade e mortalidade desses pacientes e também identificar precocemente fatores de risco que aumentam significativamente essas patologias.

Quiste de duplicación gástrica en el adulto. Reporte de un caso y revisión de la bibliografía / Cyst of gastric duplication in adults. Case report and review of the bibliography

RESUMEN Las duplicaciones del tracto gastrointestinal son malformaciones congénitas poco frecuentes que pueden afectar cualquier segmento del tubo digestivo. Suelen presentarse en los primeros dos años de vida con síntomas de pobre ganancia de peso y masa abdominal palpable o pueden ser asintomáticos hasta la adultez. Reportamos el caso de un paciente masculino de 37 años que fue evaluado por epigastralgia y antecedente de hemorragia digestiva superior. La endoscopia alta reveló lesión subepitelial en fundus gástrico ulcerada con sospecha diagnóstica de tumor del estroma gastrointestinal (GIST). El ultrasonido endoscópico confirmó masa gástrica con focos de necrosis y calcificación, compatible con tumor estromal tipo GIST. Se realizó resección gástrica distal en cuña sin complicaciones. El informe de patología señaló duplicación gástrica.

ABSTRACT Gastrointestinal tract duplications are rare congenital malformations that can affect any segment of the digestive tract. They usually occur in the first two years of life with symptoms of poor weight gain and palpable abdominal mass or may be asymptomatic until adulthood. We report the case of a 37-year-old male patient who was evaluated for epigastralgia and a history of upper gastrointestinal bleeding. High endoscopy revealed ulcerated subepithelial lesion in gastric fundus with diagnostic suspicion of gastrointestinal stromal tumor (GIST). Endoscopic ultrasound confirmed gastric mass with foci of necrosis and calcification, compatible with stromal tumor type GIST. Distal gastric resection was performed in wedge without complications. The pathology report noted gastric duplication.

Malrotación intestinal en el adulto diagnosticado posterior a presentación del síndrome pospolipectomía en ciego: reporte de un caso / Intestinal malrotation in adults diagnosed after presentation of post polypectomy syndrome in the cecum: report of a case

RESUMEN La malrotación intestinal es una anomalía congénita de la rotación y fijación intestinal, diagnosticada de forma infrecuente en la edad adulta. Se presenta un caso de malrotación intestinal en un paciente adulto previamente asintomático con cambios en el hábito intestinal en los últimos 6 meses al que se le realiza una colonoscopia ambulatoria con la evidencia de un pólipo en el ciego, posterior a su resección presenta dolor abdominal agudo en fosa ilíaca izquierda que permite la realización de estudios imagenológicos que confirman el diagnóstico.

ABSTRACT Intestinal malrotation is a congenital anomaly of intestinal rotation and fixation, diagnosed infrequently in adulthood. We report the presence of intestinal malrotation in a previously asymptomatic adult patient with changes in bowel habit in the last 6 months after a colonoscopy is performed with evidence of a polyp in the cecum, after resection presenting acute abdominal pain in the left iliac fossa that allows imaging to confirm the diagnostic.

Quiste de duplicación gástrica en el adulto: una rara entidad / Gastric duplication cyst in the adult: a rare entity

Resumen Objetivo Reportar el caso clínico de un quiste de duplicación gástrica en un paciente adulto. Materiales y Método Paciente de sexo masculino de 70 años con una tumoración quística supramesocólica, con síntomas digestivos inespecíficos. La imagenología solicitada no determinó la etiología ni origen de la misma planteándose múltiples diagnósticos diferenciales. Se realizó una laparotomía exploradora. Resultados La laparotomía confirmó el origen gástrico de la tumoración. Se realizó la resección completa de la misma con resección gástrica en forma de gastrectomía atípica. El estudio anatomopatológico de la pieza confirmó un quiste de duplicación gástrica. Discusión Los quistes de duplicación gástrica son una enfermedad congénita rara, se diagnostican principalmente en la etapa neonatal, siendo raro en el adulto. La mayoría son lesiones únicas, no comunicantes, asintomáticas y de difícil diagnóstico preoperatorio siendo habitual el diagnostico definitivo en el intraoperatorio y con el estudio histológico de la pieza. Conclusión El quiste de duplicación gástrica debe tenerse en cuenta en los diagnósticos diferenciales de toda lesión quística supramesocólica. Son lesiones potencialmente malignas siendo la resección completa la que brinda el diagnóstico y tratamiento definitivo.

Aim To report the clinical case of a gastric duplication cyst in an adult patient. Materials and Method 70 year old male patient with a symptomatic supramesocolic cystic lesion. Preoperative imagenology was not able to determine the exact origin or etiology. Several differential diagnosis were made and finally an exploratory laparotomy was performed. Results The laparotomy determined the gastric origin and a complete resection including gastric wall was done. The anatomopathological study confirmed it was a gastric duplication cyst. Discussion Gastric duplication cysts are a rare congenital disease, diagnosed mainly in the neonatal stage, with rare presentation in the adult stage. Most of these lesions are unique, non-communicating, usually asymptomatic and difficult to diagnose preoperatively, with definitive diagnosis being common in intraoperative and histological study of the piece. Conclusion The gastric duplication cyst must be taken into account in the differential diagnosis of any supramesocolic cystic lesion. They are potentially malignant lesions, and complete resection provides the definitive diagnosis and treatment.

Assessment of fetal superior mesenteric artery and vein by three-dimensional power Doppler sonography / 浙江大学学报·医学版

OBJECTIVE@#To analyze the application of three-dimensional power Doppler sonography (3-DPDS) in evaluation of the superior mesenteric artery (SMA) and superior mesenteric vein (SMV) in second-trimester fetus.@*METHODS@#Three-dimensional volume probe was used to collect the 3-DPDS blood flow images in 50 normal fetuses of 22-24 weeks and 50 fetuses of 30-32 weeks, respectively. The characteristics of three-dimensional ultrasound were analyzed. The clinical and imaging data of 4 fetuses of 26-32 weeks with midgut volvulus were analyzed retrospectively.@*RESULTS@#The display rates of SMA and SMV were 93%in normal group by 3-DPDS and those in volvulus group were 4/4 and 3/4, respectively. The SMV trunk was parallel to and on the right side of the SMA in the normal group, while 3 cases in volvulus group showed the characteristic relationship of SMV swirling around SMA.@*CONCLUSIONS@#3-DPDS can be used to observe the spatial relationship of SMA and SMV visually in fetus during the second trimester and is of value to diagnose and predict the outcome of midgut volvulus.

Lesión de Dieulafoy: reporte de dos casos / Dieulafoy lesion: a report of two cases

Se describen dos casos de lesión de Dieulafoy, la cual es definida como una anormalidad de una arteria grande o arteriola, que conserva su calibre al aproximarse a la mucosa. Esta lesión suele presentarse como sangrado gastrointestinal masivo no doloroso e inestabilidad hemodinámica y puede ser causa de hemorragia gastrointestinal fatal. El diagnóstico definitivo es anatomopatológico aunque con la endoscopia se puede alcanzar una precisión elevada siendo esta última el tratamiento de elección. La enfermedad presentaba una mortalidad cercana al 80% antes de la terapia endoscópica y gracias a esta actualmente se ha reducido al 13%. La experiencia del endoscopista y los recursos disponibles influyen en forma directa con la eficacia en el diagnostico, tratamiento y sobrevida de los pacientes.

Two cases of Dieulafoy lesion, defined as a malformation in a large artery or arteriole that retains its caliber when approaching the mucosa, are described here. This lesion usually causes non-painful massive gastrointestinal bleeding and hemodynamic instability and can cause a fatal gastrointestinal hemorrhage. The definitive diagnosis is pathologic, although a high precision can be achieved by endoscopy, that is the treatment of choice. The disease had a mortality rate near 90% before the endoscopic therapy and, thanks to it, it has currently been reduced to 13%. The endoscopist's experience and the available resources influence directly on the effectiveness of diagnosis, management and survival of patients.

Hallazgos endoscópicos en fallecidos por sangrado digestivo alto no variceal por desequilibrio ácido péptico / Endoscopic findings in deceased due to high digestive bleeding no variceal due to peptic acid imbalance

Introducción: La hemorragia digestiva alta es asumida como una emergencia patológica de causas diversas, que deviene en complicaciones fatales con relativa frecuencia.Objetivo:Identificar los hallazgos endoscópicos presentes en pacientes con desenlaces fatales (muerte) por HDA de etiología ácido-páptica, durante 3 años consecutivos.Métodos:Se realizó una investigación descriptiva de serie de casos para valorar los hallazgos endoscópicos en fallecidos por sangrado digestivo alto no variceal por desequilibrio ácido péptico en 25 pacientes egresados de los Servicios de Cuidados Intensivos e Intermedios y de Cirugía General del Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" de Santiago de Cuba, durante el trienio 2012 (enero)-2015 (diciembre).Resultados:Los ancianos mayores de 66 años resultaron el grupo de edad preponderante y del sexo masculino. Los antecedentes predominantes en la serie estuvieron liderados por el consumo de AINE, antecedente de enfermedad acido-péptica conocida e hipertensión arterial. El diagnóstico más utilizado resultó el clínico endoscópico (56%). Conclusiones:Los procesos ulcerosos duodenales con tamaños inferiores a 2cm resultaron los más frecuentes y con predominio de la clasificación de Forrest II-b, lo cual expresa por si solo su importancia en cuanto al riesgo de resangrado y de fatales desenlaces, pudiendo servir los datos para futuros estudios similares al relacionar los mismos con resultados de terapias intervencionistas

Introduction:Upper gastrointestinal hemorrhage is assumed as a pathological emergency of diverse causes, which results in fatal complications with relative frequency.Objective:To identify the endoscopic findings present in patients with fatal outcomes (death) due to HDA of acid-páptica etiology, during 3 consecutive years.Methods:A descriptive investigation of case series was carried out to evaluate the endoscopic findings in deceased persons due to high non-variceal digestive bleeding due to peptic acid imbalance in 25 patients graduated from the Intensive and Intermediate Care Services and General Surgery of the Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" of Santiago de Cuba, during the triennium 2012 (January) -2015 (December).Results:The elderly over 66 years were the predominant age group and male.The predominant antecedents in the series were led by the consumption of NSAIDs, a history of known acid-peptic disease and arterial hypertension. The most used diagnosis was the endoscopic clinician (56%).Conclusions:The duodenal ulcer processes with sizes smaller than 2cm were the most frequent and with a predominance of the Forrest II-b classification, which in itself expresses its importance in terms of risk of rebleeding and fatal outcomes, which can serve for future similar studies when relating them to the results of interventional therapies

Recurrent acute pancreatitis caused by pancreatic biliary maljunction due to long common channel / Pancreatitis aguda recurrente causada por deficiente unión pancreático-biliar debido a un colédoco largo

The pancreatic biliary maljunction is a rare anomaly that affects mainly females, defined as an anatomical maljunction of the pancreatic duct and the biliary duct confluence, and may be a rare cause of recurrent acute pancreatitis. In order to early diagnosis and prompt treatment, ERCP has an important role in it

La Malformación de la unión biliopancreática es una afección rara y ocurre más en mujeres jóvenes. Es una causa de pancreatitis aguda de causa no conocida. CPRE es una herramienta eficiente para el diagnóstico y también para ser de la terapéutica

Tratamiento actual de la acalasia, reporte de un caso y revisión de la literatura / Current treatment of achalasia. A case report and literature review

Resumen: Presentamos el caso de una joven de 16 años con síntomas digestivos, principalmente disfagia y dolor retroesternal. Luego de ser diagnosticada de acalasia (sintomatología compatible), que se confirma por manometría de alta resolución, se indica tratamiento quirúrgico (miotomía de Heller + funduplicatura de Toupet), con cirugía mínimamente invasiva (laparoscopia), La evolución fue muy favorable: desaparecieron los síntomas digestivos y fue notable la pronta recuperación. Se revisa la literatura de las distintas opciones terapéuticas y sus principales indicaciones. Palabras claves: acalasia, manometría de alta resolución, miotomía de Heller, funduplicatura de Toupet

Abstract: We report the case of 15 year old female with digestive symptoms, mainly dysphagia and chest pain. After being diagnosed with possible achalasia (compatible clinical), is confirmed by high-resolution manometry, surgical treatment is indicated (myotomy heller + fundoplication toupet), with minimally invasive surgery (laparoscopy), with a very favorable evolution, disappearing digestive symptoms and produced a remarkable recovery in a short time. We do a literature review of therapeutic options available and their main indications. Key words: achalasia, high-resolution manometry, Heller myotomy, Toupet fundoplication

Hallazgos endoscópicos y patológicos en pacientes con VIH y síntomas digestivos de un hospital universitario / Endoscopic and Pathological Findings in Patients with HIV and Digestive Symptoms at a University Hospital

Introducción: el tracto gastrointestinal es un sitio frecuentemente afectado por el VIH; sin embargo, en la práctica clínica algunos hallazgos normales en la endoscopia pueden no serlo, lo cual conlleva a estos pacientes a no recibir tratamiento oportuno para patologías gastrointestinales. Métodos: estudio observacional descriptivo en pacientes con VIH que consultaron por síntomas digestivos y que requirieron endoscopia y/o colonoscopia durante el año 2014 en el Hospital Universitario de Santander. Se tomaron datos sociodemográficos, clínicos y paraclínicos. Se realizaron 41 endoscopias altas y 29 colonoscopias en 54 pacientes. A todo estudio se le practicó biopsia. Resultados: la edad promedio fue de 39 años, la sintomatología digestiva con mayor reporte fue la diarrea y las lesiones orales; 87% tenían conteo menor a 200 CD4, solo 24% reciben actualmente TARAE. Los diagnósticos más frecuentes por anatomía patológica diferentes a normalidad fueron: Candidiasis (17%) en esófago, gastritis crónica moderada (26,7%) en estómago y colitis crónica inespecífica moderada tanto en colon izquierdo (44,8%) como en colon derecho (51,7%). Conclusiones: los hallazgos endoscópicos y patológicos concuerdan con la frecuencia de presentaciones reportadas en la literatura, aunque no se encontraron neoplasias ni agentes infecciosos como micobacterias. Los oportunistas más frecuentes fueron la cándida y el citomegalovirus. Al confrontar el diagnóstico de normalidad entre el endoscopista y la anatomía patológica, solamente en esófago había una concordancia aceptable, a diferencia del estómago y el colon, donde la disparidad es evidente. Por lo anterior, en pacientes con VIH/sida que requieran endoscopia sería importante siempre considerar la toma biopsias de manera protocolizada.

Introduction: Although the gastrointestinal tract is frequently affected by HIV, in clinical practice abnormalities related to HIV often appear to be normal when seen through an endoscope. The consequence is that these patients do not receive timely treatment for gastrointestinal diseases. Methods: This is an observational study of HIV patients who came to the hospital of the Universidad Industrial de Santander because of digestive symptoms that required either endoscopy or colonoscopy, or both ,during 2014. Socio-demographic, clinical and laboratory data were collected. A total of 41 upper endoscopies and 29 colonoscopies were performed in 54 patients. Biopsies were taken and analyzed in all cases. Results: The mean patient age was 39 years old, the most frequent digestive symptoms were diarrhea and oral lesions, 87% of these patients had CD4 counts below 200, and only 24% currently receive HAART. The most frequent diagnoses were: esophageal candidiasis (17%), moderate chronic gastritis in the stomach (26.7%), and moderate chronic nonspecific colitis in the left colon (44.8%) and in the right colon (51.7%). Conclusions: Endoscopic and pathological findings are consistent with the frequencies of presentations of gastrointestinal pathologies reported in the literature except that no tumors or infectious agents such as mycobacteria were found. The most common opportunistic infections were Candida and Cytomegalovirus. Diagnostic agreement between the endoscopist and pathologist varied. There was had only fair agreement for the esophagus, but there were large disparities for the stomach and colon. Consequently, when HIV/AIDS patients require endoscopy, it is important that the protocol call for biopsy samples and analysis.

Validation of questionnaires to assess quality of life related to fecal incontinence in children with anorectal malformations and hirschsprung's disease / Validação de questionários para avaliação da qualidade de vida relacionada à continência fecal em crianças com malformações anorretais e doença de hirschsprung

Surgical treatment of anorectal malformations (ARMs) and Hirschsprung's disease (HD) leads to alterations in bowel habits and fecal incontinence, with consequent quality of life impairment. The objectives were to create and validate a Questionnaire for the Fecal Incontinence Index (FII) based on the Holschneider score, as well as a Questionnaire for the Assessment of Quality of Life Related to Fecal Incontinence in Children and Adolescents (QQVCFCA), based on the Fecal Incontinence Quality of Life. Methods: The questionnaires were applied to 71 children submitted to surgical procedure, in two stages. Validity was tested by comparing the QQVCFCA and a generic quality of life questionnaire (SF-36), and between QQVCFCA and the FII. A group of 59 normal children was used as control. Results: At two stages, 45.0% (32/71) and 42.8% (21/49) of the patients had fecal incontinence. It was observed that the QQVCFCA showed a significant correlation with the SF-36 and FII (Pearson's correlation 0.57), showing that the quality of life is directly proportional to improvement in fecal incontinence. Quality of life in patients with fecal incontinence is still globally impaired, when compared with control subjects (p<0.05, Student's t-test). There were also significant differences between the results of children with ARMs and children with HD. Conclusions: QQVCFCA and FII are useful tools to assess the quality of life and fecal incontinence in these groups of children. Children with ARMs submitted to surgical procedure and HD have similar quality of life impairment.

O tratamento cirúrgico das malformações anorretais (MAR) e da doença de Hirschsprung (DH) leva a alterações do hábito intestinal e incontinência fecal com prejuízo da qualidade de vida. Os objetivos foram criar e validar o Questionário para o Índice de Continência Fecal (ICF), baseado no Holschneider Criteria, bem como o Questionário para Avaliar a Qualidade de Vida Relativa à Continência Fecal em Crianças e Adolescentes (QQVCFCA), baseado no Fecal Incontinence Quality of Life. Métodos: Os questionários foram aplicados em 71 crianças operadas, em duas etapas. A validade foi testada por meio da comparação do QQVCFCA e um questionário genérico de qualidade de vida (SF-36) e entre o QQVCFCA e o ICF. Um grupo de 59 crianças normais foi usado como controle. Resultados: Nas duas etapas, 45,0% (32/71) e 42,8% (21/49) dos pacientes apresentaram incontinência fecal. Verificou-se que o QQVCFCA apresentou correlação significativa com o SF-36 e o ICF (correlação de Pearson 0,57) e mostrou que a qualidade de vida é diretamente proporcional à melhoria da continência fecal. A qualidade de vida no paciente com incontinência fecal está ainda comprometida globalmente, em comparação com os indivíduos controles (p<0,05; teste t de Student). Não houve ainda diferença significativa entre os resultados de crianças com MAR e crianças com DH. Conclusões: O QQVCFCA e o ICF são instrumentos úteis para a avaliação da qualidade de vida e da incontinência fecal nesses grupos de crianças. Crianças operadas de MAR e DH apresentam comprometimentos semelhantes da qualidade de vida.

Idiopathic meconium peritonitis as a surgical emergency: A case report in a newborn / Peritonitis meconial idiopática como urgencia quirúrgica. Reporte de caso en una recién nacida

Meconium peritonitis is a rarely described condition that is typically found in fetal and perinatal patients. It manifests in different ways and requires an early diagnosis. In this case report, a clinical suspicion of the disease was made at the antenatal period through an obstetric ultrasound scan showing an abdominal mass in both the bottom and top right quadrants. The patient initial symptoms were those of acute intestinal obstruction. Nevertheless, these symptoms improved after surgical approach was timely performed. Based on this outcome, it can be concluded that a favorable outcome to this pathology depends on its early diagnosis, since an early diagnosis decreases morbidity and mortality chances.

La peritonitis meconial es una entidad poco descrita, propia de la edad fetal y perinatal, que se presenta de diversas formas y requiere un diagnóstico temprano. En el presente caso se realiza sospecha clínica desde el periodo antenatal, por medio de una ecografía obstétrica que muestra una masa abdominal ocupando el cuadrante derecho inferior y superior. La paciente inicia con síntomas agudos de obstrucción intestinal que mejoran luego de un abordaje quirúrgico oportuno. De acuerdo a lo anterior, se concluye que un desenlace favorable en esta patología depende de un diagnóstico temprano, pues a través del mismo se disminuyen las probabilidades de morbilidad y mortalidad

Prevalencia, formas clínicas y factores asociados a defectos congénitos del sistema digestivo / Prevalence, clinical presentation and factors associated to congenital defects of the digestive system

El sistema digestivo es de los más afectados por defectos congénitos, los cuales constituyen un problema de salud global por aparecer entre las primeras causas de mortalidad infantil y por lo difícil de su prevención.Objetivo: identificar factores asociados a la aparición de defectos congénitos del sistema digestivo y la magnitud del riesgo que implica su presencia en el municipio Camagüey.Método: estudio de casos y controles con un universo conformado por todas las concepciones del período estudiado. De la población compuesta por 53 defectos congénitos del sistema digestivo, la muestra fue de 30 casos. Los 30 controles fueron niños sanos de la misma área de salud e igual sexo y edad probable para cada caso, en el periodo desde enero de 2006 a enero del 2011.Resultados: los defectos congénitos del sistema digestivo fueron segundos en prevalencia superados por el sistema nervioso y seguidos por las cardiopatías. La gastrosquisis fue la anomalía más frecuente, seguida por las hernias diafragmáticas, el onfalocele y las atresias esofágicas. El consumo de café en la madre (p=0,002;OR:5,53;IC:1,03-1,14), el hábito de fumar en el padre (p=0,009;OR:6,45;IC:1,57-26,36) y los antecedentes familiares de anomalías (p=0,009;OR:6,40;CI:1,60-25,66) fueron los factores que mostraron asociación estadística con la presencia de defectos congénitos del sistema digestivo.Conclusiones: no se constataron frecuencias erráticas que indicaran la acción de teratógenos exógenos; cada factor independiente identificado incrementó en más de cinco veces la probabilidad de presentar defectos congénitos del sistema digestivo y su asociación triplicaría esa cifra. Los resultados sugieren redirigir el proyecto a la exploración exhaustiva de los factores identificados y se recomiendan estudios sucesivos con muestras mayores para llegar a conclusiones clínicas con mejor certidumbre...

Digestive system is one of the most affected by congenital defects which constitute a global health problem; they are among the main causes of infant mortality and also difficult to prevent.Objective: to identify factors associated to congenital defects of the digestive system and the magnitude of the risk that entails its presence in Camagüey municipality.Methods: a case-control study was conducted from January 2006 to January 2011. The universe was composed of all the conceptions of the studied period, of a population composed of 53 congenital defects; the sample was of 30 cases. The 30 control group members were healthy children from the same health area, of the same sex and probable age for each case.Results: congenital defects of the nervous system and cardiopathies predominated over congenital malformations of the digestive system. Gastroschisis was the most frequent anomaly fallowed by diaphragmatic hernias, omphalocele, and esophageal atresia. Coffee consumption in the mother (p=0,002;OR:5,53;IC:1,03-1,14), smoking in the father (p=0,009;OR:6,45;IC:1,57-26,36), and family history of anomalies (p=0,009;OR:6,40;CI:1,60-25,66) were the factors that showed statistical association to the presence of congenital defects of digestive system.Conclusions: erratic frequencies that indicated the action of exogenous teratogens were not established; each identified independent factor increased in more than five times the probability of presenting congenital defects of the digestive system and its action would triple that number. Results suggest redirecting the project to the exhaustive exploration of the identified factors; subsequent studies with greater samples to get to clinical conclusions with more certitude are recommended...