RESUMEN
A choledochoduodenal fistula is an abnormal connection between the common bile duct and the duodenum, which are associated with a history of problems in the common bile duct. It has appeared in 0.74% of patients submitted for biliary tract surgery. The most frequent symptoms of non-obstructive enteric biliary fistulas are: epigastric pain, cholangitis (80.91%), jaundice (54,.26%), fever (50.69%), nausea and/or vomiting (10.30%), abdominal distension (0.39%), asymptomatic (0.11%), and diarrhea (0.11%). Diagnostic imaging methods provide the data of greatest interest in revealing the presence of air in the bile duct. This method, as well as barium reflux under the biliary tree in contrasted studies and in ERCP, reveal the fistulous tract and its location. Neither the prevalence, nor the clinical characteristics that pertain to its presentation, are well known among our population. Possible treatments for this illness include conservative treatment with medication, endoscopic sphincterotomy, and surgical therapy.
RESUMEN
The cecal appendix mucocele is considered a cystic dilation of obstructive etiology that produces an accumulation of mucoid substance. It may be of benign or malignant origin. 50-year-old female, with no significant personal pathological history, presents with repetitive clinical symptoms of abdominal pain, similar to the process of acute appendicitis, without systemic inflammatory response data, which improves with analgesic management, is protocolized by laboratory studies and imaging, diagnosing appendicular tumor, so it is protocolized for surgical resolution, during which it is decided to do right hemicolectomy due to the macroscopic features of ascending colon. The clinical course and prognosis of mucinous appendicular lesions are closely related to their histology and the presence and extent of peritoneal dissemination. With a survival of 91 to 100% after a conventional appendectomy. The cecal appendix mucocele is considered a benign neoplasm; with good survival provided it is diagnosed in time and an appropriate surgical approach is performed; in our case fortunately it could be protocolized correctly; perform a surgical resection with free edges of oncological cells confirmed by histopathology, so our patient could be discharged from the service being free of oncological pathology at this time.
RESUMEN
Sporotrichosis is a subacute to chronic infection caused by the dimorphic fungal genus Sporothrix. The infection usually affects the skin and subcutaneous tissues, but occasionally it can occur at other sites, mainly in immunocompromised patients. The symptoms of extracutaneous sporotrichosis can be subtle and diagnosis is often delayed. A 54-year-old male was received, originally from Huajuapan de León, Oaxaca; who was with an established diagnosis of type 2 diabetes mellitus; later admitted by the general surgery service with a diagnosis of necrotizing fasciitis of the left and right thoracic limb. When culture was collected with Sporothrix schenckii report, management was established with itraconazole, potassium iodide and with subsequent addition of amphotericin B, with antibiotic therapy directed for superinfection by opportunistic agents. After multiple surgical cleanings with degradation of necrotic tissue, implementation of negative pressure system and amputation of nonviable fingers, it was decided to proceed with the application of skin autografts, despite the persistence of the agent in subsequent culture reports, which are fully integrated, without evidence of new ulcerodular lesions so far. Although there are currently no parameters defined in the literature that guide the time or the appropriate conditions to perform skin grafts in the areas affected by cutaneous sporotrichosis, there are, on the contrary, reports of successful cases where surgical management has been effective even in the presence of positive cultures for Sporothrix schenckii. We consider that these results open the panorama of options for the current management of cutaneous sporotrichosis, making it necessary to consider surgical management in the therapeutic range of the same, allowing the deliberation on other more conservative options before the failure of classical therapy and the imminence of amputation.
RESUMEN
Vesicular agenesis refers to the congenital absence of the gallbladder, however, vesicular agenesia is a very scarce condition worldwide, so there is little information available on its clinical presentation and surgical data. This is a 79-year-old male patient, with a history of diabetes mellitus of long evolution, without a surgical history, who comes for colic pain of 15 days of evolution in right hypochondrium, as well as unquantified fever and jaundice, during its initial evaluation in the emergency room para clinics were requested observing leukocytosis, hyperbilirubinemia and elevation of liver enzymes, ultrasound of liver and bile ducts reported common anatomical situation gallbladder, occupied entirely by multiple hyperechogenic images, configuring sign of W.E.S. and common bile duct of 7.2 mm, concluding gallbladder scleroatrophic and vesicular agenesia during trans-surgery. Vesicular agenesis is an extremely rare condition that is mostly diagnosed during surgery, which can lead to erroneous diagnosis and unnecessary surgery in patients with symptoms including biliary colic, choledocholithiasis with or without cholangitis, and an ultrasound showing a scleroatrophic gallbladder. Surgeons In situations where there is clinical evidence consistent with biliary colic in a context of gallbladder agenesis, and the symptoms persist without finding any other cause, a surgical approach to release adhesions could be considered; since, as observed, this may result in improved symptoms, although the explanation is not yet completely clear.
RESUMEN
Liver is the organ most frequently injured after blunt or penetrating abdominal trauma, being in pediatrics a pathology that has an increasing incidence; Non-operative management is the hallmark of treatment, however cases of secondary biliary leakage have been described, which may affect the intrahepatic or extrahepatic track. A male 8 years old, with blunt trauma in the right hypochondrium, presenting acute abdomen and hemodynamic instability, requiring exploratory laparotomy with a grade III liver injury in VI and VII hepatic segments. Four weeks after discharge, he presented as a complication a giant biloma in VII and VIII hepatic segments, performing percutaneous drainage guided by ultrasound. The incidence of biliary complications related to hepatic trauma is low, 4% in pediatric patients, dividing into bilomas or biliary fistulas; the presentation of biliary leakage is very non-specific and early diagnosis difficult; in the bilomas, the tomography allows to define precisely its size, nature, distribution and regional anatomy in relation to adjacent structures, as well as underlying cause. The approach of choice is percutaneous or endoscopic drainage, with surgical management being the last option.
RESUMEN
Liver is the organ most frequently injured after blunt or penetrating abdominal trauma, being in pediatrics a pathology that has an increasing incidence; Non-operative management is the hallmark of treatment, however cases of secondary biliary leakage have been described, which may affect the intrahepatic or extrahepatic track. A male 8 years old, with blunt trauma in the right hypochondrium, presenting acute abdomen and hemodynamic instability, requiring exploratory laparotomy with a grade III liver injury in VI and VII hepatic segments. Four weeks after discharge, he presented as a complication a giant biloma in VII and VIII hepatic segments, performing percutaneous drainage guided by ultrasound. The incidence of biliary complications related to hepatic trauma is low, 4% in pediatric patients, dividing into bilomas or biliary fistulas; the presentation of biliary leakage is very non-specific and early diagnosis difficult; in the bilomas, the tomography allows to define precisely its size, nature, distribution and regional anatomy in relation to adjacent structures, as well as underlying cause. The approach of choice is percutaneous or endoscopic drainage, with surgical management being the last option.