Diverticulitis aguda del intestino delgado como causa infrecuente de abdomen agudo en el adulto mayor: Reporte de caso / Acute diverticulitis of small bowel as rare cause of acute abdomen inthe elderly: Case report

Introducción. El dolor abdominal es uno de los principales motivos de admisión a urgencias y una de las causas más frecuentes es la enfermedad diverticular, que aumenta su prevalencia en el adulto mayor. Sin embargo, la diverticulitis del intestino delgado es una enfermedad infrecuente y en la mayoría de casos es asintomática. No obstante, la perforación de un divertículo intestinal es una complicación común de esta patología, por lo que debe ser considerado como un diagnóstico diferencial de abdomen agudo en este grupo poblacional. Caso clínico. Paciente masculino de 71 años, quien consultó por dolor abdominal de inicio súbito, con signos de irritación peritoneal al examen físico. Dado su deterioro hemodinámico fue llevado a cirugía y en la laparotomía exploratoria se halló una diverticulitis aguda perforada de yeyuno e íleon distal. Resultados. El paciente cursó con una adecuada evolución postoperatoria, sin reingresos. Conclusión. La diverticulitis aguda yeyuno-ileal es una causa importante, pero no frecuente de perforación intestinal. Hay muy pocos casos reportados en la literatura, lo que la convierte en un reto diagnóstico para el médico de urgencias y el cirujano general. No obstante, debe ser considerado como un diagnóstico diferencial en adultos mayores con abdomen agudo.

Introduction. Abdominal pain is one of the main reasons for admission to the emergency room and one of the most frequent causes is diverticular disease, which increases its prevalence in the elderly. However, diverticulitis of the small bowel is rare and in most cases asymptomatic. However, perforation of an intestinal diverticulum is a common complication of this pathology and should be considered as a differential diagnosis of acute abdomen in this population group. Clinical case. A71-year-old male patient presented with abdominal pain of sudden onset, with signs of peritoneal irritation. Given his hemodynamic deterioration, he was taken to surgery and in the exploratory laparotomy an acute perforated diverticulitis of the jejunum and distal ileum was found. Results. The patient had an adequate postoperative evolution, without readmissions. Conclusion. Acute jejuno-ileal diverticulitis is an important but uncommon cause of intestinal perforation. There are very few cases reported in the literature, which makes it a diagnostic challenge for the emergency physician and general surgeon. However, it should be considered as a differential diagnosis in older adults with acute abdomen.

Estudio comparativo del dolor abdominal en las culturas maya Tzeltal, maya Tzotzil y maya Q ́eqchi ́y el uso de Ageratina ligustrina para su tratamiento / Comparative study of abdominal pain in the Mayan cultures Tzeltal, Maya Tzotzil and Maya Q ́eqchi´ and use of Ageratina ligustrina for the treatment

El presente estudio es una comparación del dolor abdominal producido por trastornos gastrointestinales, aliviado por Ageratina ligustrina , entre los grupos maya Tzeltal, Tzotzil y Q ́eqchi ́, el cual integró un enfoque etnomédico, etnobotánico y transcultural, comparando estudios previos con el presente trabajo de campo. Para evaluar la eficacia de Ageratina para aliviar el dolor abdominal, se realizó un inventario de las moléculas reportadas en esta especie, así como de su actividad farmacológica, a través de una revisión bibliográfica. Los resultados mostraron que la epidemiología del dolor producido por TGI, su etnobotánica y el modelo explicativo del dolor abdominal fueron similares entre grupos étnicos. Asimismo, se identificaron 27 moléculas con efectos antiinflamatorios y antinociceptivos, lo que podría explicar por qué esta especie es culturalmente importante para los pobladores maya Tzeltal, Tzotzil y Q ́eqch i ́ para el alivio del dolor abdominal, mientras que, desde el punto de vista biomédico, es una especie con potencial para inhibir el dolor visceral.

The current study is a comparison of the abdominal pain conception produced by gastrointestinal disorders, relieved by Ageratina ligustrina , among inhabitants of the Mayan Tzeltal, Tzotzil, and Q'eqchi' groups ethnomedical, ethnobotanical, and cross -cultural approaches were used to compare previous studies with the present field work. To evaluate the efficacy of A. ligustrina to relieve pain, also through a bibliographic review an inventory of the molecules present in this species was performed, as well as their pharmacological activity. The results showed that the epidemiology of pain produced by GID, its ethnobotany, and the explanatory model of abdominal pain are similar among ethnic groups. Likewise, 27 molecules with anti-inflammatory and anti-nociceptive effects were identified, which could explain why this species is culturally important for the Mayan Tzeltal, Tzotzil, and Q'eqchi' groups for the relief of abdominal pain, while, from a biomedical point of view, it is a species with potential to inhibit visceral pain.

Síndrome de la arteria mesentérica superior (Síndrome de Wilkie): A propósito de un caso en una adolescente / Superior mesenteric artery syndrome (Wilkie syndrome): A case report in an adolescent

Introducción. El síndrome de la arteria mesentérica superior, también conocido como síndrome de Wilkie, es una entidad infrecuente en la que una reducción del ángulo o espacio aorto-mesentérico determina una compresión extrínseca con obstrucción del tercio distal del duodeno, demostrando síntomas y signos característicos de obstrucción intestinal. El pilar del tratamiento es el manejo médico conservador con repleción nutricional, con el objetivo de aumentar el grosor de la grasa retroperitoneal y con esto resolver la compresión duodenal. Caso clínico. Paciente de 16 años, con un curso crónico marcado por dolor abdominal, estreñimiento, distensión, pirosis y pérdida de peso. Inicialmente se trató como una enfermedad ácido-péptica, con pobre mejoría, por lo que se realizaron estudios imagenológicos con lo que se documentó una disminución del ángulo aortomesentérico. Resultado. Se instauró un manejo médico con un protocolo de repleción nutricional por vía oral, para lograr ganancia de peso y evitar la cirugía. Conclusión. Con base a los síntomas y hallazgos en imágenes diagnósticas se hizo el diagnóstico de síndrome de la arteria mesentérica superior, que es una causa de obstrucción intestinal con muy baja incidencia. Su presentación clínica incluye gran variedad de síntomas, entre los que destaca el dolor abdominal y la pérdida de peso. Es frecuente la confusión con otras enfermedades más frecuentes, como enfermedad ácido-péptica, reflujo gastrointestinal y malabsorción. Su diagnóstico requiere un alto índice de sospecha, por lo que es importante conocer esta entidad y considerarla en el estudio de pacientes con los síntomas mencionados.

Introduction. Superior mesenteric artery syndrome, also known as Wilkie syndrome, is a rare entity in which a reduction in the aorto-mesenteric angle or space determines extrinsic compression with obstruction of the distal third of the duodenum, demonstrating characteristic symptoms and signs of intestinal obstruction. The mainstay of treatment is conservative medical management with nutritional repletion, with the aim of increasing the thickness of the retroperitoneal fat and thereby resolving duodenal compression. Clinical case. A 16-year-old patient, with a chronic course marked by abdominal pain, constipation, bloating, heartburn and weight loss. Initially was treated as an acid-peptic disease, with poor improvement. Imaging studies were performed, which documented a decrease in the aorto-mesenteric angle. Conclusion. Based on the symptoms and findings on diagnostic images, the diagnosis of superior mesenteric artery syndrome was made, which is a cause of intestinal obstruction with a very low incidence. Its clinical presentation includes a wide variety of symptoms, among which abdominal pain and weight loss stand out. Confusion with other more common diseases is common, such as acid-peptic disease, gastrointestinal reflux and malabsorption. Its diagnosis requires a high index of suspicion, so it is important to know this entity and consider it in the study of patients with the aforementioned symptoms.

Umbilical hernia in pediatric patients attending outpatient department in tertiary care centre

Background: Umbilical hernias are estimated to affect 15% of children. Age, race, gestational age, and coexisting disorders are some of the variables that affect it. In comparison to the general population, there are greater incidences of connective tissue illnesses in children, premature delivery, low birth weight, syndromic newborns, black children, and children with pathologies that raise intraabdominal pressure. To determine the prevalence and to assess the risk factors of umbilical hernia in pediatric patients attending outpatient department (OPD) in tertiary care centre.Methods: The present observational study was conducted in paediatric OPD, of a tertiary care centre over a period of one year. A total of 100 study subjects were enrolled with suspected umbilical hernia. The data was collected with the help of a structured clinical proforma and analysed with SPSS version 20.0.Results: In our study the most prevalent age group involved being 0-1 years (6%) followed by 8-10 years (3%) and 2-4 years (2%). Umbilical hernia was seen more in males (64%) than females. Low birth weight (81%), premature delivery (54.54%), and undernutrition (90.9%) were the risk factors that were observed to be associated with the development of umbilical hernia.Conclusions: The study concluded that the overall prevalence of umbilical hernia was 11% and the associated risk factors were premature delivery, low birth weight and poor nutrition.

Cornual pregnancy with a history of recurrent ectopic pregnancy

The health of both the mother and the fetus is at risk when symptomatic maternal arrhythmias occur during pregnancy. Sustained symptomatic arrhythmias should be managed, much like in the non-pregnant population. The specific arrhythmia that has been identified or is suspected must be treated. Electrical cardioversion is used to treat supraventricular arrhythmias when medication therapy and physical therapy, such as sinus carotid massage or valsalva movements, fail or in life-threatening conditions where the patient is hemodynamically unstable. A 27-year-old primipara came to Bengkalis hospital at 37 weeks of gestation due to complaints of palpitations. palpitations felt for 4 hours before admission to the hospital. The patient had experienced the same complaint and was examined by a cardiologist who said that the patient had a tendency to arrhythmia and was given bisoprolol. An ECG examination was carried out in the emergency room, the impression was supraventricular tachycardia with HR 185 bpm, an abdominal termination of pregnancy was carried out, and the cardiologist performed cardioversion in the operating room 3 times, and the mother's HR returned to sinus rhythm. The outcome was a baby girl born with a birth weight of 3200 grams, an Apgar score of 8/9. Mother was treated and went home on the 3rd postoperative day in good condition. Provided that a multidisciplinary approach, continuous fetal heart rate monitoring and the possibility to perform a caesarean section are applied, it can be concluded that cardioversion is a safe and effective treatment for maternal tachycardia in pregnancy.

Características clínicas de niños con apendicitis aguda que acuden al Servicio de Urgencias del Hospital Regional de Pilar en el periodo 2020 al 2023

Introducción: La apendicitis aguda, definida como la inflamación del apéndice vermiforme, es la causa más frecuente de abdomen agudo quirúrgico y es la patología aguda quirúrgica más común en la infancia y en el niño mayor. Objetivo: Determinar las características clínicas de niños con apendicitis aguda que acuden al Servicio de Urgencias del Hospital Regional de Pilar durante el periodo 2020 al 2023. Materiales y métodos: Estudio observacional descriptivo, retrospectivo, de corte transversal en pacientes pediátricos que acuden al servicio de urgencias del Hospital Regional de Pilar. Incluyó pacientes de 4 a 15 años que acudieron al servicio de urgencias por cuadro de dolor abdominal agudo durante el periodo enero 2020 a julio 2023. Resultados: Se realizaron 80 apendicetomías en niños de 4 a 15 años, la media de edad fue 11±3años; predominó el sexo femenino en el 34,4%; el principal motivo de consulta fue dolor abdominal más vómitos con un tiempo promedio de evolución de 29,6±22horas; se presentó signo de defensa muscular en el 77,5%; la característica apendicular predominante fue flegmonosa en el 51,3%; el tiempo promedio de estancia hospitalaria fue de 3±1,2días y el 71,3% de los niños no presentó complicación aguda. Conclusión : El conocimiento de las características clínicas de la apendicitis aguda resultan de suma importancia para el médico en el Servicio de Urgencias para un diagnóstico precoz y; por ende, una apendicetomía temprana minimizando tanto las tazas de complicaciones intraoperatorias como posoperatorias.

Introduction: Acute appendicitis, defined as inflammation of the vermiform appendix, is the most common cause of acute surgical abdomen and is the most common acute surgical pathology in childhood and older children. Objective: Determine the clinical characteristics of children with acute appendicitis who attend the Emergency Service of the Pilar Regional Hospital during the period 2020 to 2023. Materials and methods: Descriptive, retrospective, cross-sectional observational study in pediatric patients attending the emergency service of the Pilar Regional Hospital. It included patients aged 4 to 15 years who attended the emergency department due to acute abdominal pain during the period January 2020 to July 2023. Results: 80 appendectomies were performed in children from 4 to 15 years old, the average age was 11±3 years; The female sex predominated in 34.4%; The main reason for consultation was abdominal pain plus vomiting with an average duration of 29.6±22 hours; sign of muscular defense was present in 77.5%; the predominant appendiceal characteristic was phlegmonous in 51.3%; The average length of hospital stay was 3±1.2 days and 71.3% of the children did not present acute complications. Conclusion: Knowledge of the clinical characteristics of acute appendicitis is of utmost importance for the doctor in the Emergency Department for early diagnosis and therefore, an early appendectomy minimizes both intraoperative and postoperative complication rates.

Divertículo de Meckel complicado. Experiencia de 15 años en un hospital interzonal / Complicated Meckel's diverticulum. Fifteen years of experiencein an interzonal hospital in the Province of Buenos Aires

Introducción: el divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal. Puede presentarse con hemorragia, obstrucción intestinal o diverticulitis, complicaciones que disminuyen con la edad, por lo que en el adulto el diagnóstico suele ser incidental. El tratamiento de las complicaciones es quirúrgico, mediante diverticulectomía o resección segmentaria del intestino delgado, dependiendo de sus características morfológicas. Objetivo: analizar nuestra experiencia en el manejo del divertículo de Meckel complicado en un período de 15 años. Diseño: estudio descriptivo, observacional, transversal, retrospectivo. Material y métodos: se revisaron las historias clínicas de los pacientes operados por divertículo de Meckel complicado en el Servicio de Cirugía General del Hospital San Roque durante el periodo 2007-2022. Se registraron datos demográficos, presentación clínica, diagnóstico preoperatorio, tratamiento quirúrgico, complicaciones postoperatorias y hallazgos histopatológicos. Resultados: se incluyeron 25 pacientes, 21 (84%) hombres, 3 menores de 18 años. La presentación clínica fue un síndrome de fosa iliaca derecha en el 80% de los casos, obstrucción intestinal en el 16% y hemorragia en el 4%. En solo 2 casos se realizó el diagnóstico preoperatorio, confirmado mediante tomografía computada. Se realizó diverticulectomía en el 68% de los pacientes y resección segmentaria el 32%. El abordaje fue laparotómico en el 64%, principalmente en el periodo inicial y laparoscópico en el 36%. Hubo una complicación IIIb de Clavien-Dindo en un paciente pediátrico tratado con drenaje percutáneo. En un solo paciente (4%), que se presentó con hemorragia digestiva masiva, se encontró epitelio de tipo gástrico y páncreas ectópico en el divertículo. Conclusiones: En nuestra experiencia el divertículo de Meckel complicado se presentó predominantemente en hombres. La complicación más frecuente en el adulto fue la diverticulitis. El diagnóstico preoperatorio fue infrecuente y realizado por tomografía computada. La diverticulectomía es suficiente en la mayoría de los casos. Actualmente, la laparoscopia es una herramienta segura, rentable y eficiente que permite el diagnóstico y tratamiento oportunos de esta entidad. (AU)

Introduction: Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. It can present with bleeding, intesti-nal obstruction or diverticulitis, complications that decrease with age, so in adults the diagnosis is usually incidental. Treatment of complications is surgical, through diverticulectomy or segmental resection of the small intestine, depending on its morphological characteristics. Objective: to analyze our experience in the management of complicated Meckel's diverticulum over a period of 15 years. Design: descriptive, observational, cross-sectional, retrospective study. Materials and methods: the medical records of patients operated on for complicated Meckel's diverticulum in the General Surgery Service of the San Roque Hospital during the period 2007-2022 were reviewed. Demo-graphic data, clinical presentation, preoperative diagnosis, surgical treatment, postoperative complications, and histopathological findings were recorded. Results: twenty-five patients were included, 21 (84%) men, 3 under 18 years of age. The clinical presentation was a right iliac fossa syndrome in 80% of cases, intestinal obstruction in 16% and hemorrhage in 4%. In only 2 cases was the preoperative diagnosis made, confirmed by computed tomography. Diverticulectomy was performed in 68% of patients and segmental resection in 32%. The approach was by laparotomy in 64%, mainly in the initial period, and by laparoscopy in 36%. There was a Clavien-Dindo IIIb complication in a pediatric patient treated with percutaneous drain-age. In only one patient (4%), who presented with massive gastrointestinal bleeding, gastric-type epithelium and ectopic pancreas were found in the diverticulum. Conclusions: In our experience, complicated Meckel's diverticulum occurred predominantly in men. The most frequent complication in adults was diverticulitis. Preoperative diagnosis was infrequent and was made by computed tomography. Diverticulectomy is sufficient in most cases. Currently, laparoscopy is a safe, profitable and efficient tool that allows for the timely diagnosis and treatment of this entity. (AU)

Todani Type I Common Bile Duct Cyst in an Adult Patient: Clinical Case and Literature Review / Quiste de colédoco Todani I en una paciente adulta: caso clínico y revisión de la literatura

Abstract Bile duct cysts are characterized by intrahepatic or extrahepatic bile duct dilation. It is a rare congenital pathology, diagnosed mainly in children. The clinical manifestation in adults is usually nonspecific but essential due to their increased risk of developing carcinoma. We present the case of a 37-year-old female patient who consulted for pain in the epigastrium radiating to the right hypochondrium, associated with emesis and choluria. The hepatobiliary ultrasound was normal, but due to the risk of choledocholithiasis, a magnetic resonance cholangiopancreatography was performed, revealing a cystic dilation of the proximal common bile duct of approximately 2 cm, classified as Todani type I. Bile duct cysts have been associated with several complications, and cholangiocarcinoma is the most important. The probability of malignancy is higher in adults and Todani type I cysts.

Resumen Los quistes de vía biliar se caracterizan por la dilatación de los conductos biliares intrahepáticos o extrahepáticos. Es una patología congénita poco frecuente, diagnosticada principalmente en niños. La presentación clínica en adultos suele ser inespecífica, pero importante debido a su riesgo aumentado de desarrollar carcinoma. Se presenta el caso de una paciente de 37 años que consulta por dolor en epigastrio irradiado al hipocondrio derecho, asociado a emesis y coluria. La ecografía hepatobiliar resultó normal, pero debido al riesgo de coledocolitiasis se realizó una colangiopancreatografía por resonancia magnética en la que se evidenció una dilatación quística del colédoco proximal de aproximadamente 2 cm, clasificada como Todani tipo I. Los quistes de vía biliar se han asociado a varias complicaciones, y el colangiocarcinoma es la más importante. La probabilidad de malignización es mayor en adultos y en los quistes Todani tipo I.

Vólvulo de intestino delgado como forma de presentación inusual de obstrucción intestinal / Small bowel volvulus as an unusual presentation of intestinal obstruction

Introducción: Dentro de las causas poco frecuentes de oclusión intestinal se encuentra el vólvulo de intestino delgado, el cual consiste en una torsión anormal del intestino alrededor del su propio eje de mesenterio, que provoca una obstrucción mecánica del intestino. Objetivo: Describir la semiografía del vólvulo de intestino delgado en un paciente de edad avanzada. Caso clínico: Paciente masculino de 62 años de edad, que ingresa en el cuerpo de guardia de cirugía, por dolor abdominal, tipo cólico intermitente, con una evolución de 72 horas; además, presenta distensión abdominal, náuseas y vómitos. Con el cuadro clínico, más los exámenes complementarios, se constata oclusión intestinal mecánica, causada por un vólvulo del intestino delgado. A los 5 días de ser intervenido quirúrgicamente se complicó por una perforación intestinal debido a necrosis del asa. Conclusiones: Debido a su presentación atípica y sus graves complicaciones, se precisa un diagnóstico certero y tratamiento urgente al paciente con vólvulo del intestino delgado, ya que pone en riesgo la vida(AU)

Introduction: Among the rare causes of intestinal obstruction is small intestine volvulus, which consists of an abnormal twisting of the intestine around its own mesentery axis, which causes a mechanical obstruction of the intestine. Objective: To describe the semiography of small intestine volvulus in an elderly patient. Clinical case: 62-year-old male patient, admitted to the surgery ward, due to abdominal pain, intermittent colic type, with an evolution of 72 hours; In addition, he presents abdominal distention, nausea and vomiting. With the clinical picture, plus complementary examinations, mechanical intestinal occlusion is confirmed, caused by a volvulus of the small intestine. Five days after undergoing surgery, it was complicated by intestinal perforation due to necrosis of the loop. Conclusions: Due to its atypical presentation and serious complications, an accurate diagnosis and urgent treatment are required for patients with small intestine volvulus, since it puts life at risk(AU)

An interesting case of right ovarian cyst torsion: case report

Ovarian torsion is a comparatively rare gynecological emergency. It commonly presents with complaints of acute abdominal pain, nausea, and vomiting. It occurs due to twisting of the ovarian pedicle leading to ischemic changes in the ovary. It can even result in complete loss of blood supply, eventually necrosis of the ovary. It is diagnosed clinically and can be confirmed on ultrasound color doppler. The management of ovarian torsion depends on the age of the patient, size of the mass, ovary condition, and USG findings. Early diagnosis and treatment of torsion are necessary to preserve the viability of the ovary. We are reporting a case of a 30-year-old female with right ovarian cyst torsion of size 6.3×6.8×6 cm. Once torsion is diagnosed surgery is the mainstay of treatment, either detorsion and ovariopexy or oophorectomy if the ovary cannot be salvaged.

Recurrent abdominal pain in children: a review

Recurrent tummy (abdominal) pain (RAP) is among the most prevalent symptoms where children experience frequent stomach pain over an extended period. RAP is prevalent in children, affecting 10-20% of school aged children. There is no consensus regarding this widespread issue's genesis, investigation, and management. This review touches on a few concerns about children's recurrent abdominal pain.

Plasmodium falciparum malaria with acute abdominal pain as the first symptom: a case report / 中国血吸虫病防治杂志

Plasmodium falciparum malaria, caused by Plasmodium falciparum infection, is an Anopheles mosquito-transmitted infectious diseases, which predominantly occurs in tropical areas of Africa. P. falciparum malaria is characterized by complex and atypical clinical manifestations, and high likelihood of misdiagnosis and missing diagnosis, and may be life-threatening if treated untimely. This case report presents the diagnosis and treatment of a P. falciparum malaria case with acute abdominal pain as the first symptom.

Recto-sigmoïdite induite par administration de purgatifs à propos d'un cas / Recto-sigmoiditis induced by purgative administration: a case report

Il s'agit d'un patient de 25 ans reçu pour hématochézie de grande abondance et douleurs abdominales après utilisation par voie orale et rectale d'un purgatif à base de graines de Jatropha curcas ou pignon d'Inde appelée en bambara (langue locale du Mali) « Bagani ¼ et de Scoparia dulcis appelée en bambara « timitimini ¼. La coloscopie réalisée a permis de retrouver une nécrose du colon descendant. Le patient est décédé dans un tableau de choc septique par perforation colique.

This 25-year-old patient was presented with profuse hematochezia and abdominal pain following oral and rectal use of a purgative based on Jatropha curcas or "pignon d'Inde" seeds, known in Bambara (the local language of Mali) as "Bagani", and Scoparia dulcis, known in Bambara as "timitimini". Colonoscopy revealed necrosis of the descending colon. The patient died of septic shock due to colonic perforation

Intestinal endometriosis: outcomes from a multidisciplinary specialized referral center / Endometriose intestinal: resultados de um centro de referência multidiscipilinar especializado

ABSTRACT BACKGROUND: Deep penetrating endometriosis (DE) can affect abdominal and pelvic organs like the bowel and bladder, requiring treatment to alleviate symptoms. AIMS: To study and investigate clinical and surgical outcomes in patients diagnosed with DE involving the intestines, aiming to analyze the effectiveness of surgical treatments. METHODS: All cases treated from January 2021 to July 2023 were included, focusing on patients aged 18 years or older with the disease affecting the intestines. Patients without intestinal involvement and those with less than six months of post-surgery follow-up were excluded. Intestinal involvement was defined as direct invasion of the intestinal wall or requiring adhesion lysis for complete resection. Primary outcomes were adhesion lysis, rectal shaving, disc excision (no-colectomy group), and segmental resection (colectomy group) along with surgical complications like anastomotic leak and fistulas, monitored for up to 30 days. RESULTS: Out of 169 patients with DE surgically treated, 76 met the inclusion criteria. No colectomy treatment was selected for 50 (65.7%) patients, while 26 (34.2%) underwent rectosigmoidectomy (RTS). Diarrhea during menstruation was the most prevalent symptom in the RTS group (19.2 vs. 6%, p<0.001). Surgical outcomes indicated longer operative times and hospital stays for the segmental resection group, respectively 186.5 vs. 104 min (p<0.001) and 4 vs. 2 days, (p<0.001). Severe complications (Clavien-Dindo ≥3) had an overall prevalence of 6 (7.9%) cases, without any difference between the groups. There was no mortality reported. Larger lesions and specific symptoms like dyschezia and rectal bleeding were associated with a higher likelihood of RTS. Bayesian regression highlighted diarrhea close to menstruation as a strong predictor of segmental resection. CONCLUSIONS: In patients with DE involving the intestines, symptoms such as dyschezia, rectal bleeding, and menstrual period-related diarrhea predict RTS. However, severe complication rates did not differ significantly between the segmental resection group and no-colectomy group.

RESUMO RACIONAL: A endometriose profunda infiltrativa (EP) pode afetar órgãos abdominais e pélvicos, tais como o intestino e a bexiga, necessitando de tratamento para aliviar os sintomas. OBJETIVOS: Estudar e investigar resultados clínicos e cirúrgicos em pacientes com diagnóstico de EP envolvendo o intestino, visando analisar a eficácia dos tratamentos cirúrgicos. MÉTODOS: Foram incluídos todos os casos atendidos de janeiro de 2021 a julho de 2023, com foco em pacientes com 18 anos ou mais com a doença acometendo o intestino. Foram excluídos pacientes sem comprometimento intestinal e aqueles com menos de seis meses de acompanhamento pós-operatório. O envolvimento intestinal foi definido como invasão direta da parede intestinal ou necessidade de lise de aderências para ressecção completa. Os desfechos primários foram lise de aderências, raspagem retal e excisão discóide (grupo não colectomia), e ressecção segmentar (grupo colectomia), juntamente com complicações cirúrgicas como fístulas, monitoradas por até 30 dias. RESULTADOS: Das 169 pacientes com EP tratadas cirurgicamente, 76 preencheram os critérios de inclusão. Não foi indicado colectomia em 50 (65,7%) pacientes, enquanto 26 (34,2%) foram submetidos à retossigmoidectomia (RTS). A diarreia durante a menstruação foi o sintoma mais prevalente no grupo RTS (19,2% vs. 6,0%, p<0,001). Os resultados cirúrgicos indicaram tempos operatórios e internações hospitalares mais longos para o grupo de ressecção segmentar, respectivamente, 186,5 vs. 104 min (p<0,001) e 4 vs. 2 dias, (p<0,001). As complicações graves (Clavien-Dindo ≥3) tiveram prevalência global de 6 (7,9%) casos, sem diferença entre os grupos. Não houve mortalidade relatada. Lesões mais graves e sintomas específicos como disquezia e sangramento retal foram associados a maior probabilidade de indicação de RTS. A regressão bayesiana destacou a diarreia próxima à menstruação como um forte preditor de ressecção segmentar. CONCLUSÕES: Em pacientes com endometriose envolvendo os intestinos, sintomas como disquezia, sangramento retal e diarreia relacionada ao período menstrual predizem a indicação de RTS. No entanto, as taxas de complicações graves não diferiram significativamente entre o grupo de ressecção segmentar e o grupo sem colectomia.

Variability in presentation and management of gastric volvulus: report of 3 cases

Gastric volvulus is a pathology of acute or subacute presentation. Depending on the type, a gastric volvulus can present as an emergency if there is vascular compromise with necrosis and high risk of perforation and its surgical resolution is mandatory. Subacute gastric volvulus does not compromise the organ or organism urgently but is associated with high morbidity and should be resolved when the patient is in optimal conditions to offer definitive treatment. Depending on the torsion axis, it is classified as axial or mesenteroaxial organ, both merit reduction according to their presentation and the clinical context of the patient.

Caracterización de pacientes operados por obstrucción intestinal mecánica / Characterization of patients operated of mechanical intestinal obstruction

Introducción: En Cuba, la oclusión intestinal mecánica es una de las causas más frecuentes de abdomen agudo y constituye la segunda causa de cirugía de urgencia. Objetivo: Caracterizar una serie de pacientes intervenidos quirúrgicamente, con diagnóstico de obstrucción intestinal mecánica. Métodos: Se realizó un estudio observacional descriptivo transversal en sujetos atendidos durante el año 2022 en el servicio de cirugía general del Hospital Docente Clínico - Quirúrgico Miguel Enríquez. Se estudiaron 81 pacientes; se recogieron las variables sexo, edad, antecedentes patológicos personales, hábitos tóxicos, estadía hospitalaria, causa de la oclusión intestinal, complicaciones y estado al egreso. Se realizó análisis de frecuencias. Resultados: Hubo mayor porcentaje del sexo femenino (50,6 por ciento), de las edades comprendidas de 31 a 40 años (23,5 por ciento), los pacientes con hipertensión arterial (14,8 por ciento) y los fumadores (18,5 por ciento). La causa más frecuente de oclusión fueron las bridas y adherencias (44,4 por ciento) y la complicación más frecuente fue la bronconeumonía (8 por ciento). Falleció solo el 3,7 por ciento de los pacientes. Conclusiones: Los pacientes se caracterizaron por estar entre la tercera y cuarta décadas de la vida, con predominio del sexo femenino, con antecedentes de salud, sin hábitos tóxicos, con estadía hospitalaria entre 1 y 5 días, presencia de bridas y adherencias como causa de la obstrucción y baja frecuencia de complicaciones y fallecimientos(AU)

Introduction: In Cuba, mechanical intestinal obstruction is one of the most frequent causes of acute abdomen, and is the second cause of emergency surgery. Objective: To characterize a series of patients undergoing surgery with a diagnosis of mechanical intestinal obstruction. Methods: A cross-sectional descriptive observational study was carried out in the population treated during the year 2022 in the general surgery service of the Miguel Enríquez Clinical-Surgical Teaching Hospital. The population was made up of 81 patients with whom we worked in its entirety. The variables sex, age, personal pathological history, toxic habits, hospital stay, cause of intestinal obstruction, complications, and status at discharge were studied. A study of absolute and relative frequencies was carried out. Methods: A cross-sectional descriptive observational study was carried out on subjects treated during 2022 in the general surgery service of the Miguel Enríquez Clinical-Surgical Teaching Hospital. 81 patients were studied; The variables sex, age, personal pathological history, toxic habits, hospital stay, cause of intestinal obstruction, complications and status at discharge were collected. Frequency analysis was performed. Results: There was a higher percentage of females (50.6 percent), aged between 31 and 40 years (23.5 percent), patients with high blood pressure (14.8 percent) and smokers (18.5 percent). The most common cause of occlusion was flanges and adhesions (44.4 percent), and the most common complication was bronchopneumonia (8 percent). Only 3.7 percent of patients died. Conclusions: The patients are characterized by being between the third and fourth decades of life, with a predominance of the female sex, with a health history, without toxic habits, with a hospital stay between 1 and 5 days, presence of flanges and adhesions as a cause of obstruction and low frequency of complications and deaths(AU)

Trombosis venosa mesentérica y portal como causa infrecuente de obstrucción e isquemia intestinal en paciente joven. Reporte de caso / Mesenteric and Portal Venous Thrombosis as an infrequent cause of intestinal Obstruction and Ischemia in young patients. A case report

Resumen La isquemia mesentérica aguda se asocia a una mortalidad de entre el 50 y el 100%, la causa más rara de esta es la trombosis venosa de los vasos mesentéricos (5%) y portal (1%). Las manifestaciones clínicas son diversas, siendo el dolor abdominal el principal síntoma. La tomografía computarizada con contraste intravenoso en fase portal es la imagen más precisa para el diagnóstico. El tratamiento en fase aguda se basa en anticoagulación, fluidos intravenosos, antibióticos profilácticos, descanso intestinal y descompresión. La laparotomía de control de daños, incluida la resección intestinal y el abdomen abierto, pueden estar justificados en última instancia para pacientes con necrosis intestinal y sepsis. Caso clínico: Hombre de 35 años, sin antecedentes de importancia, solo tabaquismo desde hace 15 años. Refirió que 5 días previos comenzó a presentar dolor en el epigastrio tipo cólico, de intensidad moderada, posteriormente refirió que el dolor se generalizó y aumentó de intensidad, acompañado de náusea, vómito, intolerancia a la vía oral y alza térmica. Al examen físico tuvo datos de respuesta inflamatoria sistémica, estaba consciente y orientado, con abdomen doloroso a la palpación superficial y profunda a nivel generalizado, pero acentuado en el flanco derecho, rebote positivo con resistencia, timpanismo generalizado, peristalsis ausente. Se ingresó a quirófano a laparotomía exploradora, encontrando lesión a intestinal isquémica-necrótica a 190-240 cm del ángulo de Treitz, y 400 cc de líquido hemático; se realizó resección de la parte intestinal afectada, con entero-enteroanastomosis término-terminal manual. Se envió pieza a patología, y se reportó un proceso inflamatorio agudo con necrosis transmural y congestión vascular. Ante estos hallazgos se realizó angiotomografía abdominal que reportó defecto de llenado en la vena mesentérica superior, secundario a trombosis que se extendía hasta la confluencia y la vena porta. Conclusión: La trombosis venosa mesentérica y portal es una patología muy infrecuente en pacientes jóvenes sin factores de riesgo en los que se presenta dolor abdominal. El diagnóstico es complejo debido a que los datos clínicos y de laboratorio son poco específicos. Sin embargo, debemos tenerla en cuenta en el diagnóstico diferencial de etiologías de dolor abdominal.

Abstract Acute Mesenteric Ischemia is associated with a mortality rate between 50% and 100%; the rarest cause of this is venous thrombosis of the mesenteric (5%) and portal (1%) vessels. The clinical manifestations are diverse, with abdominal pain being the main symptom. Computed tomography with intravenous contrast in the portal phase is the most accurate image for diagnosis. Treatment in the acute phase is based on anticoagulation, intravenous fluids, prophylactic antibiotics, intestinal rest, and decompression. Damage control laparotomy, including bowel resection and open abdomen, may ultimately be warranted for patients with bowel necrosis and sepsis. Clinical case: 35-year-old man, with no significant history, only smoking for 15 years. For 5 days before, he reported crampy epigastric pain of moderate intensity. He subsequently reported that the pain became generalized and increased in intensity, accompanied by nausea, vomiting, oral intolerance, and temperature rise. The physical examination showed signs of a systemic inflammatory response, conscious and oriented, abdomen painful on superficial and deep palpation at a generalized level but accentuated on the right flank, positive rebound with resistance, generalized tympanism, absent peristalsis. The operating room was entered for exploratory laparotomy, finding an ischemic-necrotic intestinal lesion at 190 - 240 cm from the angle of Treitz, and 400cc of blood fluid. Resection of the affected intestinal part is performed, with entire manual terminal end anastomosis. The specimen was sent to pathology, reporting an acute inflammatory process with transmural necrosis and vascular congestion. Given these findings, abdominal CT angiography was performed, which reported a filling defect in the superior mesenteric vein, secondary to thrombosis that extended to the confluence and the portal vein. Conclusion: Mesenteric and portal venous thrombosis is a very rare pathology in young patients without risk factors in whom abdominal pain occurs. The diagnosis is complex because the clinical and laboratory data are not very specific. However, we must take it into account in the differential diagnosis of abdominal pain etiologies.

Obstrucción intestinal secundario a vólvulo de sigmoides en un paciente joven Reporte de un caso / Intestinal Obstruction Secondary to Sigmoid Volvulus in a Young Patient. Case report

Resumen El vólvulo de sigmoides ocurre como resultado de una torsión del eje mesentérico colónico, cuenta con una etiología multifactorial y controvertida, de fisiopatología no clara aún. Presenta un cuadro clínico de inicio inespecífico y posteriores signos y síntomas de oclusión intestinal; su diagnóstico se establece mediante tomografía computarizada, con una sensibilidad y especificidad mayor al 90%. El manejo dependerá de la condición clínica del paciente. Caso clínico: Hombre de 29 años con antecedente de síndrome de Asperger. Refirió que desde 7 días previos a su ingreso presentó dolor tipo cólico difuso, asociado a distensión abdominal e intolerancia a la vía oral. Acudió a valoración hospitalaria donde se realizóa tomografía computarizada con niveles hidroaéreos, torsión de arteria mesentérica inferior de aspecto de torbellino. Se realizó laparotomía exploradora a través de la cual se encontró sigmoides dilatado y volvulado, con perforación en la unión rectosigmoidea; se realizó sigmoidectomía con colorectoanastomosis. Al quinto día presentó datos de respuesta inflamatoria con abdomen agudo, por lo que ingresó a laparotomía exploradora donde se encontró dehiscencia de anastomosis; se realizó procedimiento de Hartmann. El paciente presentó choque séptico y falleció a las 24 horas del postquirúrgico. Discusión: La presentación de vólvulo sigmoides generalmente se presenta en personas mayores de 70 años, pocos casos se describen en personas jóvenes y están relacionados con enfermedad de dismotilidad intestinal. El paciente no contaba con factores predisponentes, el diagnóstico se estableció con imágenes características de la enfermedad, como la imagen en torbellino, se decidió manejo quirúrgico con la realización de resección con colorectoanastomosis. Conclusión: La oclusión intestinal por vólvulo sigmoides es una patología infrecuente en jóvenes y de clínica inespecífica. Ante un paciente que presente datos de oclusión intestinal deberá ser abordado de manera apropiada, sobre todo en pacientes en quienes hayan debutado con una clínica insidiosa y persistente de dolor abdominal secundario a oclusión intestinal, sean jóvenes con o sin factores de riesgo.

Abstract Sigmoid volvulus occurs due to a torsion of the colonic mesenteric axis, it has a multifactorial and controversial etiology, and its pathophysiology is not yet clear. Presenting a clinical picture of non-specific onset and later signs and symptoms of intestinal occlusion, its diagnosis is established with computed tomography with a sensitivity and specificity greater than 90%. Management will depend on the clinical condition of the patient. Clinical case: A 29-year-old man with a history of Asperger syndrome. He referred 7 days prior to admission with diffuse cramping pain, associated with abdominal distension and oral intolerance. He went to the hospital for evaluation where a computed tomography was performed with air-fluid levels, torsion of the inferior mesenteric artery with a whirlwind appearance. Exploratory laparotomy was performed, finding a dilated and volvulated sigmoid with perforation at the rectosigmoid junction. A sigmoidectomy with colorectal anastomosis was performed. On the fifth day, he presented data of inflammatory response with acute abdomen, entering exploratory laparotomy finding anastomosis dehiscence, Hartmann procedure was performed. The patient presented septic shock, died 24 hours after surgery. Discussion: The presentation of sigmoid volvulus generally occurs in people older than 70 years, few cases are described in young people and are related to intestinal dysmotility disease, the patient did not have predisposing factors, the diagnosis is established with characteristic images of the disease such as whirlwind image, surgical management is decided by performing resection with colorectal anastomosis. Conclusion: Intestinal occlusion due to sigmoid volvulus is an infrequent pathology in young people and with non-specific symptoms. When faced with a patient presenting evidence of intestinal occlusion, this should be appropriately addressed, especially in patients who have debuted with insidious and persistent symptoms of abdominal pain secondary to intestinal occlusion, whether they are young with or without risk factors.

Paediatric hereditary coproporphyria: a diagnostic challenge

Hereditary coproporphyria (HCP) is a hepatic porphyria, presenting with acute attacks of neurovisceral symptoms. We present a case of a young girl presenting with abdominal pain and vomiting episodes starting with menses. She also had severe hyponatremia and seizures. Laboratory investigations including urine and fecal protoporphyrin were negative, 10% dextrose solution and sodium level correction with supportive treatment was given. With this treatment her condition significantly improved but she presented again after a month with similar complaints at the time of her menses. Genetic testing was done and diagnosis of HCP was made. It can be concluded that considering Porphyrias in the differential diagnosis for repeat episodes of unexplained abdominal pain can help initiate early treatment and prevent complications.

Caracterización clínico-epidemiológica de pacientes operadas de embarazo ectópico en la provincia de Camagüey / Clinical-Epidemiological Characterization of Patients Operated on for Ectopic Pregnancy in Camagüey Province

Introducción: Los datos clínicos y antecedentes epidemiológicos resultan de vital importancia en el diagnóstico oportuno del embarazo ectópico. Objetivo: Determinar las características clínico-epidemiológicas de pacientes operadas de embarazo ectópico. Métodos: Se diseñó y se realizó un estudio descriptivo, de corte transversal, tipo serie de casos en un universo de 130 pacientes operadas de embarazo ectópico en el Hospital Ginecobstétrico de Camagüey durante el período comprendido de enero a diciembre de 2020. Las variables estudiadas incluyeron: grupos de edades, color de la piel, municipio de procedencia, factores de riesgo, signos y síntomas, así como localización y estado hemodinámico. Resultados: Primaron las pacientes en el grupo de edad de 30-34 años (32,3 porciento), color de piel blanca (76,9 porciento), procedentes del municipio Camagüey (68,5 porciento). La tasa de incidencia provincial por cada 100 embarazos se ubicó en 2,2 porciento, superada por los municipios Camagüey (3,5 porciento) y Jimaguayú (3,0 porciento). El principal factor de riesgo identificado fue el tabaquismo (66,2 porciento), en tanto el dolor abdominal estuvo presente en el 100 porciento de los casos. Se reportó con mayor frecuencia la localización tubárica (91,0 porciento), y el 59,1 porciento se clasificó como no accidentado. Conclusiones: Se determinaron ciertas características en la serie estudiada, de acuerdo con la preponderancia de la variable de los signos y síntomas según los grupos de edades, como elemento a tener en cuenta. La presencia mayoritaria de factores de riesgo modificables supone que sobre estos se debe intervenir desde la atención primaria de salud(AU)

Introduction: Clinical data and epidemiological background are of vital importance for the timely diagnosis of ectopic pregnancy. Objective: To determine the clinical-epidemiological characteristics of patients operated on for ectopic pregnancy. Methods: A descriptive, cross-sectional study of case series type was designed and carried out in a universe of 130 patients operated on for ectopic pregnancy at the gynecobstetric hospital of Camagüey during the period from January to December 2020. The studied variables included age groups, skin color, municipality of origin, risk factors, signs and symptoms, as well as localization and hemodynamic status. Results: There was a predominance of patients in the age group of 30-34 years (32.3 percent), white skin color (76.9 porciento), and from the municipality of Camagüey (68.5 ). The provincial incidence rate per 100 pregnancies was 2.2 porciento, surpassed by the municipalities of Camagüey (3.5 percent and Jimaguayú (3.0 percent). The main identified risk factor was smoking (66.2 percent), while abdominal pain was present in 100 percent of the cases. Tubal location was the most frequently reported (91.0 percent), and 59.1 percent were classified as unruptured. Conclusions: Certain characteristics were determined in the studied series, according to the preponderance of the variable of signs and symptoms by age groups, as an element to be taken into account. The majority presence of modifiable risk factors implies that these should be addressed by primary health care(AU)