Bazo accesorio intrapancreático / Intrapancreatic accesory spleen

Existen pocos informes de bazo intrapancreático accesorio y algunos asociados a quistes epiteliales. Suelen cursar asintomáticos y confundirse con tumores neuroendocrinos no funcionantes o adenocarcinoma de páncreas, debido a su características radiológicos y a la inespecifidad de los síntomas. Nosotros reportamos un paciente de sexo masculino que se documentó una lesión de 3 cm en la cola del páncreas en la T.A.C. de abdomen y posteriormente confirmada por la R.M.N. Se llevó a cabo una pancreatectomía distal sin esplenectomía. El diagnóstico definitivo de patología fue un bazo intrapanacreático accesorio.

There are fews reports of intrapancreatic accessory spleen and some refer epithelial cysts. Most of these lesions are asymptomatic and my be misdiagnosed as a non-functioning neuroendocrine tumor or pancreas adenocarcinoma, due to their radiological characteristic and lack of symptomatology. We reported one male patient with a 3 cm lesion in the tail of the pancreas on computed tomography scan and later confirmed with RMN. A pancreatectomy distal without splenectomy performed. The final pathological diagnosis eas a intrapancreatic accessory spleen.

Medición de presión intrabdominal por método intravesical: validación de la técnica en humanos / Intra-abdominal pressure measurement using intravesical method: validation of the technique in humans

Currently the compartmental abdominal syndrome is recognized as a relevant clinical picture in the context of the critical surgical patient. For an adequate diagnosis and handling of the picture, measurement of the pressure in the mentioned compartment, the abdomen is fundamental. Several methods have been applied with this objetive, where the most utilized is that of intra-vesical measurement. The objetive of our study is the validation of the technique of intra-vesical measure of pressure in humans. Patients that are to undergo laparoscopic surgery were included. Intra-abdominal pressure was measured via intra-peritoneal de Veres needle technique associated to a CO2 insufflator performing increasing pressure curve up to tha safe limit of (18 mmHg. Parallely the intra-vesical pressure was measured with a three-way N°18 Foley probe (latex, Kendall), adjusting the secondary way to a pressure transducer. 20 patients were evaluated, with a total of 220 measurements. Through linear regression method a strong positive correlation was observed between de Veres needle and Foley probe with r = 0.713, P=0,00001. The method seems valid with a projected line of y = 4.77 + 0.69x, for a 95 per cent confidence interval. There were two cases where, clearly for the observer, there was no correlation, in one of them due to multiple previous surgeries (it was even necessary to change to open surgery) and in another case it was an obese patient (IMC 29.56). We come to the conclusion that measurement of intravesical pressure as a method for evaluating the intra-abdominal pressure is adequate on humans, considering a lower sensitivity to the changes in abdominal pressure, therefore the clinical conduct in the particular case must be taken with several measurements and associated to the relevant symptomatology described for the abdominal compartmental syndrome. We also recommend precaution on obese patients and those with multiple previous surgeries.