[Multiple aneurysms splenic; surgical exclusion with conservation of the spleen]. / Aneurismas esplénicos múltiples; exclusión quirúrgica con conservación del bazo.

BACKGROUND: Aneurysm of the splenic artery is diagnosed when the diameter of the splenic artery is greater than 1cm. It occupies third place among abdominal aneurysms. It is more frequent in women (4:1). It is associated with trauma, haemodynamics and local hormonal effects during pregnancy, portal hypertension (including the Caroli syndrome), arterial degeneration, atherosclerosis, and liver transplantation. It is difficult to diagnose, and it generally presents as ruptured, thus once the diagnosis is made, the surgical approach is indicated due to its high mortality. CLINICAL CASE: Female of 66 years of age with a diagnosis of splenic artery aneurysm, with pulsing sensation at epigastric level of 8 months onset. On physical examination there is a palpable throbbing mass of 9 cm of diameter approximately, for which she was admitted. The computed tomography angiography with reconstruction showed three splenic aneurysms. Two were tied and the larger one was repaired by endo-aneurysmorrhaphy. DISCUSSION: Visceral aneurysms are extremely rare. They are currently increasing and are the third leading cause of cardiovascular death, as morbidity/mortality is high. The surgical treatment must be done selectively according to their size. Selection of the surgical techniques depends on the anatomic location and the need for revascularisation, the aetiology and the experience of the surgeon. CONCLUSION: A review has been presented on the advances in diagnostic, and management, concluding that the best is to preserve the spleen, and whatever the technique it must be performed by trained surgeons.

Modelo biológico no vivo para la enseñanza de la técnica de venodisección en alumnos de pregrado de la carrera de medicina / Non-live biological model for the teaching of the venous cutdown technique to undergraduate medical students

Objetivo: Proporcionar material didáctico útil al estudiante y al médico general para conocer la técnica de venodisección en un modelo biológico no vivo. Sede: Departamento de Cirugía, Facultad de Medicina, UNAM. Diseño: Modelo de enseñanza. Material y método: Se proporcionan indicaciones, contraindicaciones, características anatómicas y técnica a considerar. Empleamos pata de cerdo como modelo didáctico por ser accesible en costos, disponibilidad y un modelo fácilmente reproducible por los alumnos. Por su semejanza con los eventos clínicos que suceden en los pacientes a nivel hospitalario, consideramos que representa un buen método de enseñanza de habilidades quirúrgicas en el pregrado. Conclusión: El actual modelo biológico es una opción viable y representativa de la venodisección; el alumno aprende a identificar al paciente que requiere de este procedimiento; una vez identificado, podrá realizar el procedimiento de manera adecuada evitando, en la medida de lo posible, cualquier tipo de complicación.

Objective: To provide teaching material useful for the medical student and the general physician to learn the venous cutdown technique in a non-live biological model. Setting: Department of Surgery, School of Medicine, UNAM. Design: Teaching model. Material and method: Indications, contraindication, anatomical characteristics and technique to be considered will be provided. We use a pig foot as didactic model because it is accessible in terms of costs, availability, and can be reproduced easily by students. Due to its similarity with clinical events occurring in patients at the hospital level, we consider that it represents a good teaching method of surgical skills at the undergraduate level. Conclusion: The current biological model is a viable option and representative of venous cutdown. The student learns to identify the patient that requires this procedure, once identified he will be able to perform the procedure adequately avoiding, as much as possible, any type of complication.