Síndrome de Boerhaave secundario a vólvulo gástrico / Boerhaave’s syndrome secondary to gastric volvulus

El síndrome de Boerhaave es una ruptura espontánea del esófago, causada por un aumento de presión intraluminal que se produce en el contexto de una presión negativa intratorácica. Tiene un alto índice de morbimortalidad (14-40%), por lo que precisa un diagnóstico y tratamiento precoces. Debería incluirse en el diagnóstico diferencial del dolor epigástrico en un paciente que ha presentado vómitos. Las hernias de hiato paraesofágicas pueden complicarse con una volvulación gástrica. Esta, a su vez, puede producir necrosis tanto esofágica como gástrica que requiere un manejo quirúrgico precoz. Presentamos el caso de un paciente de 83 años que presentó una volvulación gástrica como complicación de una hernia de hiato, con vómitos asociados que desencadenaron un síndrome de Boerhaave. Se trata del segundo caso publicado en la literatura (AU)

Boerhaave’s syndrome is a spontaneous rupture of the oesophagus, caused by an increase of intraluminal pressure that is produced in the context of negative intrathoracic pressure. It has a high index of morbimortality (14-40%), which is why it requires early diagnosis and treatment. When a patient presents vomiting, the differential diagnosis should include epigastric pain. Para-esophageal hiatal hernias can be complicated by gastric volvulus. In its turn, this can produce both oesophageal and gastric necrosis requiring early surgical treatment. We describe the case of an 83-year-old patient who presented gastric volvulus with complications from a hiatal hernia with associated vomiting, which triggered Boerhaave’s syndrome. This is the second case published in the literatura (AU)

[Boerhaave's syndrome secondary to gastric volvulus]. / Síndrome de Boerhaave secundario a vólvulo gástrico.

Boerhaave's syndrome is a spontaneous rupture of the oesophagus, caused by an increase of intraluminal pressure that is produced in the context of negative intrathoracic pressure. It has a high index of morbimortality (14-40%), which is why it requires early diagnosis and treatment. When a patient presents vomiting, the differential diagnosis should include epigastric pain. Para-esophageal hiatal hernias can be complicated by gastric volvulus. In its turn, this can produce both oesophageal and gastric necrosis requiring early surgical treatment. We describe the case of an 83-year-old patient who presented gastric volvulus with complications from a hiatal hernia with associated vomiting, which triggered Boerhaave´s syndrome. This is the second case published in the literature. Key words. Boerhaave´s syndrome. Gastric volvulus. Surgical treatment.

[Intestinal intussusception as the first manifestation of lung cancer]. / Invaginación intestinal como primera manifestación del cáncer de pulmón.

Intussusception is a rare form of intestinal obstruction in adults. Most cases are caused by malignant lesions in the intestinal wall, which in exceptional cases are caused by metastases. The initial manifestation of lung cancer as metastasis to the gastrointestinal tract is an extremely rare event. In most cases metastases are diagnosed after the primary lung tumour, when potentially life-threatening complications such as perforation, obstruction or haemorrhage develop, often requiring emergency surgery. Regardless of treatment, these patients have very poor prognosis due to the advanced stage of their disease. The study describes the case of a 48-year-old man presenting at the emergency department with a bowel obstruction of a week's duration, who was diagnosed via CT scan with small-bowel intussusception, and via chest x-ray with a suspicious lung nodule. Emergency surgery was performed, with intestinal resection of the invaginated area and anastomosis. Postoperative recovery was uneventful. The histopathological diagnosis was intestinal metastasis from lung carcinoma. Stage IV primary malignant lung tumour was confirmed, with spread through the lungs, bones, brain and metastases in both adrenal glands. Received palliative treatment with radiation and chemotherapy, and died five months after diagnosis.

Invaginación intestinal como primera manifestación del cáncer de pulmón / Intestinal intussusception as the first manifestation of lung cancer

La invaginación intestinal es una causa muy poco frecuente de obstrucción intestinal en el adulto. La mayoría están causadas por lesiones malignas en la pared intestinal, siendo excepcional que se produzcan por metástasis. La manifestación inicial del cáncer de pulmón como metástasis en el tracto gastrointestinal es un hecho extremadamente raro. En la mayoría de los casos las metástasis se diagnostican después del tumor primario pulmonar, cuando desarrollan complicaciones potencialmente mortales como perforación, obstrucción o hemorragia, que a menudo requieren una intervención quirúrgica urgente. Independientemente del tratamiento, estos pacientes tienen un pronóstico muy sombrío dado el estado avanzado de su enfermedad. Describimos el caso un hombre de 48 años con un cuadro de obstrucción intestinal de una semana de evolución, que fue diagnosticado en el servicio de Urgencias mediante tomografía computarizada de invaginación de intestino delgado, y en radiografía simple de tórax de nódulo pulmonar sospechoso. Se decidió intervención quirúrgica urgente, realizándose resección intestinal de la zona invaginada y anastomosis, presentando un postoperatorio sin incidencias. El diagnóstico anatomopatológico fue de metástasis intestinal de carcinoma de pulmón. Se confirmó el tumor maligno primario de pulmón en estadio IV, con diseminación pulmonar, ósea, cerebral y metástasis en ambas glándulas suprarrenales. Recibió tratamiento paliativo con radioterapia y quimioterapia, falleciendo transcurridos 5 meses del diagnóstico (AU)

Intussusception is a rare form of intestinal obstruction in adults. Most cases are caused by malignant lesions in the intestinal wall, which in exceptional cases are caused by metastases. The initial manifestation of lung cancer as metastasis to the gastrointestinal tract is an extremely rare event. In most cases metastases are diagnosed after the primary lung tumour, when potentially life-threatening complications such as perforation, obstruction or haemorrhage develop, often requiring emergency surgery. Regardless of treatment, these patients have very poor prognosis due to the advanced stage of their disease. The study describes the case of a 48-year-old man presenting at the emergency department with a bowel obstruction of a week's duration, who was diagnosed via CT scan with small-bowel intussusception, and via chest x-ray with a suspicious lung nodule. Emergency surgery was performed, with intestinal resection of the invaginated area and anastomosis. Postoperative recovery was uneventful. The histopathological diagnosis was intestinal metastasis from lung carcinoma. Stage IV primary malignant lung tumour was confirmed, with spread through the lungs, bones, brain and metastases in both adrenal glands. Received palliative treatment with radiation and chemotherapy, and died five months after diagnosis (AU)