Congenital pouch colon: an unusual case report. / Bolsa colónica congénita. Reporte de un caso inusual.

INTRODUCTION: Congenital pouch colon (CPC) is a rare malformation. It causes variable dilatation of the colon associated with anorectal malformation (ARM), usually presenting a fistula towards the genitourinary tract. CASE REPORT: 2-day-old female patient, with no relevant medical history. She had abdominal distension and imperforate anus. She underwent colostomy. She had an irregular evolution with high colostomy debits. Contrast imaging studies were performed, which demonstrated an erroneous exteriorization of the jejunal loop. She underwent an exploratory open surgery, which confirmed the previous diagnosis and incidentally found colonic agenesis, with ileum entering in a pouch of 6 cm of diameter that connects with the bladder. DISCUSSION: CPC is a common pathology in certain eastern countries and extremely rare in western countries. In Ecuador, no records of reported cases were found. A correct pre-surgical analysis of ARM patients should be carried out to achieve an adequate planning and surgical approach, thus reducing morbidity and mortality.

INTRODUCCION: La bolsa colónica congénita (BCC) es una malformación poco común en la que se produce una dilatación variable del colon asociada a malformación anorrectal (MAR), generalmente presenta una fistula hacia el tracto genitourinario. CASO CLINICO: Paciente femenino de 2 días de vida, sin antecedentes médicos de relevancia, presenta distensión abdominal y ano imperforado, es sometida a colostomía, presenta evolución irregular con débitos altos a través de la colostomía, se realizan estudios contrastados de imagen donde se observa exteriorización errónea de asa de yeyuno, se somete a laparotomía exploratoria donde se comprueba lo descrito y además se reporta como hallazgo incidental agenesia colónica con desembocadura del íleon en una bolsa de 6 cm de diámetro que se conecta con la vejiga. DISCUSION: La BCC es una patología común en ciertos países orientales y extremadamente rara en países occidentales; en Ecuador, no se encontraron registros de casos reportados. Se debe realizar un correcto análisis prequirúrgico de los pacientes con MAR para conseguir una adecuada planificación y abordaje quirúrgico disminuyendo con ello la morbimortalidad en el paciente.

Bolsa colónica congénita. Reporte de un caso inusual / Congenital pouch colon: an unusual case report

INTRODUCCIÓN: La bolsa colónica congénita (BCC) es una malformación poco común en la que se produce una dilatación variable del colon asociada a malformación anorrectal (MAR); generalmente presenta una fístula hacia el tracto genitourinario. CASO CLÍNICO: Paciente femenino de 2 días de vida, sin antecedentes médicos de relevancia, presenta distensión abdominal y ano imperforado. Es sometida a colostomía, presenta evolución irregular con débitos altos a través de la colostomía, se realizan estudios contrastados de imagen donde se observa exteriorización errónea de asa de yeyuno, se somete a laparotomía exploratoria donde se comprueba lo descrito y además se reporta como hallazgo incidental agenesia colónica con desembocadura del íleon en una bolsa de 6 cm de diámetro que se conecta con la vejiga. DISCUSIÓN: La BCC es una patología común en ciertos países orientales y extremadamente rara en países occidentales; en Ecuador no se encontraron registros de casos reportados. Se debe realizar un correcto análisis prequirúrgico de los pacientes con MAR para conseguir una adecuada planificación y abordaje quirúrgico, disminuyendo con ello la morbimortalidad en el paciente

INTRODUCTION: Congenital pouch colon (CPC) is a rare malformation. It causes variable dilatation of the colon associated with anorectal malformation (ARM), usually presenting a fistula towards the genitourinary tract. CLINICAL CASE: 2-day-old female patient, with no relevant medical history. She had abdominal distension and imperforate anus. She underwent colostomy. She had an irregular evolution with high colostomy debits. Contrast imaging studies were performed, which demonstrated an erroneous exteriorization of the jejunal loop. She underwent an exploratory open surgery, which confirmed the previous diagnosis and incidentally found colonic agenesis, with ileum entering in a pouch of 6 cm of diameter that connects with the bladder. DISCUSSION: CPC is a common pathology in certain eastern countries and extremely rare in western countries. In Ecuador, no records of reported cases were found. A correct pre-surgical analysis of ARM patients should be carried out to achieve an adequate planning and surgical approach, thus reducing morbidity and mortality

Medical Students for Tissue Procurement, a 10-Year Experience in a Large University Hospital: An Exportable Model?

OBJECTIVE: The objective of this study was to describe tissue procurement activity performed during 10 years (2004-2014) by trained medical students in a large university hospital. METHODS: In this study, third to sixth year medical students were trained as in-hospital Tissue Coordinators (Tc) to perform tissue procurement activity on a 24/7 schedule supervised by an on-call senior Transplant Coordinator (sTC) in a large university hospital. Tc duty consisted of detection, initial evaluation of all hospital deaths, donor's family approach for tissue donation, and retrieval logistics organization, including corneal tissue retrieval after training and certification. They also assist sTC in organ procurement activity. RESULTS: A total of 18,931 deaths were prospectively evaluated, 79% of whom (n = 14,879) presented medical contraindications for tissue donation. Of the remaining 4052 (21%) potential tissue donors (PTD), 2522 (62%) were not converted into real donors, mostly due to family refusal (66%; n = 1650) followed by detection system failure and other logistical issues (34%; n = 872). A total of 2814 corneal units, 225 skin donations, 327 muscleskeletal tissue donations, 91 blood vessels donations, and 177 heart valve donations were obtained from the remaining 1530 (38%) real donors. Tissue potentiality increased from 19% to 43% throughout the study period as a consequence of the fluctuating acceptance criteria used by tissue banks depending on tissue demand. CONCLUSIONS: The tissue donation program performed by trained students was successful in achieving a high and sustainable tissue donation rate in a large university hospital.