Drenaje transrectal de abscesoperianastomótico en resección anterior baja porcáncer de recto. Un método de rescate en casosseleccionados / Transrectal drainage of perianastomotic abscess after low anterior resection for rectal carcinoma. A rescue method in selected patients

Las fístulas anastomóticas tras resección anterior baja mediante técnica de doble grapado en cáncer de recto pueden abocar al fracaso de la técnica con colostomía definitiva. Presentamos una pauta terapéutica de rescate en tres pacientes mediante drenaje transanastomótico del absceso retrorrectal, nutrición parenteral y antibioterapia (AU)

[Psoas abscess in Crohn's disease. Preoperative evaluation and surgical attitude]. / Abscesos de psoas en la enfermedad de Crohn. Valoración preoperatoria y actitud quirúrgica.

Three patients with psoas abscess secondary to Crohn's diseases are reported with the aim of discussing the diagnosis and surgical management of these patients. It is concluded that computerized tomography is the method of choice for the diagnosis and follow up of this complication. Surgery should be individualized but in stable patients abscess drainage should be attempted in addition to resection of the intestine involved. Finally, given the great risk of pulmonary thromboembolism in these patients, intensive prophylactic anticoagulant therapy is required.

[Intestinal obstruction and peritoneal carcinomatosis after endoscopic resection of transitional carcinoma of urinary bladder]. / Obstrucción intestinal y carcinomatosis peritoneal tras reseción endoscópica de carcinoma transicional de vejiga urinaria.

Gut involvement in bladder tumours is low, even exceptional in the presence of surface, low-grade neoplasia. The authors explain their experience in the diagnosis and management of a patient treated endoscopically for a vesical surface tumour which subsequently exhibited peritoneal and gut metastatic seeding. The various mechanisms for gut dissemination of vesical neoplasias and the repercussion of their endoscopic management are discussed.

[Heterotopic gastric mucosa in the ileum with perforated ulcer]. / Mucosa gástrica heterotópica de íleon con úlcera perforada.

Heterotopic gastric mucosa (HGM) in the small bowel, other than in the Meckel's diverticulum or other congenitally anomalous bowel, is exceedingly rare. A patient with HGM of the small intestine with perforation of the ileum due to ulceration of the adjacent mucosa is presented. The authors remark the importance of the histological criteria to differentiate between true HGM from metaplastic changes, two entities with different behavior and prognostic implications.

[Undifferentiated small cell carcinoma (oat-cell type) of the colon. Prognostic and therapeutic implications]. / Carcinomas indiferenciados de células pequeñas (Tipo oat-cell) de colon. Implicaciones pronósticas y terapéuticas.

AIM: This report reviews the clinical and pathologic features of four patients with small-cell anaplastic carcinoma (SCAC) of the colon and describes in detail their histological and immunohistochemical characteristics. METHODS: Four patients with a SCAC of the colon diagnosed by conventional light microscopy, immunohistochemistry and ultrastructure were reviewed; clinical presentation, tumor location and spread, surgical procedure, adjuvant therapy and clinical outcome were recorded. RESULTS: There were two women and two man, with an average age of 55 (range, 40-66) years. Two tumors were located in the sigmoid and two in right colon. Cases 1, 3 and 4 were removed at laparotomy by segmental resection along with lymph nodes. All cases had liver metastases. Pathologic study identified out-cell subtype in all cases and two histopathologic patterns: pure SCAC (cases 2 and 4) and mixed exocrine-SCC differentiation (cases 1 and 3). Three patients were treated with cyclophosphamide, cisplatin and etoposide. Two patients (cases 2 and 4) died of widely metastatic disease; cases 1 and 3 had partial remission lasting 9 and 3 months, respectively. CONCLUSIONS: Due to extremely aggressive behavior of colon SCAC with early metastatic spread, CT scans of the chest-abdomen and radionuclide bone scan should be performed. In the presence of metastatic disease, multiagent chemotherapy with combined etoposide and cisplatin should be instituted.

[Villous adenoma of the appendix caused acute appendicitis]. / Adenoma velloso de apéndice causante de apendicitis aguda.

Villous adenoma of the appendix is a rare pathologic entity, the treatment is controversial. We describe the case of a patient complaining of abdominal pain that was diagnosed as acute appendicitis. Pathological examination of the surgical specimen revealed a villous adenoma of the appendix. We comment the therapeutic options and we review the literature about this pathological entity.

[Ogilvie syndrome. Diagnostic and therapeutic attitude]. / Síndrome de Ogilvie. Actitud diagnóstica y terapéutica.

Ogilvie's syndrome (OS) is a clinical condiction with the symptoms, signs and radiological appearances of acute bowell obstruction but without any apparent mechanical cause. Diagnosis and treatment are often delayed and many patients are still inappropriately managed which in turn results in an increase in morbidity and mortality. We have reviewed our experience in eleven patients with OS in order to establish a system for their diagnostic and therapeutic management.

[Carcinoma in situ of the gallbladder. The prognostic and therapeutic implications]. / Carcinoma in situ de vesícula biliar. Implicaciones pronósticas y terapéuticas.

We have studied samples from gallbladders of five patients with carcinoma in situ over a 6-year period. Two were men and three women with du age ranging between 38 and 68 years (mean age 56). The microscopic criteria employed for the diagnosis of carcinoma in situ were pseudostratification of the epithelium, nuclear crowding, loss of cell polarity, atypical mitotic divisions and absence of stromal invasion. Cholecystectomy was carried in all patients due to cholelithiasis. Signs and symptoms were those related to the presence of stones and none of the patients was the presence of carcinoma suspected clinically. All patients are alive and symptom-free 14-84 months after surgery. Authors concluded that patients with carcinoma in situ of the gallbladder usually follows a good course after cholecystectomy.

[Acute abdomen in anticoagulated patients. Its assessment and the surgical indications]. / Abdomen agudo en pacientes anticoagulados. Valoración e indicaciones quirúrgicas.

Bleeding complications associated with anticoagulant drugs can development abdominal pain simulating acute surgical conditions of abdomen. We report six cases of intraabdominal spontaneous haemorrhage presenting as an acute abdomen in patients on anticoagulant therapy: two rectus sheath hematomas, a abdominal wall hematoma, a spontaneous hemoperitoneum, a retroperitoneal hematoma and an intramural hematoma of the small bowel. The article conclude that computed tomography examination provided useful information in this complications because can demonstrate the size and location of the mass and its relation to normal intra-abdominal structures. Finally, authors expose the surgical indications of the different bleeding syndromes in this patients.

[Importance of surgical staging in patients with cancer of the exocrine pancreas]. / Importancia del estadiaje quirúrgico en pacientes con cáncer de páncreas exocrino.

A retrospective analysis of 64 patients with adenocarcinoma of the exocrine pancreas was carried out to determine the impact of stage of the disease and surgical treatment on survival. Significant differences (p < 0.05) were observed in the survival rates of stage I (36%), stage II (12%), stage III (15%) and stage IV (0%). Patients with pancreatectomy had better prognosis (32%) than those with palliative procedures (11%) (p < 0.025). The presence of positive lymph nodes in patients with tumor resection didn't show significant differences on survival. Survivors showed a short prodome of symptoms (< 3 weeks) and a resected neoplasm (p < 0.025).