[Gallstone ileus: a diagnostic and therapeutic challenge. Presentation of a clinical case]. / Íleo biliar: un reto diagnóstico y terapéutico. Presentación de un caso clínico.

Background: Gallstone ileus represents 4% of the causes of bowel obstruction in general population, but it increases to 25% in patients above 65 years of age. Gallstone ileus does not present with unique symptoms, making diagnosis difficult. It has a high mortality (12 to 27%) due to associated comorbidities and diagnostic delay. The aim of this case report is to communicate the importance of prompt diagnosis and surgical management of gallstone ileus. Clinical case: It is presented the clinical case of a 67-year-old female patient with a history of long-standing diabetes mellitus without medical control, without previous surgical history, who began suffering 2 days prior to admission to the emergency room with signs and symptoms of intestinal occlusion. She was given medical management without improvement and diagnostic delay of mechanical intestinal occlusion that was surgically intervened 7 days after the onset of clinical symptoms, finding gallstone ileus in the exploratory laparotomy, with satisfactory resolution of the pathology despite the diagnostic delay. Conclusions: Gallstone ileus is a difficult clinical entity to diagnose and therefore requires a high index of suspicion. The aim of gallstone ileus treatment is to release the obstruction, which is done through enterolithotomy. It is the recommended technique for gallstone ileus management because of its lower morbidity and mortality, compared with the other techniques.

Introducción: el íleo biliar representa el 4% de las causas de obstrucción intestinal en la población en general, pero incrementa a un 25% en los pacientes de más de 65 años. No presenta síntomas únicos, lo cual hace difícil su diagnóstico. Tiene una alta mortalidad (entre 12 y 27%) debido a las comorbilidades asociadas y al retraso diagnóstico. El objetivo de este caso clínico es comunicar la importancia del diagnóstico oportuno y el manejo quirúrgico del íleo biliar. Caso clínico: se presenta el caso clínico de una paciente de 67 años con antecedente de diabetes mellitus de larga evolución sin control médico, sin antecedentes quirúrgicos previos, cuyo padecimiento comenzó dos días antes de su ingreso a urgencias con signos y síntomas de oclusión intestinal. Se le dio manejo médico sin mejoría y hubo retraso diagnóstico de oclusión intestinal mecánica, la cual fue intervenida quirúrgicamente siete días después del inicio del cuadro clínico. En la laparotomía exploradora se encontró un íleo biliar, con resolución satisfactoria de la patología a pesar del retraso diagnóstico. Conclusiones: el íleo biliar es una entidad clínica de difícil diagnóstico que requiere un alto índice de sospecha. El objetivo del tratamiento del íleo biliar es liberar la obstrucción por medio de la enterolitotomía. Comparada con las otras técnicas, esta es la técnica recomendada para el manejo del íleo biliar, debido a su menor morbimortalidad.

Landfill Leachate from an Urban Solid Waste Storage System Produces Genotoxicity and Cytotoxicity in Pre-Adolescent and Young Adults Rats.

Landfill leachate is a complex mixture of organic and inorganic molecules, as well as environmental pollutants that can cause harm to ecosystems and living beings. The micronucleus test in peripheral blood erythrocytes was used to evaluate the genotoxic and cytotoxic effects of exposure to a landfill leachate from an outdoor solid waste storage system on Wistar strain rats at different developmental stages, pre-adolescents and young adults, and the heavy metal content of the leachate was determined by atomic absorption spectrometry. Contents of arsenic, cadmium, chromium, mercury, and lead in the landfill leachate were outside the allowable international standards, and the exposure to the landfill leachate caused genotoxic and cytotoxic effects on Wistar rats, where the pre-adolescent animals were more susceptible to the toxics contained in the landfill leachate than young adults. Heavy metals contained in landfill leachate, individually or synergically with other molecules can be responsible for clastogenic and cytotoxic effects that can be harmful to humans and ecosystems.