ABSTRACT
Introducción y objetivos: La endometriosis es una enfermedad con una incidencia que puede llegar al 50% en mujeres en edad fértil. La endometriosis apendicular se presenta en el 1% de estas pacientes, con una clínica variable: su presentación más frecuente es la propia de una apendicitis. El objetivo del estudio es describir y analizar las características clínicas y anatomopatológicas de los casos de endometriosis apendicular de los últimos 10años en el Hospital 12 de Octubre. Pacientes y métodos: Presentamos el estudio retrospectivo de los casos de endometriosis apendicular de nuestro centro en los últimos 10 años. Resultados: Encontramos 22 casos de endometriosis apendicular de un total de 7.051 piezas. La mediana de edad de las pacientes fue de 38,5 años, con 3 pacientes fuera de edad fértil. El inicio fue un abdomen agudo en 16 pacientes; hasta en 10 casos se requirió la realización de 2pruebas de imagen. La endometriosis apendicular fue sospechada en tan solo 2 pacientes. El abordaje laparoscópico fue la técnica de preferencia en los casos crónicos o dudosos. En 6 de las piezas apareció una apendicitis concomitante. Conclusiones: La endometriosis apendicular presenta un difícil diagnóstico preoperatorio y debe ser tenida en cuenta en el diagnóstico diferencial de la apendicitis aguda y considerar que puede ocurrir fuera de la edad fértil
Introduction and objectives: Endometriosis is a disease with an incidence that may reach 50% in women of childbearing age. Appendiceal endometriosis occurs in 1% of these patients. Although symptoms vary, it typically manifests with the same symptoms as appendicitis. The aim of this study was to describe and analyse the clinical, anatomical and pathological characteristics of the appendiceal endometriosis cases treated over the last decade at 12 de Octubre Hospital. Patients and methods: We present a retrospective study of the cases of appendiceal endometriosis treated at our centre over the last 10 years. Results: We found 22 cases of appendiceal endometriosis from a total of 7051 cases. Median patient age was 38.5 years, with 3 patients not of childbearing age. Acute abdomen was the initial manifestation in 16 patients, requiring the performance of 2imaging tests in 10 cases. Appendiceal endometriosis was suspected in only 2 patients. The laparoscopic approach was the preferred technique in chronic or doubtful cases. Concomitant appendicitis was found in 6cases. Conclusions: Appendiceal endometriosis presents a preoperative diagnostic challenge and should be considered in the differential diagnosis of acute appendicitis, bearing in mind that it can arise in women not of childbearing age
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Endometriosis/diagnosis , Endometriosis/pathology , Appendicitis/complications , Appendicitis/diagnosis , Retrospective Studies , Diagnosis, Differential , Laparotomy , Laparoscopy , Length of StayABSTRACT
BACKGROUND: Surgical complications in multivisceral transplantation (MVT) are frequent and always severe. Those related to technical issues are relevant as they have implications not only on the graft but also on patient survival. The aim of this study was to review our case-based data and experience with 5 MVT performed since December 2004. CASE REPORT: A 38 year-old woman presented with ultra-short bowel syndrome due to massive ischemia also affecting the celiac trunk. She also had moderate to severe hepatitis/steatosis with some degree of fibrosis on liver biopsy, due to long-term home parenteral nutrition (HPN). An MVT was carried out in September 2010 including the liver, stomach, pancreatoduodenal complex with the spleen, and small bowel. The postoperative course was complicated by a leak from the pyloromiotomy, requiring reoperation on postoperative day 13. She also had central line catheter infection and renal impairment, requiring renal replacement therapy, and was discharged on postoperative day 150. Fifteen days later she was hospitalized because of severe abdominal pain associated with an abdominal mass. Computed tomography showed an aortic donor graft pseudoaneurysm, so we decided to operate on the patient. A complete resection of the pseudoaneurysm using an interposed polytetrafluoroethylene graft was performed. Six months after the MVT, the patient died due to sepsis, despite a functional graft and complete digestive autonomy. CONCLUSIONS: Although this complication is rare, surgical complications in MVT are severe and may seriously impair graft and patient survival.
