Malrotación intestinal en adulto y apendicitis aguda / Intestinal malrotation in adults and acute appendicitis

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[Urachal sinus: an unusual cause of recurrent umbilical discharge in adults]. / Uracosinus: una causa poco frecuente de onfalitis recurrente en adultos.

Urachal sinus is a rare congenital anomaly due to incomplete closure the urachus in the umbilical region, it is very rare in adults. 47-year-old male who arrived at our Emergency Department with recurrent umbilical discharge. Not response medical treatment (oral antibiotic and drainage). Abdominal computerized tomography scan confirmed the urachal sinus with omphalitis. Surgical complete excision with omphalectomy was performed. Any complications in the postoperative was observed.

Uracosinus: una causa poco frecuente de onfalitis recurrente en adultos / Urachal sinus: an unusual cause of recurrent umbilical discharge in adults

El uracosinus es una anomalía congénita poco frecuente secundaria a la obliteración incompleta del uraco en su porción infraumbilical, que puede aparecer a cualquier edad. Presentamos un paciente de 47 años que acudió al servicio de urgencias por supuración umbilical persistente que no había respondido al tratamiento médico (antibioterapia y curas). El TAC confirmó la existencia de un sinus del uraco con cambios de onfalitis. La cirugía consistió en la resección en bloque del mismo con onfalectomía. El postoperatorio transcurrió sin incidencias

Urachal sinus is a rare congenital anomaly due to incomplete closure the urachus in the umbilical region, it is very rare in adults. 47-year-old male who arrived at our Emergency Department with recurrent umbilical discharge. Not response medical treatment (oral antibiotic and drainage). Abdominal computerized tomography scan confirmed the urachal sinus with omphalitis. Surgical complete excision with omphalectomy was performed. Any complications in the postoperative was observed

Probabilidad de supervivencia en traumatismos graves. Análisis del modelo TRISS en un registro hospitalario / Probability of survival after severe trauma: analysis of the TRISS methodology in a hospital registry

Introducción. La creación desde los años ochenta de amplias bases de datos de pacientes traumatizados ha hecho posible el desarrollo y validación, mediante el empleo de modelos estadísticos de regresión logística, de unas normas de probabilidad de supervivencia basadas en las escalas de gravedad del traumatismo. Pacientes y métodos. Hemos analizado, mediante el modelo TRISS, que combina los valores del RTS, ISS, la edad del paciente y el tipo de traumatismo (cerrado o penetrante), la probabilidad de supervivencia (Ps) (mortalidad esperada) de los pacientes con traumatismo grave (n = 464) recogidos en nuestro registro entre junio de 1993 y julio de 1997, comparándola con la mortalidad observada. La rentabilidad diagnóstica del modelo la hemos evaluado mediante el uso de curvas ROC para el traumatismo cerrado y el penetrante. Sobre la base del cálculo de la probabilidad de supervivencia hemos determinado el número de muertes inesperadas (pacientes que fallecen a pesar de tener una Ps > 0,50) y también de supervivencias inesperadas. Resultados. El área bajo la curva ROC fue de 0,84 y 0,89 para el traumatismo cerrado y el penetrante, respectivamente. La mortalidad global fue del 23,7 por ciento, para una mortalidad esperada del 28,6 por ciento según el modelo TRISS. En el traumatismo cerrado la mortalidad observada fue del 27,5 por ciento, frente a una mortalidad esperada (Ps 0,50) por traumatismo cerrado y dos por traumatismo penetrante. Conclusiones. El modelo TRISS tiene, en nuestro registro de traumatismo grave, una sensibilidad predictiva de evolución final que es alta en el traumatismo penetrante y bastante menor en el traumatismo cerrado. Puede ser útil para analizar individualmente las muertes potencialmente evitables, así como para el control de la calidad asistencial a nuestros pacientes traumatizados (AU)

Transanal self-expanding metal stents as an alternative to palliative colostomy in selected patients with malignant obstruction of the left colon.

BACKGROUND: Palliative colostomy is still unavoidable in many patients with malignant obstruction of the left colon. This report describes an initial experience and follow-up in a small series of patients with left-sided colon obstruction in whom transanal self-expanding metal stent (SEMS) placement was attempted for palliative purposes. METHODS: Palliative transanal SEMS placement was attempted in 11 patients with malignant obstruction of the rectosigmoid region. The selection criteria included patients with advanced pelvic disease, peritoneal carcinomatosis and/or multiple parenchymatous metastatic disease. Wallstent oesophageal endoprostheses were used, and the technique was carried out by interventional radiologists. RESULTS: The technique succeeded in relieving the obstruction in seven patients, and surgical intervention was prevented in six. Five of these six patients died with an unobstructed colon from 26 days to 7 months after SEMS placement. The technique failed in four patients, three of whom underwent emergency colostomy. CONCLUSION: Transanal SEMS placement is an appealing method for the relief of obstruction in selected patients, obviating the need for palliative colostomy.

Early resolution of Ogilvie's syndrome with intravenous neostigmine: a simple, effective treatment.

PURPOSE: Our aim was to assess the value of a parasympathomimetic drug (neostigmine) in the early resolution of acute colonic pseudo-obstruction (Ogilvie's syndrome). METHODS: A prospective study was undertaken in 18 consecutive patients (mean age, 76 (range, 31-87) years) with acute colonic pseudo-obstruction. After a varying period of conservative treatment in all cases, 16 patients with persistent, massive abdominal distention were given intravenous neostigmine. RESULTS: A rapid and satisfactory clinical and radiologic decompression of the large bowel was obtained in 12 patients (75 percent) after a single dose of the drug; another patient had complete resolution after a second dose, and the other 3 patients had only partial resolution, in one of them after a second dose of the drug. No patient required surgical decompression of the bowel. CONCLUSION: These results give support to the theory of excessive parasympathetic suppression in most cases of Ogilvie's syndrome. The treatment with intravenous neostigmine has proved very effective, preventing in many cases prolonged periods of uncomfortable and potentially hazardous conventional conservative management and avoiding surgical treatment in a consecutive series of patients.

[Massive rectal hemorrhage caused by nonspecific colonic ulcers]. / Rectorragia masiva por úlceras cólicas inespecíficas.

Nonspecific colon ulcers are a rare disease which may produce lower gastrointestinal bleeding. A history of previous nonsteroidal anti-inflammatory drugs ingestion may be recorded in most patients. The right colon is the main location, being the cecum the most frequent site. However, they may be distributed in all the large intestine, including the rectum. We present a case of lower massive gastrointestinal hemorrhage produced by nonspecific colic ulcers requiring emergency total colectomy. Although infrequent, they have to be considered in every patient with lower gastrointestinal bleeding and previous nonsteroidal anti-inflammatory drugs ingestion.