[Polypoid lesions of the gallbladder]. / Lesiones polipoideas de la vesícula biliar.

This retrospective analysis evaluated 25 patients with benign polypoid lesions and 2 cases with malignant polyps of the gallbladder who had undergone cholecystectomy at Belén Hospital, Trujillo, Perú, from January, 1966 through December, 1993 in a attempt to elucidate the clinicopathological aspects of these patients. Cholelithiasis and cholesterolosis were present as associated findings in about 68% and 12% of patients respectively. The median age was of 48.8 +/- 15 years, the male:female ratio was 1:4, a right upper quadrant pain was the most common symptom (100%) and nonvisualization of a diseased gallbladder was seen in about 44% of cholecystograms. Microscopically, the lesions were classified as follow: Hyperplasias (n = 11), adenomas (n = 10), cholesterol polyps (n = 2), inflammatory polyps (n = 2) and malignant polyps (n = 2). Seventy six percent of benign lesions measured less than 0.5 cm and 12% were multiple lesions. The average diameter of malignant polyps was larger than 3 cm. We concluded that the benign epithelial tumors of the gallbladder are extremely rare cases and the treatment of choice for adenomatous polyps should be surgical for the possibility of developing malignant transformation.

[An index of the severity of intestinal gangrene due to colonic volvulus]. / Puntaje de severidad de la gangrena intestinal por vólvulo de colon.

This retrospective analysis evaluated 50 patients with gangrenous colonic volvulus two cases with ileocecal volvulus, one case with volvulus of the colon transverse and 47 cases with sigmoid volvulus- who were managed by primary resection with anastomosis (n = 21) or resection plus colostomy (n = 29) at Belén Hospital, Trujillo, Perú, from January 1, 1967 to July 31, 1993. The principal aim of the study was to identify by univariate analysis the combination of predictive risk factors for postoperative mortality. The following factors were associated with increased mortality: mean arterial pressure lower than 70 mmHg (p = 0.004), presence of purulent or fecaloid peritoneal fluid (p = 0.013) or evidence of macroscopic bowel perforation (p < 0.001). A method of quantifying the risk of mortality following gangrene of the loop using these factors was described. Each factor was given a weight value ranging from 0 a 2 (0 = major, 1 = moderate, 2 = minor) according to the severity of injury estimate. The sum of the individual factor scores comprised the final score of the Severity of Gangrenous Colon by Volvulus (S.S.G.C.). In this series the 30-day mortality rate was of 30%. A S.S.G.C. resulted greater than 4 in 34 (68%) of the patients. This was associated with a 9% mortality rate and contrasted to a 75% when the S.S.G.C. was equal to or less than 4. Mortality developed in 33% of the patients operated on using an immediate anastomosis (S.S.G.C., 4.2 +/- 0.99) and it was of 28% in those whose operation was resection plus colostomy (S.S.G.C., 3 +/- 0.87).(ABSTRACT TRUNCATED AT 250 WORDS)

[Surgical mortality and long-term recurrence of ileocecal volvulus]. / Mortalidad operatoria y recurrencia a largo plazo por vólvulo ileocecal.

Acute ileocecal volvulus is a condition of the abdomen which requires emergency treatment and is currently managed by several methods with a mortality rate of 25%. Surgical options include detorsion, cecostomy for nongangrenous volvulus or resection when gangrene is present. We studied the mortality and recurrence rate of ileocecal volvulus. This retrospective analysis evaluated 16 patients who underwent operation at Belen Hospital, Trujillo, Peru, between January 1966 and August 1992. As of August 1992, median follow-up was 160 months for 13 surviving patients (range, 6 to 307 months). Eleven men and 5 women with a median age of 52.3 + 21.1 years (range, 9 months to 83 years) formed the study population. Sixty eight percent of cases were 41 to 80 years of age and all women were than 40 years of age. Most of them were from the Peruvian Andes (81.3%), were from Indian and Spanish extraction (93.7%), and farmers (50%). Twelve patients (75%) developed a chronic ileocecal volvulus and 4 (25%) had an acute presentation. The clinical picture presented as large bowel obstruction in all patients. An ileocecal volvulus was accurately diagnosed by plain films of the abdomen in only 2 patients (16%) pre-operatively. A variety of procedures were used: cecopexy (9 cases), right hemicolectomy (3 cases) simple detorsion (2 cases), Mickulics exteriorization-resection (1 case) and cecostomy (1 case). The operative mortality rate was 18.7%. There were no recurrences after cecopexy. The most frequent post-operative complications were bronchopneumonia (18.7%), and wound infection (18.7%).(ABSTRACT TRUNCATED AT 250 WORDS)