[The "rendez-vous" maneuver as a technical option to access the bile ducts: case series report]. / Maniobra de "rendez-vous" como una opción técnica de acceso a la vía biliar: reporte de casos.

The "rendez-vous" maneuver is a technical option, to have in mind, for the bile ducts access. This technique assures a "guided" canulation of the bile duct during the laparoscopic cholecystectomy (LC). We analyzed three clinical cases of patients with cholecysto-choledocolithiasis, in whose were planned Endoscopic Retrograde Cholangio-Pancreatography (ERCP) and LC during the same surgical intervention. The "rendez-vous" maneuver was employed as a technical option to access the bile duct, after an initial (failed) endoscopic attempt of cannulation. An intraoperative cholangiography was performed and a guide wire was inserted through the cystic duct, allowing the endoscopic capture and the guided cannulation of the bile duct. The therapeutic objective was achieved in all patients. There was not associated morbid-mortality and all patients were satisfied with the surgical outcome. In these series of cases, the "rendez-vous" maneuver was a viable, safe and useful technical option to access the bile ducts. Futhermore, the cholecysto-choledocolithiasis was treated during the same surgical intervention. A postoperative bile duct exploration becomes unnecessary.

“Proyectil deglutido”: Ilustración de una trayectoria raramente observada en trauma cervical pediátrico por arma de fuego / "The swallowed bullet": ilustration of a rare missile trajectory in a pediatric gunshot neck injury

Objetivos: Comunicar el caso clínico de un paciente pediátrico con traumacervical penetrante por arma de fuego, con una trayectoria del proyectil raramente observada. Métodos: Describimos e ilustramos el caso clínico de un escolar con trauma cervical penetrante por proyectil de arma de fuego, con orificio de entrada en zona III izquierda. Las radiografías de abdomen demostraron la ubicación intraabdominal del proyectil, determinándose posteriormente, que el proyectil penetró a la oro faringe y luego fue deglutido por el paciente, sin ocasionar otras lesiones. Resultados: Se observó una evolución satisfactoria con el manejo noquirúrgico. Conclusiones: Los proyectiles de arma de fuego en su trayectoria, generalmente determinan daño a múltiples órganos. En el caso descrito, la ubicación radiológica inicial del proyectil obligó a descartar lesiones en órganos cervicales, intratorácicos e intraabdominales, lo cual permitió ilustrar esta infrecuente y casi inocua trayectoria (AU)

Background: The probability of a bullet deglutition is are mote cause of consultation. Objectives: To communicate a clinical case of gunshot wound’s penetrating cervical trauma in a pediatric patient, with a no frequent trajectory. Methods: We describe and illustrate a clinical case of penetrating neck gunshot wound in the left zone III. At the initial radiological examination, we observed an intraabdominal location of the bullet. The analysis of the clinical case demonstrated an or pharyngeal injury, and a “swallowed bullet”, without other lesions. Results: We observed a satisfactory evolution with a nonsurgical management. There was no associated morbidity. Conclusion: The gunshot bullet’s trajectory generally implies a multipleorgans lesion. In this case, the initial radiological location of the bullet deserved to rule out cervical, intrathoracic and intraabdominal organs injuries, allowing illustrate this infrequent and almost “harmless “trajectory (AU)

["The swallowed bullet": illustration of a rare missile trajectory in a pediatric gunshot neck injury]. / "Proyectil deglutido": ilustración de una trayectoria raramente observada en trauma cervical pediátrico por arma de fuego.

BACKGROUND: The probability of a bullet deglutition is a remote cause of consultation. OBJECTIVES: To communicate a clinical case of gunshot wound's penetrating cervical trauma in a pediatric patient, with a no frequent trajectory. METHODS: We describe and illustrate a clinical case of penetrating neck gunshot wound in the left zone III. At the initial radiological examination, we observed an intraabdominal location of the bullet. The analysis of the clinical case demonstrated an oropharyngeal injury, and a "swallowed bullet", without other lesions. RESULTS: We observed a satisfactory evolution with a nonsurgical management. There was no associated morbidity. CONCLUSION: The gunshot bullet's trajectory generally implies a multiple organs lesion. In this case, the initial radiological location of the bullet deserved to rule out cervical, intrathoracic and intraabdominal organs injuries, allowing illustrate this infrequent and almost "harmless" trajectory.