Teleconsultation in General Surgery during COVID-19 pandemic, satisfaction survey and feasibility for future.

BACKGROUND: The COVID-19 pandemic has made us to respond to the needs of the community. Telemedicine has gained worldwide acceptance. We describe our experience with teleconsultation in surgical patients during the first wave of the COVID-19 pandemic and evaluate patient satisfaction and the feasibility of maintaining it as a future strategy in selected patients. METHODS: An observational, retrospective, single-site cohort study was carried out by reviewing electronic medical records and conducting a telephone survey. RESULTS: During this time, 1706 teleconsultations have been carried out: 59.5% of patients were rescheduled, 26.1% have been solved and of these 57.3% (255 patients) have been discharged; 12.19% were not contacted. The 73.6% considered that teleconsultation was able to fully or partially resolve the reason for their medical appointment; 61.6% were willing to continue with teleconsultation; 15.2% of the patients needed some kind of help or required a second call to speak with a family member, and 37.2% would prefer a face-to-face visit because of difficulties with the teleconsultation. The overall satisfaction was 8.7 out of 10. CONCLUSIONS: Telemedicine has demonstrated to be a useful tool even for surgical patients during COVID-19 pandemic. A high proportion of patients can be managed by telephone call. Patients reported a high degree of satisfaction. Teleconsultation is a feasible strategy not also during the current COVID-19 pandemic but also for future.

Invaginación colocólica por anisakiasis, una causa infrecuente de obstrucción intestinal / Colonic intussusception caused by anisakiasis. A rare cause of obstruction

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[Caecal bascule, an unusual cause of intestinal obstruction]. / Báscula cecal, una causa infrecuente de obstrucción intestinal.

BACKGROUND: Caecal bascule is an infrequent type of caecal volvulus. It appears when the caecum folds upon itself, causing an intestinal obstruction. It is usually diagnosed using imaging techniques or intra-operatively. A constrictive band related to previous abdominal surgery is frequently present, and acts as an inflexion point that results in a closed loop obstruction of the ascending colon. It has been reported in young women and in elderly hospitalised patients. The aim of this report is to describe the clinical features, diagnostic difficulties, and management strategies of this unusual entity. CLINICAL CASE: An 83-year-old male with concurrent acute neurological illness presented with history of intestinal obstruction. Because of a previous right nephrectomy, postoperative adhesions were suspected and conservative treatment initiated. As no improvement was seen, a computed tomography scan was obtained. Abdominal tomography showed an intestinal obstruction and a caecal bascule with vascular compromise. A right colectomy was performed. CONCLUSIONS: Caecal bascule is a rare cause of intestinal obstruction. The suspicion should be heightened when caecal ectopic dilation is present. Computed tomography scan is the preferred imaging technique, especially for ill patients. Right colectomy and primary anastomosis is the most appropriate surgical technique. Awareness of this entity can prevent the high morbidity and mortality rates of this condition.

Adrenalectomía bilateral laparoscópica por feocromocitoma en el síndrome de Von Hippel Lindau: técnica con 4 trocares / Bilateral Laparoscopic adrenalectomy due to a phaeochromocytoma in Von Hippel-Lindau Syndrome: a technique with 4 trocars

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Aneurisma esplénico asociado a una fístula arteriovenosa hiliar / Splenic Aneurism Associated with a Hilar Arteriovenous Fistula

Los aneurismas esplénicos son los aneurismas viscerales más frecuentes. Habitualmente son asintomáticos y se diagnostican de forma incidental al realizar estudios de imagen por otra patología. Su importancia clínica radica en la posibilidad de ruptura y la elevada mortalidad que ello implica. La mayoría de los aneurismas son únicos y de pequeño tamaño. La presencia de una fístula arteriovenosa hiliar o intraesplénica asociada es excepcional y suele estar en relación con traumatismos, cirugías previas, infecciones o ser de origen congénito. Presentamos el caso de un aneurisma intraesplénico asociado a una fístula arteriovenosa en el hilio, tratado satisfactoriamente mediante abordaje laparoscópico (AU)

Splenic aneurisms are the most frequent visceral aneurisms. These aneurisms are usually asymptomatic and are diagnosed incidentally by imaging studies performed for other diseases. The clinical importance of these entities lies in the possibility of rupture, leading to high mortality. Most aneurisms are single and small-sized. The presence of an associated hilar or intrasplenic arteriovenous fistula is exceptional and is usually related to trauma, prior surgery, or infections; a congenital origin may also be involved. We present a case of intrasplenic aneurism associated with a hilar arteriovenous fistula, which was satisfactorily treated through the laparoscopic approach (AU)

[Splenic aneurism associated with a hilar arteriovenous fistula]. / Aneurisma esplénico asociado a una fístula arteriovenosa hiliar.

Splenic aneurisms are the most frequent visceral aneurisms. These aneurisms are usually asymptomatic and are diagnosed incidentally by imaging studies performed for other diseases. The clinical importance of these entities lies in the possibility of rupture, leading to high mortality. Most aneurisms are single and small-sized. The presence of an associated hilar or intrasplenic arteriovenous fistula is exceptional and is usually related to trauma, prior surgery, or infections; a congenital origin may also be involved. We present a case of intrasplenic aneurism associated with a hilar arteriovenous fistula, which was satisfactorily treated through the laparoscopic approach.

Lesiones gastrointestinales y mesentéricas en el paciente politraumatizado: incidencia, demora diagnóstica y pronóstico / Gastrointestinal and mesenteric injuries in the trauma patient: incidence, diagnosis delay and prognosis

Introducción Las lesiones gastrointestinales y mesentéricas (LGIM) son poco frecuentes en el traumatizado, y su diagnóstico es, en ocasiones, tardío. Nuestros objetivos han sido determinar la fiabilidad diagnóstica inicial de la tomografía computarizada (TC) en nuestro centro, así como la posible repercusión clínica de la demora diagnóstica en estas lesiones. Material y método Estudio retrospectivo de los pacientes con LGIM recogidos en nuestro Registro de Trauma Grave entre 1993 y 2006.ResultadosDe los 1.495 traumatizados registrados, 632 tenían traumatismo abdominal y 105 (16,6%) presentaron LGIM, en un 46% secundarias a un traumatismo cerrado. El ISS y el NISS medios fueron 20 y 25, respectivamente. La mortalidad fue de 9 (8,5%) pacientes, 4 contra pronóstico. En 56 (53%) casos se realizó una TC, y se observaron signos de LGIM en sólo 37. En otros 43 (41%) pacientes se indicó una laparotomía urgente por inestabilidad o signos clínicos de lesión intraabdominal. En 21 (20%) casos la cirugía se demoró más de 8h, y la causa más frecuente fue un falso negativo en la TC. Conclusiones La incidencia total de LGIM ha sido alta en nuestro medio (el 31% en traumatismo abdominal penetrante y el 10,7% en cerrado). Diversos factores como la ausencia inicial de clínica, la baja sensibilidad diagnóstica de la TC (un 34% de falsos negativos) y el manejo conservador de las lesiones de órgano sólido han llevado a diagnóstico y tratamiento tardíos en 1 de cada 5 pacientes de nuestra serie, sin que ello haya implicado un aumento significativo de la morbilidad infecciosa (AU)

Background Gastrointestinal and mesenteric injuries (GIMI) are uncommon in trauma patients, and their diagnosis are often delayed. Our aims were to determine the reliability of CT scan in our centre, and to assess the clinical significance of a delayed diagnosis. Materials and method Retrospective analysis of cases confirmed at laparotomy. Patients were identified at the Severe Trauma Registry of Gregorio Marañón University General Hospital, between 1993 and 2006.ResultsWe found 105 (16.6%) GIMI out of 632 patients with abdominal trauma, in a Registry with 1495 severe trauma cases included. A total of 46% had blunt injuries. The mean injury severity score (ISS) and new ISS (NISS) were 20 and 25, respectively. There were 9 (8.5%) deaths, 4 of which were unexpected. A CT scan was performed in 56 (53%) cases, and only in 37 there were signs suggestive of a GIMI. In another 43 (41%) patients an urgent laparotomy was indicated because of positive clinical findings or instability. Surgery was delayed for more than 8 hours in 21 (20%) patients, the most common reason being a false negative result in the CT scan. Conclusions The overall incidence of GIMI was high in our centre (31% due to penetration and 10.7% blunt trauma). Several factors, such as the initial lack of symptoms, a low diagnostic sensitivity of the CT scan (34% false negatives), and the non-surgical management of solid organ injuries, have contributed to a delayed diagnosis and treatment in one out of each five patients in our series, but this has not led to a significant increase in septic complications in this group (AU)

[Gastrointestinal and mesenteric injuries in the trauma patient: incidence, diagnosis delay and prognosis]. / Lesiones gastrointestinales y mesentéricas en el paciente politraumatizado: incidencia, demora diagnóstica y pronóstico.

BACKGROUND: Gastrointestinal and mesenteric injuries (GIMI) are uncommon in trauma patients, and their diagnosis are often delayed. Our aims were to determine the reliability of CT scan in our centre, and to assess the clinical significance of a delayed diagnosis. MATERIALS AND METHOD: Retrospective analysis of cases confirmed at laparotomy. Patients were identified at the Severe Trauma Registry of Gregorio Marañón University General Hospital, between 1993 and 2006. RESULTS: We found 105 (16.6%) GIMI out of 632 patients with abdominal trauma, in a Registry with 1495 severe trauma cases included. A total of 46% had blunt injuries. The mean injury severity score (ISS) and new ISS (NISS) were 20 and 25, respectively. There were 9 (8.5%) deaths, 4 of which were unexpected. A CT scan was performed in 56 (53%) cases, and only in 37 there were signs suggestive of a GIMI. In another 43 (41%) patients an urgent laparotomy was indicated because of positive clinical findings or instability. Surgery was delayed for more than 8 hours in 21 (20%) patients, the most common reason being a false negative result in the CT scan. CONCLUSIONS: The overall incidence of GIMI was high in our centre (31% due to penetration and 10.7% blunt trauma). Several factors, such as the initial lack of symptoms, a low diagnostic sensitivity of the CT scan (34% false negatives), and the non-surgical management of solid organ injuries, have contributed to a delayed diagnosis and treatment in one out of each five patients in our series, but this has not led to a significant increase in septic complications in this group.