Assessment of postoperative morbidity in Spanish hospitals: Results from a national survey.

BACKGROUND: The methodology used for recording, evaluating and reporting postoperative complications (PC) is unknown. The aim of the present study was to determine how PC are recorded, evaluated, and reported in General and Digestive Surgery Services (GDSS) in Spain, and to assess their stance on morbidity audits. METHODS: Using a cross-sectional study design, an anonymous survey of 50 questions was sent to all the heads of GDSS at hospitals in Spain. RESULTS: The survey was answered by 67 out of 222 services (30.2%). These services have a reference population (RP) of 15 715 174 inhabitants, representing 33% of the Spanish population. Only 15 services reported being requested to supply data on morbidity by their hospital administrators. Eighteen GDSS, with a RP of 3 241 000 (20.6%) did not record PC. Among these, 7 were accredited for some area of training. Thirty-six GDSS (RP 8 753 174 (55.7%) did not provide details on all PC in patients' discharge reports. Twenty-four (37%) of the 65 GDSS that had started using a new surgical procedure/technique had not recorded PC in any way. Sixty-five GDSS were not concerned by the prospect of their results being audited, and 65 thought that a more comprehensive knowledge of PC would help them improve their results. Out of the 37 GDSS that reported publishing their results, 27 had consulted only one source of information: medical progress records in 11 cases, and discharge reports in 9. CONCLUSIONS: This study reflects serious deficiencies in the recording, evaluation and reporting of PC by GDSS in Spain.

Traumatismo esplénico secundario a colonoscopia: una complicación infrecuente

Introducción: La colonoscopia es un procedimiento frecuente y seguro, no exento sin embargo de complicaciones. El traumatismo esplénico es una complicación infrecuente, pero potencialmente mortal. Caso Clínico: Mujer de 75 años, consultaba por dolor y distensión abdominal tras colonoscopia. A la exploración presentaba dolor a la palpación en epigastrio e hipocondrio izquierdo sin irritación peritoneal. La TC urgente informaba de hematoma esplénico de 10 x 2,6 cm sin signos de sangrado activo. Fue tratada de forma conservadora con evolución favorable. Conclusión: El manejo del traumatismo esplénico depende de la estabilidad hemodinámica, el grado de la lesión y la presencia de sangrado activo. En casos seleccionados, el tratamiento conservador constituye una alternativa para evitar cirugías innecesarias, aunque se debe monitorizar al paciente de forma estricta durante 48-72 h en una Unidad de Cuidados Intensivo. Aunque la lesión esplénica secundaria a la colonoscopia es una complicación infrecuente, puede presentar alta morbimortalidad si pasa inadvertida.

Introduction: Colonoscopy is a frequent and routine procedure, and even though it is considered safe, it can have complications. The splenic traumatism is an infrequent complication, but potentially mortal. Clinical Case: Woman 75 years old, consulted for abdominal pain and distension after a colonoscopy. Physical examination revealed pain in epigastric and left hypochondrium without peritoneal irritation. Urgent TC scan reported a splenic hematoma of 10 x 2,6 cm, without active bleeding. She received non-operative treatment with a favorable evolution. Conclusion: The management depends on the hemodynamic stability, the grade of injury and the presence of and active bleeding. In selected cases, non-operative treatment is an option that avoids unnecessary surgeries, even if the patient must stay 48-72 h hospitalized in an Intensive Care Unit for a strict monitoring of vital signs. Although the splenic injury secondary a colonoscopy is an infrequent complication, it can be potentially mortal if it is not diagnosed.

GIST is not all that it seems.

We present a 41-year-old female who was admitted to our hospital with a history of 2-month epigastric pain and vomiting. Physical examination was normal. Upper gastrointestinal endoscopy showed a sessile submucosal tumor with central ulceration in the gastric body-antrum. Biopsies revealed a gastric mucosa without changes. Nevertheless, endoscopic ultrasound-guided biopsies showed interlacing bundles of spindle cells. The immunohistochemical study was negative for CD117 and smooth muscle actin and positive for S100 protein. A CT scan identified a heterogeneous mass in the stomach wall.

No es GIST todo lo que parece / GIST is not all that it seems

We present a 41-year-old female who was admitted to our hospital with a history of 2-month epigastric pain and vomiting. Physical examination was normal. Upper gastrointestinal endoscopy showed a sessile submucosal tumor with central ulceration in the gastric body-antrum. Biopsies revealed a gastric mucosa without changes. Nevertheless, endoscopic ultrasound-guided biopsies showed interlacing bundles of spindle cells. The immunohistochemical study was negative for CD117 and smooth muscle actin and positive for S100 protein. A CT scan identified a heterogeneous mass in the stomach wall (AU)

Respuesta a «Encuesta nacional sobre el tratamiento de la apendicitis aguda en España durante la fase inicial de la pandemia por COVID-19» / Response to «National survey on the treatment of acute appendicitis in Spain during the initial period of the COVID-19 pandemic»

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Lumen-apposing metal stent deployment failure.

Endoscopic ultrasound-guided transmural drainage has become a first-line therapy for pancreatic fluid collections (1). The appearance of lumen-apposing metal stents has resulted in an authentic revolution, due to their efficacy (clinical success rate of 93%) and easy deployment (technical success rate of 98%) (2). They are associated with a shorter procedure time, lower risk of migration and a wider lumen, which could provide a more effective drainage (3). We report the case of a 78-year-old male who developed an infected pancreatic pseudocyst as a late complication of an acalculous severe acute pancreatitis. An endoscopic ultrasound-guided transmural drainage was performed after a failed computed tomography-guided percutaneous drainage with placement of a pig-tail catheter. A gastrocystic fistula was created and an AxiosTM lumen-apposing metal stent (Boston Scientific; Massachusetts, United States) was inserted. Nevertheless, it remained lodged in the pancreatic pseudocyst at the time of deployment. A computed tomography scan confirmed stent placement inside the collection (Figure 1). After endoscopic balloon dilatation of gastrocystic fistulous tract, removal was unsuccessful with proximal traction of the lumen stent flange using biopsy forceps. Surgical treatment was decided and a gastrotomy was performed, the fistula was identified in the posterior gastric wall and the stent was removed. Endoscopic ultrasound-guided transmural drainage of pancreatic fluid collections using lumen-apposing metal stents is a safe procedure. However, it is not exempt of complications such as stent migration, bleeding, gastrointestinal perforation and air embolism (4). Technical failure of lumen-apposing metal stents deployment is a rare complication that may require surgical treatment if endoscopic removal is not possible.

A propósito de «Respuesta a "Resultados en el tratamiento de traumatismos esplénicos utilizando un protocolo multidisciplinar en 110 pacientes consecutivos en un hospital de nivel II"» / In relation to "Response to 'Management of splenic injuries utilizing a multidisciplinary protocol in 110 consecutive patients at a level II hospital"

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Habilidades no técnicas en cirugía: una asignatura pendiente / Non-technical skills in surgery: A pending subject

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[Tumores neuroendocrinos pancreáticos. Nuestra experiencia]. / Pancreatic neuroendocrine tumors. Our experience.

Pancreatic neuroendocrine tumors are rare. It is a heterogeneous group of neoplasms with very different behavior and prognosis. They can appear sporadically or associated with genetic syndromes. They are divided into functioning and non-functioning. A descriptive retrospective study of patients diagnosed with pancreatic neuroendocrine tumor was performed. The incidental diagnosis of these tumors is increasingly. The only curative treatment for these tumors is surgical excision, depending on the location and characteristics of the tumor and the patient. In selected cases a conservative attitude is recommended.

Los tumores neuroendocrinos pancreáticos son poco frecuentes. Es un grupo heterogéneo de neoplasias con comportamiento y pronóstico muy diferentes. Pueden aparecer de manera esporádica o asociados a síndromes genéticos. Se dividen en funcionantes y no funcionantes. Se realizó un estudio retrospectivo descriptivo de los pacientes diagnosticados de tumor neuroendocrino pancreático. Como se refleja en nuestra serie, cada vez es más frecuente el diagnostico incidental de estos tumores. El único tratamiento curativo de estos tumores es la exéresis quirúrgica, según la localización y las características del tumor y del paciente. En casos seleccionados se puede optar por una actitud conservadora.

[Metástasis en el lóbulo frontal como primera manifestación clínica de un carcinoma folicular de tiroides]. / Frontal lobe metastases as the initial presentation of follicular thyroid carcinoma.

ANTECEDENTES: El carcinoma folicular de tiroides puede producir metástasis a distancia, siendo las localizaciones más habituales el pulmón y el hueso. Las metástasis cerebrales son inusuales, y es poco habitual que aparezcan como primera manifestación de cáncer. CASO CLÍNICO: Paciente varón de 80 años, que tras una caída al suelo comenzó con alteración del comportamiento, desorientación y pérdida del control de esfínteres. La tomografía computarizada cerebral evidenció una masa en el lóbulo frontal derecho. Se realizó la extirpación de la lesión cerebral, cuyo estudio histológico informó de metástasis de carcinoma folicular de tiroides. CONCLUSIÓN: La manifestación de la enfermedad con metástasis cerebrales es muy infrecuente, y empeora el pronóstico notablemente. BACKGROUND: Follicular thyroid carcinoma can produce distant metastases, generally occur to lung followed by bone. Brain metastases are unusual, and onset manifestation is little frequently. CLINICAL CASE: A 80-years old men presented disturbance behavior, desorientation and loss of sphincters after fallin to the ground. Computed tomography scan showed a lesion in the right frontal lobe. The patient underwent a craniotomy to remove the brain tumor, histopathology confirmed of follicular thyroid carcinoma metastases. CONCLUSION: At initial diagnosis brain metastasis are extremely rare, with adverse prognosis.

Obstrucción intestinal por evisceración vaginal como complicación tardía de la braquiterapia / Intestinal obstruction due to vaginal evisceration as a late complication of brachytherapy

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