[Prospective study of digestive stomas complications]. / Estudio prospectivo sobre las complicaciones de los estomas digestivos.

The surgical treatment of colorectal pathology can often lead to the need for a stoma, either colostomy or ileostomy. This surgery is associated with a high rate of complications. OBJECTIVE: The objective of this study is to describe the frequency of stomas complications, identify associated risk factors as well as new prevention strategies. MATERIALS AND METHODS: Prospective observational cohort study on patients who underwent an ileostomy or colostomy at the Hospital U. Infanta Leonor between April 2016 and October 2017. RESULTS: A total of 87 stomas were performed in 83 patients, of which 77.01% had at least one complication. The most presented complication was dermatitis (54.02%), followed by detachment (40.23%) and flat stoma (21.84%). The greatest number of complications occurred in the second week of the postoperative period. The average height of the stomas made was 10.6 mm. BMI was associated as a risk factor for the development of stoma complications. Of all the patients, 55 had follow-up until 6 months. CONCLUSION: Although our complication rate is high, this outcome is similar to others studies previously published. BMI was the unique risk factor associated with the development of stoma complications. New strategies related to the surgical technique can be developed to decrease our complication rate.

Estudio prospectivo sobre las complicaciones de los estomas digestivos

El tratamiento quirúrgico de la patología colorrectal puede conllevar en muchas ocasiones la necesidad de realizar un estoma, ya sea colostomía o ileostomía. Este tipo de cirugía se asocia a una alta tasa de complicaciones. Objetivo: El objetivo de este estudio es describir la frecuencia de las complicaciones, identificar factores de riesgo así como estrategias de prevención. Materiales y métodos: Estudio de cohorte observacional prospectiva, de pacientes a los que se les realizó ileostomía o colostomía en el Hospital Universitario Infanta Leonor entre abril de 2016 y octubre de 2017. Resultados: Se realizaron un total de 87 estomas en 83 pacientes, de los cuales un 77,01% presentó al menos una complicación. La complicación más presentada fue la dermatitis (54,02%), seguida del desprendimiento (40,23%) y del estoma plano (21,84%). El mayor número de complicaciones se dieron en la segunda semana del postoperatorio. La altura media de los estomas realizados fue 10,6 mm. Se ha encontrado el índice de masa corporal como factor de riesgo asociado al desarrollo de complicaciones de las ostomías, no existiendo significación estadística en nuestros pacientes con respecto al resto de factores estudiados. Conclusiones: Nuestra tasa de complicaciones es similar a lo publicado previamente en la literatura. El índice de masa corporal ha sido el único factor de riesgo de nuestra serie. Se han encontrado puntos susceptibles de mejora con respecto a la técnica quirúrgica para reducir el número de complicaciones.

The surgical treatment of colorectal pathology can often lead to the need for a stoma, either colostomy or ileostomy. This surgery is associated with a high rate of complications. Objective: The objective of this study is to describe the frequency of stomas complications, identify associated risk factors as well as new prevention strategies. Materials and methods: Prospective observational cohort study on patients who underwent an ileostomy or colostomy at the Hospital U. Infanta Leonor between April 2016 and October 2017. Results: A total of 87 stomas were performed in 83 patients, of which 77.01% had at least one complication. The most presented complication was dermatitis (54.02%), followed by detachment (40.23%) and flat stoma (21.84%). The greatest number of complications occurred in the second week of the postoperative period. The average height of the stomas made was 10.6 mm. BMI was associated as a risk factor for the development of stoma complications. Of all the patients, 55 had follow-up until 6 months. Conclusion: Although our complication rate is high, this outcome is similar to others studies previously published. BMI was the unique risk factor associated with the development of stoma complications. New strategies related to the surgical technique can be developed to decrease our complication rate.

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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