Reparación de hernia crural irreductible con contenido único de trompa de falopio. Reporte de un caso / Repair of irreducible crural hernia with single content of Fallopian tube. Report of a case

No disponible

Phlegmonous gastritis: A rare entity as a differential diagnostic of an acute abdomen. Description of a case and a bibliographic review.

Phlegmonous gastritis is a rare bacterial infection of the gastric wall, which progress rapidly. It is characterized by a purulent inflammation that can affect the entire gastrointestinal tract and presents a high mortality rate. We are reporting a case of phlegmonous gastritis in an HIV-seropositive man successfully treated with antibiotics. Moreover, a review of the English andSpanish literature is carried out, from 1980 to the present time.The most frequently involved microorganism is Streptococcus spp. (57 %), but the polimicrobial infection is also frequent (17 %). The most important symptom is the intensive epigastric pain associated with vomits and most cases were diagnosed by CT and/or fibrogastroscopy. There are many existing risk factors described.The main one is the immunesuppression, although in 40 % of the cases no risk factors were identified. The global mortality is 27 % without identifying significant differences between antibiotics and surgical treatment, for that reason it is recommended to initiate antibiotic treatment right from the beginning and postponing surgery for the refractory cases and complications.

Abordaje laparoscópico por incisión única del hígado izquierdo: experiencia inicial / Single-port laparoscopic approach of the left liver: Initial experience

INTRODUCCIÓN: Los avances tecnológicos han permitido el desarrollo de la cirugía laparoscópica por incisión única, iniciada con la colecistectomía y usada, posteriormente, para abordar otras enfermedades abdominales. Sin embargo, la cirugía hepática laparoscópica por puerto único es excepcional. Se presenta la experiencia inicial en cirugía hepática por incisión única. MATERIAL Y MÉTODO: Entre mayo de 2012 y diciembre de 2013 se intervino a 5 pacientes mediante abordaje laparoscópico por incisión única. La indicación quirúrgica fue por enfermedad benigna en un caso y maligna en 4. Para la colocación del dispositivo de puerto único se practicó una incisión supraumbilical derecha de 3-5 cm. En todos los casos las lesiones estaban situadas en los segmentos II o III hepáticos. Se realizaron 4 seccionectomías laterales izquierdas y una hepatectomía izquierda. RESULTADOS: El tiempo operatorio fue de 135 min. No hubo casos de conversión a cirugía laparoscópica convencional ni a cirugía abierta. La dieta oral se inició a las 18 h. No hubo complicaciones postoperatorias ni necesidad de transfusión sanguínea. La estancia hospitalaria mediana fue de 3 días. El grado de satisfacción fue muy bueno en 4 casos y bueno en uno y los pacientes retornaron a las actividades de la vida diaria a los 8 días. DISCUSIÓN: La cirugía hepática laparoscópica por incisión única es segura y factible en casos seleccionados y podría aportar menor agresión quirúrgica y mejores resultados estéticos. Se requieren estudios comparativos para determinar las ventajas reales de este abordaje

INTRODUCTION: New technological advances have enabled the development of single-port laparoscopic surgery. This approach began with cholecystectomy and subsequently with other abdominal surgeries. However, few publications on laparoscopic liver surgery have described the use of complete single-port access. We present our initial experience of a single-port laparoscopic hepatectomy. MATERIAL AND METHODS: Between May 2012 and December 2013, 5 single-port laparoscopic hepatectomies were performed: one for benign disease and four for colorectal liver metastases. The lesions were approached through a 3-5 cm right supraumbilical incision using a single-port access device. All the lesions were located in hepatic segments II or III. Four left lateral sectorectomies and one left hepatectomy were performed. RESULTS: Median operative time was 135 min. No cases were converted to conventional laparoscopic or open surgery. The oral intake began at 18 h. There were no postoperative complications and no patients required blood transfusion. The median hospital stay was 3 days. The degree of satisfaction was very good in 4 cases and good in one. Patients resumed their normal daily activities at 8 days. DISCUSSION: Single-port laparoscopic hepatectomy is safe and feasible in selected cases and may reduce surgical aggression and offer better cosmetic results. Comparative studies are needed to determine the real advantages of this approach

Single-port laparoscopic approach of the left liver: initial experience.

INTRODUCTION: New technological advances have enabled the development of single-port laparoscopic surgery. This approach began with cholecystectomy and subsequently with other abdominal surgeries. However, few publications on laparoscopic liver surgery have described the use of complete single-port access. We present our initial experience of a single-port laparoscopic hepatectomy. MATERIAL AND METHODS: Between May 2012 and December 2013, 5 single-port laparoscopic hepatectomies were performed: one for benign disease and four for colorectal liver metastases. The lesions were approached through a 3-5 cm right supraumbilical incision using a single-port access device. All the lesions were located in hepatic segments II or III. Four left lateral sectorectomies and one left hepatectomy were performed. RESULTS: Median operative time was 135 min. No cases were converted to conventional laparoscopic or open surgery. The oral intake began at 18 h. There were no postoperative complications and no patients required blood transfusion. The median hospital stay was 3 days. The degree of satisfaction was very good in 4 cases and good in one. Patients resumed their normal daily activities at 8 days. DISCUSSION: Single-port laparoscopic hepatectomy is safe and feasible in selected cases and may reduce surgical aggression and offer better cosmetic results. Comparative studies are needed to determine the real advantages of this approach.

Liposarcoma multicéntrico sincrónico y metacrónico / Multicentric, synchronous and metachronous liposarcoma

No disponible

Gastritis flemonosa: una entidad poco frecuente como diagnóstico diferencial del abdomen agudo. Descripción de un caso y revisión bibliográfica / Phlegmonous gastritis: a rare entity as a differential diagnostic of an acute abdomen. Description of a case and a bibliographic review

La gastritis flemonosa es una infección bacteriana poco frecuente y rápidamente progresiva de la pared gástrica. Se caracteriza por una inflamación purulenta que puede afectar a todo el tracto gastrointestinal y que presenta un índice elevado de mortalidad. En este trabajo se comunica un caso de gastritis flemonosa en un paciente seropositivo para la infección por VIH tratado exitosamente con antibioticoterapia. Además, se realiza una revisión de los casos publicados en la bibliografía médica, en inglés y español desde 1980 hasta la actualidad. El microorganismo más frecuentemente implicado es Streptococcus spp. (57 %), pero también destaca la infección polimicrobiana (17 %). El síntoma más común es el dolor epigástrico intenso asociado a vómitos y la mayoría de casos fueron diagnosticados mediante TC y/o endoscopia. Existen numerosos factores de riesgo descritos, el principal es la inmunosupresión, aunque en el 40 % de los casos no se identificó ningún factor de riesgo. La mortalidad global es del 27 %, sin identificar diferencias significativas entre el tratamiento antibiótico y quirúrgico, por lo que se recomienda instaurar el tratamiento antibiótico de manera precoz y reservar la cirugía para los casos refractarios y las complicaciones (AU)

Phlegmonous gastritis is a rare bacterial infection of the gastric wall, which progress rapidly. It is characterized by a purulent inflammation that can affect the entire gastrointestinal tract and presents a high mortality rate. We are reporting a case of phlegmonous gastritis in an HIV-seropositive man successfully treated with antibiotics. Moreover, a review of the English and Spanish literature is carried out, from 1980 to the present time. The most frequently involved microorganism is Streptococcus spp. (57 %), but the polimicrobial infection is also frequent (17 %). The most important symptom is the intensive epigastric pain associated with vomits and most cases were diagnosed by CT and/ or fibrogastroscopy. There are many existing risk factors described. The main one is the immunesuppression, although in 40 % of the cases no risk factors were identified. The global mortality is 27 % without identifying significant differences between antibiotics and surgical treatment, for that reason it is recommended to initiate antibiotic treatment right from the beginning and postponing surgery for the refractory cases and complications (AU)