Ovarian involvement in Crohn´s disease: A rare complication.

BACKGROUND: The transmural condition of Crohn's disease predisposes to fistulae or abscesses. The internal fistulae incidence is about 15%. Among them, enteroovarian fistula is rarely described on the literature. Herein, the authors present three cases of enteroovarian fistulas. CASE REPORTS: Two women are diagnosed with ileal Crohn's disease that presented a pelvic abscess diagnosed by ultrasound and CT. On surgery, an inflammatory mass involving the ileum and the ovary was found. The third woman was operated because of a tuboovarian abscess and was diagnosed with ileal Crohn's disease afterwards. In the three cases, the histopathological analysis of the ovary showed granulomas with abscess compatible with Crohn's disease. In one of the cases, multinucleated giant cells were found in the foreign body reaction to vegetable matter. A right ileocolectomy and an adnexectomy were performed in all three cases. No further involvement of the contralateral ovary or other gynaecological complications was observed. DISCUSSION: The treatment of Crohn's disease complications should be individualised. In the case of ovarian involvement, surgical treatment should include adnexectomy.

Afectación ovárica en la enfermedad de Crohn: una complicación rara / Ovarian involvement in Crohn´s disease: a rare complication

Introducción: la naturaleza transmural de la enfermedad de Crohn predispone a fístulas o abscesos. La incidencia de las fístulas internas está alrededor del 15%. Entre ellas, las fístulas enteroováricas son raramente descritas en la literatura. Se presentan tres casos de fístulas enteroováricas. Casos clínicos: dos mujeres diagnosticadas de enfermedad de Crohn ileal presentaron un absceso pélvico que fue diagnosticado mediante ecografía y TC. En la cirugía se halló una masa inflamatoria que afectaba al íleon y al ovario. La tercera mujer fue operada por un absceso tuboovárico y diagnosticada posteriormente de enfermedad de Crohn ileal. En los tres casos, el análisis anatomopatológico del ovario demostró la existencia de granulomas con abscesos compatible con la enfermedad de Crohn. En uno de los casos se hallaron células gigantes multinucleadas como reacción a cuerpo extraño, tratándose de material vegetal. En los tres casos se realizó una ileocolectomía derecha y una anexectomía. En el seguimiento no se ha observado afectación alguna del ovario contralateral, ni otras complicaciones ginecológicas. Discusión: el tratamiento de las complicaciones de la enfermedad de Crohn debe ser individualizado. En caso de afectación ovárica, el tratamiento quirúrgico debe incluir la anexectomía (AU)

Background: The transmural condition of Crohn’s disease predisposes to fistulae or abscesses. The internal fistulae incidence is about 15%. Among them, enteroovarian fistula is rarely described on the literature. Herein, the authors present three cases of enteroovarian fistulas. Case reports: Two women are diagnosed with ileal Crohn’s disease that presented a pelvic abscess diagnosed by ultrasound and CT. On surgery, an inflammatory mass involving the ileum and the ovary was found. The third woman was operated because of a tuboovarian abscess and was diagnosed with ileal Crohn’s disease afterwards. In the three cases, the histopathological analysis of the ovary showed granulomas with abscess compatible with Crohn’s disease. In one of the cases, multinucleated giant cells were found in the foreign body reaction to vegetable matter. A right ileocolectomy and an adnexectomy were performed in all three cases. No further involvement of the contralateral ovary or other gynaecological complications was observed. Discussion: The treatment of Crohn's disease complications should be individualised. In the case of ovarian involvement, surgical treatment should include adnexectomy (AU)

Efectos adversos en la cirugía de la apendicitis aguda / Adverse outcomes in the surgical treatment of acute appendicitis

Objetivo. Describir los efectos adversos en la apendicectomía por apendicitis aguda y analizar las asociaciones entre estos resultados y determinadas características del paciente y del ingreso hospitalario. Material y métodos. Cohorte de 792 pacientes intervenidos de apendicitis aguda en la que se registraron prospectivamente las complicaciones postoperatorias, las reintervenciones y los fallecimientos, y se identificaron retrospectivamente los reingresos. Se utilizó una regresión logística para valorar las asociaciones entre complicaciones y características de los pacientes y del ingreso. Resultados. El 9,8% de los pacientes desarrolló alguna complicación posquirúrgica (infección de herida, 4,2%; complicaciones intraabdominales, 2,1%). El 0,7% requirió reintervención durante el ingreso, el 0,5% precisó ingreso en la UCI y 5 pacientes (0,6%) fallecieron. El 3,2% reingresó en el servicio de cirugía en el año siguiente de la intervención, por un problema relacionado con la cirugía previa. Los casos complicados tuvieron una estancia mayor que los no complicados (9,6 frente a 3,5 días). Las complicaciones posquirúrgicas se asociaron a una mayor edad (45-65 años: odds ratio = 3,62; p 65 años: odds ratio = 8,68; p < 0,001) y a la apendicitis complicada con perforación/peritonitis (odds ratio = 3,69; p < 0,005). El reingreso relacionado con la intervención previa sólo se asoció a la presencia de complicaciones durante el ingreso (odds ratio = 18,79; p < 0,001). Conclusiones. En la apendicectomía, los efectos adversos más relevantes son la infección de la herida y el absceso intraperitoneal, que se relacionan con la mayor edad de los pacientes y con la apendicitis perforada. Este subgrupo de alto riesgo debe alertar al cirujano a extremar la vigilancia en el proceso de atención hospitalaria (AU)

Objectives. To describe adverse outcomes after appendectomy for acute appendicitis and to analyze the association between these outcomes and specific characteristics of the patient and hospital admission. Material and methods. We studied a cohort of 792 patients who underwent appendectomy for acute appendicitis. Postoperative complications, reoperations and deaths were prospectively studied and all readmissions were retrospectively identified. Logistic regression was used to evaluate the relationship between complications and patient characteristics, as well as hospital admission. Results. Postsurgical complications developed in 9.8% of the patients. These complications mainly consisted of surgical wound infection (4.2%) and intra-abdominal complications (2.1%). A total of 0.7% of patients underwent reoperation during admission, 0.5% were admitted to the intensive care unit and five patients (0.6%) died in hospital. The rate of operation-related readmissions in the following year was 3.2%. Length of hospital stay was longer in patients with complications than in those without complications (9.6 and 3.5 days, respectively). Postoperative complications were associated with older age (45-65 years, OR 3.62, p < 0.001; more than 65 years OR 8.68, p < 0.001) and acute appendicitis complicated with peritonitis or perforation (OR 3.69, p < 0.005). Readmissions related to previous surgery were associated only with complications during the first admission (OR 18.79, p < 0.001). Conclusions. In appendectomy, the most frequent adverse outcomes are surgical wound infection and intra-abdominal complications, which are associated with older patients and perforations. This subgroup of patients at high risk requires closer surveillance (AU)

Experiencia en el estudio de efectos adversos en un servicio de cirugía general / Experience with adverse outcomes in a General Surgery Department

Objetivo: Describir los efectos adversos tras la cirugía de la pared abdominal, y analizar las asociaciones entre estos resultados y determinadas características del paciente y del ingreso hospitalario. Material y métodos: Cohorte de 931 pacientes intervenidos de cirugía de la pared abdominal, en la que se registraron, de forma prospectiva, las complicaciones postoperatorias, las reintervenciones y la mortalidad. Se utilizó la regresión logística para valorar las asociaciones entre las complicaciones y las características de los pacientes y del ingreso. Resultados: El 16,3% de los pacientes desarrolló alguna complicación posquirúrgica, entre las que destacan las relacionadas con la herida quirúrgica, que se presentaron en un 9,3% (seroma, 4%; hematoma, 3,7%, e infección, 1,5%). Los fallos orgánicos afectaron al 1,1% de los pacientes y las complicaciones intraabdominales, a menos del 0,5%. El 0,6% de los pacientes requirió reintervención durante el ingreso, el 0,3% precisó ingreso en la UCI y 4 (0,4%) fallecieron durante el ingreso. La presencia de complicaciones se asoció a los grupos de edad superior a 46 años (46-65 años, odds ratio [OR] = 2,06; 66-79 años, OR = 3,11); a los varones (OR = 2,06); al ingreso urgente (OR = 1,85), y a la anestesia locorregional (OR = 1,81) y general (OR = 1,99). Conclusiones: Se presenta un sistema de información que posibilita la monitorización de sucesos adversos en cirugía y, a su vez, analizar los factores que se asocian a peores resultados. Aunque la mayor parte de los factores de riesgo identificados quedan fuera del control del cirujano, configuran un subgrupo de pacientes de alto riesgo en los que debería incrementarse la vigilancia

Objective: To describe adverse events after abdominal wall hernia repair and to analyze the association between these outcomes and certain characteristics of the patient and hospital admission. Material and methods: A cohort of 931 patients who underwent abdominal wall hernia repair was evaluated. Postoperative complications, reoperations and mortality were prospectively studied. Logistic regression was used to evaluate the association of complications with patient characteristics and hospital admission. Results: A total of 16.3% of patients developed postsurgical complications, mainly those related to the surgical wound, which were present in 9.3% (seroma 4%, hematoma 3.7% and infection 1.5%). Organ failure affected 1.1% of patients and intra-abdominal complications were found in less than 0.5%; 0.6% underwent reoperation during admission, 0.3% were admitted to the intensive care unit and four patients (0.4%) died in hospital. Postoperative complications were associated with age groups older than 46 years (46-65 years, odds ratio [OR] = 2.06; 66-79 years, OR = 3.11), male sex (OR = 2.06), urgent admission (OR = 1.85), regional anesthesia (OR = 1.81) and general anesthesia (OR = 1.99). Conclusions: We are introducing an information system that allows adverse outcomes in surgery to be monitored and, in turn, the factors associated with the poorest results to be analyzed. Although most of the risk factors identified were beyond the surgeon's control, a subgroup of high risk patients should undergo closer surveillance

[Adverse outcomes in the surgical treatment of acute appendicitis]. / Efectos adversos en la cirugía de la apendicitis aguda.

OBJECTIVES: To describe adverse outcomes after appendectomy for acute appendicitis and to analyze the association between these outcomes and specific characteristics of the patient and hospital admission. MATERIAL AND METHODS: We studied a cohort of 792 patients who underwent appendectomy for acute appendicitis. Postoperative complications, reoperations and deaths were prospectively studied and all readmissions were retrospectively identified. Logistic regression was used to evaluate the relationship between complications and patient characteristics, as well as hospital admission. RESULTS: Postsurgical complications developed in 9.8% of the patients. These complications mainly consisted of surgical wound infection (4.2%) and intra-abdominal complications (2.1%). A total of 0.7% of patients underwent reoperation during admission, 0.5% were admitted to the intensive care unit and five patients (0.6%) died in hospital. The rate of operation-related readmissions in the following year was 3.2%. Length of hospital stay was longer in patients with complications than in those without complications (9.6 and 3.5 days, respectively). Postoperative complications were associated with older age (45-65 years, OR 3.62, p < 0.001; more than 65 years OR 8.68, p < 0.001) and acute appendicitis complicated with peritonitis or perforation (OR 3.69, p < 0.005). Readmissions related to previous surgery were associated only with complications during the first admission (OR 18.79, p < 0.001). CONCLUSIONS: In appendectomy, the most frequent adverse outcomes are surgical wound infection and intra-abdominal complications, which are associated with older patients and perforations. This subgroup of patients at high risk requires closer surveillance.

Preoperative uracil, tegafur, and concomitant radiotherapy in operable rectal cancer: a phase II multicenter study with 3 years' follow-Up.

PURPOSE: To assess tolerance and efficacy of preoperative treatment with uracil/tegafur and radiotherapy (RT) followed by surgery and postoperative flurouracil (FU)/leucovorin (LV) in patients with rectal cancer. PATIENTS AND METHODS: Patients (n = 94) with potentially resectable tumors, ultrasound at stages T2N+ (n = 4), T3 (n = 77), T4 (n = 13) were treated with UFT (400 mg/m2/d, 5 days a week for 5 weeks) and concomitant RT to the pelvis (45 Gy; 1.8 Gy/d over 5 weeks). Patients underwent surgery 5 to 6 weeks later followed by four cycles of FU/LV. Primary end points included downstaging, pathologic responses, and sphincter-preserving surgery. Secondary end points were recurrence-free survival and overall survival. RESULTS: All patients received the full RT dose. Fifteen patients (16%) needed UFT dose reduction. Preoperative G3+ toxicities included diarrhea (14%), leukopenia (1%), thrombocytopenia (1%), and nausea (4%). The downstaging rate was 54%, pathologic complete response (pCR) was 9% and, in an additional 23%, there were only residual microscopic foci. When cellular viability criteria were taken into account, the pCR was 15%. From 43 patients with abdominoperineal resection indication, 11 (25%) had sphincter-preserving surgery performed. Postoperative scheduled chemotherapy dose was not administered to 24% of patients because of G3+ toxicity (diarrhea, 8%; mucositis, 9%; and leukopenia, 7%). Patients with downstaging had significantly higher survival and recurrence-free survival rates than those without. At 3 years, actuarial patterns of failure were pelvic, 5% and distant, 11%. OS was 75%. CONCLUSION: UFT combined with RT is safe and effective. In resectable rectal cancer, if preoperative treatment is considered, this approach can be an option.