[Treatment of a severe Clostridium difficile infection with colonic lavages. Report of one case]. / Ileostomía en asa derivativa y lavado colónico intraoperatorio como alternativa de tratamiento en un caso de colitis grave por Clostridium difficile.

A loop ileostomy with intraoperative anterograde colonic lavage has been described as an alternative to colectomy in the management of cases of Clostridium difficile infection refractory to medical treatment. We report a 69 years old diabetic women admitted with a septic shock. An abdominal CAT scan showed a pan-colitis that seemed to be infectious. A polymerase chain reaction was positive for Clostridium Difficile. Due to the failure to improve after full medical treatment, a derivative loop ileostomy and intra-operatory colonic lavage were performed, leaving a Foley catheter in the proximal colon. In the postoperative period, anterograde colonic instillations of Vancomycin flushes through the catheter were performed every 6 hours. Forty eight hours after surgery, the patient improved. A colonoscopy prior to discharge showed resolution of the pseudomembranous colitis.

Ileostomía en asa derivativa y lavado colónico intraoperatorio como alternativa de tratamiento en un caso de colitis grave por Clostridium difficile / Treatment of a severe Clostridium difficile infection with colonic lavages. Report of one case

A loop ileostomy with intraoperative anterograde colonic lavage has been described as an alternative to colectomy in the management of cases of Clostridium difficile infection refractory to medical treatment. We report a 69 years old diabetic women admitted with a septic shock. An abdominal CAT scan showed a pan-colitis that seemed to be infectious. A polymerase chain reaction was positive for Clostridium Difficile. Due to the failure to improve after full medical treatment, a derivative loop ileostomy and intra-operatory colonic lavage were performed, leaving a Foley catheter in the proximal colon. In the postoperative period, anterograde colonic instillations of Vancomycin flushes through the catheter were performed every 6 hours. Forty eight hours after surgery, the patient improved. A colonoscopy prior to discharge showed resolution of the pseudomembranous colitis.

[Giant Meckel's diverticulum in an adult]. / Divertículo de Meckel gigante en un adulto.

Meckel's diverticulum results from a partial persistence of the omphalomesenteric duct and is the most common congenital anomaly of the gastrointestinal tract, affecting about 2% of the general population. Its presentation as a giant Meckel's diverticulum (>5 cm) is rare and is associated with major complications. We report a case of a 53 year-old woman with constipation for at least ten years. A colonoscopy from eight years ago suggested megacolon. The patient consults in the last month for abdominal pain associated with anorexia. The computed tomography scan image suggested an ileal megadiverticulum. An exploratory laparotomy revealed a saccular dilatation of the distal ileum of 6 x 15.5 cm, located 20 cm away from the ileocecal valve. We resected the involved segment of distal ileum and performed a manual ileo-ascendo anastomosis. The biopsy showed a saccular dilatation of the wall, lined by small intestinal mucosa with areas of gastric metaplasia, supporting the diagnosis of giant Meckel's diverticulum.

El divertículo de Meckel corresponde a la persistencia parcial del conducto onfalomesentérico, representa la anomalía congénita más frecuente del tracto gastrointestinal y afecta alrededor del 2% de la población general. La presentación como divertículo de Meckel gigante (>5 cm) es infrecuente y está asociada a una mayor tasa de complicaciones. Se presenta el caso de una mujer de 53 años que refiere constipación de al menos diez años; una colonoscopía de hace ocho años sugiere un megacolon y en el último mes la paciente ha presentado dolor abdominal asociado a anorexia. Se realiza una tomografía computarizada con imagen que sugiere la presencia de megadivertículo ileal, por lo que se decide realizar una laparotomía exploradora que evidencia una dilatación sacular del íleon distal a 20 cm de la válvula ileocecal de 15,5 x 6 cm aproximadamente. Se reseca el segmento comprometido del íleon distal, que queda cerrado a nivel de la válvula ileocecal, y se realiza una íleo-ascendo anastomosis manual. La biopsia informa dilatación sacular de la pared, revestida por mucosa de intestino delgado con áreas de metaplasia gástrica, hallazgos compatibles con un divertículo de Meckel gigante.

Ecología térmica de Microlophus occipitalis (Sauria: Tropiduridae) en el Bosque Seco de Llanura de Tumbes, Perú / Thermal ecology of Microlophus occipitalis (Sauria: Tropiduridae) in the Plain Dry Forest of Tumbes, Peru

Se estudió la ecología termal de Microlophus occipitalis Peters 1871 en el Bosque Seco de Llanura de Tumbes (noroeste del Perú). La temperatura corporal promedio fue de 36,1 ± 1,8 ºC, similar a las temperaturas exhibidas por Microlophus peruvianus en el norte del Perú. No se identificaron diferencias entre la temperatura corporal y el grado de termorregulación de hembras y machos, posiblemente asociado a su estructura social y uso de microhábitat. La temperatura del aire y del sustrato afectaron la temperatura corporal de Microlophus occipitalis, aunque la temperatura del aire afecta en mayor grado la variación de la temperatura corporal. Se sugiere realizar estudios más detallados en esta especie, especialmente bajo escenarios de cambio climático en el noroeste del Perú.

The thermal ecology of Microlophus occipitalis Peters 1871 in the plain dry forests of Tumbes (northewestern Peru) was studied. Mean body temperature was 36.1 ± 1.8 ºC, similar to body temperatures exposed by Microlophus peruvianus in northern Peru. There were no differences between body temperature and degree of thermoregulation of males and females, due to a possible association to their social structure and microhabitat use. Air and substrate temperature affects the body temperature of Microlophus occipitalis, where air temperature accounts for a significant proportion of body temperature variation. We suggest more detailed studies on this lizard species, especially under climate change scenarios in northwestern Peru.

Ecología de Phyllodactylus angustidigitus y P. gerrhopygus (Squamata: Phyllodactylidae) de la Reserva Nacional de Paracas, Perú / Ecology of Phyllodactylus angustidigitus and P. gerrhopygus (Squamata: Phyllodactylidae) from the Reserva Nacional de Paracas, Peru

Actualmente se desconocen muchos aspectos de la ecología de Phyllodactylus angustidigitus (Dixon & Huey 1970) y P. gerrhopygus (Weigmann, 1834). En el presente trabajo investigamos algunos aspectos del nicho de P. angustidigitus y P. gerrhopygus en la Reserva Nacional de Paracas (RNP). Se evaluó y comparó la distribución, uso de hábitats (nicho espacial), horarios de actividad (nicho temporal) y dieta (nicho trófico) de estas dos especies de gecónidos. Adicionalmente, se estimó la oferta de recursos alimentarios mediante el uso de trampas pit-fall. Phyllodactylus angustidigitus estuvo presente en la mayoría de las localidades evaluadas, y fue registrado en los hábitats de desierto y lomas. Phyllodactylus gerrhopygus fue registrado únicamente en la Península de Paracas y en el oasis de Sta. Cruz, en los hábitats de desierto, lomas y oasis. Ambas especies fueron registradas en actividad sólo en horarios nocturnos. La dieta de P. angustidigitus y P. gerrhopygus estuvo caracterizada principalmente por el consumo de insectos. Ambas especies presentaron dietas de tipo generalistas, debido a la amplitud del nicho trófico, y oportunistas, debido a la semejanza en la composición de sus dietas con la oferta estimada de recursos alimentarios en el medio ambiente. Las dietas de ambas especies fueron semejantes. Adicionalmente, la cercanía filogenética entre P. angustidigitus y P. gerrhopygus producen semejanzas en el nicho espacial (uso de hábitats), temporal (horarios de actividad), y en sus dietas. Estas importantes similitudes en el uso de los recursos del medio, pueden derivar en una potencial competencia por los recursos de su medio ambiente entre estos gecónidos simpátricos. La información proporcionada en este trabajo demuestra la necesidad de diseñar una adecuada estrategia para garantizar el estado de conservación de P. angustidigitus.

Until now, ecology of Phyllodactylus angustidigitus and P. gerrhopygus are unknown. In this work, we researched some aspects of P. angustidigitus and P. gerrhopygus niches at National Reserve of Paracas (RNP). We evaluated and compared: distribution, habitat use (spatial niche), activity patterns (temporal niche) and diet (trophic niche), all these aspects in both geckonids species. We estimated resource supply through pitfall traps. Paracas geckonid, P. angustidigitus, has been present in most of the RNP evaluated locations, and it was reported in desert and hills habitats. Southern geckonid, P. gerrhopygus, was reported only in Paracas peninsula and Sta. Cruz, in desert, hills and oasis habitats. Both species were founded in activity at night time. P. angustidigitus and P. gerrhopygus diet consisted in insects. The diet of these species shows a generalist behavior, caused by the trophic niche amplitude, and an opportunistic behavior, explained with similarity between diet composition and environment resource supply. Diet of both species was similar. Additionally the phylogenetic proximity between P. angustidigitus y P. gerrhopygus produces spatial niche similarities (habitat use) and temporal niche similarities (activity patterns) and trophic niche (diet). These important similarities in resources use can be derived in a potential competition of environmental resources between these simpatric geckonids. The information provided in this paper shows the need to design an appropriate strategy to ensure the conservation status of P. angustidigitus.

Dieta de la lagartija de las playas Microlophus peruvianus (Reptilia: Tropiduridae) en la playa Santo Domingo, Ica, Perú / Diet of the beach lizard Microlophus peruvianus (Reptilia: Tropiduridae) in the Santo Domingo beach, Ica, Peru

La lagartija de las playas Microlophus peruvianus es uno de los saurios más conspicuos del Desierto Costero peruano, sin embargo, existe muy poca información sobre su dieta. Se reporta información de la dieta de M. peruvianus en la playa Santo Domingo, Ica, que evidencia importantes diferencias entre los principales item alimentarios de juveniles y adultos, que podrían estar reduciendo la competencia intraespecífica.

Even the beach lizard Microlophus peruvianus is one of the most conspicuous saurian species in the Peruvian desert, however there is almost none information about its diet. Here we reported important evident about the diet differences of both M. peruvianus adult and juvenile in Santo Domingo beach, Ica, which could be reduced the intraspecific competition between them.

Succinea peruviana (Gastropoda) en la dieta de la lagartija de las Lomas Microlophus tigris (Sauria) en la Reserva Nacional de Lachay, Lima, Perú / Succinea peruviana (Gastropoda) in the diet of the Lomas lizard Microlophus tigris (Sauria) from the Lachay National Reserve, Peru

El presente trabajo informa de la presencia del caracol Succinea peruviana en la dieta de la lagartija de las Lomas Microlophus tigris, la misma que habita el mesohábitat de Lomas con árboles en la Reserva Nacional de Lachay. Este es el primer informe del consumo de caracoles por lagartijas del Desierto Costero Peruano.

We report the snail Succinea peruviana in the diet of the Lomas lizard Microlophus tigris, which inhabit the mesohabitat from the formation forested of Lomas in the Lachay National Reserve. This is the first report of snails in the diet of Peruvian coastal desert lizards.

[Splenic abscesses. Report of seven cases]. / Abscesos esplénicos: Comunicación de siete casos y revisión de la literatura.

BACKGROUND: Splenic abscesses are uncommon, appear in subjects with predisposing factors such as systemic infections and have high mortality rates. AIM: To report seven patients with splenic abscesses. MATERIAL AND METHODS: Retrospective review of medical records of patients with a splenic abscess treated between 1987 and 2005. RESULTS: The records of four women and three males aged 20 to 74 years, were reviewed. The most common presenting symptoms were fever and abdominal pain and all had predisposing factors. Six patients had a leukocyte count of 19,500 x mm(3). Mean erythrocyte sedimentation rate and C reactive protein values were 75 mm/h and 13.5 mg/dl. Diagnosis was made with ultrasound in two patients and CT scan in five. Six patients had an unique abscess and one patient had multiple lesions. A splenectomy was done in three patients as the first choice treatment and in one, due to medical treatment failure. In two patients, a CT guided percutaneous drainage was performed and one patient was subjected to medical treatment only. Abscess cultures were positive in 50% of patients subjected to percutaneous drainage and in 50% of splenectomized patients. No patient died and no complications were observed in the early or late postoperative period. CONCLUSION: Splenic abscesses are associated to predisposing conditions. The first choice is surgical treatment, but percutaneous drainage is also a therapeutic option.

[Bouveret syndrome: report of four cases]. / Síndrome de Bouveret: Resolución endóscopica y quirúrgica de cuatro casos clínicos.

UNLABELLED: Bouveret syndrome is a duodenal obstruction caused by a biliary stone. AIM: To report patients with Bouveret syndrome. MATERIAL AND METHODS: Retrospective review of medical records of patients with Bouveret syndrome treated between 1976 and 2006. RESULTS: We report three women and one man with a mean age of 62.5 years. None had a previous diagnosis of cholelithiasis. AH presented with colicky pain in the right upper quadrant and vomiting, suggesting gastric retention. The diagnosis was suspected after a barium meal in two patients and with a CT scan on the other two. The endoscopical extraction or fragmentation of stones was attempted in three patients but was successful only in one. Three patients were operated and a stone impacted in the first portion of the duodenum was identified, along with a cholecystoduodenal fistula. A duodenostomy and stone extraction was performed. One patient was subjected to a cholecystectomy fistula repair and gastrojejunoanastomosis. No patient died and all were discharged within 8 to 12 days after surgery. CONCLUSIONS: Bouveret syndrome is an uncommon complication of cholelithiasis. Endoscopy can be diagnostic and therapeutic. Surgery is the other therapeutic option.

Síndrome de Bouveret: Resolución endóscopica y quirúrgica de cuatro casos clínicos / Bouveret syndrome: Report of four cases

Bouveret syndrome is a duodenal obstruction caused by a biliary stone. Aim: To report patients with Bouveret syndrome. Material and Methods: Retrospective review of medical records of patients with Bouveret syndrome treated between 1976 and 2006. Results: We report three women and one man with a mean age of 62.5 years. None had a previous diagnosis of cholelithiasis. AH presented with colicky pain in the right upper quadrant and vomiting, suggesting gastric retention. The diagnosis was suspected after a barium meal in two patients and with a CT scan on the other two. The endoscopical extraction or fragmentation of stones was attempted in three patients but was successful only in one. Three patients were operated and a stone impacted in the first portion of the duodenum was identified, along with a cholecystoduodenal fistula. A duodenostomy and stone extraction was performed. One patient was subjected to a cholecystectomy fistula repair and gastrojejunoanastomosis. No patient died and all were discharged within 8 to 12 days after surgery. Conclusions: Bouveret syndrome is an uncommon complication of cholelithiasis. Endoscopy can be diagnostic and therapeutic. Surgery is the other therapeutic option.

Nematofauna de tres especies de lagartijas (Sauria: Tropiduridae yGekkonidae) de la Reserva Nacional de Paracas, Ica, Perú / Nematofauna of three species of lizards (Sauria: Tropiduridae and Gekkonidae) from National Reserve Paracas, Ica, Peru

Los nemátodos Thubunaea iguanae y Spauligodon viracochai son reportados para tres especies de lagartijas en la Reserva Nacional de Paracas, Ica, Perú. El primer nematodo fue registrado para Microlophus peruvianus y Microlophus thoracicus thoracicus, mientras que el segundo fue registrado para Phyllodactylus angustidigitus. Estos reportes representan dos nuevos hospederosy una nueva localidad para T. iguanae, nematodo reportado por primera vez para Sudamérica, además del registro de un nuevo hospedero para S. viracochai.

The nematode Thubunaea iguanae and Spauligodon viracochai are reported for three species of lizards from Paracas National Reserve, Ica, Peru. The fi rst nematode was found on Microlophusperuvianus and Microlophus thoracicus thoracicus while the second one was found on Phyllodactylus angustidigitus. Reports are two new host records and a new locality record for T. iguanae,and a fi rst record for South America, and a new host for S. viracochai.