Surgical management of gallstone ileus after one anastomosis gastric bypass: A case report.

BACKGROUND: Gallstone ileus following one anastomosis gastric bypass (OAGB) is an exceptionally rare complication. The presented case report aims to highlight the unique occurrence of this condition and its surgical management. Understanding the clinical presentation, diagnostic challenges and successful surgical intervention in such cases is crucial for healthcare professionals involved in bariatric surgery. CASE SUMMARY: We present a case report of gallstone ileus following OAGB and discuss its diagnosis and surgical management. A 66-year-old female with a history of OAGB presented to the emergency room with symptoms of small bowel obstruction. Computed tomography scan revealed a gallstone impacted in the distal ileum, causing obstruction. The patient underwent a laparoscopically assisted enterolithotomy, during which the gallstone was extracted and the enterotomy was closed. The patient had an uneventful recovery and was discharged on postoperative day four. CONCLUSION: Gallstone ileus should be considered as a possible complication after OAGB, and prompt surgical intervention is usually required for its management. This case report contributes to the limited existing literature, providing insights into the management of this uncommon complication.

Oclusión intestinal en paciente renal crónico secundario a bezoar de telas Reporte de un caso clínico / Intestinal Occlusion in a Chronic Renal Patient Secondary to Textile Bezoar. Clinical Case Report

Resumen Los "bezoar" son conglomerados de materiales no comestibles ingeridos voluntaria o involuntariamente, no digeridos e incapaces de transitar por el tracto intestinal. Principalmente afectan a jóvenes mujeres o adolescentes que presentan el fenómeno llamado "pica", y a pesar de que se ha registrado una alta prevalencia de este fenómeno en pacientes con enfermedad renal crónica (ERC), ha sido poco estudiado. Caso clínico: Paciente del sexo masculino de 35 años de edad que cursa con ERC KDIGO-5 en tratamiento con diálisis peritoneal; se obtiene el hallazgo de "bezoar plástico" transoperatorio (laparotomia por oclusión intestinal) a 10 cm de la válvula ileocecal. El paciente fallece por complicaciones de la patología de origen. Se plantea la necesidad de realizar la búsqueda de comportamientos en pacientes con ERC, que indiquen al cirujano la sospecha, dado que los pacientes generalmente ocultan u omiten referir sobre la ingesta de material extraño.

Abstract The "bezoar" are conglomerates of inedible materials ingested voluntarily or involuntarily, which are not digested and are unable to pass through the intestinal tract. They mainly affect young women or adolescents who present the phenomenon called "pica", despite the fact that a high prevalence of this phenomenon of "pica" has been registered in patients with chronic kidney disease, it has been little studied. Clinical case: A 35-year-old male with CKD KDIGO-5 undergoing peritoneal dialysis treatment, which was found to have a transoperative "plastic bezoar" (laparotomy for intestinal occlusion) 10 cm from the ileocecal valve. The patient died due to complications of his pathology. Discussion: the clinical case raises the need to search for behaviors such as pica in patients with CKD, as well as to develop the suspicion to the surgeon, since patients generally hide or ignore reporting foreign material phagia.

Report and follow-up on two new patients with congenital mesoblastic nephroma.

BACKGROUND: Tumors are rare in neonatal age. Congenital mesoblastic nephroma (CMN) is a usually benign renal tumor observed at birth, or in the first months of life. It may also be identified prenatally and associated with polyhydramnios leading to preterm delivery. Effective treatment is surgical in most cases, consisting in total nephrectomy. In literature, very few studies report on the neonatal management of such a rare disease, and even less are those describing its uncommon complications. CASES PRESENTATION: We report on two single-center newborns affected with CMN. The first patient is a preterm female baby, born at 30+ 1 weeks of gestation (WG) due to premature labor, with prenatal (25 WG) identification of an intra-abdominal fetal mass associated with polyhydramnios. Once obtained the clinical stability, weight gain, instrumental (computed tomography, CT, showing a 4.8 × 3.3 cm left renal neoformation) and histological/molecular characterization of the lesion (renal needle biopsy picture of classic CMN with ETV6-NTRK3 translocation), a left nephrectomy was performed at 5 weeks of chronological age. The following clinical course was complicated by intestinal obstruction due to bowel adherences formation, then by an enterocutaneous fistula, requiring multiple surgical approaches including transitory ileo- and colostomy, before the conclusive anastomoses intervention. The second patient is a 17-day-old male term baby, coming to our observation due to postnatal evidence of palpable left abdominal mass (soon defined through CT, showing a 7.5 × 6.5 cm neoformation in the left renal lodge), feeding difficulties and poor weight gain. An intravenous diuretic treatment was needed due to the developed hypertension and hypercalcemia, which regressed after the nephrectomy (histological diagnosis of cellular CMN with ETV6-NTRK3 fusion) performed at day 26. In neither case was chemotherapy added. Both patients have been included in multidisciplinary follow-up, they presently show regular growth and neuromotor development, normal renal function and no local/systemic recurrences or other gastrointestinal/urinary disorders. CONCLUSIONS: The finding of a fetal abdominal mass should prompt suspicion of CMN, especially if it is associated with polyhydramnios; it should also alert obstetricians and neonatologists to the risk of preterm delivery. Although being a usually benign condition, CMN may be associated with neonatal systemic-metabolic or postoperative complications. High-level surgical expertise, careful neonatological intensive care and histopathological/cytogenetic-molecular definition are the cornerstones for the optimal management of patients. This should also include an individualized follow-up, oriented to the early detection of any possible recurrences or associated anomalies and to a better quality of life of children and their families.

Primary Ventral Hernia Repair and the Risk of Postoperative Small Bowel Obstruction: Intra Versus Extraperitoneal Mesh.

OBJECTIVE: The aim of this study was to compare the likelihood of bowel obstruction according to the placement of the mesh (either intraperitoneal or extraperitoneal) in ventral hernia repairs. MATERIALS AND METHODS: Patients were divided into two groups, an intraperitoneal (IP) group (mesh placed by laparoscopy or with an open approach) and an extraperitoneal (EP) group, all operated on in the Digestive Surgery Department at the Dijon University Hospital. The primary outcome was the occurrence of an episode of bowel obstruction requiring hospitalization and confirmed by abdominal CT scan. RESULTS: Between March 2008 and July 2021, 318 patients were included, with 99 patients in the EP group (71 meshes placed preperitoneally and 28 placed retromuscularly) and 219 patients in the IP group (175 patients operated on laparoscopically versus 44 patients by direct approach). Three patients presented an episode of acute intestinal obstruction, with no difference between the two groups (p = 0.245), although all bowel obstructions occurred in the IP group and with the laparoscopic approach (1.7% of patients operated on by laparoscopy). The occlusive events occurred at 1 month, 2 years, and 3 years. There was no difference in terms of recurrence or postoperative chronic pain. There were more seroma and mesh infections in the EP group (p < 0.05). Two patients operated on by laparoscopy had undetected bowel injuries, prompting emergent surgery for peritonitis. CONCLUSIONS: No statistically significant difference was found in terms of bowel obstruction between the intraperitoneal and the extraperitoneal position, but all cases of obstruction happened in the intraperitoneal mesh group. Visceral lesions remain a major complication of the laparoscopic approach that should not be neglected.

An Occlusive Form of Acute Gangrenous Appendicitis With Periappendicular Abscess in an Elderly Patient: A Case Report and Literature Review.

Acute appendicitis represents one of the common causes of admission to the emergency department. In rare cases, patients with appendicitis can suffer complications such as intestinal obstruction. These particular cases of occlusive appendicitis with a periappendicular abscess usually occur in elderly patients and can develop in an aggressive form, nonetheless with a favorable evolution. We present a case of an 80-year-old male patient, reporting symptoms similar to an occlusive digestive pathology: abdominal pain, intestinal transit disorders, and fecal vomiting. A computerized tomography scan suggested a mechanical bowel obstruction. The patient had an exploratory laparotomy indication to find the cause of the obstruction. The peritoneal cavity inspection revealed an occlusive form of acute gangrenous appendicitis with a periappendicular abscess. An appendectomy was performed. In conclusion, as surgeons, we must always take into consideration that acute appendicitis can represent a cause of intestinal obstruction, especially in elderly patients.

Gallstone ileus, a rare cause of intestinal occlusion. A case report.

Recurrent gallstone ileus has a recurrence of 2-8.2% with a mortality of 12-20%, secondary to an enteric or cholecystic gallstone. A male patient with a diagnosis of intestinal occlusion secondary to biliary ileus and cholecystoduodenal fistula, performing enterotomy and closure in two planes with drainage placement. Two months after presenting the clinical of intestinal occlusion, medical management began and an abdominal tomography was performed, finding an image suggestive of recurrent gallstone ileus, treated with laparotomy.

El íleo biliar recurrente tiene una frecuencia del 2-8.2% y una mortalidad del 12-20%, que se presenta de forma secundaria a un cálculo biliar entérico o colecístico. Varón que cursa con diagnóstico de oclusión intestinal secundaria a íleo biliar y fístula colecistoduodenal. Se realiza enterotomía y cierre en dos planos con colocación de drenaje. Dos meses después, el paciente presenta un cuadro clínico de oclusión intestinal, por lo que se inicia manejo médico y se realiza la correspondiente tomografía computarizada abdominal, encontrando una imagen sugestiva de íleo biliar recurrente, con manejo por laparotomía.

Primary Squamous Cell Carcinoma of the Sigmoid Revealed by Acute Intestinal Occlusion in Moroccan Young Male Patient: A Case Report and Literature Review.

Primary colorectal squamous cell carcinoma (SCC) is an extremely rare subtype of colon cancer, with an incidence of less than 1% of colorectal malignancies. We report a case of a 40-year-old male patient admitted to the emergency department with symptoms of acute intestinal obstruction. Histopathological evaluation of colonoscopic biopsies revealed squamous cell carcinoma. A sigmoidectomy was performed. In order to enrich the medical literature, we add our case to the collection of colorectal squamous cell carcinoma cases by analyzing and summarizing the clinical, pathological, and therapeutic features of this rare entity.

Oclusión intestinal mecánica secundaria a hernia de Littré / Mechanical Intestinal Occlusion Secondary to Littré's Hernia

Introducción: La hernia de Littré se define como la presencia de un divertículo de Meckel en cualquier orificio herniario. Se han reportados muy pocos casos en la literatura por su frecuencia tan baja referida al 2 por ciento de la población general. Objetivo: Reportar y compartir el tratamiento exitoso de un caso clínico poco frecuente de oclusión intestinal mecánica por hernia de Littré. Caso clínico: Se trata de un paciente masculino, de 69 años de edad, raza blanca y con antecedentes de hipertensión arterial hace siete años, para lo que lleva tratamiento regular con captopril. Acudió al Servicio de Urgencias de Cirugía general del Hospital Clínico Quirúrgico Docente "Lucía Íñiguez Landín" por presentar dolor abdominal tipo cólico localizado difusamente, de moderada intensidad, sin irradiación precisa y acompañado de dos vómitos biliosos de poca cantidad, además de parada de la emisión de gases y heces fecales dos días antes, por lo que se ingresó para tratamiento quirúrgico urgente con diagnóstico de oclusión intestinal mecánica. Conclusiones: El diagnóstico preoperatorio de la hernia de Littré es poco probable, sobre todo si se acompaña de oclusión intestinal por lo que casi siempre es transoperatorio. El tratamiento quirúrgico del divertículo depende del estado inflamatorio y vascular(AU)

Introduction: Littré's hernia is defined as the presence of a Meckel's diverticulum in any hernial orifice. Very few cases have been reported in the literature because of its very low frequency, referred to as of 2 percent of the general population. Objective: To report and share the successful management of a rare clinical case of mechanical intestinal occlusion due to Littré's hernia. Clinical case: This is the case of a 69-year-old white male patient with a history of arterial hypertension for seven years, for which he has been receiving regular treatment with captopril. He went to the general surgery emergency department of Lucía Íñiguez Landín Clinical Surgical Teaching Hospital for presenting diffusely localized colicky abdominal pain, of moderate intensity, without precise irradiation and accompanied by two small amounts of bilious vomiting, in addition to stopping gas and stool emission two days earlier, for which he was admitted for urgent surgical treatment with a diagnosis of mechanical intestinal occlusion. Conclusions: The preoperative diagnosis of Littré's hernia is unlikely, especially if accompanied by intestinal occlusion, a reason why it is almost always transoperative. The surgical treatment of the diverticulum depends on the inflammatory and vascular status(AU)

Case Report: A rare case of small bowel obstruction secondary to plasma cell myeloma.

Gastrointestinal (GI) involvement of plasma cell neoplasms is extremely rare. Herein, we describe the case of a 74-year-old Caucasian woman who came to our attention with abdominal pain, food vomiting, and weight loss of 10 kg over 1 year. A computed tomography scan of the abdomen revealed circumferential thickening of terminal ileum, for which the patient underwent an urgent 20-cm-long ileal resection. Histopathological and immunophenotypic analysis revealed a plasma cell neoplasm of the ileum. Subsequent investigations found a serum monoclonal immunoglobulin A component, an osteolytic lesion of the left jaw, and a clonal bone marrow plasma cell infiltrate carrying 1q21 amplification. Given the final diagnosis of plasma cell myeloma (PCM), the patient underwent a VMD (bortezomib, melphalan, and dexamethasone) chemotherapy regimen, achieving a complete remission after a 12-month treatment. For disease relapse, two further chemotherapy regimens were later attempted. At the last follow-up 4 years after the diagnosis, the patient is still alive. This case draws attention to the extramedullary presentation of plasma cell neoplasms, even if rare, as a prompt diagnosis seems to result in a better prognosis. In addition, it highlights the relevance of a multidisciplinary approach, involving gastroenterologists, hematologists, and pathologists, to the diagnosis and management of these neoplasms.

Anestesia total intravenosa en pacientes con síndrome oclusivo intestinal / Total Intravenous anesthesia in patients with intestinal occlusive syndrome

Introducción: La anestesia total intravenosa es una técnica de anestesia general en la que se administran los fármacos exclusivamente por vía endovenosa, en ausencia de agentes inhalatorios. Objetivo: Describir los resultados que se observaron en el empleo de la anestesia total intravenosa en los pacientes con diagnóstico de síndrome oclusivo para tratamiento quirúrgico. Métodos: Se desarrolló una investigación observacional descriptiva, longitudinal en el Hospital General Docente "Abel Santamaría Cuadrado", de enero de 2014 a enero de 2017. De un universo de 417 pacientes, se seleccionó una muestra de 205 casos que cumplieron con los criterios de inclusión y exclusión. Las variables fueron presión arterial media, frecuencia cardíaca, saturación de oxígeno, complicaciones, tiempo de recuperación, nivel de sedación y respuesta analgésica. Resultados: El 95,61 por ciento de los casos se mantuvieron normotensos y el 96,10 por ciento con frecuencia cardíaca normal. Se constataron signos clínicos de superficialidad anestésica en el 1,46 por ciento de los individuos. La mayoría de los casos se recuperaron entre 10 y 20 min para un 92,19 por ciento. Se observó un nivel de sedación insuficiente en 189 pacientes (92,19 por ciento). No se evidenciaron complicaciones posoperatorias en el 96,58 por ciento. La respuesta analgésica fue adecuada en el 95,12 por ciento de los casos. Conclusiones: La aplicación de la anestesia total intravenosa para cirugía por oclusión intestinal demostró resultados satisfactorios como método anestésico(AU)

Introduction: Total intravenous anesthesia is a general anesthesia technique in which drugs are administered exclusively intravenously, in the absence of inhalation agents. Objective: To describe the outcomes observed in the use of total intravenous anesthesia in patients diagnosed with occlusive syndrome for surgical treatment. Methods: A descriptive, longitudinal and observational research was carried out in Abel Santamaría Cuadrado General Teaching Hospital of Pinar del Río, Cuba, from January 2014 to January 2017. From a universe of 417 patients, a sample of 205 cases that met the inclusion and exclusion criteria was selected. The variables were mean arterial pressure, heart rate, oxygen saturation, complications, recovery time, level of sedation, and analgesic response. Results: 95.61 percent of the cases remained normotensive and 96.10 percent kept a normal heart rate. Clinical signs of sedation were found in 1.46 percent of the individuals. Most of the cases recovered between 10 and 20 minutes, accounting for 92.19 percent. Insufficient sedation was observed in 189 patients (92.19 percent). No postoperative complications were observed in 96.58 %. Analgesic response was adequate in 95.12 percent of cases. Conclusions: The application of total intravenous anesthesia for intestinal occlusion surgery showed satisfactory outcomes as an anesthetic method(AU)

Cáncer colorrectal y anal en Sancti Spíritus en un quinquenio / Colorectal and Anal Cancer in Sancti Spíritus in a Five-Year Period

Introducción: El cáncer colorrectal y anal es una enfermedad de elevada incidencia y la oclusión intestinal es su complicación más frecuente. Objetivo: Describir la incidencia y la mortalidad de los pacientes con cáncer colorrectal y anal y oclusión intestinal mecánica por esa causa. Métodos: Se realizó un estudio descriptivo de serie de casos que incluyó a los pacientes con diagnóstico de oclusión intestinal por cáncer colorrectal en Sancti Spíritus, Cuba, desde el 1ro de enero de 2014 hasta el 31 de diciembre de 2018. Se estudiaron pacientes vivos y fallecidos. Resultados: La incidencia de cáncer colorrectal y anal tuvo la mayor tasa en el 2016 con 28,73 por 100 000 habitantes. El mayor número de pacientes ocluidos fue en 2017 con 52. Conclusiones: La incidencia de cáncer colorrectal y anal y de oclusión por esa causa se encuentra por encima de los reportes cubanos, similar a los que ocurre en países de la región. La mortalidad por oclusión está por encima de investigaciones internacionales(AU)

Introduction: Colorectal and anal cancer is a disease with high incidence and intestinal obstruction is its most frequent complication. Objective: To describe the incidence and mortality of patients with colorectal and anal cancer and mechanical intestinal occlusion due to this cause. Methods: A descriptive case series revision was carried out including patients diagnosed with intestinal occlusion due to colorectal cancer in Sancti Spíritus, Cuba, from January 1, 2014 to December 31, 2018. Living patients and deceased were studied. Results: The incidence of colorectal and anal cancer had the highest rate in 2016, that is, 28.73 per 100,000 inhabitants. The highest number of occluded patients was in 2017 with 52. Conclusions: The incidence of colorectal and anal cancer and occlusion because of this reason is above Cuban reports, similar to what occurs in countries in the region. Mortality due to occlusion is above international investigations(AU)

Cirugía de urgencia en pacientes con cáncer de colon complicado en Hospital Universitario "General Calixto García" / Emergency Surgery in Patients with Complicated Colon Cancer at General Calixto García University Hospital

Introducción: El cáncer de colon mantiene un importante impacto social y una alta morbilidad a pesar de programas de detección precoz existentes. Ocupa el cuarto lugar entre los tumores malignos y un número importante de pacientes son operados de urgencia por las complicaciones de esta enfermedad, muchas veces desconocida hasta el momento de la cirugía. Objetivo: Caracterizar la cirugía de urgencia realizada a los pacientes con diagnóstico de cáncer de colon complicado. Método: Se realizó un estudio observacional, descriptivo, de corte transversal entre enero de 2014 y diciembre de 2016, en el Servicio de Cirugía General. La muestra fue de 96 pacientes portadores de esta entidad en el Hospital Universitario "General Calixto García". Resultados: Se analizó la incidencia según sexo, relación sexo/localización, relación localización/complicación, estadificación y mortalidad. Prevalecieron los tumores de colon en el sexo femenino y por ende fueron más frecuente las pacientes con complicaciones quirúrgicas por esta entidad en nuestro centro. Predominó la localización derecha globalmente, con predominio femenino. La oclusión intestinal fue la complicación más frecuente. Sobresalió el estadio II según TNM con un 37,5 por ciento y una mortalidad postoperatoria del 31 por ciento. Conclusiones: Nuestros datos coinciden con la tendencia nacional sobre la mayor incidencia del cáncer de colon en pacientes femeninas, son estas las que mayor tasa de morbilidad y mortalidad reportan. Seguir perfeccionando el programa de prevención y detección temprana de la entidad y su tratamiento oportuno causará la reducción de los índices que hoy se exhiben(AU)

Introduction: Colon cancer still has an important social impact and high morbidity despite existing early detection programs. It ranks fourth among malignant tumors, while a significant number of patients undergo emergency surgery for complications of this disease, many times unknown until the time of surgery. Objective: To characterize the emergency surgery performed to patients with a diagnosis of complicated colon cancer. Method: An observational, descriptive, cross-sectional study was carried out, between January 2014 and December 2016, in the general surgery service. The sample consisted of 96 patients with this entity and from General Calixto García University Hospital. Results: The incidence was analyzed according to sex, sex/location relationship, location/complication relationship, staging and mortality. Colon tumors prevailed in the female sex and, therefore, patients with surgical complications from this entity were more frequent in our center. There right location predominated globally, with a predominance in the female sex. Intestinal obstruction was the most frequent complication. Stage two, according to the TNM classification, stood out, accounting for 37.5 percent, together with a postoperative mortality of 31 percent. Conclusions: Our data coincide with the national trend on the highest incidence of colon cancer in female patients, who account for the highest morbidity and mortality rates. Continuing to improve the entity's prevention and early detection program, as well as its timely treatment, will bring about a reduction in the rates nowadays reported(AU)

Idiopathic giant pancreatic pseudocyst presenting in emergency with abdominal compartment syndrome and intestinal occlusion: Case report and review of the literature.

INTRODUCTION AND IMPORTANCE: This is the first case of idiopathic giant pancreatic pseudocyst (IGPP) causing intestinal occlusion, intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) reported in the literature. Diagnosis of IGPP in emergency is a challenge because of its rarity and the absence of a history of pancreatitis or pancreatic trauma and specific clinical presentation. Abdominal contrast-enhanced computed tomography (CECT) represents the gold standard in diagnosing of pancreatic cyst (PP). Different types of treatment of PP are reported in the literature. CASE PRESENTATION: A 52-year-old Caucasian female was admitted to the Emergency Department with a three-day history of abdominal pain, inability to pass gas or stool, nausea and vomiting, oliguria and a seven-day history of abdominal swelling and swollen legs. Physical examination revealed abdominal distention, abdominal pain, swelling in the legs. CECT showed a voluminous cystic pancreatic mass suspected of neoplasm. Laboratory tests reported high serum levels of BUN, creatinine and C-reactive protein and neutrophilic leukocytosis. After preoperative diagnosis of ACS, the patient was taken to the operating room for pancreatic resection. The postoperative course was uneventful. Diagnosis of IGPP was made by histopathological examination. CLINICAL DISCUSSION: IGPP is difficult to diagnose in emergency. Although different types of drainage of IGPP are described in the literature, pancreatic resection represents the treatment of choice when a cystic pancreatic neoplasm cannot be excluded. CONCLUSION: IGPP is a rare disease that may cause intestinal occlusion, IAH and ACS. Pancreatic resection if necessary is safe and therapeutic with acceptable morbidity and mortality.

Caracterización de los pacientes operados de oclusión intestinal mecánica por cáncer colorrectal y anal / Characterization of patientes operated in mechanical bowel occlusion by colorrectal and anal cancer

RESUMEN Fundamento: El cáncer colorrectal y anal es una enfermedad de alta incidencia, y la oclusión intestinal su complicación más frecuente. Objetivo: Caracterizar los pacientes operados de oclusión intestinal mecánica por cáncer colorrectal y anal. Metodología: Se realizó un estudio observacional descriptivo que incluyó todos los pacientes con oclusión intestinal mecánica por cáncer colorrectal y anal operados en el Hospital General Provincial Camilo Cienfuegos de Sancti Spíritus, en el período del 1.ro de enero de 2016 al 31 de diciembre de 2018. Se registraron 126 pacientes con este diagnóstico. Se incluyeron las variables demográficas, el estado físico, se determinaron el hematocrito, la glucemia, la creatinina, la gasometría arterial, los hallazgos imagenológicos y la estadía hospitalaria. Se evaluaron además la localización del tumor causante de la oclusión, las técnicas quirúrgicas, las complicaciones, las reintervenciones y sus causas. Para el análisis de los resultados se utilizó la estadística descriptiva e inferencial. Resultados: La media de la edad fue de 71 años, predominaron los pacientes del sexo femenino (51.6 %) y con tumores de colon izquierdo 62 pacientes. Se complicó el 45.2 % de la serie, se reintervino el 19 % y la causa de mayor incidencia fue la peritonitis. Falleció el 27 % de los enfermos. Conclusiones: Las características de la población no difieren de los resultados expuestos por otros autores. La mortalidad, en correspondencia con las complicaciones presentadas, se observó por encima de lo reportado en investigaciones internacionales.

ABSTRACT Background: Colorectal and anal cancer is a high incidence disease, and bowel occlusion its most frequent complication. Objective: To describe the patients operated on mechanical bowel occlusion due to colorectal and anal cancer. Methodology: A descriptive observational study was conducted in all patients with mechanical bowel occlusion due to colorectal and anal cancer operated at the Sancti Spíritus General Provincial Hospital Camilo Cienfuegos from January 1st, 2016 to December 31st, 2018. 126 patients were registered with this diagnosis. Demographic variables, like physical state, hematocrit, glycemia, creatinine, arterial blood gas, imaging findings, and hospital stay were included. The tumor location as causing of the occlusion, surgical techniques, complications, reoperations and their causes were also evaluated. Descriptive and inferential statistics were used for the analysis of the results. Results: The mean age was 71 years, female sex predominated (51.6 %) and 62 patients with left colon tumors. 45.2 % of the series was complicated, 19 % had to be re-operated and the cause of the highest incidence was peritonitis. 27 % of the patients died. Conclusions: The population characteristics do not differ from the results reported by some other authors. According to the complications showed, mortality was over that reported in international investigations.

Oclusión intestinal mecánica por divertículo de Meckel en un adulto / Mechanical intestinal occlusion by Meckel's diverticulum in an adult

Introducción: La incidencia del divertículo de Meckel en la población general, es aproximadamente del 1 al 2 por ciento y las manifestaciones clínicas son vistas en solo el 20 por ciento de estas personas. El diagnóstico en el 80 por ciento restante es incidental y se hace por hallazgos quirúrgicos. La forma oclusiva de presentación es infrecuente y requiere un elevado índice de sospecha. Objetivos: Describir la presentación clínica y características quirúrgicas de la oclusión intestinal mecánica por divertículo de Meckel en el adulto. Caso clínico: Paciente masculino de 54 años de edad, que acudió por un cuadro doloroso abdominal y elementos clínicos de un síndrome oclusivo. Durante la intervención quirúrgica se constató un divertículo de Meckel de base ancha, como punto de fijación y vólvulo del intestino delgado. Se realizó resección y anastomosis término - terminal en un plano. La evolución postoperatoria fue satisfactoria. Conclusiones: La oclusión intestinal mecánica, secundaria al divertículo de Meckel, constituye una causa infrecuente de síndrome oclusivo que se debe tener presente en la práctica quirúrgica(AU)

Introduction: The incidence of Meckel's diverticulum in the general population is approximately 1 to 2 percent and clinical manifestations are seen in only 20 percent of these people. The diagnosis in the remaining 80 % is incidental and is made by surgical findings, reported in approximately 2 percent of autopsies. Objective: To describe the clinical presentation and surgical characteristics of mechanical intestinal occlusion by Meckel's diverticulum in the adults. Clinical case: 54-year-old male patient who was attended with a painful abdominal condition and clinical elements of an occlusive syndrome. During surgery, a broad-based Meckel's diverticulum was found as a point of attachment, and small intestine volvulus. A terminal resection and anastomosis was performed in one plane. Postoperative evolution was satisfactory. Conclusions: Mechanical intestinal occlusion secondary to Meckel's diverticulum is a rare cause of occlusive syndrome that must be taken into account in surgical practice(AU)

Caso infrecuente de oclusión intestinal por vólvulo de íleon / Infrequent case of intestinal occlusion due to ileum volvulus

Introducción: La oclusión intestinal mecánica es una enfermedad frecuente en los servicios quirúrgicos, sin embargo el vólvulo de intestino delgado es una de sus causas poco frecuentes. Objetivos: Describir las características clínicas de un caso de oclusión intestinal por vólvulo de íleon. Caso clínico: Paciente masculino de 63 años, con antecedentes de etilismo y pancreatitis crónica, para lo cual no llevaba tratamiento regular. Acudió al cuerpo de guardia por dolor abdominal de aproximadamente 24 horas de evolución. Presentó dos vómitos con restos alimentarios, sin fiebre u otros síntomas de interés. Semiotécnicamente el dolor era mantenido, difuso en todo el abdomen, intenso, punzante, no se aliviaba con analgésicos, sin otros síntomas acompañantes. Se realizaron estudios de laboratorio e imagenológicos, los resultados fueron sugerentes de un síndrome oclusivo y/o perforativo. Se decidió tratamiento quirúrgico, se diagnosticó una oclusión intestinal por vólvulo de íleon. Conclusiones: El diagnóstico del vólvulo de intestino delgado, requiere un alto índice de sospecha, debido a lo infrecuente en el adulto. Los hallazgos de imagen son de utilidad en el diagnóstico temprano. El tratamiento es eminentemente quirúrgico; se impone la resección intestinal del segmento afectado siempre que el tejido intestinal no sea viable(AU)

Introduction: Mechanical intestinal occlusion is a common disease in surgical services, however small bowel volvulus is one of its rare causes. Objectives: To describe the clinical characteristics of a case of intestinal occlusion due to ileum volvulus. Clinical case: A 63-year-old male patient, with a history of ethylism and chronic pancreatitis, for which he did not have regular treatment. He went to emergency due to abdominal pain of approximately 24 hours of evolution. He presented two vomits with food debris, without fever or other symptoms of interest. Semiotechnically the pain was maintained, diffuse throughout the abdomen, intense, stabbing, it was not relieved with analgesics. No other accompanying symptoms. Laboratory and imaging studies were performed, the results were suggestive of an occlusive and/or perforative syndrome. Surgical treatment was decided, an intestinal occlusion was diagnosed by ileum volvulus. Conclusions: The diagnosis of the small intestine volvulus requires a high index of suspicion, due to the infrequent occurrence in the adult. Image findings are useful in early diagnosis. The treatment is eminently surgical; Intestinal resection of the affected segment is imposed as long as the intestinal tissue is not viable(AU)

[Ileal endometriosis. An uncommon cause of bowel obstruction in women in fertile age]. / Endometriosis ileal. Causa infrecuente de obstrucción intestinal en mujeres en edad fértil.

Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It affects ~5-10% of women in their reproductive years. When it affects the intestine, it tends to be confused clinically with a wide variety of affections, which is why it has sometimes been called "the great simulator". A review of the literature shows that intestinal localization is rare and that obstruction secondary to this cause is even more unusual, with preoperative diagnosis being a challenge for surgeons. With the purpose of highlighting clinical and diagnostic imaging characteristics that help the preoperative suspicion of this entity, so rare in routine practice, we present two cases of women who underwent emergency surgery, without a previous diagnosis of endometriosis and with intestinal occlusion as the first manifestation of the disease. Treatment of intestinal occlusion by endometriosis consists of intestinal resection of the affected sector and primary anastomosis. Diagnosis of intestinal occlusion secondary to ileal endometriosis is based on a high index of suspicion and should be considered in women of childbearing age, without a history of disease and with a history of painful menstruation.

La endometriosis se define como la presencia de tejido endometrial fuera de la cavidad uterina. Ocurre en aproximadamente 5 a 10% de las mujeres en edad fértil. Cuando afecta al intestino tiende a confundirse clínicamente con una gran variedad de afecciones por lo cual en algunas oportunidades se le ha llamado también "la gran simuladora". La revisión de la literatura muestra que la localización intestinal es poco frecuente y que la obstrucción secundaria a esta causa es aún más inusual, siendo el diagnóstico preoperatorio un desafío para los cirujanos. Con el propósito de resaltar características clínicas y de estudio por imágenes que ayuden a la sospecha preoperatoria de esta entidad tan infrecuente en la práctica habitual, se presentan dos casos de mujeres operadas de urgencia, sin diagnóstico previo de endometriosis y con oclusión intestinal como primera manifestación de la enfermedad. El tratamiento consiste en la resección intestinal del sector afectado y anastomosis primaria. El diagnóstico se basa en un alto índice de sospecha y debería ser considerado en mujeres en edad fértil, sin antecedentes patológicos y con historia de menstruaciones dolorosas.

Íleo biliar, una causa poco frecuente de oclusión intestinal / Gallstone Ileus, A Rare Cause of Intestinal Occlusion

RESUMEN Introducción: El íleo biliar representa el 4 por ciento de las causas de obstrucción intestinal en la población general. Objetivo: Mostrar un paciente con cuadro de oclusión intestinal por íleo biliar que fue diagnosticado y tratado en el transoperatorio. Caso clínico: Paciente de 78 años de edad con un cuadro oclusivo por un íleo biliar, al cual se le realizó enterolitotomía como tratamiento definitivo. Conclusiones: El íleo biliar es una causa de oclusión intestinal que todo cirujano general debe tener presente ante un anciano con elementos clínicos e imaginológicos de oclusión y sin intervenciones quirúrgicas previas o hernias de la pared abdominal(AU)

ABSTRACT Introduction: Gallstone ileus represents 4 percent of the causes of intestinal obstruction in the general population. Objective: To present a patient with intestinal obstruction due to gallstone ileus and who was diagnosed and treated during the intraoperative period. Clinical case: The is presented of a 78-year-old patient with an occlusive condition due to gallstone ileus, who underwent enterolithotomy as definitive management procedure. Conclusions: Gallstone ileus is a cause of intestinal occlusion that every general surgeon should be aware of in the presence of an elderly with clinical and imaging elements of occlusion and without previous surgical interventions or hernias of the abdominal wall(AU)

Endometriosis ileal. Causa infrecuente de obstrucción intestinal en mujeres en edad fértil / Ileal endometriosis. An uncommon cause of bowel obstruction in women in fertile age

Resumen La endometriosis se define como la presencia de tejido endometrial fuera de la cavidad uterina. Ocurre en aproximadamente 5 a 10% de las mujeres en edad fértil. Cuando afecta al intestino tiende a confundirse clínicamente con una gran variedad de afecciones por lo cual en algunas oportunidades se le ha llamado también "la gran simuladora". La revisión de la literatura muestra que la localización intestinal es poco frecuente y que la obstrucción secundaria a esta causa es aún más inusual, siendo el diagnóstico preoperatorio un desafío para los cirujanos. Con el propósito de resaltar características clínicas y de estudio por imágenes que ayuden a la sospecha preoperatoria de esta entidad tan infrecuente en la práctica habitual, se presentan dos casos de mujeres operadas de urgencia, sin diagnóstico previo de endometriosis y con oclusión intestinal como primera manifestación de la enfermedad. El tratamiento consiste en la resección intestinal del sector afectado y anastomosis primaria. El diagnóstico se basa en un alto índice de sospecha y debería ser considerado en mujeres en edad fértil, sin antecedentes patológicos y con historia de menstruaciones dolorosas.

Abstract Endometriosis is defined as the presence of endometrial tissue outside the uterine cavity. It affects ~5-10% of women in their reproductive years. When it affects the intestine, it tends to be confused clinically with a wide variety of affections, which is why it has sometimes been called "the great simulator". A review of the literature shows that intestinal localization is rare and that obstruction secondary to this cause is even more unusual, with preoperative diagnosis being a challenge for surgeons. With the purpose of highlighting clinical and diagnostic imaging characteristics that help the preoperative suspicion of this entity, so rare in routine practice, we present two cases of women who underwent emergency surgery, without a previous diagnosis of endometriosis and with intestinal occlusion as the first manifestation of the disease. Treatment of intestinal occlusion by endometriosis consists of intestinal resection of the affected sector and primary anastomosis. Diagnosis of intestinal occlusion secondary to ileal endometriosis is based on a high index of suspicion and should be considered in women of childbearing age, without a history of disease and with a history of painful menstruation.