Procalcitonin and C-reactive protein as early markers of postoperative intra-abdominal infection in patients operated on colorectal cancer.

PURPOSE: The aim of this study was to evaluate the accuracy of serum procalcitonin (PCT) and C-reactive protein (CRP) for early diagnosis of postoperative intra-abdominal infections (PIAI) after elective surgery for colorectal cancer. METHODS: Prospective observational study including patients operated on for colorectal cancer between January and December of 2015 was performed. Serum PCT and CRP levels were measured before surgery and daily until postoperative day 3. RESULTS: One hundred twenty patients were included. Seven patients (5.8%) had PIAI. PCT levels were significantly higher in patients with PIAI on postoperative days 1 and 3, whereas CRP levels only were significantly more elevated on postoperative day 3. The ratio between CRP levels on postoperative day 3 and CRP levels on postoperative days 2 (CRP D3/CRP D2) and 1 (CRP D3/CRP D1) was significantly higher in patients with PIAI. PCT on postoperative day 3, for a cutoff of 0.45 ng/mL, had the best sensitivity (100%) with a specificity of 73.8%. The ratio CRP D3/CRP D1 yielded the higher specificity and positive predictive value (90.9 and 27.3%, respectively, for a cutoff of 1.8). The higher negative predictive value was obtained for PCT on postoperative days 1 and 3 (100%, with cutoff of 0.76 and 0.45 ng/mL, respectively) and for CRP on postoperative day 3 (100% with cutoff of 10 mg/dL). CONCLUSION: PCT and CRP serum levels are associated with the appearance of PIAI after colorectal cancer surgery, although the positive predictive values were low for both PCT and CRP. However, the negative predictive values were high.

Vólvulo gástrico en paciente con antecedentes de cirugía cardíaca / Gastric volvulus in a patient with a history of cardiac surgery

El vólvulo gástrico se define como la rotación del estómago alrededor de uno de sus ejes, clasificándose en órgano-axial o mesentérico-axial según el eje de rotación. Se considera una enfermedad poco frecuente, con una prevalencia no establecida claramente hasta la fecha. Puede presentarse de forma aguda, donde supone una urgencia médica debido al riesgo de complicaciones derivadas del sufrimiento vascular de la víscera, como isquemia, necrosis y perforación. Clínicamente, el vólvulo agudo se caracteriza por la presencia de la tríada de Borchardt consistente en vómitos, dolor torácico o epigastralgia, con imposibilidad para colocar una sonda nasogástrica, sin embargo el vólvulo crónico presenta una sintomatología poco específica, pudiendo ocasionar síntomas durante años si no es tratado. Presentamos un nuevo caso de vólvulo gástrico en paciente de mediana edad con antecedentes de cirugía cardíaca en la infancia, que tras sufrir varios episodios de dolor torácico es diagnosticada de vólvulo gástrico mesentérico-axial (AU)

Gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes, with organoaxial and mesenteroaxial volvulus being distinguished according to the direction of rotation. It is an uncommon disease with a prevalence that is not clearly established. Gastric volvulus may present as an acute form, which is a medical emergency as it may lead to gastric strangulation with a high risk of ischaemia, necrosis and perforation. Clinically, it is characterised by the Borchardt Triad that consist of pain, vomiting and inability to pass a nasogastric tube. However, chronic volvulus presents with non-specific symptoms and these may persist for years if not treated. We present one new case of gastric volvulus in a middle-aged patient with a history of cardiac surgery in childhood (AU)