Features and outcomes of rectal cancer patients treated in a hospital in Bogotá, Colombia: a retrospective cohort study.

Rectal cancer is an increasing disease worldwide. The outcomes of its treatment are related to the preoperative characteristics of the patient. The objective of this study was to describe sociodemographic, clinical and surgical characteristics and outcomes of patients operated on for rectal cancer at Hospital Universitario Mayor Méderi (HUM) during the period within 2013-2017.A retrospective descriptive cohort-type study was carried out by consulting the clinical records of patients above the age of 18 years with a clinical/histopathological diagnosis of rectal cancer and an institutional follow-up in those who underwent surgery with laparoscopic anterior resection of the rectum carried out by the coloproctology service of the HUM between 2013 and 2017. For statistical analysis, the SPSS V22 program was used.Data from 133 patients were collected during the study period, most of them male, with more frequent involvement of the lower rectum. Complications occurred in 25% of the patients. Conversion rate to open surgery was 8.6%, in-hospital death was associated with cardiovascular comorbidity, corticosteroid uses and with the presence of complications. Sociodemographic characteristics of the patients were similar to the world population. The institution has a low prevalence of anastomotic dehiscence, global complications are comparable with international statistics.

Open versus percutaneous tracheostomy in patients with COVID-19: retrospective cohort analysis.

BACKGROUND: During the COVID-19 pandemic, a great number of patients required Mechanical Ventilation (MV). Tracheostomy is the preferred procedure when difficult weaning is presented. Surgical techniques available for performing tracheostomy are open and percutaneous, with contradictory reports on the right choice. This paper aims to describe the clinical results after performing a tracheostomy in patients with COVID-19, regarding both surgical techniques. METHODS: An observational, analytical study of a retrospective cohort was designed. All patients admitted to the Hospital Universitario Mayor Méderi, between March 2020 and April 2021 who presented COVID-19 requiring MV and who underwent tracheostomy were reviewed. Open versus percutaneous tracheostomy groups were compared and the primary outcome evaluated was in-hospital mortality. RESULTS: A total of 113 patients were included in the final analysis. The median age was 66.0 (IQR: 57.2 - 72.0) years old and 77 (68.14%) were male. Open tracheostomy was performed in 64.6% (n = 73) of the patients and percutaneous tracheostomy in 35.4% (n = 40) with an in-hospital mortality of 65.7% (n = 48) and 25% (n = 10), respectively (p < 0.001). In a multivariate analysis, open tracheostomy technique [OR 9.45 (95% CI 3.20-27.92)], older age [OR 1.05 (95% CI 1.01-1.09)] and APACHE II score [OR 1.10 (95% CI 1.02-1.19)] were identified as independent risk factors for in-hospital mortality. Late tracheostomy (after 14 days) [OR 0.31 (95% CI 0.09-1.02)] and tracheostomy day PaO2/FiO2 [OR 1.10 (95% CI 1.02-1.19)] were not associated to in-hospital mortality. CONCLUSIONS: Percutaneous tracheostomy was independently associated with lower in-hospital mortality and should be considered the first option to perform this type of surgery in patients with COVID-19 in extended MV or difficulty weaning.

Primary mesenteric neuroendocrine tumor: Case report.

INTRODUCTION AND IMPORTANCE: Neuroendocrine tumors most frequently originate from the gastrointestinal tract (GIT). Their presentation in tissues other than the GIT and pancreas is usually due to metastatic involvement from lesions at these sites. There have been a few cases of neuroendocrine tumors identified in tissues such as the mesentery and peritoneum, without identification of a primary lesion supporting their origin as metastasis. CASE PRESENTATION: We present the case of a patient with abdominal pain, in whom a primary mesenteric neuroendocrine tumor was identified. The patient completed one year of follow-up without identification of an additional lesion. Case Reported in line with the SCARE criteria. CLINICAL DISCUSSION: This is a rare condition with few reports in the literature, without significant changes in its classification or management. CONCLUSION: The search for a primary lesion and follow-up are essential to characterize the presence of primary mesenteric neuroendocrine tumors.

Leiomioma parasitario retroperitoneal: reporte de un caso / Retroperitoneal parasitic leiomioma: A case report

Resumen ANTECEDENTES: Los leiomiomas parasitarios son una variante poco común de la miomatosis uterina. Se han identificado en la pared abdominal, intestino delgado, muñón cervical o vaginal, vasos iliacos, ovarios, colon sigmoides y en el omento mayor. OBJETIVO: Reportar un caso clínico de leiomioma parasitario retroperitoneal y revisar la bibliografía al respecto. CASO CLÍNICO: Paciente de 57 años, con diagnóstico de NIC-III y hemorragia uterina anormal. Acudió a consulta debido a una sensación de masa y dolor abdominal, pérdida de peso subjetiva, hiporexia, disfagia y plenitud gástrica de cuatro meses de evolución. En los estudios de extensión se documentó una masa retroperitoneal grande y elevación de los marcadores tumorales Ca 125 y Ca 19-9. La resección de la masa se efectuó mediante laparotomía, con hallazgo histopatológico de mioma parasitario. CONCLUSIÓN: Los leiomiomas parasitarios deben considerarse en el diagnóstico diferencial de pacientes con antecedente de histerectomía o miomectomía, sobre todo en el contexto de la morcelación. El tratamiento consiste en cirugía o inhibidores de la aromatasa y análogos de la hormona liberadora de gonadotropina (leiomiomatosis peritoneal diseminada).

Abstract BACKGORUND: Parasitic leiomyomas are a rare entity, defined as an unusual variant of uterine myomatosis. Have been documented in the abdominal wall, small intestine, cervical or vaginal stump, iliac vessels, ovaries, sigmoid colon, and greater omentum. OBJECTIVE: To report a clinical case of retroperitoneal parasitic leiomyoma and review the literature. CLINICAL CASE: A 57-year-old patient with a diagnosis of CIN-III and secondary abnormal uterine bleeding, who consulted for a sensation of abdominal mass and pain, subjective weight loss, hyporexia, dysphagia and gastric fullness, of four months of evolution. Extension studies document a large retroperitoneal mass and elevation of tumor markers Ca 125 and Ca 19-9. We practice surgical management of her gynecological pathology and resection of the mass by laparotomy, with histopathological finding of myoma. CONCLUSION: Parasitic leiomyomas should be suspected in patients with a detected mass and a history of hysterectomy or myomectomy, especially in the context of morcellation. The treatment of this condition is surgical and, in cases of disseminated peritoneal leiomyomatosis, pharmacological treatments have been used with aromatase inhibitors and gonadotropin-release hormone analogues.

Gangliocytic paraganglioma in a 24-year-old male patient: an infrequent cause of gastrointestinal bleeding.

Los paragangliomas gangliocíticos son tumores neuroendocrinos infrecuentes del sistema gastrointestinal, generalmente de curso benigno y en la gran mayoría de los casos asintomáticos. Presentamos el caso de un paciente joven, previamente sano, quien consulta por dolor abdominal y hemorragia de vías digestivas altas. En la endoscopia de vías digestivas altas se evidencia una lesión pediculada en la segunda porción del duodeno. Se decide realizar laparotomía mediana y duodenectomía con resección del tumor duodenal pediculado. Los resultados del estudio histológico e inmunohistoquímico fueron compatibles con paraganglioma gangliocítico duodenal. Posterior al procedimiento presenta adecuada recuperación, sin evidencia de recidiva en el seguimiento.Gangliocytic paragangliomas are infrequent neuroendocrine tumors, usually of benign course and in the vast majority without any symptoms reported. We present the case of a young, previously healthy patient, who consults for abdominal pain and upper gastrointestinal bleeding. Through an endoscopy of the upper digestive tract, a pedicle lesion is evidenced in the second portion of the duodenum. We decided to perform a medium laparotomy and duodenectomy with resection of pedicle duodenal tumor. The results of the histological and immunohistochemical study were compatible with a duodenal gangliocytic paraganglioma. After the procedure, the patient presents adequate recovery without evidence of recurrence in the follow-up.

Abdominal aortic aneurysm in a patient with situs inversus totalis.

ANTECEDENTES: El situs inversus totalis (SIT) es una condición congénita infrecuente, en la cual los órganos asimétricos del abdomen y el tórax presentan una disposición en espejo; su asociación con aneurismas de aorta abdominal (AAA) es inusual y supone un reto quirúrgico. CASO CLÍNICO: Presentamos el caso de una paciente con SIT y AAA, por lo que se decide llevar a reparación quirúrgica. El AAA en pacientes con SIT es infrecuente; en la literatura hay pocos casos reportados. A pesar de ser una relación inusual, su tratamiento de forma electiva fue segura en nuestra paciente. BACKGROUND: The situs inversus totalis (SIT) is a rare congenital condition, in which the asymmetric organs of the abdomen and thorax have a mirror ubication; its association with abdominal aortic aneurysms, is unusual. CASE REPORT: We will present the case of a patient with SIT, who has an abdominal aortic aneurysm, taken to open surgical repair. The presentation of abdominal aortic aneurysms in patients with infrequent SIT, with few reported cases in the literature. Despite being an unusual relationship, elective treatment was safe, as we seen in our patient.

Reparación endovascular de aneurisma de arteria ilíaca común asociado a fístula arterio-venosa ílio-ilíaca: reporte de caso / Endovascular repair of common iliac artery aneurysm associated with ilio-iliac arteriovenous fistula: case report

Resumen Introducción: Los aneurismas aislados de arteria ilíaca común son una patología infrecuente y habitualmente el diagnóstico es incidental. Su manejo solía ser por vía abierta, pero con el advenimiento de la cirugía endovascular, se han identificado mejores desenlaces en los pacientes llevados a este tipo de procedimientos, reservando la reparación abierta en los casos agudos y rupturas. La asociación entre estos aneurismas con fístulas ílio-ilíacas son infrecuentes y su manejo endovascular se ha reportado en solo una ocasión. Objetivo: Se presenta un caso de un paciente masculino de 82 años, con esta asociación, en el cual se decidió llevar de manera electiva a manejo endovascular de su patología. Discusión: En la literatura el manejo endovascular es ampliamente recomendado por su perfil de seguridad, sin embargo, no existe suficiente evidencia ante la presencia de una fístula ílio-ilíaca de manera concomitante, por ser una condición infrecuente. Conclusión: En el presente caso, abordamos de manera endovascular esta relación, obteniendo resultados favorables, con adecuado control de la patología, sin presentación de complicaciones.

Introduction: The isolated aneurysms of the common iliac artery correspond to an infrequent pathology; and the diagnosis of this entity is usually incidental. Its management is usually by open route, but with the advent of endovascular surgery, better outcomes have been identified in patients taken to this kind of procedure, reserving open repair for the urgent cases, like ruptures. The association between these aneurysms with ilio-iliac fistula is uncommon and their endovascular management has been reported only in one case in the literature. Aim: A case of an 82-year-old male patient will be presented, with this association, who was taken to an endovascular repair of his pathology, with good postoperative results. Discussion: In the literature, endovascular management is recommended by its safety profile, however there is insufficient evidence in the presence of an ilio-iliac fistula concomitantly, because it is an infrequent condition. Conclusion: In the present case, we address this relationship endovascularly, obtaining favorable results, with adequate control of the pathology, without presenting any complications.

Herniorrafia hiatal y fundoplicatura laparoscópica de Toupet en un paciente con esófago corto / Hiatal herniorrhaphy and Toupet laparoscopic fundoplication in a patient with short esophagus

El esófago corto es una complicación infrecuente del reflujo gastroesofágico, polémico para algunos autores. Su diagnóstico se hace de manera intraoperatoria, ante la imposibilidad de conservar un esófago intrabdominal mayor a tres centímetros desde el hiato diafragmático. Algunos expertos niegan la existencia de esta entidad, argumentando que se debe a una mala disección del esófago. En este artículo, se presenta el caso de un paciente sometido a herniorrafia hiatal con colocación de malla, con gran dificultad para conservar una adecuada longitud del esófago abdominal, y que no requirió gastroplastia (AU)

Short esophagus is an uncommon complication of gastroesophageal reflux, controversial for some authors. The diagnosis is made intraoperatively when , the impossibility of leaving an intra-abdominal esophagus longer than 3 cm becomes patent. Some experts, however, doubt about the existence of this entity, arguing that it is due to a bad dissection of the esophagus. In this article, we present the case of a patient where a hiatal herniorraphy was performed with great difficulty to conserve an adequate length of the abdominal esophagus, without requiring gastroplasty (AU)

Evaluación de la disfagia en pacientes con enfermedades neurológicas y su relación con riesgo de desnutrición / Assessment of dysphagia in neurological disease patients and its relation to risk factor for malnutrition

Resumen: ANTECEDENTES Los pacientes con enfermedades neurológicas son susceptibles a padecer disfagia frecuentemente no diagnosticada. OBJETIVO Determinar la existencia de disfagia en pacientes con enfermedad neurológica atendidos en la consulta externa y su relación con el riesgo de desnutrición. MATERIAL Y MÉTODO Estudio descriptivo transversal, efectuado de enero a diciembre de 2016. Se realizó valoración clínica de las fases de la deglución, se aplicó el cuestionario EAT-10 versión en español, se tomaron medidas antropométricas, se estimó la ingesta calórica y se determinó el riesgo nutricional, el índice de Quetelet y la Evaluación Global Subjetiva. RESULTADOS Se analizaron 55 pacientes, 54.5% mujeres, con edad media de 47.29 años. La disfagia afectó a 49.1% de los pacientes; los pacientes con riesgo de desnutrición representaron 25.5%. Los pacientes con disfagia representaron 33.3% y tuvieron mayor riesgo de desnutrición vs 17.9% sin disfagia (p < 0.001). El género femenino (OR 1.23; IC95% 0.42-3.58; p = 0.451), la diabetes mellitus (OR 2.95; IC95% 0.52-16.75; p = 0.196), el antecedente de neumonía (OR 2.12; IC95% 1.59-2.81; p = 0.236) y la enfermedad neurológica crónica (OR 1.65; IC95% 0.49-5.53; p = 0.301) se relacionaron con incremento de disfagia. CONCLUSIONES La prevalencia de disfagia no diagnosticada es elevada y se asocia con mayor desnutrición.

Abstract: BACKGROUND Neurological diseases patients are susceptible to dysphagia, frequently not diagnosed. OBJECTIVE To determine the presence of dysphagia in patients attending for neurological pathology of extern consult and its relation with malnutrition. MATERIAL AND METHOD A prospective, cross-sectional study, performed from January to December 2016, that evaluated dysphagia symptoms, clinically phases of swallowing, and EAT-10 questionnaire validated to Spanish was applied. Risk factors were determined, as well as nutritional risk, Quetelet Index, Global Subjective Assessment, and demographics data. RESULTS Of the 55 patients, 54.5% were women; mean age was of 47.29 years. The prevalence of dysphagia was 49.1%; patients with risk malnutrition represented 25.5%. Dysphagia patients accounted for 33.3% and had a higher risk of malnutrition vs 17.9% without dysphagia (p < 0.001). The risk of dysphagia increased in women (OR 1.23, 95% CI 0.42-3.58, p = 0.45), diabetes mellitus (OR 2.95, 95 % CI 0.52-16.75, p = 0.19), patients with history of pneumonia (OR 2.12, 95% CI 1.59-2.81; p = 0.236) and chronic neurological disease (OR 1.65, 95% CI 0.49-5.53, p = 0.30). CONCLUSIONS There is high prevalence of undiagnosed dysphagia and it's associated with greater risk of malnutrition.