Esplenectomía por tumor hematopoyético extramedular esclerosante del bazo / Splenectomy for sclerosing extramedullary hematopoietic tumor of the spleen

RESUMEN Los tumores hematopoyéticos extramedulares son infrecuentes; se caracterizan por la presencia de elementos formes de la sangre en distintas etapas madurativas, con megacariocitos atípicos y proliferación fibroblástica. Se comunica el caso clínico de un tumor hematopoyético extramedular esclerosante del bazo en un varón de 71 años, con antecedentes patológicos de hipertensión, diabetes, portador de virus hepatitis C. En estudio por malestar abdominal se identificaron mediante imágenes lesiones esplénicas múltiples. Se planteó origen vascular, sin poder descartar otro tipo de lesiones, por lo que se decidió esplenectomía laparoscópica. El estudio histopatológico e inmunohistoquímico diagnosticó un tumor hematopoyético extramedular esclerosante del bazo. Son neoplasias de baja incidencia y escasa evidencia en cuanto a etiopatogenia, diagnóstico y tratamiento. Se presentan como lesiones únicas o múltiples, y pueden afectar diferentes órganos. Están asociados a síndromes mieloproliferativos crónicos. Solo su confirmación histopatológica permite diferenciarlos de otros tumores malignos.

ABSTRACT Extramedullary hematopoietic tumors are rare and characterized by the presence of hematopoietic elements at various stages of maturity, atypical megakaryocytes, and fibroblastic proliferation. We report the case of a patient with sclerosing extramedullary hematopoietic tumor of the spleen.The patient was 71-year-old man with a history of hypertension, diabetes, and hepatitis C virus infection. Multiple spleen lesions were identified in imaging tests during workup due to abdominal discomfort. Although a vascular tumor was suspected, laparoscopic splenectomy was decided after considering other possible causes. The pathology examination revealed a sclerosing extramedullary hematopoietic tumor of the spleen, which was confirmed by immunohistochemical tests. These tumors are usually single or, less frequently, multiple lesions affecting different organs and are associated with chronic myeloproliferative syndromes. The histologic confirmation is mandatory due to their similarity to malignant tumors. Extramedullary hematopoietic tumors are rare, and there is little scientific clinical evidence regarding their diagnosis and management. The histological confirmation is mandatory due to their similarity to malignant tumors.

Saliva sampling and its direct lysis is an excellent option for SARS-CoV-2 diagnosis in paediatric patients: comparison with the PanBio COVID-19 antigen rapid test in symptomatic and asymptomatic children.

Introduction. Lateral flow test (LFTs) have been used as an alternative to reverse transcription quantitative PCR (RT-qPCR) in point-of-care testing. Despite their benefits, the sensitivity of LFTs may be low and is affected by several factors. We have previously reported the feasibility of using direct lysis of individual or pools of saliva samples from symptomatic and asymptomatic patients as a source of viral genomes for detection by RT-qPCR.Hypothesis. Direct lysed saliva is more sensitive than antigen tests to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in samples from children.Aim. Our goals here were to valuate the specificity and sensitivity of the PanBio COVID-19 antigen rapid test device (Ag-RTD) compared with RT-qPCR of direct lysed saliva.Methodology. We evaluated the performance of the PanBio COVID-19 Ag-RTD in comparison to RT-qPCR direct lysed saliva from paired samples of 256 symptomatic and 242 asymptomatic paediatric patients.Results. Overall, although there were no differences in the specificity (96.6%), we found a lower sensitivity (64.3%) of the PanBio Ag-test RTD compared to saliva in both symptomatic and asymptomatic patients. In addition, the sensitivity of PanBio was not correlated with the viral load present in the samples.Conclusion. Our data highlight the benefits of using RT-qPCR and saliva samples for SARS-CoV-2 detection, particularly in paediatric patients.

Valor de la ecografía abdominal en el diagnóstico de apendicitis aguda / Value of abdominal ultrasound in the diagnosis of acute apendicitis

RESUMEN Antecedentes : la apendicitis aguda es una de las causas más frecuentes de consulta y cirugía en los servicios de urgencia. Su diagnóstico en algunos casos continúa siendo difícil. Objetivo: valorar el rendimiento de la ecografía abdominal en el diagnóstico de apendicitis aguda en un centro asistencial de salud de tercer nivel. Material y métodos : se realizó un estudio de prueba diagnóstica, retrospectivo y longitudinal. La población consistió en 113 pacientes, con una media de edad de 24 años (rango 3-90), que consultaron por dolor en fosa iliaca derecha, a los cuales se les realizó ecografía abdominal y se pudo realizar su seguimiento hasta contar con resultado de anatomía patológica, entre febrero 2016 y febrero 2018. Se analizó la sensibilidad, la especificidad, el valor predictivo positivo y el valor predictivo negativo de la ecografía abdominal en el diagnóstico de apendicitis aguda. Resultados : la ecografía fue positiva para el diagnóstico de apendicitis en 32 pacientes (28,3%) y fue negativa en 81 pacientes (71,7%). Fueron operados 53 pacientes (46,9%); en 44 (38,9%) de estos se constató la enfermedad; en 9 pacientes (7,96%) el apéndice estaba sano, y entre estos pacientes, la ecografía había sido negativa para apendicitis. La sensibilidad fue del 68,1% y especificidad del 97,1%, el valor predictivo positivo de 93,7% y el valor predictivo negativo de 82,7%, presentando un 6,3% de falsos positivos y un 17,2% de falsos negativos. Conclusión : los resultados obtenidos son coincidentes con los de la literatura internacional, y confirman que la ecografía es un estudio útil para el diagnóstico de apendicitis aguda.

ABSTRACT Background : Acute appendicitis is one of the most common reasons for emergency departments visits and emergency surgery. In some cases, its diagnosis is still difficult. Objective : The aim of this study was to evaluate the performance of abdominal ultrasound in the diagnosis of acute appendicitis in a tertiary health care center. Material and methods : We conducted longitudinal study to evaluate the performance of a diagnostic test using data retrospectively collected. The population was made up of 113 patients [mean age: 24 years (range 3-90)], who consulted for pain in the right iliac fossa, underwent abdominal ultrasound and could be followed up until the results of the pathological examination were available between February 2016 and February 2018. The analysis included sensitivity, specificity, positive predictive value and negative predictive value of ultrasound for the diagnosis of acute appendicitis. Results : Ultrasound was positive for the diagnosis of appendicitis in 32 patients (28.3%) and was negative in 81 patients (71.7%). Fifty-three patients (46.9%) underwent surgery; 44 (38.9%) had confirmed appendicitis while the appendix was healthy in 9 patients (7.96%), and among these patients, the ultrasound had been negative for appendicitis. Sensitivity was 68.1%, specificity 97.1%, the positive predictive value was 93.7% and the negative predictive value 82.7%, with a false positive rate of 6.3% and a false negative rate of 17.2%. Conclusion : The results obtained coincide with those of the international literature and confirm that ultrasound is a useful tool for the diagnosis of acute appendicitis.

Hemorragia digestiva alta grave por fistula entre arteria esplénica y manga gástrica / Severe upper gastrointestinal bleeding due to fistula between splenic artery and gastric sleeve / Hemorragia digestiva alta grave devido a fístula entre artéria esplênica e manga gástrica

La hemorragia digestiva determinada por una fístula entre manga gástrica y seudoaneurisma de arteria esplénica o polo superior de bazo es infrecuente. Se presenta un caso clínico de una paciente de 52 años con antecedentes de cirugía de manga gástrica y fuga anastomótica. Ingresó por hemorragia digestiva alta grave. Se operó de emergencia y realizó punto hemostático sobre cara posterior de manga gástrica. Se reintervino por resangrado realizándose la gastrectomía y esplenopancreatectomía distal por solución de continuidad de arteria esplénica. Dada la inestabilidad hemodinámica se efectuó un esofagostoma y yeyunostomía, reconstruyéndose a los 8 meses con buena evolución.

Gastrointestinal bleeding caused by a fistula between the gastric sleeve and a pseudoaneurysm of the splenic artery or upper pole of the spleen is uncommon. A clinical case of a 52-year-old patient with a history of gastric sleeve surgery and anastomotic leak is presented. She was admitted for severe upper gastrointestinal bleeding. She underwent emergency surgery and performed a hemostatic stitch on the posterior face of the gastric sleeve. She underwent reoperation due to rebleeding, performing gastrectomy and distal splenopancreatectomy due to discontinuation of the splenic artery. Given the hemodynamic instability, an esophagostomy and jejunostomy were performed, reconstructing at 8 months with good evolution.

O sangramento gastrointestinal causado por uma fístula entre a manga gástrica e um pseudoaneurisma da artéria esplênica ou pólo superior do baço é incomum. Apresenta-se o caso clínico de um paciente de 52 anos com história de cirurgia de manga gástrica e fístula anastomótica. Ele foi internado por hemorragia digestiva alta grave. Uma operação de emergência foi realizada e um ponto hemostático foi realizado na face posterior da manga gástrica. Foi reoperado por ressangramento, realizando gastrectomia e esplenopancreatectomia distal por descontinuação da artéria esplênica. Dada a instabilidade hemodinâmica, foi realizada esofagostomia e jejunostomia, reconstruindo aos 8 meses com boa evolução.

Clinical Uses of Ketamine in Children: A Narrative Review.

Ketamine is a phencyclidine derivative that acts as a noncompetitive N-methyl-D-aspartate as well as a glutamate receptor antagonist. It also has other minor mechanisms that contribute to its extensive drug profile. Ketamine is a bronchodilator and maintains normal airway reflexes and, thus, permits spontaneous respiration. This, coupled with the fact that it produces potent analgesia, makes it highly suitable for children. Despite its many merits, the drug's side effects, along with its cultural image of being a drug of abuse, a drug used in veterinary medicine, or a "date-rape drug" have sullied its reputation within the armamentarium of medicine. Even though it is widely used in developing countries, its use in Western nations has diminished. We have strived to explore the various clinical uses of ketamine in children through this article. In addition, the article also highlights how some of the fears associated with using the drug are unfounded and provides ways by which the drug's side effects can be prevented and managed.

The Development and Impact of Anxiety With Migraines: A Narrative Review.

Migraine is a chronic, disabling neurological disorder characterized by recurrent episodes of headache. Psychiatric disorders have been reported to arise due to a patient's physical and emotional stress caused by migraine episodes, with anxiety disorders being one of the most commonly associated psychiatric disorder with migraine. This association poses the question of similar or shared pathogenesis between the two disorders and raises a concern for the diagnosis and management of situations when these disorders present together. In this review, we discuss the possible shared mechanism for the development of anxiety disorders in the presence of migraine, such as the vascular, nervous, and genetic factors that might hold the key to their association. We also discuss the number of clinical features shared by these conditions and provide evidence for the higher degree of association between these conditions. A focused evaluation of anxiety disorders in migraine might benefit patients with earlier diagnoses and improve their quality of life with effective pharmacotherapy and psychotherapy. This review also emphasizes the importance of preventing future migraine episodes with effective prophylactic medications to reduce the risk of developing anxiety disorders, and the need to discuss the medical and psychiatric management of anxiety disorders in patients suffering from migraines on an acute and long-term basis. ​​​​​​.

Vinculum of Cardiovascular Disease and Inflammatory Bowel Disease: A Narrative Review.

Inflammatory bowel disease (IBD), comprising of ulcerative colitis (UC) and Crohn's disease (CrD), is a chronic relapsing-remitting inflammation of the bowel with extraintestinal involvement. Numerous studies published in the last decade have underlined the dangerous cardiovascular disease (CVD) outcomes of IBD, such as ischemic heart disease, heart failure, and stroke, and the need for better therapeutic and prognostic strategies. This article elucidated the pathological web of mechanisms that link IBD with CVD, such as immune dysregulation, endothelial dysfunction, arterial stiffness, and dysbiosis, with a comprehensive review of clinical studies standing for and against the notion in pediatric and adult populations. The current treatment and prevention aim at disease remission and dietary strategies shown to reduce the CVD risk. Exploration of other supplemental preventive and treatment methods, especially during active flares of disease, to reduce the risk of arterial thromboembolic disease (ATED) is the need of the hour.

Neurological and Neuropsychiatric Manifestations of Antiphospholipid-Antibody Syndrome (APS).

Antiphospholipid antibody syndrome (APS) is an autoimmune disorder mediated by the presence of a group of autoantibodies, specifically the anticardiolipin antibody (aCL), the beta-2 glycoprotein I (ß2GPI), and the lupus anticoagulant (LA). Patients diagnosed with antiphospholipid antibody syndrome (APS) present with many symptoms, the most common being the consequence of thrombotic events that can be catastrophic and lead to mild to severe residual disabilities over a significant amount of time and can impair the quality of life. These events are often present in the younger population. Many times, these thrombotic events are heralded by a spectrum of psychiatric symptoms, which when worked up in the right direction may hint toward an oncoming thrombotic event and may potentially prevent those events by prompting primary prophylaxis treatment by the treating physician. In this review, we aim to comprehensively put forth the many neurological and neuropsychiatric manifestations of APS, their pathology, and management.

Sepsis and Thrombocytopenia: A Nowadays Problem.

Sepsis is a life-threatening organ failure produced by a dysregulated host response to infection that involves 15.6% of hospital mortality. The most common signs and symptoms of sepsis are hypotension, tachypnea, fever, and leukocytosis, whether suspected or confirmed. Including a major one, thrombocytopenia is a sign that is an independent predictor of poor outcomes in patients with sepsis, increasing their mortality rate and their length of stay in the intensive care unit (ICU). So far, the ongoing treatment for this problem is securing the airway, treating hypoxemia, and providing vascular access for hydration, antibiotic delivery, and vasopressors, if needed. This article has reviewed the different possible mechanisms found for sepsis-associated thrombocytopenia, going from the most acknowledged one as decreased platelet production to the potential aftermath of sepsis itself as disseminated intravascular coagulation (DIC). This article has also discussed the future treatment for patients suffering from thrombocytopenia and sepsis, going from phase I and II trials as GI antagonists to the well-known drug aspirin as a possible treatment for this problem.

Metástasis ganglionar cervical bilateral de un cáncer originado en un quiste tirogloso / Bilateral lymph node metastases from a thyroglossal duct cyst carcinoma

RESUMEN Presentamos una paciente de 47 años, sexo femenino, tiroidectomía total por bocio multinodular hace 20 años. Consulta por adenomegalias yúgulo-carotídeas bilaterales cuya citopunción evidenció metástasis ganglionar bilateral de cáncer papilar de tiroides. Ecografía y tomografía evidenciaron quiste tirogloso. Cirugía: operación de Sistrunk más vaciamiento cervical central y bilateral selectivo. Anatomía patológica: cáncer papilar de tiroides en quiste tirogloso, adenomegalias metastásicas. El 5-7% de los quistes tiroglosos tienen tejido tiroideo, el 1% de ellos desarrollarán carcinoma, y de estos, un 7-15% presentarán metástasis ganglionar cervical. Informamos una patología infrecuente con una inusual presentación clínica: adenomegalias cervicales bilaterales, cuya citopunción orientó la búsqueda del tumor primario.

ABSTRACT We report the case of a 47-year-old female patient with a history of total thyroidectomy 20 years before due to multinodular goiter, with palpable jugular-carotid lymph nodes in both side of the neck. The fine needle aspiration biopsy revealed bilateral lymph node metastases of a papillary thyroid carcinoma. A thyroglossal duct cyst was found on ultrasound and computed tomography scan. Surgery: Sistrunk procedure plus selective central and bilateral selective neck dissection. Pathology report: papillary thyroid carcinoma in a thyroglossal duct cyst with lymph node metastases. Thyroid gland tissue may be present in 5-7% of thyroglossal duct cysts; 1% may develop cancer and cervical lymph node metastases will occur in 7-15% We report a rare condition with unusual clinical presentation: bilateral enlargement of neck lymph nodes with a positive fine needle aspiration biopsy that guided the search for the primary tumor.

Pooling saliva samples as an excellent option to increase the surveillance for SARS-CoV-2 when re-opening community settings.

In many countries a second wave of infections caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has occurred, triggering a shortage of reagents needed for diagnosis and compromising the capacity of laboratory testing. There is an urgent need to develop methods to accelerate the diagnostic procedures. Pooling samples represents a strategy to overcome the shortage of reagents, since several samples can be tested using one reaction, significantly increasing the number and speed with which tests can be carried out. We have reported the feasibility to use a direct lysis procedure of saliva as source for RNA to SARS-CoV-2 genome detection by reverse transcription quantitative-PCR (RT-qPCR). Here, we show that the direct lysis of saliva pools, of either five or ten samples, does not compromise the detection of viral RNA. In addition, it is a sensitive, fast, and inexpensive method that can be used for massive screening, especially considering the proximity of the reincorporation of activities in universities, offices, and schools.

Encuentros clínicos virtuales como estrategia de enseñanza ante la suspensión de cursos presenciales en 2020: evaluación estudiantil / Virtual clinical meetings as a teaching strategy before the suspension of face-to-face courses in 2020: student evaluation / Encontros clínicos virtuais como estratégia de ensino antes da suspensão dos cursos presenciais em 2020: avaliação dos alunos

Introducción: Desde el inicio de la pandemia Covid-19 la enseñanza de clínica quirúrgica ha representado un gran desafío y motivó el desarrollo de encuentros clínicos virtuales. El objetivo del presente trabajo es comunicar una forma novedosa en Uruguay de docencia virtual de Clínica Quirúrgica y su evaluación de los estudiantes. Métodos: Los encuentros clínicos virtuales son una herramienta educativa basada en situaciones clínicas reales donde el estudiante fue protagonista de la actividad. Los encuentros se realizaron con frecuencia semanal y 2 horas de duración, utilizado la plataforma Zoom. Al finalizar la actividad se realizó una encuesta de satisfacción a los estudiantes y los resultados resumidos en porcentajes. Resultados: Participaron 90 estudiantes y 10 docentes. Se realizaron 12 encuentros clínicos virtuales. Esta actividad fue considerada importante por el 88,5% de los estudiantes en su proceso de aprendizaje. La dinámica con mayor aceptación fue las viñetas con preguntas en tiempo real (59,6%), seguido de bases teóricas con preguntas en tiempo real (17,3%) y el análisis de caso clínico por grupo (15,4%). La sugerencia más importante es que se mantenga esta actividad independientemente del reintegro a la presencialidad en el futuro. Conclusión: La utilización de los encuentros clínicos virtuales ha demostrado ser una herramienta alternativa a las actividades presenciales durante la pandemia Covid-19 y en el futuro se convertirá en un complemento significativo dada la alta aceptación tanto por parte de los estudiantes como docentes.

Introduction: Since the beginning of the covid-19 pandemic, teaching surgical clinics has represented a great challenge and this motivated the development of virtual clinical meetings. The objective of this work is to communicate a new way in Uruguay of approaching the virtual teaching of Surgical Clinics and its evaluation by students. Methods: Virtual clinical encounters is an educational tool based on real clinical situations where the student was the protagonist of the activity. With a weekly frequency and 2 hours of duration, using the Zoom platform. At the end of the activity, a student satisfaction survey was carried out and the results summarized in percentages. Results: 90 students and 10 teachers participated.12 virtual clinical meetings were held. This activity was considered important by 88.5% of the students in their learning process. The dynamics with the highest acceptance were the vignettes with questions in real time (59.6%), followed by theoretical bases with questions in real time (17.3%) and the analysis of clinical case by group (15.4%). The most important suggestion is that this activity be maintained regardless of the reinstatement to the presence in the future. Conclusion: The use of virtual clinical meetings has proven to be an alternative tool to face-to-face activities during the covid-19 pandemic and in the future it will become a significant complement given the high acceptance by both students and teachers.

Introdução: Desde o início da pandemia covid-19, ensinar clínica cirúrgica tem representado um grande desafio e isso motivou o desenvolvimento de reuniões clínicas virtuais. O objetivo deste trabalho é comunicar uma nova forma no Uruguai de abordar o ensino virtual de Clínicas Cirúrgicas e sua avaliação pelos alunos. Métodos: O Encontro Clínico Virtual é uma ferramenta educacional baseada em situações clínicas reais onde o aluno foi o protagonista da atividade. Com frequência semanal e 2 horas de duração, utilizando a plataforma Zoom. No final da atividade, foi realizado um inquérito de satisfação dos alunos e os resultados resumidos em percentagens. Resultados: Participaram 90 alunos e 10 professores.12 reuniões clínicas virtuais foram realizadas. Essa atividade foi considerada importante por 88,5% dos alunos em seu processo de aprendizagem. As dinâmicas com maior aceitação foram as vinhetas com questões em tempo real (59,6%), seguidas das bases teóricas com questões em tempo real (17,3%) e a análise do caso clínico por grupo (15,4%). A sugestão mais importante é que essa atividade seja mantida independentemente de um retorno à presença no futuro. Conclusão: O uso de reuniões clínicas virtuais provou ser uma ferramenta alternativa às atividades presenciais durante a pandemia covid-19 e, no futuro, se tornará um complemento significativo, dada a alta aceitação por alunos e professores.

Variación anatómica de la vía biliar tipo F de Blumgart / Anatomical variation of Blumgart´s F type bile duct / Variacão anatômica do ducto biliar do tipo F de Blumgart

Se presenta el caso de una paciente de 40 años portadora de litiasis biliar sintomática que se operó de coordinación por abordaje laparoscópico

Guzmania panamensis (Bromeliaceae) - a new species from Talamanca Mountain in Veraguas province, Western Panama.

Guzmania panamensis (Bromeliaceae), a new species so far endemic to Veraguas province, Western Panama, is described and illustrated. The new species is recognized due to its peduncle much longer than the leaves and its red floral bracts, shorter than the yellow flowers. The new species is compared to morphologically similar species, namely Guzmania monostachia, Guzmania berteroniana, Guzmania elvallensis, and Guzmania skotakii.

Diversity and levels of endemism of the Bromeliaceae of Costa Rica - an updated checklist.

An updated inventory of the Bromeliaceae for Costa Rica is presented including citations of representative specimens for each species. The family comprises 18 genera and 198 species in Costa Rica, 32 species being endemic to the country. Additional 36 species are endemic to Costa Rica and Panama. Only 4 of the 8 bromeliad subfamilies occur in Costa Rica, with a strong predominance of Tillandsioideae (7 genera/150 spp.; 75.7% of all bromeliad species in Costa Rica). 124 species (62.6%) grow exclusively epiphytic, additional 59 spp. (29.8%) are facultative epiphytes. The most diverse genus is Werauhia, with 59 species (29.8% of the Costa Rican bromeliad flora), followed by Tillandsia with 40 species (20.2%) and Guzmania with 28 spp. (8.6%).

ResumenEs presentada una lista de chequeo actualizada de 18 géneros y 198 especies de Bromeliaceae conocidas de Costa Rica. Por consiguiente, las bromelias endémicas de Costa Rica, ahora comprenden 32 especies. Adicionalmente, 36 especies tienen un endemismo compartido con Panamá. Sólo 4 de las 8 subfamilias actualmente reconocidas ocurren en Costa Rica con fuerte predominio de Tillandsioideae (7 géneros/150 spp.; 75.7% del total de especies de bromelias de Costa Rica). 124 especies (62.6%) crecen como epífita, 59 especies adicionales (29.8%) son epifitas facultativas. El género mejor representado es Werauhia, con 59 especies (29.8% de la flora de bromelias de Costa Rica), seguido por Tillandsia con 40 spp. (20.2%) y Guzmania con 28 especies (8.6%).

Complicaciones agudas del linfoma yeyuno-ileal / Acute complications of jeyuno-ileal lymphoma

El linfoma de intestino delgado es una entidad cuya incidencia oscila entre el 1 y 4 por ciento de todos los tumores malignos del aparato digestivo. Es habitual su presentación clínica como cuadros agudos de abdomen, lo que determina que el cirujano se enfrente a los mismos en los servicios de urgencia. En estas circunstancias, y con un diagnóstico etiológico no siempre establecido, se emprende el tratamiento quirúrgico. Su confirmación anátomo patológica, permite emprender el tratamiento adyuvante en base a quimio y radioterapia. Se analizan en forma retrospectiva seis casos clínicos que se presentaron como cuadros agudos de abdomen y fueron sometidos a cirugía de urgencia, sin complicaciones ni mortalidad operatoria.

Oclusión cerrada por cáncer de colon izquierdo. Experiencia sobre resección y anastomosis en un tiempo / Occlusion due to left colonic cancer. Experience with resection and anastomosis in a single procedure

Los autores presentan su experiencia en el manejo de la oclusión cerrada por cáncer de colon izquierdo, en el período comprendido entre los años 1993 y 1999, en la ciudad de Florida. Se realizaron 18 procedimientos, de los cuales en 16 casos se resecó el tumor, en 15 de los mismos se reconstruyó el tránsito intestinal en el mismo acto quirúrgico y de estos últimos, en 14 pacientes se realizó una anastomosis colo-cólica (77,7 por ciento de los 18 pacientes, 87,5 por ciento de los pacientes resecados). La morbilidad no superó a la establecida para otros procedimientos ya impuestos y la mortalidad ocurrió en 3 pacientes, destacándose que no existió falla de sutura sospechada en ninguno de los casos.

Carcinoma neuroendócrino de recto / Neuroendocrine carcinoma of the rectum

Se analiza un caso clínico de un cáncer neuroendócrino de recto, variedad histológica infrecuente y altamente agresiva de los cánceres de esta topografía, en una paciente de 79 años, en un estadio IV de la estadificación TNM, a la cual se le realizó una resección anterior baja de recto oncológica. En su evolución inmediata desarrolla una rápida progresión lesional y la laparotomía exploradora realizada 4 meses después, muestra la infiltración gástrica por el mismo proceso, por lo cual se decide no actuar sobre la misma. Se analizan diferentes factores pronósticos.