[Meckel's diverticulum as a cause of massive rectal bleeding]. / Divertículo de Meckel como causa de rectorragia masiva.

A fit three months old male baby was admitted in our hospital with a history of massive painless fresh rectal bleeding. Blood transfusion, hemodynamic stabilization and emergency laparotomy were necessary because of the high suspect of Meckel's diverticulum as the cause of bleeding. It is an uncommon case due to the low age of the patient and the severity of clinical presentation.

Divertículo de Meckel como causa de rectorragia masiva / Meckel´s dicerticulum as a cause of massive rectal bleeding

Se presenta el caso de un lactante varón de 3 meses, sin antecedentes de interés, que fue remitido a nuestro centro por rectorragia masiva indolora. Requirió transfusión sanguínea, estabilización hemodinámica y laparotomía urgente por alta sospecha de divertículo de Meckel como causa del sangrado. Se trata de un caso poco frecuente en la literatura debido a la corta edad del paciente y la severidad de la presentación clínica (AU)

A fit three months old male baby was admitted in our hospital with a history of massive painless fresh rectal bleeding. Blood transfusion, hemodynamic stabilization and emergency laparotomy were necessary because of the high suspect of Meckel’s diverticulum as the cause of bleeding. It is an uncommon case due to the low age of the patient and the severity of clinical presentation (AU)

Laparoscopic treatment of cholelithiasis in cirrhotic patients.

OBJECTIVE: To assess the safety and efficacy of laparoscopy in the treatment of symptomatic cholelithiasis in patients with Child's Class A and Class B cirrhosis. STUDY DESIGN: Descriptive and retrospective study. PATIENTS: We studied 14 patients (mean age 60 yrs) with Child's Class A and Class B hepatic cirrhosis who underwent laparoscopic cholecystectomy. We analyzed the occurrence of intraoperative and postoperative complications. RESULTS: Eight patients were women (57.14%) and 6 were men (42.85%). Eight of the 14 patients presented with Child's Class B cirrhosis and 6 patients with Class A. Cholecystectomy was programmed for all patients. The average duration of surgery was 77 min. Intraoperative complications occurred in 2 patients (14.28%) in the form of liver bed bleeding. Postoperative complications were observed in 3 patients (21.42%), 2 presented with ascites which led to a worsening of Child's Class in one of them, and the third patient presented with angina-like symptoms (acute, sharp pain in the chest irradiating to the back). Mean length of hospital stay was 3 days. No postoperative morbidity or mortality occurred, and there were no conversions. CONCLUSIONS: LC (laparoscopic cholecystectomy) is a safe and effective alternative for the treatment of symptomatic cholelithiasis in patients with well-compensated Child's Class A and Class B cirrhosis. Postoperative morbi-mortality is low, bleeding is unimportant, and both duration of surgical procedure and hospital stay are short.

Experiencia en el tratamiento laparoscópico de la colelitiasis del cirrótico / Laparoscopic treatment of cholelithiasis in cirrhotic patients

Objective: to assess the safety and efficacy of laparoscopy inthe treatment of symptomatic cholelithiasis in patients withChild´s Class A and Class B cirrhosis.Study design: descriptive and retrospective study.Patients: we studied 14 patients (mean age 60 yrs) withChild´s Class A and Class B hepatic cirrhosis who underwent laparoscopiccholecystectomy. We analyzed the occurrence of intraoperativeand postoperative complications.Results: eight patients were women (57.14%) and 6 weremen (42.85%). Eight of the 14 patients presented with Child´sClass B cirrhosis and 6 patients with Class A. Cholecystectomywas programmed for all patients. The average duration of surgerywas 77 min. Intraoperative complications occurred in 2 patients(14.28%) in the form of liver bed bleeding. Postoperative complicationswere observed in 3 patients (21.42%), 2 presented withascites which led to a worsening of Child´s Class in one of them,and the third patient presented with angina-like symptoms (acute,sharp pain in the chest irradiating to the back). Mean length ofhospital stay was 3 days. No postoperative morbidity or mortalityoccurred, and there were no conversions.Conclusions: LC (laparoscopic cholecystectomy) is a safe andeffective alternative for the treatment of symptomatic cholelithiasisin patients with well-compensated Child´s Class A and Class Bcirrhosis. Postoperative morbi-mortality is low, bleeding is unimportant,and both duration of surgical procedure and hospital stayare short

Objetivo: evaluar la seguridad y eficacia del uso de la laparoscopiaen pacientes cirróticos en estadio A y B de Child-Pugh concolelitiasis sintomática.Diseño del estudio: estudio descriptivo, retrospectivo.Pacientes: catorce pacientes con una edad media de 60 añosdiagnosticados de cirrosis hepática en estadios A y B que se lespracticó colecistectomía laparoscópica. Se estudia la aparición decomplicaciones intraoperatorias y postoperatorias tras la intervenciónResultados: ocho (57,14%) casos eran mujeres y 6 ( 42,85%)varones. De los 14 pacientes, 8 presentaban un estadio Child-Pugh B y 6 un Child-Pugh A. Todos los pacientes se intervienende colelitiasis de forma programada. El tiempo operatorio mediofue de 77 min. Dos (14,28%) de los pacientes presentaron complicacionesintraoperatorias, sangrado del lecho quirúrgico. Tres(21,42%) pacientes presentaron complicaciones postoperatorias:dos (14,28%) presentaron ascitis con empeoramiento del Child-Pugh en uno de ellos y el otro presentó un cuadro anginoso. Laestancia media de estos pacientes es de 3 días. No hubo ningunamuerte tras la intervención y no hubo ninguna reconversión.Conclusiones: la CL es una alternativa segura y efectiva en eltratamiento de colelitiasis sintomáticas en pacientes con cirrosisen estadio A y B compensada. Ofrece una baja morbimortalidadpostoperatoria con una escasa pérdida de sangre, un tiempo operatoriocorto y una reducida estancia hospitalaria

Fístula biliar tras hepatorrafia por traumatismo hepático. Posibilidad de tratamiento postural / Biliary fistula associated with hepatorrhaphy for liver injury. A possible postural management

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