Quiste de duplicación gástrica en el adulto: una rara entidad / Gastric duplication cyst in the adult: a rare entity

Resumen Objetivo Reportar el caso clínico de un quiste de duplicación gástrica en un paciente adulto. Materiales y Método Paciente de sexo masculino de 70 años con una tumoración quística supramesocólica, con síntomas digestivos inespecíficos. La imagenología solicitada no determinó la etiología ni origen de la misma planteándose múltiples diagnósticos diferenciales. Se realizó una laparotomía exploradora. Resultados La laparotomía confirmó el origen gástrico de la tumoración. Se realizó la resección completa de la misma con resección gástrica en forma de gastrectomía atípica. El estudio anatomopatológico de la pieza confirmó un quiste de duplicación gástrica. Discusión Los quistes de duplicación gástrica son una enfermedad congénita rara, se diagnostican principalmente en la etapa neonatal, siendo raro en el adulto. La mayoría son lesiones únicas, no comunicantes, asintomáticas y de difícil diagnóstico preoperatorio siendo habitual el diagnostico definitivo en el intraoperatorio y con el estudio histológico de la pieza. Conclusión El quiste de duplicación gástrica debe tenerse en cuenta en los diagnósticos diferenciales de toda lesión quística supramesocólica. Son lesiones potencialmente malignas siendo la resección completa la que brinda el diagnóstico y tratamiento definitivo.

Aim To report the clinical case of a gastric duplication cyst in an adult patient. Materials and Method 70 year old male patient with a symptomatic supramesocolic cystic lesion. Preoperative imagenology was not able to determine the exact origin or etiology. Several differential diagnosis were made and finally an exploratory laparotomy was performed. Results The laparotomy determined the gastric origin and a complete resection including gastric wall was done. The anatomopathological study confirmed it was a gastric duplication cyst. Discussion Gastric duplication cysts are a rare congenital disease, diagnosed mainly in the neonatal stage, with rare presentation in the adult stage. Most of these lesions are unique, non-communicating, usually asymptomatic and difficult to diagnose preoperatively, with definitive diagnosis being common in intraoperative and histological study of the piece. Conclusion The gastric duplication cyst must be taken into account in the differential diagnosis of any supramesocolic cystic lesion. They are potentially malignant lesions, and complete resection provides the definitive diagnosis and treatment.

[Delayed surgery in impacted common bile duct calculi: lower percentage of biliary tract interventions]. / Cirugía en diferido de la litiasis coledociana impactada: menor porcentaje de intervención sobre la vía biliar.

INTRODUCTION: The choice of immediate or delayed surgery in patients with common bile duct calculi without severity criteria is controversial. Studies of patients with common bile duct calculi show that in a considerable percentage of these patients there is spontaneous passage of these stones without the need for surgery. AIM: To compare the percentage of common bile duct stones found at surgery between patients with impacted common bile duct stones undergoing immediate and delayed surgery. PATIENTS AND METHOD: Patients admitted to the Hospital de Clínicas Manuel Quintela with a diagnosis of impacted common bile duct stones were retrospectively reviewed. The patients were classified into two groups: those who underwent exploratory common bile duct surgery within 48 hours of admission (immediate surgery) and those who underwent surgery after the first 48 hours of admission (delayed surgery). The number of patients with a finding of common bile duct stones in each group was analyzed. RESULTS: Seventy patients (37 in the immediate surgery group and 33 in the delayed surgery group) were analyzed. Among the patients who underwent immediate surgery, 92% showed common bile duct stones on cholangiography or another instrumental procedure. In the group that underwent delayed surgery, this percentage was 64% (P< .004). Three factors predicting the absence of spontaneous passage of stones after 48 hours of admission were identified: age more than 70 years, jaundice of 7 days' duration or more and common bile duct stones visible by imaging techniques. CONCLUSIONS: The results of this study suggest that delayed surgery of impacted common bile duct stones reduces the number of patients requiring common bile duct surgery as well as the number of patients requiring biliary drainage. Patients aged more than 70 years old, with jaundice of more than 7 days' duration and with common bile duct stones visible by imaging techniques do not benefit from delayed surgery.

Cirugía en diferido de la litiasis coledociana impactada: menor porcentaje de intervención sobre la vía biliar / Delayed surgery in impacted common bile duct calculi: lower percentage of biliary tract interventions

Objetivo: El objetivo de este trabajo es comparar el porcentaje de litiasis de la vía biliar principal encontrado en el momento de la exploración coledociana entre los pacientes con litiasis coledociana impactada intervenidos en forma inmediata y en forma diferida. Pacientes y método. Se efectuó un análisis retrospectivo en pacientes que ingresaron en el Hospital de Clínicas Manuel Quintela con diagnóstico de litiasis coledociana impactada. Los pacientes fueron clasificados en 2 grupos: pacientes que fueron sometidos a exploración de la vía biliar principal antes de las 48 h del ingreso (exploración inmediata) o después de ese lapso (exploración diferida) y se analizó el número de pacientes con exploración positiva para cálculos en la vía biliar principal en cada grupo. Resultados. Se reclutó a 70 pacientes: 37 fueron explorados en forma inmediata y 33 en forma diferida. Entre los pacientes explorados antes de las 48 h, el 92% tuvo una colangiografía o una exploración instrumental positiva para cálculos en la vía biliar, mientras que en los pacientes explorados luego de las 48 h el porcentaje fue del 64% (p < 0,004). Se identificaron 3 factores predictores de no migración espontánea de los cálculos aún esperando más de 48 h: edad mayor de 70 años, ictericia de 7 o más días de evolución y cálculo en la vía biliar visible en la exploración por imagen. Conclusiones. Los resultados de nuestro estudio indican que la cirugía diferida de la litiasis coledociana impactada disminuye el número de pacientes en los que es necesaria la instrumentación de la vía biliar principal y reduce el número de pacientes con drenaje biliar. Los pacientes mayores de 70 años, con ictericia de más de 7 días de duración o con cálculo visible en la vía biliar por estudio de imagen no se benefician de diferir la cirugía (AU)

Introduction. The choice of immediate or delayed surgery in patients with common bile duct calculi without severity criteria is controversial. Studies of patients with common bile duct calculi show that in a considerable percentage of these patients there is spontaneous passage of these stones without the need for surgery. Aim. To compare the percentage of common bile duct stones found at surgery between patients with impacted common bile duct stones undergoing immediate and delayed surgery. Patients and method. Patients admitted to the Hospital de Clínicas Manuel Quintela with a diagnosis of impacted common bile duct stones were retrospectively reviewed. The patients were classified into two groups: those who underwent exploratory common bile duct surgery within 48 hours of admission (immediate surgery) and those who underwent surgery after the first 48 hours of admission (delayed surgery). The number of patients with a finding of common bile duct stones in each group was analyzed. Results. Seventy patients (37 in the immediate surgery group and 33 in the delayed surgery group) were analyzed. Among the patients who underwent immediate surgery, 92% showed common bile duct stones on cholangiography or another instrumental procedure. In the group that underwent delayed surgery, this percentage was 64% (P<.004). Three factors predicting the absence of spontaneous passage of stones after 48 hours of admission were identified: age more than 70 years, jaundice of 7 days' duration or more and common bile duct stones visible by imaging techniques. Conclusions. The results of this study suggest that delayed surgery of impacted common bile duct stones reduces the number of patients requiring common bile duct surgery as well as the number of patients requiring biliary drainage. Patients aged more than 70 years old, with jaundice of more than 7 days' duration and with common bile duct stones visible by imaging techniques do not benefit from delayed surgery (AU)