Absceso masivo de pared abdominal por diverticulitis aguda evolucionada / Massive abscess in abdominal wall due to complicated diverticulitis

La mayoría de los pacientes con divertículos de colon no presentan complicaciones y, en caso de presentarlas, suelen ser intraabdominales. Exponemos el caso de un varón de 52 años que consultó en el Servicio de Urgencias por dolor abdominal de 3 semanas de evolución asociado a tumoración infraumbilical con signos de flogosis. La analítica sanguínea mostró leucocitosis importante con desviación izquierda y elevación de la proteína C reactiva. La tomografía computarizada evidenció un gran absceso de pared abdominal que comunicaba con cambios inflamatorios en sigma ("en reloj de arena"). Se decidió intervenir de forma quirúrgica urgente hallando diverticulitis aguda de sigma muy evolucionada. Se realizó drenaje y colostomía en cañón de escopeta sobre varilla. El absceso de pared abdominal como debut de diverticulitis aguda complicada es una forma de presentación muy infrecuente de esta patología, existiendo pocos antecedentes descritos en la literatura al respecto

The majority of patients with diverticula have not any complications. If they appear, they use to present as an intra-abdominal complication. We present the case of a 52-year-old man who came to the Emergency Service with lower abdominal pain for 3 weeks and a visible mass with inflammatory signs in this site. The blood test showed a marked leucocytosis with neutrophilia and the compute tomography revealed an abscess of the abdominal wall related with inflammatory changes in sigmoid colon ("hourglass"). We decided emergency surgery and we found evolved acute sigmoid diverticulitis. Local drainage of the abscess and loop colostomy opened over a rod were performed. The abdominal wall abscess as a form of debut of acute complicated diverticulitis is a very uncommon presentation of this pathology. There are few antecedents in the literature about this matter

Otsc clip lost in abdomen 3 years

OTSC is a safe and effective endoscopic method used in the treatment of gastrocutaneous or esophageal fistulas. The authors describe a clinic case which an intraabdominal clip was found 3 years after she was managed with an over-the-scope-clip (OTSC) to repair a gastrocutaneous fistula.In this case, the abdominal pain could be related to a self-limited localized peritonitis that resolved without the need of any medical treatment. Efficacy and safety of over-the-scope clip, including complications after endoscopic submucosal dissection are discussed

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