Seat belt-induced intestinal perforation.

OBJECTIVE: To determine whether a relationship exists between bowel perforation and seat belt use in patients presenting abdominal trauma after traffic accidents. EXPERIMENTAL DESIGN: We prospectively studied every patient admitted to the emergency room with abdominal trauma after a traffic accident. PATIENTS AND METHODS: We included every patient diagnosed (clinically, by ultrasound or computerized tomography or at laparotomy) as suffering intraabdominal injury. The degree of trauma was classified according to the Injury Severity Score, taking into account the number of abdominal injuries associated with mortality and seat belt use. RESULTS: A total of 146 patients were studied. The spleen was the most frequently injured organ (n = 56). The mean Injury Severity Score was 19. Head injuries were more common among patients not wearing the seat belt. Thirteen cases of bowel perforation in patients who had been using the seat belt (p < 0.0001) were observed. CONCLUSION: Seat belt use can decrease the mortality rate associated with traffic accidents. However, a significant increase exists in the incidence of bowel perforations among seat belt wearers, probably as a result of improper use.

[Low digestive hemorrhage caused by amebic colitis]. / Hemorragia digestiva baja por colitis amebiana.

Amebiasis is an infectious disease produced by Entamoeba histolytica, which has invasion capacity of the colon mucosa. It has different clinical forms, varying from the asymptomatic carrier state to severe, although not frequent, fulminant or necrotizing colitis, with an important necrosis of the colon mucosa. Perforation or intestinal bleeding are possible. We report one case of patient who had a history of recent travel to India. Was admitted with a clinical picture of abdominal pain, diarrhea and fever. Initially he received treatment with Metronidazole and steroids, because of doubts in the endoscopy diagnosis of Crohn's Disease versus Amebic Colitis. The patient developed a fulminant colitis, that required emergency surgery because of lower intestinal massive bleeding. During the operation perforations of the caecum and rectum were found. We performed a total colectomy with ileostomy and closing of the stump rectal. Six months later a second operation was made for the reconstruction of the intestinal continuity by an ileal pouch and rectal anastomosis.

[Retractile mesenteritis. Report of 3 cases]. / Mesenteritis retráctil. A propósito de tres casos.

Mesenteric panniculitis is an infrequent pathology; the diagnosis is made by the pathologist and it is characterized by inflammation, fibrosis and retraction of the mesenteric fat. We report three new cases of retractile mesenteritis or mesenteric panniculitis, two cases presented with intestinal obstruction and the other had an abdominal tumour. In all cases the pathological diagnosis was retractile mesenteritis.

[Synchronous colonic and rectal carcinomas]. / Carcinomas sincrónicos de colon y recto.

We present a retrospective study of 360 patients with surgically treated colorectal neoplasm between 1982 and 1990, in order to determine the incidence of synchronous colorectal carcinomas; and to analyze diagnosis procedures, detection time, pathology and treatment strategies. The incidence of synchronous carcinomas was 5.5% (20 cases). Only 30% of them were diagnosed preoperatively, and up to 40% were discovered in the pathological examination. In 2 patients 3 synchronous tumors were well found. All the synchronous neoplasms were differentiated, 65% of them were Dukes stage A. Synchronous colorectal polyps were found in 80% of patients. Complete exploration of the colon preoperatively by a routine pan-colonoscopy is recommended. In regard to the treatment of patients with synchronous colorectal carcinomas, partial colectomies are indicated as long as oncological criteria are followed, and the colon had been fully explored.

[Retroperitoneal hematoma secondary to anticoagulation treatment as a cause of abdominal pain]. / Hematoma retroperitoneal secundario a tratamiento anticoagulante como causa de dolor abdominal.

Retroperitoneal haematoma during anticoagulant therapy is a rare cause of abdominal pain. Over the past five years, five cases of retroperitoneal haemorrhage, two of them due to heparin and three to oral anticoagulant, were diagnosed in our hospital. All patients presented with abdominal pain and a mass. The authors conclude that a high degree of suspicion is mandatory when patients on anticoagulant therapy present with abdominal pain.