Current management of colonic volvulus. Results of a treatment protocol.

Colonic volvulus affects mainly the geriatric population and is associated with a high number of complications when treated by emergency surgery. The development of alternative methods has replaced and reduced the number of traditional surgical procedures. We present the results of treatment of colonic volvulus in a surgical service in Alicante, Spain. Between 1993 and 1997 a total of 17 cases in 15 patients were diagnosed, 16 in the sigmoid colon and 1 in the cecum. In 9 (60%) patients endoscopic devolvulation was successful. In 2 (22%) of these patients the problem recurred, and was resolved by a second endoscopic treatment. Three patients (20%) required surgery, and 3 others (20%) were treated with radiological reduction (barium enema) and rectal catheter. The average hospital stay of patients treated with endoscopy and barium enema was 2-3 days, being 7 days in patients who underwent surgery. Management with endoscopy is initially effective in most cases of volvulus of the sigmoid colon. This procedure affords decompression and adequate preparation of selected patients for surgical resection, which is the treatment of choice and provides the greatest guarantee against subsequent recurrence.

[Management of colostomies with plug: clinical aspects and patient evaluation]. / Manejo de las colostomías mediante obturador: aspectos clínicos y evaluación de los pacientes.

AIM: To assess the effectiveness of the one-piece disposable plug device Conseal (Coloplast A/S, Espergaerd, Denmark) in colostomy patients, considering clinical and social aspects. PATIENTS AND METHODS: Twenty patients with definitive (perineal-abdominal amputation 17 cases) or transitory (Hartmann in 3 cases) colostomy were studied prospectively. No patient used self-irrigations. All of them completed the study. After obtaining the patient's consent, we analyzed for comfort, leaks, security, easy handling and skin conditions by means of personal interview and clinical examination. RESULTS: Sixteen patients (80%) had previously used conventional colostomy bags, 4 (20%) started to use the plug device during the postoperative period (average 8.7 days). Fifteen patients (75%) preferred to use the plug, whereas 5 (25%) considered the plug was insecure. CONCLUSIONS: Our study suggests that the one-piece disposable plug device improves the quality of life in patients with colostomy, although adequate selection of patients and previous training are mandatory.

[Hepatocarcinoma: a rare form of presentation]. / Hepatocarcinoma: forma infrecuente de presentación.

A case of acute abdomen presenting with pain in the right upper abdomen, pyrexia and leukocytosis is presented. At laparotomy, hepatocarcinoma with necrosis and associated acute cholecystitis was found. This is apparently an unusual report of hepatocarcinoma presenting as acute cholecystitis.