[Multiple angiodysplasia of the small intestine. A diagnostic and therapeutic challenge]. / Angiodisplasia múltiple de intestino delgado. Un reto diagnóstico y terapéutico.

Small bowel bleeding is infrequent and presents a challenge to the clinician. Approximately 30-40% of gastrointestinal bleeding localized in the small bowel is due to angiodysplasia, a vascular malformation. We present the case of a patient with multiple angiodysplasia of the small bowel who required push enteroscopy and capsule endoscopy to establish the diagnosis. Treatment with subcutaneous octreotide was successful. In conclusion, in doubtful cases or in patients with persistent hemorrhage, capsule endoscopy can improve the diagnostic yield of enteroscopy in bleeding gastrointestinal vascular lesions such as angiodysplasia. Endoscopic treatment (laser coagulation) and drug therapy (somatostatin or analogs) are valid alternatives in inoperable or non-resectable cases.

Resultados de las eventrorrafias con prótesis. A propósito de 168 casos / Results of prosthetic eventration repair. A report of 168 cases

Objetivo. Valorar cuáles son los factores de riesgo de recidiva en las eventrorrafias con prótesis. Pacientes y métodos. Estudio retrospectivo de 168 eventrorrafias con prótesis en las que analizamos los siguientes parámetros: edad, sexo, obesidad, broncopatía, eventrorrafia previa, cirugía programada o de urgencias, datos de la eventración (localización y tamaño), material protésico utilizado, complicaciones en el postoperatorio, recidiva y tiempo de seguimiento. Resultados. Cuarenta y cuatro pacientes (26,2 por ciento) habían sido previamente intervenidos de dicha eventración, 12 (7,14 por ciento) eran obesos y 16 (9,5 por ciento) broncópatas. La localización más frecuente de la eventración era la línea media, y en 135 casos (80,4 por ciento) se realizó cirugía programada. Los pacientes fueron seguidos una media de 75,8 ñ 5,21 meses, presentando recidiva 30 pacientes (17,8 por ciento). En el análisis univariante, las variables que presentaron significación estadística con la recidiva fueron el tamaño de la eventración (p = 0,0443) y las complicaciones locales postoperatorias (p = 0,0063), y en el multivariante las complicaciones locales postoperatorias (p = 0,009). Conclusiones. Es fundamental evitar las complicaciones locales postoperatorias (infección de herida, hematoma o seroma), ya que debilitan la eventrorrafia y predisponen a la recidiva (AU)

[Esophageal perforations. Presentation of 23 cases]. / Perforaciones esofágicas. Presentación de 23 casos.

AIM: Esophageal perforations are the most serious perforations of the digestive tract and their treatment remains controversial. The aim of this study was to analyse the outcome of patients with esophageal perforations given surgical and conservative treatment. PATIENTS AND METHODS: Retrospective study of 23 patients with esophageal perforations, 8 cervical (35%) and 15 thoracic (65%). Medical treatment was indicated in patients who fulfilled Cameron's criteria (minimal signs of clinical sepsis; disruption contained in the mediastinum; drainage of the cavity back into the esophagus; minimal symptoms). The remaining patients underwent surgery. RESULTS: Two patients with cervical perforations (25%) met Cameron's criteria. Evolution after conservative treatment was favourable. The remaining patients (75%) were surgically treated: simple closure of the perforation was performed in four and drainage of the cervical abscess in two. Two of the patients who underwent surgery presented pleural hemorrhage, one of which was associated with pneumonia. Four patients with thoracic perforation (27%) met the criteria for conservative treatment. One presented respiratory distress syndrome during treatment and required intensive care. Evolution was favorable in all. The remaining 11 patients (73%) received surgical treatment: in five (46%) simple closure of the perforation was performed, in three (27%) bipolar exclusion was performed and in the remaining patients, other techniques were used. Morbidity was 82% (nine patients) mainly due to pneumonia and mortality was 46% (five patients). CONCLUSIONS: Treatment of esophageal perforation should be individualized. Conservative treatment should be considered in patients meeting Cameron's criteria as their evolution is favorable, with low morbidity and mortality and surgery is not necessary.