Pelvic actinomycosis secondary to intrauterine device.

Actinomycosis is a rare bacterial infection causing lesions and abscesses, often mimicking tumors. It commonly affects the cervicofacial, abdominal, and thoracic regions. We present a case of a woman with an intrauterine device (IUD) who developed an abscess and abdominal symptoms. Initial studies suggested a tumor, but biopsy revealed inflammation. Subsequently, she was diagnosed with Actinomyces Israelii infection, her IUDwas removed, and she was treated with penicillin, resulting in improvement. Pelvic actinomycosis is uncommon and often diagnosed late, often post-surgery, requiring combined surgical and medical treatment.

Burkitt's lymphoma in the adult as an unusual cause of large bowel obstruction.

Bowel obstruction is an uncommon clinical presentation in Burkitt´s lymphoma, specially in adults. This type of lymphoma is classified within B-cell non-Hodgkin´s lymphomas, which is characterized by its aggressiveness and quickly tumoral growth. The clinical presentation related to the gastrointestinal tract is unusual, but it can be presented as intussusception, obstruction or ischemic perforation. Here we describe a case of Burkitt´s lymphoma with bowel obstruction as a clinical debut.

Atraumatic splenic rupture secondary to appendicular perforation by cecal volvulus.

Atraumatic splenic rupture, an infrequent surgical emergency, constitutes a life-threatening situation. The lack of a traumatic background makes it difficult to suspect. We present a case of a 45-year-old woman, with history of bariatric surgery, referred to our emergency due to 3 weeks long abdominal and lumbar pain, in shock. Imaging diagnosis of splenic rupture, emergent surgery was performed with atypical findings and good evolution. The bibliographic review, background and surgical findings allowed to postulate causality in this unusual presentation. Despite its low frequency, this pathology involves significant mortality and must be present in the patient in shock in the emergency room.

La rotura esplénica atraumática, una emergencia quirúrgica infrecuente, constituye una situación de riesgo vital. La falta de antecedente traumático dificulta su sospecha. Presentamos el caso de una mujer de 45 años, con antecedente de cirugía bariátrica, remitida a nuestro servicio de urgencias por dolor abdominal y lumbar de 3 semanas, en shock. Con el diagnóstico imagenológico de rotura esplénica, se realizó cirugía emergente, con hallazgos atípicos, y la paciente tuvo una buena evolución. La revisión bibliográfica, los antecedentes y los hallazgos quirúrgicos permitieron postular la causalidad en esta inusual presentación. Pese a su poca frecuencia, esta patología comporta una mortalidad importante y debe tenerse presente ante un paciente en shock en la sala de urgencias.

[Crossed renal ectopia in a patient with a complicated sigma neoplasia]. / Ectopia renal cruzada en un paciente con neoplasia de sigma complicada.

BACKGROUND: Crossed renal ectopia is a rare pathology that is often asymptomatic. Intraoperative detection with a sigma complicated neoplasia is more infrequent and requires correct management to avoid a renal ureteral injury. AIM: To present a case report of a patient with a sigma complicated neoplasia and a crossed renal ectopia detected incidentally. CASE REPORT: We present the case of a 62-year-old man that was submitted for emergency surgery for a sigma perforated neoplasm, and who presented with a previously undiagnosed left-side CRE. During surgery there was a need to insert 2-double-J stents as a guide to both ureters and to avoid any injury to them. DISCUSSION: Crossed renal ectopia is a rare, often asymptomatic entity, the diagnosis of which is usually incidental. In our case, the detection of a concomitant complicated neoplasm, required identification of both ureters due the anatomic doubt of its localization and to avoid them being injured. In conclusion, upon finding a casual crossed renal ectopia during an emergency surgery of sigma, we recommend the identification of the ureters to facilitate its location and to avoid any injury to the ureters.

Reparación de roturas del ligamento cruzado anterior con sistema aperfix / Anterior cruciate ligament reconstruction with the aperfix system

Introducción: la reconstrucción del Ligamento Cruzado Anterior (LCA) con isquiotibiales resistiría 1216 N, con una pérdida extensora de sólo un 3%. Nuestro objetivo es revisar nuestra experiencia con este procedimiento con el sistema Aperfix®. Material y métodos: Estudio observacional, descriptivo y retrospectivo. Tamaño muestral de 224 casos, seguimiento mínimo de 12 meses. Analizamos entre otros: filiación, movilidad, R.N.M., tiempo quirúrgico y escala Lysholm. Analizamos diferencias estadísticas entre el abordaje femoral desde el portal anteromedial o desde el túnel tibial, mediante los test t de Student, U de Mann Whitney y Chi Cuadrado, con S.P.S.S. 20.0. Resultados: Edad media de 36.5 ± 8.7 años, Lachmann previo en el 96.8% y Pívot Shift previo positivo en el 51.4%, lesiones meniscales asociadas en el 73.8%. Tiempo quirúrgico: 87.1± 18.9 minutos, Lachmann postquirúrgico en el 17.4% y Pívot Shift negativo en el 98.9%. Flexión final de 128.1 ± 5.2°, 95.8 ± 7 puntos de escala final de Lysholm. Complicaciones en el 11%. Altas por mejoría en el 98.9%. No hallamos diferencias significativas entre ambas formas de realización del túnel femoral. Sólo con respecto al tiempo quirúrgico, p=0.004, siendo éste algo mayor cuando se realizada desde el portal anteromedial. Conclusiones: En nuestra experiencia, la ligamentoplastia con el sistema Aperfix® mejora la escala Lysholm, con escasas complicaciones y buen resultado funcional. No hallamos grandes diferencias en cuanto a la realización del túnel femoral, sólo un mayor tiempo quirúrgico cuando se realiza desde el portal anteromedical.

Introduction: reconstruction of the anterior cruciate ligament (A.C.L.) with hamstring grafts would resist 1216 N, with an extensor loss of only 3%. Our goal is to review our experience with this procedure with the Aper x® system. Material and methods: Observational, descriptive and retrospective study. Sample size of 224 cases, minimum followup of 12 months. We analyzed among others: liation, mobility, M.R.I., surgical time and Lysholm’s scale. We analyzed statistical differences between femoral approach from anteromedial portal or from tibial tunnel, using the Student t, Mann Whitney U and Chi Square tests, with S.P.S.S. 20.0. Results: Mean age was 36.5 ± 8.7 years, Lachmann’s test previous surgery was positive in 96.8% and Pivot Shift in 51.4%. There were associated meniscal injuries in 73.8%. Surgical time was 87.1 ± 18.9 minutes. Post-surgical Lachmann’s test was positive at 17.4% and post-surgical Pivot Shift was negative at 98.9%. Final exion was 128.1 ± 5.2°, with 95.8 ± 7 points at Lysholm’s scale. There were complications in 11%. 98.9% of patients returned to their previous jobs. We did not nd signi cant differences between both forms of femoral tunneling. Only with respect to surgical time, p = 0.004, it was longer for cases operated by means of anteromedial portal. Conclusions: In our experience, ligamentoplasty with the Aper x® system improves Lysholm’s scale, with a few complications and good functional outcome. We do not nd great differences in performance of femoral tunnel, only a longer surgical time when it was performed from the anteromedial portal.