[Recurrent ingestion of foreign bodies and abdominal self-injury as a form of attempted suicide]. / Ingestión reiterada de cuerpos extraños y autoagresiones abdominales como intento de suicidio.

Accidental ingestion of foreign bodies is fairly common in the general population. However, recurrent, deliberate ingestion of foreign bodies associated with continual abdominal self-mutilation with blunt objects is extremely unusual. We present the case of a young woman with an underlying psychiatric disorder who repeatedly presented to the emergency department of our hospital for attempted suicide. The most frequent reason for presenting to the emergency department was ingestion of multiple objects, usually sharp metal objects, frequently associated with abdominal self-mutilation using a sharp instrument. Treatment consisted of extraction of the foreign bodies through upper gastrointestinal endoscopy or abdominal surgery. The patient has survived all these attempts with minimal morbidity.

[Diaphragmatic hernia of Morgagni-Larrey in adults: analysis of 10 cases]. / Hernia diafragmática de Morgagni-Larrey en el adulto: análisis de 10 casos.

Congenital diaphragmatic hernia of Morgagni-Larrey is a rare entity that usually presents on the right side. These hernias, occurring in the anterior midline through the sternocostal hiatus of the diaphragm, are usually discovered incidentally when the patient has reached adulthood, or when they become symptomatic due to intestinal involvement (occlusive symptoms) or when respiratory dysfunction occurs. We present 10 patients (mean age: 69 years) with symptomatic sternocostal hernia and intestinal occlusion. In 7 patients, the hernia was located on the right (Morgagni's hernia) and in three it was located on the left (Larrey's hernia). Most of the patients presented important associated comorbidity, mainly cardiovascular and neoplastic. Surgical treatment consisted of reduction of the contents of the herniated sac and hernia repair through simple suture with or without mesh for reinforcement, mainly through the abdominal approach. Mortality in this series was nil. The infrequency of this entity and its diagnosis mainly in adults, with a high prevalence of circumstances favoring abdominal hernias, suggest that an embryological defect of the sternocostal foramina of Morgagni or Larrey are an essential element in the physiopathology of these processes.

Analysis of the quality of life in patients after pelvic pouch operation.

AIM: The aim of this study is to analyse the quality of life in patients with ileoanal pouch respect to a diverting loop ileostomy. MATERIALS AND METHODS: Fifteen patients (8 women and 7 men) with mean average age of 33 years who underwent mucosal proctectomy, colectomy, ileal-pouch-anal anastomosis and temporary loop ileostomy. Quality of life was studied when the patients had an ileostomy and follow-up evaluation, one year after restitution of anal defecation. The surgeons' evaluation was done using a health scale. RESULTS: Among the patients with temporary ileostomy, 40% reported bad tolerance, 53% leakage of stoma bag and 26% skin problems. The mean stool frequency among ileoanal anastomosis was four per day, 87% reported total continence, 13% had major complications and they needed pouch removal. 67% patients with ileostomy reported dietary restrictions against 13% patients functioning with pelvic pouch (p = 0.004). 13% patients with ileostomy had restricted sport activities. Social activities were restricted for 40% and 26% had limitations in their ability to work. Sex life was affected in 20% of patients with ileostomy and 13% of patients with ileal pouch anastomosis. 73% of patients presented an excellent level of satisfaction with pouch. CONCLUSION: Quality of life after ileoanal pouch anastomosis is higher than ileostomy.

[Cytomegalovirus enteritis and colitis in nonimmunodepressed patients, a primary disease or superinfection?]. / Enteritis y colitis por citomegalovirus en pacientes no inmunodeprimidos, afectación primaria o sobreinfección?

Cytomegalovirus disease is an opportunistic infection that is seen in patients with inmunodeficiencies. The group most commonly affected are AIDS and transplanted patients. Only a few cases of cytomegalovirus disease in non-immunocompromised patients have been reported. In localized disease, the gastrointestinal tract is the most frequently affected. We report two cases of acute abdomen caused by cytomegalovirus enteritis and colitis (histopathological diagnosis) without any underlying immune disorder. The role that the cytomegalovirus infection might play in the development of the clinical manifestations in these two cases is discussed. Without an established immunodeficiency we must be careful to attribute to cytomegalovirus infection the direct responsibility of the lesions. In the reported cases, the existence of intestinal ischemia is more than just a clinical hypothesis and pathological examination is inconclusive. The absence of an immunocompromised state, the presentation as an acute abdomen and the clinical course forwards intestinal occlusion in the first case are not characteristic of cytomegalovirus enteritis and colitis. We conclude that the two reported cases are in fact an ischemic enteritis upon which cytomegalovirus enteritis and colitis was superimposed, an association that has not been reported before.

[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.

Actividad funcional postesplenectomía: valor de la esplenosis espontánea o inducida-autotrasplante / Postsplenectomy functional activity: value of spontaneous plenosis or autotransplantation induced

Se presenta la experiencia de 9 pacientes esplenectomizados y en los que se les practicó autotrasplante y de 29 pacientes también esplenectomizados en que no se les efectuó autotrasplante. Se concluye que la existencia de una actividad esplénica recidival, espontánea o inducida -autotrasplante-, aunque tiende a restablecer algunos de los parámetros del funcionalismo esplénico, no implica la existencia de diferencias significativas en los mismos, con respecto a los pacientes que carecen de esta actividad o ésta es mínima

[Usefulness of transrectal echography in the study of rectal cancer]. / Utilidad de la ecografía transrectal en el estudio del cáncer de recto.

This paper presents the initial results of a study designed to measure the ability of transrectal ultrasonography (TU) in determining the degree of local invasion of rectal cancer, comparing the preoperative radiographic diagnosis with the histological one. The series consists of 30 patients. In 24 cases preoperative TU was performed--following confirmation of the histological diagnosis--and in six cases UT was used after surgery to study the anastomosis. The postoperative group consists of eight males and 16 females, with a mean age of 70; in 14 cases the tumors were located in the lower third of the rectum, and in 10 cases in the middle third. In 12 of these 24 cases, pelvic CAT was also performed. TU showed the correct stage in 17 of the 24 (70.8%), with two false positives and five false negatives. CAT showed the correct diagnosis in 10 out of 12 (83%), with one false positive and one false negative. In the follow-up of the surgical patients, TU was normal in five cases and local recurrence was diagnosed. On the basis of our results, we consider that TU is a method with a high degree of diagnostic reliability in preoperative staging of rectal cancer; it can be associated with CAT; furthermore, it is an important screening method for early diagnosis of local recurrence at the suture line. Its main drawbacks are in studying high and stenosing lesions.

[Appendicular diverticulitis: a review of 5 cases]. / Diverticulitis apendicular: revisión de cinco casos.

Of a total of 3,669 appendectomies, five corresponded to appendicular diverticulosis (0.13%), all of which had an inflammatory pathology. Four patients underwent emergency surgery with a diagnosis of acute appendicitis, and in only one was a correct preoperative diagnosis made. There were three cases of acute primary diverticulitis and one appendicitis with secondary diverticular affectacion. Another patient was operated electively for a history of long evolution; during the surgical act an appendicular inflammatory mass was found that the pathological report described as diverticulitis with subacute periappendicitis. Certain aspects of this entity are remarked and the bibliography is reviewed.

[Immunoglobulins and the complement system in colorectal cancer]. / Inmunoglobulinas y sistema del complemento en el cáncer colorrectal.

In the present paper is studied the concentration in peripheral blood of immunoglobulins IgG, IgA, IgM and factors C3 and C4 of the complement system in a group of 120 patients with colorectal cancer operated on with radical intention. Preoperative values are compared to postoperative results and the values obtained on diagnosis of tumoral recurrence with the object of describing possible immunologic alterations existent in the patient with colorectal carcinoma. It is concluded that there are no significant relations between the biochemical parameters studied and age, sex, tumoral localization and Duke's clinical stages. Patients with pre and postoperative IgA values above normal present a poor prognosis, with an associated recurrence of 60% (p = 0.001) and 80% (p = 0.000), respectively; postoperative C3 levels above normal also represent a factor of poor prognosis, recurrence appearing in 80% (p = 0.001) and metastases in 85% (p = 0.000).