Fallo hepático posthepatectomía y fístula biliar: manejo multidisciplinar a propósito de un caso / Liver failure posthepatectomy and biliary fistula: multidisciplinar treatment

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Liver failure posthepatectomy and biliary fistula: multidisciplinar treatment.

The main cause of morbimor-mortality after major liver surgery is the development of liver failure posthepatectomy(LFPH). Treatment must involve multiple options and will be aggressive from the beginning. We report a case of a patient with cholangiocarcinoma perihilar treated with surgery: right hepatectomy extended to sI + IVb with develop of LFPH and biliary fistula and being management successfully in a multidisciplinary way.

Complicaciones quirúrgicas en los body-packers: una urgencia infrecuente pero potencialmente letal / Surgical complications in drug body-packers: an uncommon but potentially lethal emergency

Introducción: El tráfico de drogas mediante la introducción de paquetes de sustancias ilícitas en cavidades corporales supone un riesgo de padecer una obstrucción gastrointestinal y/o intoxicación grave para la persona que las trasporta. Nuestro país está considerado como puerta de entrada a Europa para drogas, y algunos hospitales españoles tienen experiencia en el manejo de este tipo de pacientes. Dos hospitales en Madrid, entre ellos el Hospital General Universitario Gregorio Marañón (HGUGM), reciben estos potenciales pacientes desde el aeropuerto de Barajas. Objetivo Analizar los resultados del tratamiento conservador y de la necesidad de cirugía en los body-packers. Métodos Estudio retrospectivo observacional de pacientes ingresados entre enero de 2000 y diciembre de 2008 con el diagnóstico de body-packer. Son ingresados en la Unidad de Custodiados de nuestro centro aquellos con síntomas gastrointestinales, signos de intoxicación o tóxicos positivos. El (..) (AU)

Introduction: Drug flicking by means of introducing packets of illegal substances in body cavities carries a risk of suffering from a gastrointestinal obstruction and/or severe poisoning in the person who transports them. Spain is considered as the port of entry to Europe for drugs, and some Spanish hospitals have experience in managing these types of patients. Two hospitals in Madrid, including the Gregorio Marañón University General Hospital(HGUGM), received these potential patients from the Madrid Barajas airport. Objective: To analyse the results of the conservative treatment and the need for surgery in ‘‘body-packers’’. Material and methods: A retrospective, observational study of patients diagnosed as a body packer between January 2000 and December 2008. Those with gastrointestinal symptoms, signs of poisoning, or positive for drugs of abuse, were admitted to the Custodial Unit of our hospital. The conservative treatment consisted of digestive rest and imaging studies until expulsion from the body. Asymptomatic patients were discharged from the Emergency Department. Results: A total of 549 patients, with a median age of 31 years, and of whom 81% were males, were hospitalised during this period. Less than half (40%) showed positive for drugs in the urine, with cocaine in 80% of the cases (..) (AU)

[Surgical complications in drug body-packers: an uncommon but potentially lethal emergency]. / Complicaciones quirúrgicas en los body-packers: una urgencia infrecuente pero potencialmente letal.

INTRODUCTION: Drug trafficking by means of introducing packets of illegal substances in body cavities carries a risk of suffering from a gastrointestinal obstruction and/or severe poisoning in the person who transports them. Spain is considered as the port of entry to Europe for drugs, and some Spanish hospitals have experience in managing these types of patients. Two hospitals in Madrid, including the Gregorio Marañón University General Hospital (HGUGM), received these potential patients from the Madrid Barajas airport. OBJECTIVE: To analyse the results of the conservative treatment and the need for surgery in "body-packers". MATERIAL AND METHODS: A retrospective, observational study of patients diagnosed as a body-packer between January 2000 and December 2008. Those with gastrointestinal symptoms, signs of poisoning, or positive for drugs of abuse, were admitted to the Custodial Unit of our hospital. The conservative treatment consisted of digestive rest and imaging studies until expulsion from the body. Asymptomatic patients were discharged from the Emergency Department. RESULTS: A total of 549 patients, with a median age of 31 years, and of whom 81% were males, were hospitalised during this period. Less than half (40%) showed positive for drugs in the urine, with cocaine in 80% of the cases. Of the 549 patients with initial conservative treatment, 27 (4.9%) had serious complications (16, bowel obstruction, and 11 with signs of poisoning). Of these, 23 required surgery (the 16 obstructions and 7 of the poisonings); 2 were successfully treated in ICU, and 2 died before surgery (0.4%) of the cases. The most frequent surgical treatment was enterotomy and/or gastrostomy to extract the packets. Thirteen (56%) of those operated on had associated morbidity (11 abdominal infections and 2 nosocomial infections). CONCLUSIONS: Conservative treatment is safe in 95% of the patients. A small percentage required surgical treatment, basically for gastrointestinal obstruction or severe poisoning.

[Lumbar abscess secundary to retained gallstones]. / Absceso Lumbar Secundario a Colelitiasis Retenida.

Lost gallstones after accidental opening of the gallbladder during cholecystectomy usually under laparoscopy, can cause late complications. Intra-abdominal abscess is the most frequent and the diagnosis is based on imaging techniques (abdominal ultrasound or computed tomography scan). Surgical drainage with gallstones removal seems to be the best approach, due to the fact that a simple percutaneous drainage has a high failure rate. However, a posterior abdominal wall abscess as the initial manifestation of intra-abdominal abscess due to retained gallstones is uncommon, and this prompted us to report this case.

Absceso lumbar secundario a colelitiasis retenida / Lumbar abscess secundary to retained gallstones

Los cálculos abandonados tras apertura accidental durante una colecistectomía, generalmente laparoscópica, pueden producir complicaciones tardías, siendo el absceso intraabdominal la más frecuente. El diagnóstico se basa en la prueba de imagen (ecografía/tomografía computerizada), siendo el drenaje y la extracción quirúrgica de los cálculos la mejor opción terapéutica, ya que el drenaje percutáneo presenta una elevada tasa de fracasos. Sin embargo, el absceso en pared abdominal posterior como manifestación inicial de un absceso intraabdominal debido a colelitiasis retenida es poco frecuente, por lo que reportamos este caso.

Lost gallstones after accidental opening of the gallbladder during cholecystectomy usually under laparoscopy, can cause late complications. Intra-abdominal abscess is the most frequent and the diagnosis is based on imaging techniques (abdominal ultrasound or computed tomography scan). Surgical drainage with gallstones removal seems to be the best approach, due to the fact that a simple percutaneous drainage has a high failure rate. However, a posterior abdominal wall abscess as the initial manifestation of intra-abdominal abscess due to retained gallstones is uncommon, and this prompted us to report this case.