[Current treatment of hepatic trauma]. / Actualización del tratamiento de los traumatismos hepáticos.

The therapeutic and diagnostic approach of liver trauma injuries (by extension, of abdominal trauma) has evolved remarkably in the last decades. The current non-surgical treatment in the vast majority of liver injuries is supported by the accumulated experience and optimal results in the current series. It is considered that the non-surgical treatment of liver injuries has a current rate of success of 83-100%, with an associated morbidity of 5-42%. The haemodynamic stability of the patient will determine the applicability of the non-surgical treatment. Arteriography with angioembolisation constitutes a key technical tool in the context of liver trauma. Patients with haemodynamic instability will need an urgent operation and can benefit from abdominal packing techniques, damage control and post-operative arteriography. The present review attempts to contribute to the current, global and practical management in the care of liver trauma.

Actualización del tratamiento de los traumatismos hepáticos / Current treatment of hepatic trauma

El abordaje diagnóstico y terapéutico del traumatismo hepático (y, por extensión, del traumatismo abdominal) ha evolucionado notablemente en las últimas décadas. El actual manejo conservador (no quirúrgico) de la inmensa mayoría de los traumatismos hepáticos se sustenta en la experiencia acumulada y los óptimos resultados de las múltiples series publicadas hasta la fecha. Se considera que el tratamiento no quirúrgico del traumatismo hepático comporta una tasa general de éxito del 83-100%, con una morbilidad asociada del 5-42%. La estabilidad hemodinámica del paciente determinará la aplicabilidad del tratamiento conservador. Las técnicas de arteriografía y angioembolización constituyen pilares clave en el contexto de un traumatismo hepático. Los enfermos en situación de inestabilidad hemodinámica precisarán una intervención quirúrgica urgente y pueden beneficiarse de técnicas de packing abdominal, damage control y arteriografía perioperatoria. El presente trabajo de revisión pretende aportar una visión general y práctica del manejo del traumatismo hepático a la luz de los conocimientos actuales (AU)

The therapeutic and diagnostic approach of liver trauma injuries (by extension, of abdominal trauma) has evolved remarkably in the last decades. The current non-surgical treatment in the vast majority of liver injuries is supported by the accumulated experience and optimal results in the current series. It is considered that the non-surgical treatment of liver injuries has a current rate of success of 83-100%, with an associated morbidity of 5-42%. The haemodynamic stability of the patient will determine the applicability of the non-surgical treatment. Arteriography with angioembolisation constitutes a key technical tool in the context of liver trauma. Patients with haemodynamic instability will need an urgent operation and can benefit from abdominal packing techniques, damage control and post-operative arteriography. The present review attempts to contribute to the current, global and practical management in the care of liver trauma (AU)

Perforación endoscópica iatrogénica del colon: ¿es posible una opción conservadora?. Respuesta de los autores / Iatrogenic perforation of the colon: could it be a conservative option?. Authors’ reply

No disponible

[Body packer: review and experience in a referral hospital]. / Body packer: revisión y experiencia en un hospital de referencia.

Smuggling of illicit drugs by concealing them within the human body (body packer) is a medical-legal issue that has increased in the last few decades. Physicians, especially those working in the emergency department, should be familiar with the diagnostic and therapeutic management -usually conservative management- of this type of patient and their possible complications. The present article reviews the general concepts and physiopathology associated with transport of packages in the digestive tract and describes the experience of a referral hospital with a protocol specifically designed for these patients.

Body packer: revisión y experiencia en un hospital de referencia / Body packer: review and experience in a referral hospital

El transporte de drogas ilegales en el interior del organismo (body packer) representa un problema médico-legal en claro aumento en las últimas décadas. Los facultativos, especialmente aquellos con actividad en los servicios de urgencias, han de familiarizarse con el manejo diagnóstico y terapéutico ­habitualmente conservador­ de este tipo de pacientes y de sus posibles complicaciones. El presente artículo revisa los conceptos y fisiopatología generales asociados al transporte de paquetes en el tracto digestivo y describe la experiencia de un centro sanitario de referencia con un protocolo específicamente diseñado para estos enfermos (AU)

Smuggling of illicit drugs by concealing them within the human body (body packer) is a medical-legal issue that has increased in the last few decades. Physicians, especially those working in the emergency department, should be familiar with the diagnostic and therapeutic management ­usually conservative management­ of this type of patient and their possible complications. The present article reviews the general concepts and physiopathology associated with transport of packages in the digestive tract and describes the experience of a referral hospital with a protocol specifically designed for these patients (AU)

[Laparoscopic adrenalectomy for suspected isolated adrenal metastasis]. / Adrenalectomía laparoscópica por sospecha de metástasis adrenal solitaria.

INTRODUCTION: Isolated adrenal metastasis is uncommon. Both resection and the laparoscopic approach in this entity are controversial. The aim of this study was to evaluate the indications, diagnosis and utility of laparoscopic adrenalectomy (LA) in patients with isolated adrenal metastasis. PATIENTS AND METHOD: A prospective study was conducted in patients with current or previous tumoral disease and with isolated adrenal metastasis. RESULTS: Sixteen patients, with a mean age of 58 years, were selected. Fifteen LA were performed (one patient was found to have an inoperable tumor at surgery). Histopathological analysis revealed non-tumoral disease in two patients. The most common metastatic disease was non-small cell lung carcinoma (NSCLC) (10 patients), followed by colorectal cancer metastasis (two patients). The mean tumor size was 4.7 cm and was 3.8 cm on computed tomography (p = 0.09). The disease-free interval (DFI) in the NSCLC group was shorter than that in the remaining tumors (p = 0.17). The mean length of follow-up was 39 months, with a mean survival of 39.7 months. The mean actuarial survival at 2 and 5 years was 61% and 17%. At the end of the study, five patients were alive: two were disease free, one had recurrent disease, one had margin involvement and one was awaiting resection of the primary tumor. Eight patients died. One patient survived 9 years after surgery. CONCLUSIONS: LA for metastasis can be performed without oncological disadvantage and should be offered to patients with resectable disease, a DFI > 6 months, and a tumoral size that allows laparoscopic resection.

Adrenalectomía laparoscópica por sospecha de metástasis adrenal solitaria / Laparoscopic adrenalectomy for suspected isolated adrenal metastasis

Introducción. La metástasis adrenal solitaria es una afección infrecuente y su resección resulta controvertida. Asimismo, se discute su abordaje laparoscópico. El objetivo de este estudio es evaluar las indicaciones, el diagnóstico y la utilidad de la adrenalectomía laparoscópica (AL) en pacientes con metástasis adrenal solitaria. Pacientes y método. Se realizó un estudio prospectivo en pacientes con enfermedad tumoral actual o previa y con metástasis adrenal solitaria. Resultados. Se seleccionó a 16 pacientes, con una media de edad de 58 años. Se practicaron 15 AL (un caso resultó irresecable); 2 pacientes presentaron histopatología no tumoral. La enfermedad metastásica más frecuente fue el carcinoma pulmonar de no células pequeñas (CPNCP) (10 casos), seguido de la metástasis de carcinoma colorrectal (2 casos). El tamaño tumoral medio fue de 4,7 cm, y en la tomografía computarizada fue de 3,8 cm (p = 0,09). El intervalo libre de enfermedad (ILE) en el grupo con CPNCP fue menor que para las demás tumoraciones (p = 0,17). El tiempo medio de seguimiento fue de 39 meses, con una supervivencia media de 39,7 meses. La supervivencia actuarial media a los 2 y a los 5 años fue del 61 y el 17%. Al finalizar el estudio, 5 pacientes permanecen vivos: 2 libres de enfermedad, 1 con recurrencia metastásica, 1 con márgenes afectos y 1 pendiente de resección del tumor primario. Fallecieron 8 pacientes. Un paciente sobrevivió 9 años tras la cirugía. Conclusiones. La adrenalectomía laparoscópica por metástasis puede realizarse sin ninguna desventaja oncológica y se debe ofrecerla a pacientes con enfermedad resecable, ILE > 6 meses y un tamaño tumoral resecable mediante esta técnica (AU)

Introduction. Isolated adrenal metastasis is uncommon. Both resection and the laparoscopic approach in this entity are controversial. The aim of this study was to evaluate the indications, diagnosis and utility of laparoscopic adrenalectomy (LA) in patients with isolated adrenal metastasis. Patients and method. A prospective study was conducted in patients with current or previous tumoral disease and with isolated adrenal metastasis. Results. Sixteen patients, with a mean age of 58 years, were selected. Fifteen LA were performed (one patient was found to have an inoperable tumor at surgery). Histopathological analysis revealed non-tumoral disease in two patients. The most common metastatic disease was non-small cell lung carcinoma (NSCLC) (10 patients), followed by colorectal cancer metastasis (two patients). The mean tumor size was 4.7 cm and was 3.8 cm on computed tomography (p = 0.09). The disease-free interval (DFI) in the NSCLC group was shorter than that in the remaining tumors (p = 0.17). The mean length of follow-up was 39 months, with a mean survival of 39.7 months. The mean actuarial survival at 2 and 5 years was 61% and 17%. At the end of the study, five patients were alive: two were disease free, one had recurrent disease, one had margin involvement and one was awaiting resection of the primary tumor. Eight patients died. One patient survived 9 years after surgery. Conclusions. LA for metastasis can be performed without oncological disadvantage and should be offered to patients with resectable disease, a DFI > 6 months, and a tumoral size that allows laparoscopic resection (AU)