Protocol of a clinical trial on the effectiveness of pudendal nerve block with and without neurostimulation in reducing posthemorroidectomy pain.

INTRODUCTION: Hemorrhoidal pathology is the most frequent proctological problem with a prevalence of 44% of the adult population. The most effective treatment is surgery but it also has the highest postoperative pain rate with moderate to severe pain rates of 30-40% during the first 24-48 hours. Here lies the importance of seeking measures to improve this situation, such as the pudendal nerve block with local anesthetic. However, the variability of the pudendal nerve sometimes makes its blockade ineffective and for this reason nerve location methods are sought to achieve a higher rate of success. The main aim of the study is to compare pain in the immediate postoperative period (24 h) after hemorrhoidectomy in patients with pudendal nerve block guided by anatomical references and guided by neurostimulation. METHODS: The present project proposes the performance of a single-center, triple-blind, randomized clinical trial of efficacy, carried out under conditions of routine clinical practice. Patients over 18 years old with hemorrhoids refractory to medical treatment, symptomatic grade III-IV and grade II hemorrhoids that do not respond to conservative procedures in a third level hospital in Spain and that are subsidiaries of surgery in major ambulatory surgery will be included. Demographic variables, variables on hemorrhoidal pathology, details of surgery, verbal numeric pain scale in the preoperative period and surgical complications will be collected. RESULTS: Not avaliable until the end of the study. CONCLUSIONS: The pudendal nerve block guided by anatomical landmarks has been shown to be useful in postoperative pain control after hemorrhoidectomy although the use of the neurostimulator has not been well studied and we believe it may improve outcom.

Pileflebitis: Complicación infrecuente de la colecistitis aguda / Pylephlebitis: rare complication of acute cholecystitis

Presentamos un caso de pileflebitis secundaria a colecistitis aguda en una mujer de 79 años que presentaba dolor en HCD de 3 días de evolución. La trombosis séptica de la vena porta, también llamada pileflebitis, es una complicación infrecuente de procesos infecciosos intraabdominales, generalmente secundaria a procesos supurativos en su área de drenaje, considerándose la diverticulitis aguda la causa más frecuente. Se trata de una entidad con una alta tasa de mortalidad que a pesar de nuevos antibióticos y anticoagulantes se mantiene en torno al 35% (AU)

We report a case of pylephlebitis secondary acute cholecystitis in woman of 79 who had pain in HCD of 3 days duration. Septic thrombosis of the portal vein, also called pylephlebitis, is a rare complication of intra-abdominal infectious processes, usually secondary to suppurative processes in its drainage area, acute diverticulitis considered the most common cause. It is an entity with a high mortality rate despite new antibiotics and anticoagulants remains at around 35% (AU)

Íleo biliar colónico secundario a fístula colecitocolónica / Colonic gallstone ileus secondary a cholecystocolonic fistula

Presentamos un caso de ileo biliar colónico secundario a fístula colecistocolónica en una mujer de 76 años con clínica de obstrucción intestinal. Se denomina íleo biliar a la obstrucción mecánica del intestino delgado o del colon como consecuencia del paso de una o más litiasis a través de una fístula biliodigestiva. Únicamente entre 1-15 % de estas fístulas producen cuadro de obstrucción intestinal siendo la más frecuente la colecistoduodenal (65-77%) (AU)

We report a case of colonic gallstone ileus secondary a cholecystocolonic fistula. An 76-years-old woman was admitted to the hospital because she had been symptoms of intestinal obstruction. Colonic gallstone ileus is a rare cause of mechanical large bowel obstruction. It occurs most commonly of a passage of one or more stones through biliodigestive fistula. Only between 1-15% of these fistulas pruduce bowel obstruction. The most frequent fistula is cholecystoduodenal (65-77%) (AU)