Acute upper gastrointestinal bleeding secondary to aortoesophageal fistula. Endoscopic treatment using the over-the-scope clip (OTSC®) system.

Aortoesophageal fistula is an extremely rare cause of upper gastrointestinal bleeding associated with high morbidity and mortality. Early clinical suspicion, as well as correct management since diagnosis, can increase the probability of survival of this gastrointestinal emergency. We present the first case reported of an aortoesophageal fistula successfully treated with the OTSC system, representing another therapeutic option for this high-risk entity.

Enfermedad de Forestier-Rotes-Querol (hiperostosis esquelética idiopática difusa) / Forestier Rotes-Querol disease (diffuse idiopathic skeletal hyperostosis)

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Laparoscopic treatment of large bowel obstruction due to a self-locating peritoneal dialysis catheter.

INTRODUCTION: Peritoneal dialysis has been used in the treatment of end-stage renal disease for a long time. The development of continuous ambulatory peritoneal dialysis (CAPD) has achieved an acceptable device of renal replacement therapy. PRESENTATION OF CASE: We report a 55 year-old patient who was initiated on CAPD in February 2016. Three months later, the Tenckhoff catheter was removed due to its malfunction, and a new self-locating peritoneal dialysis catheter was placed in the left side of the abdomen. In September 2016, the patient presented with symptoms of intestinal obstruction. A CT scan revealed a collapsed sigmoid colon with the tungsten tip of the catheter supported on the mesosigmoid as the cause of the occlusion. DISCUSSION: Herein, a rare but clinically important case of mechanical large bowel obstruction due to self-locating peritoneal dialysis catheter is presented. The weight added to the tip of the self-locating catheter for the purpose of stretching it, can be dangerous if a displacement takes place. A laparoscopic procedure was performed, resolving the obstruction by reinserting the peritoneal catheter in its right position. CONCLUSION: The weight added to the tip of self-locating catheters is a matter of concern, since intimate contact between the peritoneal catheter and the intestinal wall can result in perforation or intestinal occlusion.

[Integral management of the process of laparoscopic cholecystectomy]. / Gestión integral del proceso de colecistectomía laparoscópica.

INTRODUCTION: One of the most important objectives of public healthcare services is to guarantee integral healthcare to patients; activity is currently focussed on process management. Analysis of a "key" process could have health, social and economic effects if measures to improve the results are designed. The aim of the present study was to evaluate the process of laparoscopic cholecystectomy in our hospital in order to determine its strong and weak points. MATERIAL AND METHOD: We performed a prospective observational study of the laparoscopic cholecystectomy (LC) process in the Jarrio Hospital between January 2001 and December 2002. A working group was formed and a process flowchart was designed by consensus. The different steps of the process were evaluated through the main indicators of quality: accessibility, efficiency, and effectiveness, including cost, the convalescence period, and patient satisfaction. The results were compared with the standards defined by the Andalusian Health Council, bibliographic sources, and hospital commissions. The statistical analysis was performed with 95% confidence intervals of the main results. RESULTS: A series of 86 patients who underwent LC was evaluated. The results for accessibility showed wide variability in delays for specialist consultations, the waiting list for surgery, and urgent diagnostic tests, often exceeding the standards. The laparoscopic approach was more frequent than open cholecystectomy; morbidity and mortality with LC were below the reference standards and compliance with established prophylaxis protocols was close. The efficiency markers showed that the length of hospital stay for elective LC was close to the standard; however, for cholecystitis preoperative length of stay was longer than the standard. Overall patient satisfaction with medical care and non-medical services was high. CONCLUSIONS: Quality analysis of a process allowed us to identify strong points such as the high rate of laparoscopic cholecystectomy -showing good effectiveness and efficiency- the quality of informed consent, and patient satisfaction. Required improvements consisted of shortening preoperative length of stay in acute cholecystitis and waiting lists, informing patients about the length of the convalesce period, eliminating routine type and screen, and admitting patients on the day of surgery.

Gestión integral del proceso de colecistectomía laparoscópica / Integral management of the process of laparoscopic cholecystectomy

Introducción. Entre los objetivos básicos de la sanidad pública está garantizar la atención integral al paciente, y centrar la actividad en la gestión por procesos. El análisis de un proceso "clave" podría tener un efecto tanto desde el punto de vista sanitario como social y económico si se desarrollan medidas encaminadas a mejorar los resultados. El objetivo de este trabajo es el análisis del proceso de colecistectomía laparoscópica (CL) en nuestro hospital para determinar sus puntos fuertes y sus posibilidades de mejora. Material y método. Se realiza un estudio observacional y prospectivo del proceso de CL durante el período enero 2001-diciembre 2002. Mediante consenso de un grupo de trabajo se elaboró un diagrama de flujo y se realizó la evaluación de la gestión median-te indicadores de calidad: accesibilidad, eficiencia, efectividad, incluyendo el coste, la baja laboral y la satisfacción del paciente. Se consideraron como estándares los definidos por la Consejería de Salud de la Junta de Andalucía, los aceptados en bases bibliográficas y técnicas de grupo. Se exponen los intervalos de confianza del 95% de los resultados más relevantes. Resultados. Se evaluó a 86 pacientes intervenidos mediante CL. Existe variabilidad en la espera para la consulta, para la realización de cirugía y pruebas diagnósticas de urgencia, que exceden los estándares. La CL ha predominado sobre la cirugía abierta con tasas de morbimortalidad por debajo de los estándares y elevada adhesión a los protocolos de profilaxis. La estancia de la CL programada se aproxima mucho al objetivo, mientras que en la urgente las estancias preoperatorias son más elevadas de lo aceptable. En la satisfacción del paciente la puntuación global ha sido alta en los aspectos médicos y no médicos. Conclusiones. Destacan como puntos fuertes el elevado índice de cirugía laparoscópica, con una alta efectividad y eficiencia, la calidad del consentimiento informado y la satisfacción global de los pacientes. Como posibilidades de mejora: la demora en la cirugía de la colecistitis aguda, la priorización de las listas de espera, la orientación sobre el tiempo de baja laboral, suprimir el type-screen y la implantación del ingreso en el día (AU)

Introduction. One of the most important objectives of public healthcare services is to guarantee integral healthcare to patients; activity is currently focussed on process management. Analysis of a "key" process could have health, social and economic effects if measures to improve the results are designed. The aim of the present study was to evaluate the process of laparoscopic cholecystectomy in our hospital in order to determine its strong and weak points. Material and method. We performed a prospective observational study of the laparoscopic cholecystectomy (LC) process in the Jarrio Hospital between January 2001 and December 2002. A working group was formed and a process flowchart was designed by consensus. The different steps of the process were evaluated through the main indicators of quality: accessibility, efficiency, and effectiveness, including cost, the convalescence period, and patient satisfaction. The results were compared with the standards defined by the Andalusian Health Council, bibliographic sources, and hospital commissions. The statistical analysis was performed with 95% confidence intervals of the main results. Results. A series of 86 patients who underwent LC was evaluated. The results for accessibility showed wide variability in delays for specialist consultations, the waiting list for surgery, and urgent diagnostic tests, often exceeding the standards. The laparoscopic approach was more frequent than open cholecystectomy; morbidity and mortality with LC were below the reference standards and compliance with established prophylaxis protocols was close. The efficiency markers showed that the length of hospital stay for elective LC was close to the standard; however, for cholecystitis preoperative length of stay was longer than the standard. Overall patient satisfaction with medical care and non-medical services was high. Conclusions. Quality analysis of a process allowed us to identify strong points such as the high rate of laparoscopic cholecystectomy ­showing good effectiveness and efficiency­ the quality of informed consent, and patient satisfaction. Required improvements consisted of shortening preoperative length of stay in acute cholecystitis and waiting lists, informing patients about the length of the convalesce period, eliminating routine type and screen, and admitting patients on the day of surg (AU)