[Diverticular duodenal disease as incidental finding with computer tomography]. / La enfermedad diverticular duodenal como hallazgo incidental detectado por tomografía computarizada.

BACKGROUND: Duodenal diverticular disease is a frequent condition but clinical diagnosis can be chalenging. Less than 10% of the cases are symptomatic and symptoms are vague. Only between 1% to 2% will require surgical treatment. OBJECTIVE: To establish the prevalence of duodenal diverticulum (Dd) in patients who underwent abdominal computed tomography (CT). METHODS: A retrospective review of all cases with Dd identified incidentally during abdominal CT scan was performed. Clinical data regarding type, location, differential diagnosis and complications were recorded. RESULTS: During the study period 12,704 abdominal CT scans were performed and 50 patients with Dd were identified (prevalence 0.46%). Thirty patients were women (60%) and the mean patient age was 69 years (range: 23 - 93 years). In thirteen patients the Dd were located in the second portion (26%) and 24 in the third portion of the duodenum (48%). Three Dd were detected in the papillary region, one of them (2%) was complicated with hemorrhage and required surgical treatment. CONCLUSIONS: Dd were detected in the 0.46% of the abdominal CT scans. Most of them were incidentally detected (94%). The prevalence of these lesions increases with age. Dd may mimic a cystic neoplasm in the head of the pancreas in 28% of cases and produce complications as bleeding in 2% of the cases.

Two-trocar technique for terminal sigmoid colostomy in a patient with complex pelvic fracture.

We report a multiple trauma case with complex pelvic fractures and perineal wounds. The patient had a laparoscopic abdominal exploration with a simultaneous laparoscopic colostomy using the same wounds. Only two trocars were needed to perform both procedures. The technique is detailed here. The procedures were performed in less than an hour, with excellent postoperative recovery, achieving complete diversion of the rectal fecal contents.