Outpatient closure in a late colo-cutaneous postoperative anastomotic leak managed with EVAC in Bucaramanga, Colombia. Case report.

INTRODUCTION: After Hartmann-type colostomy, the adequate selection of some patients allows reversal and closure of the colostomy, however, this reversal is not free of complications. Among complications, anastomotic leaks and fistulae can have functional, economic, and oncological consequences. Complications have been treated with surgery; yet, this management has changed considerably in recent years, moving towards less invasive therapies. PRESENTATION OF CASE: This is the report of a 42-year-old man with a history of closed abdominal trauma with perforation of the sigmoid colon managed with a Hartmann-type colostomy. Six months later, he was admitted for a Hartmann reversal procedure without immediate complications. He was assessed again after 4 months observing a small area of erythema and periumbilical edema. EUS was performed without evidence of collections. Colonoscopy evidenced a 7-mm fistulous orifice in the colocolonic anastomosis. The Endo-VAC system was used, performing endoscopically exchanges twice a week following a low-residue diet. The procedure was performed on an outpatient basis and the closure of the leak hole in the colonic anastomosis was achieved in 30 days. DISCUSSION: Endoluminal vacuum therapy or EVAC, is an adaptation of the therapy used for negative pressure wound closure. This minimally invasive technique has been used for the treatment of gastrointestinal leaks and fistulae in selected patients and within a hospital setting. Our case presents the use of this technique in a late colocutaneous postoperative leak on an outpatient basis. CONCLUSION: To the best of our knowledge we report the first case of a late colocutaneous anastomotic leak managed with EVAC on an outpatient basis.

Pancreatic tuberculosis mimicking a neoplastic mass in an immunosuppressed patient who also presented adenopathy syndrome: Case report.

Introduction: Pancreatic tuberculosis is unusual, with an incidence reported to be less than 4,7 % worldwide. Case report: We report the case of a 32-year-old man recently diagnosed with HIV whose adenopathy syndrome was understudy. Lymph node cervical and bone marrow biopsies were performed without evidence of neoplastic infiltration, fungal infection, or tuberculosis. He arrived at the emergency room for acute band abdominal pain radiating to the back. Results: Contrast-enhanced abdominal computed tomography revealed a mass in the head of the pancreas which generates intra- and extrahepatic bile duct dilation. Serial sputum, PPD, Genexpert, bronchoscopy and ultrasound fine needle aspiration biopsy were negative for tuberculosis, with no evidence of microorganisms or malignancy; cultures results pending. A second biopsy was requested using a No. 19 needle reporting a necrotizing process with acid-fast bacilli, compatible with tuberculosis, and the pending cultures results were positive for the mycobacterium tuberculosis complex, confirming the diagnosis. Conclusion: Clinical awareness of pancreatic tuberculosis in immunosuppressed patients in our country, may lead to faster and accurate diagnosis study and management, using minimally invasive techniques as diagnostic tools.