Revisión retrospectiva del tratamiento quirúrgico en el megacolon chagásico / Retrospective review of surgical treatment of the chagasic megacolon

Se revisan las historias clínicas de cuatro centros quirúrgicos y casos personales totalizando en 28 años de experiencia 1.203 pacientes operados. Estos Centros quirúrgicos se encuentran en Cochabamba-Bolivia y son Hospital Clínico Viedma, Caja Nacional de Salud, Instituto Gastroenterológico Boliviano-Japonés y caja Petrolera de Salud. En cuanto a sexo se refiere hay una relación de hombres (3) y mujeres(2). La edad más frecuente está comprendida en la década de 50 a 60 años con un 28.4 de pacientes. Menores de 30 años son el 3.6 y mayores de 80 años el 1

Retroperitoneal drainage in the management of the septic phase of severe acute pancreatitis.

Eighteen consecutive patients with sepsis due to surgically confirmed peripancreatic necrosis extending diffusely into the retroperitoneal fat were treated in our hospital from 1980 to 1987. Management consisted of early retroperitoneal debridement of necrotic tissue and drainage through lumbar incisions. Enteral nutrition was implemented in all patients 3-8 days after their first surgery. A total of 40 reoperations were required--an average of 2.6 per patient. Complications included respiratory failure (17), renal failure (4), gastrointestinal bleeding (4), retroperitoneal bleeding (1), and gastrointestinal fistulas (6). Four (22%) of the 18 patients died; the major cause of death was multiple organ failure secondary to sepsis. Before 1980, all patients with severe pancreatitis treated in our hospital died, despite the use of different management techniques. The use of the extraperitoneal route for early debridement of necrotic tissue and to avoid contamination of the peritoneal cavity has substantially reduced the mortality associated with peripancreatic necrosis in our hospital. The mortality in this series of patients (22%) compares very favorably with that reported in studies of similar patients.