Respiratory distress and tracheal deviation secondary to sigmoid volvulus / Dificultad respiratoria y desviación traqueal secundaria a vólvulo sigmoideo ­ Un reporte de caso

INTRODUCTION: The trachea is a semiflexible tube of 1.5 to 2 cm in width and 10 to 13 cm in length. Its deviation might be caused by not only diverse thoracic but also abdominal pathologies, which may compromise the airway. We present a case of a severe tracheal deviation due to an abdominal pathology causing displacement of mediastinal structures. CLINICAL CASE: A 78-year-old woman presents with difficulty breathing. History of chronic bedridden and frequently constipated, last stool 5 days prior. On physical examination, cachectic complexion, dry mucous membranes, breathing superficially with scarce wheezing, SatO2 82% on room air. Abdomen distended with an absence of bowel sounds. Chest x-rays show severe tracheal deviation and abdominal x-ray with coffee bean sign. A laparotomy evidences a large sigmoid volvulus. A sigmoidectomy and descending colon colostomy is performed. Room air oxygen saturation improved after extubation to 96%.CONCLUSION: Desaturation and tracheal deviation were caused by a large sigmoid volvulus. Although these pathologies were thoracic, clinicians should suspect different underlying pathologies, in this case, abdominal

INTRODUCCIÓN: La tráquea es un tubo semiflexible de 1-5 a 2 cm de ancho y 10 a 13 cm de longitud. Puede presentar desviaciones en su trayecto, no solo por patologías torácicas, sino también abdominales, las cuales pueden comprometer la vía aérea. Presentamos el caso de una desviación severa de la tráquea por una patología abdominal que ocasionó desplazamiento de las estructuras mediastinales. REPORTE DE CASO: Mujer de 78 años que se presenta por dificultad respiratoria. Antecedente de postramiento crónico en cama y estreñimiento frecuente, con última deposición 5 días previos. En la exploración física presenta complexión caquéctica, mucosas secas, respiración superficial con sibilancias, saturando 82% al aire ambiente. Abdomen distendido con ausencia de ruidos intestinales. Radiografía torácica muestra desviación traqueal severa y la radiografía abdominal muestra signo del grano de café. En el abordaje por laparotomía se evidencia un vólvulo sigmoideo grande. Se realizó sigmoidectomía y colostomía del colon descendiente. La saturación al aire ambiente mejoró después de la extubación a 96%. CONCLUSIÓN: La desaturación y desviación traqueal fueron causadas por un vólvulo sigmoideo grande. Aunque estas patologías eran torácicas, el clínico debe sospechar diferentes patologías de base, como en este caso, abdominales.

Pseudoobstrucción colónica aguda (Sindrome de Ogilvie) posterior a una nefrectomía radical: Reporte de caso / Acute Colonic Pseudo-Obstruction (Ogilvie'S Syndrome) After Radical Nephrectomy: Case Report

El Sindrome de Ogilvie se caracteriza por una dilatación masiva del colon y una clínica sugestiva de obstrucción intestinal mecánica, sin causa orgánica. Presentamos un caso de dilatación aguda idiopática del colon secundaria a una cirugía abdominal. El objetivo de este reporte fue la descripción de una patología urológica inusual que puede pasarse por alto o tratarse como un íleo adinámico y, la revisión de la literatura relacionada con la definición, factores de riesgos, etiología, fisiopatología y el tratamiento de la misma. Paciente masculino de 61 años con antecedente de nefrectomía radical izquierda por tumor renal que, a las 48hs del alta hospitalaria, consultó por presentar distensión abdominal aguda. Se solicitó una radiografía abdominal y una tomografía computada que evidenciaba importante dilatación intestinal y un diámetro cecal mayor a 12cm. Se practicó una laparotomía exploradora de urgencia constatándose dilatación colónica del colon transverso y ascendente con un cambio de diámetro a nivel del ángulo esplénico, sin causa osbtructiva. Finalmente, se realizó colostomía en asa. A los 6 meses de seguimiento, la videocolonoscopía no mostró lesiones endoluminales concluyendo en un Sindrome de Ogilvie secundario a la nefrectomía. Finalmente, se efectuó reconstrucción del tránsito con buena evolución posterior. En nuestro caso, el Sindrome de Ogilvie fue una complicación postoperatoria y como fallaron las terapias conservadoras iniciales instauradas, este reporte provee una modalidad de tratamiento alternativo. Si se reconoce temprano y se trata adecuadamente, la pseudoobstrucción se resolverá en la mayoría de los pacientes y la tasa de mortalidad posterior será menor.

Ogilvie's Syndrome is characterized by massive dilation of the colon and symptoms suggestive of mechanical intestinal obstruction, without organic cause. We present a case of acute idiopathic dilation of the colon secondary to abdominal surgery. The aim of this case report was the presentation of an unusual pathology that can be overlooked or treated as adynamic ileus and the review of the literature addressing the definition, risk factors, etiology, pathophysiology and treatment of it. A 61-year-old male patient with a history of a left radical nephrectomy due to a renal tumor. At 48hs after from his hospital discharge, he consulted for presenting acute abdominal distension. An abdominal radiograph and a computed tomography scan showed evidence of dilated loops of bowel with caecal diameter more than 12 cm. An emergency laparotomy was performed with an evidence of ascending and transverse colon distension with diameter change at a splenic angle level, it showed no apparent cause. The surgical procedure ends with a loop transverse colostomy. At 6 months of follow up, the colonoscopy control did not show endoluminal injuries, we can infer a secondary Ogilviés syndrome to nephrectomy. Finally, the patient received a restoring intestinal and showed good progress. In our case, Ogilviés syndrome was a postoperative complication and as the initial conservative therapies implemented failed, this report provides an alternative treatment modality. If recognized early and treated appropriately, pseudo-obstruction will resolve in most patients and the subsequent mortality rate will be minor.

Carboxymethylcellulose and psyllium effects in sand output of horses with asymptomatic sand accumulation / [Efeitos da carboximetilcelulose e do psyllium sobre a eliminação de areia de cavalos com sablose assintomática]

The aim of this study was to evaluate the effects of Psyllium (PSY) and Carboxymethylcellulose (CMC) administration on fecal elimination of sand in horses with asymptomatic sand accumulations. Eight horses were selected from sandy areas and randomly divided into 2 groups of four animals. The subjects were treated either with CMC or PSY. The presence of intestinal sand was confirmed through radiography and glove sedimentation test. The study was performed in two phases, with a 7-day interval. In phase I, all the animals received 8 liters of warm water; in phase II, the CMC group received 8 liters of water + 1g/kg of CMC, whereas the PSY group received 8 liters of water + 1g/kg of PSY. All administrations were performed through nasogastric intubation and fractionated in 2 equal volume administrations with an interval of two hours. General and specific physical examination of the digestive system were performed in conjunction with abdominal ultrasonography before the administrations and after 6, 12, 24, 36 and 48 hours, aiming to evaluate intestinal motility and presence of sand. All the feces eliminated by the animals within the 72 hours following the administrations were quantified, diluted and sedimented in order to calculate the sand output (g/kg of feces). All the animals were also subjected to radiographic examination to quantify sand accumulation prior to phase I and after 72 hours of phases I and II. No adverse effects were observed after the treatments. It was possible to notice higher sand elimination in both groups during the phase I, whereas no difference was observed in sand elimination rates between the groups in phase II. The radiographic scores presented differences between the initial timepoint and 72h in phases I and II for both groups. Based on the sand elimination rates and radiographic score, this study demonstrated that sand output was greater after administration of water alone, compared to CMC and Psyllium, leading to the inference that removal of the sandy environment and prevention of sand re-ingestion are effective measures for the elimination of sand from the colon of horses with asymptomatic sand accumulations.(AU)

O objetivo deste estudo foi avaliar os efeitos da administração do psyllium (PSY) e da carboximetilcelulose (CMC) sobre a eliminação fecal de areia em equinos com sablose assintomática. Oito equinos com confirmação radiográfica de sablose assintomática foram divididos em dois grupos (grupo CMC e grupo PSY). O estudo foi realizado em duas fases, com intervalo de sete dias. Na fase 1, todos os animais receberam 8L de água; na fase 2, o grupo CMC recebeu 8L de água + 1g/kg de CMC e o grupo PSY recebeu 8L de água + 1g/kg de PSY. Antes da administração de cada solução e após seis, 12, 24, 36 e 48 horas, foram realizados exame físico e ultrassonografia abdominal. Todas as fezes eliminadas em 72 horas foram avaliadas para quantificar a eliminação de areia (g/kg de fezes). Antes da fase 1 e após 72 horas das fases 1 e 2, o exame radiográfico foi realizado para quantificar o escore de acúmulo de areia. Houve maior eliminação de areia após a administração de água em comparação com a administração de CMC, e não se observou diferença entre a CMC e o PSY. Uma redução significativa nos escores radiográficos de acúmulo de areia foi observada após a administração de água, bem como a manutenção dos escores após a administração da CMC e do PSY. Com base na produção de areia e no escore radiográfico, este estudo sugere que a remoção do ambiente arenoso, impedindo a reingestão de areia, é uma medida eficaz para a eliminação da areia do cólon de cavalos com acúmulos de areia assintomáticos.(AU)

Perforación de sigma secundaria a migración de prótesis biliar / Sigma Perforation Secondary to Migration of Biliary Prosthesis

RESUMEN Introducción: La migración de una prótesis en la vía biliar es una complicación muy poco frecuente que normalmente se expulsa de forma natural, pero en raras ocasiones puede cursar con complicaciones severas. Objetivo: Describir una complicación rara por migración de una prótesis biliar. Caso clínico: Se presenta un paciente de sexo masculino de 75 años, portador de stent biliar que presenta una perforación de sigma secundaria a migración de la prótesis. Conclusiones: Las migraciones protésicas deben vigilarse y si no se eliminan de manera espontánea o el paciente presenta síntomas, se debe proceder a su retirada endoscópica o quirúrgica(AU)

ABSTRACT Introduction: Migration of a prosthesis in the bile duct is a very rare complication normally expelled in a natural way, but on rare occasions it can lead to severe complications. Objective: To describe a rare complication due to migration of biliary prosthesis. Clinical case: A case is presented of a 75-year-old male patient with a biliary stent who presented a sigmoid perforation secondary to migration of the prosthesis. Conclusions: Prosthetic migrations should be monitored and, if they are not eliminated spontaneously or the patient presents with symptoms, they should be removed endoscopically or surgically(AU)

Obstrucción duodenal congénita de etiología múltiple: reporte de un caso con malrotación intestinal, bandas de Ladd y membrana duodenal intrínseca como causantes de obstrucción intestinal en el neonato / Congenital duodenal obstruction of multiple etiology: case report with intestinal malrotation, Ladd bands and intrinsic duodenal membrane as causes of intestinal obstruction in the neonate

Resumen: La obstrucción duodenal congénita agrupa un amplio espectro de anomalías en el desarrollo del intestino delgado; se clasifica según su etiología tanto en extrínseca como intrínseca. Su presentación es relativamente común, teniendo una incidencia de 1: 2.500-10.000 nacidos vivos y normalmente presenta asociación con aneuploidías (como la trisomía 21) y malformaciones cardíacas. Las imágenes tienen un papel importante en la aproximación diagnóstica y la radiografía de abdomen simple, es el primer escalón en la aproximación de la obstrucción intestinal. El tratamiento involucra una exploración quirúrgica del abdomen con corrección de los defectos encontrados. Este es un reporte de caso de un neonato que presentó obstrucción duodenal congénita de etiología tanto extrínseca (malrotacion intestinal y bandas de Ladd) como obstrucción intrínseca (membranas duodenales).

Abstract: Congenital duodenal obstruction groups together a broad spectrum of abnormalities in the development of the small intestine; it is classified according to its etiology as both extrinsic and intrinsic. Its presentation is relatively common, having an incidence of 1: 2.500-10.000 live births and it is normally associated with aneuploidy (such as trisomy 21) and cardiac malformations. Images play an important role in the diagnostic approach, with simple abdominal radiography being the first step in the approximation of intestinal obstruction. The treatment corresponds to a surgical exploration of the abdomen with resolution of the defects found. This is a case report of a newborn who presented congenital duodenal obstruction of both extrinsic etiology (intestinal malrotation and Ladd bands) and intrinsic obstruction (duodenal membranes).

Radiographic predictors determined with an objective assessment tool for neonatal patients with necrotizing enterocolitis / Preditores radiográficos determinados com uso de ferramenta de avaliação objetiva para pacientes neonatais com enterocolite necrotizante

ABSTRACT Objective: The objective of this study was to develop and validate a computational tool to assist radiological decisions on necrotizing enterocolitis. Methodology: Patients that exhibited clinical signs and radiographic evidence of Bell's stage 2 or higher were included in the study, resulting in 64 exams. The tool was used to classify localized bowel wall thickening and intestinal pneumatosis using full-width at half-maximum measurements and texture analyses based on wavelet energy decomposition. Radiological findings of suspicious bowel wall thickening and intestinal pneumatosis loops were confirmed by both patient surgery and histopathological analysis. Two experienced radiologists selected an involved bowel and a normal bowel in the same radiography. The full-width at half-maximum and wavelet-based texture feature were then calculated and compared using the Mann-Whitney U test. Specificity, sensibility, positive and negative predictive values were calculated. Results: The full-width at half-maximum results were significantly different between normal and distended loops (median of 10.30 and 15.13, respectively). Horizontal, vertical, and diagonal wavelet energy measurements were evaluated at eight levels of decomposition. Levels 7 and 8 in the horizontal direction presented significant differences. For level 7, median was 0.034 and 0.088 for normal and intestinal pneumatosis groups, respectively, and for level 8 median was 0.19 and 0.34, respectively. Conclusions: The developed tool could detect differences in radiographic findings of bowel wall thickening and IP that are difficult to diagnose, demonstrating the its potential in clinical routine. The tool that was developed in the present study may help physicians to investigate suspicious bowel loops, thereby considerably improving diagnosis and clinical decisions.

RESUMO Objetivo: O objetivo deste estudo foi desenvolver e validar uma ferramenta computacional para auxiliar as decisões radiológicas na enterocolite necrotizante. Metodologia: Pacientes que exibiam sinais clínicos e evidências radiográficas do estágio 2 ou superior de Bell foram incluídos no estudo, que resultou em 64 exames. A ferramenta foi usada para classificar o aumento localizado da espessura da parede intestinal e a pneumatose intestinal com medidas de largura total a meia altura e análises de textura baseadas na decomposição da energia wavelet. Os achados radiológicos de aumento suspeito da espessura da parede intestinal e das alças na pneumatose intestinal foram confirmados pela cirurgia e análise histopatológica do paciente. Dois radiologistas experientes selecionaram um intestino afetado e um intestino normal na mesma radiografia. A largura total a meia altura e a característica da textura baseada em wavelet foram então calculadas e comparadas com o uso do teste U de Mann-Whitney. Foram calculados a especificidade, sensibilidade, valores preditivos positivos e negativos. Resultados: Os resultados da largura total a meia altura foram significativamente diferentes entre a alça normal e a distendida (mediana de 10,30 e 15,13, respectivamente). Medidas de energia wavelet horizontal, vertical e diagonal foram avaliadas em oito níveis de decomposição. Os níveis 7 e 8 na direção horizontal apresentaram diferenças significativas. Para o nível 7, as medianas foram 0,034 e 0,088 para os grupos normal e com pneumatose intestinal, respectivamente, e para o nível 8, as medianas foram 0,19 e 0,34, respectivamente. Conclusões: A ferramenta desenvolvida pode detectar diferenças nos achados radiográficos do aumento da espessura da parede intestinal e PI de difícil diagnóstico, demonstra seu potencial na rotina clínica. A ferramenta desenvolvida no presente estudo pode ajudar os médicos a investigar alças intestinais suspeitas e melhorar consideravelmente o diagnóstico e as decisões clínicas.

Extensive renal sinus lipomatosis in xanthogranulomatous pyelonephritis simulating liposarcoma

ABSTRACT Renal replacement lipomatosis is a condition characterized by varying degrees of renal parenchymal atrophy and perirenal fibrofatty proliferation secondary to chronic inflammation such as xanthogranulomatous pyelonephritis. In severe cases, imaging findings can be misdiagnosed as retroperitoneal liposarcoma.

Retención de cápsula endoscópica en enfermedad de Crohn ¿cómo manejarla? / Retained capsule endoscopy in Crohn´s disease: how to manage it?

Capsule endoscopy is a technique that allows the study of the small intestine, through a device that is swallowed by the patient, capturing images as it travels through the digestive tract. Capsule retention is the most serious complication. We report the case of a 69 year-old male presenting with iron deficiency anemia, with normal upper endoscopy and colonoscopy; but obscure gastrointestinal bleeding was diagnosed and therefore a study with capsule endoscopy was requested. The patient evolves with retained capsule in the small intestine with ulcerated stenosis as shown by imaging. This finding was confirmed by enteroscopy with biopsy, without being able to extract the capsule. Medical management with corticosteroids was indicated for intestinal obstruction secondary to inflammatory stenosis in the context of Crohn's disease: The capsule was expelled after 21 days of ingestion, with a positive outcome

La cápsula endoscópica es una técnica que permite el estudio del intestino delgado, mediante un dispositivo que es deglutido por el paciente y captura imágenes en su recorrido por el tubo digestivo. La complicación más grave es la retención de la cápsula. Se reporta el caso de un paciente de sexo masculino, de 69 años con anemia ferropénica, con endoscopia alta y colonoscopia normal; planteándose sangrado gastrointestinal de origen oscuro por lo que se solicita estudio con cápsula endoscópica. El paciente evoluciona con retención de la cápsula en intestino delgado, visualizándose en las imágenes la presencia de estenosis ulcerada, hallazgo que se confirma mediante enteroscopia con toma de biopsias, sin lograr extraer la cápsula. Se indica manejo médico con corticoides por obstrucción intestinal secundario a estenosis inflamatoria en contexto de enfermedad de Crohn, expulsando espontáneamente la cápsula al día 21 de su ingestión, sin complicaciones.

Tratamiento médico del "body packer" entre los años 2014 y 2016 en un hospital universitario del caribe colombiano / Medical management of the "body packer" at a university hospital in the colombian caribbean in the period 2014-2016

Introducción. El término "body packer" hace referencia a sujetos portadores de objetos intraabdominales extraños, que contienen drogas ilícitas con fines de contrabando. La mayoría son pacientes asintomáticos, en quienes se instaura conducta expectante, observación clínica estrecha y administración de medicamentos para la evacuación de los paquetes, con miras a prevenir posibles complicaciones, como obstrucción intestinal o intoxicación, asociadas a su transporte intraabdominal. Materiales y método. Se llevó a cabo un estudio transversal de linealidad retrospectiva en pacientes admitidos en la E.S.E Hospital Universitario del Caribe entre los años 2014 y 2016,bajo la sospecha diagnóstica de "body packer". Luego de una revisión de las bases de datos institucionales se analizaron variables demográficas y clínicas de los sujetos incluidos en el estudio. Resultados. Se incluyeron 4 pacientes de género masculino, entre los 22 y 66 años de edad. La cantidad de cápsulas transportadas en promedio fue de 43, para una máxima de 74. La cocaína fue la sustancia que más se identificó. Para la evacuación de los paquetes se empleó irrigación intestinal con polietilenglicol. El tiempo de evacuación máximo fue de 48 horas y no hubo complicaciones asociadas al manejo proporcionado. Discusión. Estudios respecto al tema, como este, confirman la seguridad del manejo conservador del paciente asintomático y apoyan el uso de polietilenglicol dada su efectividad para lograruna limpieza intestinal completa y por su bajo riesgo de complicaciones asociado a su uso en comparación con otros métodos, así como la menor necesidad de intervenciones quirúrgicas. Se requieren estudios prospectivos aleatorizados controlados a partir de los cuales se determinen, con base en mayor evidencia, las mejores prácticas a seguir

Introduction. The term "body packer" refers to subjects carrying intraabdominal foreign objects that contain illicit drugs for contraband purposes. The majority of patients are asymptomatic, in whom expectant management is established, with close clinical observation and administration of medications for evacuation of the packages, with prevention of possible complications such as intestinal obstruction or intoxication associated with intraabdominal transport. Materials and method. A retrospective linearity cross sectional study was carried out in patients admitted to the Hospital Universitario del Caribe, Cartagena, Colombia, under the diagnostic suspicion of "body packer" in the period 2014 and 2016. After a review of the institutional databases, demographic and clinical variables of the study subjects were analyzed. Results. Four patients were included, male, ages 22 to 66 years. The average number of capsules transported was 43, with maximum of 74. Cocaine was the substance mainly identified. Intestinal irrigation with polyethylene glycol was used for intestinal evacuation. The maximum evacuation time was 48 hours and there were no complication associated with the given management. Discussion. The existing studies on the subject, as well as this one, confirm the safety of the conservative management in the asymptomatic patient and support the effectiveness of polyethyleneglycol in achieving complete intestinal cleansing and the low risk of complications associated with its use with respect to other methods, together with diminished need for surgical intervention. Controlled randomized prospective studies are required to provide greater evidence in order to determine the best practice to be followed

Torção de cólon em um felino doméstico: relato de caso / Colon torsion in a domestic cat: case report

A torção de cólon em felinos é uma patologia rara. Os principais sinais apresentados são de abdome agudo e podem levar o animal rapidamente a óbito. O presente trabalho tem o objetivo de relatar um caso de torção de cólon em um felino. Este é o primeiro relato dessa enfermidade no Brasil. O diagnóstico foi realizado por meio do histórico e de exames de imagem. O animal foi encaminhado para a cirurgia, mas, devido à gravidade e extensão das lesões intestinais, foi realizada a eutanásia.(AU)

Colon torsion in felines is a rare pathology. The main signs presented are of acute abdomen and the condition can quickly lead to death. This paper aims to report a case of twisted colon in a feline. This is the first report of colon torsion in Brazil. The presumptive diagnosis was made through history and imaging. The patient was submitted to surgery, where, due to severity and extent of lesions, euthanasia was performed.(AU)

Divertículo colónico gigante: Dos nuevos casos en la literatura / Giant Colonic Diverticulum: Two New Cases in Literature / Divertículo gigante de colom: Dois novos casos na literatura

Introducción: El divertículo colónico gigante es una presentación rara de la enfermedad diverticular del colon descrita por primera vez en la literatura francesa en 1946; se define cuando su diámetro es mayor a 4cm. Objetivo: Adicionar a la literatura dos casos diagnosticados en la Fundación Oftalmológica de Santander, Colombia debido al bajo número de casos reportados en la actualidad; además, mencionar los principales datos encontrados en la literatura en cuanto a la epidemiología, la presentación clínica, los diagnósticos diferenciales, las herramientas diagnósticas más importantes a tener en cuenta y la diferencia de los esquemas de tratamiento. Presentación de los casos: Se presentan dos casos de pacientes con clínica de dolor abdominal para los cuales se solicitaron estudios imagenológicos que permitieron realizar un adecuado diagnóstico de divertículo colónico gigante; el primero fue manejado de manera conservadora con antibiótico-terapia y el segundo de forma quirúrgica con resección de colon transverso con anastomosis primaria. Conclusiones: El divertículo colónico gigante es una entidad poco frecuente y por tanto escasamente descrita en la literatura asociada en su mayoría con la diverticulosis. Se presenta con una clínica muy diversa, sugestiva de múltiples patologías abdominales que deben ser descartadas para poder realizar un adecuado diagnóstico por medio de técnicas de imagen como la radiografía, el colon por enema y la tomografía axial computarizada que representan las principales herramientas diagnósticas de esta entidad. El tratamiento de elección es la intervención quirúrgica, sin embargo, en contextos determinados como pacientes ancianos, asintomáticos y con alto riesgo quirúrgico puede manejarse de manera conservadora. Su importancia a pesar de la baja prevalencia radica en la necesidad del diagnóstico oportuno para evitar una alta tasa de complicaciones. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Divertículo colónico gigante: Dos nuevos casos en la literatura MedUNAB 2017; 20(2): 235-243].

Introduction: The giant colonic diverticulum is a rare presentation of the diverticular disease of the colon described for the first time in French literature in 1946 and it is defined when its diameter is greater than 4cm. Objective: To add to the literature two more cases diagnosed in the Ophthalmological Foundation of Santander, Colombia due to the low number of cases reported today; in addition, to mention the main data found in the literature in terms of epidemiology, clinical presentation, differential diagnoses, the most important diagnostic tools to consider and the difference of treatment schemes for it. Presentation of the cases: Two cases of patients with abdominal pain clinic for whom imaging studies were requested that allowed an adequate diagnosis of giant colonic diverticulum are presented. The first one was managed conservatively with antibiotic therapy and the second one was surgically treated with a transverse colon resection with primary anastomosis. Conclusions: The giant colonic diverticulum is a rare entity and therefore poorly described in the literature associated mostly with diverticulosis. It is presented with a very diverse clinic, suggestive of multiple abdominal pathologies that must be discarded in order to perform an adequate diagnosis by means of imaging techniques such as x-rays, colon by enema and computerized axial tomography scan which represent the main diagnostic tools for this entity. The treatment of choice is surgery; however, in determined contexts such as with elderly patients who are asymptomatic and with a high surgical risk can be managed conservatively. Its importance despite its low prevalence lies in the need for timely diagnosis to avoid a high rate of complications. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Giant Colonic Diverticulum: Two New Cases in Literature. MedUNAB 2017; 20(2): 235-243].

Introdução: O divertículo colônico gigante é uma apresentação rara da doença diverticular do cólon descrita pela primeira vez na literatura francesa em 1946; é definido quando seu diâmetro é maior que 4cm. Objetivo: Adicionar à literatura dois casos diagnosticados na Fundação Oftalmológica de Santander, Colômbia devido ao baixo número de casos relatados no presente; Além disso, mencionar os principais dados encontrados na literatura em termos de epidemiologia, apresentação clínica, diagnósticos diferenciais, as ferramentas de diagnóstico mais importantes a serem consideradas e a diferença de esquemas de tratamento. Apresentação dos casos: Foram apresentados dois casos de pacientes com clínica de dor abdominal para os quais foram solicitados estudos de imagem que permitiram um diagnóstico adequado de divertículo colônico gigante; O primeiro foi administrado de forma conservadora com terapia antibiótica e o segundo foi tratado cirurgicamente com ressecção do colo cruzado com anastomose primária. Conclusões: Divertículo colônico gigante é uma entidade rara e, portanto, pouco descrita na literatura associada principalmente à diverticulose. É apresentado um quadro clínico muito diverso, sugestivo de múltiplas patologias abdominais que devem ser descartadas para poder fazer um diagnóstico adequado por meio de técnicas da imagem como a radiografia, o cólon por enema e tomografia axial computorizada que representam as principais ferramentas Diagnóstico desta entidade. O tratamento a escolher é a cirurgia, no entanto, em determinados casos como é a dos pacientes idosos, assintomáticos e com alto risco cirúrgico podem ser tratados de forma tradicional. Sua importância, apesar da baixa prevalência, reside na necessidade de um diagnóstico oportuno para evitar uma alta taxa de complicações. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Divertículo gigante de colom: Dois novos casos na literatura. MedUNAB 2017; 20(2): 235-243].

Metaplasia ósea endometrial / Endometrial osseous metaplasia

La metaplasia ósea endometrial es una patología que se presenta con poca frecuencia y causa una gran variedad de síntomas como: sangrado uterino, dolor pélvico e infertilidad. Esta última, generalmente es secundaria y junto con el antecedente previo de aborto, constituyen una pieza clave en la sospecha diagnóstica. En el estudio de esta enfermedad, es necesario el uso de ecografía transvaginal y radiografía simple abdominal. El tratamiento definitivo se realiza mediante la extracción histeroscópica del material óseo, el cual es enviado a patología para corroborar el diagnóstico. La infertilidad revierte con la extracción del tejido óseo y no se han demostrado complicaciones en gestaciones futuras. Presentamos el caso de una paciente con metaplasia ósea endometrial por su rareza e importancia en el diagnóstico diferencial de sangrado uterino(AU)

Endometrial osseous metaplasia is a rare pathology that causes a variety of symptoms such as uterine hemorrhage, pelvic pain and infertility. This last consequence is generally secondary, and along with a history of abortions, represents a key element in suspected diagnosis. It is necessary to use transvaginal ultrasound and simple abdominal radiography for the study of the disease. The final treatment is performed by hysteroscopic removal of the bone material, which is sent to the pathology laboratory to confirm diagnosis. The infertility may be eliminated with the removal of the bone material and no further complications in future pregnancies have been observed. This is the case of a patient with endometrial osseous metaplasia, which is reported because of its infrequency and importance in the differential diagnosis of uterine bleeding(AU)

Mesotelioma pleural maligno en ocho pacientes y revisión del tema / Malignant pleural mesothelioma in eight patients and review of topic

Se actualizan aspectos etiopatogénicos, clínicos, diagnósticos y terapéuticos en el mesotelioma pleural maligno, enfermedad temida e infrecuente en nuestro medio. Nos impresionó sobremanera, una profesional de salud tratada recientemente y en etapa temprana que apenas sobrevivió un año. El objetivo es elevar el conocimiento sobre el tema para tratar de mejorar la sobrevida. Se presentan una síntesis de ocho pacientes estudiados y tratados con este diagnóstico en los hospitales "Amalia Simoni", "Manuel Ascunce Domenech", "Madam Curie" de Camagüey y el "Martín Chang Puga" de Nuevitas desde 1998 hasta 2015, señalando el cuadro clínico, exámenes complementarios, diagnóstico, tratamiento médico quirúrgico y los resultados. Más de la mitad de los pacientes eran fumadores con pequeño derrame pleural inicial que hicieron pensar en la enfermedad, todo lo contrario cuando no existió derrame. Hubo tres enfermos donde el diagnóstico nos sorprendió por lo inesperado. La sobrevida fue baja con una media alrededor de 11 meses, solo uno vivió dos años. Los complementarios utilizados se ajustan a otros reportes y nuestras posibilidades. El tratamiento fue actualizado y acorde a otras series en el momento del diagnóstico. Se compara nuestra casuística, la cual se asemeja a publicaciones foráneas en cuanto a diagnóstico, tratamiento y sobrevida. Señalamos que, independiente de algunos recursos desde el punto de vista diagnóstico y terapéutico con que no contamos, los resultados se ajustan a la literatura actual y la sobrevida lograda fue sin dudas, adversa(AU)

Several etiopathogenetic, clinical, diagnostic and therapeutic aspects of the malignant pleural mesothelioma, fearful and infrequent disease in our context, are updated. It was really impressive the case of a female health professional that was recently treated at early stage of disease and barely survived one year. The objective of this review was to raise the level of knowledge on this disease in oder to improve survival rates. To this end, eight patients with this diagnosis, who were studied and treated in "Amalia Simoni", "Manuel Ascunce Domenech", "Madame Curie" hospitals in Camaguey and in "Martin Chang Puga" in Nuevitas from 1998 to 2015 were presented. Their clinical picture, supplementary tests, diagnosis, medical and surgical treatment and final results were described. Half of them were smokers with initial small pleural effusion that made the specialists suspect the existence of the disease. There were three patients whose diagnoses surprised the physicians because they were unexpected. Survival was low and the average survival rate was 11 months, although one managed to live two years. The indicated supplementary tests were similar to those of other reports and adjusted to our setting. Treatment was updated and consistent with other series at the time of diagnosis. The casuistry in our conditions was compared to others and it was similar in terms of diagnosis, treatment and survival rates to the one shown in foreign publication. Regardless of some unavailable diagnostic and therapeutic resources, the results of the treatment agree with those of the current literature on the topic and the survival rate was undoubtedly negative(AU)

Absceso intrabdominal secundario a tuberculosis intestinal en el Hospital General Dolisie de la República del Congo / Intra-abdominal abscess secondary to intestinal tuberculosis in general hospital Dolisie, Republic of Congo

La incidencia de TB intestinal es desconocida, ya que puede ser asintomática y por su naturaleza a menudo resulta en diagnósticos erróneos, por lo que se debe tener un alto índice de sospecha en poblaciones de alto riesgo. Los abscesos intrabdominales en el curso de esta es una complicación poco frecuente, con una incidencia entre 2 y 30 por ciento. Presentamos un paciente masculino de 52 años de edad, con masa abdominal en mesogástrio, asociada a dolor abdominal y pérdida de peso. Se comienza su estudio con Rx. de tórax y ecografía abdominal, el cual reporta masa de 90 x 47 mm en el peritoneo, es intervenido quirúrgicamente y drenado por absceso intrabdominal. Se diagnostica TB intestinal, su evolución fue satisfactoria después de iniciado el tratamiento antituberculoso. Ante un paciente con síntomas de abdomen agudo, es importante realizar un diagnóstico temprano de TB intestinal. Esto evitaría una intervención innecesaria, porque el diagnóstico de la TB intestinal es médico. Si se realiza la intervención, puede confirmarse el diagnóstico mediante las lesiones encontradas; acción que impediría una resección intestinal innecesaria pues el tratamiento antituberculoso resolvería la TB. Generalmente, el diagnóstico se realiza durante una cirugía o por procedimientos invasivos con otros propósitos, por ser esta de difícil diagnóstico clínico y que la irregularidad del tratamiento antituberculoso es un importante factor de riesgo para el desarrollo de complicaciones en la TB intestinal diagnosticada. Esta es altamente efectivo en la resolución de complicaciones de moderada gravedad como la obstrucción intestinal y los abscesos intrabdominales(AU)

The incidence of intestinal tuberculosis is unknown since it may be symptom-free and lead to frequent misdiagnoses, so one should highly suspect of intestinal tuberculosis in high risk populations. The intra-abdominal abscesses are rare complications, with an incidence rate of 2 to 30 percent. Here is the case of a 52 years-old male patient who had an abdominal in her mesogastrium associated to abdominal pain and weight loss. The first testing was thorax X-ray and abdominal ultrasound, which revealed the presence of a 90x74mm mass in the peritoneum. As a result, he was operated on including intrabdominal abscess drainage. The final diagnosis was intestinal tuberculosis, being the recovery satisfactory after the anti-tuberculosis treatment. It is fundamental to make emphasis on the importance of early diagnosis of intestinal tuberculosis in patients with acute abdomen symptoms in risk groups since this may avoid surgical treatment. The diagnosis based on macroscopic findings in case of surgical treatment may also avoid unnecessary intestinal resections. Generally speaking, the diagnosis is made during a surgery or by invasive procedures with other purposes since the clinical diagnosis is difficult; irregular anti-tuberculosis treatment is a significant risk factor for the development of complications in diagnosed intestinal tuberculosis. It is highly effective in the resolution of moderate-severity complications such as intestinal obstruction and intra-abdominal abscesse(AU)