Implantation of migrated biliary stents in the digestive tract.

BACKGROUND: Biliary stents constitute an alternative for the palliative treatment of benign or malignant biliary obstruction, biliary strictures, choledocholithiasis, biliary fistulas from lateral lesions of the biliary duct or cystic duct leaks due to slippage of clip closure. Obstruction resulting in cholangitis is common. Proximal migration to the biliary duct or distal migration to the duodenum with subsequent passage per rectum are relatively frequent, but impaction and perforation of the bowel are rare. CASE OUTLINES: Two cases are reported. In one patient a migrated stent impacted in the caecal wall, and in the other the impaction produced a perforation of an adherent small bowel loop. Both patients were treated surgically and made an uneventful recovery. DISCUSSION: Biliary stents migrate in 8-10% of patients and are generally eliminated by natural means. Occasionally they impact and perforate the digestive tract, usually in the duodenum or other fixed areas or in bowel affected by adhesions due to a previous operation. Although endoscopy is the treatment of choice to retrieve them, operation should be performed whenever there is suspicion of perforation of the intestinal wall.

Necrosis pancreática: aspectos clínicos y terapéuticos / Pancreatic necrosis: clinical and therapeutical aspects

Se analizan retrospectivamente 22 pacientes portadores de necrosis pancreática. De los exámenes complementarios por imágenes, la tomografía computada es la más útil para el diagnóstico y evaluación de la extensión de la necrosis pancreática y peripancreática. Si bien la presente serie favorecería la indicación de necrosectomía y cierre primario del abdómen abierto, el número de pacientes y la imposibilidad ética de realizar estudios "randomizados", impiden conclusiones definitivas. La mortalidad global fue del 54% y las causas más importantes, fallas multiorgánicas y sepsis. Se estima que la alta mortalidad se debe a demora en el diagnóstico, debridamiento incompleto e insuficiente apoyo nutricional.

The need of drainage after cholecystectomy.

In an attempt to rationalize the use of intraperitoneal drainage of the subhepatic space after simple, elective cholecystectomy, a prospective study was designed to compare the post-operative course with and without drainage. There was a higher incidence of postoperative fever of unknown origin and wound infection in the drained group. In the group without drainage the hospital postoperative stay was shorter and there were no complications. The results suggest that routine surgical drainage after uncomplicated cholecystectomy is unnecessary and could be a source of postoperative fever and a higher incidence of wound infection.