[Surgical treatment of acute cholecystitis. Results of an early intervention protocol]. / Tratamiento quirúrgico de la colecistitis aguda. Resultado de un protocolo de actuación precoz.

A prospective study of 425 patients operated for gallstones was undertaken in order to assess the applicability of a protocol including early surgery in acute cholecystitis. Acute cholecystitis (AC) was present in 119 patients who had 123 episodes of AC (28%). Of 114 patients diagnosed as having AC, 103 were operated on before 72 h and the remaining before 7 days. There were no significant differences between the AC series and that of 306 patients who underwent an elective operation, in regard to morbidity, mortality or length of hospitalization. Early cholecystectomy can be recommended for the treatment of AC as its results are comparable to those of elective surgery.

Swallowing of hydrochloric acid: study of 25 cases.

INTRODUCTION: Ingestion of hydrochloric acid solutions (Salfumant/Salfuman) constitute a relatively frequent emergency in our environment. It is a strong acid, highly corrosive, the swallowing of which causes a very serious necrosis of the gastrointestinal tract. AIM: We review our experience on emergency treatment of inpatients after the swallowing of watery hydrochloric acid solutions, in order to identify the most important prognosis factor. PATIENTS AND METHODS: During the last thirteen years, 25 patients have been attended in our center with the diagnosis of hydrochloric acid swallowing. The clinical and therapeutical characteristics are respectively analyzed, as well as the high morbi-mortality of these kind of emergencies. RESULTS: Global mortality of the series has been 48% (12 patients). The common characteristic of these 12 patients was the esophagogastric massive necrosis, and the duodenopancreatic frame necrosis. Ten patients who did not present duodenal necrosis or were operated on of later complications, survived. Three patients could be managed with medical conservative treatment. CONCLUSIONS: Hydrochloric acid swallowing constitutes an extraordinary severe emergency, with a high mortality, mainly related to necrosis extension to the duodenopancreatic frame.

Massive necrosis of the gastrointestinal tract after ingestion of hydrochloric acid.

OBJECTIVE: To describe our experience of dealing with patients admitted as emergencies after massive ingestion of hydrochloric acid, and to find out the most important prognostic factors. DESIGN: Retrospective review. SETTING: Teaching hospital, Spain. SUBJECTS: 21 patients with massive necrosis of the upper gastrointestinal tract after ingestion of acid who presented during the past 14 years (November 1984-March 1998). INTERVENTIONS: All patients were operated on immediately, 17 without an endoscopic examination. In all cases, the laparotomy showed various degrees of damage to the intra-abdominal oesophagus (from oedema to blackening) and gastric necrosis. Twelve patients also had necrosis of the entire duodenum. In the other nine, the necrosis did not affect more than the pylorus or duodenum. All these 12 patients were treated by a total oesophago-gastrectomy without thoracotomy. Of the 12 patients with total necrosis of the duodenum, 4 did not have resections and in 8, various massive resections of the necrotic structures were done. MAIN OUTCOME MEASURES: Mortality. RESULTS: Fourteen of the 21 patients died during the operation or in the early or late postoperative period. All 12 patients with total duodenal necrosis died, whereas only 2 patients in the other group. CONCLUSIONS: The ingestion of relatively small amounts of water-based solutions of hydrochloric acid of 24% or 32% concentration produces immediate and massive necrosis of the upper digestive tract, which results in high mortality. The poor prognosis might be improved by rapid responses to stop duodenal necrosis.

Suprarrenalectomía por laparoscopia / Laparoscopic adrenalectomy

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