[Intussusception in the adult: a rare cause of mechanical obstruction]. / Invaginación intestinal en el adulto. Una causa infrecuente de obstrucción mecánica.

Intussusception is an infrequent cause of mechanical intestinal obstruction in the adult. We present herein two clinical cases of intussusception with different etiologies. In the first case, the underlying cause was a lipoma, and in the second, it was metastasis from melanoma. In both cases the intussusception was identified through computed tomography and treatment was intestinal resection. Pathologic anatomy provided the definitive diagnosis. Etiology is diverse and it is more common for obstruction to be due to organic lesions that are malignant at the level of the colon and benign at the level of the small bowel. Currently there are more preoperative diagnoses thanks to the advances made in imaging study techniques. Intestinal resection continues to be the treatment of choice in the majority of cases, because of the high percentage of malignant lesions as the underlying cause.

Bullhorn and bullfighting injuries.

PURPOSE: Our purpose was to present our hospital experience with bullhorn injuries. METHODS: A retrospective analysis of patients in our Trauma Registry (1993-2012). RESULTS: Fifteen patients were included. All were hemodynamically stable on presentation, with a mean Glasgow Coma Scale (GCS) score and a Revised Trauma Score (RTS) of 15 and 11.9, respectively. The Injury Severity Score (ISS) and New Injury Severity Score were 13.6 ± 6 and 15.9 ± 9, respectively. Seven had an ISS > 15. Injuries resulted from an isolated blunt trauma (BT) in four, penetrating trauma (PT) in seven, with extensive soft tissue injuries (STI) in three, and a combined BT + PT mechanism in four patients, with extensive STI in all. Three patients had injuries to vessels in the groin, two with prehospital vein ligation. Five patients had abdominal visceral injuries, and another had a sheathed goring, with a traumatic abdominal wall hernia and retroperitoneal hematoma. Four patients had thoracic injuries, and one of them had a traumatic thoracoplasty with a large open thoracic wound, a flail chest, and extensive STI. Two patients had traumatic brain injury, and six had bone fractures. Two-thirds of patients required a surgical procedure under general anesthesia. Morbidity included three surgical site infections, one leg compartment syndrome, and one persistent lymph drainage. There was no mortality, and the mean length of hospital stay was 16 days. CONCLUSIONS: Bullhorn and bullfighting injuries frequently have a multimechanistic origin which goes beyond a pure penetrating trauma. Associated blunt and STI were common in our series, and the overall prognosis of patients admitted to hospital was good.