Diverticulitis cecal simulando apendicitis aguda / Cecal diverticulitis mimicking acute appendicitis

Se describen cinco casos de diverticulitis cecal: todos presentaban dolor leve a moderado en fosa iliaca derecha sin otros signos de toxicidad. Todos fueron intervenidos con diagnóstico inicial de apendicitis aguda. Tres casos no presentaron duda de ser diverticulitis cecal durante cirugía y se realizó diverticulectomía, en los otros dos se realizó colectomía derecha y anastomosis (por importante proceso inflamatorio y sospecha de cáncer). Uno de los casos con colectomía presentó dehiscencia, falla multiorgánica y óbito.

We describe five cases of cecal diverticulitis: all of them present with mild or moderate pain in right lower quadrant without other toxicity sign. In all of them the initial diagnosis was acute appendicitis. At the surgery, three cases present no doubt of cecal diverticulitis and diverticulectomy was made, in the two others right colectomy with anastomosis was perform (because of important inflammation and suspicious of cancer). One of the colectomy cases present dehiscence, organ failure and death.

WSES guidelines for emergency repair of complicated abdominal wall hernias.

Emergency repair of complicated abdominal hernias is associated with poor prognosis and a high rate of post-operative complications.A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013, during the 2nd Congress of the World Society of Emergency Surgery with the goal of defining recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel.

[Prevalence and sequence of metaplasia-dysplasia-carcinoma of the gallbladder. A single centre retrospective study]. / Prevalencia y secuencia metaplasia-displasia-carcinoma de vesícula biliar. Estudio retrospectivo unicéntrico.

INTRODUCTION: We report the frequency and age of metaplasia, dysplasia and carcinoma of the gallbladder, and seek to establish a sequence of progression of these, since several studies suggest that this is the carcinogenesis pathway. MATERIAL AND METHODS: Descriptive retrospective cross-sectional study over a period of 4 years, with an analytical component of 1,514 patients with cholelithiasis, in whom cholecystectomy were performed. RESULTS: The mean age of the sample was 46 years and 72% of patients were female. The prevalence (and mean age) of pyloric metaplasia, intestinal metaplasia, dysplasia and carcinoma was 22.6 (47), 2.1 (46), 0.2 (54) and 0.6% (63 years), respectively. There was a significant association between intestinal and pyloric metaplasia (P<.001, chi(2)) and between dysplasia and carcinoma (P<.005, Yates), but not between metaplasia and dysplasia. CONCLUSION: Improved studies should be conducted for the correct interpretation of the pathogenesis of gallbladder cancer.

Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study).

Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18-98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients.The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.

Adult intussusception with perforation and secondary peritonitis. Case report.

BACKGROUND: Intussuception is an uncommon condition in adults. It is usually secondary to an organic lesion that may be malignant. The most common clinical presentation is as a partial bowel obstruction that requires surgical management. Preoperative diagnosis remains difficult; therefore, this paper presents a case report and a brief review of adult intussusception. CLINICAL CASE: We present the case of a 24-year-old female with a 36-h evolution of lower abdominal pain with nausea, vomiting and diarrhea and a previous episode 8 days earlier. Pneumoperitoneum was observed on chest x-ray and surgery was decided upon. Peritonitis due to ileoileal intussusception was found, caused by an inflammatory fibroid polyp with microperforations. Small bowel resection with end-to-end anastomosis was performed and the patient had an uneventful recovery. CONCLUSIONS: Adult intussusception is an infrequent condition with nonspecific symptoms such as pain, nausea and vomiting. With more frequent use of tomography in patients with abdominal pain, correct diagnosis can be achieved. Treatment requires resection of the involved bowel without attempted reduction.