Prospective Study on Individualized Dose Adjustment of Tolvaptan Based on Urinary Osmolality in Patients With ADPKD.

Introduction: Tolvaptan has been shown to reduce renal volume and delay disease progression in autosomal-dominant polycystic kidney disease (ADPKD). However, no biomarkers are currently available to guide dose adjustment. We aimed to explore the possibility of individualized tolvaptan dose adjustments based on cut-off values for urinary osmolality (OsmU). Methods: This prospective cohort study included patients with ADPKD, with rapid disease progression. Tolvaptan treatment was initiated at a dose of 45/15 mg and increased based on OsmU, with a limit set at 200 mOsm/kg. Primary renal events (25% decrease in estimated glomerular filtration rate [eGFR] during treatment), within-patient eGFR slope, and side effects were monitored during the 3-year follow-up. Results: Forty patients participated in the study. OsmU remained below 200 mOsm/kg throughout the study period, and most patients required the minimum tolvaptan dose (mean dose, 64 [±10] mg), with a low discontinuation rate (5%). The mean annual decline in eGFR was -3.05 (±2.41) ml/min per 1.73 m2 during tolvaptan treatment, compared to the period preceding treatment, corresponding to a reduction in eGFR decline of more than 50%. Primary renal events occurred in 20% of patients (mean time to onset, 31 months; 95% confidence interval [CI] = 28-34). Conclusion: Individualized tolvaptan dose adjustment based on OsmU in patients with ADPKD and rapid disease progression provided benefits in terms of reducing eGFR decline, compared with reference studies, and displayed lower dropout rates and fewer side effects. Further studies are required to confirm optimal strategies for the use of OsmU for tolvaptan dose adjustment in patients with ADPKD.

Prevalence of urinary tract cancer in the Spanish cohort of the IDENTIFY study.

INTRODUCTION: Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population. PATIENTS AND METHODS: An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018. RESULTS: A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR 1.05 (95% CI 1.03-1.06; P < 0.001)), visible hematuria (VH) OR 2.19 (95% CI 1.13-4.24; P = 0.02)) and smoking (ex-smokers: OR 2.11(95% CI 1.30-3.40; P = 0.002); smokers: OR 2.36 (95% CI 1.40-3.95; P = 0.001)) were associated with higher probability of bladder cancer. CONCLUSION: This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients.

[Hypertension as a common element of renal transplantation with pressor kidney and posterior reversible encephalopathy syndrome]. / Hipertensión como elemento común de trasplante renal con riñón presor y del síndrome de encefalopatía posterior reversible.

Secondary arterial hypertension accounts for only 5-10% of cases of arterial hypertension, hence the importance of its clinical suspicion for diagnosis. One of the most common causes of secondary hypertension is renovascular hypertension, caused by renal hypoperfusion and activation of the renin-angiotensin-aldosterone system. In addition to arterial hypertension being one of the most prevalent cardiovascular risk factors in the population, its poor control can cause acute neurological disorders such as Posterior Reversible Leukoencephalopathy syndrome (PRES), being characteristic the appearance of visuals alterations. Next, we present the case of a kidney transplant patient with well-controlled arterial hypertension with worsening secondary to renal artery stenosis and development of PRES.

Acute phase characteristics and long-term complications of pulmonary embolism in COVID-19 compared to non-COVID-19 cohort: a large single-centre study.

BACKGROUND: To compare the severity of pulmonary embolism (PE) and the long-term complications between patients with and without COVID-19, and to investigate whether the tools for risk stratification of death are valid in this population. METHODS: We retrospectively included hospitalized patients with PE from 1 January 2016 to 31 December 2022. Comparisons for acute episode characteristics, risk stratification of the PE, outcomes, and long-term complications were made between COVID and non-COVID patients. RESULTS: We analyzed 116 (27.5%) COVID patients and 305 (72.4%) non-COVID patients. In patients with COVID-19, the traditional risk factors for PE were absent, and the incidence of deep vein thrombosis was lower. COVID patients showed significantly higher lymphocyte count, lactate dehydrogenase, lactic acid, and D-dimer levels. COVID patients had PE of smaller size (12.3% vs. 25.5% main pulmonary artery, 29.8% vs. 37.1% lobar, 44.7% vs. 29.5% segmental and 13.2% vs. 7.9% subsegmental, respectively; p < 0.001), less right ventricular dysfunction (7.7% vs. 17.7%; p = 0.007) and higher sPESI score (1.66 vs. 1.11; p < 0.001). The need for mechanical ventilation was significantly higher in COVID patients (8.6% vs. 1.3%; p < 0.001); However, the in-hospital death was less (5.2% vs. 10.8%; p = 0.074). The incidence of long-term complications was lower in COVID cohort (p < 0.001). PE severity assessed by high sPESI and intermediate and high-risk categories were independently associated with in-hospital mortality in COVID patients. CONCLUSION: The risk of in-hospital mortality and the incidence of long-term complications were lower in COVID-19. The usual tools for risk stratification of PE are valid in COVID patients.

Impact of BK Polyomavirus Plasma Viral Load in Kidney Transplant Outcomes.

BACKGROUND: BK polyomavirus infection (BKVi) is an important cause of kidney transplant (KT) loss, but there is scarce evidence on the impact of BK plasma viral load on graft function and long-term KT survival. METHODS: A retrospective cohort study including all KT recipients with BKVi (BK viremia identified in ≥3 consecutive samples by polymerase chain reaction) in our center from January 2010 to December 2020 was performed. A case-control study (1:2) was performed. We grouped the cases according to their highest peak viral load: low-level viremia (<10,000 copies/mL) and high-level viremia (≥10,000 copies/mL). To identify risk factors for BKVi, a logistic regression analysis was achieved, and a multivariable Cox regression was used to describe risk factors for graft loss. RESULTS: A total of 849 KTs were performed, and 67 presented BKVi (low-level viremia, n = 35 and high-level viremia, n = 26). In logistic regression analysis male sex (odds ratio [OR], 4.226; 95% CI, 1.660-10.758, P = .002), age (OR, 1.047; 95% CI, 1.008-1.088; P = .018), and retransplant (OR, 4.162; 95% CI, 1.018-17.015; P = .047) were predictors of BKVi. Acute rejection was more frequent in the BKVi group (18% vs 4.9%, P = .004), and graft survival was lower in patients with BKVi and high-level viremia (P = .027). In Cox regression analysis, BKVi (hazard ratio, 3.657; 95% CI, 1.146-11.670; P = .029) and specific BKV (BK polyomavirus) high-level viremia (hazard ratio, 1.988; 95% CI, 1.012-3.907; P = .046) were predictors of shorter graft survival. CONCLUSIONS: BKV high-level viremia was associated with BKV nephropathy and poorer graft survival. Additionally, acute rejection is more frequent after BKVi. It is necessary to develop strategies safe and effective for these patients.

Acute Kidney Injury and Urinary and Histopathological Disorders in Kidney Transplant Patients with SARS-CoV-2 Infection.

BACKGROUND: Acute kidney injury (AKI) is a manifestation of SARS-CoV-2 infection. The evidence in kidney transplant (KT) is limited, as there are scarce data about the histologic features in graft biopsies of these patients. MATERIAL AND METHODS: A retrospective cohort study of KTs with SARS-CoV-2 infection from August 28, 2020, to April 23, 2021. We collected the incidence of AKI and the presence of urinary and histopathological disorders. Both groups were compared (AKI vs no AKI). Immunohistochemical and reverse transcription-polymerase chain reaction studies were performed on the anatomopathological samples. RESULTS: In our study, 72 KTs had SARS-CoV-2 infection and, among them, 27 patients (35.1%) developed AKI related to increased severity and a worse evolution of the infection, defined by a greater presence of pneumonia (P < .001), hospitalization (P < .001), admission to the intensive care unit (P < .001), the need for ventilation support (P < .001), and continuous renal replacement therapy (P < .001). In the multivariable analysis, pneumonia behaved as an independent predictor for AKI development (P = .046). No differences were observed between proteinuria a month before and after infection (P = .224). In addition, 5 patients showed microhematuria and 2 patients presented transient glycosuria without hyperglycemia. Of the 5 kidney biopsies performed, 1 biopsy (20%) showed positive reverse transcription polymerase chain reaction for SARS-CoV-2. CONCLUSIONS: AKI is a frequent and potentially serious complication in KT patients. Occasionally it could be accompanied by abnormalities in the urinary sediment. Of 5 biopsied patients, 1 patient had positive reverse transcription polymerase chain reaction in renal tissue, which suggests the systemic spread of the virus and the tropism for the renal graft.

Efficacy of octreotide in bleeding recurrence from small bowel angioectasia: A comparative study.

INTRODUCTION: Fifty percent of small bowel bleeding is caused by angioectasia and the rebleeding rate due to small bowel angioectasia (SBA) is 80%. Its endoscopic treatment is difficult. Beneficial effects of octreotide on gastrointestinal angioectasia have been described, but no studies have reported its efficacy in SBA. AIM: Our aim was to investigate the effectiveness of octreotide in the prevention of rebleeding due to SBA. MATERIAL AND METHODS: Sixteen patients with bleeding caused by SBA were assigned to treatment with octreotide 100 µg/24 h SC, for at least 6 months, and compared with a non-treatment group of 36 patients. The primary outcome was the rebleeding rate, and the secondary outcomes were the number of hospital readmissions, bleeding-related death, and adverse effects. RESULTS: Octreotide was administered for 10.5 ± 8.4 months. Follow-up was 12.9 ± 17.3 months and 15.3 ± 17.7 months, in the treatment and non-treatment groups, respectively (p = 0.09). At the end of follow-up, 4 (25%) treatment group patients and 26 (72.2%) non-treatment group patients presented with rebleeding (p = 0.002). In the treatment group and non-treatment group, the cumulative probability of remaining rebleeding-free at one year was 79% vs 44.2%, and 79% vs 34.6% at 2 years, respectively (p = 0.05). Through the multiple logistic regression analysis, treatment was the protective variable. Six patients presented with adverse events. One of those patients (6.25%) had a major adverse event. CONCLUSIONS: Our results suggest that treatment with octreotide could be efficacious in the prevention of rebleeding due to SBA.

Surgical Wound Dehiscence in Kidney Transplantation: Risk Factors and Impact on Graft Survival.

BACKGROUND: Surgical wound dehiscence (SWD) is a frequent complication after kidney transplantation (KT) but there is not enough evidence of its impact on graft survival. METHODS: A retrospective cohort study including all KT patients with SWD in our center from January 2015 to July 2020 was performed. A case-control study was performed and for each case of SWD, 2 controls were selected (2:1). To identify risk factors for SWD, a logistic regression analysis was carried out and a multivariable Cox regression was used to describe risk factors for graft survival. RESULTS: In our center, 503 KT were performed, and 39 patients presented SWD. They were older (62.1 vs 57.1 years; P = .030), most had diabetes mellitus (59% vs 28.6%; P = .002) and their body mass index was higher (31 vs 26.9 kg/m2; P < .001). In multivariable logistic regression analysis, diabetes mellitus (P = .024) and a body mass index ≥30 kg/m2 at time of transplantation (P = .018) were predictors of SWD. A higher rate of delayed graft function was described in SWD (P = .013) and it was associated with a longer hospital stay (20.9 vs 15 days; P = .004). Graft survival was lower in patients with SWD (P = .036). In multivariable Cox regression analysis, time in renal replacement therapy (P = .020) and SWD (P = .028) were predictors of shorter graft survival. CONCLUSION: SWD is a risk factor for graft survival. The presence of diabetes mellitus and a higher body mass index are predictors for the appearance of this complication.

Association between preoperative baseline pulse pressure and estimated pulse wave velocity and acute renal failure and mortality following colorectal surgery. A single-centre observational study.

BACKGROUND: Elevated pulse wave velocity is a haemodynamic parameter considered to be a risk factor for the development of cardiovascular alterations, while pulse pressure is a predictor of cardiovascular complications and development of acute renal failure after both cardiac and non-cardiac surgery. Our objective was to determine whether baseline pulse pressure and estimated pulse wave velocity are associated with renal failure and 30-day mortality following colorectal surgery. METHODS: Retrospective observational study. A total of 816 adult patients undergoing elective colorectal surgery were evaluated by performing multivariable logistic regression analysis to determine whether baseline pulse pressure and estimated pulse wave velocity were independently associated with complications, specifically renal failure and 30-day postoperative mortality, and whether pulse pressure and estimated pulse wave velocity thresholds correlated with outcomes. RESULTS: Baseline pulse pressure was 56.00 mmHg (45.00;68.00) and estimated pulse wave velocity was 13.16 m/s (10.76;14.85). Baseline pulse pressure was not associated with acute renal failure or mortality in the univariate model. Baseline estimated pulse wave velocity was not associated with complications, acute renal failure, or mortality. An estimated pulse wave velocity of 13.78 m/s significantly predicted acute renal failure (AUC 0.654 [0.588-0.720]) and mortality (AUC 0.698 [0.600-0.796]). CONCLUSIONS: Neither pulse pressure nor preoperative baseline estimated pulse wave velocity were associated with acute renal failure or postoperative mortality. The preoperative estimated pulse wave velocity threshold of 13.78 m/s predicted an increased risk of acute renal failure and postoperative mortality.

Association between preoperative baseline pulse pressure and estimated pulse wave velocity and acute renal failure and mortality following colorectal surgery. A single-centre observational study. / Asociación entre la presión de pulso y la velocidad onda pulso estimada basal preoperatoria con las complicaciones postoperatorias, insuficiencia renal aguda y mortalidad tras cirugía colorrectal. Estudio unicéntrico observacional.

BACKGROUND: Elevated pulse wave velocity is a haemodynamic parameter considered to be a risk factor for the development of cardiovascular alterations, while pulse pressure is a predictor of cardiovascular complications and development of acute renal failure after both cardiac and non-cardiac surgery. Our objective was to determine whether baseline pulse pressure and estimated pulse wave velocity are associated with renal failure and 30-day mortality following colorectal surgery. METHODS: Retrospective observational study. A total of 816 adult patients undergoing elective colorectal surgery were evaluated by performing multivariable logistic regression analysis to determine whether baseline pulse pressure and estimated pulse wave velocity were independently associated with complications, specifically renal failure and 30-day postoperative mortality, and whether pulse pressure and estimated pulse wave velocity thresholds correlated with outcomes. RESULTS: Baseline pulse pressure was 56.00mmHg (45.00;68.00) and estimated pulse wave velocity was 13.16m/s (10.76;14.85). Baseline pulse pressure was not associated with acute renal failure or mortality in the univariate model. Baseline estimated pulse wave velocity was not associated with complications, acute renal failure, or mortality. An estimated pulse wave velocity of 13.78m/s significantly predicted acute renal failure (AUC 0.654 [0.588-0.720]) and mortality (AUC 0.698 [0.600-0.796]). CONCLUSIONS: Neither pulse pressure nor preoperative baseline estimated pulse wave velocity were associated with acute renal failure or postoperative mortality. The preoperative estimated pulse wave velocity threshold of 13.78m/s predicted an increased risk of acute renal failure and postoperative mortality.

Determination study of contaminants of emerging concern at trace levels in agricultural soil. A pilot study.

In this study, we aimed to develop and validate a quick, easy, and robust extraction method for the simultaneous determination of 30 organic contaminants of emerging concern (CECs) including some transformation products in soil samples. Three different extraction methods based on an ultrasonic cylindrical probe (UAE), a pressurized liquid extraction (PLE), and a QuEChERS method were compared. Ultra-performance liquid chromatography coupled with electrospray tandem mass spectrometry (LC-MS/MS) was used for identification and quantification of the target analytes. A modified QuEChERS method showed the best results in terms of extractability and accuracy. The extraction procedure developed provided adequate extraction performances (70% of the target analytes were recovered within a 70-99% range), with good repeatability and reproducibility (variations below 20%) and great sensitivity (LOQ < 0.1 ng/g in most cases). No matrix effects were observed for 70% of the compounds. Finally, the analytical methodology was applied in a pilot study where agricultural soil was irrigated with reclaimed water spiked with the contaminants under study. Of the 25 CECs added in irrigation water, a total of 13 pesticides and 5 pharmaceutical products were detected at concentration ranges from 0.1 to 1.2 ng/g (d.w) and from 0.1 to 2.0 ng/g (d.w), respectively.

[Seroprevalence of antibodies against measles virus in Galicia: trends during the last ten years depending on age and sex]. / Seroprevalencia de anticuerpos frente al virus del sarampión en Galicia: tendencias durante los últimos diez años en función de la edad y sexo.

OBJECTIVE: In 1998, the Europe Region of the World Health Organization set the goal of eliminating measles. In this study, the prevalence of immunity against measles virus in the population of the health area of Santiago de Compostela was analyzed based on data obtained between 2008-2018. METHODS: A total of 7,150 different patients were studied and divided into groups according to their year of birth: 2010-2017, 2000-2009, 1990-1999, 1980-1989, 1953-1979 and <1953. The serum determination of IgG against measles virus was performed using a commercialized chemiluminescent immunoassay. RESULTS: A minimum (76%) was observed for measles virus protection rates in those born between 1990-1999. By age group it was seen that in all groups the women presented a higher percentage of antibodies against measles. In a logistic regression model with year of birth and sex, an odds ratio of 1.06 (p<0.001) was obtained for the year of birth and of 0.82 (p=0.0013) for sex. CONCLUSIONS: It was observed lower seroprevalences from the implantation of the vaccine and a more pronounced change during the implantation period. From the vaccination plan for measles of the year 2000 in Galicia, the rates of protection against the virus of the measles have been increasing in our area. Although there is a greater proportion of women protected against men, these differences are small.

Resistive Switching and Charge Transport in Laser-Fabricated Graphene Oxide Memristors: A Time Series and Quantum Point Contact Modeling Approach.

This work investigates the sources of resistive switching (RS) in recently reported laser-fabricated graphene oxide memristors by means of two numerical analysis tools linked to the Time Series Statistical Analysis and the use of the Quantum Point Contact Conduction model. The application of both numerical procedures points to the existence of a filament connecting the electrodes that may be interrupted at a precise point within the conductive path, resulting in resistive switching phenomena. These results support the existing model attributing the memristance of laser-fabricated graphene oxide memristors to the modification of a conductive path stoichiometry inside the graphene oxide.

Do surgical site complications after ankle fracture surgery reduce with Aquacel Extra Ag®? / ¿Disminuyen las complicaciones cutáneas tras la cirugía de fracturas de tobillo con el uso de Aquacel Extra Ag®?

INTRODUCTION: Ankle fractures account for up to 10% of total fractures. Most of them require surgical fixation, which involves an important risk of wound complications. The aim of this study was to determine whether a silver-impregnated occlusive surgical dressing (Aquacel Ag Extra®) was effective in reducing the rates of wound complications after ankle fracture open reduction and internal fixation compared to standard sterile dressing. METHODS: We prospectively reviewed 233 patients who underwent ankle fracture open reduction and internal fixation. Surgeons switched from using a standard dressing to an Aquacel Ag Extra® from July 2017 to February 2018, without other major changes in perioperative management. We compared skin complications between both groups after 3 months' follow-up. RESULTS: The statistical analysis showed that there is no difference in the prevalence of skin complications between both groups. CONCLUSIONS: The theoretical advantages of silver impregnated dressings need further prospective randomized controlled studies to assess the appropriate indications for their use in orthopaedic surgery.

Cell-specific expression of insulin/insulin-like growth factor-I receptor hybrids in the mouse brain.

Insulin (IR) and insulin-like growth factor I (IGF-IR) receptors share structural homology and can form hybrid heterodimers. While different observations suggest that hybrid receptors are important in physiology and pathology, little is known about their function in the brain. To gain further insight into the role of IR/IGF-IR hybrids in this organ, we analyzed their cellular distribution in the mouse brain. We combined proximity ligation assays (PLA) for IR and IGF-IR, a technique that detects close protein-protein interactions, with immunocytochemistry for brain cell markers to identify IR/IGF-IR hybrids in the major types of brain cells. Intriguingly, while all the types of brain cells analyzed co-express both receptors, only neurons, astroglia, and microglia show readily detectable IR/IGF-IR hybrids. Hybrid PLA signal was negligible in brain endothelial cells and was absent in oligodendrocytes. Hybrids were comparatively more abundant in neurons and peaked after brain development was completed. Cell-specific expression and greater abundance in the adult brain suggests specialized actions of IR/IGF-IR hybrids in this organ, particularly in neurons.

A Meiotic Checkpoint Alters Repair Partner Bias to Permit Inter-sister Repair of Persistent DSBs.

Accurate meiotic chromosome segregation critically depends on the formation of inter-homolog crossovers initiated by double-strand breaks (DSBs). Inaccuracies in this process can drive aneuploidy and developmental defects, but how meiotic cells are protected from unscheduled DNA breaks remains unexplored. Here we define a checkpoint response to persistent meiotic DSBs in C. elegans that phosphorylates the synaptonemal complex (SC) to switch repair partner from the homolog to the sister chromatid. A key target of this response is the core SC component SYP-1, which is phosphorylated in response to ionizing radiation (IR) or unrepaired meiotic DSBs. Failure to phosphorylate (syp-16A) or dephosphorylate (syp-16D) SYP-1 in response to DNA damage results in chromosome non-dysjunction, hyper-sensitivity to IR-induced DSBs, and synthetic lethality with loss of brc-1BRCA1. Since BRC-1 is required for inter-sister repair, these observations reveal that checkpoint-dependent SYP-1 phosphorylation safeguards the germline against persistent meiotic DSBs by channelling repair to the sister chromatid.

Divertículo de Meckel volvulado asociado a brida como causa de obstrucción en intestino delgado / Volvulated Meckel's diverticulum associated to intestinal adhesion as a cause of small bowel obstruction

Resumen Introducción: El divertículo de Meckel (DM) es una anomalía congénita gastrointestinal producto de obliteración incompleta del conducto onfalomesentérico, habitualmente en menores de dos años. Como complicación destaca obstrucción intestinal, intususcepción e inflamación. Caso Clínico: Paciente de sexo masculino, 19 años, sin antecedentes mórbidos. Ingresa a Urgencias por dolor abdominal, 24 h de evolución, que inicia en mesogastrio y luego irradia a fosa ilíaca derecha (FID), intenso, asociado a vómitos, fiebre y taquicardia. Al examen abdominal destaca resistencia muscular, dolor en FID, Blumberg positivo y ruidos hidroaéreos disminuidos. Se realiza laparotomía de McBurney hallándose gran cantidad de líquido libre citrino viscoso y signos de obstrucción de intestino delgado; decidiendo cierre de laparotomía de McBurney y realizar laparotomía media infraumbilical. Se encuentra divertículo de Meckel torcido y estrangulado, con brida hacia raíz del mesenterio de intestino delgado distal. Se realiza resección DM y bridolisis, recuperando vitalidad de asa y apendicectomía profiláctica. Discusión: El diagnóstico preoperatorio del DM es infrecuente y requiere exploración quirúrgica. El DM volvulado es raro, en nuestro caso produjo obstrucción intestinal secundaria a brida entre DM y mesenterio.

Introduction: Meckel's diverticulum is the most frequent gastrointestinal anomaly. It's more frequently seen in children less than 2 years of age. It's caused by the incomplete obliteration of the omphalomesenteric conduct. Case report: 19 year old male patient with no previous medical history presents sudden onset of high intensity abdominal pain, initially located in the periumbilical region, radiating to right lower quadrant associated with emesis, fever and tachycardia. Physical examination showed abdominal guarding, rebound tenderness and decreased bowel sounds. During McBurney laparotomy a large volume of viscous free fluid was found and signs of small bowel obstruction, deciding close McBurney laparotomy and performing sub-umbilical midline laparotomy. Meckel diverticulum is founded, twisted and strangled, with a bridle adhesion to the mesenteric root, compromising the small bowel. The adherence and the MD are resected, obtaining appropriate peristaltic activity and color. Appendectomy and peritoneal lavage are performed without complications. Discussion: preoperatory diagnosis of MD is unfrequented and its need surgical exploration. MD's volvulus is infrequent and in our case, intestinal obstruction it's secondary to an adherence between the volvulated MD and the mesentery.