Asunto(s)
Gases , Dilatación Gástrica/complicaciones , Vena Porta , Enfermedad Aguda , Humanos , Masculino , Persona de Mediana EdadRESUMEN
PURPOSE: To analyse acute cholecystitis (AC) management during the first pandemic outbreak after the recommendations given by the surgical societies estimating: morbidity, length of hospital stay, mortality and hospital-acquired SARS-CoV-2 infection rate. METHODS: Multicentre-combined (retrospective-prospective) cohort study with AC patients in the Community of Madrid between 1st March and 30th May 2020. 257 AC patients were involved in 16 public hospital. Multivariant binomial logistic regression (MBLR) was applied to mortality. RESULTS: Of COVID-19 patients, 30 were diagnosed at admission and 12 patients were diagnosed during de admission or 30 days after discharge. In non-COVID-19 patients, antibiotic therapy was received in 61.3% of grade I AC and 40.6% of grade II AC. 52.4% of grade III AC were treated with percutaneous drainage (PD). Median hospital stay was 5 [3-8] days, which was higher in the non-surgical treatment group with 7.51 days (p < 0.001) and a 3.25% of mortality rate (p < 0.21). 93.3% of patients with SARS-CoV-2 infection at admission were treated with non-surgical treatment (p = 0.03), median hospital stay was 11.0 [7.5-27.5] days (p < 0.001) with a 7.5% of mortality rate (p > 0.05). In patients with hospital-acquired SARS-CoV-2 infection, 91.7% of grade I-II AC were treated with non-surgical treatment (p = 0.037), with a median hospital stay of 16 [4-21] days and a 18.2% mortality rate (p > 0.05). Hospital-acquired infection risk when hospital stay is > 7 days is OR 4.7, CI 95% (1.3-16.6), p = 0.009. COVID-19 mortality rate was 11.9%, AC severity adjusted OR 5.64 (CI 95% 1.417-22.64). In MBLR analysis, age (OR 1.15, CI 95% 1.02-1.31), SARS-CoV-2 infection (OR 14.49, CI 95% 1.33-157.81), conservative treatment failure (OR 8.2, CI 95% 1.34-50.49) and AC severity were associated with an increased odd of mortality. CONCLUSION: In our population, during COVID-19 pandemic, there was an increase of non-surgical treatment which was accompanied by an increase of conservative treatment failure, morbidity and hospital stay length which may have led to an increased risk hospital-acquired SARS-CoV-2 infection. Age, SARS-CoV-2 infection, AC severity and conservative treatment failure were mortality risk factors.
Asunto(s)
Antibacterianos/uso terapéutico , COVID-19 , Colecistectomía/estadística & datos numéricos , Colecistitis Aguda , Tratamiento Conservador , Infección Hospitalaria , Control de Infecciones , COVID-19/diagnóstico , COVID-19/mortalidad , COVID-19/prevención & control , Colecistitis Aguda/diagnóstico , Colecistitis Aguda/epidemiología , Colecistitis Aguda/terapia , Estudios de Cohortes , Comorbilidad , Tratamiento Conservador/métodos , Tratamiento Conservador/estadística & datos numéricos , Infección Hospitalaria/epidemiología , Infección Hospitalaria/virología , Drenaje/métodos , Drenaje/estadística & datos numéricos , Femenino , Humanos , Control de Infecciones/métodos , Control de Infecciones/organización & administración , Control de Infecciones/normas , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Medición de Riesgo , SARS-CoV-2 , España/epidemiologíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Dilatación Gástrica/diagnóstico por imagen , Dilatación Gástrica/cirugía , Hipertensión/complicaciones , Neumatosis Cistoide Intestinal/diagnóstico por imagen , Dolor Abdominal/etiología , Tomografía Computarizada de Emisión/métodos , Intubación Gastrointestinal/métodosRESUMEN
Wandering spleen is an uncommon entity, characterized by the anomalous position of the spleen, caused by the absence or laxity of its suspensory ligaments. The most common symptoms are usually due to intermittent or complete torsion of the splenic pedicle with subsequent infarction. We report a case of torsion of a wandering spleen. Laparoscopic splenectomy was performed and recovery was uneventful. Although few cases of wandering spleen treated laparoscopically have been reported in the literature, laparoscopy has been demonstrated to be a safe technique for the treatment of this entity.
Asunto(s)
Laparoscopía , Esplenectomía , Ectopía del Bazo/cirugía , Adulto , Humanos , Masculino , Tomografía Computarizada por Rayos X , Anomalía Torsional , Resultado del Tratamiento , Ectopía del Bazo/diagnóstico por imagenRESUMEN
El bazo ectópico o errante (wandering spleen) es una anomalía muy infrecuente caracterizada por una mala posición del bazo como consecuencia de una ausencia o laxitud de los ligamentos suspensorios del bazo. Las manifestaciones clínicas suelen producirse por una torsión completa o intermitente del pedículo esplénico, con el consiguiente riesgo de isquemia del bazo. Presentamos un caso de bazo ectópico con torsión del pedículo, tratado mediante esplenectomía laparoscópica sin complicaciones. Aunque hay pocos casos comunicados en la literatura científica, la laparoscopia ha demostrado ser una técnica válida y segura en el tratamiento del bazo ectópico (AU)
Wandering spleen is an uncommon entity, characterized by the anomalous position of the spleen, caused by the absence or laxity of its suspensory ligaments. The most common symptoms are usually due to intermittent or complete torsion of the splenic pedicle with subsequent infarction. We report a case of torsion of a wandering spleen. Laparoscopic splenectomy was performed and recovery was uneventful. Although few cases of wandering spleen treated laparoscopically have been reported in the literature, laparoscopy has been demonstrated to be a safe technique for the treatment of this entity (AU)