RESUMEN
Anastomotic leakage (AL) is a defect of the intestinal wall at the anastomotic site and is one of the most severe complications in colorectal surgery. Previous studies have shown that the immune system response plays a significant role in the development of AL. In recent years, DAMPs (damage-associated molecular patterns) have been identified as cellular compounds with the ability to activate the immune system. The NLRP3 inflammasome plays an important role in the inflammatory responses which are mediated by DAMPs such as ATP, HSP proteins or uric acid crystals, when found in extracellular environments. Recent publications suggest that systemic concentration of DAMPs in patients with colorectal surgery may determine the inflammatory process and have a role in the occurrence of AL and other post-surgery complications. This review provides valuable knowledge about the current evidence supporting this hypothesis and highlights the possible role of these compounds in postoperative processes, which could open a new path to explore new strategies to prevent possible post-surgical complications.
Asunto(s)
Anastomosis Quirúrgica , Fuga Anastomótica , Cirugía Colorrectal , Humanos , Alarminas , Anastomosis Quirúrgica/efectos adversos , Fuga Anastomótica/etiología , Complicaciones Posoperatorias/prevención & control , Periodo PosoperatorioRESUMEN
INTRODUCTION: Diagnosis of colorectal cancer (CRC) based on clinical symptoms is usually established in its advanced stages. One strategy for reducing mortality is the early detection and removal of preneoplastic and initial neoplastic lesions, even before the first symptoms appear, by means of population-based screening campaigns. The aim of the present study is to determine whether CRC diagnosed via a screening campaign has more favourable histopathological prognostic factors than when diagnosed in the symptomatic phase. MATERIAL AND METHODS: The prospective study of all the patients undergoing programmed CRC surgery at the JM Morales Meseguer Hospital (Spain) is between 2004 and 2010. The patients were divided into two groups: one diagnosed from clinical symptoms and one through a screening campaign. The following factors were compared: tumour size; degree of tumour invasion of the wall; lymph node, perineural and lymphovascular involvement; tumour stage; and grade of differentiation. RESULTS: Compared to the symptomatic group, the screen-detected patients had smaller-sized tumours (lesions of less than 5 cm in 84 vs 69.55%, p < 0.001), a lower degree of colorectal wall invasion (T0-1 in 36 vs 9.02%, p < 0.001), less lymph node involvement (N0 in 72 vs 58.76%, p > 0.05), less vascular invasion (7.20 vs 15.22%, p = 0.79) and less perineural invasion (6.4 vs 20.70%, p < 0.001). The TNM staging in the screening group was lower than in the symptomatic group (stage 0-1 in 50.40 vs 18.58%, p < 0.001). CONCLUSIONS: CRC diagnosed through a population-based screening programme presents more favourable histopathological characteristics than that diagnosed from the appearance of symptoms.
Asunto(s)
Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer , Tamizaje Masivo , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/patología , Femenino , Humanos , Consentimiento Informado , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Estadificación de Neoplasias , PronósticoRESUMEN
Segmental ischemic colitis is an uncommon disease in young patients, being usually associated to drug abuse, infectious or autoimmune diseases. We present a case that, in spite of a complete diagnostic study, had repeatedly two attacks of intestinal necrosis during his admission.
Asunto(s)
Intestinos/patología , Colitis , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/patología , Enfermedades del Colon/cirugía , Humanos , Ileostomía , Íleon/cirugía , Intestinos/diagnóstico por imagen , Intestinos/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Necrosis , Tomografía Computarizada por Rayos XRESUMEN
Adenocarcinoid tumour of the appendix is a rare entity characterised by the presence of a double component (neuroendocrine and glandular). It originates in the neuroendocrine cells of the appendicular mucosa. A preoperative diagnosis of a primary appendiceal tumour is uncommon and more so one suggesting an adenocarcinoid pathology. Optimal treatment is debated between a simple appendectomy and a more extensive resection, which occasionally includes hysterectomy and bilateral ovariectomy. Our aim is to report this rare entity and conduct a review of the literature on the different treatment options.
Asunto(s)
Adenocarcinoma/cirugía , Neoplasias del Apéndice/cirugía , Apéndice/cirugía , Adenocarcinoma/patología , Apendicectomía , Neoplasias del Apéndice/patología , Apéndice/patología , Colectomía , Femenino , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: Endometriosis is a relatively common disease among women with child-bearing potential, and rare before puberty or following menopause. It consists of the presence of hormone-responsive endometrium outside the endometrial cavity. CASE REPORT: We report the case of a patient with a rectal lesion, initially approached as a primary rectal malignancy, where histopathology eventually revealed an adenocarcinoma arising from endometrial tissue in the colonic wall. DISCUSSION: Endometriosis has an estimated rated of 10-20%. Sites may be split up into two larger categories - gonadal and extragonadal. The frequency of extragonadal endometriosis in the bowel is estimated to involve 3%-37% of women with pelvic endometriosis, and most lesions are found in the sigmoid colon and rectum. The malignant transformation of endometriotic lesions is estimated between 0.3% and 1% of cases. The gold standard in the diagnosis of intestinal endometriosis is exploratory laparotomy and the pathological study of specimens. Adjuvant radiotherapy and chemotherapy, although used for some patients, have not proven effective.
Asunto(s)
Adenocarcinoma/patología , Transformación Celular Neoplásica , Enfermedades del Colon/patología , Endometriosis/patología , Lesiones Precancerosas/patología , Neoplasias del Recto/patología , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Procalcitonin (PCT) and C-Reactive Protein (CRP) are acute-phase reactants that indicate the presence and severity of an infection. The aim of this study was to verify the utility of CRP and PCT as tools for early diagnosis of anastomotic leakage (AL) in patients undergoing elective colorectal surgery. A prospective observational study including 95 patients undergoing elective colorectal surgery with anastomosis, where patients were divided into two groups according to whether or not AL happened. Different variables were compared using a uni- and multivariate analyses to identify the risk factors for AL. Receiver Operating Characteristic (ROC) curves were added to establish a cut-off point for CRP and PCT. The inflammatory marker levels were analysed in other complications different from AL. AL was detected in 11 patients (14%), 7 required an emergency reoperation. The overall morbidity rate was 42.1% and the mortality was 3.2%. In the univariate study, increased CRP on days 3 and 5, male sex and intraoperative complications were significantly associated with AL. In the multivariate study, CRP on day 5 was the only factor related to AL. AUC at ROC curves showed that CRP results ≥ 15.3 mg/dL on day 3 and 9.1 mg/dL on day 5 were predictors of AL. Normal CRP and PCT values had a high negative predictive value. CRP on postoperative day 5 is a reliable marker for early detection of anastomotic leakage in colorectal surgery. Both CRP and PCT on days 3 and 5 have a high negative predictive value.Trial registration: The study has been registered at ClinicalTrials.gov. Code: NCT04632446.
Asunto(s)
Fuga Anastomótica , Cirugía Colorrectal , Fuga Anastomótica/diagnóstico , Biomarcadores , Cirugía Colorrectal/efectos adversos , Diagnóstico Precoz , Humanos , Masculino , Valor Predictivo de las Pruebas , Polipéptido alfa Relacionado con CalcitoninaAsunto(s)
Enteritis/cirugía , Enteritis/terapia , Eosinofilia/cirugía , Eosinofilia/terapia , Gastritis/cirugía , Gastritis/terapia , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/terapia , Dolor Abdominal/etiología , Anciano , Procedimientos Quirúrgicos del Sistema Digestivo , Servicios Médicos de Urgencia , Enteritis/patología , Eosinofilia/patología , Gastritis/patología , Humanos , Obstrucción Intestinal/patología , MasculinoRESUMEN
AIM: To analyse factors that may predict the appearance of rib fracture complications during the first days of evolution and determine whether the number of fractures is related to these complications. METHOD: Retrospective case-control study of patients admitted with a diagnosis of rib fractures between 2010 and 2014. Two groups were established depending on the appearance or not of pleuropulmonary complications in the first 72 h, and the following were compared: age, sex, Charlson comorbidity index (CCI), number and uni- or bilateral involvement, mechanism of trauma, days of hospital stay, haemoglobin on discharge minus haemoglobin on admission, pleuropulmonary complications during admission (pneumothorax, haemothorax or pulmonary contusion) and placement of pleural drainage. RESULTS: One hundred and forty-one cases of rib fractures were admitted in the period mentioned. There were no differences in the patients' baseline characteristics (age, sex and Charlson Comorbidity Index) between the two groups. Differences were found in the number of fractures (2.98 ± 1.19 in the group without complications vs 3.55 ± 1.33 in the group with complications, p = 0.05) and in the drop in the level of haemoglobin (0.52 ± 0.91 mg/dl vs 1.22 ± 1.29 mg/dl, p = 0.01). The length of hospital stay varied considerably in each group (5.35 ± 4.05 days vs 7.86 ± 6.96 days), but without statistical significance (p = 0.11). CONCLUSIONS: The number of fractured ribs that best predicted the appearance of complications (delayed pleuropulmonary complications and greater bleeding) was 3 or more.
Asunto(s)
Contusiones/epidemiología , Fracturas Múltiples/epidemiología , Hemotórax/epidemiología , Lesión Pulmonar/epidemiología , Neumotórax/epidemiología , Fracturas de las Costillas/fisiopatología , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Contusiones/etiología , Femenino , Fracturas Múltiples/complicaciones , Fracturas Múltiples/fisiopatología , Hemoglobinas/metabolismo , Hemorragia/sangre , Hemorragia/epidemiología , Hemorragia/etiología , Hemotórax/etiología , Humanos , Tiempo de Internación/estadística & datos numéricos , Lesión Pulmonar/etiología , Masculino , Persona de Mediana Edad , Derrame Pleural/epidemiología , Neumonía/epidemiología , Neumotórax/etiología , Insuficiencia Respiratoria/epidemiología , Estudios Retrospectivos , Fracturas de las Costillas/complicaciones , Factores de Riesgo , España/epidemiologíaRESUMEN
INTRODUCTION: Population-based screening programmes for colorectal cancer (CRC) allow an early diagnosis, even before the onset of symptoms, but there are few studies and none in Spain on the influence they have on patient survival. The aim of the present study is to show that patients receiving surgery for CRC following diagnosis via a screening programme have a higher survival and disease-free survival rate than those diagnosed in the symptomatic stage. MATERIAL AND METHODS: Prospective study of all the patients undergoing programmed surgery for CRC at the JM Morales Meseguer Hospital in Murcia (Spain) between 2004 and 2010. The patients were divided into two groups: (a) those diagnosed through screening (125 cases); and (b) those diagnosed in the symptomatic stage (565 cases). Survival and disease-free survival were analysed and compared for both groups using the Mantel method. RESULTS: The screen-detected CRC patients show a higher rate of survival (86.3% versus 72.1% at 5 years, p<0.05) and a lower rate of tumour recurrence (73.4% versus 88.3% at 5 years, p<0.05). CONCLUSIONS: Population-based screening for CRC is an effective strategic measure for reducing mortality specific to this neoplasia.
Asunto(s)
Neoplasias Colorrectales/diagnóstico , Tamizaje Masivo/métodos , Anciano , Neoplasias Colorrectales/mortalidad , Detección Precoz del Cáncer/métodos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estudios ProspectivosRESUMEN
INTRODUCTION: Transanal endoscopic microsurgery is a widely used and valid technique with established indications. However, the cost of surgical anoscopes is not available in all centers. Many authors have described transanal resection of rectal tumors through a single laparoscopy port such as the SILS system. MATERIALS AND METHODS: We analyzed 5 cases of patients undergoing transanal resection with an SILS device. The clinical, surgical, and oncological data were assessed. RESULTS: The median distance to the anal margin was 7.2 cm (range, 5 to 10 cm) and median tumor size was 3 cm (range, 1 to 6 cm). Median operating time was 75 minutes (range, 60 to 120 min). A postsurgical rectorrhagia occurred in 1 of the case. Two cases were adenocarcinoma, 2 were adenomas, and the other was a mucosa without any tumor remnants. The margins were negative in all cases. CONCLUSIONS: Transanal resection of rectal tumors using the SILS technique is a feasible procedure. Longer series and prospective studies are necessary.
Asunto(s)
Adenocarcinoma/cirugía , Adenoma Velloso/cirugía , Colectomía/métodos , Endoscopios , Microcirugia/métodos , Cirugía Endoscópica por Orificios Naturales/instrumentación , Neoplasias del Recto/cirugía , Adenocarcinoma/diagnóstico , Adenoma Velloso/diagnóstico , Anciano , Canal Anal , Biopsia , Colonoscopía , Endosonografía , Diseño de Equipo , Humanos , Masculino , Persona de Mediana Edad , Resonancia Magnética Nuclear Biomolecular , Neoplasias del Recto/diagnóstico , Resultado del TratamientoRESUMEN
BACKGROUND: Retrorectal or presacral space is occupied during embryological stem cell development and therefore may contain a heterogeneous group of tumors. CLINICAL CASE: We report the case of a 22-year-old male with a pilonidal cyst operated due to recurrent pilonidal sinus cyst. Final diagnosis after pelvic computed tomography is large retrorectal cystic tumor and magnetic resonance diagnosis of a presacral cystic compatible wtih germ cell tumor. The tumor was removed surgically through the abdomen and diagnosis of cystic teratoma was established. CONCLUSION: Retrorectal tumors are rare lesions whose presence must be ruled out in case of recurrent sinus.
Antecedentes: durante el desarrollo embriológico, el espacio retrorrectal o presacro está ocupado por células pluripotenciales y, por tanto, puede contener un grupo heterogéneo de tumores. Caso clínico: se comunica el caso de un paciente masculino de 22 años de edad, intervenido de sinus pilonidal recidivado. Con estudios de tomografía computada de pelvis y resonancia magnética nuclear se sospechó la existencia de un tumor quístico presacro compatible con tumor germinal; la lesión se extirpó quirúrgicamente por vía abdominal y se estableció el diagnóstico definitivo de teratoma quístico. Conclusiones: los tumores retrorrectales son lesiones poco habituales que es necesario descartar en caso de sinus recidivantes.
Asunto(s)
Neoplasias Pélvicas/diagnóstico , Seno Pilonidal/etiología , Teratoma/diagnóstico , Diagnóstico Diferencial , Quiste Epidérmico/diagnóstico , Humanos , Imagen por Resonancia Magnética , Masculino , Neoplasias Pélvicas/complicaciones , Neoplasias Pélvicas/epidemiología , Neoplasias Pélvicas/patología , Neoplasias Pélvicas/cirugía , Seno Pilonidal/cirugía , Recurrencia , Infección de la Herida Quirúrgica/etiología , Teratoma/complicaciones , Teratoma/epidemiología , Teratoma/patología , Teratoma/cirugía , Tomografía Computarizada por Rayos X , Carga Tumoral , Adulto JovenRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Neoplasias del Colon/cirugía , Isquemia/complicaciones , Isquemia/diagnóstico , Colitis Isquémica/cirugía , Patología/métodos , Necrosis/complicaciones , Colectomía/métodos , Colon/patología , Colon/cirugía , Intestinos/cirugía , Aorta Abdominal , Ecocardiografía , Dolor Abdominal/etiologíaRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Adulto Joven , Neuroblastoma/cirugía , Neoplasias Retroperitoneales/cirugía , Neuroblastoma/patología , Neoplasias Retroperitoneales/patología , Tomografía Computarizada por Rayos X , Glándulas Suprarrenales/patologíaRESUMEN
No disponible
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Adenocarcinoma/diagnóstico , Neoplasias del Apéndice/complicaciones , Neoplasias del Apéndice/cirugía , Neoplasias del Apéndice , Colectomía/métodos , Apéndice/patología , Apéndice/cirugía , ApéndiceRESUMEN
No disponible
Asunto(s)
Humanos , Masculino , Anciano , Eosinofilia/complicaciones , Gastroenteritis/complicaciones , Obstrucción Intestinal/complicaciones , Laparotomía , Tratamiento de Urgencia/métodosRESUMEN
INTRODUCCIÓN: la endometriosis es una patología relativamente frecuente en mujeres en edad fértil y poco prevalerte en mujeres prepúberes o postmenopáusicas. CASO CLÍNICO: presentamos el caso clínico de una mujer de 57 años, con antecedentes de histerectomía y doble anexectomía por endometriosis ovárica, diagnosticada de neoplasia de recto T3N1. Se realizó neoadyuvancia preoperatoria y resección anterior baja, sin complicaciones. La anatomía patológica describía infiltración de la pared rectal por adenocarcinoma pobremente diferenciado de origen ginecológico. DISCUSIÓN: la endometriosis tiene una prevalencia estimada del 10-20% y su lugar de aparición puede ser variado, tanto gonadal como extragonadal. La frecuencia de endometriosis extragonadal de localización intestinal se estima en un 3-37% de mujeres con endometriosis pélvica, y de estas la mayoría se localizan en colon sigmoide y recto. La transformación maligna de un foco de endometriosis se estima entre el 0,3 y el 1%. El gold estándar para el diagnóstico es la resección y estudio histológico. La radioterapia y quimioterapia adyuvante todavía no ha demostrado su clara utilidad
BACKGROUND: Endometriosis is a relatively common disease among women with child-bearing potential, and rare before puberty or following menopause. It consists of the presence of hormone-responsive endometrium outside the endometrial cavity. CASE REPORT: We report the case of a patient with a rectal lesion, initially approached as a primary rectal malignancy, where histopathology eventually revealed an adenocarcinoma arising from endometrial tissue in the colonic wall. DISCUSSION: Endometriosis has an estimated rated of 10-20%. Sites may be split up into two larger categories - gonadal and extragonadal. The frequency of extragonadal endometriosis in the bowel is estimated to involve 3%-37% of women with pelvic endometriosis, and most lesions are found in the sigmoid colon and rectum. The malignant transformation of endometriotic lesions is estimated between 0.3% and 1% of cases. The gold standard in the diagnosis of intestinal endometriosis is exploratory laparotomy and the pathological study of specimens. Adjuvant radiotherapy and chemotherapy, although used for some patients, have not proven effective
Asunto(s)
Femenino , Humanos , Persona de Mediana Edad , Endometriosis/patología , Neoplasias del Recto/patología , Complicaciones Posoperatorias/diagnóstico , Quimioterapia Adyuvante , Neoplasias del Recto/cirugíaRESUMEN
No disponible