[Reduction of ileocolic intussusception with hydrostatic enema under ultrasound guidance in pediatric patients: Case report]. / Reducción de intususcepción ileocólica con enema hidrostático bajo guía ecográfica en pacientes pediátricos: Reporte de casos.

Ileocolic intussusception is a pediatric emergency with initial non-surgical treatment. Ultrasound-guided hydrostatic reduction in pediatric patients is a widely used initial treatment method in the world; however, its use is not widespread in our environment. We present 4 cases of patients with ileocolic intussusception treated by ultrasound-guided hydrostatic reduction in the Instituto Nacional de Salud del Niño - San Borja (INSNSB), with therapeutic reduction and without complications.

Ileocolonic intussusception due to severe endometriosis.

Endometriosis is the presence of normal endometrial tissue outside the uterus, which may appear in up to 15% of fertile female population. Bowel endometriosis is uncommon, and obstruction due to endometrial ileocolic intussusception is extremely rare. Herein, we report a case of a 27-year-old female who presented with bowel obstruction due to ileocolic intussusception secondary to endometriosis. A 27-year-old female, without pregnancies, and with a 1 year history of endometriosis presented to the emergency department referring severe abdominal pain in right lower quadrant, nausea and vomiting, she had medical history of prior episodes of mild abdominal pain due to endometriosis with OB/GYN follow-up. Physical examination revealed abdominal distension with decreased bowel movements to auscultation. A CT scan reported suspicion of intussusception. Colonoscopy was ordered, where an ileocolic intussusception was found. Diagnostic laparoscopy was performed, and the initial diagnosis was confirmed. A right hemicolectomy with extracorporeal anastomosis was achieved without any surgical complications. The patient was discharge on postoperative day 4 and continues doing well on a 12 month follow-up. Ileocolic intussusception due to endometriosis is a very rare condition, and it must be considered a differential diagnosis in female patients in reproductive age, when presenting with intestinal obstruction.

Bowel obstruction due to video capsule endoscopy in a patient with Crohn's disease.

BACKGROUND: The retention of the endoscopic capsule (EC) is a serious complication and exceptionally, acute intestinal obstruction is conditioned. CLINICAL CASE: 64 years-old man, previously treated by gastroenterology for Crohn's disease. With good initial response to pharmacological treatment for 6 weeks, subsequently with the onset of pain and symptoms not explained by colonoscopy. EC was performed, presenting at 48 hours bowel obstruction symptoms with data of systemic inflammatory response and peritoneal irritation. Exploratory laparotomy with bowel resection and side-to-side stapled anastomosis was performed, histopathology report confirmed obstruction of the bowel lumen due to impacted EC in ileal stenosis area. In the immediate postoperative period with good evolution. At 8 weeks of the procedure, he went for an enterocutaneous fistula, which had a good response to conservative treatment. CONCLUSION: The rate of retention of CE in Crohn's disease is 5-6%, prior to its use, it is recommended to perform imaging studies to evaluate the bowel permeability, however negative studies do not exclude the presence of stenosis. In cases where intestinal resection is indicated, it is recommended to be wide with side-to-side stapled anastomosis to reduce the risk of recurrence of the disease.

ANTECEDENTES: La retención de la cápsula endoscópica (CE) es una complicación grave y provoca de forma excepcional obstrucción intestinal aguda en su presentación. CASO CLÍNICO: Paciente masculino de 64 años, tratado previamente por gastroenterología por enfermedad de Crohn. Muestra buena respuesta inicial al tratamiento farmacológico por seis semanas, pero después refiere dolor y síntomas no explicados por la colonoscopia. Se realizó CE, con aparición a las 48 horas de cuadro de obstrucción intestinal, signos de respuesta inflamatoria sistémica e irritación peritoneal. Se practicó laparotomía exploradora más resección intestinal con anastomosis laterolateral mecánica y el informe de histopatología confirmó obstrucción de la luz intestinal por CE impactada en la zona de estenosis del íleon terminal. En el postoperatorio inmediato la evolución es buena. A las ocho semanas del procedimiento acude por fístula enterocutánea que tuvo buena respuesta al tratamiento conservador. CONCLUSIÓN: La tasa de retención de CE en la enfermedad de Crohn es de 5 a 6%; antes de programarla se recomienda realizar estudios de imagen para evaluar la permeabilidad de la luz intestinal, si bien los estudios negativos no excluyen la presencia de estenosis. En los casos en que esté indicada la resección intestinal, se recomienda que ésta sea amplia con anastomosis laterolateral mecánica para reducir el riesgo de recurrencia de la enfermedad.

Intussusception reveals MUTYH-associated polyposis syndrome and colorectal cancer: a case report.

BACKGROUND: We are reporting a rare case of MUTYH-associated polyposis, a colorectal cancer hereditary syndrome, diagnosticated after an intussusception. Colorectal cancer is an important cause of cancer related mortality that can be manifested by an intussusception, a rare occurrence in adults and almost always related to tumors. Approximately 5% of colorectal cancers can be attributed to syndromes known to cause hereditary colorectal cancer, such as MUTYH-associated polyposis, autosomal genetic syndrome associated with this disease. CASE PRESENTATION: We present the case of a 44 years old male, that sought medical consultation with a complaint of abdominal discomfort, that after five days changed its characteristics. The patient was sent to the emergency department were a CT-scan revealed intestinal sub-occlusion by ileocolic invagination. Right colectomy was carried out. The anatomic-pathological examination revealed a moderately differentiated mucinous adenocarcinoma and multiples sessile polyps, which led to the suspicion of a genetic syndrome. In the genetics analysis two mutations were observed in the MUTYH gene, and MUTYH-associated polyposis was diagnosticated. CONCLUSION: This case demonstrates the importance of meticulous analysis of the patient examinations results to identify possible discrete alterations that can lead to improved understanding of disease.

[Divertículo de Meckel con tejido pancreático ectópico en un niño de 12 años con invaginación intestinal. Reporte de caso y revisión de la literatura]. / Meckel diverticulum with ectopic pancreatic tissue in a 12-year-old boy with intestinal invagination. Case report and review of the literature.

INTRODUCCIÓN: El divertículo de Meckel es un remanente del conducto onfalomesentérico y su prevalencia es del 2%. CASO CLÍNICO: Niño de 12 años con dolor abdominal, acompañado de evacuaciones mucosanguinolentas y hematemesis, con masa en cuadrante inferior derecho. En la laparotomía quirúrgica se encontró invaginación, y se realizó desinvaginación y resección del divertículo de Meckel. CONCLUSIÓN: La asociación de divertículo de Meckel con tejido pancreático heterotópico en niños es poco frecuente. Clínicamente, su principal manifestación es la invaginación intestinal en la literatura revisada, y el ultrasonido constituye el mejor estudio para el diagnóstico de invaginación intestinal, no así para el divertículo de Meckel o el tejido pancreático heterotópico, en los que la tomografía sería una opción. INTRODUCTION: Meckel's diverticulum is a remnant of the omphalomesenteric duct and its prevalence is 2%. CLINICAL CASE: A 12-year-old male with abdominal pain, accompanied by muco-sanguineous evacuations and hematemesis, with right lower quadrant mass. In the laparotomy, invasion was found; intussusception reduction and resection of the Meckel's diverticulum was performed. CONCLUSION: The association of Meckel's diverticulum with heterotopic pancreatic tissue in children is rare, its main manifestation is intussusception and ultrasound is an option for diagnosis.

[Gallstone ileus, surgical management review]. / Íleo biliar, revisión del manejo quirúrgico.

BACKGROUND: Gallstone ileus (GI) represents a rare cause of mechanical intestinal occlusion, which is caused by the impaction of a gallstones at the gastrointestinal tract, being most frequently the terminal ileum; its etiology is due to the passage of a calculum through a biliary-enteric fistula. Due to its low incidence, diagnostic suspicion and adequate initial surgical treatment are essential for an adequate clinical evolution. OBJECTIVE: A bibliographic review on the current surgical management of GI was carried out and exemplified by the presentation a clinical case. CLINICAL CASE: 78-year-old male with bowel obstruction, upon undergoing a CT scan, a gallstone at the level of distal ileum is displayed, therefore, an exploratory laparotomy (ex lap) is performed with enterotomy and extraction of the calculus. The patient bestowed adequate postoperative clinical evolution, and the presence of a cholecystoduodenal fistula is documented by an upper endoscopy. DISCUSSION: GI represents an uncommon pathology, however, there is discrepancy in the literature regarding the initial surgical management, especially in whether or not a biliary procedure should be associated with emergency enterolithotomy. CONCLUSION: GI is associated with complications secondary to diagnostic delay and its late surgical resolution, although the initial treatment is aimed at resolving the intestinal obstruction through enterotomy and gallstone extraction, there is controversy regarding the preferred time for cholecystectomy and repair of biliary-enteric fistula, being the two-stage surgery the surgical procedure of choice, especially in patients with a high risk of complications.

ANTECEDENTES: El íleo biliar (IB) es una causa poco frecuente de oclusión intestinal mecánica, causado por la impactación de un cálculo biliar en el tubo digestivo, siendo la localización más frecuente el íleon terminal; se debe al paso de un cálculo a través de una fístula bilioentérica. Debido a su baja incidencia, la sospecha diagnóstica y el tratamiento quirúrgico inicial adecuado son de gran importancia para la evolución clínica. OBJETIVO: Realizar una revisión bibliográfica sobre el manejo quirúrgico actual del IB y ejemplificarlo mediante la presentación de un caso clínico. CASO CLÍNICO: Varón de 78 años con cuadro de oclusión intestinal, con presencia de cálculo biliar en el íleon distal por tomografía. Se realiza laparotomía exploradora con enterotomía y extracción del cálculo. Cursa con adecuada evolución posquirúrgica, documentándose fístula colecistoduodenal por panendoscopia. DISCUSIÓN: El IB es una patología poco común, por lo cual existe discrepancia en cuanto al tipo de manejo quirúrgico ideal, sobre todo en si se debe o no asociar un procedimiento biliar a la enterolitotomía de urgencia. CONCLUSIÓN: El IB se asocia a complicaciones secundarias al retraso diagnóstico y a una mala elección de la técnica quirúrgica inicial. Si bien el tratamiento está encaminado a resolver la obstrucción intestinal mediante enterotomía y extracción del cálculo biliar, existe controversia en cuanto al tiempo preferido para realizar la colecistectomía y la reparación de la fístula bilioentérica, siendo la cirugía en dos tiempos el procedimiento quirúrgico de elección, sobre todo en pacientes con alto riesgo de complicaciones.

[Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review]. / Enfermedad diverticular yeyuno-ileal complicada tratada quirúrgicamente: serie de 12 casos y revisión de literatura.

OBJECTIVE: To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015. MATERIALS AND METHODS: We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT. RESULTS: In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). CONCLUSIONS: Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice.

Enfermedad diverticular yeyuno-ileal complicada tratada quirúrgicamente: serie de 12 casos y revisión de literatura / Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review

Objetivo: Realizar un análisis retrospectivo de una serie de casos de diverticulitis yeyuno-ileal complicadas tratadas quirúrgicamente en nuestro servicio durante el periodo comprendido entre los años 2002 al 2015. Materiales y métodos: Se trató quirúrgicamente 12 casos de diverticulosis yeyuno-ileal complicadas, 7 mujeres y 5 varones. La edad media fue 76 años. La presentación clínica en todos los casos fue dolor abdominal agudo, uno de ellos con hemorragia digestiva. Todos presentaron leucocitosis, neutrofilia y aumento de reactantes de fase aguda. A todos los pacientes se les realizó TAC abdominal urgente. Resultados: En 11 casos hubo congruencia entre estudio de imagen y hallazgos quirúrgicos. La localización de los divertículos fue yeyuno (9) e íleon (3). Siempre se realizó laparotomía exploradora urgente encontrándose perforación diverticular con peritonitis (7 casos), perforación diverticular con absceso (4 casos) y en un caso un área isquémica con perforación diverticular tras embolización. Se realizó siempre resección intestinal y anastomosis. En ningún caso se conocía previamente el diagnóstico de diverticulosis yeyuno-ileal. Nuestras complicaciones fueron: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusiones: La diverticulitis yetuno-ileal es una entidad infrecuente, suele ser la forma de debut de una enfermedad diverticular no conocida previamente. El TAC abdominal es de gran utilidad diagnóstica. La resección del segmento afecto es el tratamiento de elección

Objective: To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015. Materials and methods: We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT. Results: In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusions: Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice

[Gastrointestinal bleeding and delirium, challenges in the diagnosis of gallstone ileus: A case report and review of literature]. / Sangrado de tubo digestivo y delirium, retos en el diagnóstico de íleo biliar: reporte de un caso y revisión de bibliografía.

BACKGROUND: Gallstone ileus is a non-strangulated mechanical obstruction of the small bowel or colon as a result of the passage of gallstones through a biliary enteric fistula. It is a rare complication of cholelithiasis, affects patients over 65 years, and the disease occurs predominantly in females. Preoperative diagnosis is difficult due to the lack of specific signs and symptoms in elderly patients with multiple comorbidities. CLINICAL CASE: A 93-year-old female presenting with a one-week history of upper gastrointestinal bleeding, electrolyte imbalance and community- acquired pneumonia pneumonia. During her prolonged hospital stay she presented an intestinal obstruction. The diagnosis of gallstone ileus was made by CT scan. Despite surgical treatment, she died due to late diagnosis. CONCLUSIONS: Gallstone ileus is a rare pathology, difficulty in diagnosis prolongs hospital stay, which directly influences mortality.

[Elective laparoscopic right colectomy for caecal volvulus: case report and literature review]. / Colectomía derecha laparoscópica electiva por vólvulo cecal: reporte de un caso y revisión de la literatura.

BACKGROUND: Caecal volvulus is an uncommon cause of intestinal obstruction. Its clinical presentation is non-specific, with the diagnosis usually confirmed by barium enema and abdominal computed tomography. Treatment depends on many factors, and minimally invasive approaches are becoming the treatment of choice. CLINIC CASE: A 54 years old female, admitted to the Emergency Department with clinical symptoms of intestinal obstruction. On physical examination she had a palpable, firm, and tympanitic mass in the right abdomen, with peritoneal irritation. The radiographs of the abdomen, barium enema and abdominal computed tomography showed caecal volvulus. As she showed a full remission after the barium enema, with no clinical or biochemical data of systemic inflammatory response syndrome or peritoneal irritation, she was discharged to her home. Two weeks later, a laparoscopic right hemicolectomy was performed with an ileo-transverse extracorporeal anastomosis. Her progress was satisfactory, and she was discharged 4 days after surgery due to improvement. CONCLUSION: Caecal volvulus is a rare cause of intestinal obstruction, with high mortality rates, and is caused by excessive mobility of the caecum. Its incidence is increasing. Treatment depends on many factors. Early non-surgical untwisting, followed by an elective laparoscopic surgical procedure offers several advantages and reduces mortality.

[Adult intestinal malrotation associated with intestinal volvulus]. / Malrotación intestinal en adulto asociada a vólvulo intestinal.

BACKGROUND: Intestinal malrotation is a congenital anomaly of the intestinal rotation and fixation, and usually occurs in the neonatal age. OBJECTIVE: Description of a clinical case associated with acute occlusive symptoms. CLINICAL CASE: A case of intestinal malrotation is presented in a previously asymptomatic woman of 46 years old with an intestinal obstruction, with radiology and surgical findings showing an absence of intestinal rotation. CONCLUSIONS: Intestinal malrotation in adults is often asymptomatic, and is diagnosed as a casual finding during a radiological examination performed for other reasons. Infrequently, it can be diagnosed in adults, associated with an acute abdomen.

[Intestinal intussusception secondary to myofibroblastic tumor in an elderly patient. Case report]. / Intususcepción intestinal secundaria a tumor miofibroblástico en un adulto mayor. Reporte de caso.

BACKGROUND: Intussusception is defined as a segment of the gastrointestinal tract and mesentery within the lumen of an adjacent segment. It is a rare condition in adults that can occur anywhere in the gastrointestinal tract from the stomach to the rectum. Only 5% of all intussusceptions are presented in adults, and in 1-5% of all cases of intestinal obstruction. Inflammatory myofibroblastic tumour is rare, and is usually found in the lung, and rarely detected in some intestinal portions. It causes a variety of non-specific symptoms, with those that present as an intussusception being uncommon. CLINICAL CASE: A female of 69 years with partial bowel obstruction secondary to intestinal intussusception due to an inflammatory myofibroblastic tumour, a rarely diagnosed condition and never published before. DISCUSSION: Inflammatory myofibroblastic tumours are rare, and in this case with an atypical presentation that was surgically resolved satisfactorily. These entities are difficult to diagnose, with histopathology giving the definitive diagnosis. A literature review was performed to gather recent information about their diagnosis and treatment. CONCLUSIONS: Inflammatory myofibroblastic tumours require a high level of suspicion, as diagnosis prior to surgery is difficult. Surgery is considered the treatment of choice, requiring leaving free surgical edges to prevent recurrences.

Obstrucción colónica por cálculo / Colonic obstruction by gallstone

El íleo biliar es una rara complicación de la colelitiasis, que se caracteriza por presentar clínicamente una obstrucción intestinal mecánica intraluminal, secundaria a la impactación de un cálculo biliar en el tubo digestivo, debido a la existencia de una fístula bilio-entérica. El diagnóstico preoperatorio es difícil, ya que presenta síntomas y signos de obstrucción intestinal, los cuales son muy inespecíficos para sospechar un íleo biliar. El tratamiento de elección en el manejo del íleo biliar es el quirúrgico. Habitualmente se realiza una cirugía en dos tiempos, enterolitotomía como único gesto, sin embargo no hay una técnica quirúrgica definitiva estandarizada. Presentamos el caso de una paciente de 70 años que acude al Departamento de Urgencias con el diagnóstico clínico de obstrucción intestinal mecánica baja, de cuatro días de evolución, como consecuencia de un cálculo impactado en colon sigmoides.

Gallstone ileus is a rare complication of cholelithiasis, which is characterized by clinically presenting as an intraluminal mechanical intestinal obstruction secondary to the impaction of a gallstone in the digestive tract, due to the existence of a biliary-enteric fistula. The preoperative diagnosis is difficult, since it presents symptoms and signs of intestinal obstruction, which are very unspecific to suspect a Biliary Ileus. The treatment of choice in the management of gallstone ileus is surgery; usually is performed in two stages, whole lithotomy as the only gesture, however there is no standardized definitive surgical technique. We present the case of a 70-year-old patient, who attended the emergency department with the clinical diagnosis of low mechanical bowel obstruction, four days of evolution, as a result of a stone impacted in the sigmoid colon.