Endometriosis apendicular. Nuestra experiencia en los últimos 11 años / Appendiceal endometriosis. A retrospective analysis of 11 years’ experience

Introducción y objetivos: La endometriosis es una enfermedad con una incidencia que puede llegar al 50% en mujeres en edad fértil. La endometriosis apendicular se presenta en el 1% de estas pacientes, con una clínica variable: su presentación más frecuente es la propia de una apendicitis. El objetivo del estudio es describir y analizar las características clínicas y anatomopatológicas de los casos de endometriosis apendicular de los últimos 10años en el Hospital 12 de Octubre. Pacientes y métodos: Presentamos el estudio retrospectivo de los casos de endometriosis apendicular de nuestro centro en los últimos 10 años. Resultados: Encontramos 22 casos de endometriosis apendicular de un total de 7.051 piezas. La mediana de edad de las pacientes fue de 38,5 años, con 3 pacientes fuera de edad fértil. El inicio fue un abdomen agudo en 16 pacientes; hasta en 10 casos se requirió la realización de 2pruebas de imagen. La endometriosis apendicular fue sospechada en tan solo 2 pacientes. El abordaje laparoscópico fue la técnica de preferencia en los casos crónicos o dudosos. En 6 de las piezas apareció una apendicitis concomitante. Conclusiones: La endometriosis apendicular presenta un difícil diagnóstico preoperatorio y debe ser tenida en cuenta en el diagnóstico diferencial de la apendicitis aguda y considerar que puede ocurrir fuera de la edad fértil

Introduction and objectives: Endometriosis is a disease with an incidence that may reach 50% in women of childbearing age. Appendiceal endometriosis occurs in 1% of these patients. Although symptoms vary, it typically manifests with the same symptoms as appendicitis. The aim of this study was to describe and analyse the clinical, anatomical and pathological characteristics of the appendiceal endometriosis cases treated over the last decade at 12 de Octubre Hospital. Patients and methods: We present a retrospective study of the cases of appendiceal endometriosis treated at our centre over the last 10 years. Results: We found 22 cases of appendiceal endometriosis from a total of 7051 cases. Median patient age was 38.5 years, with 3 patients not of childbearing age. Acute abdomen was the initial manifestation in 16 patients, requiring the performance of 2imaging tests in 10 cases. Appendiceal endometriosis was suspected in only 2 patients. The laparoscopic approach was the preferred technique in chronic or doubtful cases. Concomitant appendicitis was found in 6cases. Conclusions: Appendiceal endometriosis presents a preoperative diagnostic challenge and should be considered in the differential diagnosis of acute appendicitis, bearing in mind that it can arise in women not of childbearing age

Migración rectal de dispositivo intrauterino / Rectal migration of intrauterine device

Fundamento y objetivo: Los dispositivos intrauterinos (DIU), constituyen el 23% del uso general de las medidas contraceptivas reversibles en todo el mundo. Entre las complicaciones más graves secundarias a su uso, destacan la perforación uterina y la migración del dispositivo. Material y método: Se presenta un caso de migración de DIU a través de pared rectal en una mujer de 40 años, que acude al servicio de urgencias por dolor brusco y rectorragia. A la exploración física se objetiva el componente horizontal del DIU saliendo a través del orificio anal y mediante tacto rectal se palpa el componente vertical alojado en recto; localización que se verifica mediante la realización de una TC abdominopélvica. En este caso, se realizó una extracción colonoscópica del cuerpo extraño. Conclusiones: En general, cuando una perforación es identificada, se recomienda la extracción del dispositivo lo antes posible. Para ello se pueden usar técnicas endoscópicas o quirúrgicas, en función de la localización, por lo que cada caso debe ser individualizado

Background and objectives: Intrauterine devices (IUDs) constitutes the 23% of the general use of reversible contraceptive measures in the world. Among the most serious complications secondary to its use include uterine perforation and migration of the device. Patients and methods: A case of migration of IUD through rectal wall is presented in a woman of 40 years old, who came to the emergency department with sudden pain and rectal bleeding. The physical examination aimed to the horizontal component of the IUD getting out through the anal canal and hosted by DRE the vertical component at right is palpable. This localization is verified by performing abdominal and pelvic CT. In this case, a colonoscopic removal of foreign body was made. Conclusions: In general, when a perforation is identified, the extraction of the device is recommended as soon as possible. Endoscopic techniques or surgery could be use for it depending on the location; so that each case must be individualized

Renal failure associated with intestinal transplantation: our experience in Spain.

BACKGROUND: Renal failure (RF) is a frequent complication in non-renal solid organ transplants. In the present study, we analyze our experience with intestinal transplants (ITx). METHODS: Between 2004 and 2012, we performed 21 ITx in 19 adult patients. Alemtuzumab was used as an induction agent followed by tacrolimus. Renal function was assessed before ITx and during the perioperative period. RESULTS: The main cause for transplants was non-resectable desmoids tumors (33.3%), followed by vascular thrombosis (19%) and others. Medical complications were frequent, especially infectious diseases, which were the most common (51%). Surgical complications were also frequent, but most of them (>50%) were mild but leading to a great number of re-operations and prolonged stays in hospital. Acute rejection is very frequent (66.6%) but mild in more than 70% of the cases. Finally, RF was very frequent (68.4%; 13/19 patients) and accounted for 15.6% of all medical complications. Causes were multiple. One patient is awaiting a kidney transplant, but no other patients need renal replacement therapy at the moment. Ileostomy closure was performed in 5 of 12 patients alive, showing improved renal function in 3 of them. CONCLUSIONS: RF is a problem in ITx and is always multifactorial. Increases in hospital stay, higher morbidity and is a cause for hospital readmission. Almost all patients had an impaired renal function when discharged. Immunosuppressants and ileostomy closure as soon as possible might prevent RF.

Porcine acellular dermal matrix for delayed abdominal wall closure after pediatric liver transplantation.

Children are one of the groups with the highest mortality rate on the waiting list for LT. Primary closure of the abdominal wall is often impossible in the pediatric population, due to a size mismatch between a large graft and a small recipient. We present a retrospective cohort study of six pediatric patients, who underwent delayed abdominal wall closure with a biological mesh after LT, and in whom early closure was impossible. A non-cross-linked porcine-derived acellular dermal matrix (Strattice(™) Reconstructive Tissue Matrix; LifeCell Corp, Bridgewater, NJ, USA) was used in all of the cases of the series. After a mean follow-up of 26 months (21-32 months), all patients were asymptomatic, with a functional abdominal wall after physical examination. Non-cross-linked porcine-derived acellular dermal matrix (Strattice(™) ) is a good alternative for delayed abdominal wall closure after pediatric LT. Randomized controlled trials are necessary to determine the best moment and the best technique for abdominal wall closure.

Malignancy after liver transplantation: cumulative risk for development.

BACKGROUND: Solid organ recipients are at high risk to develop malignancies due to the complex interactions of several factors, constituting a major cause of late death after transplantation. PATIENTS AND METHODS: We retrospectively reviewed an historic cohort of adult liver recipients from cadaveric donors (multiorgan recipients excluded) performed from 1986-2002 with a minimum follow-up of 36 months. The Kaplan-Meier method was used to assess cumulative risk to develop malignancy and survival analyses. RESULTS: Among the 528 patients undergoing orthotopic liver transplantation (OLT) with a mean follow-up of 2400 days, 98 developed cancer among which 25% were skin malignancies. Sixty-seven patients developed at least 1 noncutaneous malignancy, an overall incidence of 12.7%. Eighteen percent suffered from posttransplant lymphoproliferative disease; 14%, lung cancer; 4%, Kaposi's sarcoma; 7%, genitourinary malignancies; and 17%, oropharyngeal or laryngeal cancer. The cumulative patient risks to develop noncutaneous malignancies at 5, 10, and 15 years posttransplantation were 9% (confidence interval [CI]: 0.06-0.11), 18% (CI: 0.14-0.23), and 25% (CI: 0.18-0.31), respectively. CONCLUSIONS: OLT recipients are at higher risk to develop malignancies after transplantation, reaching a cumulative risk of 25% at 15 years. Long-term surveillance measures and screening programs must be seriously conducted for selected groups.

Incidence of de novo nonmelanoma skin tumors after liver transplantation for alcoholic and nonalcoholic liver diseases.

INTRODUCTION: Skin tumors are the most common malignancies after orthotopic liver transplantation (OLT). They have been related to sunlight exposure, tobacco consumption, and immunosuppression. The aim of this study was to compare the incidence of de novo skin tumors (nonmelanoma) in patients who underwent liver transplantation for alcoholic cirrhosis versus nonalcoholic diseases. PATIENTS AND METHODS: Between April 1986 and July 2004, we performed 1000 OLT in a population of 888 recipients. This study was performed in a sample of 701 adult recipients who survived >2 months after transplantation: 276 patients (39.4%) underwent OLT for alcoholic cirrhosis (AC-group), and 425 (60.6%) for nonalcoholic disease (N-AC). The overall incidence of de novo skin tumors was 3.5% (25 tumors): 5.4% (15 tumors) in the AC-group and 2.4% (10 tumors) in the N-AC group (P = .027). Two patients developed two tumors. There were 19 men and 4 women, mean age at OLT of 54.4 +/- 6.8 years (range, 40 to 66 years). The mean time from OLT to tumor diagnosis was 66.1 +/- 51.4 months (range, 3 to 165 months): 56.4 +/- 44.4 months in the AC-group versus 80.6 +/- 59.8 months in the N-AC group (P = NS). Histologically, 17 tumors (68%) were basal cell carcinomas and eight tumors (32%) were squamous cell carcinomas (P = .128). Fourteen patients (60.8%) were smokers: 11 patients (84.6%) in the AC-group versus 3 patients (30%) in the N-AC group (P = .012). All the patients underwent tumor resection, with only one patient dying, because of lymph node invasion of the neck. CONCLUSION: There was a higher incidence of de novo skin tumors among patients who smoked who underwent OLT for alcoholic cirrhosis.