Intestinal pneumatosis as a manifestation of systemic sclerosis.

A 60-year-old female patient was admitted to the emergency room for a 7-day history of abdominal bloating, nausea, vomiting, constipation, and lack of flatus. She had been diagnosed with systemic sclerosis (SSc) 10 years ago and had been using methotrexate, sildenafil, and prednisone. She did not present any signs of instability, but physical examination showed malnourishment status and abdominal tenderness and distention. Plain abdominal radiography was suggestive of sigmoid volvulus, confirmed and successfully resolved after endoscopic decompression therapy. Eight months later, the patient developed a new episode of abdominal obstruction. Computed Tomography (CT) scan identified a distended sigmoid colon due to its torsion with gas areas within the bowel wall. This time, endoscopic decompression had failed to treat, so exploratory laparotomy was performed. Colonic distention and sigmoid volvulus were identified during the procedure, after which sigmoidectomy followed by primary anastomosis was performed. Neither perforation nor masses were found. Furthermore, the anatomopathological study was inconsistent with vascular, inflammatory, or neoplastic diseases.

Fístula sigmoido-cervical secundaria a una enfermedad diverticular complicada / Sigmoido-cervical fistula due to diverticular disease

Resumen Introducción: Las fístulas secundarias a una enfermedad diverticular complicada son una indicación formal de cirugía electiva en el 4 a 23% de los casos. Caso Clínico: Se presenta el caso de una mujer de 52 años con antecedentes de una histerectomía subtotal por miomatosis uterina que consulta por cuadro de dolor abdominal en hipogastrio acompañado de fiebre de 4 días de evolución. La tomografía computada (TC) de abdomen y pelvis describe una diverticulitis complicada con absceso peridiverticular. Tratada con antibióticos con buena respuesta clínica consulta a los 3 meses en nuestro servicio por pérdida de material fecal por vagina. Nueva TC confirma la presencia de una colección perisigmoidea y engrosamiento de la pared vesical. La colonoscopía informa una estenosis franqueable a nivel de sigmoides y se constata salida de gases por vagina. La corrección quirúrgica electiva incluyó una sigmoidectomía abierta con traquelectomía en block, cierre de la cúpula vaginal y anastomosis colorrectal mecánica, con buena evolución posoperatoria, sin recidiva a los 12 meses de seguimiento. La fístula sigmoido-cervical es una complicación rarísima de la enfermedad diverticular complicada que puede ocurrir en pacientes sometidas a una histerectomía subtotal previa. Aunque el diagnóstico de la fístula es clínico, la colonoscopía y la TC permiten descartar otras etiologías. La resección radical del segmento afectado es el tratamiento estándar en pacientes aptos.

Introduction: Diverticular disease is complicated by fistulas in 4% to 23% of patients. Case Report: A woman 52 years-old previously operated on with parcial histerectomy was successfully treated with antibiotics due to diverticulitis complicated with an abscess. Three months later the patient presented with vaginal discharge of faeces. Computed tomography showed wall thickening of sigmoid colon and vesical wall. Colonoscopy exclude cancer and confirmed the exit of gas through vagina. En-bloc resection of the sigmoid colon with traquelectomy with primary anastomosis was performed. The postoperative course was good without recurrence after 12 months of follow up. Sigmoido-cervical fistula is a very rare benign fistula due to diverticular disease. Diagnosis is basically clinic, but tomography and colonoscopy are important to exclude other causes of fistulas. Radical surgery with primary anastomosis is the standard treatment.

Pediatric sigmoid volvulus due to Chagas disease.

Exposure and infections by Trypanosoma cruzi are the fourth cause of loss of potential life years between parasitic and infectious diseases. We describe the case of a 11-year-old patient with intestinal occlusion, surgically treated with intestinal volvulus, the surgical specimen is sent to histopathology reporting Chagasic megacolon. The age range of presentation is a challenge in the absence of nonspecific symptoms. There is no pediatric statistical data that define trypanosomiasis in a latent or chronic state and will be diagnosed in adult stages due to the physiopathological alterations that they will present.

La exposición y las infecciones por Trypanosoma cruzi ocupan el cuarto lugar entre las causas de pérdida de años de vida potenciales por enfermedades parasitarias e infecciosas. Se describe el caso de un niño de 11 años, con cuadro de oclusión intestinal, intervenido quirúrgicamente con datos de vólvulo intestinal. La pieza quirúrgica se envió a histopatología, que reportó megacolon chagásico. El rango de edad de presentación es un reto ante la falta de síntomas inespecíficos. No se cuenta con datos estadísticos pediátricos que definan la tripanosomiasis en estado latente o crónico, y estos niños serán diagnosticados en la etapa adulta por las alteraciones fisiopatológicas que presentarán.

Hormone treatment as first line therapy is safe and relieves pelvic pain in women with bowel endometriosis.

OBJECTIVE: To evaluate clinical features and complications in patients with bowel endometriosis submitted to hormonal therapy. METHODS: Retrospective study based on data extracted from medical records of 238 women with recto-sigmoid endometriosis treated between May 2010 and May 2016. RESULTS: Over the course of follow-up, 143 (60.1%) women remained in medical treatment while 95 (39.9%) presented with worsening of pain symptoms or intestinal lesion growth (failure of medical treatment group), with surgical resection performed in 54 cases. Women in the Medical Treatment Group were older (40.5±5.1 years versus 37.3±5.8 years; p<0.0001) and had smaller recto sigmoid lesions (2.1±1.9 versus 3.1±2.2; p=0.008) compared to those who had failed to respond to medical treatment. Similar significant reduction in pain scores for dysmenorrhea, chronic pelvic pain, cyclic dyschezia and dysuria was observed in both groups; however greater reduction in pain scores for dyspareunia was noted in the Surgical Group. Subjective improvement in pain symptoms was also similar between groups (100% versus 98.2%; p=0.18). Major complications rates were higher in the Surgical Group (9.2% versus 0.6%; p=0.001). CONCLUSION: Patients with recto-sigmoid endometriosis who failed to respond to medical treatment were younger and had larger intestinal lesions. Hormonal therapy was equally efficient in improving pain symptoms other than dyspareunia compared to surgery, and was associated with lower complication rates in women with recto-sigmoid endometriosis. Medical treatment should be offered as a first-line therapy for patients with bowel endometriosis. Surgical treatment should be reserved for patients with pain symptoms unresponsive to hormonal therapy, lesion growth or suspected intestinal subocclusion.

Hormone treatment as first line therapy is safe and relieves pelvic pain in women with bowel endometriosis / O tratamento hormonal como terapia de primeira linha é seguro e melhora a dor pélvica em mulheres com endometriose intestinal

ABSTRACT Objective: To evaluate clinical features and complications in patients with bowel endometriosis submitted to hormonal therapy. Methods: Retrospective study based on data extracted from medical records of 238 women with recto-sigmoid endometriosis treated between May 2010 and May 2016. Results: Over the course of follow-up, 143 (60.1%) women remained in medical treatment while 95 (39.9%) presented with worsening of pain symptoms or intestinal lesion growth (failure of medical treatment group), with surgical resection performed in 54 cases. Women in the Medical Treatment Group were older (40.5±5.1 years versus 37.3±5.8 years; p<0.0001) and had smaller recto sigmoid lesions (2.1±1.9 versus 3.1±2.2; p=0.008) compared to those who had failed to respond to medical treatment. Similar significant reduction in pain scores for dysmenorrhea, chronic pelvic pain, cyclic dyschezia and dysuria was observed in both groups; however greater reduction in pain scores for dyspareunia was noted in the Surgical Group. Subjective improvement in pain symptoms was also similar between groups (100% versus 98.2%; p=0.18). Major complications rates were higher in the Surgical Group (9.2% versus 0.6%; p=0.001). Conclusion: Patients with recto-sigmoid endometriosis who failed to respond to medical treatment were younger and had larger intestinal lesions. Hormonal therapy was equally efficient in improving pain symptoms other than dyspareunia compared to surgery, and was associated with lower complication rates in women with recto-sigmoid endometriosis. Medical treatment should be offered as a first-line therapy for patients with bowel endometriosis. Surgical treatment should be reserved for patients with pain symptoms unresponsive to hormonal therapy, lesion growth or suspected intestinal subocclusion.

RESUMO Objetivo: Avaliar características clínicas e complicações em pacientes com endometriose intestinal submetidos ao tratamento hormonal. Métodos: Dados de prontuários de 238 pacientes com endometriose de retossigmoide tratadas entre maio de 2010 e maio de 2016 foram coletados para este estudo retrospectivo. Resultados: Durante o período de acompanhamento, 143 (60,1%) mulheres mantiveram tratamento clínico, enquanto 95 (39,9%) tiveram piora dos sintomas de dor ou aumento da lesão intestinal (grupo falha de tratamento clínico), sendo 54 submetidas ao tratamento cirúrgico. As mulheres no Grupo Tratamento Clínico eram mais velhas (40,5±5,1 anos versus 37,3±5,8 anos; p<0,0001) e tinham lesões intestinais menores (2,1±1,9 versus 3,1±2,2; p=0,008) em comparação ao grupo falha de tratamento clínico. Redução significativa e semelhante do escore de dor na dismenorreia, dor pélvica crônica, disquezia cíclica e disúria cíclica foi observada nos Grupos Tratamento Clínico e Cirúrgico. Dispareunia, no entato, teve uma redução maior no Grupo Cirurgia. A redução subjetiva dos sintomas dolorosos também foi semelhante entre os Grupos Clínico e Cirúrgico (100% versus 98,2%; p=0,18). O Grupo Tratamento Cirúrgico foi relacionado a uma maior taxa de complicações graves (9,2% versus 0,6%; p=0,001) em comparação ao Grupo Tratamento Clínico. Conclusão: Falha no tratamento clínico em pacientes com endometriose de retossigmoide foi observada em mulheres mais jovens que tinham lesões intestinais maiores. O tratamento clínico hormonal foi igualmente eficaz na melhora dos sintomas de dor, exceto dispareunia, em comparação ao tratamento cirúrgico em mulheres com endometriose intestinal, mas com menor taxa de complicações. O tratamento clínico deve ser oferecido como primeira opção em pacientes com endometriose intestinal, enquanto o tratamento cirúrgico deve ser reservado para pacientes sem melhora nos sintomas de dor com tratamento hormonal, progressão das lesões ou suspeita de suboclusão intestinal.

Megacolon andino y vólvulo del sigmoides de la altura: Presentación de 418 casos entre 2008 - 2012 en el hospital C. Monge - Puno, Perú / Andean megacolon and sigmoid volvulus in the high altitude: Presentation of 418 cases between 2008 - 2012 at C. Monge Hospital, Puno, Peru

Objetivo: El presente estudio describe el manejo médico y quirúrgico del vólvulo de sigmoides debido a dolicomegacolon andino en un hospital a una altitud mayor a 3000 msnm. Material y métodos: Estudio descriptivo, observacional, transversal de 418 pacientes con diagnóstico de vólvulo de sigmoides; admitidos inicialmente por cuadros de obstrucción intestinal, en el Hospital de Juliaca Carlos Monge - Puno, Perú, durante el periodo 2008-2012. Los datos fueron procesados a través del programa SPSS versión 21. Resultados: Se registraron 418 pacientes, la media de edad fue de 60 años, rango 18-89 años, con una proporción hombre/mujer de 3,5/1. El manejo no quirúrgico se hizo en 64 (15,4%), el tratamiento empleado fue de enema salino 20 casos 31% y sonda rectal 44 (69%), se presentó recurrencia en 27 pacientes (45%), los cuales tuvieron cirugía con resección anastomosis primaria, de estos la mortalidad correspondió a 8 pacientes (30%). De los 354 pacientes sometidos a manejo quirúrgico de emergencia 325 fueron sometidos a sigmoidectomia con anastomosis primaria (92%), mientras 29 tuvieron colostomía a lo Hartmann (8%), la morbilidad para ambos procedimientos fue de 52 casos (14,7%), la mortalidad para ambos procedimientos fue de 45 casos (12,7%). Conclusiones: El vólvulo sigmoides debido a megacolon andino tuvo una edad media de 60 años. El 15,4% tuvo manejo no quirúrgico, la tasa de recurrencia fue de 45%, mortalidad de 30%. El 84,7% tuvo manejo quirúrgico; el 92% tuvo resección anastomosis primaria y 8% colostomía a lo Hartmann, la morbilidad fue de 14,7% y la mortalidad de 12,7%.

Objective: The present study describes the medical and surgical management of sigmoid volvulus due to Andean dolicomegacolon in a hospital at an altitude above 3000 m. Material and methods: A descriptive, observational, crosssectional study of 418 patients diagnosed with sigmoid volvulus; Admitted initially due to intestinal obstruction, in the Hospital of Juliaca Carlos Monge. Puno-Perú, during the period 2008-2012. The data were processed through the SPSS software version 21. Results: A total of 418 patients were enrolled, the mean age was 60 years, range 18-89 years, and the male/female ratio was 3.5/1. Nonsurgical management was done in 64 (15.4%), the treatment used was saline enema 20 cases (31%) and rectal catheter 44 (69%), recurrence was present in 27 patients (45%), who had surgery with primary anastomosis resection, of which the mortality corresponded to 8 patients (30%). Of the 354 patients undergoing emergency surgical management, 325 were submitted to sigmoidectomy with primary anastomosis (92%), while 29 had Hartmann's colostomy (8%), the morbidity for both procedures was 52 cases (14.7%), Mortality for both procedures was 45 cases (12.7%). Conclusions: In patients with sigmoid volvulus due to Andean megacolon the mean age was 60 years. The 15.4% had non-surgical management, the recurrence rate was 45%, and mortality 30%. Patients with surgical management was 84.7%, from this group; 92% had primary anastomosis resection and 8% Hartmann colostomy, morbidity was 14.7% and mortality was 12.7%.

[Colonic gallstone ileus: A rare cause of intestinal obstruction]. / Íleo biliar colónico: una rara causa de obstrucción intestinal.

BACKGROUND: A gallstone colonic ileus is a very rare condition. CLINICAL CASE: The case is reported of an 87 year-old patient who came to the Emergency Department due to an intestinal obstruction of several days onset, which was caused by a gallstone affected sigmoid colon. CONCLUSION: Colonic gallstone ileus is a rare disease that usually occurs in older patients due to the passage of large gallstone directly from the gallbladder to colon, through a cholecystocolonic fistula. It has a high morbidity and mortality.

[Andean megacolon and sigmoid volvulus in the high altitude. Presentation of 418 cases between 2008 - 2012 at C. Monge Hospital, Puno, Peru]. / Megacolon andino y vólvulo del sigmoides de la altura. Presentación de 418 casos entre 2008 - 2012 en el hospital C. Monge Puno, Perú.

OBJECTIVE: The present study describes the medical and surgical management of sigmoid volvulus due to Andean dolicomegacolon in a hospital at an altitude above 3000 m. MATERIAL AND METHODS: A descriptive, observational, crosssectional study of 418 patients diagnosed with sigmoid volvulus; Admitted initially due to intestinal obstruction, in the Hospital of Juliaca Carlos Monge. Puno-Perú, during the period 2008-2012. The data were processed through the SPSS software version 21. RESULTS: A total of 418 patients were enrolled, the mean age was 60 years, range 18-89 years, and the male/female ratio was 3.5/1. Nonsurgical management was done in 64 (15.4%), the treatment used was saline enema 20 cases (31%) and rectal catheter 44 (69%), recurrence was present in 27 patients (45%), who had surgery with primary anastomosis resection, of which the mortality corresponded to 8 patients (30%). Of the 354 patients undergoing emergency surgical management, 325 were submitted to sigmoidectomy with primary anastomosis (92%), while 29 had Hartmann's colostomy (8%), the morbidity for both procedures was 52 cases (14.7%), Mortality for both procedures was 45 cases (12.7%). CONCLUSIONS: In patients with sigmoid volvulus due to Andean megacolon the mean age was 60 years. The 15.4% had non-surgical management, the recurrence rate was 45%, and mortality 30%. Patients with surgical management was 84.7%, from this group; 92% had primary anastomosis resection and 8% Hartmann colostomy, morbidity was 14.7% and mortality was 12.7%.

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.

Vascular entrapment of the sciatic plexus causing catamenial sciatica and urinary symptoms.

AIM OF THE VIDEO / INTRODUCTION: Pelvic congestion syndrome is a well-known cause of cyclic pelvic pain (Ganeshan et al., Cardiovasc Intervent Radiol 30(6):1105-11, 2007). What is much less well known is that dilated or malformed branches of the internal or external iliac vessels can entrap the nerves of the sacral plexus against the pelvic sidewalls, producing symptoms that are not commonly seen in gynecological practice, such as sciatica, or refractory urinary and anorectal dysfunction (Possover et al., Fertil Steril 95(2):756-8. 2011). The objective of this video is to explain and describe the symptoms suggestive of vascular entrapment of the sacral plexus, as well as the technique for the laparoscopic decompression of these nerves. METHOD: Two anecdotal cases of intrapelvic vascular entrapment are used to review the anatomy of the lumbosacral plexus and demonstrate the laparoscopic surgical technique for decompression at two different sites, one on the sciatic nerve and one on the sacral nerve roots. RESULT: After surgery, the patient with the sciatic entrapment showed full recovery of the sciatica and partial recovery of the myofascial pain. The patient with sacral nerve root entrapment showed full recovery with resolution of symptoms. CONCLUSION: The symptoms suggestive of intrapelvic nerve entrapment are: perineal pain or pain irradiating to the lower limbs in the absence of a spinal disorder, and lower urinary tract symptoms in the absence of prolapse of a bladder lesion. In the presence of such symptoms, the radiologist should provide specific MRI sequences of the intrapelvic portion of the sacral plexus and a team and equipment to expose and decompress the sacral nerves should be prepared.

Comparative study of collagen deposition in the colon wall of patients operated for sigmoid diverticular disease.

PURPOSE: To investigate the deposition of collagen in the colon wall of patients with sigmoid diverticulitis. METHODS: Samples of sigmoid tissue from 15 patients (disease group), seven men and eight women aged 37-77 years who underwent surgery for the treatment of diverticulitis, were selected. For the control group, specimens from five patients, three men and two women aged 19-58 years undergoing emergency surgery for sigmoid trauma were selected. These subjects had no associated diseases. The histological study of the surgical specimens was performed by staining with hematoxylin-eosin and picrosirius and using a histochemical method for collagen quantification. RESULTS: Collagen deposition in the colon wall in terms of area (F), glandular epithelium (E) and total area was significantly higher in the disease group compared to control (p=0.003, p=0.026 and p=0.010, respectively). The collagen volume fraction (F fraction) and muscle tissue (M fraction) were also significantly higher compared to control (p=0.044 and p=0.026, respectively). The muscle (M area) and volume fraction of glandular epithelium (E fraction) did not differ significantly between the two groups, (p=0.074 and p=1.000, respectively). CONCLUSION: In this study, collagen deposition in the colon wall of the patients operated for sigmoid diverticulitis was higher compared to patients without the disease.

Comparative study of collagen deposition in the colon wall of patients operated for sigmoid diverticular disease

PURPOSE: To investigate the deposition of collagen in the colon wall of patients with sigmoid diverticulitis.METHODS: Samples of sigmoid tissue from 15 patients (disease group), seven men and eight women aged 37-77 years who underwent surgery for the treatment of diverticulitis, were selected. For the control group, specimens from five patients, three men and two women aged 19-58 years undergoing emergency surgery for sigmoid trauma were selected. These subjects had no associated diseases. The histological study of the surgical specimens was performed by staining with hematoxylin-eosin and picrosirius and using a histochemical method for collagen quantification.RESULTS: Collagen deposition in the colon wall in terms of area (F), glandular epithelium (E) and total area was significantly higher in the disease group compared to control (p=0.003, p=0.026 and p=0.010, respectively). The collagen volume fraction (F fraction) and muscle tissue (M fraction) were also significantly higher compared to control (p=0.044 and p=0.026, respectively). The muscle (M area) and volume fraction of glandular epithelium (E fraction) did not differ significantly between the two groups, (p=0.074 and p=1.000, respectively).CONCLUSION: In this study, collagen deposition in the colon wall of the patients operated for sigmoid diverticulitis was higher compared to patients without the disease.

Oclusión intestinal por nudo ileosigmoideo / Intestinal occlusion by Ileosigmoid Knot

La oclusión intestinal es una causa frecuente de abdomen agudo quirúrgico. Dentro de sus múltiples casusas se encuentra el nudo ileosigmoideo, entidad rara en el mundo, pero puede verse con relativa frecuencia en algunas latitudes geográficas como Asia, Medio Oriente y otros países del continente africano. El objetivo de este trabajo es presentar cuatro casos de pacientes con oclusión intestinal por nudo ileosigmoideo en los hospitales Souro Sanu de Bobo Diulaso, Burkina Faso y Wa Regional Hospital, de Gana. Se intervinieron quirúrgicamente, se hizo resección en bloque de los segmentos ileales y sigmoideos gangrenados con anastomosis íleo-ascendente y colostomía de tipo Hartman. Los pacientes evolucionaron satisfactoriamente y luego de tres meses se restableció definitivamente el tránsito intestinal. Se realizó una revisión de la literatura(AU)

Intestinal occlusion is a frequent cause of surgical acute abdomen. Among its multiple causes are the ileosigmoid knot, a rare entity worldwide, which is relatively frequent in some geographic areas such as Asia, Middle East and Africa. The objective of this paper was to present four patients with intestinal occlusion due to ileosigmoid knot in Souro Sanu of Bobo Diulaso hospitals in Burkina Faso and Wa Regional Hospital in Ghana. They were operated on through block resection of gangrenous ileal and sigmoid segments with ascending ileoanastomosis and Hartrman-type colostomy. The patients recovered satisfactorily and three months later, the intestinal transfer was finally re-established. A literature review on the topic was made(AU)

Sigmoidectomy with primary anastomosis for complicated diverticulitis.

BACKGROUND: It is possible to resect the perforated segment and reestablish intestinal continuity with adequate morbidity and mortality results in patients with complicated diverticulitis. AIMS: To evaluate the type of surgery performed at our center and the results of the procedures in patients with complicated diverticulitis. MATERIAL AND METHODS: All patients that underwent sigmoidectomy due to complicated diverticulitis within the time frame of 2005-2012 were included in the study. The primary objective was to evaluate the type of surgery performed. The secondary objective was to evaluate patient morbidity and mortality after 30 postoperative days. RESULTS: The study included 77 patients with a mean age of 51.17±12.80 years. The majority of the patients were men (64.9%) (n=50) and the mean BMI was 28.24±4.06kg/m2. A total of 63.6% (n=49) patients presented with a Hinchey iii-iv classification. Sigmoidectomy with primary anastomosis was performed in 58.4% (n=45) of the patients, 48.8% (22/45) of whom presented with Hinchey iii-iv. Primary anastomosis was more frequently performed in patients that had Hinchey i-ii(P=.001). Open surgery was carried out in 85.7% (n=66) of the cases. The mean surgery duration was longer in the patients with primary anastomosis (181.73±68.2min vs. 152.13±65.8min) (P>.05). Colorectal surgeons performed the procedures in 44.2% (n=34) of the cases. Complications presented in 23.4% (n=18) of the patients and there was a tendency toward more complications in patients that underwent the Hartmann's procedure. The mortality rate was 2.6% (n=2). CONCLUSIONS: Sigmoidectomy with primary anastomosis is a frequent surgery in patients with complicated diverticulitis at our hospital. There was no difference in morbidity and mortality, compared with the Hartmann's procedure.

Manejo del vólvulo de sigmoides en el Hospital Subregional de Andahuaylas / Management of sigmoid volvulus in the Sub-Regional Hospital Andahuaylas

Objetivos: Determinar los resultados del manejo de los pacientes con vólvulo de sigmoides en el Hospital Subregional de Andahuaylas en el periodo comprendido del 01 de enero del 2007 al 31 de diciembre del 2013. Material y métodos: se realizó un estudio, descriptivo, retrospectivo, de casos. La muestra seleccionada estuvo comprendida por 293 pacientes, que ingresaron al servicio de cirugía general del Hospital Subregional de Andahuaylas en el periodo que comprende el estudio. Los instrumentos empleados estuvieron conformados por una ficha de recolección de datos convenientemente elaborada para los fines de estudio. Resultados: el grupo etario más frecuente está entre los 60 y 69 años de edad (24.9 por ciento); el 80.9 por ciento (237) fueron del sexo masculino y 19.1 por ciento (56) del sexo femenino: el antecedente fisiológico más frecuente fue la constipación crónica (48.5 por ciento); en el 100 por ciento de los pacientes hubo dolor abdominal y no eliminación de heces y flatos: el diagnóstico definitivo se fundamentó. además de la evaluación clínica. en la Radiografía Simple de Abdomen en posición de pie en el 100 por ciento de los casos; se operaron 283 pacientes (96.6 por ciento); de estos el procedimiento más frecuente fue la sigmoidectomía y anastomosis primaria termino terminal en el 89.8 por ciento de los casos. Hubo complicaciones en 24 pacientes operados siendo la más frecuente las fistulas enterocutáneas. La mortalidad fue del 8.5 por ciento; siendo la causa más frecuente la sepsis abdominal y shock séptico. Conclusiones: Los resultados del manejo del vólvulo de sigmoides son buenos con una baja frecuencia de complicaciones. Las características clínicas de los pacientes con vólvulo de sigmoides fueron la constipación crónica, dolor abdominal, ausencia de eliminación de heces y flatos. El diagnóstico definitivo se fundamentó en la radiografía simple de abdomen. El procedimiento quirúrgico de mayor frecuencia fue la sigmoidectomía y anastomosis...

Increased risk of incisional hernia after sigmoid colectomy for diverticulitis compared with colon cancer.

BACKGROUND: We aimed to determine if an increased incidence of incisional hernias is present in patients undergoing sigmoidectomy for diverticulitis vs cancer. The pathophysiology of diverticulitis is poorly understood, but might involve a collagen vascular abnormality that can predispose to incisional hernia. STUDY DESIGN: In this IRB-approved, retrospective study, patients who underwent sigmoid colectomies for diverticulitis or cancer between January 2003 and September 2012 were studied. Exclusion criteria included the development of surgical site infections and neoadjuvant chemoradiotherapy. A multivariate logistic regression was used with covariate adjustments for known risk factors for hernia development. RESULTS: Four hundred forty-two patients (mean age 59.3 ± 13.9 years) with a median follow-up of 30 months were analyzed. The incidence of incisional hernia was 15.1% in diverticulitis patients vs 5.8% in the cancer cohort (41 of 271 vs 10 of 171; p = 0.003). Univariate analysis of risk factors associated with postoperative incisional hernia included steroid use (p = 0.007), wound packing (p = 0.001), higher American Society of Anesthesiologists classification (p = 0.001), absorbable suture closure (p = 0.02), blood transfusion (p = 0.04), stoma formation (p = 0.02), increased body mass index (p = 0.008), and history of incisional hernia (p = 0.00008). Multivariate logistic regression demonstrated a persistent association between diverticulitis and hernia development (p = 0.01). Odds of a hernia developing after sigmoidectomy for diverticulitis were 2.82 times greater than in the cancer cohort (95% CI, 1.3-6.6). CONCLUSIONS: The incidence of an incisional hernia developing after a sigmoid colectomy is significantly higher when performed for diverticulitis as compared with cancer. This might be due to a connective tissue disorder, which predisposes to development of both diverticula and hernias.

Reparación primaria vs derivación colónica como estrategia de elección en el manejo del vólvulo de sigmoides / Primary repair vs. colonic derivation as a strategy of choice in the management of sigmoid volvulus

Objetivos: Evaluar los resultados del manejo del vólvulo de sigmoides con Resección anastomosis versus colostomía en pacientes atendidos en el servicio de cirugía del Hospital Daniel Alcides Carrión del Callao en el periodo comprendido entre Enero del 2005 a Abril del 2013. Material y métodos: se realizó un estudio, descriptivo, retrospectivo, de casos. La muestra seleccionada estuvo comprendida por 80 pacientes (40 operados de resección y anastomosis y 40 pacientes operados de derivación colónica), que ingresaron al servicio de cirugía general del Hospital Nacional Daniel Alcides Carrión en el periodo que comprende el estudio. Los instrumentos empleados estuvieron conformados por una ficha de recolección de datos convenientemente elaborada para los fines de estudio. Resultados: El grupo etario más frecuente está entre los 60 y 69 años de edad (23.8 por ciento); el 95 por ciento (75) fueron del sexo masculino y 5 por ciento (4) del sexo femenino; el antecedente fisiológico más frecuente fue la constipación crónica (57.5 por ciento); en el 100 por ciento de los pacientes hubo dolor abdominal y no eliminación de heces y flatos; el diagnóstico definitivo se fundamentó, además de la evaluación clínica, en la radiografía simple de abdomen en posición de pie en el 100 por ciento de los casos. Hubo complicaciones en 15 pacientes operados siendo la más frecuente la infección de herida operatoria. La mortalidad fue del 6.3 por ciento; siendo la causa más frecuente la sepsis abdominal y shock séptico. Conclusiones: No hubo diferencias estadísticamente significativas en cuanto a los resultados del manejo del vólvulo de sigmoides con resección anastomosis versus colostomía en pacientes atendidos en el servicio de cirugía del Hospital Daniel Alcides Carrión del Callao (P>0.05).