ABSTRACT
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Subject(s)
Humans , Male , Aged , Intestinal Obstruction/diagnosis , Tissue Adhesions/diagnosis , Intestinal Obstruction/surgery , Tissue Adhesions/surgery , Abdominal Pain/etiology , Abdomen/diagnostic imaging , Abdomen/pathology , Tomography, X-Ray Computed , Diagnosis, DifferentialABSTRACT
INTRODUCCIÓN: la coledocolitiasis puede ser primaria (cálculos formados originalmente en la vía biliar) o secundaria (cálculos que han migrado de la vesícula biliar al colédoco). Nuestro objetivo fue estudiar las diferencias clínicas entre ambos tipos de coledocolitiasis en pacientes colecistectomizados. MATERIAL Y MÉTODOS: estudio comparativo y retrospectivo en el que se compararon pacientes colecistectomizados que presentaron coledocolitiasis. Se definió como coledocolitiasis residual o secundaria (grupo 1) la que apareció en los dos primeros años tras la colecistectomía y coledocolitiasis primaria (grupo 2) la que apareció después de los dos primeros años tras la colecistectomía. La coledocolitiasis se confirmó mediante colangiopancreatografía retrógrada endoscópica (CPRE) o cirugía. RESULTADOS: los pacientes con coledocolitiasis primaria (n = 14) tuvieron mayor edad (61,5 ± 20,3 vs. 74,4 ± 10,5 años; p = 0,049), mayor índice de masa corporal (IMC) (27,7 ± 4,3 vs. 31,6 ± 4,6 kg/m2; p = 0,043) y mayor diámetro de la vía biliar extrahepática (10,7 ± 2,7 vs. 14,7 ± 3,5 mm; p = 0,004) respecto a los pacientes con coledocolitiasis residual o secundaria (n = 11). Todos los pacientes fueron tratados mediante CPRE. No hubo diferencias entre los grupos 1 y 2 en cuanto a recidivas (36,2 % vs. 14,3 %; p = 0,350), intervalo libre de enfermedad (64,6 ± 30,9 vs. 52,2 ± 37,7 meses; p = 0,386) y supervivencia global (73,6 ± 32,4 vs. 54 ± 41,9 meses; p = 0,084). CONCLUSIONES: los pacientes con coledocolitiasis primaria presentan mayor edad, mayor IMC y mayor diámetro de la vía biliar respecto a los pacientes con coledocolitiasis residual o secundaria. La CPRE es una buena opción terapéutica para la resolución de ambos tipos de coledocolitiasis
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Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Choledocholithiasis/surgery , Choledocholithiasis/etiology , Cholangiopancreatography, Endoscopic Retrograde , Kaplan-Meier Estimate , Retrospective Studies , CholecystectomyABSTRACT
INTRODUCTION: choledocholithiasis can be primary from stones originally formed in the choledocho or secondary from stones that have migrated from the gallbladder to the choledocho. The objective of this study was to determine the clinical differences between both types of choledocholithiasis in cholecystectomy patients. MATERIAL AND METHODS: a comparative and retrospective study was performed of cholecystectomy patients who presented choledocholithiasis. Residual or secondary choledocholithiasis (group 1) was defined as those which appear in the first two years after cholecystectomy and primary choledocholithiasis (group 2) was defined as those which appear two years after cholecystectomy. Choledocholithiasis was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) or surgery. RESULTS: patients with primary choledocholithiasis (n = 14) were older (61.5 ± 20.3 vs 74.4 ± 10.5 years; p = 0.049) and had a greater body mass index (BMI) (27.7 ± 4.3 vs 31.6 ± 4.6 kg/m2; p = 0.043) and a larger extrahepatic bile duct diameter (10.7 ± 2.7 vs 14.7 ± 3.5 mm; p = 0.004) compared to patients with residual or secondary choledocholithiasis (n = 11). All patients were treated by ERCP. There were no differences between groups 1 and 2 regarding recurrences (36.2 % vs 14.3 %; p = 0.350), disease-free survival (64.6 ± 30.9 vs 52.2 ± 37.7 months; p = 0.386) and overall survival (73.6 ± 32.4 vs 54 ± 41.9 months; p = 0.084). CONCLUSIONS: patients with primary choledocholithiasis were older and had a greater BMI and a larger diameter of the bile duct compared to patients with residual or secondary choledocholithiasis. ERCP is a good therapeutic option for the resolution of both types of choledocholithiasis.
Subject(s)
Cholecystectomy, Laparoscopic , Choledocholithiasis , Cholangiopancreatography, Endoscopic Retrograde , Cholecystectomy , Choledocholithiasis/diagnostic imaging , Choledocholithiasis/surgery , Humans , Neoplasm Recurrence, Local , Retrospective StudiesABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/secondary , Melanoma/diagnostic imaging , Melanoma/pathology , Gallbladder Neoplasms/therapy , Antineoplastic Agents, Immunological/administration & dosage , Cholecystectomy, Laparoscopic , Follow-Up Studies , Nivolumab/administration & dosageABSTRACT
Melanoma metastasizes to the gastrointestinal tract in 2-4% of cases. In addition, it is the tumor that most frequently metastasizes to the gallbladder (50-67% of metastasis at this level). Even so, these metastases are infrequent. The indication of cholecystectomy will be provided by the patient performance status, extension and prognosis of disease. Although open surgery is preferred to treat melanoma metastasis at this level, laparoscopic surgery could be a safe technique that allows a fast recovery of the patient. We present the case of a 48-year-old man with melanoma metastases in the gallbladder treated by laparoscopic cholecystectomy.
Subject(s)
Cholecystectomy, Laparoscopic , Gallbladder Neoplasms , Melanoma , Cholecystectomy , Gallbladder Neoplasms/diagnostic imaging , Gallbladder Neoplasms/surgery , Humans , Male , Melanoma/diagnostic imaging , Melanoma/surgery , Middle AgedABSTRACT
El signo de Chilaiditi es la interposición de intestino delgado o colon entre el hígado y el diafragma. Este hallazgo incidental se ve en el 0,025-0,28% de las radiografías de tórax y abdomen. Entre los factores predisponentes destacan la ausencia, hiperlaxitud o elongación de los ligamentos suspensorios del colon transverso, el colon redundante o la elevación del hemidiafragma derecho. La atrofia o hipoplasia hepática es una causa infrecuente de este signo radiológico. Por otro lado, la vesícula biliar suprahepática es la localización más infrecuente de las ectopias vesiculares (0,026-0,7%). Se asocia con un desarrollo anormal del lóbulo hepático derecho como la agenesia, hipoplasia o atrofia. Presentamos el caso de un varón de 73 años con signo de Chilaiditi, hipoplasia hepática y colecistitis aguda litiásica en una vesícula biliar ectópica suprahepática
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Subject(s)
Humans , Male , Aged , Chilaiditi Syndrome/diagnostic imaging , Cholecystitis, Acute/diagnostic imaging , Cholecystitis, Acute/surgery , Liver/abnormalities , Liver/diagnostic imaging , Tomography, X-Ray Computed , CholecystectomyABSTRACT
Chilaiditi's sign is the interposition of small bowel or colon between the liver and diaphragm. This incidental finding is seen in 0,025-0,28% of the chest and abdominal radiographies. Predisposing factors include the absence, laxity or elongation of the suspensory ligaments of the transverse colon, redundant colon or elevation of the right hemidiaphragm. Atrophy or hypoplasia of the liver is an uncommon cause of this radiological sign. On the other hand, suprahepatic gallbladder is the most infrequent location of gallbladder ectopies (0,026-0,7%). It is associated with an abnormal development of the right liver lobe such as agenesis, hypoplasia or atrophy. We present the case of a 73-year-old man with Chilaiditi's sign, hepatic hypoplasia and acute calculous cholecystitis in an ectopic suprahepatic gallbladder.
Subject(s)
Cholecystitis, Acute , Liver , Aged , Colon , Diaphragm , Humans , Male , SyndromeABSTRACT
BACKGROUND: Hidradenitis is a disorder where abscesses appear after the infection of the apocrine sweat glands. It is located normally in the axillae, groin, perineal region, and the scalp. CLINICAL CASE: A 37 year old male was referred by his GP to the General Surgery Department with axillary hidradenitis which had evolved over the years. The physical examination shows signs of hidradenitis in both axillae, with a noticeable suppurative hidradenitis in the right armpit. En bloc extirpation was performed to remove the whole affected area. The pathological examination revealed a cutaneous leishmaniasis. Subsequently, fucidin was administered topically, as well as local infiltrations of one millilitre of Glucantime™. DISCUSSION: Hidradenitis normally appears in intertriginous areas and its manifestation is accompanied by recurrent subcutaneous nodules. The incidence rate in females is three times higher than in males. The isolated Hidradenitis caused by Leishmania is a rare condition presented only in endemic areas or in immunocompromised patients, such as HIV-infected patients. Clinical manifestations can be different and the diagnosis can be confirmed through haematoxylin-eosin. The main pattern displays a disorganised granuloma without necrosis. Systemic or topical treatment can be applied. Immunotherapy treatment is the most common. CONCLUSIONS: Hidradenitis caused by Leishmania in HIV-negative patients is a rare condition. Therefore it is important to perform a good histological diagnosis and to administer the right treatment.
Subject(s)
Hidradenitis/parasitology , Leishmaniasis, Cutaneous/complications , Adult , Antiprotozoal Agents/therapeutic use , Axilla/parasitology , Combined Modality Therapy , Fusidic Acid/therapeutic use , HIV Seronegativity , Hidradenitis/drug therapy , Hidradenitis/surgery , Humans , Leishmaniasis, Cutaneous/diagnosis , Leishmaniasis, Cutaneous/drug therapy , Leishmaniasis, Cutaneous/surgery , Male , Meglumine/therapeutic use , Meglumine Antimoniate , Organometallic Compounds/therapeutic use , RecurrenceABSTRACT
BACKGROUND: Pneumoperitoneum is defined as the existence of extraluminal air in the abdominal cavity. In 80-90% of cases is due to perforation of a hollow organ. However, in 10-15% of cases, it is nonsurgical pneumoperitoneum. OBJECTIVE: The case of a patient undergoing mechanical ventilation, developing abdominal compartment syndrome tension pneumoperitoneum is reported. CLINICAL CASE: Female, 75 years old asking for advise due to flu of long term duration. Given her respiratory instability, admission to the Intensive Care Unit is decided. It is then intubated and mechanically ventilated. Chest x-ray revealed a large pneumoperitoneum but no pneumothorax neither mediastinum; and due to the suspicion of viscera perforation with clinical instability secondary to intra-abdominal hypertension box, emergency surgery was decided. CONCLUSIONS: When discarded medical history as a cause of pneumoperitoneum, it is considered that ventilation is the most common cause. Benign idiopathic or nonsurgical pneumoperitoneum, can be be treated conservatively if the patient agrees. But if intraabdominal hypertension prevails, it can result in severe respiratory and hemodynamic deterioration, sometimes requiring abdominal decompression to immediately get lower abdominal pressure and thus improve hemodynamic function.
Subject(s)
Barotrauma/complications , Intra-Abdominal Hypertension/etiology , Intubation, Intratracheal/adverse effects , Pneumoperitoneum/etiology , Pulmonary Alveoli/injuries , Respiration, Artificial/adverse effects , Aged , Barotrauma/physiopathology , Decompression, Surgical , Emergencies , Female , Hemodynamics , Humans , Influenza, Human/complications , Intermittent Positive-Pressure Ventilation , Intra-Abdominal Hypertension/physiopathology , Intra-Abdominal Hypertension/surgery , Laparotomy , Pneumoperitoneum/physiopathology , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapyABSTRACT
Introducción. La endometriosis es una enfermedad ginecológica cuya prevalencia oscila alrededor del 5-10% de las mujeres. La localización es pélvica en la mayoría de los casos; sin embargo, en un pequeño grupo de pacientes, puede presentarse en regiones diferentes de esta. Material y métodos. Estudio descriptivo, observacional y retrospectivo de las historias clínicas de 26 pacientes intervenidas quirúrgicamente de endometriosis de localización extraovárica en el Hospital General Universitario de Ciudad Real en el período comprendido entre enero del 2003 y enero del 2013. Resultados. Nuestra serie consta de 26 pacientes intervenidas de endometriosis de localización extraovárica. Las localizaciones, por orden de frecuencia, fueron: pared abdominal, ombligo, vulva, apéndice, íleon, saco herniario y colon. Discusión. La localización extrapélvica de la endometriosis se presenta con muy baja frecuencia. El tratamiento quirúrgico es la elección, llevando a cabo una resección con márgenes suficientes que permitirá reducir las posibilidades de recidiva (AU)
Introduction. Endometriosis is a gynecological disease with a prevalence of about 5% to 10% of women. Localization is usually pelvic but in a small group of patients the disease can be localized elsewhere. Material and methods. We performed a descriptive, observational and retrospective study of the medical records of 26 patients treated surgically for extraovarian endometriosis at the University General Hospital of Ciudad Real between January 2003 and January 2013. Results. Our series included 26 patients who underwent surgery for extraovarian endometriosis. In order of frequency, the locations were the abdominal wall, umbilicus, vulva, appendix, ileum, hernia sac and colon. Discussion. The frequency of extrapelvic endometriosis is very low. The treatment of choice is surgery. Resection with adequate margins reduces the chances of recurrence (AU)
Subject(s)
Humans , Female , Endometriosis/epidemiology , Endometriosis/prevention & control , Cicatrix/diagnosis , Cicatrix/therapy , Appendix/surgery , Ileum/surgery , Recurrence/prevention & control , Endometriosis/diagnosis , Endometriosis/surgery , Retrospective Studies , Abdominal Wall/surgery , Umbilicus/surgerySubject(s)
Adenoma, Villous/complications , Colonic Neoplasms/complications , Intussusception/etiology , Water-Electrolyte Imbalance/etiology , Adenoma, Villous/diagnosis , Adenoma, Villous/pathology , Aged , Colonic Neoplasms/diagnosis , Colonic Neoplasms/pathology , Female , Humans , Intussusception/diagnosis , Intussusception/pathology , Rectal Diseases/diagnosis , Rectal Diseases/etiology , Rectal Diseases/pathology , Water-Electrolyte Imbalance/diagnosisABSTRACT
Introducción. El histiocitoma fibroso maligno constituye la neoplasia sarcomatosa más frecuente en los adultos, pero la mama es una localización excepcional. Presentamos el caso de una mujer que comenzó con una tumoración de crecimiento progresivo en la mama derecha. Caso clínico. Mujer de 68 años que consulta por autopalpación de un nódulo en la mama derecha que ha crecido de forma progresiva en los últimos meses. La mamografía y la ecografía muestran una imagen nodular con bordes bien definidos, situada en intercuadrantes superiores de mama derecha, sin adenopatías axilares. Se decidió intervención quirúrgica y el estudio histológico definitivo fue informado como neoformación mesenquimal fusocelular con patrón estoriforme. El estudio inmunohistoquímico fue compatible con un histiocitoma fibroso maligno. Conclusión. Es primordial el diagnóstico diferencial de esta entidad clínica debido a la variabilidad histológica de los tumores sarcomatosos. Sus características clínicas y radiológicas pueden hacerlo pasar desapercibido, pero su comportamiento agresivo hace necesario un diagnóstico precoz, lo cual permitirá un tratamiento adecuado para lograr el aumento en la supervivencia(AU)
Introduction. Malignant fibrous histiocytoma is the most common sarcomatous neoplasm in adults. Localization in the breast, however, is exceptional. We report the case of a woman who presented with progressive tumoral growth in the right breast. Case report. A 68-year-old woman consulted for a self-palpated nodule in the right breast that had grown steadily in the last few months. Mammography and ultrasound showed a nodule with well-defined borders, located in the upper inner quadrant of the right breast. There was no axillary lymphadenopathy. Surgery was performed and the histological examination gave a definitive diagnosis of mesenchymal spindle cell neoplasm with storiform pattern. Immunohistochemical analysis was compatible with a diagnosis of malignant fibrous histiocytoma. Conclusion. Due to the histological variability of sarcomatous tumors, differential diagnosis is paramount in malignant fibrous histiocytoma. Because of their clinical and radiological features, malignant fibrous histiocytoma can be overlooked. Because these tumors are aggressive, an early diagnosis is essential to allow appropriate treatment and to increase survival(AU)
