ABSTRACT
Colonic lipomas are benign tumors originating in mesenchymal tissue and are considered the second most common benign tumor in the colon after adenomatous polyps. They tend to affect women more; their most frequent location is the right colon. Generally, these lipomas do not exhibit symptoms, but when they reach a considerable size, they can cause manifestations. They can also result in complications such as obstruction, intussusception, and perforation. Since their radiological characteristics are similar to fat, they can be visualized using computed tomography. Still, the final diagnosis is made through colonoscopy, where a fatty mass with an oval shape and elastic capacity is observed. Lesions can be removed endoscopically or surgically. Spontaneous expulsion of a lipoma rectally is rare, and its mechanism is not yet fully understood. Although the literature establishes a cut-off point of 2 cm to decide between endoscopic or laparoscopic resection, the former is increasing and can extend this limit. Surgical resection is recommended in cases such as the one in this article. This case is the biggest reported colonic lipoma (13 cm) expelled spontaneously.
Los lipomas colónicos son tumores benignos que se originan en el tejido mesenquimal y se consideran el segundo tumor benigno más común en el colon, después de los pólipos adenomatosos. Tienden a afectar más a mujeres y su localización más frecuente es el colon derecho. Por lo general, estos lipomas no presentan síntomas, pero cuando alcanzan un tamaño considerable pueden causar manifestaciones. También pueden dar lugar a complicaciones como obstrucción, intususcepción y perforación. Dado que sus características radiológicas son similares a la grasa, pueden ser visualizados mediante tomografía computarizada, aunque el diagnóstico definitivo se realiza mediante colonoscopia, donde se observa una masa grasa con forma ovalada y capacidad elástica. Las lesiones pueden ser extirpadas endoscópicamente o quirúrgicamente. La expulsión espontánea de un lipoma por vía rectal es rara y su mecanismo aún no está completamente comprendido. Aunque la literatura establece un punto de corte de 2 cm para decidir entre resección endoscópica o laparoscópica, la primera está en aumento y puede ampliar este límite. En casos grandes, como el reportado en este artículo, se recomienda una resección quirúrgica. Este caso particular se destaca por ser el lipoma de colon más grande reportado hasta ahora (13 cm) expulsado espontáneamente.
ABSTRACT
Acute transverse myelitis (TM) is an inflammatory disease that manifests with motor, sensory, and autonomic symptoms of rapid progression with catastrophic outcomes; the three main causes of acute TM are demyelinating diseases, infections, and autoimmune inflammatory diseases such as systemic lupus erythematosus (SLE). TM is one of the 19 neuropsychiatric diseases associated with SLE according to the American College of Rheumatology (ACR) and has been described as affecting 1 to 2% of all cases of SLE and is frequently misdiagnosed, leading to a high rate of morbidity and mortality. This report highlights the case of a 25-year-old woman with a history of SLE who consulted for a progressive decrease in lower limb strength and loss of sphincter control, accompanied by dysesthesias from the abdomen to the feet. Upon examination, she exhibited severe paraparesis and preserved myotendinous reflexes, and a sensory level at T10 was documented. A contrast-enhanced MRI of the thoracolumbar spine was performed, showing signal hyperintensity on T2 and Short Tau Inversion Recovery (STIR) from T6 to T10. These findings are compatible with TM. Given the refractory response to initial management, the use of cyclophosphamide was required. After one week of hospital treatment, the patient achieved partial neurological recovery and was discharged for continued outpatient rheumatology care. For the diagnosis of TM in patients with SLE, a high clinical suspicion is required. Recognizing and immediately addressing this condition is crucial to prevent catastrophic outcomes and the high morbidity and mortality that stem from this association.
ABSTRACT
Intestinal intussusception in adult patients is a rare entity, which corresponds to about 5% of all causes of intestinal obstruction, its diagnosis is not easy given the lack of specific symptoms of patients who present it. This is mainly based on the findings of imaging studies, surgical management is the cornerstone of treatment of this pathology and its success will be determined by timely diagnosis as well as by the expertise of the treating surgeon. This article presents the case of a 62-year-old male patient who consults due to nonspecific abdominal pain and irritative urinary symptoms, who due to persistence of abdominal pain despite medical management is taken to surgery where it is diagnosed intraoperatively. an intestinal intussusception at the level of the distal ileum.
Subject(s)
Intestinal Obstruction , Intussusception , Neoplasms , Male , Humans , Aged , Middle Aged , Intussusception/diagnosis , Intussusception/etiology , Intestinal Obstruction/diagnosis , Intestinal Obstruction/etiology , Abdominal Pain , IleumABSTRACT
La tuberculosis miocárdica es una localización infrecuente que, en general, se caracteriza por cuadros clínicos silentes. Su diagnóstico se basa en la alta sospecha clínica y hallazgos inespecíficos en las imágenes cardíacas, pero la histopatología continúa siendo el estándar de oro para establecer el diagnóstico. La terapia antituberculosa ha sido exitosa, presentando mejoría radiológica y clínica en la mayoría de los casos. Presentamos el caso de una infección miocárdica por Mycobacterium tuberculosis en un hombre de 34 años que consultó por un cuadro de disnea de varias semanas de evolución. Se pesquisó un derrame pleural derecho y pericárdico grave, sin signos de taponamiento cardíaco. La RPC para M. tuberculosis en líquido pleural resultó positiva. El estudio histológico de pericardio y miocardio evidenció una pericarditis crónica y una inflamación granulomatosa, no necrosante, con células gigantes multinucleadas en el tejido miocárdico. Se estableció el diagnóstico de tuberculosis pleural, pericárdica y miocárdica y se inició tratamiento antituberculoso, presentando una mejoría clínica significativa.
Myocardial tuberculosis is a rare location that is generally characterized by silent clinical pictures. Diagnosis is based on high clinical suspicion and some nonspecific findings on cardiac imaging, but histological findings remain the gold standard. Treatment with standard antitubercular drugs llave been successful, presenting radiological and clinical improvement in most cases. We report a case of myocardial infection by Mycobacterium tuberculosis in a 34-year-old man, who presented with several weeks of dyspnea and evidence of right pleural effusion and severe pericardial effusion, without signs of cardiac tamponade. PCR for M. tuberculosis was positive in pleural fluid. The histologic study of pericardium and myocardium showed myocardial fibers with non-necrotizing granulomatous inflammation with multinucleated giant cells. Due to all the above, a diagnosis of pleural and myocardial tuberculosis was made, and tuberculosis treatment was started with significant clinical improvement.
ABSTRACT
La intususcepción intestinal en pacientes adultos es una entidad infrecuente, la cual corresponde alrededor del 5% de todas las causas de obstrucción intestinal. Su diagnóstico no es fácil, dado lo poco especifico de los síntomas de los pacientes que la presentan; este se sustenta principalmente en los hallazgos de los estudios de imagen. El manejo quirúrgico es la piedra angular del tratamiento de esta patología, y su éxito va a estar determinado por el diagnóstico oportuno y la experticia del cirujano tratante. En este artículo se presenta el caso de un paciente masculino de 62 años, que consulta por cuadro de dolor abdominal inespecífico y síntomas urinarios irritativos, el cual por persistencia del dolor abdominal pese al manejo medico es llevado a cirugía, donde se diagnostica de manera intraoperatoria una invaginación intestinal a nivel de íleon distal.
Intestinal intussusception in adult patients is a rare entity, which corresponds to about 5% of all causes of intestinal obstruction, its diagnosis is not easy given the lack of specific symptoms of patients who present it. This is mainly based on the findings of imaging studies, surgical management is the cornerstone of treatment of this pathology and its success will be determined by timely diagnosis as well as by the expertise of the treating surgeon. This article presents the case of a 62-year-old male patient who consults due to nonspecific abdominal pain and irritative urinary symptoms, who due to persistence of abdominal pain despite medical management is taken to surgery where it is diagnosed intraoperatively. an intestinal intussusception at the level of the distal ileum.
