[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.

Tuberculosis ileocecal: revisión de la literatura a partir de un caso clínico / Ileocecal tuberculosis: literature review from a case report

Tuberculosis (TB) remains a major public health challenge. The true incidence of intestinal TB is unknown, as it can be asymptomatic, and by its nature, often diverts its diagnosis to neoplastic diseases or inflammatory bowel disease. Therefore, we must have a high index of suspicion, not only in high risk populations and immunocompromised patients. Diagnostic tests that certify the pathology, don’t always achieve excellent performance. Endoscopic findings are not always clear in differentiating malignancy, and in some cases, a therapeutic trial may be needed to confirm the disease. We present the case of a patient with chronic diarrhea, consumptive syndrome and without respiratory symptoms at its onset.

La tuberculosis (TBC) sigue siendo un reto importante de salud pública. La verdadera incidencia de TBC intestinal es desconocida, ya que puede ser asintomática, y por su naturaleza a menudo desvía su diagnóstico a patologías neoplásicas o de enfermedad inflamatoria intestinal. Por lo tanto, se debe tener un alto índice de sospecha, no sólo en poblaciones de alto riesgo y en pacientes inmunocomprometidos. Las pruebas diagnósticas que certifiquen la patología no siempre se logran ni tienen un excelente rendimiento. Los hallazgos endoscópicos no siempre son claros para diferenciarla de una neoplasia, y en algunos casos una prueba terapéutica puede ser la confirmación de la enfermedad. Presentamos el caso de un paciente con diarrea crónica, cuadro consuntivo y sin síntomas respiratorios al inicio de su cuadro.

Abdominal angiostrongyliasis: report of two cases with different clinical presentations.

Abdominal angiostrongyliasis is a sporadic infectious disease caused by the nematode Angiostrongylus costaricensis. It usually presents as acute abdomen, secondary to mesenteric ischemia, and pronounced eosinophilia. In some cases its course is insidious and transient, and the diagnosis is suspicious. The disease is confirmed by the detection of A. costaricensis elements in surgical specimen. The treatment is supportive, with avoidance of antihelminthic administration due to a possible erratic migration followed by worsening of the disease. We report two cases, both with intense eosinophilia and serum IgG-ELISA positive to A. costaricensis. The first case presented ileal perforation and was surgically treated. The second one showed hepatic nodules at ultrasound and was only symptomatically treated, evolving to an apparent protracted resolution. These two cases exemplify different clinical forms of the disease, one of them with liver involvement.

Abdominal angiostrongyliasis: report of two cases with different clinical presentations / Angiostrongilíase abdominal: relato de dois casos com diferentes apresentações clínicas

Abdominal angiostrongyliasis is a sporadic infectious disease caused by the nematode Angiostrongylus costaricensis. It usually presents as acute abdomen, secondary to mesenteric ischemia, and pronounced eosinophilia. In some cases its course is insidious and transient, and the diagnosis is suspicious. The disease is confirmed by the detection of A. costaricensis elements in surgical specimen. The treatment is supportive, with avoidance of antihelminthic administration due to a possible erratic migration followed by worsening of the disease. We report two cases, both with intense eosinophilia and serum IgG-ELISA positive to A. costaricensis. The first case presented ileal perforation and was surgically treated. The second one showed hepatic nodules at ultrasound and was only symptomatically treated, evolving to an apparent protracted resolution. These two cases exemplify different clinical forms of the disease, one of them with liver involvement.

A angiostrongilíase abdominal é doença esporádica decorrente da infecção pelo nematódeo Angiostrongylus costaricensis. Costuma manifestar-se como abdome agudo secundário a isquemia mesentérica, além de marcada eosinofilia. Pode também apresentar-se de forma insidiosa e transitória, exigindo alta suspeita clínica para o diagnóstico. A doença é confirmada pela identificação de elementos do A. costaricensis em peças cirúrgicas. O tratamento é apenas de suporte, devendo-se evitar o uso de anti-helmínticos pela possibilidade de migração errática do verme com piora do quadro. Aqui foram apresentados dois casos, ambos com acentuada eosinofilia e ELISA-IgG sérico positivo para A. costaricencis. O primeiro caso cursou com perfuração ileal e foi tratado cirurgicamente. O segundo caso apresentou nódulos hepáticos ao ultrassom e foi tratado sintomaticamente, evoluindo para lenta resolução. Estes dois casos exemplificam diferentes formas de apresentação clínica da doença, uma delas com envolvimento hepático.

Reducción hidrostática de invaginación intestinal guiada por ultrasonido: una nueva opción / Us guided hydrostatic reduction of intssusception: a new option

lleocolic intussusception is an important cause of acute abdomen in infants. When there is no surgical indication, reduction under fluorosco-pic vision has been the main radiologic treatment performed in our country. Ultrasound examination is broadly used as a diagnostic method but reports on local experiences with ultrasound for guidance in intussusception reduction have not been recorded. A series of five cases of successful hydrostatic reduction performed under ultrasonographic control is presented and images of different stages of the reduction process are shown. Our aim is to promote a change in monitoring procedures so as to avoid the use of ionizing radiation.

La invaginación ileocólica es una causa importante de abdomen agudo en lactantes y su tratamiento de elección en nuestro medio es la reducción bajo visión fluoroscópica, cuando no existe indicación quirúrgica. El ultrasonido es utilizado como método de diagnóstico y su uso como guía para la reducción de la invaginación no ha sido comunicado en nuestro medio. Se presenta una pequeña serie de 5 casos de reducciones hidrostáticas exitosas efectuadas bajo control ultrasonográfico y se muestran imágenes de ultrasonido características de las diferentes etapas de la desinvaginación, con el objeto de estimular el cambio de método de monitorización en este procedimiento, evitando el uso de radiación ionizante.

Chagasic enteropathy.

Involvement of the hollow organs of the digestive apparatus can occur in patients in the chronic phase of Chagas' disease. The basic mechanism is destruction of neurons of the enteric nervous system. Whereas megaesophagus and megacolon are the most notable and most extensively studied expressions of the digestive form of Chagas' disease, involvement of the small intestine (Chagasic enteropathy) is less frequent and less known than involvement of the two above mentioned entities. Chagasic enteropathy can be responsible for important clinical and laboratory manifestations resembling those of dyspeptic syndrome, intestinal pseudo-obstruction and bacterial overgrowth in the small intestine. Chagasic enteropathy also involves peculiar functional changes, especially those related to motor activity of the organ and to intestinal absorption of carbohydrates. In practice, the diagnosis is based on radiographic documentation of dilation of visceral segments. Treatment consists of clinical control of the above syndromes and, eventually, appropriate surgical operations.

[Total parenteral nutrition in the absence of kidney function for the treatment of the complications of gastrointestinal surgery]. / Nutrición parenteral total en ausencia de función renal para el tratamiento de complicaciones de la cirugia gastrointestinal.

This is a preliminary report on an eight-year-old child with uremia (terminal renal failure) on chronic dialysis, that developed a postoperative high output small bowel fistula associated with sepsis and malnutrition. She was successfully treated with a Total Parenteral Nutrition (TPN) scheme including an amino acid solution with 60% essential amino acids and 40% non-essential amino acids, now available in Peru, without increasing the frequency of hemodialysis for a 72-day period on TPN. Attention is drawn to Nutritional Support Team Approach.

Vólvulus de sigmoides / Sigmoid volvulus

El objetivo de este artículo es revisar la epidemiología, fisiopatogenia, diagnóstico y tratamiento del vólvulus del sigmoides. La manifestación clínica de este es de obstrucción intestinal, y llega a tener una mortalidad tan elevada del 30 por ciento. La frecuencia del vólvulus del sigmoides tiene dos patrones geográficos diferentes. En los países industrializados como EUA, Europa Occidental, la edad de presentación es en gente mayor de 60 años y causa obstrucción intestinal entre el 2-10 por ciento. En cambio en los países subdesarrollados de Africa, India, Europa Oriental, Brasil e Irán se presenta en gente más joven entre 30 y 40 años y aumenta la incidencia de obstrucción intestinal entre el 30.50 por ciento.

Hydrostatic reduction of ileocolic intussusception: a second attempt in the operating room with general anesthesia.

Over a 3-year-period, standard treatment with hydrostatic pressure from a contrast enema failed to reduce ileocolic intussusception in 31 of 62 children. With the child anesthetized in the operating room, a second contrast enema was given before laparotomy. Of the 31 intussusceptions, 21 (68%) were reduced without complication, thereby avoiding the discomfort, longer hospitalization, complications, and expense of surgery. Nine of the remaining 10 intussusceptions were difficult to reduce manually during surgery or required resection. The overall nonoperative reduction rate for the 3-year period was 84%; for the last 2 years it was 90%. Success with the second enema may be related to the effects of general anesthesia. In addition, partial reduction with the first enema may improve blood flow from the intussusceptum so that it becomes smaller and easier to reduce with the second enema. Because it can easily be added to standard management protocols without increased risk, routine use of this second enema with anesthesia is recommended.