Left Perforated Colonic Tumor with Synchronous Locally Advanced Right Colonic Tumor.

Colorectal cancer is one of the most common malignant neoplasms worldwide. Overall mortality is 33%. Synchronous colorectal cancer refers to more than one malignant tumor detected in different segments of the colon, simultaneously or within 6 months of initial diagnosis. The development of colorectal cancer is a multistep process that originates with a genetic mutation leading to a malignant phenotype and generating a growth advantage. Colorectal cancer presents up to 16% of hypermutations, of which 75% are characterized by microsatellite instability which in turn leads to poorer cell differentiation. Patients with synchronous tumors appear to have a higher proportion of microsatellite instability than patients with single tumors. The clinical case of a 35-year-old man with a perforated left colon tumor and a locally advanced synchronous tumor of the right colon and signs of acute abdomen is presented. The treatment should be based on the location of the synchronous tumors, stage at the time of approach, and the patient's condition. However, when faced with a complication secondary to colonic cancer, adhering to the principles of oncological surgery can be overcome by the nature of the emergency.

Is albumin a predictor of severity and mortality in patients with abdominal sepsis?

BACKGROUND: Patients with a lower level of albumin have a more severe infection, the level of said biomarker is a strong predictor of mortality. OBJECTIVE: To determine the usefulness of the serum albumin level as a predictor of severity and mortality. METHODS: Retrospective, descriptive, cross-sectional study of patients diagnosed with abdominal sepsis. During the period from April 2016-February 2017. The severity was determined by Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), Mannheim and mortality. The sample was divided into those with albumin > 2.9 mg/dl and < 2.8 mg/dl. RESULTS: We included 155 cases, 62 female and 93 male; the main organ causing abdominal sepsis was the appendix 42%. The average albumin for the sample was 3.2 mg/dl (DE ± 0.9). The findings, subjected to statistical verification by means of the Mann-Whitney test, showed statistical significance among the cases with albumin < 2.8 mg/dl with those have ranged Mannheim > 26 points (p = 0.001), APACHE > 15 (p = 0.015) and SOFA > 6 (p = 0.001), No statistical significance was obtained between albumin level < 2.8, and mortality (p = 0.052). CONCLUSION: Albumin can be considered as a predictor of severity, although not as a predictor of mortality.

INTRODUCCIÓN: Los pacientes con unos valores más bajos de albúmina presentan una infección más grave; el nivel de dicho biomarcador es un fuerte predictor de la mortalidad. OBJETIVO: Determinar la utilidad de la concentración sérica de albúmina como predictor de gravedad y mortalidad. MÉTODO: Estudio retrospectivo, descriptivo, transversal, de pacientes con diagnóstico de sepsis abdominal, atendidos durante el periodo de abril de 2016 a febrero de 2017. Se determinaron la gravedad mediante APACHE II, SOFA y Mannheim, y la mortalidad. Se dividió la muestra en pacientes con albúmina > 2.9 y < 2.8 mg/dl. RESULTADOS: Se incluyeron 155 casos (62 mujeres y 93 hombres); el principal órgano causante de sepsis abdominal fue el apéndice (42%). El valor medio de la albúmina para la muestra se situó en 3.2 mg/dl (desviación estándar: ± 0.9). Los hallazgos, sometidos a verificación estadística mediante la prueba U de Mann-Whitney, mostraron una relación con significancia estadística entre los casos con albúmina < 2.8 mg/dl y los casos con puntaje de Mannheim > 26 puntos (p = 0.001), APACHE > 15 (p = 0.015) y SOFA > 6 (p = 0.001). No se obtuvo significancia estadística entre el valor de la albúmina < 2.8 y la mortalidad (p = 0.052). CONCLUSIÓN: La albúmina puede ser considerada como un predictor de gravedad, pero no de mortalidad.

Factores de riesgo asociados al desarrollo de fístula anal / Risk factor associated to the development of anal fistula

Objetivo: Determinar los factores de riesgo asociados para el desarrollo de fístula anal posterior a absceso anal. Sede: Hospital General de México. Diseño: Estudio de casos y controles. Análisis estadístico: Análisis univariado. Pacientes y métodos: Se incluyeron 250 pacientes observados en el periodo de mayo de 2009 a enero de 2012, evaluados en consulta externa de la Unidad de Coloproctología con el diagnóstico de absceso anal y con tres meses o más de seguimiento. Las variables analizadas fueron: edad, ocupación, diabetes mellitus, tabaquismo, consumo de alcohol, antibióticos previos y posteriores al drenaje, tipo de evacuación de acuerdo a la escala de Bristol, anorrecepción, tiempo de evolución del absceso y lugar de drenaje del absceso (consultorio, quirófano o espontáneamente). Resultados: De los 250 pacientes con absceso anal tratados con un drenaje simple, 103 (41.2%) desarrollaron fístula anal. Los resultados del análisis univariado no mostraron significancia estadística para ninguna de estas variables. Conclusión: No identificamos factor de riesgo, estudiados en este trabajo, para poder determinar qué pacientes pueden desarrollar fístula anal posterior a un evento de absceso anal.

Objective: To determine the risk factors associated to the development of anal after an anal abscess. Setting: General Hospital of Mexico (third level health care center). Design: Case-controls study. Statistical analysis: Univariate analysis. Patients and methods: The study comprised 250 patients observed in the period of May 2009 to January 2012 assessed in the outpatient clinic of the Coloproctology Unit, with a diagnosis of anal abscess and three months or more of follow-up. Analyzed varaibles were: age, ocupation, diabetes mellitus, smoking, alcohol consumption, previous antibiotics and after the drainage, type of evacuation according to the Bristol scale, anal reception, time of abscess evolution, and site where drainage of the abscess was performed (outpatient clinic, surgery room, or spontaneously). Results: Of the 250 patients with an anal abscess treated with a simple drainage, 103 (41.2%) developed an anal. Results of the univariate analysis did not reveal any statistical significance for any of the studied variables. Conclusion: We did not identify any risk factor in this paper to be able to determine which patients can develop an anal after an anal abscess event.