Management of Malignant Gastric Outlet Obstruction: A Comprehensive Review on the Old, the Classic and the Innovative Approaches.

Gastrojejunostomy is the principal method of palliation for unresectable malignant gastric outlet obstructions (GOO). Gastrojejunostomy was traditionally performed as a surgical procedure with an open approach butrecently, notable progress in the development of minimally invasive procedures such as laparoscopic gastrojejunostomies have emerged. Additionally, advancements in endoscopic techniques, including endoscopic stenting (ES) and endoscopic ultrasound-guided gastroenterostomy (EUS-GE), are becoming more prominent. ES involves the placement of self-expandable metal stents (SEMS) to restore luminal patency. ES is commonly the first choice for patients deemed unfit for surgery or at high surgical risk. However, although ES leads to rapid improvement of symptoms, it carries limitations like higher stent dysfunction rates and the need for frequent re-interventions. Recently, EUS-GE has emerged as a potential alternative, combining the minimally invasive nature of the endoscopic approach with the long-lasting effects of a gastrojejunostomy. Having reviewed the advantages and disadvantages of these different techniques, this article aims to provide a comprehensive review regarding the management of unresectable malignant GOO.

Hemorragia hepática espontánea como causa inusual de abdomen agudo hemorrágico / Spontaneous hepatic hemorrhage as unusual cause of acute intra-abdominal hemorrhage

RESUMEN La hemorragia hepática espontánea (HHE) es una afección rara que resulta de una lesión en el parénquima hepático producida sin una causa externa. Presentamos el caso de una mujer de 74 años que, durante una internación por reagudización de su enfermedad pulmonar obstructiva crónica (EPOC), desarrolla episodio de hemorragia hepática espontánea que evoluciona a shock hemorrágico. Se realiza cirugía con resección atípica de carcinoma hepatocelular (HCC) con hemorragia activa en segmento III hepático. La paciente responde al tratamiento inicial, pero a los 16 días posoperatorios fallece en Unidad de Terapia Intensiva (UTI) debido a una afección respiratoria.

ABSTRACT Spontaneous hepatic hemorrhage (SHH) is a rare condition resulting from a breach in the hepatic parenchyma that occurs without an external cause. We report the case of a 74-year-old woman who, while being hospitalized due to exacerbation of chronic obstructive pulmonary disease (COPD), presented an episode of SHH with hemorrhagic shock. She underwent atypical resection of a hepatocellular carcinoma (HCC) with active bleeding in liver segment III. The patient had a favorable response to the initial treatment but died in the intensive care unit (ICU) on postoperative day 16 due to a respiratory tract complication.

Tratamiento mininvasivo de las complicaciones del traumatismo hepático cerrado / Minimally invasive management of blunt hepatic trauma complications

RESUMEN Antecedentes: el manejo no operatorio del traumatismo hepático cerrado es exitoso en el 95% de los pacientes hemodinámicamente normales. Las lesiones de alto grado presentan una tasa de complicaciones de hasta un 14%, y una mortalidad del 27% cuando requieren cirugía abierta. Material y métodos: estudio descriptivo de informe de casos. Resultados: 3 casos con traumatismo hepático de alto grado. "A": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, drenaje percutáneo de absceso hepático, recambio de catéter y CPRE, por fístula biliar persistente. "B": cirugía de control de daño inicial sin hepatectomía, drenaje percutáneo de absceso hepático y posterior recambio. "C": manejo no operatorio inicial, lavado laparoscópico por hemoperitoneo sintomático, posterior drenaje percutáneo de absceso hepático y recambio de drenajes. No presentaron mortalidad. Conclusión: estos casos resumen la utilización de las diferentes modalidades del manejo del traumatismo hepático cerrado y la posibilidad del manejo mininvasivo de las complicaciones.

ABSTRACT Background: Nonoperative management of blunt hepatic trauma is successful in 95% of hemodynamically stable patients. The complication rate of high-grade injuries is 14% and mortality reaches 27% when they require open surgery. Material and methods: We conducted a descriptive study of case reports. Results: Three cases of high-grade hepatic trauma are reported. "A": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess, catheter replacement and ERCP due to persistent biliary fistula. "B": initial damage control surgery without liver resections, percutaneous drainage of liver abscess and catheter replacement. "C": initial nonoperative management, laparoscopic lavage due to symptomatic hemoperitoneum, percutaneous drainage of liver abscess and catheter replacement. None of the patients died. Conclusion: These cases summarize the use of different management modalities of blunt hepatic trauma and the possibility of minimally invasive management of the complications.

Cuidados prenatales y de puerperio en el primer nivel de atención de Bahía Blanca en el año 2013 / Prenatal and postpartum care in the primary care of Bahia Blanca in 2013

Introducción: Los cuidados prenatales son una prioridad para el Primer Nivel de Atención y deben ser mejorados. Objetivos: Describir el perfil de las consultas de embarazadas y puérperas en el primer nivel de atención de Bahía Blanca durante 2013. Material y Métodos: estudio descriptivo, observacional, análisis cuantitativo. Resultados: Se analizaron 4697 consultas: 4288 por control de embarazo y 409 por puerperio. El 21,5 % fueron menores de 19 años, 69% entre 20 y 34, y 9.2% mayores de 35. El 2,5% presento anemia, 1.74% problemas tiroideos, 1.38% infección urinaria, 0.94% vulvovaginitis, 0.43% hipertensión arterial, 0.18% diabetes, 0.11% violencia de género, 0.14% tabaquismo. Discusión: La distribución de edad es similar a la media nacional. Son escasos los controles de puerperio. Las enfermedades asociadas son menos que la media nacional. Conclusiones: deben propiciarse los controles de puerperio. Los datos son útiles para la gestión local. Deben mejorarse los registros. Palabras Clave: Atención Prenatal. Atención Primaria de Salud. Complicaciones del Embarazo.

Introduction: Prenatal care is a priority for the primary care level ands hould be improved. Objectives: To describe the profile of pregnant and postpartum consultations in primary care Bahia Blanca during 2013. Material and Methods: A descriptive, observational study, quantitative analysis. Results: 4697 consultations were analyzed by birth control 4288 and 409 by puerperium. 21.5% were under 19, 69% between 20 and 34, and 9.2% over 35. The 2.5% showed anemia, thyroid problems 1.74%, 1.38% UTI, vulvovaginitis 0.94%, 0.43% hypertension pressure, diabetes 0.18%, 0.11% GBV, 0.14% smoking. Discussion: The age distribution is similar to the national average. There are few controls puerperium. Associated diseases are less than the national average. Conclusions: there should be focus controls puerperium. The data are useful for local management. Records should be improved. Key words: Prenatal Care. Primary Health Care. Complications of Pregnancy.