Repeated pancreatic resection for pancreatic metastases from renal cell Carcinoma: A Spanish multicenter study (PANMEKID).

BACKGROUND AND OBJECTIVES: Recurrent isolated pancreatic metastasis from Renal Cell Carcinoma (RCC) after pancreatic resection is rare. The purpose of our study is to describe a series of cases of relapse of pancreatic metastasis from renal cancer in the pancreatic remnant and its surgical treatment with a repeated pancreatic resection, and to analyse the results of both overall and disease-free survival. METHODS: Multicenter retrospective study of patients undergoing pancreatic resection for RCC pancreatic metastases, from January 2010 to May 2020. Patients were grouped into two groups depending on whether they received a single pancreatic resection (SPS) or iterative pancreatic resection. Data on short and long-term outcome after pancreatic resection were collected. RESULTS: The study included 131 pancreatic resections performed in 116 patients. Thus, iterative pancreatic surgery (IPS) was performed in 15 patients. The mean length of time between the first pancreatic surgery and the second was 48.9 months (95 % CI: 22.2-56.9). There were no differences in the rate of postoperative complications. The DFS rates at 1, 3 and 5 years were 86 %, 78 % and 78 % vs 75 %, 50 % and 37 % in the IPS and SPS group respectively (p = 0.179). OS rates at 1, 3, 5 and 7 years were 100 %, 100 %, 100 % and 75 % in the IPS group vs 95 %, 85 %, 80 % and 68 % in the SPS group (p = 0.895). CONCLUSION: Repeated pancreatic resection in case of relapse of pancreatic metastasis of RCC in the pancreatic remnant is justified, since it achieves OS results similar to those obtained after the first resection.

Enfermedad diverticular complicada: toma de posición sobre tratamiento ambulatorio, intervención de Hartmann, lavado-drenaje peritoneal y cirugía laparoscópica. Documento de consenso de la Asociación Española de Coloproctología y Sección de Coloproctología de la Asociación Española de Cirujanos / Complicated diverticular disease: Position statement on outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage and laparoscopic approach. Consensus document of the Spanish Association of Coloproctology and the Coloproctology Section of the Spanish Association of Surgeons

Desde la Asociación Española de Coloproctología (AECP) y la Sección de Coloproctología de la Asociación Española de Cirujanos (AEC), se propone un documento de consenso sobre la enfermedad diverticular complicada que pueda ser de utilidad en la toma de decisiones. En él se expone, principalmente, la actualidad en el tratamiento ambulatorio, la intervención de Hartmann, el lavado laparoscópico peritoneal, así como el papel del abordaje laparoscópico en la resección colónica (AU)

The Spanish Association of Coloproctology (AECP) and the Coloproctology Section of the Spanish Association of Surgeons (AEC), propose this consensus document about complicated diverticular disease that could be used for decision-making. Outpatient management, Hartmann's procedure, laparoscopic peritoneal lavage, and the role of a laparoscopic approach in colonic resection are exposed (AU)

Intususcepción ileocólica en el adulto como presentación de un linfoma no Hodgkin de intestino delgado / Ileocolic Intussusception in Adults due to Small-Bowel Non-Hodgkin's Lymphoma

La intususcepción intestinal, definida como la penetración de un segmento intestinal en otro adyacente, es una causa infrecuente de obstrucción intestinal en el adulto. El objetivo de este trabajo es presentar el caso de un paciente adulto con intususcepción ileocólica como presentación de un linfoma no Hodgkin de intestino delgado. Este paciente presenta una causa poco frecuente de intususcepción intestinal. Dada lo inespecífico de la clínica, el diagnóstico etiológico suele ser intraoperatorio, precisando resección de la lesión causante y, en el caso de nuestro paciente, quimioterapia adyuvante(AU)

Intestinal intussusception, defined as penetration of an intestinal segment into an adjacent, is a rare cause of intestinal obstruction in adults. The aim of this paper is to present the case of an adult patient with ileocolic intussusception as presenting a non-Hodgkin lymphoma of the small intestine. This patient has a rare cause of intestinal intussusception. Because of its non-specific clinical, etiologic diagnosis is usually intraoperative, requiring resection of the culprit lesion and, in the case of our patient, adjuvant chemotherapy(AU)

Malformación arteriovenosa pancreática / Pancreatic arteriovenous malformation

No disponible

Pneumomediastino y enfisema subcutáneo cervical por diverticulitis aguda perforada colónica / Pneumomediastinum and cervical subcutaneous emphysema caused by a perforated acute colonic diverticulitis

No disponible

Neumomediastino espontáneo con sospecha de síndrome de Boerhaave / Spontaneous pneumomediastinum, Boerhaave syndrome suspected

El neumomediastino espontáneo es una rara entidad definida como la presencia de aire en el mediastino de causa no yatrógena ni traumática. Suele afectar a pacientes en edad pediátrica, generalmente asociado a la crisis asmática. Otros desencadenantes son el Valsalva, ejercicio intenso, vómitos, cetoacidosis diabética o consumo de drogas. Clínicamente es típica la asociación de dolor torácico y disnea y generalmente se trata de un proceso benigno que se resuelve con tratamiento conservador. Sin embargo, su presentación clínica suele resultar más confusa en pacientes adolescentes y adultos, donde en ocasiones es indistinguible de la ruptura espontánea del esófago (Síndrome de Boerhaave), siendo fundamental un correcto diagnóstico diferencial entre ambas entidades dadas las diferentes implicaciones terapéuticas y pronósticas, como en el caso que presentamos. La presentación clínica puede ser idéntica. No obstante, los pacientes con perforación esofágica tienden a la sepsis progresiva, con mortalidades elevadas si el diagnóstico se retrasa. En nuestro caso el aspecto del paciente, la leucocitosis, el dolor abdominal y la historia compatible nos hizo plantearnos esa posibilidad. Siempre que exista la sospecha de perforación esofágica está indicado practicar más pruebas diagnósticas, de las cuales la TAC con contraste oral hidrosoluble es de elección, pues permite valorar el estado de la pared esofágica y la presencia de colecciones líquidas asociadas (AU)

Spontaneous pneumomediastinum is a rare entity which is defined as the presence of air in the mediastinum not caused by trauma or secondary to any medical procedure. It usually affects patients in the pediatric age, most frequently in the context of an asthma exacerbation. Other triggers are Valsalva maneuvers, intense exercise, vomiting, diabetic ketoacidosis and drug use. It is usually presented as an association of chest pain and dyspnea and it is generally a benign process that resolves with conservative treatment. However, clinical presentation is more confusing in adolescents and adult patients, where it is sometimes indistinguishable from spontaneous rupture of the esophagus (Boerhaave syndrome). A correct differential diagnosis between these two entities is essential, given the different therapeutic and prognostic implications, as in the case we present. Clinical presentation may be identical. However, patients with esophageal perforation tend to progressive sepsis with high mortality rates if diagnosis is delayed. In our case, the patient’s appearance, leukocytosis, abdominal pain and a compatible history supported this possibility. It is mandatory to practice more diagnostic tests whenever rupture of the esophagus is suspected. The practice of a CT exploration after the oral administration of water-soluble contrast may be the best choice because it allows to assess the esophageal wall and the presence of associated fluid collections (AU)