Grade III chondrosarcoma of the left iliopubic branch: A case report.

INTRODUCTION AND IMPORTANCE: Chondrosarcomas are the third most frequent malignant bone tumors. With pelvic bones being their most common primary location, diagnosis and treatment of these tumors is especially challenging due to the diverse clinical manifestations and involvement of critical anatomic structures. We present the case of a grade III pelvic chondrosarcoma of the left iliopubic branch managed through a multidisciplinary approach. CASE PRESENTATION: A 26-year-old male patient presented with a 1-year history of a mass in the left iliopubic branch. The imaging findings suggested chondrosarcoma and showed extrinsic compression of pelvic structures causing right hydronephrosis, marked elongation and tortuosity of the sigmoid colon, and anterior and superior displacement of the bladder. Following multidisciplinary meeting it was decided to perform a left hemicolectomy, colostomy, and internal hemipelvectomy in the 1-2-3 left zones, with resection of the intrapelvic and intra-abdominal tumor, and preservation of the left lower extremity. The patient presented two episodes of intestinal obstruction, which resolved with medical management. Was discharged without presenting further complications. CLINICAL DISCUSSION: Chondrosarcomas management demands a methodical approach. Appropriate surgical strategy requires individualization according to the characteristics of the lesion and the degree of involvement of surrounding structures. Complete resection of the tumor and preservation of the lower extremity function are critical achievements. CONCLUSION: This case underscores the effective management of a challenging tumor such as pelvic chondrosarcoma. The multidisciplinary approach and collaboration of several specialties was crucial to reach an appropriate surgical strategy.

Características clínicas y tratamiento de la enfermedad de Crohn perianal fistulizante en Colombia: resultados de un registro multicéntrico / Clinical characteristics and treatment of perianal fistulising Crohn's disease in Colombia: Results of a multicentric registry

Introducción: La enfermedad de Crohn (EC) perianal fistulizante es un fenotipo de mal pronóstico. No existen estudios en nuestro medio. Nuestro objetivo es determinar las características clínicas, sociodemográficas y el tratamiento de la EC perianal fistulizante en un registro multicéntrico colombiano. Materiales y métodos: Se realizó un estudio observacional multicéntrico, retrospectivo, con recolección prospectiva de la información, en los principales centros de referencia de enfermedad inflamatoria intestinal (EII) del país. Las variables continuas se expresaron como medianas y rangos intercuartílicos. Las variables de resultado categóricas fueron comparados por la prueba de Chi-cuadrado. Resultados: Se documentaron 65 pacientes con EC perianal fistulizante, con una mediana de edad de aparición de fistula perianal de 31,0 años (rango: 24-42), predominando en hombres (61,5%; razón H:M: 1,4:1). Las fístulas perianales complejas fueron más frecuentes que las simples (75,35 vs. 24,6%). En cuanto al tratamiento médico, el 66,2% de los pacientes recibieron antibióticos, el 64,6% esteroides, el 78,5% terapia biológica, el 47,7% setones no cortantes y el 46,2% requirieron manejo quirúrgico, diferente a la colocación de setones. En solo el 29,2% se logró remisión completa de la fístula, y el 9,2% de los pacientes terminaron en colostomía definitiva. Los pacientes con EC con fístulas complejas recibieron más terapia biológica comparado con pacientes con EC y fístulas simples (84,8 vs. 56,3%; p: 0,038). Conclusiones: La EC perianal fistulizante es de mal pronóstico en nuestro medio, solo 3 de cada 10 pacientes logran la remisión completa a pesar del tratamiento. Un manejo multidisciplinario es fundamental para el manejo integral de esta difícil enfermedad.(AU)

Introduction: Perianal fistulizing Crohn's disease (CD) is a phenotype with a poor prognosis. There are no studies in our country. Our objective is to determine the clinical, sociodemographic and treatment characteristics of perianal fistulizing CD in a Colombian multicenter registry. Materials and methods: A retrospective, multicenter observational study was carried out, with prospective data collection, in the main reference centers for inflammatory Bowel disease (IBD) in the country. Continuous variables were expressed as medians and interquartile ranges. The categorical outcome variables were compared by the Chi-square test. Results: Sixty-five patients with perianal fistulizing CD were documented, with a median age of appearance of perianal fistula of 31.0 years (range: 24-42), predominantly in men (61.5%; H:M ratio: 1.4:1). Complex perianal fistulas were more frequent than simple ones (75.35 vs. 24.6%). Regarding medical treatment, 66.2% of the patients received antibiotics, 64.6% steroids, 78.5% biological therapy, 47.7% non-cutting setons, and 46.2% required surgical management, other than seton placement. Only 29.2% achieved complete remission of the fistula, and 9.2% of the patients ended up in a definitive colostomy. CD patients with complex fistulas received more biological therapy, compared to CD patients with simple fistulas (84.8 vs. 56.3%; P: 0.038). Conclusions: Perianal fistulizing CD has a poor prognosis in our setting, only 3 out of 10 patients achieve complete remission despite treatment. A multidisciplinary management is essential for the comprehensive management of this difficult pathology.(AU)

Clinical characteristics and treatment of perianal fistulising Crohn's disease in Colombia: Results of a multicentric registry. / Características clínicas y tratamiento de la enfermedad de Crohn perianal fistulizante en Colombia: resultados de un registro multicéntrico.

INTRODUCTION: Perianal fistulizing Crohn's disease (CD) is a phenotype with a poor prognosis. There are no studies in our country. Our objective is to determine the clinical, sociodemographic and treatment characteristics of perianal fistulizing CD in a Colombian multicenter registry. MATERIALS AND METHODS: A retrospective, multicenter observational study was carried out, with prospective data collection, in the main reference centers for inflammatory Bowel disease (IBD) in the country. Continuous variables were expressed as medians and interquartile ranges. The categorical outcome variables were compared by the Chi-square test. RESULTS: Sixty-five patients with perianal fistulizing CD were documented, with a median age of appearance of perianal fistula of 31.0 years (range: 24-42), predominantly in men (61.5%; H:M ratio: 1.4:1). Complex perianal fistulas were more frequent than simple ones (75.35 vs. 24.6%). Regarding medical treatment, 66.2% of the patients received antibiotics, 64.6% steroids, 78.5% biological therapy, 47.7% non-cutting setons, and 46.2% required surgical management, other than seton placement. Only 29.2% achieved complete remission of the fistula, and 9.2% of the patients ended up in a definitive colostomy. CD patients with complex fistulas received more biological therapy, compared to CD patients with simple fistulas (84.8 vs. 56.3%; P: 0.038). CONCLUSIONS: Perianal fistulizing CD has a poor prognosis in our setting, only 3 out of 10 patients achieve complete remission despite treatment. A multidisciplinary management is essential for the comprehensive management of this difficult pathology.

Enfoque del manejo de cuerpos extraños colorrectales: revisión de la literatura / Literature Review of Management of Colorectal Foreign Bodies

Resumen La presentación de pacientes con cuerpos extraños a nivel rectal no es poco frecuente; sin embargo, hay pocas estadísticas sobre la epidemiología de esta entidad. La mayor parte de la literatura publicada hace mención a reporte de casos o series de casos. Los cuerpos extraños rectales son insertados de forma intencional o no intencional, y constituyen un reto diagnóstico y terapéutico para el médico; por lo que el médico a cargo requiere de la habilidad y conocimiento para extraer objetos de diferentes formas y tamaños. Los cuerpos extraños rectales son generalmente observados en la población adulta; en relación con la estimulación erótica o asalto sexual. Adicionalmente, algunos cuerpos extraños pueden ser ingeridos ocasionalmente, pasando a través del tracto gastrointestinal y alojándose en el recto, aunque esta situación es la menos común; en especial en pacientes con enfermedades mentales, trastornos visuales, alcohólicos o usuarios de prótesis dentales. La finalidad de esta revisión es establecer unas pautas de manejo y dar a conocer un algoritmo para el enfoque de los cuerpos extraños colorrectales.

Abstract Patients with foreign bodies in their rectums are not uncommon, but statistics on the epidemiology of this entity are scarce. Most of the literature published consists of case reports or case series. Foreign rectal bodies, whether inserted intentionally or unintentionally, constitute a diagnostic and therapeutic challenge for physicians who need skill and knowledge to extract objects of different shapes and sizes. Foreign rectal bodies are generally observed in the adult population in relation to erotic stimulation or sexual assault. Occasionally, foreign bodies are ingested and pass through the gastrointestinal tract to lodge in the rectum. Although this situation is the least common, it does occur, especially in patients with mental illnesses, visual disorders, or alcoholism and among users of dental prostheses. The purpose of this review is to establish management guidelines and to present an algorithm for the approach to colorectal foreign bodies.

Postpolypectomy syndrome presenting with "microperforation" and pneumoperitoneum: conservative approach for a rare cause of acute abdominal pain / Síndrome pospolipectomía de presentación como "microperforación" y neumoperitoneo: abordaje conservador para una rara causa de dolor abdominal

Introducción. El Síndrome Pospolipectomía es una causa rara de dolor abdominal posterior a resecciones de pólipos por colonoscopia, cuyo caso, en ciertos pacientes se debe considerar el manejo conservador. Métodos. Se revisa la literatura sobre el síndrome en mención y se reporta un caso. Resultados. Nuestra paciente presentó con cuadro de dolor abdominal posterior a una polipectomía colonoscópica, tratado mediante un manejo conservador con base en los hallazgos clínicos, tomográficos y paraclínicos. Su recuperación fue favorable y no requirió intervenciones adicionales. Conclusiones. El manejo conservador con líquidos endovenosos, antibióticos y suspensión de vía oral puede ser una opción en pacientes con síndrome pospolipectomía incluso, en contexto de ¨micro-perforaciones¨ cuando no haya irritación peritoneal

Post-polypectomy syndrome is a rare cause of acute abdominal pain following colonoscopic polyp resections. Conservative treatment may be considered in selected patients. We present a literature review of Post-polypectomy syndrome and report a case and our experience with a young female who presented with an acute abdominal pain following a colonoscopic polypectomy. We selected a conservative approach based on clinical findings, lab tests and CT results; the patient had complete recovery and no additional intervention was required. Conservative treatment with IV fluids, nothing by mouth and antibiotics can be an alternative treatment plan for selected patients with mini-perforations presenting without peritoneal irritation

Bezoar gástrico de plástico como causa de pancreatitis aguda: reporte de un caso y revisión de la literatura / Gastric plastic bezoar causing acute pancreatitis: case report and literature review

Introducción. Un bezoar se define como un elemento no digerible atrapado en algún punto del tubo digestivo, el cual puede ser ingerido de forma intencional o accidental. El primer reporte de un bezoar en la literatura médica lo hizo Baudamant en 1779. Caso clínico. Se presenta un caso de un bezoar de plástico, un cepillo dental, como causa de pancreatitis aguda y su manejo por laparoscopia, con una revisión de la literatura. Discusión y conclusiones. Aunque los bezoares gástricos son poco frecuentes, y más aún el de plástico, es importante tenerlos en cuenta como causa de pancreatitis aguda. Definitivamente, el abordaje laparoscópico es el ideal en pacientes sin obstrucción intestinal o inestabilidad hemodinámica

Introduction: A bezoar is defined as an indigestible element trapped somewhere in the gastrointestinal tract, which can be ingested intentionally or accidentally. The first report of a Bezoar in the medical literature was by W. Baudamant in 1779. Case report: We present the case of a plastic bezoar, a toothbrush, as the cause of acute pancreatitis and its management by laparoscopy, and a literature review. Discussion and conclusions: Although gastric bezoars are rare conditions, and furthermore so plastic bezoars, it is important to take them into account as a rare cause of acute pancreatitis. Definitely the laparoscopic approach is ideal for patients without intestinal obstruction or hemodynamic instability