Pneumatosis cystoides intestinalis: driven by the symptoms.

Cystic pneumatosis is an uncommon condition characterized by the presence of cysts in the submucosa and serous intestine. Although in most patients it is usually a chance finding, it can sometimes cause abdominal pain, diarrhea and even acute abdominal symptoms, as in the case presented. In most cases, conservative treatment is usually chosen, although in situations of sepsis, intestinal obstruction or suspected peritonitis, surgical treatment may be indicated as in the case described.

Hematoma subcapsular esplénico espontáneo y mononucleosis infecciosa: una asociación de interés para el cirujano

La rotura espontánea de bazo es una complicación infrecuente pero muy grave de la mononucleosis infecciosa. Dada la urgencia con la que suele presentarse tal situación, la esplenectomía suele ser la opción quirúrgica más utilizada. Presentamos el caso de un paciente en el que con el diagnóstico de rotura esplénica espontánea se somete a laparoscopia diagnóstica en la que se consigue la preservación del bazo con buena evolución clínica. A la luz de este paciente, consideramos que, en caso de estabilidad clínica y hematomas subcapsulares de bazo, la laparoscopia con preservación esplénica es una opción viable y con buenos resultados. (provisto por Infomedic International)

Spontaneous rupture of the spleen is a rare but very serious complication of infectious mononucleosis. Given the urgency with which such a situation usually presents, splenectomy is usually the most used surgical option. We present the case of a patient diagnosed with spontaneous splenic rupture who underwent diagnostic laparoscopy in which spleen preservation was achieved with good clinical evolution. In the light of this patient, we consider that, in the case of clinical stability and subcapsular haematomas of the spleen, laparoscopy with splenic preservation is a viable option with good results. (provided by Infomedic International)

Abscesos Hepáticos Piógenos Múltiples: ¿Una Patología Superada O Un Reto Médico Vigente?: Un Caso A Recordar

El absceso hepático piógeno es una patología que aún en nuestros días supone un reto médico, ya que su curso clínico suele ser grave, el diagnóstico frecuentemente tardío y la mortalidad elevada. En las últimas décadas hemos asistido a diversos avances, como la introducción de los antibióticos de amplio espectro y el desarrollo de técnicas de imagen e intervencionistas que han mejorado la eficacia diagnóstica y el pronóstico de esta patología. Pese a ello, la presencia de abscesos hepáticos piógenos múltiples no es una patología superada y presentamos un caso clínico que ilustre esta patología y justifique que ha de tenerse en cuenta en el arsenal diagnóstico para poder tratarlo precozmente y disminuir así su alta morbimortalidad. (provisto por Infomedic International)

Pyogenic liver abscess is a pathology that still poses a medical challenge today, since its clinical course is usually severe, diagnosis is often late, and mortality is high. In recent decades we have witnessed several advances, such as the introduction of broad-spectrum antibiotics and the development of imaging and interventional techniques that have improved the diagnostic efficacy and prognosis of this pathology. Despite this, the presence of multiple pyogenic liver abscesses is not a pathology that has been overcome and we present a clinical case that illustrates this pathology and justifies that it must be considered in the diagnostic arsenal in order to treat it early and thus reduce its high morbimortality. (provided by Infomedic International)

Abdomen agudo por actinomicosis / Acute abdomen caused by actinomycosis

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Proctalgia y atrapamiento del nervio pudendo: una asociación por descubrir / Proctalgia and pudendal nerve entrapment: an association to know

Introducción: El síndrome de atrapamiento del nervio pudendo (SANP) es una entidad clínica, poco conocida en el ámbito de la Cirugía General, que comprende un amplio abanico de síntomas urinarios, sexuales y proctológicos. El interés para el cirujano general radica en toda la clínica que pueden presentar estos pacientes en la esfera proctológica. De diagnóstico complejo, exige un tratamiento secuencial que incluye distintas herramientas. El objetivo del presente estudio es exponer el SANP desde el punto de vista de la cirugía general, exponiendo un estudio realizado en pacientes afectos de proctalgia para valorar los resultados en el seguimiento a partir de los seis meses. Métodos: Presentamos un estudio observacional que evalúa 53 pacientes afectos de proctalgia en el contexto de un SANP que han sido sometidos a tratamiento con punción-hidrodistensión corticoideo-anestésica del nervio pudendo y sus ramas terminales, observando su respuesta inmediata en términos clínicos de dolor y en seguimiento a partir de los seis meses. Resultados: De los datos obtenidos de nuestra muestra, se observa que el tratamiento con dichas punciones mejora al 79,25 % de los pacientes en el periodo inmediato tras la punción, y el 39,62 % de los pacientes mantienen dicha mejoría a partir de los seis meses. Conclusiones: Concluimos que ante la presencia de proctalgia, el cirujano debe descartar la existencia de un SANP y que, según nuestro estudio, el tratamiento con punción corticoideoanestésica es una opción eficaz de tratamiento que logra mejorar a un importante porcentaje de pacientes

Introduction: Pudendal nerve entrapment (PNE) is a clinical syndrome, little known in the field of General Surgery, which includes a wide range of urinary, sexual and proctological symptoms. The interest for general surgeons lies in the whole clinical study that these patients may present as regards proctology. Complex diagnosis requires a sequential treatment that includes different tools. The aim of this study is to present PNE from the point of view of general surgery by showing a study carried out in patients with proctalgia to assess the results at follow-up after 6 months. Methods: We present an observational study evaluating 53 proctalgia patients in a PNE context who have undergone hydrocortisone puncture of the pudendal nerve, for anesthetic reasons, and its terminal branches, observing its immediate response in clinical terms of pain and in follow-up as from six months. Results: Based on the data obtained from our sample, it may be seen that the treatment with these punctures improves 79.25% of patients in the period immediately after puncture and 39.62% of patients maintain this improvement after the six months. Conclusions: We conclude that in the presence of proctalgia, surgeons should ignore the presence of PNE and that, according to our study, corticosteroid puncture treatment for anesthesia is an effective treatment option that provides relief to a significant percentage of patients

Comunicación pleuroperitoneal en paciente con diálisis peritoneal: un caso de interés para el cirujano / Pleuroperitoneal communication in a patient with peritoneal dialysis: An interesting case for the surgeo

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Apendicectomía laparoscópica por sistema «glove port¼: nuestros primeros 100 casos / Laparoscopic appendicectomy by 'glove port' system: Our first 100 cases

Resumen Introducción: La apendicectomía laparoscópica por puerto único supone un avance en las técnicas mínimamente invasivas. El objetivo de este estudio es mostrar nuestra serie de 100 casos de apendicitis aguda, intervenidos mediante técnica de puerto único utilizando el sistema «glove port¼, exponiendo nuestra técnica, resultados y seguimiento de nuestros pacientes. Material y métodos: Exponemos la serie de 100 casos intervenidos desde febrero de 2013 hasta enero de 2017 detallando los elementos que componen el sistema «glove port¼. Resultados: De las 100 apendicitis intervenidas, hubo 3 colecciones postoperatorias y una infección de herida quirúrgica, lo que muestra los buenos resultados obtenidos con esta técnica, haciendo hincapié en el excelente resultado estético. También señalamos que es un sistema económico que no encarece la laparoscopia convencional. Conclusiones: La apendicectomía laparoscópica por puerto único es segura, eficaz, económica y útil para que el cirujano adquiera habilidad en el abordaje laparoscópico por puerto único.

Abstract Introduction: Single port laparoscopic appendectomy is an advance in minimally invasive techniques. The objective of this study is to show our series of 100 cases of acute appendicitis, operated through a single port technique using the 'glove port' system, exposing our technique, results and follow up of our patients. Material and methods: We present the series of 100 cases intervened from February 2013 to January 2017 detailing the elements that make up the 'glove port' system. Results: Of the 100 operated appendicitis, there were 3 postoperative collections and 1 surgical wound infection, which shows the good results obtained with this technique, emphasizing the excellent aesthetic result. We also point out that it is an economic system that does not make conventional laparoscopy more expensive. Conclusions: Single port laparoscopic appendectomy is safe, effective, economical and useful for the surgeon to acquire skills in a single port laparoscopic approach.

Pancreatitis aguda necroticohemorrágica en malaria falciparum / Acute hemorrhagic necrotizing pancreatitis in falciparum malaria

La malaria o paludismo es una patología causada por un parásito denominado Plasmodium, propia de países tropicales. Entre la sintomatología más frecuente destaca la malaria cerebral, ictericia, crisis convulsivas, anemia, hipoglucemia, fallo renal y acidosis metabólica, entre otras. Presentamos el caso de un paciente diagnosticado de paludismo, que presentó un cuadro de pancreatitis aguda necroticohemorrágica con mala evolución, como ejemplo inusual de dicha asociación descrita en nuestro país (AU)

Malaria is a pathology caused by a parasite called Plasmodium, characteristic of tropical countries. The most frequent symptomatology includes cerebral malaria, jaundice, convulsive crisis, anemia, hypoglycemia, kidney failure and metabolic asidosis, among others. We are presenting the case of a patient diagnosed with malaria who suffered from acute necrotizing hemorrhagic pancreatitis and evolved poorly, as an example of this combination of symptoms, rarely found in our country (AU)

Acute hemorrhagic necrotizing pancreatitis in falciparum malaria.

Malaria is a pathology caused by a parasite called Plasmodium, characteristic of tropical countries. The most frequent symptomatology includes cerebral malaria, jaundice, convulsive crisis, anemia, hypoglycemia, kidney failure and metabolic asidosis, among others. We are presenting the case of a patient diagnosed with malaria who suffered from acute necrotizing hemorrhagic pancreatitis and evolved poorly, as an example of this combination of symptoms, rarely found in our country.

Fijación del material protésico en la hernioplastia inguinal abierta: sutura vs. cola sintética / Prosthetic material fixation in open inguinal hernioplasty: suture vs. synthetic glue

Introducción: El empleo de colas sintéticas se ha convertido en práctica habitual en varios campos quirúrgicos. El objetivo de este estudio es comparar los resultados del pegamento y de la sutura convencional a corto y a medio plazo en la fijación de las prótesis en la hernioplastia inguinal abierta con técnica de tapón y parche. Materiales y métodos Estudio prospectivo comparativo incluyendo 198 pacientes con diagnóstico de hernia inguinal no recidivada intervenidos a cielo abierto y asignados de manera aleatoria a fijación de las mallas con pegamento de cianoacrilato (n=101) o con sutura (n=98). Se analizaron las características demográficas, las complicaciones a corto plazo, la estancia postoperatoria, la baja laboral, la recidiva herniaria y la neuralgia inguinal crónica. Resultados La morbilidad global ha sido del 13,9% en el grupo del pegamento y del 30,9% en el grupo de sutura. No observamos reacciones inflamatorias ni casos de migración de la prótesis. La estancia postoperatoria ha sido de 14,7h en el caso de fijación con pegamento y de 19,1h en el caso de suturas (p<0,0001). No encontramos diferencia entre los 2 grupos en cuanto a días de baja laboral. La morbilidad a corto plazo fue superior en el caso de fijación con sutura (19,6 vs. 10,9%). Al año, se observó una recidiva en el grupo de sutura (1%) y ninguna en el grupo del pegamento. No obstante, la tasa de neuralgia crónica de intensidad moderada/severa fue de 2,9% en el grupo de pegamento y de 10,3% en el grupo de sutura (p=0,03) (AU)

Introduction: The use of synthetic glues has become normal practice in several surgicalfields. The objective of this study is to compare the short and medium term results of glue and conventional suture in the fixation of the prosthesis in open inguinal hernia repair with a plug and patch technique. Materials and methods: A comparative prospective study was conducted on 198 patients with a diagnosis of a non-recurrent inguinal hernia subjected to open surgery and randomly assigned to mesh fixation with cyanoacrylate glue (n = 101) or with suture (n = 98). The demographic characteristics, short-term complications, hospital stay, time off work, herniarecurrence, and chronic inguinal neuralgia, were analysed. Results: The overall morbidity was 13.9% in the glue group, and 30.9% in the suture group. No undue inflammatory reactions ormeshmigration were observed in the group. The postoperative stay was 14.7 h for the glue group, and 19.1 h in the suture group (P < .0001). No differences were found regarding days off work. The short-term morbidity was higher in the suture group (19.6% vs. 10.9%). After one year, there was one recurrence in the suture group (1%), and none in the glue group. However, the incidence of moderate/severe intensity chronic neuralgia was 2.9% in the glue group, and 10.3% in the suture group(P = .03).Conclusion: The use of cyanoacrylate is safe and effective in open inguinal hernia repair, with good results in the short and medium term (AU)

[Prosthetic material fixation in open inguinal hernioplasty: suture vs. synthetic glue]. / Fijación del material protésico en la hernioplastia inguinal abierta: sutura vs. cola sintética.

INTRODUCTION: The use of synthetic glues has become normal practice in several surgical fields. The objective of this study is to compare the short and medium term results of glue and conventional suture in the fixation of the prosthesis in open inguinal hernia repair with a plug and patch technique. MATERIALS AND METHODS: A comparative prospective study was conducted on 198 patients with a diagnosis of a non-recurrent inguinal hernia subjected to open surgery and randomly assigned to mesh fixation with cyanoacrylate glue (n=101) or with suture (n=98). The demographic characteristics, short-term complications, hospital stay, time off work, hernia recurrence, and chronic inguinal neuralgia, were analysed. RESULTS: The overall morbidity was 13.9% in the glue group, and 30.9% in the suture group. No undue inflammatory reactions or mesh migration were observed in the group. The post-operative stay was 14.7h for the glue group, and 19.1h in the suture group (P<.0001). No differences were found regarding days off work. The short-term morbidity was higher in the suture group (19.6% vs. 10.9%). After one year, there was one recurrence in the suture group (1%), and none in the glue group. However, the incidence of moderate/severe intensity chronic neuralgia was 2.9% in the glue group, and 10.3% in the suture group (P=.03). CONCLUSION: The use of cyanoacrylate is safe and effective in open inguinal hernia repair, with good results in the short and medium term.