Tratamiento y seguimiento del plastrón apendicular / Management of appendicular mass

Introducción. El tratamiento del plastrón apendicular continúa siendo controvertido. Hay autores que defienden un tratamiento conservador inicial seguido de una apendicectomía programada. Objetivos. Nuestro propósito ha sido analizar la utilidad de este tratamiento y el momento óptimo para la intervención. Material y métodos. Se trata de un estudio retrospectivo de los casos tratados en nuestro Hospital durante los últimos 8 años. Se han analizado: tasa de éxito del tratamiento conservador, tiempo de espera hasta la apendicectomía, dificultad técnica y complicaciones. Resultados. Nuestra serie incluye 19 casos. En todos ellos se administró antibioterapia intravenosa y, en 14 de ellos, además, se realizó drenaje peritoneal (estancia media de 11,5 días). En 3 pacientes (16%) fue necesario realizar la apendicectomía de manera precoz (a los 12, 30 y 40 días). En 16 (84%), el manejo conservador funcionó y la apendicectomía se realizó transcurridos entre 3 y 12 meses (media: 6,6 meses): cuatro por abordaje abierto y 12 mediante laparoscopia (siendo necesario reconvertirla en 3 casos). La estancia media fue de 1,8 días, con sólo una complicación (absceso de pared). De los 16 casos, en 11 la intervención fue sencilla (no adherencias o leves) y el tiempo medio de espera fue de 5,5 meses (rango 3-6). En 5 casos había muchas adherencias, la intervención fue difícil y la espera media de 9,4 meses (rango 9-12).Conclusiones. El manejo conservador es una opción eficaz de tra tamiento para el plastrón apendicular, con una tasa de éxito del 84% en nuestra serie. Según nuestra experiencia, la apendicectomía resulta más sencilla cuando se realiza entre 3-6 meses (AU)

Objectives. Our aim has been to revise the usefulness of this management and the optimal time to carry out the appendectomy. Methods. We made a retrospective review of all the appendicular mass cases treated in our hospital during the last 8 years. We analyzed the success rate of the non-operative approach, the interval until the delayed appendectomy was performed, difficulty found at surgery and the occurred complications. Results. Our series includes 19 appendicular mass cases managed initially by a non-operative approach. Intravenous antibiotics were administered to all of them and in 14 cases a peritoneal drainage was placed (the average length of stay was of 11.5 days). In 3 cases (16%) early appendectomy was performed (12, 30 and 40 days after the onset of the symptoms). In 16 (84%) the conservative approach succeeded and the appendectomy was delayed 3-12 months (average: 6.6 months). Four of them were performed by an open approach and 12 by laparoscopy (in 3 of which conversion was needed). The average length of stay was of 1.8 days, with only one complication (wound abscess). Of these 16 delayed appendectomies, 11 were not technically difficult to perform (average wait of 5.5 months) and in 5 cases the procedure was difficult due to multiple adhesions (average wait of 9.4 months).Conclusion: Conservative management of appendicular mass is useful, with a success rate of 84% in our series. The appendectomy was less hazardous if performed 3-6 months after the onset of the symptoms (AU)

[Management of appendicular mass]. / Tratamiento y seguimiento del plastrón apendicular.

BACKGROUND: Management of appendicular mass is still controversial. Some authors plead for an initial non-operative approach followed by a delayed appendectomy. OBJECTIVES: Our aim has been to revise the usefulness of this management and the optimal time to carry out the appendectomy. METHODS: We made a retrospective review of all the appendicular mass cases treated in our hospital during the last 8 years. We analyzed the success rate of the non-operative approach, the interval until the delayed appendectomy was performed, difficulty found at surgery and the occurred complications. RESULTS: Our series includes 19 appendicular mass cases managed initially by a non-operative approach. Intravenous antibiotics were administered to all of them and in 14 cases a peritoneal drainage was placed (the average length of stay was of 11.5 days). In 3 cases (16%) early appendectomy was performed (12, 30 and 40 days after the onset of the symptoms). In 16 (84%) the conservative approach succeeded and the appendectomy was delayed 3-12 months (average: 6.6 months). Four of them were performed by an open approach and 12 by laparoscopy (in 3 of which conversion was needed). The average length of stay was of 1.8 days, with only one complication (wound abscess). Of these 16 delayed appendectomies, 11 were not technically difficult to perform (average wait of 5.5 months) and in 5 cases the procedure was difficult due to multiple adhesions (average wait of 9.4 months). CONCLUSION: Conservative management of appendicular mass is useful, with a success rate of 84% in our series. The appendectomy was less hazardous if performed 3-6 months after the onset of the symptoms.

[Nephro-urologic complications of presacral teratomas]. / Secuelas nefrourológicas de los teratomas presacros.

Neonatal presacral teratoma is a very unusual tumor. Because of its deep pelvic location and huge size, it can cause urinary obstruction and interfere with renal development during prenatal life. We have treated three patients and followed them up for six, three and one years. In all of them hydronephrosis and ureteral ectasia disappeared after excision of the tumor but some degree of calyceal club deformity persists in two patients. VUR persisted in one case for six years and was finally operated upon. Our last case has recently been operated for persistent left megaureter. This patient had also neonatal respiratory distress and mediastinal pneumothorax probably related to some degree of pulmonary hypoplasia. A close urologic follow-up is strongly advised in these patients.

Hydatid renal cyst with characteristic sonographic pattern. A case report.

The kidney is a rare localisation of the hydatid cyst even in countries with a high rate of infestation. We report a case of renal hydatid cyst in a five-year-old girl. Conventional radiology did not yield any diagnosis, whereas in this case renal ultrasonography showed characteristic echographic signs pointing to the origin of the disease.

[Surgical repair of the spleen in children]. / Reparación quirúrgica del bazo en el niño.

Splenectomy is the easiest solution, and a still widespread surgical approach for the management of traumatic spleen rupture. Nevertheless, the evidence of an increased risk of overwhelming sepsis in splenectomy patients has encouraged the development of techniques for organ repair and conservation. We report on four patients with spleen rupture repaired surgically in our institution. In two of them we performed a splenorrhaphy alone and in the remaining two this was completed with a partial splenectomy. There were no immediate or late postoperative complications. The patients have been followed-up for periods ranging from 1 to 2 1/2 years and all show isotopic evidence of spleen activity in amount related to the remaining organ. We feel that splenic repair and conservation is possible in most cases and must always be given a trial.

[Omphalosite monster (acardius acephalus). Apropos of a case]. / Monstre omphalosite (acardius acephalus). A propos d'une observation.

The omphalosite monster is acardiac (deprived of heart) and his survival is only possible through intrauterine life because of the umbilical vascular connections with his healthy monochorionic twin brother who takes in charge the circulation of both. We report one typical case of the acephalic variety in which all structures derived from the fetal cephalic fold were absent. Its only eventual clinical interest is limited to the prenatal radiological diagnosis and the neonatal onset of congestive heart failure in the healthy twin, a fact which must be known in order to establish an early treatment. On this occasion, we briefly review the current knowledge about this very rare form of monstrosity.