Extrinsic ileal occlusion secondary to appendiceal mucocele of unusual size.

Appendiceal mucocele due to papilar cystadenoma is a rare condition, characterized by a diffuse swelling, a distension of the lumen secondary to accumulation of mucoid substance and occasional mucinous intraperitoneal deposits. It is often asymptomatic (approximately 25%) and is found incidentally during abdominal imaging studies or surgical exploration. Pre-operative recognition is difficult but very important because of the possibility of rupture during surgery with the development of pseudomyxoma peritonei. A case of benign mucocele presenting acutely as an occlusive syndrome is reported. The surgical treatment consisted of an appendicectomy with partial caecectomy. The clinicopathological and imaging diagnostic features of this pathological entity, as well as the main therapeutic approaches suggested in the literature, are commented on.

Small intestinal strangulation due to a primary internal paracecal hernia.

The discovery of a paracolic hernia is an unusual event, even for an experienced specialist in colorectal surgery. We report a case of a 59-year-old woman with no previous history of abdominal surgery, who presented to the Emergency Department complaining of episodic abdominal pain and distension accompanied by a palpable mass in the right lower quadrant. At laparotomy, a paracecal hernia with small bowel volvulation was found. The prime objective of this report is to draw the clinician's attention to the necessity of making a rapid diagnosis of internal hernias.

Spontaneous retroperitoneal hemorrhage from adrenal artery aneurysm.

Spontaneous adrenal hemorrhage is a very rare but serious disorder of the adrenal gland that can require emergent treatment. We report on a 42-year-old man who underwent selective angiography for diagnosis and treatment of retroperitoneal hemorrhage from small adrenal artery aneurysm. This case gives further details about the value of transluminal artery embolization in the management of visceral aneurysm rupture.

[Immuno-nutritional prognostic factors in acute cholecystitis]. / Estudio de factores pronósticos inmunonutricionales en la colecistitis aguda.

A set of parameters that could be used to identify possible immunonutritional disturbances and serve as clinical evolution markers were measured in 210 patients diagnosed of acute cholecystitis (136 females and 74 males, 64.8 and 35.2% respectively) who were admitted into the Surgery Service of the Hospital General de 1++Elche. The prognostic evaluation indices were: a) Nutritional: hematocrit, hemoglobin, total protein, albumin, transferrin; b) Immunological: total lymphocytes and delayed hypersensitivity reaction test. The results obtained were analyzed and compared to those of the literature in this field.

[Bacteriologic findings as a prognostic factor in the course of acute cholecystitis]. / Hallazgos bacteriológicos como factor pronóstico en la evolución de la colecistitis aguda.

We made a bacteriological study of bile in a consecutive study of 210 patients studied in the General Surgery Department of the General Hospital of Elche (Spain) who underwent cholecystectomy for acute lithiasic cholecystitis, as a prognostic factor in the clinical evolution of these patients. The results obtained led us to the following conclusions. 1. The presence of positive bile culture is a risk factor predisposing to postoperative septic complications. 2. Bile cultures were more frequently positive in patients over 60-years-old. 3. In the early stages of the disease, positive cultures were more frequent. 4. The organism most often isolated was E. coli, so antibiotic treatment should be directed mainly against this agent.

[An infrequent etiologic agent of vesicointestinal fistula]. / Infrecuente agente etiológico de las fístulas vesicointestinales.

We present a case of colovesical fistula originated by a foreign body (chicken bone) in a patient without prior intestinal pathology, which emigrates spontaneously to the bladder. We comment on its diagnosis and the therapy carried out.