[Acute abdomen due to complicated intramural duodenal haematoma. Report of a case and review of the literature]. / Abdomen agudo por hematoma duodenal intramural complicado. Presentación de un caso y revisión en la literatura.

BACKGROUND: Intramural duodenal haematoma is a rare entity that usually occurs in the context of patients with coagulation disorders. A minimum percentage is related to processes such as pancreatitis and pancreatic tumours. CLINICAL CASE: The case is presented of a 45 year-old male with a history of chronic pancreatitis secondary to alcoholism. He was seen in the emergency room due to abdominal pain, accompanied by toxic syndrome. The abdominal computed tomography reported increased concentric duodenal wall thickness, in the second and third portion. After oesophageal-gastro-duodenoscopy, he presented with haemorrhagic shock. He had emergency surgery, finding a hemoperitoneum, duodenopancreatic tumour with intense inflammatory component, as well a small bowel perforation of third duodenal portion. A cephalic duodenopancreatectomy was performed with pyloric preservation and reconstruction with Roux-Y. DISCUSSION: Treatment of a duodenal haematoma is nasogastric decompression, blood transfusion and correction of coagulation abnormalities. Surgery is indicated in the cases in which there is no improvement after 2 weeks of treatment, or there is suspicion of malignancy or major complications arise. CONCLUSIONS: Duodenal intramural haematoma secondary to chronic pancreatitis is rare, although the diagnosis should be made with imaging and, if suspected, start conservative treatment and surgery only in complicated cases.

Metástasis hepáticas de origen colorrectal sincrónicas: ¿intervención simultánea o secuencial? / Simultaneous or sequential treatment of liver metastases of colon cancer?: experience in 76 patients

Background: Synchronous liver metastases of colon cancer can be managed with sequential or simultaneous surgical management of the primary tumor and the metastases. Aim: To compare the evolution of patients whose liver metastases were treated sequentially or simultaneously. Material and Methods: Retrospective analysis of 76 patients aged 63 +/- 11 years (67 percent males). In 25, metastases were managed simultaneously and in 51 there were treated sequentially after a period of chemotherapy. All interventions were performed by the same surgeon. Results: Patients treated sequentially had a higher number of metastases andmore lymph nodes involved than their counterparts treated simultaneously. The overall resectability index was 78 percent. Eighteen major and 28 minor hepatic resections were carried out. Significantly more major resections were carried out in the sequential treatment group. Mean hospital stay was 11 days and 20 percent of patients had complications, with no differences between groups. Survival at one, three and five years was 75, 45 and 36 percent in the simultaneous treatment and 76, 49 and 29 percent in the sequential treatment group (with no significant differences between groups). Conclusions: In this group of patients no differences in complications or survival were observed when liver metastases were treated simultaneously or sequentially. However groups were not homogeneous.

Introducción: Existen distintas estrategias para el tratamiento de las metástasis hepáticas de origen colorrectal sincrónicas (MHCRS): cirugía secuencial, según respuesta a quimioterapia, intervención simultá-nea del tumor y las metástasis o cirugía hepática previa al tumor primario; el uso de una u otra estrategia es aún controvertido. Objetivo: Comparar la morbimortalidad y supervivencia en dos grupos de pacientes con MHCRS intervenidos de forma simultánea versus secuencial. Pacientes y Métodos: Definimos las MHCRS como aquellas que se diagnostican antes o durante la intervención del tumor primario. Se comparan dos grupos de pacientes con MHCRS, 25 sometidos a intervención simultánea (grupo 1) y 51 tras quimioterapia (intervención secuencial: grupo 2). La cirugía hepática la realizó el mismo cirujano. Revisamos datos del paciente, del tumor primario, intervención quirúrgica, transfusión perioperatoria, morbimortalidad y supervivencia. Resultados: 76 pacientes, con edad media de 62,79 +/- 11,3 años. El número de metástasis y la invasión ganglionar del tumor primario fueron mayores en el grupo 2 de forma estadísticamente significativa. Índice de resecabilidad: 77,6 por ciento: 18 resecciones hepáticas mayores y 28 menores, con diferencias significativas entre ambos grupos (p = 0,05). La estancia media (10,89 días), Índice de morbilidad (19,7 por ciento) y supervivencia actuarial a 1,3 y 5 años fueron similares (75 por ciento, 45 por ciento y 36 por ciento en el grupo 1 y de 76 por ciento, 49 por ciento y 29 por ciento en el grupo 2). Mortalidad: 1,6 por ciento. Conclusiones: Las MHCRS pueden ser intervenidas de forma simultánea al tumor primario en pacientes seleccionados siempre que el equipo sea especializado. La morbimortalidad y la supervivencia son similares tanto en la intervención simultánea como en la secuencial.