Trauma cervical penetrante: experiencia de un hospital de enseñanza en México / Penetrating cervical trauma: experience of a teaching hospital in Mexico

Introducción. El trauma cervical penetrante es una entidad poco frecuente, con tendencia al alza, de considerable morbimortalidad. Es fundamental conocer su manejo por cirujanos en entrenamiento, quienes en su mayoría son comúnmente los proveedores del tratamiento en las áreas de urgencias. El objetivo de este estudio fue demostrar la experiencia de un centro de trauma en México en el tratamiento de trauma cervical penetrante administrado por cirujanos en entrenamiento. Métodos. Estudio retrospectivo de pacientes con diagnóstico de trauma cervical penetrante sometidos a exploración cervical entre los años 2014 y 2019. Se identificaron 110 expedientes, se excluyeron 26 por falta de datos indispensables para la investigación y se analizaron los datos de 84 pacientes. Resultados. El 96,4 % de los pacientes fueron hombres, la mayoría entre 16 y 50 años (83,3 %) y la zona anatómica II fue la más comúnmente lesionada (65,4 %). Las etiologías más frecuentes fueron heridas por arma cortopunzante (67,9 %) y heridas por proyectil de arma de fuego (25 %). El 95 % de los procedimientos fueron realizados por residentes de cuarto y quinto año. La mediana de días de estancia hospitalaria fue de 2 días. La incidencia de complicaciones fue de 9,5 % y la mortalidad de 1,2 %. Conclusiones. Los cirujanos generales en etapa de formación entrenados en centros de trauma tienen la capacidad de tratar de forma óptima el trauma cervical penetrante sin modificación de las tasas de morbimortalidad descritas en la literatura internacional.

Introduction. Penetrating cervical trauma is a rare entity, with an upward trend, of considerable morbidity and mortality. It is essential to acknowledge its management by surgeons in training, who are usually the providers in the emergency areas. The objective of this study was to demonstrate the experience of a trauma center in Mexico in the treatment of penetrating cervical trauma by surgeons in training. Methods. This was a retrospective study of patients diagnosed with penetrating cervical trauma who underwent cervical examination between 2014 and 2019; 110 records were identified, 26 were excluded due to lack of essential data for the analysis, and the data of 84 patients were included. Results. 96.4% of the patients were men, the majority between 16 and 50 years old (83.3%) and the anatomic zone II was the most frequently injured (65.4%). The most common etiologies were stab wounds (67.9%) and gunshot wounds (25%). Ninety five percent of the procedures were performed by fourth- and fifth-year residents. The median number of days of hospital stay was 2 (2-4) days. The incidence of complications was 9.5% and mortality in 1.2%. Conclusions. General surgeons in the trauma training stage can optimally treat penetrating cervical trauma with the same morbidity and mortality rates described in the international literature.

Endovascular management of arterioenteric fistula: a case report.

Arterioenteric fistulas (AEFs) are a rare disease. They are a communication between a major artery and digestive tract. We present a patient who, after suffering a gunshot wound to the abdomen, underwent an exploratory laparotomy with damage control surgery, who later presented with hematemesis and melena. Studies were performed where an aneursyma of the right renal artery and gastrointestinal bleeding due to primary arterioenteric fistula were evidenced, which is successfully treated by angioembolization. Endovascular therapy for the treatment of AEF is a useful resource in patients with the previous abdominal surgeries that could make their management more difficult.

Las fístulas arterio-entéricas son un padecimiento infrecuente. Son una comunicación entre una arteria mayor y el tracto digestivo. Paciente masculino quien sufre una herida por arma de fuego en abdomen se le realiza una laparotomía exploradora con cirugía de control de daños, quien posteriormente presenta cuadro de hematemesis y melena. Se realizan estudios donde se evidencia un aneursima de la arteria renal derecha y sangrado de tubo digestivo por fístula arterioentérica primaria, la cual se trata por medio de angioembolización de manera exitosa. La terapia endovascular para el tratamiento de fístula arterio-enterica es un recurso útil en pacientes con cirugías abdominales previas que pudieran hacer más difícil el manejo.

Hepatic epithelioid hemangioendothelioma: a diagnostic challenge of vascular tumors.

Epitheloid hemangioendothelioma is a very rare tumor, with a variable presentation and unpredictable clinical behavior. The etiology and the triggering risk factors have not been specified. Unlike other primary liver tumors, it does not arise in the background of chronic liver disease. The approach is challenging due to the spectrum of possibilities and the need for immunohistochemistry to establish the definitive diagnosis. The information available so far is limited due to the few published cases, this favors that the therapeutic options are few or that there is insufficient evidence to standardize them when the lesion is not resectable.

El hemangioendotelioma epiteloide es un tumor muy infrecuente, con una presentación variable y un comportamiento clínico impredecible. No se han precisado la etiología ni los factores de riesgo desencadenantes. A diferencia de otros tumores hepáticos primarios, no surge en el contexto de una enfermedad crónica del hígado. El abordaje es un reto debido al espectro de posibilidades y la necesidad de inmunohistoquímica para establecer el diagnóstico definitivo. La información disponible hasta el momento es limitada por los escasos casos publicados, lo que favorece que las opciones terapéuticas sean pocas o no exista la evidencia suficiente para estandarizarlas cuando la lesión no sea resecable.

Carcinoma del cístico, a propósito de un caso.

El carcinoma primario en el conducto cístico es un tumor raro y abarca del 0.1% al 0.2% de los carcinomas del tracto gastrointestinal. Presentamos el caso de un varón con pérdida de peso e ictericia, en el que se demuestra por imagen una dilatación de vías intrahepática y extrahepática condicionada por una compresión extrínseca del colédoco. Se realiza colangiografía pancreática retrógrada endoscópica que confirma la compresión, por lo que se lleva a cabo una exploración quirúrgica que evidencia una tumoración del conducto cístico. Se realiza colecistectomía con resección de ganglios linfáticos, además de anastomosis hepatoyeyunal. La tumoración se reporta como carcinoma del conducto cístico sin involucro ganglionar.Primary cystic duct carcinoma is a rare tumor and comprises 0.1% to 0.2% of carcinomas of the gastrointestinal tract. We present a case of a male with weight loss and jaundice. Evidence is shown by imaging of intrahepatic and extrahepatic duct dilatation conditioned by extrinsic bile duct compression. An endoscopic retrograde pancreatic cholangiography was performed confirming the compression, so a surgical exploration was preformed showing a tumor of the cystic duct, a cholecystectomy with resection of regional lymph nodes, as well as a hepatic-jejunal anastomosis. The tumor is reported as cystic duct carcinoma without lymph node involvement.

Manejo de la ruptura hepática espontánea en el síndrome de HELLP / Management of spontaneous hepatic rupture in HELLP syndrome

Introducción. El síndrome de HELLP es una variante grave de la preeclampsia, con una baja incidencia, entre el 0,5-0,9 % de todos los embarazos. La ruptura hepática espontánea en el embarazo es infrecuente, presenta una alta mortalidad, y se ha relacionado con hemangiomas hepáticos, coriocarcinoma y síndrome de HELLP. Caso clínico. Mujer de 29 años con embarazo de 34,3 semanas, con actividad uterina progresiva, sufrimiento fetal agudo y hallazgos compatibles con síndrome de HELLP. Se practicó cesárea de urgencia encontrando hemoperitoneo y ruptura hepática del lóbulo derecho, por lo que se realizó empaquetamiento abdominal y posterior reintervención quirúrgica. Discusión. La ruptura hepática espontánea en el embarazo es una entidad infrecuente y potencialmente mortal. Es esencial un alto nivel de sospecha para realizar el diagnóstico y la rápida intervención. Requiere un manejo multidisciplinario para un resultado exitoso. Se han descrito múltiples tratamientos que dependen de las manifestaciones clínicas y extensión de la lesión, pero es claro que la laparotomía primaria y el taponamiento constituyen la mejor elección ante el hallazgo intraoperatorio.

Introduction. HELLP syndrome is a severe variant of preeclampsia with a low incidence, between 0.5-0.9% of all pregnancies. Spontaneous hepatic rupture in pregnancy is rare, has a high mortality, and has been associated with hepatic hemangiomas, choriocarcinoma, and HELLP syndrome. Clinical case. 29-year-old woman with a 34.3-week pregnancy, with progressive uterine activity and acute fetal distress and findings compatible with HELLP syndrome. An emergency cesarean section was performed, finding hemoperitoneum and hepatic rupture of the right lobe, performing abdominal packing and subsequent surgical reoperation. Discussion. Spontaneous liver rupture in pregnancy is a rare and potentially fatal entity. A high level of suspicion is essential to make the diagnosis and prompt intervention. It requires multidisciplinary management for a successful outcome. Multiple treatments have been described that depend on the clinical manifestations and extent of the lesion, but it is clear that primary laparotomy and packing constitute the best choice before the intraoperative finding.

Endoscopic retrograde cholangiopancreatography for treatment biliopleural fistulas.

BACKGROUND: Biliopleural fistula is a rare communication between the biliary system and the pleural space secondary to ruptured hydatid cysts, hepatobiliary surgeries or penetrating wounds. There is not so much of the subject in the literature, so there is no standardized protocol for its management. OBJECTIVE: The objective of this work is to determine advantages and disadvantages of the use of ERCP as a conservative initial treatment for biliopleural fistulas. METHOD: Our retrospective study included patients with a diagnosis of biliopleural fistula who underwent ERCP as initial treatment, older than 18 years in a period from August 2016 to August 2019. RESULTS: Eight patients with a diagnosis of biliopleural fistula were included, 75% men and 25% women with a mean age of 24.5 years; the traumatic etiology was predominant in our group (89%), the diagnosis was made between days 3 and 14 after chest tube placement and we were successful in treating the fistula with ERCP in 87.5% of our patients. CONCLUSIONS: The use of ERCP as initial treatment for biliopleural fistula should be considered as the initial tool in the algorithm of management of this entity.

ANTECEDENTES: La fístula biliopleural es una comunicación poco frecuente entre el sistema biliar y el espacio pleural secundario a ruptura de quistes hidatídicos, cirugías hepatobiliares o heridas penetrantes Existe poco sobre el tema en la literatura por lo que no existe un protocolo estandarizado para su manejo. OBJETIVO: El objetivo de este trabajo es determinar ventajas y desventajas del uso de CPRE como tratamiento inicial conservador para fístulas biliopleurales. MÉTODO: Nuestro estudio retrospectivo incluyó pacientes con diagnóstico de fístula biliopleural quienes fueron sometidos a CPRE como tratamiento inicial, mayores de 18 años en un período de Agosto de 2016 a Agosto de 2019. RESULTADOS: Se incluyeron 8 pacientes con diagnístico de fístula biliopleural, 75% hombres y 25% mujeres con una media de edad de 24.5 años; la etiología traumática fue a predominante en nuestro grupo (89%), el diagnóstico se realizó entre los días 3 y 14 post colocación de sonda torácica y obtuvimos éxito en el tratamiento de la fístula con CPRE en el 87.5% de nuestros pacientes. CONCLUSIONES: El uso de CPRE como tratamiento inicial para fístula biliopleural debe ser considerada como la herramienta inicial en el algoritmo de manejo de esta entidad.

Quiste de duplicación gástrica: inusual presentación en adultos, tratado con éxito por laparoscopía.

Las duplicaciones gastrointestinales son malformaciones congénitas raras que pueden presentarse en diferentes partes del tracto gastrointestinal, de tamaño y sintomatología variable. Las duplicaciones gástricas representan el 3-5% de estas malformaciones. La presentación más frecuente es la quística, en la mayoría de los casos en la curvatura mayor. El diagnóstico es raro en la edad adulta y el tratamiento de elección es quirúrgico, el cual puede llevarse a cabo de forma convencional o por mínima invasión. Se presenta el caso de una mujer adulta con diagnóstico de quiste de duplicación gástrica en fondo gástrico adyacente a la unión gastroesofágica a quien se realizó resección total por laparoscopia.Gastrointestinal duplications are rare congenital malformations, they can appear in different parts of the gastrointestinal tract, of variable size and symptomatology. Gastric duplications represent 3-5% of these malformations, the most frequent presentation is statistical, located mostly in the greater curvature, the diagnosis is rare in adulthood, the treatment of choice is surgical, which can be carried out in a conventional or minimally invasive manner. We present the case of an adult woman diagnosed with a gastric duplication cyst in the gastric fundus adjacent to the gastroesophageal junction, who underwent total resection by laparoscopy.

[Prevalence of VHB and VHC serological markers among blood donors in the capital state of Veracruz, Mexico]. / Prevalencia de marcadores serológicos de VHB y VHC en donadores de sangre de la ciudad de Veracruz.

BACKGROUND: Chronic liver disease has a high mortality among the Mexican population. However epidemiological data on hepatitis B (HBV) and hepatitis C (HCV) infection in the southeast areas of the country is limited. Our objective was to report the prevalence of blood markers of HBV and HCV among blood donors from the capital city of Veracruz, Mexico. METHODS: Between January and December 2005 we analyzed the results of the screening tests used to detect serological markers of HBV and HCV infection (HBsAg and anti-HCV). We included demographic data of blood donors from the State Center for Blood Transfusion of the capital city of Veracruz. RESULTS: We reviewed 8,650 blood donor reports and found a prevalence of 0.057% and 1.1% for AgsHB and anti-HCV respectively. Only 2.97% of all individuals with a positive test had been previously screened for hepatic viruses. CONCLUSIONS: Results from our study indicate that the central and southeast regions of the state of Veracruz have a high anti-HCV prevalence among blood donors when compared with results from other states in Mexico. Further studies should evaluate risk factors in regions with high HCV seropositivity.

Prevalencia de marcadores serológicos de VHB y VHC en donadores de sangre de la ciudad de Veracruz / Prevalence of VHB and VHC serological markers among blood donors in the capital state of Veracruz, Mexico

Antecedentes: A pesar del impacto de las enfermedades hepáticas en la morbilidad y mortalidad de la población mexicana, existe poca información epidemiológica sobre la infección por virus de la hepatitis B (VHB) y C (VHC) en el sureste de la República mexicana. El objetivo de nuestra investigación fue determinar la prevalencia de marcadores serológicos de VHB y VHC en donadores de sangre del centro y sur de Veracruz. Métodos: Estudio retrospectivo en el Centro Estatal de la Transfusión Sanguínea de la ciudad de Veracruz, recabando resultados de los marcadores serológicos para VHB y VHC (AgsHb y antiVHC) e información demográfica de los individuos considerados aptos para realizar una donación. Resultados: Se revisaron 8650 registros de individuos, se encontró una seroprevalencia de 0.057 y 1.1% para AgsHB y antiVHC, respectivamente, con variaciones en los diferentes municipios estudiados. Únicamente 2.97% de los individuos seropositivos se había realizado escrutinio previo para la detección de virus hepatotropos. Conclusiones: Los datos indican que la región centro-sureste de Veracruz presenta elevada seroprevalencia antiVHC en donadores de sangre. Se deberá realizar estudios posteriores para determinar los factores de riesgo que la expliquen.

BACKGROUND: Chronic liver disease has a high mortality among the Mexican population. However epidemiological data on hepatitis B (HBV) and hepatitis C (HCV) infection in the southeast areas of the country is limited. Our objective was to report the prevalence of blood markers of HBV and HCV among blood donors from the capital city of Veracruz, Mexico. METHODS: Between January and December 2005 we analyzed the results of the screening tests used to detect serological markers of HBV and HCV infection (HBsAg and anti-HCV). We included demographic data of blood donors from the State Center for Blood Transfusion of the capital city of Veracruz. RESULTS: We reviewed 8,650 blood donor reports and found a prevalence of 0.057% and 1.1% for AgsHB and anti-HCV respectively. Only 2.97% of all individuals with a positive test had been previously screened for hepatic viruses. CONCLUSIONS: Results from our study indicate that the central and southeast regions of the state of Veracruz have a high anti-HCV prevalence among blood donors when compared with results from other states in Mexico. Further studies should evaluate risk factors in regions with high HCV seropositivity.

[Giant mediastinal neurilemoma. A case report]. / Neurilemoma mediastinal gigante. Presentación de un caso.

BACKGROUND: Mediastinal neurilemmoma is an infrequent and a big size neoplasm in the posterior mediastinum. There are usually no symptoms. When there is a pressure against nerves or vascular structures, it can be dangerous for the life. The main problem of this tumors is the diagnosis: surgical approach and the complete resection without injuring vital mediastinal structures. CLINICAL CASE: We report a case in a 29-year-old male with a giant mediastinal neurilemmoma. He had chest pain for two months. Chest rays showed opacity in the left chest. A broncofiberscopy, computed tomography and transthoracic biopsy were performed. Finally, the patient had a left posterolateral thoracotomy. CONCLUSIONS: The giant mediastinal neurilemmoma is a benign and asymptomatic neoplasm in most cases. When the symptoms are present, they are nonspecific. We should rule out other pathologies. The intraoperatory fiberscopy is useful for the resection of small mediastinal tumours.

Sorafenib, a systemic therapy for hepatocellular carcinoma.

Hepatocellular carcinoma is a lethal disease that requires a multidisciplinary approach and management. Surgical therapy offers long-term survival; however, few patients are candidates. There has been no accepted systemic therapy for this disease until recently. This article briefly discusses the role of RAS/RAF/MEK/ERK signaling pathway in the pathogenesis of the disease and the promising role of sorafenib for advanced disease.

Gallstones are associated with carotid atherosclerosis.

BACKGROUND/AIMS: Gallstone disease (GD) and cardiovascular disease (CD) are common diseases worldwide with considerable economical impact and they are strongly associated. Carotid atherosclerosis is an excellent marker of risk for CD like stroke and myocardial infarction. The aim of this study was to assess the association between gallstones and carotid atherosclerosis. METHODS: A cross-sectional study was conducted. We evaluated subjects with ultrasonographical evidence of GD and asymptomatic subjects without such evidence. Anthropometric, clinical and biochemical variables were collected. The Metabolic syndrome was evaluated using adult treatment panel III criteria. Carotid artery intima-media thickness (CIMT) was determined by a standard ultrasound protocol. Insulin-like growth factor-1 (IGF-1) serum levels were measured in all subjects. RESULTS: We studied 191 subjects: 62 subjects with GD (53.2% males) and 129 asymptomatic subjects without GD (65.9% males). Subjects with GD exhibited a higher body mass index, body fat percent, insulin serum levels and CIMT (P<0.05 for all). The prevalence of GD was higher in subjects with a CIMT>0.75 independently of other factors [odds ratio (OR) 2.12, 95% confidence interval (CI) 1.04-4.34; P=0.039], and for every 0.1 mm increase in CIMT the independent probability to be a case of GD increased by a factor of 1.25 (95% CI 1.02-1.53; P=0.027). IGF-1 levels did not differ among groups. CONCLUSIONS: Subjects with GD exhibit greater carotid atherosclerosis, and therefore have a higher risk for stroke and myocardial infarction.

Non-alcoholic fatty-liver disease in pediatric populations.

The increasing prevalence of obesity is not only observed in adults. Children are affected by obesity and related diseases, such as chronic liver disease, more frequently than in the past. Nonalcoholic fatty-liver disease is an important cause of chronic liver disease and in the near future will become important worldwide. Considering this phenomenon, it is important for gastroenterologists and hepatologists to be aware of the presence of nonalcoholic fatty-liver disease in pediatric populations and to treat it adequately. This practice will have important benefits for future generations. This review discusses the most important aspects in epidemiology, diagnostics and treatment of nonalcoholic fatty-liver disease in children.

[Pulmonary hamartoma. A case report]. / Hamartoma pulmonar. Informe de un caso.

A 71-years-old man presented with an incidentally finding of a tumor in the left pulmonary apex that measured approximately 4.5 cm of diameter. The patient, had de preceding of chronic smoking. Bronchoscopy with biopsy by transthoracic punction suggested the presence of epidermoid carcinoma. In the radiologic control, an increase in tumor size from 4.5 cm to 5 cm of the lesion was observed in a period of three months. The patient was submited to surgery and a tumorectomy by posterolateral thoracotomy was performed. The postoperatory evolution was satisfactory. The final diagnosis was hamartoma of the lung.

Hamartoma pulmonar: informe de un caso / Pulmonary hamartoma: a case report

El caso correspondió a un hombre de 71 años en el que se detectó incidentalmente una tumoración en ápice pulmonar izquierda de aproximadamente 4.5 cm de diámetro, asociada al antecedente de tabaquismo intenso. Se realizó broncoscopia, toma de biopsia y punción transtorácica, sugiriendo carcinoma epidermoide. En los controles radiológicos subsecuentes, se observó crecimiento de la lesión de 4.5 cm a 5 cm en un lapso de tres meses, motivo por el cual se decidió realizar tumorectomía mediante toracotomía posterolateral izquierda. La evolución postoperatoria fue satisfactoria y el diagnóstico histopatológico final fue de hamartoma pulmonar.

A 71-years-old man presented with an incidentally finding of a tumor in the left pulmonary apex that measured approximately 4.5 cm of diameter. The patient, had de preceding of chronic smoking. Bronchoscopy with biopsy by transthoracic punction suggested the presence of epidermoid carcinoma. In the radiologic control, an increase in tumor size from 4.5 cm to 5 cm of the lesion was observed in a period of three months. The patient was submited to surgery and a tumorectomy by posterolateral thoracotomy was performed. The postoperatory evolution was satisfactory. The final diagnosis was hamartoma of the lung.

Effect of Helicobacter pylori infection on gastric ghrelin expression and body weight.

BACKGROUND & AIM: Ghrelin is a peptide mainly produced by gastric tissue playing an important role in energy homeostasis. It has been suggested that inflammatory and atrophic events induced by Helicobacter pylori (H. pylori) infection in gastric mucosa compromise the survival of the ghrelin-producing cells. The aim of this study was to investigate the effect of H. pylori infection on gastric ghrelin expression and body weight. METHODS: Consecutive patients referred for upper endoscopy were invited to participate. Patients with H. pylori infection (determined by histology) were defined as cases and patients without infection as controls. The density of colonization was classified in mild, moderate, or severe infection. Body mass index (BMI) was calculated. Ghrelin-immunoreactive cells were quantified in gastric biopsies by immunohistochemical staining. RESULTS: We studied 189 cases (92 males, 97 females) and 94 controls (55 males, 39 females). Cases were older (48.16 +/- 16.44 vs. 42.88 +/- 17.04 years, p < 0.05) and exhibited a lower percentage of ghrelin-immunoreactive cells (2.13% vs. 10.43%, p < 0.05) than controls. The prevalence of obesity was significantly lower than normal-weight among all cases, independently of the severity of infection (mild infection, 17.6% vs. 47.3%, p = 0.001; moderate-severe infection, 10.4% vs. 50%, p = 0.001). Univariate analysis showed a non-significant trend suggesting a protective effect of H. pylori against obesity. Nevertheless, BMI did not differ significantly between cases and controls. CONCLUSION: Chronic H. pylori infection contributes to a lower percentage of gastric ghrelin-immunoreactive cells but has no effect on the body weight of infected patients.

Risk factors and prevalence of hepatitis virus B and C serum markers among nurses at a tertiary-care hospital in Mexico City, Mexico: a descriptive study.

BACKGROUND & AIM: Alcohol consumption and viral infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) are the first causes of chronic hepatopathy in Mexico. Medical personnel are at high risk of developing HBV and HCV infection because both viruses are transmitted parenteraly. The aim of this study was to determine the prevalence of HCV and HBV infection as well as risk factors in nurses working at Medica Sur Clinic and Foundation. METHODS: The complete nurse staff personal from our hospital was included; a questionnaire of risk factors for HCV and HBV infection was assessed. HBV and HCV infection (anti-HCV anti-HBc, and HBsAg) was determined to all of them. In anti-HCV positive persons HCV genotype and viral load was assessed. RESULTS: Three hundred seventy six nurses where studied, Anti-HBc was positive in 1.6% of all participants, none were positive for HBsAg. 0.8% of all studied population was positive for anti- HCV. Major risk factors for HBV infection where tattooing and having more than 4 sexual partners previously, and for HCV infection transfusions before 1992 and age. Only one person was anti-HCV positive with a viral charge of 5 X 106 copies, genotype 2b. CONCLUSIONS: HCV seropositivity in people with high risk was lower than general population. None was positive for HBV infection.

Migración de un clavo de Kirschner a mediastino / Migration of a Kirschner wire to the mediastinum

Introducción: El uso de implantes metálicos, como los clavos de Kirschner, es común en ortopedia; su migración puede ocasionar diversas complicaciones. Caso clínico: Mujer de 86 años con luxación inveterada de hombro derecho que se trató por fijación interna con un clavo de Kirschner. Seis meses después se tomó radiografía simple de tórax, observando una opacidad lineal (de 17.3 cm) por cuerpo extraño, atravesando el mediastino. En la tomografía axial computada se observó el clavo adyacente a la aorta y al esófago, perforando la arteria pulmonar izquierda, inmediatamente por delante del cuerpo vertebral. Se extrajo por toracotomía posterolateral izquierda complicada con laceración de la arteria pulmonar que se reparó con sutura vascular 5-0. Discusión: Se revisó la literatura sobre el tema.

Introduction: Metallic implants, as the Kirschner wire are commonly used in orthopedics. They can migrate and produce various and potentially severe complications. Clinical case: An 86 year old woman had a chronic luxation of the right shoulder treated by internal fixation with a 17.3 cm Kirschner wire. She was asymptomatic when seen six months later at the outpatient clinic; the chest X ray and CT scans showed the Kirschner wire crossing through the mediastinum, from right to left, perforating both lungs and the left pulmonary artery, in close vicinity to the aorta, the esophagus and a vertebral body. The wire was removed through a left posterolateral thoracotomy producing a laceration of the left pulmonary artery that was repaired with 5-0 vascular sutures. She is doing well. The pertinent literature is reviewed.