Derivación gástrica en Y de Roux como procedimiento de urgencia para resolver la fuga en un SADI-S / Roux-en-Y gastric bypass as an emergency procedure for resolving SADI-S leak

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Laparoscopic hemicolectomy for a patient with situs inversus totalis and colorectal cancer / Colectomia laparóscopica para um paciente com situs inversus totalis e câncer colorretal

ABSTRACT Situs inversus totalis is a congenital anatomic anomaly characterized by a complete inversion of thoracic and abdominal organs. We present a case of a 67 year-old patient diagnosed with situs inversus totals in his childhood who was referred for a two-month history of hematoquezia. Ascending colon cancer where found and he underwent a laparoscopic hemicolectomy with radical lymphadenectomy. An exhaustive preoperative study and a detailed planning of laparoscopic surgery including positions of operator and assistants and trocar sites have been performed to be aware of anatomic challenges. The operating time was 120 min and blood loss was minimal. Histologic examination showed a well-differentiated adenocarcinoma with serosal invasion and without lymph nodes metastasis (pT3N0). The patient was discharged on postoperative 6th day without complications. Laparoscopic surgery for colon cancer in patients with situs inversus totalis could be more difficult nevertheless a safe and feasible procedure should be performed successfully.

RESUMO Situs inversus totalis é uma anomalia anatómica consistindo em um investimento de órgãos abdominais. Nesse estudo, descrevemos um paciente, homem 67 anos, que foi diagnosticado com situs inversus totalis na infância. Apresentava sintomas de sangramento retal e foi diagnosticado com câncer de cólon direito e tratado cirurgicamente com receção laparoscópica. Para a realização da colectomia laparoscopica precisamos de um estudo pré-operatória completa e um plano detalhado de cirurgia com localização do trocateres e cirurgiões. A cirurgia durou 120 minutos e perde de sangue foi mínima. O resultado do exame patológico relatou adenocarcinoma (T3N0). Nosso paciente foi admitido por 7 dias e não apresentaram complicações. Para os pacientes com situs inversus totalis e câncer colorretal a receção laparoscópica pode ser mais difícil mas eficaz e segura.

Lesiones gastrointestinales y mesentéricas en el paciente politraumatizado: incidencia, demora diagnóstica y pronóstico / Gastrointestinal and mesenteric injuries in the trauma patient: incidence, diagnosis delay and prognosis

Introducción Las lesiones gastrointestinales y mesentéricas (LGIM) son poco frecuentes en el traumatizado, y su diagnóstico es, en ocasiones, tardío. Nuestros objetivos han sido determinar la fiabilidad diagnóstica inicial de la tomografía computarizada (TC) en nuestro centro, así como la posible repercusión clínica de la demora diagnóstica en estas lesiones. Material y método Estudio retrospectivo de los pacientes con LGIM recogidos en nuestro Registro de Trauma Grave entre 1993 y 2006.ResultadosDe los 1.495 traumatizados registrados, 632 tenían traumatismo abdominal y 105 (16,6%) presentaron LGIM, en un 46% secundarias a un traumatismo cerrado. El ISS y el NISS medios fueron 20 y 25, respectivamente. La mortalidad fue de 9 (8,5%) pacientes, 4 contra pronóstico. En 56 (53%) casos se realizó una TC, y se observaron signos de LGIM en sólo 37. En otros 43 (41%) pacientes se indicó una laparotomía urgente por inestabilidad o signos clínicos de lesión intraabdominal. En 21 (20%) casos la cirugía se demoró más de 8h, y la causa más frecuente fue un falso negativo en la TC. Conclusiones La incidencia total de LGIM ha sido alta en nuestro medio (el 31% en traumatismo abdominal penetrante y el 10,7% en cerrado). Diversos factores como la ausencia inicial de clínica, la baja sensibilidad diagnóstica de la TC (un 34% de falsos negativos) y el manejo conservador de las lesiones de órgano sólido han llevado a diagnóstico y tratamiento tardíos en 1 de cada 5 pacientes de nuestra serie, sin que ello haya implicado un aumento significativo de la morbilidad infecciosa (AU)

Background Gastrointestinal and mesenteric injuries (GIMI) are uncommon in trauma patients, and their diagnosis are often delayed. Our aims were to determine the reliability of CT scan in our centre, and to assess the clinical significance of a delayed diagnosis. Materials and method Retrospective analysis of cases confirmed at laparotomy. Patients were identified at the Severe Trauma Registry of Gregorio Marañón University General Hospital, between 1993 and 2006.ResultsWe found 105 (16.6%) GIMI out of 632 patients with abdominal trauma, in a Registry with 1495 severe trauma cases included. A total of 46% had blunt injuries. The mean injury severity score (ISS) and new ISS (NISS) were 20 and 25, respectively. There were 9 (8.5%) deaths, 4 of which were unexpected. A CT scan was performed in 56 (53%) cases, and only in 37 there were signs suggestive of a GIMI. In another 43 (41%) patients an urgent laparotomy was indicated because of positive clinical findings or instability. Surgery was delayed for more than 8 hours in 21 (20%) patients, the most common reason being a false negative result in the CT scan. Conclusions The overall incidence of GIMI was high in our centre (31% due to penetration and 10.7% blunt trauma). Several factors, such as the initial lack of symptoms, a low diagnostic sensitivity of the CT scan (34% false negatives), and the non-surgical management of solid organ injuries, have contributed to a delayed diagnosis and treatment in one out of each five patients in our series, but this has not led to a significant increase in septic complications in this group (AU)

[Gastrointestinal and mesenteric injuries in the trauma patient: incidence, diagnosis delay and prognosis]. / Lesiones gastrointestinales y mesentéricas en el paciente politraumatizado: incidencia, demora diagnóstica y pronóstico.

BACKGROUND: Gastrointestinal and mesenteric injuries (GIMI) are uncommon in trauma patients, and their diagnosis are often delayed. Our aims were to determine the reliability of CT scan in our centre, and to assess the clinical significance of a delayed diagnosis. MATERIALS AND METHOD: Retrospective analysis of cases confirmed at laparotomy. Patients were identified at the Severe Trauma Registry of Gregorio Marañón University General Hospital, between 1993 and 2006. RESULTS: We found 105 (16.6%) GIMI out of 632 patients with abdominal trauma, in a Registry with 1495 severe trauma cases included. A total of 46% had blunt injuries. The mean injury severity score (ISS) and new ISS (NISS) were 20 and 25, respectively. There were 9 (8.5%) deaths, 4 of which were unexpected. A CT scan was performed in 56 (53%) cases, and only in 37 there were signs suggestive of a GIMI. In another 43 (41%) patients an urgent laparotomy was indicated because of positive clinical findings or instability. Surgery was delayed for more than 8 hours in 21 (20%) patients, the most common reason being a false negative result in the CT scan. CONCLUSIONS: The overall incidence of GIMI was high in our centre (31% due to penetration and 10.7% blunt trauma). Several factors, such as the initial lack of symptoms, a low diagnostic sensitivity of the CT scan (34% false negatives), and the non-surgical management of solid organ injuries, have contributed to a delayed diagnosis and treatment in one out of each five patients in our series, but this has not led to a significant increase in septic complications in this group.