Impact of the Covid-19 pandemic on colorectal cancer surgery in Madrid

Introduction: The Covid-19 pandemic has had an important impact on colorectal cancer surgery, for hospital resources had to be redistributed in favour of Covid-19 patients. The aim of the present study is to analyze our results in colorectal oncologic surgery during the Covid-19 pandemic in patients with and without perioperative SARSCoV- 2 infection. Methods: In total, 32 patients (19 male and 13 female patients), with a mean age of 64 years (range: 57.2 to 69.5 years) with colorectal cancer underwent surgery under the recommendations of surgical societies included in a protocol. Data collection included clinical characteristics (gender, age, body mass index, American Society of Anesthesiologists score, tumor location, preoperative staging, lymphopenia), data related to SARS-CoV-2 infection (postoperative symptoms, diagnostic tests), operative details (surgical procedure, approach, duration, stoma), pathological outcomes (tumor stage, number of lymph nodes harvested, distal and circumferential radial margins, quality of the total mesorectal excision), and surgical outcomes (morbidity, mortality, hospital stay, and the rates of reoperation and readmission). Results: A total of 3 (9.4%) patients who underwent colorectal surgery during the Covid-19 pandemic were infected by SARS-CoV-2 in the postoperative period. Chronic obstructive pulmonary disease was associated with Covid-19 (6.2% versus 33.3%; p=0.042), and surgical morbidity was higher among Covid-19 patients (100% versus 37.9%; p=0.039). There were not significant differences between COVID-19 patients and non-COVID-19 patients in relation to the rest of the analyzed outcomes. Conclusion: During the Covid-19 pandemic, colorectal cancer surgery should be performed according to the recommendations of surgical societies. However, Covid- 19 patients could present a higher morbidity rate. (AU)

Nutrición enteral por yeyunostomía como causa de perforación y necrosis intestinal / Enteral feeding via jejunostomy as a cause of intestinal perforation and necrosis

Introducción: la yeyunostomía de alimentación es una excelente manera de nutrir por vía enteral a pacientes que no pueden tolerar dieta oral con una tasa de complicaciones baja. Se utiliza comúnmente una sonda de Foley, tubo de Ryle, de Kerh o catéter con aguja (Jejuno-Cath®). Caso clínico: presentamos el caso de un paciente varón de 80 años que presentó una perforación intestinal como consecuencia de la nutrición a través de un yeyunocath en el postoperatorio de una gastrectomía subtotal con reconstrucción en Y de Roux, y de otro paciente varón de 53 años con perforación gástrica y múltiples complicaciones postoperatorias, entre ellas, necrosis de un segmento de intestino delgado por impactación de nutrición enteral. Discusión: revisamos la literatura existente sobre esta rara complicación (AU)

Jejunostomy for enteral feeding is excellent for patients who cannot manage oral intake, with a low complication rate. A Foley catheter, Ryle tube, Kerh tube or needle-catheter (Jejuno-Cath®) are commonly used. It is a safe procedure but it can lead to severe complications. We present two cases: firstly, an 80 year old male who was admitted to the Emergency Room with a bowel perforation secondary to Jejuno-Cath® for enteral feeding after a subtotal gastrectomy with Roux-en-Y reconstruction; and secondly, a 53 year old male who was admitted to the Emergency Room due to gastric perforation developing multiple complications, including bowel necrosis and enteral feeding impaction. We have reviewed the recent literature with regard to this rare complication (AU)

Pancreatectomía central en el tratamiento de lesión pancreática benigna. Presentación de un caso y revisión de la literatura / Central pancreatectomy for the treatment of a benign pancreatic lesion. Case report and literature review

Presentamos el caso de una mujer de 45 años diagnosticada incidentalmente de lesión quística pancreática compatible con cistoadenoma seroso de 14 mm. Tras cinco años de seguimiento (TAC y RM) la lesión triplicó su tamaño y se indicó la intervención. Teniendo en cuenta la probable benignidad de la lesión, y en un intento de preservar tanto el bazo como la mayor cantidad posible de parénquima pancreático, se realizó una pancreatectomía central con derivación del remanente distal. Se revisa la literatura nacional e internacional publicada (AU)

We present the case of a 45 year old female patient with an incidental diagnosis of a cystic pancreatic lesion corresponding to a serous cystadenoma of 14 mm. During a 5-year follow-up (CT and MRT) the lesion tripled in size and a surgical intervention was decided upon. The lesion was thought to have a benign pathology and, in an attempt to preserve the spleen and a major portion of pancreatic tissue, a central pancreatectomy with a diversion of the remaining distal pancreas was carried out. The authors reviewed national and international publications (AU)

Declaración sobre el tratamiento actual de la obesidad grave en España / Statement on the current treatment of severe obesity in Spain

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Primer caso publicado de síndrome de Bouveret asociado a perforación duodenal y vesicular al retroperitoneo / First case reported of Bouveret´s syndrome associated to duodenal and biliary perforation to retroperitoneum

Presentamos el caso de una mujer de 69 años con diagnóstico de colelitiasis, que acudió a urgencias por cuadro de dolor abdominal intenso, náuseas y vómitos. Un TAC abdominal mostró obstrucción duodenal causada por cálculo biliar de 4 cm, fístula colecistoduodenal y neumobilia, lo que en conjunto se conoce como síndrome de Bouveret, una forma rara de íleo biliar. Adicionalmente presentaba perforación duodenal y vesicular libre a retroperitoneo en el mismo punto de tránsito colecistoduodenal. La paciente fue intervenida quirúrgicamente, realizando colecistectomía dificultosa, enterolitotomía, reparación del defecto duodenal, lavado exhaustivo y drenaje del retroperitoneo. El postoperatorio transcurrió sin complicaciones salvo infección de la herida quirúrgica (AU)

We present the case of a 69 year old woman with a history of cholecystitis, who consulted for severe abdominal pain, nausea and vomiting. Abdominal CT showed duodenal obstruction caused by a gallstone, cholecystoduodenal fistula and pneumobilia, what is known as Bouveret's syndrome, a rare form of gallstone ileus. Additionally, she presented free duodenal and vesicular perforation to retroperitoneum at the same level of the cholecystoduodenal transit point. The patient underwent a difficult cholecystectomy, enterolithotomy, repair of the duodenal defect, extensive washing and drainage of the retroperitoneum. The postoperative course was uneventful except for a laparotomy infection (AU)

Bocio amiloide en paciente con fibrosis quística / Amyloid goiter in a patient with cystic fibrosis

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Enfermedad de Hirschsprung, mutación del protooncogén RET y tiroidectomía profiláctica / Hirschsprung's disease, RET proto-oncogene mutation and prophylactic thyroidectomy

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Consideraciones técnicas para minimizar las complicaciones / Technical considerations to minimize complications

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Una causa rara de neumoperitoneo espontáneo: neumatosis quística / A rare cause of spontaneous pneumoperitoneum: cystic pneumatosis

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