[Perforation of hollow viscera in abdominal injuries]. / Perforación de víscera hueca en traumatismos abdominales.

OBJECTIVE: This is a retrospective study to evaluate our results in the treatment of abdominal trauma. DESIGN: We have analysed the incidence, the clinical characteristics, the diagnosis, the indications for laparotomy, the therapeutic methods and the morbidity-mortality. During the last 14 years we have operated on 29 hollow viscus injuries. They were divided into two groups: Eleven with penetrating or open trauma and 18 with blunt or closed traumatism. RESULTS: In the cases of blunt trauma 36.8% of injuries were located in the proximal jejunum, 21% in the terminal ileum, 15% in the colon. In the cases of penetrating trauma, small intestinal perforation predominated (46.9%). In 23.5% of the cases the colon was affected. Morbidity in blunt trauma was 38.8% and 0% in penetrating trauma. The mortality in the two groups has been zero. CONCLUSIONS: The most common surgical procedure practised for injuries to the small intestine was simple suture, and for injuries to the colon, colostomy. The most usual surgical procedures in penetrating trauma were simple suture in all small intestine injuries and for colonic lesions half had primary closure and half suture plus colostomy.

[Malignant tumors of the Vater's ampulla. Presentation of 28 cases and review of the literature]. / Tumores malignos de la ampolla de Vater. Presentación de 28 cases y revisión de la literatura.

We present a study of 28 patients, treated for adenocarcinoma of Vater's ampulla. We emphasize the distinct behavior of each one of the peri-ampullar tumors, those which affect Vater's ampulla yielding the best prognosis. We gathered data regarding gender, age, clinical manifestations, and analytical data. The confirmatory diagnosis gives us 100% of CPRE cases. All of the patients were submitted to surgical treatment with anatomic pathological confirmation of the diagnosis, be it pre or postoperative. We practiced curative surgery in 57.2% of the cases and palliative in 42.8% of the cases. We observed postoperative complications in 17.8% of the patients and peroperative mortality in 3.5%. Actual survival of the series of patients for whom exeretic surgery was performed is significantly superior to that of the other patients.

[Primary tumors of the small intestine]. / Tumores primarios del intestino delgado.

We made a retrospective analysis of 43 cases of primary tumor of the small intestine, 28 benign and 15 malignant, diagnosed and treated in our hospital over a period of 18 years. A preoperative diagnosis was reached in 13 cases (30%), while in 37.2% the tumor was a casual finding during operation by other methods. The remaining 32.5% debuted as acute abdomen and were an emergency surgical indication. Simple tumoral resection was practiced in 19 cases (44.1%) of benign tumor, intestinal resection with end-to-end anastomosis in 22 cases (51%) and only biopsy in two cases (4.6%). Coadjuvant chemotherapy was given to five patients (11.5%) and radiotherapy to one (2.3%). The one-year survival for malignant tumors was 73%, and only 18% (2 cases) survived more than 5 years after the operation).

[Synchronous multiple carcinomas of the colon and rectum. Presentation of 18 cases and review of the literature]. / Carcinomas múltiples sincrónicos del colon y recto. Presentación de 18 casos y revisión de la literatura.

We reviewed 680 cases of colorectal neoplasms with an incidence of 18 synchronous multiple carcinomas (2.7%). We describe the predominance in females (11/7), the late age of presentation (maximal incidence between 60 and 80 years) and the main symptoms of these patients. We remark the diagnostic difficulty of these tumors, despite all the methods used; the diagnosis of the second mass was intraoperative in 50% of the cases in our series. As treatment, we suggest partial colectomy, except when there is massive colonic affectation, in which we practice a total colectomy. The prognosis in these patients is similar to that of those who have a single carcinoma. We must carry out a rigorous follow-up of these patients to make an early diagnosis of any new metachronous tumors.

[Neoplasms of the rectum. A presentation of 588 cases and review of the literature]. / Neoplasias rectales. Presentación de 588 casos y revisión de la literatura.

We reviewed cancers of the rectum and rectosigmoid operated from 1970 to 1980 in the General Surgery Service of the Hospital La Fe of Valencia (Spain). Of a total of 588 patients, only 370 were resectable (62.9%), which reflects the advanced stage of the disease when these patients are seen. Of the 370 resections, 210 corresponded to lower rectum, 97 to middle rectum and 63 to upper rectum and rectosigmoid. In 80%, abdominoperineal amputation was practiced and in 20%, anterior resection; this was due to the predominance of lower tumors and the fact that at this time mechanical sutures were not in use, since these permit anterior resections that cannot be performed with normal sutures. The 5-year survival was 197 patients, 53.2%. Postoperative mortality affected 4.2%. We found complications and morbidity in 17.1%. The mean hospital stay was 18 days. In no case of anterior resection was discharge colostomy performed.