Evisceración intestinal a través de vagina / Transvaginal small bowell evisceration

Objetivos: Descripción de una complicación posquirúrgica infrecuente, la evisceración intestinal vaginal, y revisión de los factores predisponentes, diagnóstico y su tratamiento quirúrgico corrector definitivo, las vías de abordaje y las posibles técnicas quirúrgicas, basándonos en la literatura científica disponible. Material y métodos: Se presenta el caso clínico de una paciente de 46 años con la complicación referida, su evaluación inicial, manejo quirúrgico y seguimiento. Se realiza laparotomía para evaluación de la viabilidad de las asas intestinales herniadas, reparación del defecto existente en la cúpula vaginal y técnica quirúrgica correctora en el mismo tiempo quirúrgico, la colposacropexia con malla con buen resultado a corto y medio plazo. Conclusiones: La evisceración vaginal en una complicación infrecuente que requiere una valoración rápida y una actitud quirúrgica urgente, debido a la alta morbimortalidad a la que se asocia

Objectives: We describe an uncommon postoperative complication, vaginal evisceration of the intestine, and review the predisposing factors, diagnosis and definitive corrective surgery, the surgical approaches and possible surgical techniques, based on the available scientific literature. Material and methods: We report the case of a 46-year-old patient with the aforementioned complication, initial evaluation, surgical management and monitoring. We performed a laparotomy to assess the viability of the herniated intestinal loops, repair the defect in the vaginal vault and perform a surgical correction in one procedure. We used a colposacropexy mesh with good short- and medium-term results. Conclusions: Vaginal evisceration is a rare complication that requires rapid assessment and urgent surgical treatment due to the high morbidity and mortality with which it is associated

Neumomediastino y enfisema cervical tras consumo de “éxtasis” (3, 4 metilendioximetanfetamina) / Pneumomediastinum and cervical emphysema after “ecstasy” (3, 4 methylenedioxymetamphetamine) consumption

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Is pancreas and/or spleen resection required in total gastrectomy for advanced gastric cancer?

OBJECTIVE: Total gastrectomy for advanced gastric cancer is frequently combined with extended lymphadenectomy. This technique is easier when resection of distal pancreas and/or spleen is performed. We have tried to evaluate whether the resection of both structures and total gastrectomy in patients with advanced gastric cancer actually improve survival rates. PATIENTS: From 1991 to 1999, 140 patients with advanced gastric cancer underwent total gastrectomy at the General Hospital of Albacete: 43 with simple total gastrectomy, 57 with total gastrectomy plus splenectomy and 40 with total gastrectomy plus distal pancreaticosplenectomy. Univariate and multivariate analysis were conducted in order to evaluate different prognostic factors and survival curves among the groups. RESULTS: Survival rates of the three groups were compared for each factor, being only significant variables the degree of tumor infiltration in the gastric wall, the size of the tumor, the staging and the type of lymphatic infiltration. Neither splenectomy nor distal pancreaticosplenectomy improved the survival compared to simple total gastrectomy. Morbimortality rates increased with more aggressive surgical procedures, but differences were not significant. CONCLUSIONS: Resection of distal pancreas and/or spleen plus total gastrectomy for advanced gastric cancer is associated to a greater number of isolated lymph nodes, but do not improve the survival of patients.

¿Es necesaria la resección pancreática y/o esplénica en la gastrectomía total por cáncer gástrico avanzado? / Is pancreas and/or spleen resections required in total gastrectomy for advanced gastric cancer?

Objetivo: la gastrectomía total en el cáncer gástrico avanzado, es asociada a una linfadenectomía extendida en gran parte de los casos. Esta técnica se ve facilitada si se practica una resección del páncreas distal y/o del bazo. Intentamos analizar si la resección de una o ambas estructuras junto a la gastrectomía total en el cáncer gástrico avanzado, mejoraba realmente el pronóstico de los pacientes. Pacientes: desde 1991 a 1999 se han realizado 140 gastrectomías totales por cáncer gástrico avanzado en el Hospital General de Albacete: 43 mediante gastrectomía total simple, 57 mediante gastrectomía total con esplenectomía y 40 mediante gastrectomía total con pancreatectomía distal y esplenectomía. Un análisis univariante y multivariante permitió analizar los diferentes factores pronósticos y las curvas de supervivencia entre los grupos. Resultados: se comparó la supervivencia de cada grupo para cada factor analizado resultando sólo variables significativas el grado de infiltración tumoral en la pared gástrica, el tamaño del tumor, el estadiaje y el tipo de infiltración linfática. Ni la esplenectomía ni la pancreaticoesplenectomía distal mejoró la supervivencia con respecto a la gastrectomía total simple. La morbi-mortalidad fue mayor en los pacientes con cirugía más agresiva pero sin valor significativo. Conclusiones: la resección de bazo y/o páncreas distal en la gastrectomía total por cáncer gástrico avanzado conlleva un mayor número de ganglios aislados pero no influye en la supervivencia de los enfermos (AU)

Acute cholecystitis after colectomy for ulcerative colitis.

OBJECTIVE: Many different hepatobiliary diseases have been related with ulcerative colitis. In this retrospective study we tried to determine whether colectomy involves a greater risk of postoperative cholecystitis in these patients than in other patients who undergo colectomy. METHODS: From 1990 to 1998 a total of 53 subtotal or total colectomies were carried out in our hospital. 35.8% of the operations were done for ulcerative colitis (group I), 58% for cancer, 1.8% for aganglionic megacolon, and 3.6% for volvular disorders (group II). RESULTS: In group I, 21% of the patients required reoperation because of postoperative acute cholecystitis. In group II there were no cases of acute cholecystitis. Neither parenteral nutrition nor diabetes were influential factors. 94.5% of the patients in group I had emergency surgery, while emergency surgery was necessary in only 38.2% of the patients in group II. CONCLUSIONS: Acute cholecystitis after colectomy for ulcerative colitis, especially when the latter arises in an emergency situation, is a common complication. Although the sample was small, the results show that in view of the mortality from cholecystitis, prophylactic cholecystectomy may be necessary.

Colecistitis aguda en pacientes colectomizados por colitis ulcerosa / Acute cholecystitis after colectomy for ulcerative colitis

OBJETIVO: una gran variedad de enfermedades hepatobiliares han sido relacionadas con la colitis ulcerosa. En este estudio retrospectivo intentamos demostrar si en estos pacientes la colectomía conlleva un mayor riesgo de desencadenar colecistitis aguda en el postoperatorio que en otro tipo de pacientes colectomizados. PACIENTES: en el período de 1990 a 1998 hemos realizado en nuestro hospital un total de 53 colectomías subtotales o totales, de las cuales el 35,8 por ciento corresponden a colitis ulcerosa (grupo l), el 58,5 por ciento a cirugía neoplásica, el 1,8 por ciento a megacolon agangliónico y un 3,6 por ciento a patología volvular, completando estos tres últimos el grupo II. RESULTADOS: en el grupo 1 encontramos que el 21 por ciento tuvieron que ser reintervenidos por colecistitis aguda en el postoperatorio; por el contrario, en el grupo Il no se encontró ningún caso de colecistitis aguda. Ni el factor nutrición parenteral ni la diabetes fueron factores influyentes. El 94,5 por ciento de los pacientes del grupo I se operaron de forma urgente por sólo 38,2 por ciento de los enfermos del grupo II. CONCLUSIONES: la colecistitis aguda tras colectomía por colitis ulcerosa, sobre todo si se efectúa de forma urgente, es una complicación frecuente. Aunque la muestra es pequeña, los resultados indican, dada su mortalidad, que puede ser necesaria la colecistectomía profiláctica (AU)

Correlation between pressure changes and solid transport in the human left colon.

A study was made to correlate colonic pressure changes and solid transport in six volunteers with a left terminal colostomy. A minimally deformable solid (sham fecaloma) 2 cm in diameter was placed in the colonic lumen together with three perfusion catheters connected to the exterior via a semi-rigid rod to record movement and pressure changes. The results obtained indicate the presence of two types of segmentary motor phenomena: those that cause displacement and those that do not. Both reflect synchronous pressure increments, although the Displacing Motor Phenomena exhibit an aborally-directed pressure gradient in contrast to the orally orientated gradient in Non-displacing Motor Phenomena (P = 0.003). The Displacing Motor Phenomena cause rapid exit of the solid from the colostomy, but with a short mean trajectory (4.2 cm). Thus, segmentary contractions may generate forward propulsion provided that aborally-directed pressure gradients occur. A slow aboral displacement also occurs during periods of motor quiescence. This may be explained by tonic contractions undetected by conventional manometry.

[Correlation between pressure phenomena and transport of solids in the human left colon]. / Correlación entre fenómenos presivos y transporte de sólidos en el colon izquierdo humano.

The aim of this study was to correlate the pressure phenomena with the transport capacity of the left human colon. Studies were performed in 6 volunteers with a terminal left colostomy for low rectal neoplasia. Our method is original and it is based in the introduction into the colonic lumen of a 2 cm diameter litle deformable solid ballon (Sham-fecaloma) with 3 perfused catheters in the vicinity. This ballon is connected by a semirigid probe with a displacement measurer. Our results show that there are a two kinds of segmental motor phenomena: those which provoke a solid displacement (Displacement Motor Phenomenon-DMP) and those which do not (Non Displacement Motor Phenomenon-NDMP). Both are a pressure increase but the DMP show a pressure gradient in the aboral direction (P = 0.003) and the NDMP in the oral direction (P = 0.003). The DMP provoke a quickly solid output but with a short (X = 4.2 cm). In this way, we can say that segmental contractions are propulsive if in the biohydraulic system there is a pressure gradient in the distal (aboral) direction. If these gradients are not established or they are in oral direction there is no progression neither backward movements. During the periods without pressure activity also there is a slow displacement in the aboral direction (35%). These movements without pressure phenomena may be explained by the tonic contractions (stretching and shortening) not detectable by the conventional manometric systems.