Divertículo de Meckel como causa de hemorragia digestiva baja en el adulto / No disponible

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Hemorragia digestiva baja y sindrome de Klippel-Trénaunay / Lower gastrointestinal bleeding and Klippel-Trénaunay syndrome

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Tratamiento de la hernia de spiegel con mallas de polipropileno. Nuevo enfoque terapéutico / Treatment of Spigelian hernia using polypropylene mesh. A new therapeutic approach

La hernia de Spiegel es una hernia ventrolateral, rara y generalmente mal diagnosticada. Su incidencia de presentación complicada es alta y en nuestra serie ha sido del 55,5 por ciento. La exploración complementaria ideal por su accesibilidad y fiabilidad es la ecografía. Aunque la reparación anatómica se considera suficiente por su mínima incidencia de recidivas, creemos aconsejable la utilización de mallas de polipropileno. Presentamos una amplia serie de 9 casos tratados en nuestro hospital en 16 años (AU)

Leiomioblastoma primario de epiplón. Aportación de un caso y revisión bibliográfica / Primary leiomyoblastoma of the omentum. A case report and a review of the literature

Presentamos un caso de leiomioblastoma primario de epiplón intervernido en nuestro servicio. Estos tumores son neoplasias que derivan del músculo liso y afectan fundamentalmente al estómago. La aparición como tumores primarios de epiplón es extremadamente rara. En la bibliografía médica mundial solamente se han publicado 14 casos. Aportamos un nuevo caso y realizamos una revisión bibliográfica discutiendo su clínica, diagnóstico, criterios histológicos de malignidad y tratamiento (AU)

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[Rupture of the thoracic esophagus by compressed air]. / Estallido del esófago torácico por aire comprimido.

A case of rupture of the oesophagus due to the accidental passage of compressed air through the mouth is reported. Two longitudinal lacerations were present in the thoracic oesophagus; they were treated by radical oesophagectomy cervical oesophagostomy and gastrostomy for feeding. Reconstruction was made by retrosternal coloplasty. The course of the patient was uneventful.

[Rupture of an aneurysm of the hepatic artery proper and acute cholecystitis]. / Rotura de aneurisma de arteria hepática propia y colecistitis aguda.

The authors report the case of a hepatic artery aneurysm which ruptured into the peritoneal cavity in the course of acute, gangrenous cholecystitis, which was treated successfully. The clinical aspects of the case, its evolution and the histological study, which appeared to indicate that adjacent inflammation was the cause of the rupture, are discussed. Treatment of hepatic artery aneurysms is conditioned to a great degree by the gravity of the onset, and in most cases ligature is the only feasible procedure. Other forms of treatment may be possible when the aneurysm is intrahepatically located or it is diagnosed before rupture.

[Intraoperative cholangiography: its value in simple cholelithiasis]. / Colangiografía intraoperatoria: valor en la colelitiasis simple.

The present study evaluates the benefits of systematic intraoperative cholangiography (CIO) in 144 patients without preoperative suspicion of choledocholithiasis. Eleven (7.6%) of the intraoperative cholangiographies were considered abnormal by the surgeon and the presence of choledocholithiasis (3/11, 27%) was confirmed in only three cases. Pathology of the main bile duct that had been unsuspected preoperatively was found in only 2% (3/144). We conclude that routine intraoperative cholangiography of patients without preoperative suspicion of choledocholithiasis increases the cost of surgery, prolongs operative time, exposes the patient to radiation and sometimes yields false positives (5%) that lead to unnecessary exploration of the choledochus, which is accompanied by a potential increase in morbidity and a real prolongation of the postoperative hospital stay.

Results of surgery for cancer of the rectum with sphincter conservation. A randomized study on instrumental versus manual anastomosis.

We present results obtained in a group of patients included in a randomized study from 1979 to 1985 for evaluation of mechanical anastomosis after anterior resection for cancer of the rectum; 113 patients were operated on, 58 with manual and 55 with instrumental anastomosis. There was no significant difference in morbidity or mortality between the groups. The incidence of anastomotic fistulas (clinical and subclinical) was similar (12% vs. 15%), although a large number of tumors in the lower third of rectum was treated by manual anastomosis. Concerning late complications, more stenoses, although mainly asymptomatic, were detected after instrumental anastomosis (15% vs. 6%). The incidence of local recurrence within 3 years was quite similar in the 2 groups (about 15%), and usually occurred in patients who already had generalized disease.