[Pancreatic phlegmon: a potentially fatal form of acute pancreatitis]. / Flemón pancreático: una forma potencialmente fatal de pancreatitis aguda.

AIM: To report the clinical characteristics of a group of patients with pancreatic phlegmon (PF) seen at the Instituto Nacional de la Nutricion Salvador Zubiran, Mexico City. MATERIAL AND METHODS: We reviewed all the cases of acute pancreatitis hospitalized from January 1981 to December 1989. The diagnosis of pancreatic phlegmon was established when the CT scan showed a solid mass in the pancreas and peripancreatic region with more than 20 Hounsfield units without liquid collections or a fibrous capsule. We analyzed clinical, biochemical, and radiological data. RESULTS: Acute pancreatitis was diagnosed in 132 patients. In 14 a pancreatic phlegmon was observed (10.6%). Twelve were men; the mean age was 44.7 years. In six cases acute pancreatitis was secondary to alcohol abuse and in four to gallstones. Abdominal pain was present in all patients. Ten had leucocitosis and seven fever and/or jaundice. An abdominal mass was detected in three cases. The severity of pancreatitis was graded according to our institutional criteria as mild (0-2 signs) or severe (3-5 signs). In 10 patients AP was graded as mild: no mortality was observed in this group but three presented complications (two liquid collections and one an abscess). The four patients with severe pancreatitis presented complications and three died (one abscess, two multiorgan failure). Five patients were operated on. In three an abscess was drained. CONCLUSIONS: Pancreatic phlegmon is a potentially severe form of AP. All patients who died presented, in addition to PF, clinical criteria of severe pancreatitis.

[Intestinal endometriosis: a report of 3 cases]. / Endometriosis intestinal: reporte de tres casos.

Between 1978-1990 three patients were surgically treated with different kinds of intestinal endometriosis at the Instituto Nacional de la Nutrición Salvador Zubirán in Mexico City. The first patient had acute appendicitis without dysmenorrhea or pelvic endometriosis detected during laparotomy. The second patient had incomplete intestinal obstruction related to ileo-cecal involvement. She clinically had dysmenorrhea and were found multiple endometriosis implants during operation. After the ileocecal excision suppressive hormonal therapy was given, the patient developed side effects, then surgical resection of the uterus and ovaries were performed. The third patient was a 48-year-old woman who developed a progressive lower intestinal obstruction. She underwent a three-time operative procedure. Lower sigmoid resection was performed and no endometriosis implants or metastatic disease were found. Postoperative course was uneventful in all patients, no mucosal involvement or associated carcinoma was found. Surgical resection of the affected portions of the bowel was highly effective in each case.

Tuberculosis of the pancreas.

A 67-year-old woman was admitted to the hospital because of intermittent pain in the upper left quadrant of the abdomen. Ultrasound and computed tomography (CT) scan revealed a mass in the body of the pancreas, and angiography demonstrated encasement of the celiac trunk and splenic vein thrombosis. She was thought to have a pancreatic carcinoma and was surgically explored to obtain tissue for diagnosis. A hard and irregular tumor was found, and biopsies revealed granulomatous inflammation with caseous necrosis. The final diagnosis was tuberculosis, and treatment with rifampicin, isoniazid, and ethambutol was undertaken. One year later the patient is asymptomatic and new CT scan shows disappearance of the pancreatic mass.