Decision-making process in long term acute cholecystitis.

OBJECTIVE: To demonstrate that the categorization of different therapeutic options is essential for the decision-making applied to clinical management. METHOD: This paper compares the usefulness of percutaneous echo-guided cholecystostomy as the first therapeutic option in acute long-term cholecystitis versus the exclusive surgical or clinical management. RESULT: We have analyzed the usefulness of different therapeutic options in a case of long term acute cholecystitis and we have obtained the following results: isolated intravenous antibiotic therapy (0.76), surgery (0.73) and echo-guided cholecystostomy (0.93). This last option has provided good clinical-radiological results. CONCLUSION: Decision trees are a good methodological option as support of surgical and non surgical therapeutic procedures.

Primary malignant fibrous histiocytoma of the jejunum: report of a case and review of subject.

We report a new case of primary malignant fibrous histiocytoma of the jejunum. Malignant fibrous histiocytoma (MFH) occurs most commonly in the extremities and trunk, but rarely in visceral organs. However, only eight cases of primary tumours involving the small intestine, including the present, have been described. This case report documents the appearance of malignant fibrous histiocytoma as a primary lesion of the intestinal wall in a patient with a 2-month history of dyspepsia, weight loss and unspecific abdominal pain. The final diagnosis was based on the pathological report of the surgical specimen. Emphasis is placed on the clinical signs, radiological studies and pathological findings. The literature on MFH of the jejunum is also reviewed. Malignant fibrous histiocytoma is considered an aggressive tumour, and the treatment of choice is complete surgical excision. Adjuvant chemotherapy or radiation is recommended mainly in those patients in whom there is vascular or lymphatic infiltration.

[Retroperitoneal ganglioneuroma. Report of a case]. / Ganglioneuroma retroperitoneal. A propósito de un caso.

OBJECTIVE: To report an additional case of retroperitoneal ganglioneuroma. METHODS/RESULTS: A case of retroperitoneal ganglioneuroma that had been incidentally discovered in a 27-year-old male during abdominal US evaluation is described. The diagnosis was based on the histopathological findings after US-guided biopsy. The clinical features and the findings of the complementary tests, which included radiological assessment, intravenous urography, CT and cavography are presented, as well as the pathology findings. Treatment was by complete surgical excision of the tumor. CONCLUSION: Treatment of ganglioneuroma is by surgery, since the diagnosis is generally based on the histopathological analysis of the surgical specimen. For those cases with a preoperative diagnosis, some authors advocate surgery for patients with clinical evidence of neuroblastoma or another pathology arising from this disease. Although infrequent, ganglioneuroma coexisting with neuroblastoma can occur. For this reason, complete excision of the tumor is preferred.

[Duodenal obstruction due to a biliary calculus (Bouveret's syndrome)]. / Obstrucción duodenal por cálculo biliar (síndrome de Bouveret).

We present a case of duodenal obstruction caused by biliary calculus (Bouveret's syndrome) an unusual cause of gallstone ileus. The clinical presentation simulated a pyloric stenosis, the gastrointestinal X-ray study being that which allowed us to establish diagnosis. Surgery was carried out only on the duodenal obstruction with successful results.