Metástasis esplénica secundaria a carcinoma mamario / Splenic metastasis secondary to breast cancer

INTRODUCCIÓN: Los tumores de bazo primarios o metastásicos suponen menos del 0,96% de todas las metástasis. CASO CLÍNICO: Mujer de 80 años de edad intervenida 3,5 años antes por carcinoma ductal infiltrante con tratamiento neoadyuvante. Durante el seguimiento se encontró en PET-TAC recidiva tumoral en hilio esplénico. Se realizó esplenectomía laparoscópica que fue informada como adenocarcinoma de origen mamario. DISCUSIÓN: Las metástasis esplénicas son infrecuentes, suelen manifestarse como esplenomegalia asociadas a molestias abdominales. Los tumores esplénicos malignos presentan fiebre, síndrome constitucional, derrame pleural y caquexia. El diagnóstico de metástasis esplénicas suele realizarse durante el seguimiento oncológico con tomografía computarizada (TC). El tratamiento es la resección quirúrgica, aunque no existen protocolos para el tratamiento de las metástasis esplénicas. La supervivencia tras la esplenectomía por metástasis aumenta. CONCLUSIONES: La esplenectomía ante metástasis esplénicas es el tratamiento realizado habitualmente ante estos casos

INTRODUCTION: Both primitive and metastatic splenic tumours represent less than 0.96% of all metastases. CLINICAL CASE: We report the case of an 80-year-old woman, who had undergone surgery for invasive ductal carcinoma 3.5 years previously with neoadjuvant treatment. During follow-up, PET-CT revealed tumour recurrence in the splenic hilum. Laparoscopic splenectomy was performed, which was reported as an adenocarcinoma of mammary origin. DISCUSSION: Splenic metastases are infrequent, and usually present as splenomegaly associated with abdominal discomfort. The symptoms of malignant splenic lesions are fever, constitutional syndrome, pleural effusion, and cachexia. Diagnosis of splenic metastases is usually carried out during oncological follow-up with computed tomography. Treatment is surgical resection, although there are no protocols for the treatment of splenic metastases. Survival increases after splenectomy due to metastasis. CONCLUSIONS: Splenectomy for splenic metastases is the most common treatment in these cases

Variante anatómica sintomática de la duplicación de la vía biliar común tipo IV.

INTRODUCTION: Duplicity of the common bile duct is an unusual congenital disorder. CASE REPORT: A 80-year-old woman with duplication of the common bile duct with retrograde endoscopic cholangiopancreatography (ERCP) who did not resolve the symptoms. DISCUSSION: Our case is a variant of type IV to the classification of duplicity of the common bile duct. The magnetic resonance cholangiography and presurgical ERCP allows assessment of the bile ducts, their caliber, and assessment of abnormalities. The treatment before duplicity of the common bile duct will depend on the clinic and the type of opening of the accessory common bile duct. CONCLUSIONS: It is important to perform a pre-surgical study and during surgery with intrasurgical cholangiography.

INTRODUCCIÓN: La duplicidad del conducto biliar común es una alteración congénita insólita. CASO CLÍNICO: Mujer de 80 años con duplicación de la vía biliar común con colangiopancreatografías retrógradas endoscópicas (CPRE) que no solventan la clínica. DISCUSIÓN: Nuestro caso es una variante del tipo IV de la clasificación de duplicidad del conducto biliar común. La colangiopancreatografía por resonancia magnética y la CPRE prequirúrgica permiten valorar las vías biliares, su calibre y sus posibles anormalidades. El tratamiento dependerá de la clínica y del tipo de apertura del conducto biliar común accesorio. CONCLUSIONES: Es importante realizar un estudio prequirúrgico y durante la cirugía con colangiografía intraoperatoria.

Anatomy variant symptomatic of the duplication of the common bile duct type IV.

INTRODUCTION: Duplicity of the common bile duct (BCBD) is an unusual congenital disorder. CASE REPORT: A 80-year-old woman with duplication of the common bile duct with retrograde endoscopic cholangiopancreatography (ERCP) who did not resolve the symptoms. DISCUSSION: Our case is a variant of type IV to the classification of DCBC. The MR cholangiography and presurgical ERCP allows assessment of the bile ducts, their caliber, and assessment of abnormalities. The treatment before DCBC will depend on the clinic and the type of opening of the CBCA. CONCLUSIONS: It is important to perform a pre-surgical study and during surgery with CIO.

INTRODUCCIÓN: La duplicidad del conducto biliar común (DCBC) es una alteración congénita insólita. CASO CLÍNICO: Mujer de 80 años con duplicación de la vía biliar común con colangiopancreatografía retrógrada endoscópica (CPRE) que no dilucida la clínica. DISCUSIÓN: Este caso es una variante del tipo IV de la clasificación de DCBC. La colangiorresonancia y la CPRE prequirúrgica permiten valorar las vías biliares, su calibre y las anormalidades. El tratamiento depende de la clínica y el tipo de apertura del conducto biliar común accesorio. CONCLUSIONES: Es importante realizar estudio prequirúrgico y durante la operación con colangiografía intraoperatoria.

Clostridium difficile causante de síndrome de distrés respiratorio agudo tras pancreatectomía total / Acute respiratory distress syndrome due to clostridium difficile after total pancreatectomy

La diarrea nosocomial, que es la adquirida en el ámbito hospitalario, suele ser producida por Clostridium difficile. Sin embargo, en raras ocasiones puede ocasionar un síndrome de distrés respiratorio. Por ello, el diagnóstico de dicha patología es difícil si no se sospecha. El tratamiento se basa en el uso de antibiótico vía oral. Se expone el caso de una paciente de 66 años con dicha patología tras la realización de pancreatectomía total.

Nosocomial (hospital-acquired) diarrhea is usually caused by Clostridium difficile. On rare occasions it can cause acute respiratory distress syndrome (ARDS). Therefore, this condition should be suspected in order to make a diagnosis. Treatment is based on oral antibiotics. We report the case of a 66-year-old female patient with ARDS secondary to Clostridium difficile colitis after total pancreatectomy.

[Axillary hidrosadenitis due to Leishmania: Case report and literature review]. / Hidrosadenitis axilar por Leishmania: presentación de un caso y revisión de la bibliografía.

BACKGROUND: Hidradenitis is a disorder where abscesses appear after the infection of the apocrine sweat glands. It is located normally in the axillae, groin, perineal region, and the scalp. CLINICAL CASE: A 37 year old male was referred by his GP to the General Surgery Department with axillary hidradenitis which had evolved over the years. The physical examination shows signs of hidradenitis in both axillae, with a noticeable suppurative hidradenitis in the right armpit. En bloc extirpation was performed to remove the whole affected area. The pathological examination revealed a cutaneous leishmaniasis. Subsequently, fucidin was administered topically, as well as local infiltrations of one millilitre of Glucantime™. DISCUSSION: Hidradenitis normally appears in intertriginous areas and its manifestation is accompanied by recurrent subcutaneous nodules. The incidence rate in females is three times higher than in males. The isolated Hidradenitis caused by Leishmania is a rare condition presented only in endemic areas or in immunocompromised patients, such as HIV-infected patients. Clinical manifestations can be different and the diagnosis can be confirmed through haematoxylin-eosin. The main pattern displays a disorganised granuloma without necrosis. Systemic or topical treatment can be applied. Immunotherapy treatment is the most common. CONCLUSIONS: Hidradenitis caused by Leishmania in HIV-negative patients is a rare condition. Therefore it is important to perform a good histological diagnosis and to administer the right treatment.

[Abdominal compartment syndrome by tension pneumoperitoneum secondary to barotrauma. Presentation case]. / Síndrome compartimental abdominal por neumoperitoneo a tensión secundario a barotrauma. Presentación de un caso.

BACKGROUND: Pneumoperitoneum is defined as the existence of extraluminal air in the abdominal cavity. In 80-90% of cases is due to perforation of a hollow organ. However, in 10-15% of cases, it is nonsurgical pneumoperitoneum. OBJECTIVE: The case of a patient undergoing mechanical ventilation, developing abdominal compartment syndrome tension pneumoperitoneum is reported. CLINICAL CASE: Female, 75 years old asking for advise due to flu of long term duration. Given her respiratory instability, admission to the Intensive Care Unit is decided. It is then intubated and mechanically ventilated. Chest x-ray revealed a large pneumoperitoneum but no pneumothorax neither mediastinum; and due to the suspicion of viscera perforation with clinical instability secondary to intra-abdominal hypertension box, emergency surgery was decided. CONCLUSIONS: When discarded medical history as a cause of pneumoperitoneum, it is considered that ventilation is the most common cause. Benign idiopathic or nonsurgical pneumoperitoneum, can be be treated conservatively if the patient agrees. But if intraabdominal hypertension prevails, it can result in severe respiratory and hemodynamic deterioration, sometimes requiring abdominal decompression to immediately get lower abdominal pressure and thus improve hemodynamic function.