[Splenic infarction secondary to acute pancreatitis]. / Infarto esplénico secundario a pancreatitis aguda.

BACKGROUND AND OBJECTIVE: the close anatomic relationship of the pancreas with the splenic vessels and the spleen is responsible for splenic complications in the course of acute pancreatitis. Our objective was to report two cases of severe acute pancreatitis complicated by splenic infarction. PATIENTS: in a three-month period of time two patients were diagnosed with splenic infarction secondary to acute pancreatitis. In both cases splenic infarction diagnosis and follow-up were carried out using computed tomography. RESULTS: in the first case images clearly showed a narrowing of the splenic artery due to the inflammatory pancreatic condition. In the second case no involvement of the splenic vessels could be demonstrated, hence the only possible etiological explanation was a hypercoagulability state generated by pancreatitis. CONCLUSIONS: it would be advisable that splenic complications were added to the list of relevant extrapancreatic manifestations. CT is very useful for the diagnosis and follow-up of splenic complications arising in acute pancreatitis.

Infarto esplénico secundario a pancreatitis aguda / No disponible

Fundamento y objetivo: la estrecha relación anatómica delpáncreas con los vasos esplénicos y el bazo es responsable decomplicaciones esplénicas en el curso de la pancreatitis aguda. Elobjetivo es presentar dos casos clínicos de pancreatitis aguda graveque sufrieron infarto esplénico como complicación de la enfermedadpancreática.Pacientes, participantes: en un periodo de tres meses, dospacientes fueron diagnosticados de infarto esplénico secundario apancreatitis aguda. En ambos casos el diagnóstico y seguimientoevolutivo del infarto esplénico se hizo a través de tomografía axialcomputerizada.Resultados: en el primer paciente, las imágenes muestran deforma inequívoca la afectación de la arteria esplénica por el procesoinflamatorio pancreático. En el segundo, no se pudo demostrarafectación de los vasos esplénicos, por lo que la única posibleexplicación etiológica es un incremento de coagulabilidad intravascular.Conclusiones: sería recomendable añadir las complicacionesesplénicas al conjunto de complicaciones graves extrapancreáticasde la pancreatitis aguda. La tomografía axial computerizada esde gran utilidad para la detección y seguimiento de las complicacionesesplénicas de la pancreatitis aguda

Background and objective: the close anatomic relationshipof the pancreas with the splenic vessels and the spleen is responsiblefor splenic complications in the course of acute pancreatitis.Our objective was to report two cases of severe acute pancreatitiscomplicated by splenic infarction.Patients: in a three-month period of time two patients werediagnosed with splenic infarction secondary to acute pancreatitis.In both cases splenic infarction diagnosis and follow-up were carriedout using computed tomography.Results: in the first case images clearly showed a narrowing ofthe splenic artery due to the inflammatory pancreatic condition. Inthe second case no involvement of the splenic vessels could bedemonstrated, hence the only possible etiological explanation was ahypercoagulability state generated by pancreatitis.Conclusions: it would be advisable that splenic complicationswere added to the list of relevant extrapancreatic manifestations.CT is very useful for the diagnosis and follow-up of splenic complicationsarising in acute pancreatitis

[Nonelective colorectal surgery. Does age determine the results?]. / Cirugía colorrectal no electiva. Determina la edad los resultados?

OBJECTIVE: To evaluate the influence of age on the morbi-mortality after non-elective colorectal surgery. DESIGN: Retrospective analysis. SUBJECTS: 150 consecutive patients who underwent non-elective colorectal surgery between 1986 and 1992 [65 patients aged under 70 years (Group I)] and 85 patients aged 70 years or over (Group II)]. RESULTS: Using multiple regression analysis we have found: 1) Mortality is determined by the presence of associated risk factors (p < 0.001 tv = 4.11), the presence of peritonitis (p < 0.05 tv = 2.08) and by the admission-operation interval (p < 0.05 tv = 2.10). 2) Overall morbidity increases with age (p < 0.01, tv = 3.22) and the benign nature of the colorectal disease (p < 0.05, tv = 2.00). CONCLUSION: Age does not influence mortality in non-elective colorectal surgery even though it is a determinant risk factor in morbidity increase.

[Appendicular invagination]. / Invaginación apendicular.

Two cases of intussusception of the appendix are reported. The first case stands out for its rarity, corresponding exclusively to intussusception of appendicular mucosa. The second case was due to cystoadenoma of the appendix. Both cases were treated by right hemicolectomy due to the difficulty of diagnosing the condition.

[Idiopathic ulcer of the small intestine]. / Ulceración idiopática del intestino delgado.

Two cases of multiple idiopathic ulcers of the small intestine are reported, which were found in two aged patients with a significant history of vascular pathology. Despite this, the pathological examination of the surgical specimens could not demonstrate a vascular origin of such lesions.

[Digestive hemorrhage caused by vascular malformation (Rendu-Osler-Weber). A diagnostic and therapeutic challenge]. / Hemorragia digestiva por malformación vascular (Rendu-Osler-Weber). Un reto diagnóstico y terapéutico.

We present a case of gastrointestinal bleeding due to vascular malformation (Osler-Weber-Rendu disease), without cutaneous manifestations but with mucous manifestations and familiar and personal history of epistaxis. Until diagnosis, the patient underwent multiple radiologic and endoscopic tests and two surgical procedures. We would underline the diagnostic and therapeutic difficulty of recurrent gastrointestinal bleeding secondary to vascular malformation.

[Necrosis of the greater curvature following acute dilatation of the stomach]. / Necrosis de curvadura mayor secuente a dilatación aguda de estómago.

We present a case of gastric greater curvature necrosis after acute gastric dilatation. The lesion was treated by vertical resection of the greater curvature and the distal end of the gastric fundus. This is the first case described in the Spanish medical literature.

[Anisakiasis as a cause of acute appendicitis and rheumatologic picture: the first case in medical literature]. / Anisakiasis como causa de apendicitis aguda y cuadro reumatológico: primer caso en la literatura médica.

We report a case of acute abdomen due to appendicular lumen occlusion by anisakis larvae. This is the first case of human anisakiasis known in Spain, and the first case of acute appendicitis, in the medical World literature, produced by this nemathode. The association of myalgias and arthralgias stands out, being in this aspect the second case found the in medical litterature.