Tratamiento quirúrgico de la obstrucción intestinal aguda por cáncer colorrectal. experiencia reciente en 1994-1998 / Surgical treatment of acute intestinal obstruction due to colorectal cancer: recent experience occurring between 1994 and 1998

Introducción. Estudiamos prospectivamente la morbimortalidad de la cirugía urgente por obstrucción intestinal secundaria a cáncer colorrectal en 5 años (1994-1998).Pacientes y método. Incluimos a todos los pacientes tratados en este período, seleccionando la técnica de acuerdo con el riesgo del paciente y el estado del colon. Resultados. Fueron intervenidos de urgencia por obstrucción completa 60 pacientes (un 17 por ciento de todos los cánceres colorrectales intervenidos en el servicio) de los que 12 fueron de colon derecho, 45 de colon transverso e izquierdo y tres de recto. Se realizaron 50 resecciones de colon: 44 con anastomosis primaria (colectomía derecha, izquierda, segmentaria, resección anterior de recto, y colectomía subtotal) y 6 intervenciones de Hartmann, así como 9 colostomías de descarga o derivación ileocólica y una tumorectomía. Se realizó lavado anterógrado del colon en 11 de 25 pacientes candidatos a ello por resección de tumores de colon izquierdo sin colostomía. La mortalidad operatoria fue de 3 pacientes (5 por ciento) y la morbilidad del 45 por ciento, con una estancia media de 17 días. Se produjeron 2 fístulas anastomóticas que no precisaron reintervención. Conclusiones. Seleccionando la técnica quirúrgica según el estado del paciente se pueden obtener buenos resultados de morbimortalidad en estos enfermos, a pesar de realizar resección y anastomosis, sin colostomía, en la mayoría de los casos (AU)

Repair of ventral hernias with expanded polytetrafluoroethylene patch.

BACKGROUND: Operations for large and recurrent abdominal hernias have a high associated recurrence rate, although it is lower when prosthetic material is used. Expanded polytetrafluoroethylene (ePTFE) seems to be the best tolerated prosthetic material in surgery. METHODS: A series of 45 ventral hernias repaired using ePTFE for closure or reinforcement of the herniorrhaphy has been evaluated prospectively. Thirty-six were midline incisional hernias and nine were transverse or pararectal ventral hernias. There were 13 recurrent ventral hernias and three defects were operated as an emergency procedure. The patch was sutured to the anterior aponeurosis with a running non-absorbable suture. Some other kind of intra-abdominal procedure was undertaken in 12 cases. RESULTS: ePTFE was well tolerated. Complications occurred in five patients. Major complications were found in three patients: cutaneous necrosis requiring a myocutaneous flap; and infection of the prosthesis (primary, and secondary to enterocutaneous fistula due to diverticulitis, both requiring removal of the patch). Mean follow-up was 39 months and hernia recurrence occurred in only one patient. CONCLUSION: This clinical experience shows that ePTFE is a very reliable prosthetic material for the repair of abdominal wall hernias.

Giant megalo-ureter and duplex kidney in an asymptomatic adult.

An abdominal mass was palpated in an asymptomatic adult during a routine medical check-up. Ultrasonography and computed tomography scan diagnosed a simple renal cyst, a mesenteric cyst and a seminal vesicle cyst. At laparotomy a complete ureteral duplication and a giant ectopic megalo-ureter were diagnosed. Other complications were ruled out in the follow-up. Ureterectomy without heminephrectomy was performed and the patient remains asymptomatic 5 years after surgery.

[Technique and function of an experimental multiorgan transplant model in pigs]. / Técnica y función de un modelo experimental de trasplante multivisceral en el cerdo.

En bloc transplantation of the liver, duodenum and pancreas has been successful in humans for the treatment of tumors requiring exenteration of the upper abdomen. We have developed an experimental model in 40 pigs of en bloc transplantation of the liver, duodenum and pancreas. The surgical technique for organ harvesting and preservation has been correct as the early graft function was excellent. We describe in detail the surgical technique in the recipient animal, the anesthetic model and the autopsy findings. Liver function was excellent and endocrine pancreatic function was normal within 8 hours after transplantation. Absorption and insulin-secreting response was normal in a few animals studied with an oral glucose overdose and with the intravenous glucagon test.

Giant jejunoileal duplication: prenatal diagnosis and complete excision without intestinal resection.

A 7-week-old child presented to the pediatrician after persistent vomiting and abdominal distension developed. Intestinal dilatation had been detected in utero. Emergency ultrasonography showed only small bowel dilatation. There were no signs of intestinal obstruction; however, complete intestinal malrotation was demonstrated by an upper gastrointestinal series and barium enema. Intestinal duplication was also suspected, and emergency laparotomy was performed. A 70-cm-long jejunoileal duplication was found and successfully dissected free from the normal small bowel and excised without intestinal resection-anastomosis. The authors describe this unique case and the surgical technique for the treatment of small bowel duplications.

[Malignant fibrous histiocytoma of the pancreas]. / Histiocitomas fibrosos malignos de páncreas.

Malignant fibrous histiocytoma (MFH), a frequent sarcoma in retroperitoneal mesenchimal tissues, has also been reported, although in a few cases, in digestive viscera. We present a case of a primary MFH of the pancreas in a 37-year-old male, treated with a 90% distal pancreatectomy, plus external and intraoperative radiotherapy over the tumoral bed, and polychemotherapy. Response to treatment was poor, with early local recurrence, liver and bone metastases and a survival of 7 months. Only 4 other cases of MFH of the pancreas have been reported. We analyze these 5 cases: they have been usually diagnosed in young adults, with vague symptoms and large tumoral masses without jaundice. Local recurrence seems to be frequent; they develop liver metastases rather than lung metastases. Even when they are resectable, the anatomical relations of the pancreas with vital vascular structures make broad resection difficult, and local recurrences frequent. Analysis of these five reported cases of MFH of the pancreas, allows to expect a local recurrence rate higher than 50% and a 5-year-survival rate lower than 30% due to distant metastases. Only radiotherapy seems to play a role as an adjuvant treatment after surgery for pancreas and other retroperitoneal sarcoma as it significantly increases survival.