[Prognostic value of the presence of pericolic air bubbles detected by computed tomography in acute diverticulitis]. / Valor pronóstico de la presencia de burbujas de aire libre pericólico detectadas por tomografía computada en diverticulitis aguda.

BACKGROUND: Diverticular disease is common in industrialized countries. Computed tomography has been used as the preferred diagnostic method; although different scales haves been described to classify the disease, none of them encompass total disease aspects and behaviour. OBJETIVE: To analyze the patients with acute diverticulitis confirmed by computed tomography at the ABC Medical Center Campus Observatorio from January 1, 2010 to December 31, 2012, in whom pericolic free air in the form of bubbles was identified by computed tomography and if this finding can be considered as a prognostic factor for the disease. METHODS: A series of 124 patients was analyzed who had acute diverticulitis confirmed by computed tomography, in order to identify the presence of pericolic bubbles. RESULTS: Of the 124 patients, 29 presented with pericolic bubbles detected by computed tomography; of these, 62.1% had localized peritoneal signs at the time of the initial assessment, (P<.001); leukocytosis (13.33 vs 11.16, P<.001) and band count (0.97 vs 0.48, P<.001) was higher in this group. Patients with pericolonic bubbles had a longer hospital stay (5.5days vs 4.3days, P<.001) and started and tolerated liquids later (4.24days vs. 3.02days, P<.001) than the group of patients without this finding. CONCLUSIONS: The presence of pericolic bubbles in patients with acute diverticulitis can be related to a more aggressive course of the disease.

[Modification to stapled mucosectomy technique with PPH. Experience of a surgical group]. / Modificación a la técnica de mucosectomía con engrapadora PPH. Experiencia de un grupo quirúrgico.

BACKGROUND: Haemorrhoidal disease is a common disorder. Surgical treatment is indicated in cases of advanced disease. However, postoperative pain, operative time, and technical difficulties have prompted the search for new procedures and improve the existing ones. A modification is proposed to the technique of PPH (Procedure for Prolapse and Haemorrhoids) stapled haemorrhoidectomy that facilitates and standardises the procedure without altering its benefits. OBJECTIVE: To describe the postoperative results and short-term evolution of patients with internal haemorrhoidal disease, who underwent stapled mucosectomy with PPH with a modified technique. MATERIAL AND METHODS: This is a retrospective review of 35 patients who underwent stapled haemorrhoidectomy with a modified technique by the same surgical team. RESULTS: Twenty-five patients were men (71%) and 10 women (29%). Sixteen patients had grade III internal haemorrhoid disease (46%) and 19 grade IV (54%). The mean operative time was 31 minutes. Six patients had acute urinary retention. There were no cases of severe pain, bleeding, haematoma, stenosis, incontinence, thrombosis, or re-operation. The median hospital stay was 1 day. CONCLUSIONS: The proposed modification of PPH haemorrhoidectomy is performed with greater technical ease without increased morbidity, preserving the advantages of the original technique.

Características clinicopatológicas de pacientes con tumores retrorrectales en el Hospital General de México / Clinicopathological characteristics of patients with retrorectal tumors at the General Hospital of Mexico

Objetivo: Identificar la prevalencia de tumores retrorrectales y describir sus características clinicopatológicas. Sede: Hospital General de México ''Eduardo Liceaga''. Diseño: Estudio retrospectivo, observacional, descriptivo y transversal. Análisis estadístico: Porcentajes como medida de resumen para variables cualitativas. Pacientes y métodos: Revisión de expedientes clínicos para identificar a los pacientes con diagnóstico de tumor retrorrectal desde al año 2000 al 2012. Las variables a evaluar fueron: edad, sexo, síntomas, tratamiento, reporte histopatológico final y prevalencia de la enfermedad. Resultados: De un total de 28,452 consultas de primera vez, de enero de 2000 a diciembre de 2012 se identificaron 6 pacientes con tumores retrorrectales, cuatro de ellos fueron hombres (66.6%); la edad promedio fue de 57.8 años (46-69). Los principales síntomas fueron: estreñimiento en seis (100%), tenesmo en cinco (83.3%), dolor anal en tres (50%), dolor lumbar en tres (50%), rectorragia en dos (33.3%) y pérdida de peso en dos (33.3%). La duración promedio de los síntomas fue de 21.8 meses. Todos los pacientes fueron operados; tres por abordaje abdominal (50%) y tres por abordaje posterior (50%); el sangrado transoperatorio, los días de estancia hospitalaria y las complicaciones fueron mayores en el grupo de abordaje abdominal. El tumor más frecuente fue el cordoma en cuatro pacientes (66.6%) seguido de sarcoma pleomórfico en un paciente y tumor del estroma gastrointestinal en un paciente. El seguimiento fue de 4.6 meses (4 a 6). Conclusiones: Los tumores retrorrectales son una enfermedad con baja prevalencia y características clínicas heterogéneas por los tipos de tumores que se pueden localizar en esta región. El tumor maligno más frecuente fue el cordoma.

Objective: To identify the prevalence of retrorectal tumors and to describe their clinicopathological characteristics. Setting: General Hospital of Mexico ''Eduardo Liceaga'' (third level health care center). Design: Retrospective, observational descriptive, cross-sectional study. Statistical analysis: Percentages as summary measure for qualitative variables. Patients and methods: Review of clinical files to identify those patients with a diagnosis of retrorectal tumor in the period from 2000 to 2012. Analyzed variables were: age, sex, symptoms, treatment, final histopathological report, and prevalence of the disease. Results: From a total of 28,452 first-time consultations from January 2000 to December 2012, six patients were identified with retrorectal tumors, four of them were men (66-6%); average age was of 57.8 years (46-69). The main symptoms were constipation in six (110%), tenesmus in five (83.3%), anal pain in three (50%), lumbar pain in three (50%), rectorrhagia in two (33.3%), and weight loss in two (33.3%). Average length of symptoms was of 21.8 months. All patients were operated; three through an abdominal approach (50%) and three through a posterior approach (50%), transoperative bleeding, longer in-hospital stay and minor complications were encountered in the abdominal approach group. The most frequent tumor was the chordoma in four patients (66.6%) followed by a pleomorphic sarcoma in one patient, and a tumor of the gastrointestinal stroma in one patient. Follow-up was of 4.6 months (4 to 6). Conclusions: Retrorectal tumors have a low prevalence presenting with heterogeneous clinical characteristics due to the type of tumors that can occur in this region. The most frequent malignant tumor was the chordoma.