[Present state in the surgical treatment of acute cecal diverticulitis]. / Estado actual del tratamiento quirúrgico en la diverticulitis cecal aguda.

BACKGROUND: Cecal acute diverticulitis is a rare disease with symptoms similar to acute appendicitis and is therefore difficult to diagnose. OBJECTIVES: To evaluate therapeutical conduct according to clinical for ms of presentation and the intraoperative findings. LOCATION: Emergency Service of Clinical National Hospital. U.N.C. (Cordoba National University), and the ABC group. DESIGN: Retrospective observation. MATERIALS AND METHODS: Twenty-four patients with cecal diverticulitis were treated surgically, of which seventeen were men and seven were women with an average age of 47 years. The first group was formed with 16 patients and the second with 8. All patients presented abdominal pain, fever, nausea and vomiting when they were admitted, but one showed enterorrhagia and 2 abdominal distention and ileus. Physical examination produced pain and tenderness in RLQ, but in 6 peritoneum was not involved and in 4 a tumor was palpable in that region. Two patients, had a perforating acute abdominal condition. RESULTS: Sixteen right hemicolectomies were performed. In the remaining eight a cecostomy was decided. One patient died due to TEPA (Acute pulmonary thromboembolism). Abdominal wall abscesses appeared in six patients, and in four of them an incisional middle hernia appeared in postoperative period. CONCLUSIONS: We consider that in those patients presenting serious problems in deciding whether the inflammatory condition was benign or malignant, or when perforated cecal diverticulum with vascular compromise and subsequent cecal wall necrosis has been suspected, we believe that the resection is the best treatment.

Estado actual del tratamiento quirúrgico en la diverticulitis cecal aguda / Present state in the surgical treatment of acute cecal diverticulitis

BACKGROUND: Cecal acute diverticulitis is a rare disease with symptoms similar to acute appendicitis and is therefore difficult to diagnose. OBJECTIVES: To evaluate therapeutical conduct according to clinical for ms of presentation and the intraoperative findings. LOCATION: Emergency Service of Clinical National Hospital. U.N.C. (Cordoba National University), and the ABC group. DESIGN: Retrospective observation. MATERIALS AND METHODS: Twenty-four patients with cecal diverticulitis were treated surgically, of which seventeen were men and seven were women with an average age of 47 years. The first group was formed with 16 patients and the second with 8. All patients presented abdominal pain, fever, nausea and vomiting when they were admitted, but one showed enterorrhagia and 2 abdominal distention and ileus. Physical examination produced pain and tenderness in RLQ, but in 6 peritoneum was not involved and in 4 a tumor was palpable in that region. Two patients, had a perforating acute abdominal condition. RESULTS: Sixteen right hemicolectomies were performed. In the remaining eight a cecostomy was decided. One patient died due to TEPA (Acute pulmonary thromboembolism). Abdominal wall abscesses appeared in six patients, and in four of them an incisional middle hernia appeared in postoperative period. CONCLUSIONS: We consider that in those patients presenting serious problems in deciding whether the inflammatory condition was benign or malignant, or when perforated cecal diverticulum with vascular compromise and subsequent cecal wall necrosis has been suspected, we believe that the resection is the best treatment.

Estado actual del tratamiento quirúrgico en la diverticulitis cecal aguda / Present state in the surgical treatment of acute cecal diverticulitis

BACKGROUND: Cecal acute diverticulitis is a rare disease with symptoms similar to acute appendicitis and is therefore difficult to diagnose. OBJECTIVES: To evaluate therapeutical conduct according to clinical for ms of presentation and the intraoperative findings. LOCATION: Emergency Service of Clinical National Hospital. U.N.C. (Cordoba National University), and the ABC group. DESIGN: Retrospective observation. MATERIALS AND METHODS: Twenty-four patients with cecal diverticulitis were treated surgically, of which seventeen were men and seven were women with an average age of 47 years. The first group was formed with 16 patients and the second with 8. All patients presented abdominal pain, fever, nausea and vomiting when they were admitted, but one showed enterorrhagia and 2 abdominal distention and ileus. Physical examination produced pain and tenderness in RLQ, but in 6 peritoneum was not involved and in 4 a tumor was palpable in that region. Two patients, had a perforating acute abdominal condition. RESULTS: Sixteen right hemicolectomies were performed. In the remaining eight a cecostomy was decided. One patient died due to TEPA (Acute pulmonary thromboembolism). Abdominal wall abscesses appeared in six patients, and in four of them an incisional middle hernia appeared in postoperative period. CONCLUSIONS: We consider that in those patients presenting serious problems in deciding whether the inflammatory condition was benign or malignant, or when perforated cecal diverticulum with vascular compromise and subsequent cecal wall necrosis has been suspected, we believe that the resection is the best treatment. (AU)

Estado actual del tratamiento quirúrgico en la diverticulitis cecal aguda. / [Present state in the surgical treatment of acute cecal diverticulitis]

BACKGROUND: Cecal acute diverticulitis is a rare disease with symptoms similar to acute appendicitis and is therefore difficult to diagnose. OBJECTIVES: To evaluate therapeutical conduct according to clinical for ms of presentation and the intraoperative findings. LOCATION: Emergency Service of Clinical National Hospital. U.N.C. (Cordoba National University), and the ABC group. DESIGN: Retrospective observation. MATERIALS AND METHODS: Twenty-four patients with cecal diverticulitis were treated surgically, of which seventeen were men and seven were women with an average age of 47 years. The first group was formed with 16 patients and the second with 8. All patients presented abdominal pain, fever, nausea and vomiting when they were admitted, but one showed enterorrhagia and 2 abdominal distention and ileus. Physical examination produced pain and tenderness in RLQ, but in 6 peritoneum was not involved and in 4 a tumor was palpable in that region. Two patients, had a perforating acute abdominal condition. RESULTS: Sixteen right hemicolectomies were performed. In the remaining eight a cecostomy was decided. One patient died due to TEPA (Acute pulmonary thromboembolism). Abdominal wall abscesses appeared in six patients, and in four of them an incisional middle hernia appeared in postoperative period. CONCLUSIONS: We consider that in those patients presenting serious problems in deciding whether the inflammatory condition was benign or malignant, or when perforated cecal diverticulum with vascular compromise and subsequent cecal wall necrosis has been suspected, we believe that the resection is the best treatment.

Diverticulitis cecal aguda: nuestra conducta terapéutica / Cecal acute diverticulitis: our experience

Antecedentes: La diverticulitis cecal aguda es una enfermedad poco frecuente que simula el cuadro de una apendicitis aguda, y que presenta problemas en el diagnóstico. Objetivo: Evaluación de la conducta terapéutica de acuerdo a las formas clínicas de presentación y los hallazgos intraoperatorios. Lugar de aplicación: Servicio de Guardia del Hospital Nacional de Clínicas U.N.C. y grupo ABC. Diseño: Retrospectivo observacional. Método: Han sido tratados quirúrgicamente veinte pacientes con diverticulitis cecal aguda. Catorce eran del sexo masculino con una edad promedio de 48,2 años. El síntoma principal fue el dolor abdominal especialmente localizado en f.i.d., pero en 2 oportunidades se presentó un cuadro de abdomen agudo perforativo. Los pacientes fueron intervenidos quirúrgicamente con el diagnóstico de apendicitis aguda en nueve, neoplasia de ciego en tres, perforación de víscera hueca en dos, diverticulitis cecal en tres y los restantes sin sospecha diagnóstica. Resultados: Se practicaron catorce hemicolectomías derechas. En los seis restantes se efectuó una cecostomía. De éstos últimos, uno falleció en el postoperatorio por un T.E.P.A. Cinco pacientes presentaron un absceso de pared, tres de ellos tenían una hemicolectomía derecha y dos una cecostomía. En el postoperatorio alejado, tres pacientes presentaron una eventración mediana. Conclusiones: Consideramos que en aquellos pacientes con serias dificultades para decidir la malignidad o benignidad del proceso, aún siendo jóvenes, o cuando estamos frente a la probabilidad de un divertículo cecal perforado con compromiso inflamatorio o infeccioso del ciego, creemos que el mejor tratamiento es la hemicolectomía derecha

Diverticulitis cecal aguda: nuestra conducta terapéutica / Cecal acute diverticulitis: our experience

Antecedentes: La diverticulitis cecal aguda es una enfermedad poco frecuente que simula el cuadro de una apendicitis aguda, y que presenta problemas en el diagnóstico. Objetivo: Evaluación de la conducta terapéutica de acuerdo a las formas clínicas de presentación y los hallazgos intraoperatorios. Lugar de aplicación: Servicio de Guardia del Hospital Nacional de Clínicas U.N.C. y grupo ABC. Diseño: Retrospectivo observacional. Método: Han sido tratados quirúrgicamente veinte pacientes con diverticulitis cecal aguda. Catorce eran del sexo masculino con una edad promedio de 48,2 años. El síntoma principal fue el dolor abdominal especialmente localizado en f.i.d., pero en 2 oportunidades se presentó un cuadro de abdomen agudo perforativo. Los pacientes fueron intervenidos quirúrgicamente con el diagnóstico de apendicitis aguda en nueve, neoplasia de ciego en tres, perforación de víscera hueca en dos, diverticulitis cecal en tres y los restantes sin sospecha diagnóstica. Resultados: Se practicaron catorce hemicolectomías derechas. En los seis restantes se efectuó una cecostomía. De éstos últimos, uno falleció en el postoperatorio por un T.E.P.A. Cinco pacientes presentaron un absceso de pared, tres de ellos tenían una hemicolectomía derecha y dos una cecostomía. En el postoperatorio alejado, tres pacientes presentaron una eventración mediana. Conclusiones: Consideramos que en aquellos pacientes con serias dificultades para decidir la malignidad o benignidad del proceso, aún siendo jóvenes, o cuando estamos frente a la probabilidad de un divertículo cecal perforado con compromiso inflamatorio o infeccioso del ciego, creemos que el mejor tratamiento es la hemicolectomía derecha (AU)

Colostomia transversal muco-cutanea temporaria: contribucion tecnica / Temporary muco-cutaneous transversal colostomy: technical contribution

Se presentan y se analizan los resultados obtenidos en 49 pacientes en quienes se practicó una colostomía transversal muco-cutánea primaria temporaria por distintas patologías. Se destacan aspectos técnicos que a nuestro entender explican los excelentes resultados obtenidos. Dentro de los mismos llamamos la atención sobre el emplazamiento de la colostomía divulsionando el músculo recto, la ausencia total de fijación colo-parietal y el temprano de la varilla de vidrio todo lo cual a nuestro entender simplifica enormemente el cierre de este tipo de ostomías, permitiendo el uso sistemático de la anestesia local. Este hecho permite que esta cirugía pueda praticarse en forma ambulatoria y la disminución de los costos operativos

Colostomia transversal muco-cutanea temporaria: contribucion tecnica / Temporary muco-cutaneous transversal colostomy: technical contribution

Se presentan y se analizan los resultados obtenidos en 49 pacientes en quienes se practicó una colostomía transversal muco-cutánea primaria temporaria por distintas patologías. Se destacan aspectos técnicos que a nuestro entender explican los excelentes resultados obtenidos. Dentro de los mismos llamamos la atención sobre el emplazamiento de la colostomía divulsionando el músculo recto, la ausencia total de fijación colo-parietal y el temprano de la varilla de vidrio todo lo cual a nuestro entender simplifica enormemente el cierre de este tipo de ostomías, permitiendo el uso sistemático de la anestesia local. Este hecho permite que esta cirugía pueda praticarse en forma ambulatoria y la disminución de los costos operativos (AU)