Emergency laparoscopic intervention for fibrous band-induced intestinal obstruction and ischemia associated with Meckel's diverticulum: A case report.

INTRODUCTION AND IMPORTANCE: Meckel's diverticulum (MD) is a common congenital malformation of the digestive tract, often asymptomatic but occasionally leading to complications such as bowel obstruction and ischemia. Timely recognition and treatment of these complications are crucial. PRESENTATION OF CASE: We report the case of a 27-year-old male patient presenting with complete intestinal obstruction and ischemia of the ileum due to a fibrous band associated with MD. The patient presented with severe abdominal pain lasting for 10 h. Physical examination revealed a distended abdomen, antalgic position, and positive decompression. Laboratory tests showed leukocytosis and elevated lactic acid levels. Computed tomography revealed dilated small bowel loops with signs of intestinal ischemia. Emergency exploratory laparoscopy confirmed a complete ileum with ischemia and identified a fibrous band originating from the mesentery, strangulating the affected loop. The fibrous band was dissected and sectioned, confirming its association with the MD, which was resected with subsequent recovery of peristalsis and vascularization of the compromised segment. The patient had a favorable postoperative recovery without complications. DISCUSSION: MD is a rare cause of bowel obstruction, requiring a high index of suspicion for diagnosis. Despite the challenges in preoperative identification, early surgical intervention is crucial to prevent adverse outcomes. This case emphasizes the importance of promptly recognizing and managing MD-related complications to optimize patient outcomes. CONCLUSION: MD should be considered in cases of acute occlusive abdomen, despite its infrequent occurrence. Early diagnosis and timely surgical intervention are essential to minimize morbidity and mortality associated with MD-related complications.

Right-sided acute diverticulitis in the West: experience at a university hospital in Argentina.

PURPOSE: In the West, diverticular disease is located mainly in the left colon. However, it can also present in the right colon, with an incidence of 1% to 2% in Caucasians. The purpose of this study was to describe our experience in right-sided acute diverticulitis (RD). METHODS: In this retrospective study, 410 patients with acute diverticulitis treated from 2013 to 2020 were included in a university hospital in Córdoba, Argentina. Colonic diverticulitis was stratified into 2 groups; RD and left-sided acute diverticulitis. Demographic and clinical variables, laboratory and imaging findings, type of treatment, follow-up, and recurrence were analyzed. RESULTS: Sixteen patients (3.9%) with RD were identified; 62.5% were male and the mean age was 40.7±11.7 years. A total of 81.3% were Caucasian and 18.7% Native American. Significant differences were found between both groups of diverticulitis; patients with RD were younger (P=0.001), with lower BMI (P=0.01), comorbidity rate (P=0.01), Charlson comorbidity index (P=0.02), hospital stay (P=0.01), severity according to the Hinchey classification (P=0.001) and had a lower recurrence rate (P=0.001). There were no significant differences in sex (P=0.95), duration of pain until admission (P=0.05), laboratory findings (P=0.23) and treatment (P=0.34). CONCLUSION: Conservative treatment predominated in RD, with a lower rate of complications and recurrences, providing data that support conservative therapy as initial treatment in RD in our environment.

Neutrophil-to-lymphocyte ratio as a predictor of complicated acute diverticulitis: A retrospective cohort study.

INTRODUCTION: Currently, the debate on the usefulness of Neutrophil to Lymphocyte Ratio (NLR) as a predictor of complications in acute diverticulitis (AD) remains open, especially, the relation to the severity of the disease, the clinical impact, and the necessity of minimally invasive or emergency surgical procedures. On the other hand, its diagnostic efficacy has not been studied even in our field. The objective of the present study was to determine the utility and diagnostic precision of NLR in complicated acute diverticulitis (cAD). METHODS: Descriptive, retrospective cohort and analytical study. Patients older than 18 years with a diagnosis of AD were included, from 2013 to 2018. Demographic variables, days of hospitalization, leukocyte count, neutrophils, lymphocytes, ESR, CRP, and NLR were analyzed. The sensitivity and specificity for the diagnosis of cAD were determined using ROC curves. RESULTS: 325 patients were included. Of these 196 (60%) were men. The median age was 52 years. A total of 30 (9%) were categorized as cAD. The patients with cAD presented mean values in the leukocyte count (14.02 ± 4.49 × 109/l; p < 0.01), CRP (119.60 ± 87.67; p < 0.01) and NLR (7.61 ± 4.03; p < 0.01). An NLR cutoff value ≥ 4.2 was identified as the most appropriate to distinguish cAD, with a sensitivity of 80%, a specificity of 64%, NPV of 96%, and PPV of 18%. CONCLUSION: NLR is a predictive marker of cAD, with a cut-off point of 4.2 being the best diagnostic approach.

Neutrophil-to-lymphocyte ratio vs C-reactive protein as early predictors of anastomotic leakage after colorectal surgery: A retrospective cohort study.

INTRODUCTION: Colorectal surgery (CRS) is associated with high morbidity rates, being anastomotic leakage (AL) one of the most serious complications with an incidence as high as 15%, accounting for up to a third of mortality in these procedures. The identification of pre-clinical markers may allow an early diagnosis and a timely intervention. The objective of the present study was to compare the performance of neutrophil-to-lymphocyte ratio (NLR) vs C-reactive protein (CRP) as early predictors of AL in CRS. METHODS: A retrospectively analyzed consecutive patients who underwent a colorectal surgery with anastomosis from June 2015 to April 2019. Receiver-operating characteristic (ROC) curves were used to find the cutoff points with the best diagnostic performance of AL. RESULTS: A total of 116 patients were included. From 43 patients (37%) who developed a total of 63 complications, 9 (7.76%) presented with an AL with a median of 8 days (range: 5-9). No significant differences were found for NLR between patients with vs without AL. In contrast, median CRP was significantly higher in patients who subsequently presented with AL, both on day 4 (164 vs 64, p = 0.04) and 5 (94 vs 44, p < 0.001) after surgery. The best predictive performance through ROC curves was found on postoperative day 5, with a CRP value of >54 mg/dL (AUC: 0.81, Sensitivity: 89%, Specificity: 61%). CONCLUSIONS: CRP appears superior to NLR as an early predictor of AL following CRS. The best diagnostic performance was obtained on postoperative day 5 with a cutoff value of >54 mg/dL.

Metachronous extragastrointestinal stromal tumor (EGIST) in utero: Report of an unusual case.

INTRODUCTION: The gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor in the digestive tract. Currently, GIST is the name given to CD117 positive mesenchymal tumors, primary of the digestive tract, mesentery, and retroperitoneum. Nevertheless, they have been reported in the mesentery, omentum, gallbladder, bladder wall, and few cases in the uterus; known as extragastrointestinal stromal tumors (EGIST). PRESENTATION OF CASE: Seventy-six-year-old woman with a history of the third recurrence of pelvic tumor located in the uterus initially diagnosed as uterine leiomyosarcoma. CT and MRI showed a tumor in the uterine corpus of approximately 10 cm. It was decided to perform the surgical rescue. The immunohistochemistry and anatomic pathology report revealed a tumor compatible with a uterine EGIST. It was decided to perform adjuvant treatment with imatinib. Currently, the patient continues to be disease-free 20 months after the surgery. DISCUSSION: For years, GIST has often been confused with leiomyosarcoma, given that they are histologically almost indistinguishable. The IHC analysis for KIT (CD117) has become essential in the GIST diagnosis. On the other hand, stromal tumors arising outside the gastrointestinal tract are rare (5%), which have a histological and biological behavior similar to that of GISTs. CONCLUSION: EGISTs are extremely rare and often incidentally detected. Currently, evidence about this location is scarce. According to the literature, this is the first case of uterine EGIST with a metachronous presentation.

Hemicolectomía derecha laparoscópica con abordaje suprapúbico: una técnica novedosa para el tratamiento del cáncer de colon / Suprapubic laparoscopic right hemicolectomy: a novel technique for the treatment of colon cancer

Antecedentes: la hemicolectomía derecha laparoscópica con abordaje suprapúbico (HDLS) y empleo de tecnología robótica o laparoscópica de incisión única ha sido recientemente informada. La utilización de la técnica estándar multipuerto en HDLS no se ha descripto previamente. Material y métodos: entre enero y agosto del año 2018 fueron intervenidos 4 pacientes, 3 mujeres y 1 hombre, con mediana de 64 años de edad y diagnóstico de adenocarcinoma de colon derecho. Resultados: el procedimiento se realizó exitosamente en todos los pacientes, con una mediana de tiempo operatorio de 210 minutos (r:170-240). Ningún paciente tuvo complicaciones y fueron dados de alta en una mediana de 4 días (r:3-5). Todas las piezas quirúrgicas tuvieron márgenes negativos y un recuento ganglionar > 12 ganglios. A 7, 5, 4 y 2 meses del seguimiento, los pacientes se hallan vivos y libres de enfermedad. Conclusión: la técnica de HDLS multipuerto es una alternativa sencilla, factible y segura para el tratamiento del cáncer de colon en pacientes seleccionados, con un resultado funcional, estético y oncológico favorable.

Background: The suprapubic approach for laparoscopic right hemicolectomy has been reported with robotic surgery or single incision laparoscopy. The use of the suprapubic approach for standard multiport laparoscopic right hemicolectomy has not been previously described. Material and methods: Between January and September 2018, four consecutive patients (three women and one man; median age: 64 years) with right-sided colon cancer underwent laparoscopic right hemicolectomy using the suprapubic multiport approach. Results: The procedure was successful in all the patients and mean operative time was 210 minutes (IQR: 170-240). There were no complications and were discharged on postoperative day 4 (IQR: 3-5). All the surgical specimens had negative margins and lymph node count was > 12 lymph nodes. All the patients are alive and free from disease at 7, 5, 4 and 2 months of follow-up. Conclusion: The suprapubic approach for standard multiport laparoscopic right hemicolectomy is an easy, feasible and safe alternative for the treatment of colon cancer in selected patients, with a favorable functional, esthetic and oncological result.

Obstrucción duodenal por páncreas anular / Duodenal obstructon due to anular pancreas

El páncreas anular (PA) es una anomalía congénita infrecuente. Se caracteriza por la presencia de tejido pancreático ectópico alrededor del duodeno y puede estar asociado a obstrucción duodenal. Se presenta un paciente con cuadro de dolor abdominal y vómitos de 12 días de evolución. El laboratorio mostró elevación de lipasa en sangre. La tomografia computarizada de abdomen evidenció estómago y primera porción duodenal distendidos, en relación con una imagen en anillo de 5 cm de diámetro ubicada entre la cabeza del páncreas y la segunda porción del duodeno, sugestiva de PA. Ante la mala respuesta al tratamiento médico con reposo digestivo, sonda nasogástrica y nutrición parenteral, se decide conducta quirúrgica confirmando el diagnóstico de obstrucción duodenal por un PA. Se realiza gastroyeyunostomía en Y de Roux con buena evolución posquirúrgica. El PA puede manifestarse clínicamente como una obstrucción duodenal. Los casos con mala respuesta al tratamiento conservador requieren conducta quirúrgica para confirmar el diagnóstico y resolver la oclusión.

Annular pancreas (AP) is a rare congenital anomaly, characterized by ectopic pancreatic tissue surroun-ding the duodenum, that may associate with duodenal obstructon. We present a patent complaining of 12 days of abdominal pain and vomitis. Blood testis showed hyper-lipasemia. Computed tomography scan demonstrated stomach and frst duodenal porton distended in relaton to a 5 cm diameter image resembling a ring between the pancreatic head and the second porton of the duodenum, a well known characteristic of AP. Following a lack of clinical response to medical treatment, surgery was performed confirming a duodenal obstructon due to AP. Roux-en-Y gastrojejunostomy was done, with good postoperative outicome. Annular pancreas may present as a duodenal obstructon. For these cases, we suggest surgical treatment to confirm diagnosis and resolve the obstructon in cases with negative clinical response to conservative treatment.

Massive gastrointestinal bleeding in AIDS patients secondary to histoplasma and cytomegalovirus infection.

INTRODUCTION: The Cytomegalovirus (CMV) is a virus that affects the host and remains latent. When cellular immunity is suppressed, the virus is reactivated and can cause an asymptomatic or devastating infection in immunosuppressed patients. On the other hand, Histoplasmosis is typically a respiratory condition. However, in immunosuppressed patients, it may be found in unusual locations, as in the case of an intestinal condition. In some cases, this can be fatal. Small intestine CMV location is extremely rare. CASE PRESENTATION: 40-year-old man with AIDS presenting secondary massive lower gastrointestinal bleeding (MLGB) symptoms and ulcer granulomatous injuries located in the proximal ileum produced by the association of CMV and histoplasmosis. CONCLUSION: Lower gastrointestinal bleeding diagnosis and treatment pose a challenge, considering the intestine extension and difficulties for its exploration. On the other hand, the association between Histoplasmosis and CMV as a massive gastrointestinal bleeding cause has not been described. There is no bibliography on the matter.

[Ligasure vs conventional diathermy in excisional haemorrhoidectomy: a retrospective study of a single center]. / Hemorroidectomía con Ligasure vs diatermia convencional: análisis retrospectivo monocéntrico.

INTRODUCTION: Hemorrhoids are a prolapse of vasculopathic structures that cushion the anal canal and haemorrhoidectomy is the most effective treatment for grades III and IV In this retrospective study we compare the outcome after haemorrhoidectomy with Ligasure or with conventional diathermy. METHODS: From June 2005 to March 2009 we analyzed 75 patients affected by hemorrhoids (grades III and IV) who underwent haemorrhoidectomy in the University Hospital Arnau de Vilanova in Lleida. We evaluated the technique, the age and the sex, and compared the post-operative hospital stay, the post-operative pain and the complications with each of the techniques. RESULTS: We used Ligasure technique in 49 patients (65%) and conventional diathermy technique in 26 (35%). The mean age was 50.3 years. There was no significant difference in both postoperative length ofstay, with an average of2.13 days (P = 0.60), and postoperative pain in the first 15 days (P = 0.275). On the contrary, we found a significant difference in the rate of postoperative complications (P = 0.032) and in the post-surgical pain at one month (P = 0.03). CONCLUSIONS: In our experience the Ligasure haemorrhoidectomy has shown to have fewer complications and post-operative pain when compared with conventional diathermy haemorrhoidectomy.

Hemorroidectomía con Ligasure vs diatermia convencional: análisis retrospectivo monocéntrico / [Ligasure vs conventional diathermy in excisional haemorrhoidectomy: a retrospective study of a single center].

INTRODUCTION: Hemorrhoids are a prolapse of vasculopathic structures that cushion the anal canal and haemorrhoidectomy is the most effective treatment for grades III and IV In this retrospective study we compare the outcome after haemorrhoidectomy with Ligasure or with conventional diathermy. METHODS: From June 2005 to March 2009 we analyzed 75 patients affected by hemorrhoids (grades III and IV) who underwent haemorrhoidectomy in the University Hospital Arnau de Vilanova in Lleida. We evaluated the technique, the age and the sex, and compared the post-operative hospital stay, the post-operative pain and the complications with each of the techniques. RESULTS: We used Ligasure technique in 49 patients (65

) and conventional diathermy technique in 26 (35

). The mean age was 50.3 years. There was no significant difference in both postoperative length ofstay, with an average of2.13 days (P = 0.60), and postoperative pain in the first 15 days (P = 0.275). On the contrary, we found a significant difference in the rate of postoperative complications (P = 0.032) and in the post-surgical pain at one month (P = 0.03). CONCLUSIONS: In our experience the Ligasure haemorrhoidectomy has shown to have fewer complications and post-operative pain when compared with conventional diathermy haemorrhoidectomy.

Hemorroidectomía con Ligasure vs diatermia convencional: análisis retrospectivo monocéntrico. / [Ligasure vs conventional diathermy in excisional haemorrhoidectomy: a retrospective study of a single center].

INTRODUCTION: Hemorrhoids are a prolapse of vasculopathic structures that cushion the anal canal and haemorrhoidectomy is the most effective treatment for grades III and IV In this retrospective study we compare the outcome after haemorrhoidectomy with Ligasure or with conventional diathermy. METHODS: From June 2005 to March 2009 we analyzed 75 patients affected by hemorrhoids (grades III and IV) who underwent haemorrhoidectomy in the University Hospital Arnau de Vilanova in Lleida. We evaluated the technique, the age and the sex, and compared the post-operative hospital stay, the post-operative pain and the complications with each of the techniques. RESULTS: We used Ligasure technique in 49 patients (65

) and conventional diathermy technique in 26 (35

). The mean age was 50.3 years. There was no significant difference in both postoperative length ofstay, with an average of2.13 days (P = 0.60), and postoperative pain in the first 15 days (P = 0.275). On the contrary, we found a significant difference in the rate of postoperative complications (P = 0.032) and in the post-surgical pain at one month (P = 0.03). CONCLUSIONS: In our experience the Ligasure haemorrhoidectomy has shown to have fewer complications and post-operative pain when compared with conventional diathermy haemorrhoidectomy.

Análisis prospectivo de hernioplastías umbilicales en adultos / Umbilical mesh hernia repair: experience in 60 patients

Background: There is a lack of consensus on the best technique umbilical for hernia repair and several options have been use. The systematic use of prostheses is currently recommended. Aim: To evaluate the treatment of umbilical hernias with a mesh and assess the placement of a prosthetic cone as an alternative. Materials and Methods: We evaluated prospectively the surgical procedures in 60 patients with umbilical hernia aged 30 to 86 years (40 females). We excluded surgical procedures in which a mesh was not used and those performed as emergencies. When the hernia ring was of less than 3 cm in diameter, a polypropylene cone or plug was placed. A preperitoneal mesh technique was used when rings were larger. Results: Forty five patients had a ring of less than 3 cm. Among these, a polypropylene cone or plug was placed in 30 and 15 patients, respectively. A mesh was placed in the remaining patients. As surgical complications, one patient had a hematoma (1.6 percent) and three patients had seromas (5 percent). There were no surgical site infections or hernia relapse. Conclusions: Umbilical hernia repair using with polypropylene prostheses is a safe and easy to implement technique.

Introducción: A pesar de su alta prevalencia, la hernia umbilical no ha sido tan estudiada en la bibliografía como otros defectos hemiarios. No hay consenso en la mejor técnica para su reparación y varias opciones han sido utilizadas para el tratamiento de esta enfermedad. Actualmente se recomienda la utilización sistemática de prótesis para su reparación. Objetivo: Evaluar el tratamiento de la hernia umbilical con mallas y valorar la colocación de prótesis en forma de cono como alternativa en la reparación. Diseño: Prospectivo, observacional. Lugar de Aplicación: Clínica Universitaria Privada. Material y Métodos: Evaluamos 60 hernioplastías entre el Iº de enero del 2005 y Iº de agosto del 2007. Se excluyeron herniorrafias y cirugías urgentes. En hernias con anillo menor a 3 cm de diámetro colocamos plug o cono de polipropileno; anillos mayores a 3 cm se repararon con malla preperitoneal. Resultados: Edad promedio 50 a±os, sexo femenino 40 pacientes, 56 hernias primarias. Encontramos 45 pacientes con anillo menor a 3 cm, colocándose en 30 cono de polipropileno y en 15 plug. El resto de los pacientes tenían anillos de más de 3 cm y se les colocó una malla preperitoneal. Complicaciones: 1 hematoma (1,6 por ciento), 3 seromas (5 por ciento). No hubo infecciones del sitio quirúrgico ni recidivas. Conclusiones: La reparación de una hernia umbilical con prótesis de polipropileno es una técnica segura y fácil de aplicar. La colocación de cono de polipropileno, es una técnica que debe ser considerada como alternativa del tapón en hernias con anillo menor a 3 cm.

Fibromatosis mesentérica: reporte de un caso / Mesenteric fibromatosis: report of one case

El Tumor Desmolde o Fibromatosis Mesentérica es una enfermedad infrecuente en la que se reconocen 2 formas: una esporádica y otra asociada a poliposis familiar adenomatosa. De etiología desconocida, su diagnóstico preoperatorio es dificultoso y el tratamiento de elección es quirúrgico. Se pone en consideración un caso de esta entidad en un varón joven, que se presentó con dolor abdominal y fiebre. Se realizó cirugía resectiva agresiva, otorgándose el alta a los 18 días de la intervención.

Desmoid tumor or mesenteric fibromatosis is an uncommon disease with to variants: a sporadic form and one associated to familial adenomatous polyposis. Surgery is the treatment of choice. We report a 45 years old male presenting with abdominal pain and fever. An abdominal ultrasound informed the presence of a mass in the periumblical area. An Abdominal CAT sean showed a 13 cm diameter solid mass located in the left upper quadrant. The patient was operated and that mass is excised, requiring also a hemicolectomy, excision of the fourth portion of the duodenum and cholecystectomy. The pathology report of the excised tumor informs a mesenteric fibromatosis. The patient was discharged at the 18th postoperative day.

Paniculitis mesentérica asociada con absceso intraabdominal / Mesenteric panniculitis with intraabdominal abcess: report of one case

La paniculitis mesentérica es una enfermedad inflamatoria del tejido adiposo del mesenterio, de presentación infrecuente y que se caracteriza, por el engrasamiento, endurecimiento y nodularidad del mismo. Se pone en consideración un caso clínico en un varón joven, con una forma de presentación poco común que requirió de laparotomía exploradora para realizar el diagnóstico y tratamiento.

We report a 28 years old obese male presenting with abdominal pain of increasing intensity lasting 15 days. In the last days, diarrhea and fever appeared. On abdominal examination a 8 cm painful mass was palpated. An abdominal ultrasound showed an anechoic mass in the epigastrium. An abdominal CAT sean showed an inflammatory mass that involves the small bowel. The patient is subjected to a percutaneous needle aspiration, obtaining 50 mi of a purulent fluid. Due to persistence of fever, the patient was operated finding an inflammation that involved the mesentery and the great omentum and covering abscess. The pathologic study of the surgical piece reported a unspecific nodular mesenteric panniculitis.

Íleo biliar en paciente colecistectomizado: caso clínico / Biliary ileus: report of one case

El íleo biliar es una complicación rara de la litiasis biliar que ocurre en apenas el 0,1 por ciento de estos pacientes y supone el 1-6% del total de las oclusiones intestinales mecánicas del adulto. Se presenta un caso clínico de íleo biliar de localización colónica en un paciente de 45 años de edad, colecistectomizado hace 4 años, que ingresa a nuestra institución con el diagnóstico de oclusión intestinal intermitente. Tras un tratamiento inicial conservador con buena evolución durante las primeras 48 h, presenta posteriormente un agravamiento de su cuadro clínico. Se decide laparotomía exploradora con resección de colon sigmoides y anastomosis término-terminal con colostomía transversa de derivación. En el examen de la pieza se objetiva cálculo biliar de 3 cm de diámetro impactado en el colon sigmoides. Debido a lo excepcional de esta patología y los pocos reportes internacionales existentes en pacientes colecistectomizados, nuestro objetivo es poner en consideración este caso clínico y su correspondiente revisión de la literatura.

Biliary ileus is an uncommon complication of biliary stones and accounts for 1 to 6% of all mechanical intestinal obstructions in the adult. We report a 45 years oíd male, subjected to a cholecystectomy four years earlier, admitted with the diagnosis of intermittent intestinal obstruction. Due to a bad evolution with medical treatment, he was subjected to an exploratory laparotomy and sigmoid colon was excised. A latero-terminal anastomosis and a transverse colostomy were done. The examination of the surgical piece showed the presence of a 3 cm diameter biliary stone impacted in the sigmoid colon.