Ruptura de hematoma hepático secundario a terapia neural / Rupture of hepatic hematoma secondary to neural therapy

Objetivo: determinar si la terapia neural es una opción de tratamiento que pueda ser utilizada sin la aparición de efectos adversos. Presentación del caso: se presenta y analiza el caso de una paciente que ingresó a urgencias por dolor abdominal generalizado diagnosticándose hematoma hepático y realizándosele una revisión de la literatura científica. Resultados: se procedió a efectuar laparotomía con cirugía de control de daños, obteniendo resultados satisfactorios con egreso hospitalario sin complicaciones agregadas. Conclusiones: la terapia neural es un tratamiento del cual no se tiene suficiente evidencia científica que avale su seguridad en los pacientes

Objective: to determine whether neural therapy is a treatment option which can be used without the occurrence of adverse effects. Case report: we present and analyze the case of a female patient who was admitted to the emergency room for generalized abdominal pain. A hepatic hematoma was diagnosed, and a review of the scientific literature was conducted. Results: a laparotomy with damage control surgery was performed, obtaining satisfactory outcomes, with hospital discharge without any added complications. Conclusions: neural therapy is a treatment for which there is not enough scientific evidence to support its safety in patients

Workplace bullying and sexual harassment among general surgery residents in Colombia / Acoso laboral y sexual en residentes de cirugía general en Colombia

Introduction. Workplace bullying and sexual harassment are concerns among general surgery residents in Colombia. Objective. To explore the prevalence and impact of workplace bullying and sexual harassment incidents among general surgery residents in Colombia. Materials and methods. This nationwide study was conducted in 2020. Residents selfrated their exposure to workplace bullying and to sexual harassment in the forms of gender harassment, unwanted sexual attention, and sexual coercion. We analyzed demographic variables, perpetrator's characteristics, and differences between victims and non-victims. Results. The study included 302 residents. It found that 49% of general surgery residents in Colombia suffered from workplace bullying and 14.9% experienced sexual harassment. The main forms of sexual harassment were gender harassment (47%) and unwanted sexual attention (47%). Women reported significantly higher rates of being sexually harassed. Surgeons were the main perpetrators of sexual harassment. Conclusions. Workplace bullying and sexual harassment are frequent events in general surgery residency in Colombia. These findings suggest the need for interventions to improve the educational culture of surgical departments and decrease the prevalence of these behaviors.

Introducción. El acoso laboral y el acoso sexual son preocupaciones en la formación quirúrgica. Objetivo. Exploramos la magnitud de estos problemas entre los residentes de cirugía general en Colombia. Materiales y métodos. Se realizó un estudio nacional en junio de 2020. Los residentes autoevaluaron su exposición a la intimidación y el acoso sexual en forma de acoso de género, atención sexual no deseada y coerción sexual. Se analizaron variables demográficas y perpetradores entre víctimas y no víctimas. Resultados. Se incluyeron un total de 302 residentes. Las tasas de acoso laboral y sexual fueron del 49% y 14,9%, respectivamente. Las principales formas de acoso sexual correspondieron al acoso de género (47%) y la atención sexual no deseada (47%). El acoso sexual fue significativamente mayor entre las mujeres. Los cirujanos fueron los principales perpetradores. Conclusiones. El acoso laboral y el acoso sexual son frecuentes en la formación quirúrgica en Colombia. Estos hallazgos conducen a intervenciones para mejorar la cultura educativa de los departamentos quirúrgicos para disminuir la prevalencia de estos comportamientos.

Herida por asta de toro en el medio rural. Importancia de la preparación en cirugía taurina: Reporte de caso / Bull Horn Wounds in Rural Areas Importance of Preparation in Bullfighting Surgery: Case Report / Lesão com chifre de touro em zonas rurais. Importância da preparação em cirurgia tauromáquica: Relato de caso

Introducción. El trauma abdominal penetrante causado por embestida de asta de toro representa menos del 3%. Son heridas que deben ser consideradas sucias, y la primera causa de muerte por este tipo de trauma es el shock hipovolémico. Presentación de caso. Se presenta el caso de un hombre de 60 años con trauma abdominal penetrante por asta de toro en flanco izquierdo e hipogastrio de 18x8 cm de extensión, con evisceración aguda traumática. Fue llevado a laparotomía exploratoria, donde no se evidenciaron lesiones de órganos sólidos ni de vísceras huecas. El paciente evolucionó sin complicaciones. Discusión. Las heridas por asta de toro dadas sus características son consideradas sucias y alcanzan hasta un 50% de infección. Dentro de su manejo inicial se deben incluir antibióticos y abordajes quirúrgicos, según cada caso. Conclusión. El trauma abdominal penetrante causado por embestida de asta de toro es un mecanismo poco frecuente; sin embargo, los cirujanos deben estar entrenados para tratar o no de manera quirúrgica a este tipo de pacientes.

Introduction. Penetrating abdominal trauma caused by bull horn ramming represents less than 3%. These are wounds that should be considered dirty, and the leading cause of death from this type of trauma is hypovolemic shock. Case Presentation. A 60-year-old man with penetrating abdominal trauma by bull horn in the left flank and hypogastrium, 18x8 cm in extension, with acute traumatic evisceration. He was taken to exploratory laparotomy, where no solid organ or hollow viscera lesions were evidenced. The patient evolved without complications. Discussion. Given their characteristics, bull horn wounds are considered dirty and have an infection rate of up to 50%. Initial management should include antibiotics and surgical approaches, according to each case. Conclusion. Penetrating abdominal trauma caused by bull horn ramming is an infrequent mechanism; however, surgeons must be trained to treat or not to treat this type of patient surgically.

Introdução. O trauma abdominal penetrante causado pelo impulso de chifre de touro representa menos de 3%. São feridas que devem ser consideradas sujas, e a principal causa de morte por esse tipo de trauma é o choque hipovolêmico. Apresentação do caso. Homem de 60 anos com trauma abdominal penetrante por chifre de touro no flanco esquerdo e hipogástrio, 18x8 cm de extensão, com evisceração traumática aguda. Foi encaminado para laparotomia exploratória, onde não foram encontradas lesões em órgãos sólidos ou vísceras ocas. A paciente evoluiu sem complicações. Discussão. Devido às suas características, as feridas de chifre de touro são consideradas sujas e atingem até 50% de infecção. Dentro de seu manejo inicial, antibióticos e abordagens cirúrgicas devem ser incluídos, de acordo com cada caso. Conclusão. Trauma abdominal penetrante causado pelo impulso de chifre de touro é um mecanismo raro; no entanto, os cirurgiões devem ser treinados para tratar esses tipos de pacientes cirurgicamente ou não.

Laparoscopic Hartmann's reversal has better clinical outcomes compared to open surgery: An international multicenter cohort study involving 502 patients.

Background: Hartmann's procedure (HP) is used in surgical emergencies such as colonic perforation and colonic obstruction. "Temporary" colostomy performed during HP is not always reversed in part due to potential morbidity and mortality associated with reversal. There are several contributing factors for patients requiring a permanent colostomy following HP. Therefore, there is still some discussion about which technique to use. The aim of this study was to evaluate perioperative variables of patients undergoing Hartmann's reversal using a laparoscopic and open approach. Methods: The multicenter retrospective cohort study was done between January 2009 and December 2019 at 14 institutions globally. Patients who underwent Hartmann's reversal laparoscopic (LS) and open (OS) approaches were evaluated and compared. Sociodemographic, preoperative, intraoperative variables, and surgical outcomes were analyzed. The main outcomes evaluated were 30-day mortality, length of stay, complications, and postoperative outcomes. Results: Five hundred and two patients (264 in the LS and 238 in the OS group) were included. The most prevalent sex was male in 53.7%, the most common indication was complicated diverticular disease in 69.9%, and 85% were American Society of Anesthesiologist (ASA) II-III. Intraoperative complications were noted in 5.3% and 3.4% in the LS and OS groups, respectively. Small bowel injuries were the most common intraoperative injury in 8.3%, with a higher incidence in the OS group compared with the LS group (12.2% vs. 4.9%, p < 0.5). Inadvertent injuries were more common in the small bowel (3%) in the LS group. A total of 17.2% in the OS versus 13.3% in the LS group required intensive care unit (ICU) admission (p = 0.2). The most frequent postoperative complication was ileus (12.6% in OS vs. 9.8% in LS group, p = 0.4)). Reintervention was required mainly in the OS group (15.5% vs. 5.3% in LS group, p < 0.5); mortality rate was 1%. Conclusions: Laparoscopic Hartmann's reversal is safe and feasible, associated with superior clinical outcomes compared with open surgery.

Tratamiento laparoscópico de úlcera duodenal perforada mediante parche de Graham en un paciente pediátrico / Laparoscopic treatment of perforated duodenal ulcer using a Graham patch in a pediatric patient

Introducción. La úlcera duodenal perforada es una entidad de etiología no clara que rara vez ocurre en la población pediátrica. Generalmente se diagnostica de manera intraoperatoria y el tratamiento ideal incluye el uso del parche de epiplón o de ser necesario, la resección quirúrgica. Caso clínico. Se presenta un paciente de 12 años con abdomen agudo y diagnóstico tomográfico prequirúrgico de úlcera duodenal perforada, tratado por vía laparoscópica con drenaje de peritonitis y parche de Graham. La evolución y el seguimiento posterior fueron adecuados. Discusión. La úlcera duodenal perforada es una entidad multifactorial, en la que se ha implicado el Helicobacter pylori. El diagnóstico preoperatorio es un reto y el tratamiento debe ser quirúrgico. Conclusiones. Cuando se logra establecer el diagnóstico preoperatorio, se puede realizar un abordaje laparoscópico y el uso del parche de Graham cuando las úlceras son menores de dos centímetros.

Introduction. Perforated duodenal ulcer is an entity of unclear etiology that rarely occurs in the pediatric population. It is usually diagnosed intraoperatively and the ideal treatment includes the use of the omentum patch or, if necessary, surgical resection. Clinical case. A 12-year-old patient with acute abdomen and preoperative tomographic diagnosis of perforated duodenal ulcer, treated laparoscopically with peritonitis drainage and Graham patch is presented. The evolution and subsequent follow-up were adequate. Discussion. Perforated duodenal ulcer is a multifactorial entity, in which Helicobacter pylori has been implicated. Preoperative diagnosis is challenging and treatment must be surgical. Conclusions. When the preoperative diagnosis is established, a laparoscopic approach and the use of the Graham patch can be performed when the ulcers are less than two centimeters.

Divertículos duodenales periampulares y el fallo técnico-terapéutico durante colangiopancreatografía retrógrada endoscópica (CPRE) / Periampullary duodenal diverticula and technical-therapeutic failure during endoscopic retrograde cholangiopancreatography (ERCP)

Resumen Introducción y objetivos: los divertículos duodenales periampulares (DDP) son infrecuentes y su hallazgo es incidental. Además, se clasifican en tres tipos según Boix por la cercanía a la ampolla mayor. El objetivo de este estudio fue realizar una descripción de nuestra experiencia con esta anomalía anatómica y demostrar la forma en que esto afecta la tasa de éxito técnica y terapéutica del procedimiento. Material y métodos: se realizó un estudio de corte transversal, con recolección de datos de forma retrospectiva en un período de 5 años de pacientes con divertículos periampulares duodenales. Se evaluó el fracaso terapéutico, complicaciones y dificultad de canulación de la vía biliar. Resultados: se evaluó un total de 214 pacientes, con una relación mujer-hombre de 2,15:1. La distribución de los sujetos por tipo de DDP fue: tipo 1 (29,9 %), tipo 2 (51,9 %) y tipo 3 (18,2 %). La indicación más frecuente de CPRE fue los cálculos del conducto biliar común en un 53,3 %. El DDP tipo 1 presentó mayor dificultad de canulación (11,6 %) y falla terapéutica (28,12 %). Conclusión: la presencia de DDP durante la CPRE se asocia con una mayor falla técnica (falla en la canulación) y falla terapéutica (persistencia de la obstrucción biliar). Además, estas fallas aumentan considerablemente cuando se trata de una papila intradiverticular tipo 1 de la clasificación según Boix. Por lo anterior, se sugiere que los procedimientos endoscópicos biliares en estas condiciones sean realizados por endoscopistas con gran experiencia con el fin de minimizar la probabilidad de falla técnica y terapéutica, y las complicaciones asociadas.

Abstract Introduction and objectives: Periampullary duodenal diverticula are infrequent, and their finding is incidental. They are classified into three types according to Boix due to their proximity to the larger blister. This study aims to describe the experience with this anatomical abnormality and to demonstrate how this affects the technical and therapeutic success rate of the procedure. Materials y Methods: A cross-sectional study was conducted, with retrospective data collection over a 5-year period of patients with periampullary duodenal diverticula. Therapeutic failure, complications, and difficulty of cannulation of the bile duct were evaluated. Results: A total of 214 patients were evaluated, with a female-male ratio of 2.15: 1. The distribution of the subjects by type of PDD was: type 1 (29.9%), type 2 (51.9%), and type 3 (18.2%). The most frequent indication for ERCP was common bile duct stones in 53.3%. Type 1 PDD presented greater difficulty in cannulation (11.6%) and therapeutic failure (28.12%). Conclusion: The presence of PDD during ERCP is associated with greater technical failure (failure in cannulation) and therapeutic failure (persistence of biliary obstruction). In addition, this failures increases considerably when it is a type 1 intradiverticular papilla of the Boix classification. Therefore, it is suggested that biliary endoscopic procedures in these conditions are performed by highly experienced endoscopists to minimize the probability of technical and therapeutic failure and associated complications.

Surgical management of duodenal perforation after endoscopic retrograde cholangiopancreatography: case series.

BACKGROUND: Complications after endoscopic retrograde cholangiopancreatography (ERCP) are rare, approximately 0.09% to 1.8% are duodenal perforation. This type of injury requires early diagnosis and proper management since the outcomes can be catastrophic, leading to death in 20% of cases. OBJECTIVE: To show our experience in the management of these injuries in order to establish if there is benefit from minimally invasive management versus conventional management. METHOD: Observational, retrospective and descriptive study comparing patients who required surgical management after post-ERCP duodenal perforation in three centers in Bogotá, Colombia, between January 2013 and December 2018. RESULTS: 13 patients were taken to surgical management after duodenal perforation post ERCP, 7 laparoscopically (53.8%), with an average hospital stay of 10.7 days and mortality of 0% and 6 by open route (46.1%), with an average hospital stay of 33 days and mortality of 50%, with a minimum follow-up of 6 months. CONCLUSIONS: Post ERCP duodenal perforation, despite its low incidence, should be suspected due to its high mortality. Laparoscopic surgery is a good tool to address duodenal perforations after ERCP, because it presents a lower rate of complications and mortality.

ANTECEDENTES: Las complicaciones tras la colangiopancreatografía retrógrada endoscópica (CPRE) que necesitan manejo quirúrgico son limitadas y aproximadamente el 0.09-1.8% corresponden a perforación duodenal. Este tipo de lesiones requieren un diagnóstico temprano y un manejo adecuado, ya que los desenlaces pueden ser catastróficos, con una mortalidad reportada de hasta el 20%. OBJETIVO: Presentar nuestra experiencia en el manejo quirúrgico de estas lesiones. MÉTODO: Estudio observacional, retrospectivo y descriptivo, de pacientes que requirieron manejo quirúrgico por perforación duodenal tras CPRE en tres centros de Bogotá, Colombia, entre enero de 2013 y diciembre de 2018. RESULTADOS: Fueron llevados a manejo quirúrgico 13 pacientes, 7 (53.8%) por vía laparoscópica, con una estancia hospitalaria promedio de 10.7 días y una mortalidad del 0%, y 6 (46.1%) por vía abierta, con una estancia hospitalaria promedio de 33 días y una mortalidad del 50%, con seguimiento mínimo a 6 meses. CONCLUSIONES: La perforación duodenal tras una CPRE, pese a su baja incidencia, se debe sospechar por su alta morbimortalidad. La decisión del abordaje quirúrgico está condicionada por el estado clínico del paciente, y por ende está ligada al pronóstico de este.

Manejo del aneurisma roto de aorta abdominal: un reto para el cirujano general / Management of ruptured abdominal aortic aneurysm: a challenge for the general surgeon

Introducción. El aneurisma aórtico abdominal roto, tiene una mortalidad del 80 % al 90 %. Para su reparación existe una técnica abierta y otra endovascular, las cuales tienen diferencias entre sus beneficios y complicaciones. El método de elección en la actualidad para la corrección de esta alteración anatómica es endovascular, sin embargo, no es el más usado, porque no se cuenta todo el tiempo con el equipo humano de cirugía vascular para su realización. Caso clínico. Ingresa a urgencias un paciente en estado de shock de origen desconocido, con dolor abdominal de 24 horas de evolución. Se realiza una tomografía con contraste que demuestra un aneurisma aórtico abdominal infrarrenal roto. Debido a que no se contaba con el equipo de cirugía vascular, es llevado de urgencia a una corrección abierta que duró 153 minutos, con un sangrado intraoperatorio de 1754 cc. Fue dado de alta a los 12 días postoperatorios sin ninguna complicación. Discusión. La reparación endovascular del aneurisma aórtico abdominal roto es la mejor elección, ya que muestra mayores beneficios en comparación con la reparación abierta, sin embargo, no es el más utilizado, porque se necesita de un personal bien entrenado en cirugía endovascular, por lo que, dentro de la formación de los cirujanos generales, se tiene que incluir el aprendizaje de las técnicas abiertas

Introduction. The ruptured abdominal aortic aneurysm has a mortality of 80% to 90%. There is an open and an endovascular techniques for its repair, which have differences between their benefits and complications. The method of choice for the correction of this anatomical alteration is endovascular; however, it is not the most frequently used, mainly because the vascular surgical team is not available all the time to perform it.Clinical case. A patient in a state of shock of unknown origin was admitted to the emergency room, with abdominal pain of 24 hours of evolution. A contrast-enhanced CT scan demonstrated a ruptured infrarenal abdominal aortic aneurysm. Due to the lack of a vascular surgery team, the patient was rushed for an open surgery that lasted 153 minutes, with an intraoperative bleeding of 1754 cc. He was discharged 12 days after surgery without any complications.Discussion. Endovascular repair of ruptured abdominal aortic aneurysm is the best choice, since it shows greater benefits compared to open repair. However, it is not the most widely used because it requires well-trained personnel in endovascular surgery. Therefore, learning of open techniques must be included in the training of general surgeons

Multicenter Evaluation with Eckardt Score of Laparoscopic Management with Heller Myotomy and Dor Fundoplication for Esophageal Achalasia in a Pediatric Population in Colombia.

Background: Esophageal achalasia is a rare, chronic, and progressive neurodegenerative motility disorder that is characterized by a lack of relaxation of the lower esophageal sphincter. Laparoscopic Heller myotomy (LHM) is the ideal in our population. Multiple surgical and medical treatments have been raised. However, there has been a need to expand studies and generate a clear algorithm for an ideal therapeutic algorithm. Methods: Clinical record was retrospectively analyzed of patients who underwent LHM and Dor fundoplication evaluated with Eckardt score, at four Colombian medical centers between February 2008 and December 2018. Results: There were a total of 21 patients (12 males and 9 females, ages 8 months to 16 years). The time from onset of symptoms to surgery was between 5 months and 14 years. One patient had esophageal mucosa perforation, 2 patients were converted to open surgery, and 1 patient had a postoperative fistula. All patients were discharged 3 to 9 days postoperatively, at which time they tolerated normal oral feeding. During follow-up, all the patients had an improvement in nutritional status and a greater functional recovery; 4 had reflux and 1 had reflux-like symptoms. Conclusion: LHM with Dor-type fundoplication maintains the effectiveness of open surgery with low postoperative morbidity and mortality and good functional results according to Eckardt score evaluation.

Retención de videocápsula endoscópica, una nueva enfermedad médico-quirúrgica: serie de casos.

BACKGROUND: The endoscopic video capsule (EVC), a minimally invasive method of study of the gastrointestinal system indicated in occult gastrointestinal bleeding, has as main complication the retention of endoscopic capsule (CR), currently it is managed with direct extraction using double-balloon enteroscopy; however, when it fails due to its location or associated pathologies, the surgical intervention results in the most successful approach. OBJECTIVE: To evaluate clinical characteristics and management of patients with video capsule endoscopy retention. METHOD: From January 2001 to December 2018, a retrospective search was carried out in three centers, of patients with CR diagnosis, clinical variables and approach were evaluated, in addition to a critical review of the literature. RESULTS: 15 patients with a diagnosis of CR (eight 8 women and seven men), average age 65 (range: 45-77). Seven required surgical management, three endoscopic and five medical management. CONCLUSIONS: The CR is a new pathology of low prevalence, the surgical management resulting from a second therapeutic line when the removal of the VCE has not been possible endoscopically, this pathology requires special attention in the patient's medical history and symptoms for diagnosis and management.

ANTECEDENTES: La videocápsula endoscópica (VCE), método mínimamente invasivo de estudio del sistema gastrointestinal indicado en hemorragia digestiva oculta, tiene como principal complicación la retención de la cápsula endoscópica (RCE). Actualmente se maneja con extracción directa empleando enteroscopia de doble balón; sin embargo, cuando falla por su localización o por patologías asociadas, la intervención quirúrgica resulta el método de mayor éxito. OBJETIVO: Evaluar las características clínicas y el manejo de pacientes con RCE. MÉTODO: De enero de 2001 a diciembre de 2018 se realizó un búsqueda retrospectiva, en tres centros, de pacientes con diagnóstico de RCE. Se evaluaron variables clínicas y de manejo, y además se realizó una revisión crítica de la literatura. RESULTADOS: Se hallaron 15 pacientes con diagnóstico de RCE (ocho mujeres y siete hombres), con una edad promedio de 65 años (rango: 45-77). Siete requirieron manejo quirúrgico, tres manejo endoscópico y cinco manejo médico. CONCLUSIONES: La RCE es una patología nueva de baja prevalencia. El manejo quirúrgico resulta ser una segunda línea terapéutica cuando la extracción de la VCE no ha sido posible endoscópicamente. Para su diagnóstico y manejo, esta patología requiere una especial atención a la historia clínica, los antecedentes y los síntomas de los pacientes.

Laparoscopic Roux-en-Y hepaticojejunostomy reconstruction after iatrogenic bile duct injury: case series report.

INTRODUCTION: Bile duct injury (BDI) is a devastating complication after a cholecystectomy. Laparoscopic management has become a mainstay approach because of the advantages offered to patients; nevertheless, outcomes after repair are influenced by the center, the surgeon's experience, and the type of reconstruction. MATERIALS AND METHODS: Patients with common BDI managed at a referral center from January 2013 to June 2018 with a novel modified and simplified laparoscopic technique for a hepatic duct jejunostomy with a Roux-en-Y reconstruction were retrospectively reviewed. RESULTS: Twenty patients had a BDI (20/5430-0.3%), 8 (40%) had intraoperative diagnosis, and 12 (60%) patients with diagnosis before 72 h. Type E Strasberg classification, the predominant BDI was Strasberg E1 (65%), the average surgery time was 146.5 min (115-178 min), the average intraoperative bleeding was 15-50 cc. The overall complication rate was 10 % (2/20), 1 (5%) patient required, there were no mortalities, and the mean hospital stay was 5 days. One (5%) patient presented bile leak (Type SE4), and 1 (5%) patient required intensive care unit admission after reintervention. Long-term follow-up showed no bile duct stricture, cholangitis, or recurrent choledocholithiasis up to 5 years after the procedure and with a minimum of 1 year minimum follow-up. CONCLUSIONS: This simplified laparoscopic approach to bile duct reconstruction with Roux-en-Y anastomoses appears to be an effective and safe alternative to reconstructive open bile duct surgery, offering to patients the benefits of laparoscopic surgery with a low complication rate.

ANTECEDENTES: La lesión del conducto biliar es una complicación devastadora tras una colecistectomía. El tratamiento laparoscópico se ha convertido en un enfoque principal debido a las ventajas ofrecidas a los pacientes; sin embargo, los resultados después de la reparación están influenciados por el centro, la experiencia del cirujano y el tipo de reconstrucción. MÉTODO: Se revisaron retrospectivamente los pacientes con lesión del conducto biliar tratados con reconstrucción biliar en un centro de referencia, desde enero de 2013 hasta junio de 2018, por vía laparoscópica con una técnica modificada y simplificada con hepatoyeyunostomía en Y de Roux. RESULTADOS: Veinte pacientes de 5,430 tenían lesión del conducto biliar (0,3%), 8 (40%) tuvieron diagnóstico intraoperatorio y 12 (60%) diagnóstico antes de las 72 horas. Todos con una clasificación de Strasberg tipo E, con predominio de E1 (65%). El tiempo quirúrgico promedio fue de 146,5 (rango 115-178) minutos y el sangrado intraoperatorio promedio fue de 15-50 cm3. La tasa general de complicaciones fue del 10% (2/20); 1 (5%) paciente requirió reintervención. No hubo mortalidad y la estancia hospitalaria media fue de 5 días. Un paciente (5%) presentó fuga biliar (tipo SE4) y 1 (5%) paciente requirió ingreso en la unidad de cuidados intensivos después de la reintervención. El seguimiento fue de hasta 5 años tras el procedimiento, con un mínimo de 1 año, y no se han documentado estenosis del conducto biliar, colangitis ni coledocolitiasis recurrente. CONCLUSIÓN: Este enfoque laparoscópico simplificado para la reconstrucción del conducto biliar con anastomosis en Y de Roux parece ser una opción efectiva y segura a la cirugía reconstructiva del conducto biliar abierta, ofreciendo a los pacientes los beneficios de la cirugía laparoscópica y con una baja tasa de complicaciones.

Early fixation of the flail chest: case report.

ANTECEDENTES: En 1926, Jones y Richardson describen por primera vez el tórax inestable. Desde entonces existe gran controversia sobre el manejo conservador comparado con el manejo quirúrgico. OBJETIVO: Dar a conocer los beneficios, las indicaciones y las contraindicaciones de la fijación temprana de fracturas costales en el tórax inestable. CONCLUSIÓN: La reducción abierta y la fijación temprana de fracturas costales en pacientes con tórax inestable ha demostrado ser un método útil, efectivo y seguro. BACKGROUND: In 1926, Jones and Richardson described flail chest for the first time. Since then, exist great controversy about conservative vs surgical approach. OBJECTIVE: Define the benefits, indications and contraindications of the early fixation of rib fractures in flail chest. CONCLUSION: The open reduction and early fixation of rib fractures for patients with flail chest has proven to be a useful, effective and safe method.

Vólvulo del ciego, una entidad infrecuente como causa de abdomen agudo en embarazadas: reporte de caso clínico y revisión de la literatura / Volvulus of the cecum as an uncommon cause of acute abdomen in pregnant women: Case report and review of the literature

Introducción. El vólvulo cecal en el embarazo es una patología infrecuente a nivel mundial, con un espectro clínico variado y limitación en estudios diagnósticos, lo que puede resultar en un desenlace ominoso. Caso clínico. Se presenta el caso de una gestante en segundo trimestre del embarazo quien presenta abdomen agudo secundario a vólvulo cecal y sufrimiento fetal. La paciente fue llevada a cesárea de urgencia, donde además se practicó cecectomía y anastomosis íleo transversa, con mortalidad fetal. Discusión. El vólvulo cecal forma parte de los diagnósticos diferenciales en caso de abdomen agudo durante el embarazo. Tiene un pronóstico reservado, en donde pueden presentarse desenlaces maternos y perinatales adversos, con mortalidad materno fetal

Introduction. Cecal volvulus in pregnancy is an uncommon pathology worldwide, with a varied clinical spectrum and limitation in diagnostic studies, which can result in an ominous outcome.Clinical case. We present the case of a pregnant woman in the second trimester of pregnancy who presents with an acute abdomen secondary to caecal volvulus and fetal distress. The patient was taken to emergency caesarean section, where a cecectomy and transverse ileus anastomosis were also performed, with fetal mortality.Conclusion. Cecal volvulus is part of the differential diagnoses in acute abdomen during pregnancy. It has a reserved prognosis, where adverse maternal and perinatal outcomes can occur, including maternal-fetal mortality

Right mainstem bronchoplasty 18 years following thoracic spinal implant surgery.

Thoracic spinal surgery has many complications ranging from surgical site infection, chronic pain, periarticular arthrosis, displacement of spinal screws and hardware migration to a lesser degree. Reports of spinal implants penetrating the aorta have been described in the literature, however to our knowledge, lower airway obstruction due to spinal hardware migration has not been reported. Here we describe a case of a patient presenting with a right main stem bronchial obstruction and pneumonia secondary to the migration of the surgical spinal hardware into the lower airway 18 years after his initial intervention. We describe our surgical approach, management and outcomes using bronchoscopy and open thoracotomy. Bronchial obstruction is not a common complication of thoracic spinal surgery, however in remote cases patients may present with rare consequences, it is therefore important to pay close attention to patients' clinical and surgical history since surgical complications may appear years after.