Trombosis del ligamento redondo del hígado asociado a colangitis aguda / Thrombosis of the hepatic round ligament associated with acure cholangitis

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Influence of simultaneous liver and peritoneal resection on postoperative morbi-mortality and survival in patients with colon cancer treated with surgical cytoreduction and intraperitoneal hyperthermic chemotherapy. / Influencia de la resección hepática y peritoneal simultánea, en la morbimortalidad y supervivencia de los pacientes con cáncer de colon intervenidos mediante cirugía citorreductora con quimioterapia intraperitoneal hipertérmica.

INTRODUCTION: Cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy (HIPEC) has recently been established as the treatment of choice for selected patients with peritoneal carcinomatosis of colonic origin. Until recently, the simultaneous presence of peritoneal and hepatic dissemination has been considered a contraindication for surgery. The aim of this paper is to analyze the morbidity, mortality and survival of patients with simultaneous peritoneal and hepatic resection with HIPEC for peritoneal carcinomatosis secondary to colon cancer. METHODS: Between January 2010 and January 2015, 61 patients were operated on, 16 had simultaneous peritoneal and hepatic dissemination (group RH+), and 45 presented only peritoneal dissemination (group RH-). RESULTS: There were no differences between the groups in terms of demographic data, length of surgery and extension of peritoneal disease. Postoperative grade III-V complications were significantly higher in the RH+ group (56.3 vs. 26.6%; P=.032). For the whole group, mortality rate was 3.2% (two patients in group RH-, and none in group RH+). Patients with liver resection had a longer postoperative stay (14.4 vs. 23.1 days) (P=.027). Median overall survival was 33 months for RH-, and 36 for RH+ group. Median disease-free survival was 16 months for RH-, and 24 months for RH+ group. CONCLUSIONS: Simultaneous peritoneal cytoreduction and hepatic resection resulted in a significantly higher Clavien grade III-V morbidity and a longer hospital stay, although the results are similar to other major abdominal interventions. The application of multimodal oncological and surgical treatment may obtain similar long-term survival results in both groups.

Influencia de la resección hepática y peritoneal simultánea, en la morbimortalidad y supervivencia de los pacientes con cáncer de colon intervenidos mediante cirugía citorreductora con quimioterapia intraperitoneal hipertérmica / Influence of simultaneous liver and peritoneal resection on postoperative morbi-mortality and survival in patients with colon cancer treated with surgical cytoreduction and intraperitoneal hyperthermic chemotherapy

INTRODUCCIÓN: La citorreducción con quimioterapia intraperitoneal hipertérmica (HIPEC) se ha postulado como tratamiento de elección en pacientes seleccionados con carcinomatosis peritoneal por cáncer de colon. La presencia simultánea de diseminación peritoneal y hepática ha sido considerada una contraindicación para esta cirugía. El objetivo del presente estudio es analizar la morbimortalidad y supervivencia de los pacientes con carcinomatosis peritoneal por cáncer de colon, intervenidos mediante una citorreducción peritoneal y resección hepática simultánea con HIPEC. MÉTODOS: Entre enero de 2010 y enero de 2015 se intervinieron 61 pacientes, 45 pacientes con carcinomatosis peritoneal (grupo RH−) y 16 con carcinomatosis peritoneal y metástasis hepáticas (grupo RH+). RESULTADOS: No hubo diferencias significativas entre los 2grupos en los datos demográficos, ASA, duración de la intervención, ni extensión de la enfermedad peritoneal. Las complicaciones postoperatorias Clavien III-V fueron significativamente superiores en el grupo RH+ (56,3 vs. 26,6%; p = 0,03). La mortalidad global de la serie fue del 3,2% (2 pacientes en el grupo RH− y ninguno en el grupo RH+). Los pacientes con resección hepática presentaron una estancia hospitalaria significativamente más larga (14,4 vs. 23,1 días; p = 0,027). La mediana estimada de supervivencia global fue de 33 meses para RH− y de 36 meses para RH+, y la de supervivencia libre de enfermedad fue de 16 meses para RH− y de 24 para RH+. CONCLUSIONES: La citorreducción peritoneal con resección hepática simultánea presenta una morbilidad postoperatoria y una estancia hospitalaria significativamente mayores, aunque las cifras son similares a las de otras cirugías abdominales mayores. La aplicación de un tratamiento oncológico y quirúrgico multimodal permite obtener resultados de supervivencia similares en ambos grupos

INTRODUCTION: Cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy (HIPEC) has recently been established as the treatment of choice for selected patients with peritoneal carcinomatosis of colonic origin. Until recently, the simultaneous presence of peritoneal and hepatic dissemination has been considered a contraindication for surgery. The aim of this paper is to analyze the morbidity, mortality and survival of patients with simultaneous peritoneal and hepatic resection with HIPEC for peritoneal carcinomatosis secondary to colon cancer. METHODS: Between January 2010 and January 2015, 61 patients were operated on, 16 had simultaneous peritoneal and hepatic dissemination (group RH+), and 45 presented only peritoneal dissemination (group RH−). RESULTS: There were no differences between the groups in terms of demographic data, length of surgery and extension of peritoneal disease. Postoperative grade III-V complications were significantly higher in the RH+ group (56.3 vs. 26.6%; P=.032). For the whole group, mortality rate was 3.2% (two patients in group RH−, and none in group RH+). Patients with liver resection had a longer postoperative stay (14.4 vs. 23.1 days) (P=.027). Median overall survival was 33 months for RH−, and 36 for RH+ group. Median disease-free survival was 16 months for RH−, and 24 months for RH+ group. CONCLUSIONS: Simultaneous peritoneal cytoreduction and hepatic resection resulted in a significantly higher Clavien grade III-V morbidity and a longer hospital stay, although the results are similar to other major abdominal interventions. The application of multimodal oncological and surgical treatment may obtain similar long-term survival results in both groups

Shunt portocava o malformación de Abernethy / Porto-caval shunt or Abernethy malformation

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Aneurismas sintomáticos de arterias viscerales. Tratamiento quirúrgico y endovascular: a propósito de dos casos / Symptomatic visceral artery aneurysms. Surgical and endovascular treatment: two case reports

Introducción. Los aneurismas de las arterias viscerales son entidades poco comunes con una incidencia estimada de 0,01-2%. Su importancia clínica se debe a que su historia natural se caracteriza por una tendencia a la rotura, con una tasa de mortalidad que puede llegar a ser de hasta un 70%. Con el desarrollo de las nuevas técnicas de imagen ha crecido el número de hallazgos casuales de esta patología. El tratamiento clásico de estos aneurismas ha consistido en la cirugía ‘a cielo abierto’, pero con el desarrollo de las técnicas endovasculares, se ha establecido una alternativa terapéutica con menores tasas de morbimortalidad. Casos clínicos. Presentamos un caso de aneurisma de arteria mesentérica superior, tratado mediante cirugía abierta, y otro caso de aneurisma de arteria hepática tratado mediante terapia endovascular, ambos sintomáticos y con buena evolución postoperatoria. Conclusiones. El tratamiento de los aneurismas de arterias viscerales tiene como finalidad evitar su rotura y las complicaciones derivadas. El riesgo de rotura viene determinado principalmente por su tamaño y localización. La terapia endovascular presenta como principal ventaja la menor invasividad del procedimiento; sin embargo, no existen estudios comparativos, por lo que no podemos hablar de la superioridad de una terapia respecto de la otra en el tratamiento de los aneurismas viscerales

Introduction. Aneurysms in the visceral arteries are uncommon conditions with an estimated incidence of 0.01-2%. Their clinical importance derives from the fact that their natural history is characterised by a tendency to rupture, with a mortality rate that can reach up to 70%. With the development of the latest imaging techniques the number of chance findings of this pathology has grown. Treatment of these aneurysms has traditionally consisted in open surgery, but the advances in endovascular techniques have made it possible to establish a therapeutic alternative with lower morbidity and mortality rates. Case reports. We report one case of superior mesenteric artery aneurysm, which was treated using open surgery, and another case of hepatic artery aneurysm that was treated by means of endovascular therapy; both of them were asymptomatic and post-operative progress was good in the two cases. Conclusions. The aim of treating aneurysms in visceral arteries is to prevent rupture and the ensuing complications. The risk of rupture is chiefly determined by their size and location. The main advantage of endovascular therapy is that the procedure is less invasive. Nevertheless, to date no comparative studies have been conducted and so we cannot talk of one therapy being better than the other in the treatment of visceral aneurysms

Síndrome del martillo hipotenar atípico / Atypical hypothenar hammer syndrome

Introducción. La isquemia aguda por embolización distal de un aneurisma cubital es infrecuente. La mayoría de los casos descritos en la bibliografía se relacionan con el síndrome del martillo hipotenar (SMH). Caso clínico. Varón de 45 años, con dolor, parestesias y frialdad de inicio súbito en el cuarto y el quinto dedos del miembro superior derecho. En la exploración física había pulsos presentes y simétricos en miembros superiores. Frialdad y subcianosis en el quinto dedo derecho y en menor grado en el cuarto, leve disminución de la sensibilidad y movilidad conservada. Sensación de masa no pulsátil en la región hipotenar derecha. El eco-Doppler mostró una curva de oclusión distal cubital y un aneurisma trombosado de arteria cubital de 0,4 × 0,8 cm en la región hipotenar. La fotopletismografía era plana en el cuarto y quinto dedos. La angiorresonancia mostraba un aneurisma de arteria cubital distal con ausencia del arco palmar profundo y la arteriografía una arteria cubital de fino calibre con retraso en su opacificación. Conclusiones. Por los hallazgos clinicorradiológicos, y al referir el paciente el traumatismo repetitivo en la eminencia hipotenar por el uso del ordenador personal, se estableció el diagnóstico de SMH atípico. La evolución clínica fue favorable con tratamiento médico (heparina de bajo peso molecular y analgesia), desapareciendo la sintomatología durante las primeras 24 horas

Introduction. Acute ischaemia due to distal embolisation of an ulnar aneurysm is infrequent. Most of the cases reported in the literature are related to hypothenar hammer syndrome (HHS). Case report. We report the case of a 45-year-old male who suffered the sudden onset of pain, paresthesias and coldness in the 4th and 5th fingers of the right hand. The physical examination showed that pulses were present and symmetrical in the upper limbs. There was also coldness and pallor in the fifth finger of the right hand and to a lesser extent in the fourth, slightly reduced sensitivity and preserved mobility. A non-pulsating mass could be felt in the right hypothenar region. Doppler ultrasound scan revealed a distal ulnar occlusion curve and a 0.4 × 0.8 cm thrombosed aneurysm in the hypothenar region of the ulnar artery. The photoplethysmography recording was flat in the fourth and fifth fingers. Magnetic resonance angiography showed a distal ulnar artery aneurysm with the absence of the deep palmar arch and the arteriography scan revealed the presence of a thin ulnar artery with delayed opaquing. Conclusions. The clinical-imaging findings and the patient’s reporting repeated traumatic injury to the hypothenar eminence from using a personal computer led us to establish a diagnosis of atypical HHS. Clinical progress was favourable with medical treatment (low-molecular-weight heparin and analgesics) and the symptoms disappeared within the first 24 hours