Anal duplication: is surgery indicated? A report of three cases and review of the literature.

AIM OF THE STUDY: Anal canal duplications (ACDs) are extremely rare with only approximately 90 cases described in the literature. We report on three additional patients. METHODS: Cases were analyzed to evaluate presenting symptoms, physical exam and MRI findings. A comprehensive literature review was performed to compare our patients to previously described cases. IRB approval was obtained for this study (19-0394). MAIN RESULTS: The first female patient presented with an asymptomatic ACD at 2 years old. The second patient was a 13-year-old female with perianal drainage that was initially mistaken for a fistula-in-ano and ultimately found to have an ACD associated with a dermoid cyst. Both posterior midline duplications shared a common wall with the rectum, but did not communicate with it. The ACDs and dermoid cyst were successfully excised through a posterior sagittal approach with no postoperative complications. Histology demonstrated the presence of both squamous epithelium and transitional anal epithelium in each case. The third patient was 8 months old and had a tethered cord, hemisacrum, presacral mass, and anal duplication that was initially undiagnosed. These results corroborate patterns identified in other reports of ACDs with over 90% being female and in the posterior midline. The majority are asymptomatic, but may present with symptoms of local or even systemic infection. CONCLUSION: An opening in the midline posterior to the anus should raise clinical suspicion for anal canal duplication. An associated presacral mass must be ruled out. Complete excision through a posterior sagittal approach is recommended upon diagnosis to avoid symptomatic presentations. The key part of the operation is the separation of the ACD from the posterior rectal wall.

Tricobezoar en pediatría: a proposito de un caso / Tricobezoar in pediatric apropos of a case

El tricobezoar es una patología infrecuente en nuestro medio, caracterizándose por la acumulación de cabellos en el tubo digestivo. El presente trabjo es una presentación de caso clínico de una paciente, que acude al servicio de pediatría " Dr. Manuel Asencio Villarroel" del HMIGU; con cuadro de seis meses de evolución de inicio insidioso con dolor y distensión abdominal, dispepsia, halitosis, hiporexia y pérdida de peso. Luego de exámenes diagnósticos fue sometida a la laparatomía exploradora, obteniendo masa de cabello de 35 cm. por 15 cms. La evolución postquirúrgica fue favorable, siendo dada de alta sin complicaciones. Actualmente realiza seguimiento por psiquiatría.

Evaluación Final del Proyecto Organizaciones Agrícolas Privadas

Documento que presenta los resultados de la evaluación final externa contratada por USAID para el Proyecto Organizaciones Agrícolas Privadas - OAP, contemplando sus cinco componentes básicos: Asistencia técnica, capacitación, donaciones, crédito y apoyo institucional. Evaluación orientada más que a criticar acciones pasadas, a establecer nuevos aportes basados en la experiencia adquirida y las lecciones aprendidas a lo largo de dicho proyecto, buscando optimizar la ejecución de futuros proyectos de similar naturaleza