Lesión de vía biliar en trauma cerrado: nuevas tendencias en lesiones infrecuentes / Biliar injury in closed trauma: new trends in unusual injury

Objetivo: Reportar un caso clínico de lesión de la vía biliar intrapancreática tras traumatismo abdominal cerrado. Caso clínico: Paciente que acude a urgencias por intenso dolor abdominal, tras sufrir traumatismo toraco-abdominal cerrado al caer de una bicicleta. Posteriormente a su ingreso desarrolló fiebre, ictericia y patrón analítico de colestasis. Se solicitó colangiorresonancia magnética donde no se pudo valorar correctamente la vía biliar, pero se evidenció abundante líquido intraabdominal que no correspondía a sangre. Se indicó cirugía urgente ante la sospecha de lesión biliar. Se objetivó lesión de la vía biliar intrapancreática mediante colangiografía intra-operatoria y se decidió colocación de prótesis intrabiliar mediante colangiopancreatografía retrógrada endoscópica (CPRE) intraoperatoria. Conclusión: La cirugía ha sido el tratamiento convencional para la lesión de la vía biliar, pero en la actualidad la CPRE con esfinterotomía y colocación de prótesis intrabiliar es un tratamiento adecuado y resolutivo de este tipo de lesiones pudiéndose considerar como tratamiento de primera línea.

Aim: To report a clinical case of biliar injury intrapancreatic in closed abdominal trauma. Clinical case: Patient who comes to the emergency room by severe abdominal pain after suffering thoraco-abdominal blunt trauma after falling from a bicycle. After his admission he developed fever, jaundice and analytical standards of cholestasis. Magnetic resonance which failed to correctly assess the bile duct was requested but showed plenty of intra-abdominal fluid blood that did not match. Emergency surgery for suspected biliary injury was reported. Intrapancreatic injury bile duct was observed by intraoperative cholangiography and prosthesis was decided intrabiliary by intraoperative endoscopic retrograde cholangiopancreatography (ERCP). Conclusions: Surgery has been the standard treatment for bile duct injury, but now ERCP with sphincterotomy and placement of intrabiliary prosthesis is adequate and operative treatment of these injuries and can be considered as first-line treatment.

Evisceración vaginal traumática en mujer posmenopáusica / Traumatic vaginal evisceration in a postmenopausal woman

La evisceración vaginal es una emergencia médica rara que se presenta con mayor frecuencia en mujeres posmenopáusicas con antecedente de cirugía pélvica o vaginal, especialmente histerectomía, y cierta disfunción del suelo pélvico. Sin embargo, la evisceración espontánea vaginal sin antecedentes de cirugía previa en este tipo de pacientes es aún más infrecuente. Se describe a continuación un caso de evisceración vaginal traumática en una mujer posmenopáusica (AU)

Vaginal evisceration is a rare medical emergency that usually occurs in postmenopausal women with a history of pelvic or vaginal surgery, especially hysterectomy, and some pelvic floor dysfunction. Spontaneous vaginal evisceration without previous surgery in these patients is even more uncommon. We discuss a case of spontaneous vaginal evisceration after vaginal trauma in a postmenopausal woman (AU9

Cirugía endoscópica totalmente extraperitoneal de la hernia inguinal: resultados de 250 hernioplastias / Totally extraperitoneal endoscopic surgery of inguinal hernia: results of 250 hernia repairs

Introducción: El abordaje endoscópico totalmente extraperitoneal en la cirugía de la hernia inguinal ha supuesto un cambio importante, permitiendo implantar mediante un acceso cómodo una malla en el espacio preperitoneal, además de aportar las ventajas de la cirugía mínimamente invasiva (menor dolor postoperatorio y más rápida recuperación). El objetivo de este estudio es analizar los resultados de la hernioplastia endoscópica TEP, fundamentalmente en la reparación de hernias bilaterales y recidivadas o multirrecidivadas. Material y métodos En los últimos 5 años se han realizado 250 hernioplastias endoscópicas TEP en 150 pacientes. Un 63% de los pacientes intervenidos presentaban hernias bilaterales y un 16%, recidivadas. Se excluyeron hernias inguinoescrotales de gran tamaño y complicadas. Se siguió un régimen de corta estancia, estableciendo un protocolo de analgesia, profilaxis antibiótica, antitrombótica y de recogida de datos postquirúrgicos como la demanda analgésica. Al alta, se entregó a los pacientes un cuestionario donde debían rellenar los campos referentes al dolor postquirúrgico y cumplimentar una encuesta de satisfacción adjunta. Resultados Destaca de esta serie la reducida necesidad de analgesia postoperatoria, haciéndose totalmente innecesaria a las 24h en 70 pacientes (46,6%), alcanzando los 121 (80,6%) al mes de la cirugía. Reconversiones: 6 casos (4%), siempre por abertura del saco peritoneal. Infección de herida: 0%; orquiepididimitis (leve): 2%; recidivas: 6 (2,4%). Neuralgia inguinal: 1 (0,4%). Alto grado de satisfacción (95%).Conclusiones La hernioplastia endoscópica TEP es una intervención muy eficaz y segura en manos de cirujanos expertos con un aprendizaje específico. En la hernia bilateral y recidivada supone una opción interesante de reparación ya que obtiene resultados satisfactorios en términos de dolor postoperatorio y morbilidad (AU)

Introduction: The totally extraperitoneal endoscopic approach in the surgery of the inguinal hernia has experienced an important change, enabling a mesh to be implanted in the pre-peritoneal space with a comfortable access, as well as contributing to the advantages of minimally invasive surgery (less post-operative pain and a faster recovery). The objective of this study is to analyse the results of TEP endoscopic hernioplasty, mainly in the repair of bilateral hernias and recurrences or multiple recurrences. Material and methods: A total of 250 TEP endoscopic hernioplasties have been performed on150 patients in the last 5 years. The majority (63%) of the patients subjected to surgery had bilateral hernias, and 16%, recurrent. Large and complicated iguinal-scrotal hernias were excluded. A short stay regimen was followed, establishing a protocol of, analgesia, antibiotic, antithrombotic prophylaxis, and collection of post-surgical data such as analgesia demand. The patients were given a questionnaire on discharge, in which they filled in the fields on post-surgical pain, as well as an attached satisfaction questionnaire. Results: The reduced need for post-surgical analgesia was noteworthy in this series, being totally unnecessary at 24 h in 70 patients (46.6%), reaching 121 (80.6%) one month after surgery. There were 6 cases (4%) of reconversion, always due to opening of the peritoneal sac. There were no wound infections, 2% mild orchiepididymitis, 6 (2.4%) recurrence, and one (0.4%) inguinal neuralgia. There was a high level of satisfaction (95%).Conclusions: TEP endoscopic hernioplasty is a very effective and safe procedure in the hands of experienced surgeons with specific training. It is an interesting option in bliateral and recurrent hernia as it obtains satisfactory results in terms of postoperative pain and morbidity (AU)

[Totally extraperitoneal endoscopic surgery of inguinal hernia: results of 250 hernia repairs]. / Cirugía endoscópica totalmente extraperitoneal de la hernia inguinal: resultados de 250 hernioplastias.

INTRODUCTION: The totally extraperitoneal endoscopic approach in the surgery of the inguinal hernia has experienced an important change, enabling a mesh to be implanted in the pre-peritoneal space with a comfortable access, as well as contributing to the advantages of minimally invasive surgery (less post-operative pain and a faster recovery). The objective of this study is to analyse the results of TEP endoscopic hernioplasty, mainly in the repair of bilateral hernias and recurrences or multiple recurrences. MATERIAL AND METHODS: A total of 250 TEP endoscopic hernioplasties have been performed on 150 patients in the las 5 years. The majority (63%) of the patients subjected to surgery had bilateral hernias, and 16%, recurrent. Large and complicated iguinal-scrotal hernias were excluded. A short stay regimen was followed, establishing a protocol of, analgesia, antibiotic, antithrombotic prophylaxis, and collection of post-surgical data such as analgesia demand. The patients were given a questionnaire on discharge, in which they filled in the fields on post-surgical pain, as well as an attached satisfaction questionnaire. RESULTS: The reduced need for post-surgical analgesia was noteworthy in this series, being totally unnecessary at 24h in 70 patients (46.6%), reaching 121 (80.6%) one month after surgery. There were 6 cases (4%) of reconversion, always due to opening of the peritoneal sac. There were no wound infections, 2% mild orchiepididymitis, 6 (2.4%) recurrence, and one (0.4%) inguinal neuralgia. There was a high level of satisfaction (95%). CONCLUSIONS: TEP endoscopic hernioplasty is a very effective and safe procedure in the hands of experienced surgeons with specific training. It is an interesting option in bliateral and recurrent hernia as it obtains satisfactory results in terms of postoperative pain and morbidity.