Utilidad de la radiografía de abdomen en el diagnóstico de la intoxicación medicamentosa: reporte de un caso pediátrico / Use of abdominal X-ray in drug intoxication: a pediatric case report

Las intoxicaciones medicamentosas son un motivo de consulta frecuente en pediatría, además de una de las principales causas externas de mortalidad en adolescentes. El diagnóstico y tratamiento tempranos son fundamentales para el manejo adecuado de estos casos. Se presenta una niña de 13 años que, luego de ingerir un fármaco desconocido, muestra decaimiento y manifestaciones clínicas gastrointestinales. Por sospecha de intoxicación con hierro y la imposibilidad de determinar los niveles de sideremia de manera urgente, se realiza radiografía de abdomen, que confirma el diagnóstico y permite el tratamiento adecuado de la paciente. En este caso, se destaca la utilidad de la radiología para el diagnóstico en la sospecha de intoxicación con hierro, gracias a la radiopacidad de sus sales

Drug intoxication is a common reason for pediatric emergency department (ED) visits and one of the leading causes of death among teenagers. Early diagnosis and treatment are essential for a proper management of these patients. We present a 13-year-old girl attended at the ED showing excessive sleepiness and gastrointestinal symptoms after taking an unknown drug. Due to suspected iron overdose and the impossibility of measuring urgent iron levels, an abdominal X-ray was performed, which confirmed the diagnosis. We highlight the utility of radiology in the diagnosis of iron poisoning, which is possible due to its radiopacity.

Carboxymethylcellulose and psyllium effects in sand output of horses with asymptomatic sand accumulation / [Efeitos da carboximetilcelulose e do psyllium sobre a eliminação de areia de cavalos com sablose assintomática]

The aim of this study was to evaluate the effects of Psyllium (PSY) and Carboxymethylcellulose (CMC) administration on fecal elimination of sand in horses with asymptomatic sand accumulations. Eight horses were selected from sandy areas and randomly divided into 2 groups of four animals. The subjects were treated either with CMC or PSY. The presence of intestinal sand was confirmed through radiography and glove sedimentation test. The study was performed in two phases, with a 7-day interval. In phase I, all the animals received 8 liters of warm water; in phase II, the CMC group received 8 liters of water + 1g/kg of CMC, whereas the PSY group received 8 liters of water + 1g/kg of PSY. All administrations were performed through nasogastric intubation and fractionated in 2 equal volume administrations with an interval of two hours. General and specific physical examination of the digestive system were performed in conjunction with abdominal ultrasonography before the administrations and after 6, 12, 24, 36 and 48 hours, aiming to evaluate intestinal motility and presence of sand. All the feces eliminated by the animals within the 72 hours following the administrations were quantified, diluted and sedimented in order to calculate the sand output (g/kg of feces). All the animals were also subjected to radiographic examination to quantify sand accumulation prior to phase I and after 72 hours of phases I and II. No adverse effects were observed after the treatments. It was possible to notice higher sand elimination in both groups during the phase I, whereas no difference was observed in sand elimination rates between the groups in phase II. The radiographic scores presented differences between the initial timepoint and 72h in phases I and II for both groups. Based on the sand elimination rates and radiographic score, this study demonstrated that sand output was greater after administration of water alone, compared to CMC and Psyllium, leading to the inference that removal of the sandy environment and prevention of sand re-ingestion are effective measures for the elimination of sand from the colon of horses with asymptomatic sand accumulations.(AU)

O objetivo deste estudo foi avaliar os efeitos da administração do psyllium (PSY) e da carboximetilcelulose (CMC) sobre a eliminação fecal de areia em equinos com sablose assintomática. Oito equinos com confirmação radiográfica de sablose assintomática foram divididos em dois grupos (grupo CMC e grupo PSY). O estudo foi realizado em duas fases, com intervalo de sete dias. Na fase 1, todos os animais receberam 8L de água; na fase 2, o grupo CMC recebeu 8L de água + 1g/kg de CMC e o grupo PSY recebeu 8L de água + 1g/kg de PSY. Antes da administração de cada solução e após seis, 12, 24, 36 e 48 horas, foram realizados exame físico e ultrassonografia abdominal. Todas as fezes eliminadas em 72 horas foram avaliadas para quantificar a eliminação de areia (g/kg de fezes). Antes da fase 1 e após 72 horas das fases 1 e 2, o exame radiográfico foi realizado para quantificar o escore de acúmulo de areia. Houve maior eliminação de areia após a administração de água em comparação com a administração de CMC, e não se observou diferença entre a CMC e o PSY. Uma redução significativa nos escores radiográficos de acúmulo de areia foi observada após a administração de água, bem como a manutenção dos escores após a administração da CMC e do PSY. Com base na produção de areia e no escore radiográfico, este estudo sugere que a remoção do ambiente arenoso, impedindo a reingestão de areia, é uma medida eficaz para a eliminação da areia do cólon de cavalos com acúmulos de areia assintomáticos.(AU)

Síndrome de Chilaiditi. Reporte de un caso y revisión de la literatura / Chilaiditi Syndrome. Case Report and Literature Review

RESUMEN El síndrome de Chilaiditi es un hallazgo radiográfico poco frecuente. Consiste en la interposición de un asa intestinal entre el hígado y el diafragma. No existe etiología claramente establecida aunque se han planteado varias hipótesis que explican su aparición. Se presenta el caso de un paciente de sexo masculino, de 81 años que ingresó con náuseas, vómitos, dolor abdominal, ansiedad y polipnea. Se encontró en el ionograma hiponatremia con sodio sérico en 128 meq/l. La radiografía de tórax mostró aire debajo del hemidiafragma, la tomografía de tórax y abdomen encontró presencia de interposición colónica entre el hígado y el hemidiafragma derecho, imitando la presencia de aire libre. Se confirmó síndrome de Chilaiditi. El paciente fue tratado con un manejo conservador, con suspensión de la vía oral y colocación de sonda nasogástrica. Se presenta el caso por lo raro de esta entidad y porque su diagnóstico es importante para evitar someter al paciente a una intervención quirúrgica.

ABSTRACT Chilaiditi syndrome is a rare radiographic finding. It consists of the interposition of an intestinal loop between the liver and the diaphragm. There is no clearly established etiology, although various hypotheses have been put forward to explain its presence. The case of an 81-year-old male patient who was admitted with nausea, vomiting, abdominal pain, anxiety, and polypnea is presented. Serum sodium hyponatremia was found on the ionogram at 128 meq / l. The chest radiograph showed air below the hemidiaphragm, the chest and abdomen tomography found the presence of colonic interposition between the liver and the right hemidiaphragm, imitating the presence of free air. Chilaiditi syndrome was confirmed. The patient was treated with conservative management, with suspension of the oral route and placement of a nasogastric tube. The case is presented due to the rareness of this entity and because its diagnosis is important to avoid undergo the patient to surgical intervention.

Radiographic predictors determined with an objective assessment tool for neonatal patients with necrotizing enterocolitis / Preditores radiográficos determinados com uso de ferramenta de avaliação objetiva para pacientes neonatais com enterocolite necrotizante

ABSTRACT Objective: The objective of this study was to develop and validate a computational tool to assist radiological decisions on necrotizing enterocolitis. Methodology: Patients that exhibited clinical signs and radiographic evidence of Bell's stage 2 or higher were included in the study, resulting in 64 exams. The tool was used to classify localized bowel wall thickening and intestinal pneumatosis using full-width at half-maximum measurements and texture analyses based on wavelet energy decomposition. Radiological findings of suspicious bowel wall thickening and intestinal pneumatosis loops were confirmed by both patient surgery and histopathological analysis. Two experienced radiologists selected an involved bowel and a normal bowel in the same radiography. The full-width at half-maximum and wavelet-based texture feature were then calculated and compared using the Mann-Whitney U test. Specificity, sensibility, positive and negative predictive values were calculated. Results: The full-width at half-maximum results were significantly different between normal and distended loops (median of 10.30 and 15.13, respectively). Horizontal, vertical, and diagonal wavelet energy measurements were evaluated at eight levels of decomposition. Levels 7 and 8 in the horizontal direction presented significant differences. For level 7, median was 0.034 and 0.088 for normal and intestinal pneumatosis groups, respectively, and for level 8 median was 0.19 and 0.34, respectively. Conclusions: The developed tool could detect differences in radiographic findings of bowel wall thickening and IP that are difficult to diagnose, demonstrating the its potential in clinical routine. The tool that was developed in the present study may help physicians to investigate suspicious bowel loops, thereby considerably improving diagnosis and clinical decisions.

RESUMO Objetivo: O objetivo deste estudo foi desenvolver e validar uma ferramenta computacional para auxiliar as decisões radiológicas na enterocolite necrotizante. Metodologia: Pacientes que exibiam sinais clínicos e evidências radiográficas do estágio 2 ou superior de Bell foram incluídos no estudo, que resultou em 64 exames. A ferramenta foi usada para classificar o aumento localizado da espessura da parede intestinal e a pneumatose intestinal com medidas de largura total a meia altura e análises de textura baseadas na decomposição da energia wavelet. Os achados radiológicos de aumento suspeito da espessura da parede intestinal e das alças na pneumatose intestinal foram confirmados pela cirurgia e análise histopatológica do paciente. Dois radiologistas experientes selecionaram um intestino afetado e um intestino normal na mesma radiografia. A largura total a meia altura e a característica da textura baseada em wavelet foram então calculadas e comparadas com o uso do teste U de Mann-Whitney. Foram calculados a especificidade, sensibilidade, valores preditivos positivos e negativos. Resultados: Os resultados da largura total a meia altura foram significativamente diferentes entre a alça normal e a distendida (mediana de 10,30 e 15,13, respectivamente). Medidas de energia wavelet horizontal, vertical e diagonal foram avaliadas em oito níveis de decomposição. Os níveis 7 e 8 na direção horizontal apresentaram diferenças significativas. Para o nível 7, as medianas foram 0,034 e 0,088 para os grupos normal e com pneumatose intestinal, respectivamente, e para o nível 8, as medianas foram 0,19 e 0,34, respectivamente. Conclusões: A ferramenta desenvolvida pode detectar diferenças nos achados radiográficos do aumento da espessura da parede intestinal e PI de difícil diagnóstico, demonstra seu potencial na rotina clínica. A ferramenta desenvolvida no presente estudo pode ajudar os médicos a investigar alças intestinais suspeitas e melhorar consideravelmente o diagnóstico e as decisões clínicas.

Radiographic predictors determined with an objective assessment tool for neonatal patients with necrotizing enterocolitis.

OBJECTIVE: The objective of this study was to develop and validate a computational tool to assist radiological decisions on necrotizing enterocolitis. METHODOLOGY: Patients that exhibited clinical signs and radiographic evidence of Bell's stage 2 or higher were included in the study, resulting in 64 exams. The tool was used to classify localized bowel wall thickening and intestinal pneumatosis using full-width at half-maximum measurements and texture analyses based on wavelet energy decomposition. Radiological findings of suspicious bowel wall thickening and intestinal pneumatosis loops were confirmed by both patient surgery and histopathological analysis. Two experienced radiologists selected an involved bowel and a normal bowel in the same radiography. The full-width at half-maximum and wavelet-based texture feature were then calculated and compared using the Mann-Whitney U test. Specificity, sensibility, positive and negative predictive values were calculated. RESULTS: The full-width at half-maximum results were significantly different between normal and distended loops (median of 10.30 and 15.13, respectively). Horizontal, vertical, and diagonal wavelet energy measurements were evaluated at eight levels of decomposition. Levels 7 and 8 in the horizontal direction presented significant differences. For level 7, median was 0.034 and 0.088 for normal and intestinal pneumatosis groups, respectively, and for level 8 median was 0.19 and 0.34, respectively. CONCLUSIONS: The developed tool could detect differences in radiographic findings of bowel wall thickening and IP that are difficult to diagnose, demonstrating the its potential in clinical routine. The tool that was developed in the present study may help physicians to investigate suspicious bowel loops, thereby considerably improving diagnosis and clinical decisions.

Tratamiento médico del "body packer" entre los años 2014 y 2016 en un hospital universitario del caribe colombiano / Medical management of the "body packer" at a university hospital in the colombian caribbean in the period 2014-2016

Introducción. El término "body packer" hace referencia a sujetos portadores de objetos intraabdominales extraños, que contienen drogas ilícitas con fines de contrabando. La mayoría son pacientes asintomáticos, en quienes se instaura conducta expectante, observación clínica estrecha y administración de medicamentos para la evacuación de los paquetes, con miras a prevenir posibles complicaciones, como obstrucción intestinal o intoxicación, asociadas a su transporte intraabdominal. Materiales y método. Se llevó a cabo un estudio transversal de linealidad retrospectiva en pacientes admitidos en la E.S.E Hospital Universitario del Caribe entre los años 2014 y 2016,bajo la sospecha diagnóstica de "body packer". Luego de una revisión de las bases de datos institucionales se analizaron variables demográficas y clínicas de los sujetos incluidos en el estudio. Resultados. Se incluyeron 4 pacientes de género masculino, entre los 22 y 66 años de edad. La cantidad de cápsulas transportadas en promedio fue de 43, para una máxima de 74. La cocaína fue la sustancia que más se identificó. Para la evacuación de los paquetes se empleó irrigación intestinal con polietilenglicol. El tiempo de evacuación máximo fue de 48 horas y no hubo complicaciones asociadas al manejo proporcionado. Discusión. Estudios respecto al tema, como este, confirman la seguridad del manejo conservador del paciente asintomático y apoyan el uso de polietilenglicol dada su efectividad para lograruna limpieza intestinal completa y por su bajo riesgo de complicaciones asociado a su uso en comparación con otros métodos, así como la menor necesidad de intervenciones quirúrgicas. Se requieren estudios prospectivos aleatorizados controlados a partir de los cuales se determinen, con base en mayor evidencia, las mejores prácticas a seguir

Introduction. The term "body packer" refers to subjects carrying intraabdominal foreign objects that contain illicit drugs for contraband purposes. The majority of patients are asymptomatic, in whom expectant management is established, with close clinical observation and administration of medications for evacuation of the packages, with prevention of possible complications such as intestinal obstruction or intoxication associated with intraabdominal transport. Materials and method. A retrospective linearity cross sectional study was carried out in patients admitted to the Hospital Universitario del Caribe, Cartagena, Colombia, under the diagnostic suspicion of "body packer" in the period 2014 and 2016. After a review of the institutional databases, demographic and clinical variables of the study subjects were analyzed. Results. Four patients were included, male, ages 22 to 66 years. The average number of capsules transported was 43, with maximum of 74. Cocaine was the substance mainly identified. Intestinal irrigation with polyethylene glycol was used for intestinal evacuation. The maximum evacuation time was 48 hours and there were no complication associated with the given management. Discussion. The existing studies on the subject, as well as this one, confirm the safety of the conservative management in the asymptomatic patient and support the effectiveness of polyethyleneglycol in achieving complete intestinal cleansing and the low risk of complications associated with its use with respect to other methods, together with diminished need for surgical intervention. Controlled randomized prospective studies are required to provide greater evidence in order to determine the best practice to be followed

Divertículo colónico gigante: Dos nuevos casos en la literatura / Giant Colonic Diverticulum: Two New Cases in Literature / Divertículo gigante de colom: Dois novos casos na literatura

Introducción: El divertículo colónico gigante es una presentación rara de la enfermedad diverticular del colon descrita por primera vez en la literatura francesa en 1946; se define cuando su diámetro es mayor a 4cm. Objetivo: Adicionar a la literatura dos casos diagnosticados en la Fundación Oftalmológica de Santander, Colombia debido al bajo número de casos reportados en la actualidad; además, mencionar los principales datos encontrados en la literatura en cuanto a la epidemiología, la presentación clínica, los diagnósticos diferenciales, las herramientas diagnósticas más importantes a tener en cuenta y la diferencia de los esquemas de tratamiento. Presentación de los casos: Se presentan dos casos de pacientes con clínica de dolor abdominal para los cuales se solicitaron estudios imagenológicos que permitieron realizar un adecuado diagnóstico de divertículo colónico gigante; el primero fue manejado de manera conservadora con antibiótico-terapia y el segundo de forma quirúrgica con resección de colon transverso con anastomosis primaria. Conclusiones: El divertículo colónico gigante es una entidad poco frecuente y por tanto escasamente descrita en la literatura asociada en su mayoría con la diverticulosis. Se presenta con una clínica muy diversa, sugestiva de múltiples patologías abdominales que deben ser descartadas para poder realizar un adecuado diagnóstico por medio de técnicas de imagen como la radiografía, el colon por enema y la tomografía axial computarizada que representan las principales herramientas diagnósticas de esta entidad. El tratamiento de elección es la intervención quirúrgica, sin embargo, en contextos determinados como pacientes ancianos, asintomáticos y con alto riesgo quirúrgico puede manejarse de manera conservadora. Su importancia a pesar de la baja prevalencia radica en la necesidad del diagnóstico oportuno para evitar una alta tasa de complicaciones. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Divertículo colónico gigante: Dos nuevos casos en la literatura MedUNAB 2017; 20(2): 235-243].

Introduction: The giant colonic diverticulum is a rare presentation of the diverticular disease of the colon described for the first time in French literature in 1946 and it is defined when its diameter is greater than 4cm. Objective: To add to the literature two more cases diagnosed in the Ophthalmological Foundation of Santander, Colombia due to the low number of cases reported today; in addition, to mention the main data found in the literature in terms of epidemiology, clinical presentation, differential diagnoses, the most important diagnostic tools to consider and the difference of treatment schemes for it. Presentation of the cases: Two cases of patients with abdominal pain clinic for whom imaging studies were requested that allowed an adequate diagnosis of giant colonic diverticulum are presented. The first one was managed conservatively with antibiotic therapy and the second one was surgically treated with a transverse colon resection with primary anastomosis. Conclusions: The giant colonic diverticulum is a rare entity and therefore poorly described in the literature associated mostly with diverticulosis. It is presented with a very diverse clinic, suggestive of multiple abdominal pathologies that must be discarded in order to perform an adequate diagnosis by means of imaging techniques such as x-rays, colon by enema and computerized axial tomography scan which represent the main diagnostic tools for this entity. The treatment of choice is surgery; however, in determined contexts such as with elderly patients who are asymptomatic and with a high surgical risk can be managed conservatively. Its importance despite its low prevalence lies in the need for timely diagnosis to avoid a high rate of complications. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Giant Colonic Diverticulum: Two New Cases in Literature. MedUNAB 2017; 20(2): 235-243].

Introdução: O divertículo colônico gigante é uma apresentação rara da doença diverticular do cólon descrita pela primeira vez na literatura francesa em 1946; é definido quando seu diâmetro é maior que 4cm. Objetivo: Adicionar à literatura dois casos diagnosticados na Fundação Oftalmológica de Santander, Colômbia devido ao baixo número de casos relatados no presente; Além disso, mencionar os principais dados encontrados na literatura em termos de epidemiologia, apresentação clínica, diagnósticos diferenciais, as ferramentas de diagnóstico mais importantes a serem consideradas e a diferença de esquemas de tratamento. Apresentação dos casos: Foram apresentados dois casos de pacientes com clínica de dor abdominal para os quais foram solicitados estudos de imagem que permitiram um diagnóstico adequado de divertículo colônico gigante; O primeiro foi administrado de forma conservadora com terapia antibiótica e o segundo foi tratado cirurgicamente com ressecção do colo cruzado com anastomose primária. Conclusões: Divertículo colônico gigante é uma entidade rara e, portanto, pouco descrita na literatura associada principalmente à diverticulose. É apresentado um quadro clínico muito diverso, sugestivo de múltiplas patologias abdominais que devem ser descartadas para poder fazer um diagnóstico adequado por meio de técnicas da imagem como a radiografia, o cólon por enema e tomografia axial computorizada que representam as principais ferramentas Diagnóstico desta entidade. O tratamento a escolher é a cirurgia, no entanto, em determinados casos como é a dos pacientes idosos, assintomáticos e com alto risco cirúrgico podem ser tratados de forma tradicional. Sua importância, apesar da baixa prevalência, reside na necessidade de um diagnóstico oportuno para evitar uma alta taxa de complicações. [Baquero-Serrano MA, López-Martínez LA, Lubinus-Badillo FG, Higuera-Escalante EA, Rey-Grass CA. Divertículo gigante de colom: Dois novos casos na literatura. MedUNAB 2017; 20(2): 235-243].

The pilot study of radiology nursing intervention in abdominal 3-T Magnetic Resonance examination / Estudio piloto de intervención de enfermería radiológica en examen de resonancia magnética 3-t / Estudo piloto sobre a intervenção de enfermagem na radiologia em exame de ressonância magnética abdominal 3 tesla

Abstract OBJECTIVE The aim of this study was to investigate the effect of radiology nursing intervention in abdominal examination at 3-T MRI. METHOD 60 patients with abdominal diseases were divided into two groups randomly: MR nursing intervention group and control group. All the patients underwent abdominal MR examination at 3-T. The MR nursing interventions were performed in nursing intervention group. The outcomes, including one-time success rate, the ratio of diagnosable MR images and the points of image quality, were compared between these two groups. RESULTS The one-time success rates in control group and MR nursing intervention group were 66.67% and 96.67% with significant difference ( χ2 =9.017, P<0.05). The ratios of diagnosable images in the two groups were 76.67% and 96.67% with significant difference (χ2 =5.192, P<0.05). The points of MR image quality in the two groups were 1.87±0.86 and 2.33±0.55, respectively. There was significant difference between these two groups (t=-2.508, P<0.05). CONCLUSION The effective nursing intervention can make the patients cooperation better in abdominal MR examination and improve the image quality significantly.

Resumen OBJETIVO Se objetivó investigar el efecto de la intervención de enfermería radiológica en examen abdominal de IRM 3-T. MÉTODO Sesenta pacientes con enfermedades abdominales fueron divididos aleatoriamente en dos grupos: grupo intervención de enfermería RM y grupo control. Todos fueron sometidos a examen abdominal de RM 3-T. Las intervenciones de enfermería RM se efectuaron en el grupo establecido. Los resultados, incluyendo tasa de éxito en única vez, relación de imágenes de RM diagnosticables y puntos de calidad de imagen, fueron comparadas entre ambos grupos. RESULTADOS La tasa de éxito en única vez en grupo control y grupo intervención de enfermería RM fueron de 66,67% y 96,67%, expresando diferencias significativas (χ2 =9.017, P<0.05). Los puntos de calidad de imagen de RM en ambos grupos fueron 1,87±0,86 y 2,33±0,55, respectivamente. Existió diferencia significativa entre los grupos (t=-2.508, P<0.05). CONCLUSIÓN La intervención de enfermería efectiva puede mejorar la cooperación de los pacientes en examen abdominal de RM y mejorar significativamente la calidad de imagen.

Resumo OBJETIVO O objetivo deste estudo foi investigar o resultado da intervenção de enfermagem na radiologia em exame de ressonância magnética (RM) abdominal 3 Tesla. MÉTODO 60 pacientes com patologias abdominais foram aleatoriamente divididos em dois grupos: grupo de intervenção de enfermagem em RM e grupo controle. Todos os pacientes foram submetidos ao exame de RM abdominal 3 Tesla. As intervenções de enfermagem em RM foram realizadas no grupo de intervenção de enfermagem. Os resultados foram comparados entre os dois grupos, incluindo a taxa de sucesso único, o coeficiente das imagens de RM diagnosticáveis e os pontos da qualidade de imagem. RESULTADOS As taxas de sucesso único no grupo controle e no grupo de intervenção de enfermagem em RM foram 66,67% e 96,67%, com diferença significativa de (χ2 =9,017, P<0,05). Os coeficientes das imagens diagnosticáveis nos dois grupos foram 76,67% e 96,67%, com diferença significativa de (χ2 =5,192, P<0,05). Os pontos da qualidade de imagem da RM nos dois grupos foram respectivamente 1,87±0,86 e 2,33±0,55. Houve uma diferença significativa entre estes dois grupos (t=-2,508, P<0,05). CONCLUSÃO A intervenção de enfermagem eficaz pode melhorar a cooperação dos pacientes no exame de RM abdominal e melhorar consideravelmente a qualidade da imagem.

Enterocolitis necrotizante complicada con neumatosis portal en un recién nacido prematro. Reporte de caso / Necrotizing enterocolitis complicated with portal pneumatosis in a premature newborn. Case report

La enterocolitis necrotizante es una enfermedad grave que afecta a recién nacidos en especial prematuros con una incidencia y morbimortalidad elevada. Constituye la emergencia gastrointestinal más frecuente en las unidades de cuidados intensivos neonatales. Presentamos el caso de un recién nacido con 8 semanas de edad que presentó una enfermedad gastrointestinal grave con neumatosis intestinal asociado a neumatosis portal, que fue confirmado por hallazgos clínicos y quirúrgicos...

Necrotizing enterocolitis (NE) is a serious condition that affects particularly pre-term newborns and it is associated with high morbi-mortality. NE is the most frequent gastrointestinal emergency condition in neonatal intensive care units. We present a case of an 8-week child who presented severe NE with portal pneumatosis confirmed by clinical and surgical procedures...

Enema baritado en la detección de cáncer de colon. Hospital III Féliz Torrealva Gutiérrez de ESSALUD Ica. 2005-2010 / Barium enema in colon cancer detection. Hospital III Félix Torrealva Gutiérrez ESSALUD Ica. 2005-2010

Con el objetivo de determinar si el enema baritado es eficaz en la detección de cáncer de colon enpacientes atendidos en el Hospital Félix Torrealva Gutiérrez de ESSALUD Ica, se evaluaron los hallazgos radiológicos de 331 pacientes que se sometieron a estudio radiológico y colonoscópico, obteniéndose 50 casos con diagnósticos anatomo patológicos de cáncer de colon. Se evaluó la efectividad diagnóstica del enema baritado a doble contraste en la detección del cáncer de colon en frente a lacolonoscopía. El grado de sensibilidad y especificidad resultaron en 78 y 95% y el valor predictivo positivoy negativo en 76 y 96% respectivamente, con un nivel de eficacia de radiografía de colon con enema del 93 %; lo que demuestra ser una prueba útil en la detección del cáncer de colon y que se debe usar comoprueba diagnóstica de tamizaje en los lugares donde no exista colonoscopia. (AU)

In order to determine if the barium enema is effective in detecting colon cancer patients treated at the Hospital Felix Gutierrez Torrealva ESSALUD lea, radiological findings of 331 patients who underwent colonoscopy and radiological study were evaluated, yielding 50 pathological cases of colon cancer diagnoses. Diagnostic effectiveness of double contrast barium enema in screening for colon cancer versus colonoscopy was evaluated. The degree of sensitivity and specificity were 78 and 95% and positive and negative predictive value 76 and 96% respectively, with an efficiency of colon enema x-93%; what proves to be a useful test in the detection of colon cancer and to be used as a diagnostic screening test in places where no colonoscopy. (AU)

Absceso hepático piógeno por hueso de pescado: reporte de un caso / Pyogenic liver abscess due to fish bone: case report

Se informa el caso de un hombre residente en la ciudad de Bogotá, Colombia, quien consultó al servicio de urgencias del Hospital el Tunal de dicha ciudad por dolor abdominal progresivo de seis días de evolución, localizado en el cuadrante superior derecho, asociado a ictericia y fiebre, sin antecedentes relevantes. Al ingreso tenía deterioro marcado del estado general, por lo que requirió atención en la unidad de cuidados intesivos; se le hicieron estudios de imágenes diagnósticas que documentaron una colección multiseptada en el lóbulo hepático izquierdo, y un cuerpo extraño. En la laparotomía se encontró un hueso de pescado como causa del absceso. Con el drenaje y la terapia antibiótica la evolución fue favorable.

We report the case of a man who consulted the emergency department of Hospital el Tunal in Bogotá, Colombia, because of six days of progressive abdominal pain in the upper right quadrant, associated with jaundice and fever; there was no relevant information in his medical history. On admission he was found in poor general condition and required management in the intensive care unit; diagnostic imaging studies documented a multiseptate collection in the left hepatic lobe, and a foreign body. He was submitted to laparotomy in which a fish bone was found as the cause of the abscess. After drainage of the collection and with antibiotic therapy evolution was favorable.

Radiografia simples de abdome no diagnóstico da impactação fecal em crianças com constipação intestinal: comparação entre três escores radiológicos / Abdominal radiograph in the assessment of fecal impaction in children with functional constipation: comparing three scoring systems

OBJETIVOS: Comparar três escores radiológicos na pesquisa de impactação fecal em crianças com constipação intestinal. Verificar, ainda, se estes escores radiológicos são úteis na avaliação da terapia de desimpactação fecal e se apresentam relação com o tempo de trânsito colônico total. MATERIAL E MÉTODOS: Os escores de Barr, Blethyn e Leech foram aferidos por três observadores, de forma independente, em 123 radiografias de abdome. A concordância interobservador no diagnóstico da impactação fecal foi calculada para os três escores. Em 30 radiografias, foi feita a análise dos escores antes e após a desimpactação fecal. O tempo de trânsito colônico total foi calculado em 59 radiografias com o emprego de marcadores radiopacos. RESULTADOS: A concordância entre os pares de observadores, avaliada pelo coeficiente de Kappa, foi boa para os escores de Barr (0,56, 0,59 e 0,69) e Leech (0,53, 0,58 e 0,61). O escore de Blethyn apresentou menores coeficientes de Kappa (0,26, 0,32 e 0,36). Na comparação dos métodos, Leech e Barr mostraram boa correlação. Após a desimpactação fecal, houve redução estatisticamente significante (p < 0,001) dos escores, mais expressiva com o escore de Barr. Não houve relação entre os escores radiológicos e o tempo de trânsito colônico. CONCLUSÕES: Não há relação entre impactação fecal avaliada pela radiografia de abdome e o tempo de trânsito colônico total. A radiografia simples pode ser um instrumento útil ao diagnóstico da impactação fecal. O escore de Barr pode ser considerado um bom método de análise, sobretudo para avaliação da resposta ao tratamento da impactação fecal.

OBJECTIVES: To compare three radiological scores in the study of fecal impaction in children with constipation. To investigate whether these radiological scores are useful in the assessment of fecal disimpaction therapy and if they present a relation with total colonic transit time. METHODS: The Barr, Blethyn and Leech scores were measured by three observers, independently, in 123 abdominal radiographs. Interobserver agreement in the diagnosis of fecal impaction was calculated for the three scores. In 30 radiographs, the analysis of the scores was performed before and after fecal disimpaction. Total colonic transit time was calculated in 59 radiographs with the use of radiopaque markers. RESULTS: The agreement between pairs of observers was assessed by the kappa coefficient and was good for the Barr (0.56, 0.59 and 0.69) and Leech scores (0.53, 0.58 and 0.61). The Blethyn score presented lower kappa coefficients (0.26, 0.32 and 0.36). In the comparison of methods, Leech and Barr showed a good correlation. After fecal disimpaction, there was a statistically significant reduction (p < 0.001) of scores, most significantly with the Barr score. There was no relation between radiographic scores and colonic transit time. CONCLUSIONS: There is no relation between fecal impaction assessed by radiography of the abdomen and total colonic transit time. Plain radiographs may be a useful tool for the diagnosis of fecal impaction. The Barr score can be considered a good method of analysis, especially to assess the response to treatment of fecal impaction.

El signo de la cáscara de manzana en vólvulo de intestino medio / The apple-peel syndrome in midgut volvulus

The apple-peel sign represents an image visualized on oral contrast-enhanced examination of the upper gastrointestinal tract in patients with midgut volvulus. Its recognition is vital for a timely diagnosis to prevent treatment delay, since this condition represents a true surgical emergency.

El signo de la cáscara de manzana corresponde a una imagen visualizada en el estudio con contraste oral del tubo digestivo alto en pacientes que presentan vólvulo del intestino medio. Su reconocimiento es fundamental para hacer el diagnostico de manera oportuna, sin retrasar el tratamiento, ya que se considera una emergencia quirúrgica.

Radiographic study of patients submitted to total gastrectomy using Safatle reconstruction technique / Estudo radiológico em doentes submetidos a gastrectomia total com reconstrução à Safatle

BACKGROUND: Ever since the first total gastrectomy, there has always been a great concern in increasing the survival of patients, and with the advance of techniques, in improving the quality of life of these patients. The most common reconstruction technique of the gastrointestinal transit is the Roux-en-Y. The reposition of a functional pouch in place of the resected stomach was proposed to minimize the postprandial symptoms, improve the nutritional grade and consequently, the quality of life. The Safatle reconstruction of the gastrointestinal transit technique consists of, in short, in the association of the interposition of the jejunal loop with partial transit through the duodenum, with an inverted Roux-en-Y and with the creation of a pouch which resembles the dynamics of the stomach, achieved by duodenojejunal segment which has an antiperistalsis emptying. AIM: To assess, by radiographic means, the emptying of the duodenojejunal pouch in patients submitted to total gastrectomy using the Safatle reconstruction technique. METHOD: Twelve patients submitted to total gastrectomy using the Safatle technique due to gastric cancer were studied. They were summoned to perform contrasted radiographies of the esophagus-duodenum-jejunum by the videofluoroscopic method during the months of July and August, 2005. RESULTS: All the patients presented satisfactory movement of the duodenojejunal pouch and an adequate emptying in antiperistalsis without food stasis. There has been an average 25-minute drainage time of the duodenojejunal pouch. CONCLUSION: The duodenojejunal pouch, in the patients submitted to total gastrectomy using the Safatle reconstruction, presented adequate emptying and movement.

RACIONAL: Desde a primeira gastrectomia total, houve sempre a preocupação em aumentar a sobrevida e, com o aprimoramento das técnicas, de melhorar a qualidade de vida. A técnica mais aceita para a reconstrução do trânsito intestinal após gastrectomia total é a em Y-de-Roux. A reposição de um reservatório funcional no lugar do estômago ressecado foi proposta para minimizar os sintomas pós-prandiais, melhorar o grau nutricional e, conseqüentemente, a qualidade de vida. A técnica de reconstrução do trânsito intestinal pós-gastrectomia à Safatle consiste, em síntese, numa associação da interposição de alça jejunal com trânsito parcial pelo duodeno, com o Y-de-Roux invertido, e com a criação de um reservatório que se aproxima da dinâmica do estômago, obtido à custa de um segmento duodenojejunal com esvaziamento em antiperistalse. OBJETIVO: Avaliar, por método radiológico, o esvaziamento da bolsa duodenojejunal em doentes submetidos a gastrectomia total com reconstrução à Safatle. MÉTODO: Foram estudados 12 doentes submetidos a gastrectomia total por câncer gástrico com reconstrução à Safatle, convocados para realizar radiografias contrastadas de esôfago-duodeno-jejuno pelo método videofluoroscópico nos meses de julho a agosto de 2005. RESULTADOS: Todos os doentes apresentaram motricidade satisfatória da bolsa duodenojejunal com adequado esvaziamento em antiperistalse sem estase alimentar. O tempo de esvaziamento da bolsa duodenojejunal foi de 25 minutos em média. CONCLUSÃO: A bolsa duodenojejunal, nos doentes submetidos a gastrectomia total com reconstrução à Safatle, apresentou adequado esvaziamento e motricidade.