[Tratamiento ambulatorio de la diverticulitis aguda no complicada. Análisis de nuestra experiencia]. / Outpatient treatment of uncomplicated acute diverticulitis. Analysis of our experience.

OBJECTIVE: Analyze the safety and efficacy of the outpatient treatment of uncomplicated acute diverticulitis and a costs analysis. METHOD: We conducted a prospective, non-randomized study between June 2014 and June 2017. We included all patients diagnosed of uncomplicated acute diverticulitis based on clinical and abdominal computed tomography scan in the Emergency Department of the University Hospital San Juan de Alicante (Spain). Outpatient treatment consisted of oral antibiotics for 7 days (amoxicillin-clavulanate or ciprofloxacin and metronidazole in patients with betalactamic allergy), liquid diet for 72 h and analgesics. Costs were evaluated according to the Law of Rates of Valencian Community. RESULTS: Ninety patients were included, 49 females and 41 males with a median age of 56 years. Success rate was 95.5% (n = 86) requiring hospital admission 4 patients (4.5%). Antibiotic treatment was amoxicillin-clavulanate in 82 patients (91.1%) and ciprofloxacin and metronidazole in 8 (8.9%). Cost savings per patient was approximately 1985 € comparing with hypothetically all inpatient treatment. CONCLUSIONS: Outpatient treatment of uncomplicated acute diverticulitis can be performed successfully in most patients allowing an important cost savings.

OBJETIVO: Evaluar la seguridad y la eficacia del tratamiento con antibiótico oral para la diverticulitis aguda no complicada, y realizar un análisis de costos. MÉTODO: Estudio prospectivo, no aleatorizado, entre junio de 2014 y junio de 2017. Se incluyeron todos los pacientes diagnosticados de diverticulitis aguda no complicada según la clínica y la tomografía abdominal en el servicio de urgencias del Hospital Universitario San Juan de Alicante (España). El tratamiento ambulatorio consistió en antibiótico oral durante 7 días (amoxicilina-ácido clavulánico o ciprofloxacino y metronidazol en alérgicos a los betalactámicos), dieta líquida durante 72 horas y analgésicos. Los costos fueron evaluados según la Ley de Tasas de la Comunidad Valenciana. RESULTADOS: Se incluyeron 90 pacientes, 49 mujeres y 41 hombres, con una mediana de edad de 56 años. La tasa de éxito fue del 95.5% (n = 86), necesitando ingreso hospitalario cuatro pacientes (4.5%). El tratamiento antibiótico empleado fue amoxicilina-ácido clavulánico en 82 pacientes (91.1%) y ciprofloxacino con metronidazol en ocho pacientes (8.9%). El ahorro por paciente fue de 1985 euros en comparación con el hipotético ingreso de todos los pacientes. CONCLUSIONES: El tratamiento ambulatorio de la diverticulitis aguda no complicada se completó con éxito en la mayoría de los pacientes, permitiendo una importante reducción del gasto.

[Pylephlebitis: a rare but possible complication of intra-abdominal infections]. / Pileflebitis: una extraña pero posible complicación de las infecciones intraabdominales.

BACKGROUND: Pylephlebitis or septic thrombophlebitis of the portal venous system is a rare but serious complication of intra-abdominal infections which drain into the portal venous system. Its diagnosis is based on clinical suspicion and imaging tests, mainly a computed tomography scan, given the lack of specificity of the signs and symptoms. Spread of septic emboli is the major cause of morbidity and mortality. The aim of the study was to analyse patients diagnosed in our hospital. MATERIAL AND METHODS: Retrospective descriptive study of patients diagnosed with pylephlebitis in our hospital. CLINICAL CASES: Four patients were included, 3 men and one woman. In 3 cases it was acute cholecystitis that led to the diagnosis of pylephlebitis at the same time as the intra-abdominal infection. Emergency surgery was performed in one case, whilst the other 2 were treated conservatively. Blood cultures were performed in all cases, and empirical antibiotic treatment was used. In the only case of acute appendicitis, diagnosis of pylephlebitis was achieved during the study of postoperative fever, with empirical antibiotic treatment also being started. The haematologist was requested to start the required anticoagulation therapy in all cases. CONCLUSIONS: Pylephlebitis is a rare complication of intra-abdominal infections that may make lead to a worse outcome. A high level of suspicion is required as well as imaging tests to make an early diagnosis and appropriate treatment.

Hernia inguinal tubo-ovárica incarcerada / Incarcerated tuboovarian inguinal hernia

No disponible