Inguinal abscess as presentation of a right colon cancer. A systematic review.

Perforation in colorectal cancer is an uncommon condition, and neoplastic invasion of the abdominal wall with local infection is even rarer. Our objective is to present the case of an 84-year-old male with right colon cancer that manifested as an inguinal abscess, and also to perform a systematic review of the literature in PubMed, EMBASE, and Web of Science. A total of 59 cases in retrospective studies were found. Median age was 64 years, thirty cases were men and twenty-nine were women (51% and 49%, respectively). The most common location was the right colon with 27 cases (46%), followed by the left colon with 18 cases (31%), 12 cases in the transverse colon (20%), and 2 cases with colonic synchronous neoplasm (3%). Surgery was performed in two or more occasions for 33 cases (60%), and on one occasion for 21 cases (38%); medical treatment alone was administered in one case (2%). The most common histological type was adenocarcinoma (64%), followed by its mucinous variant (22%). There was recurrence in 33% of cases. Mortality at follow-up was 47%. As a limitation of our study, follow-up was heterogeneous, making it impossible to interpret long-term results regarding the influence of treatment on patient survival, also difficulted by the urgent nature of the condition and its exceptional incidence. Further studies are needed with prospective data collection on the management of colorectal cancer in the emergency setting, standardizing follow-up in order to facilitate an adequate analysis of the prognosis of the disease.

Comparison and combination of three data sources from patient medical records to determine optimal quantification of postoperative morbidity according to the Clavien Dindo Classification and the Comprehensive Complication Index. A prospective study.

INTRODUCTION: It is currently unknown which data sources from the clinical history, or combination thereof, should be evaluated to achieve the most complete calculation of postoperative complications (PC). The objectives of this study were: to analyze the morbidity and mortality of 200 consecutive patients undergoing major surgery, to determine which data sources or combination collect the maximum morbidity, and to determine the accuracy of the morbidity reflected in the discharge report. METHODS: Observational and prospective cohort study. The sum of all PC found in the combined review of medical notes, nursing notes, and a specific form was considered the gold standard. PC were classified according to the Clavien Dindo Classification and the Comprehensive Complication Index (CCI). RESULTS: The percentage of patients who presented PC according to the gold standard, medical notes, nursing notes and form were: 43.5%, 37.5%, 35% and 18.7% respectively. The combination of sources improved CCI agreement by 8%-40% in the overall series and 39.1-89.7 % in patients with PC. The correct recording of PC was inversely proportional to the complexity of the surgery, and the combination of sources increased the degree of agreement with the gold standard by 35 %-67.5% in operations of greater complexity. The CDC and CCI of the discharge report coincided with the gold-standard values in patients with PC by 46.8% and 18.2%, respectively. CONCLUSIONS: The combination of data sources, particularly medical and nursing notes, considerably increases the quantification of PC in general, most notably in complex interventions.

Quality-adjusted life years and surgical waiting list: Systematic review of the literature.

BACKGROUND: The quality-adjusted life year (QALY) is a metric that is increasingly used today in the field of health economics to evaluate the value of different medical treatments and procedures. Surgical waiting lists (SWLs) represent a pressing problem in public healthcare. The QALY measure has rarely been used in the context of surgery. It would be interesting to know how many QALYs are lost by patients on SWLs. AIM: To investigate the relationship between QALYs and SWLs in a systematic review of the scientific literature. METHODS: The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. An unlimited search was carried out in PubMed, updated on January 19, 2024. Data on the following variables were investigated and analyzed: Specialty, country of study, procedure under study, scale used to measure QALYs, the use of a theoretical or real-life model, objectives of the study and items measured, the economic value assigned to the QALY in the country in question, and the results and conclusions published. RESULTS: Forty-eight articles were selected for the study. No data were found regarding QALYs lost on SWLs. The specialties in which QALYs were studied the most in relation to the waiting list were urology and general surgery, with 15 articles each. The country in which the most studies of QALYs were carried out was the United States (n = 21), followed by the United Kingdom (n = 9) and Canada (n = 7). The most studied procedure was organ transplantation (n = 39), including 15 kidney, 14 liver, 5 heart, 4 lung, and 1 intestinal. Arthroplasty (n = 4), cataract surgery (n = 2), bariatric surgery (n = 1), mosaicplasty (n = 1), and septoplasty (n = 1) completed the surgical interventions included. Thirty-nine of the models used were theoretical (the most frequently applied being the Markov model, n = 34), and nine were real-life. The survey used to measure quality of life in 11 articles was the European Quality of Life-5 dimensions, but in 32 articles the survey was not specified. The willingness-to-pay per QALY gained ranged from $100000 in the United States to €20000 in Spain. CONCLUSION: The relationship between QALYs and SWLs has only rarely been studied in the literature. The rate of QALYs lost on SWLs has not been determined. Future research is warranted to address this issue.

Lipoma isquiorrectal gigante como causa de dolor anal, incontinencia fecal y dispareunia. Una asociación excepcional / Giant ischiorectal lipoma as a cause of anal pain, fecal incontinence and dyspareunia. An exceptional association

RESUMEN Los lipomas suponen el 50% de los tumores de partes blandas. Podrían comprimir estructuras adyacen tes. Presentamos el caso de una mujer de 49 años con dolor anal intenso asociado a urgencia defecatoria, tenesmo, incontinencia y dispareunia. Presentaba tumoración blanda a nivel del glúteo derecho compa tible con lipoma. La resonancia magnética identificó una masa de 15,7 × 9 × 6 cm, de apariencia encap sulada, que se extendía por la fosa isquioanal e isquiorrectal con impronta sobre el músculo elevador del ano, desplazando el recto. Se efectuó exéresis en bloque, con alta en 48 horas sin complicaciones. El informe de Anatomía Patológica definitivo fue lipoma. Valoramos la asociación de lipoma e incontinencia fecal con una búsqueda en PubMed. Se obtuvieron 87 artículos de los cuales ninguno respondía al objeto del estudio. Esta sintomatología es un fenómeno excepcional en la literatura, que se diagnostica funda mentalmente mediante RM y ecoendoscopia. Gran resultado funcional tras la exéresis.

ABSTRACT Lipomas account for 50% of soft-tissue tumors and may compress adjacent structures. We report the case of a 49-year-old female patient with intense anal pain associated with defecation urgency, tenesmus, incontinence and dyspareunia. A soft tumor was present in the right buttock suggestive of lipoma. On magnetic resonance imaging an apparently encapsulated mass with a size of 15.7 × 9 × 6 cm was identified extending through the ischioanal fossa and ischiorectal fossa, displacing the levator ani muscle and rectum. The lesion was excised en bloc and the patient was discharged 48 hours later without complications. The pathology report concluded that the lesion corresponded to a lipoma. We performed a bibliographic search in PubMed to assess the association between lipoma and fecal incontinence; Of the 87 articles retrieved, none of them responded to the subject of the study. These symptoms are exceptional in the literature. The diagnosis is made mainly with magnetic resonance imaging and endoscopic ultrasound. An excellent functional outcome was achieved with surgical excision.

Neumoperitoneo espontáneo no quirúrgico en paciente COVID-19 positivo con neumonía bilateral severa / Non-surgical Spontaneous Pneumoperitoneum in a COVID-19 Positive Patient With Severe Bilateral Pneumonia

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Discrepancias en el análisis de la frecuencia, tipos de complicación y costes económicos en los pacientes ectópicos de cirugía general y digestiva / Discrepancies in the analysis of frequency, type of complications and costs of outlying patients in general and digestive surgery

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Absceso inguinal como presentación de la neoplasia de colon derecho. Revisión sistemática de la literatura / No disponible

La perforación del cáncer colorrectal es infrecuente y la invasión neoplásica de la pared abdominal acompañada de infección local es una condición más rara aun. Nuestro objetivo es presentar el caso de un varón de 84 años con una neoplasia de colon derecho que se manifestaba como un absceso inguinal y realizar una revisión sistemática de la literatura en PubMed, EMBASE y Web of Science. Se encontraron en total 59 casos. Todos los estudios eran retrospectivos. La mediana de edad era de 64 años. Treinta sujetos eran hombres y veintinueve mujeres (51% y 49%). La localización más frecuente era el colon derecho en 27 casos (46%), seguido del izquierdo en 18 casos (31%), el transverso en 12 casos (20%) y dos casos (3%) con neoplasia sincrónica de colon. Se realizó cirugía en dos o más tiempos en 33 casos (60%), cirugía en un tiempo en 21 casos (38%) y tratamiento médico en un caso (2%). El tipo histológico más frecuente fue el adenocarcinoma en el 64% de los casos, seguido de la variante mucinosa (22%). Hubo recidiva en el 33% de los casos. La mortalidad durante el seguimiento fue del 47%. Como limitación de nuestro estudio, el seguimiento de los casos fue heterogéneo, imposibilitando la interpretación de los resultados a largo plazo con respecto a la influencia del tratamiento en la supervivencia de estos pacientes; además, esto se ve también dificultado al ser una condición urgente y con una incidencia excepcional. Es necesaria la realización de estudios con recolección de datos prospectiva en el manejo del CCR de urgencias, estandarizando el seguimiento para obtener un adecuado análisis del pronóstico de la enfermedad

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