Infarction of the greater omentum. Case report.

The case of a 65 year old woman presented symptoms of acute abdomen secondary to full torsion of the greater omentum is presented, diagnosed preoperatively by CT, thus avoiding emergency surgery due to good evolution with conservative attitude. This disease is a rare cause of abdominal pain, but we include it in the differential diagnosis of acute abdomen. Currently imaging techniques allow preoperative diagnosis to avoid emergency surgery, and maintain an expectant attitude to act on patient evolution. In our case, we chose conservative attitude and the patient is asymptomatic 7 months later.

Ultrasonografía endoscópica versus tomografía computarizada en la estadificación preoperatoria del cáncer gástrico / Endoscopic ultrasound versus multidetector computed tomography in preoperative gastric cancer staging

Introducción: la ultrasonografía endoscópica (USE) es la técnica de elección para la estadificación loco-regional del adenocarcinoma gástrico (ACG). Sin embargo, la introducción de la tomografía computarizada multidetector (TCMD) permite obtener estudios de muy alta calidad diagnóstica. Objetivo: nuestro objetivo fue comparar la rentabilidad diagnóstica de la USE frente a la TCMD en la estadificación loco-regional preoperatoria de los pacientes con ACG. Material y métodos: se realizó un estudio retrospectivo y comparativo entre pacientes intervenidos de ACG con estadificación preoperatoria mediante USE y TCMD de 64 filas, comparando en cada caso los resultados con el informe anatomopatológico final. Resultados: se analizaron 77 pacientes intervenidos de ACG, incluyéndose finalmente 42 que disponían de estadificación completa. Para la estadificación "T", la precisión diagnóstica (PD) global de USE fue superior a la de TCMD (62% vs. 50%). En un subanálisis entre estadios precoces (T1-2) y avanzados (T3-T4), la PD y sensibilidad (S) de la USE resultaron ser superiores a las de la TCMD (83,3% vs. 64,29% y 84,4% vs. 59,5% respectivamente), aunque sin alcanzarse niveles de significación estadística. Respecto al estadio N, la PD y S de la USE resultaron inferiores a las de la TCMD, aunque tampoco se alcanzaron diferencias estadísticamente significativas (57% vs. 64% y 29% vs. 55%). Conclusiones: en nuestra experiencia, la rentabilidad diagnóstica de la ecoendoscopia es similar a la de los nuevos TCMD en la estadificación preoperatoria T y N en pacientes con ACG. Sin embargo, ambas técnicas deberían considerarse complementarias hasta que estudios más extensos y aleatorizados puedan confirmar estos resultados (AU)

Introduction: Endoscopic ultrasonography (EUS) is the gold standard technique in loco-regional staging of gastric adenocarcinoma (GAC). Nevertheless, the introduction of multidetector-row computed tomography (MDCT) allows accurate studies to be performed. Objective: To compare the diagnostic yield of EUS and MDCT in loco-regional preoperative staging of gastric adenocarcinoma. Material and methods: This was a retrospective and comparative study of all surgical patients with GAC and preoperative staging by EUS and 64-row MDCT. The results for each case were compared with the histological data. Results: Seventy seven surgical patients with GAC were identified and forty two had a complete preoperative staging and were finally included in the study. With regard to overall accuracy of T staging, EUS was superior to MDCT (62% vs 50%). In a subanalysis of early stages (T1-T2) and advanced stages (T3-T4), accuracy and sensitivity (S) were higher for EUS than for MDTC (83.3% vs 64.29% and 84.4% vs 59.5% respectively), although this did not reach statistical significance. The overall accuracy and sensitivity of EUS for N staging was lower than that for MDCT, although neither comparison reached statistical significance (57% vs 64% and 29% vs 55%). Conclusion: EUS diagnostic yield is similar to new MDCT with regard to T and N preoperative staging of GAC. Nevertheless, both techniques should be considered as complementary until more extensive and randomized studies can confirm these results (AU)

Infarto de epiplón mayor. Caso clínico / Infarction of the greater omentum. Case report

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