Acute calculous cholecystitis in a patient with suprahepatic gallbladder, hepatic hypoplasia and Chilaiditi's sign.

Chilaiditi's sign is the interposition of small bowel or colon between the liver and diaphragm. This incidental finding is seen in 0,025-0,28% of the chest and abdominal radiographies. Predisposing factors include the absence, laxity or elongation of the suspensory ligaments of the transverse colon, redundant colon or elevation of the right hemidiaphragm. Atrophy or hypoplasia of the liver is an uncommon cause of this radiological sign. On the other hand, suprahepatic gallbladder is the most infrequent location of gallbladder ectopies (0,026-0,7%). It is associated with an abnormal development of the right liver lobe such as agenesis, hypoplasia or atrophy. We present the case of a 73-year-old man with Chilaiditi's sign, hepatic hypoplasia and acute calculous cholecystitis in an ectopic suprahepatic gallbladder.

Differences between residual and primary choledocholithiasis in cholecystectomy patients.

INTRODUCTION: choledocholithiasis can be primary from stones originally formed in the choledocho or secondary from stones that have migrated from the gallbladder to the choledocho. The objective of this study was to determine the clinical differences between both types of choledocholithiasis in cholecystectomy patients. MATERIAL AND METHODS: a comparative and retrospective study was performed of cholecystectomy patients who presented choledocholithiasis. Residual or secondary choledocholithiasis (group 1) was defined as those which appear in the first two years after cholecystectomy and primary choledocholithiasis (group 2) was defined as those which appear two years after cholecystectomy. Choledocholithiasis was confirmed by endoscopic retrograde cholangiopancreatography (ERCP) or surgery. RESULTS: patients with primary choledocholithiasis (n = 14) were older (61.5 ± 20.3 vs 74.4 ± 10.5 years; p = 0.049) and had a greater body mass index (BMI) (27.7 ± 4.3 vs 31.6 ± 4.6 kg/m2; p = 0.043) and a larger extrahepatic bile duct diameter (10.7 ± 2.7 vs 14.7 ± 3.5 mm; p = 0.004) compared to patients with residual or secondary choledocholithiasis (n = 11). All patients were treated by ERCP. There were no differences between groups 1 and 2 regarding recurrences (36.2 % vs 14.3 %; p = 0.350), disease-free survival (64.6 ± 30.9 vs 52.2 ± 37.7 months; p = 0.386) and overall survival (73.6 ± 32.4 vs 54 ± 41.9 months; p = 0.084). CONCLUSIONS: patients with primary choledocholithiasis were older and had a greater BMI and a larger diameter of the bile duct compared to patients with residual or secondary choledocholithiasis. ERCP is a good therapeutic option for the resolution of both types of choledocholithiasis.

Predictive factors for mortality in Fournier' gangrene: a series of 59 cases.

AIMS: Fournier's gangrene (FG) is the necrotizing fasciitis of the perineum and genital area and presents a high mortality rate. The aim was to assess prognostic factors for mortality, create a new mortality predictive scale and compare it with previously published scales in patients diagnosed with FG in our Emergency Department. METHODS: Retrospective analysis study between 1998 and 2012. RESULTS: Of the 59 patients, 44 survived (74%) (S) and 15 died (26%) (D). Significant differences were found in peripheral vasculopathy (S 5 [11%]; D 6 [40%]; P=.023), hemoglobin (S 13; D 11; P=.014), hematocrit (S 37; D 31.4; P=.009), white blood cells (S 17,400; D 23,800; P=.023), serum urea (S 58; D 102; P<.001), creatinine (S 1.1; D 1.9; P=.032), potassium (S 3.7; D 4.4; P=.012) and alkaline phosphatase (S 92; D 133; P=.014). Predictive scores: Charlson index (S 1; D 4; P=.013), severe sepsis criteria (S 16 [36%]; D 13 [86%]; P=.001), Fournier's gangrene severity index score (FGSIS) (S 4; D 7; P=.002) and Uludag Fournier's Gangrene Severity Index (UFGSI) (S 9; D 13; P=.004). Independent predictive factors were peripheral vasculopathy, serum potassium and severe sepsis criteria, and a model was created with an area under the ROC curve of 0.850 (0.760-0.973), higher than FGSIS (0.746 [0.601-0.981]) and UFGSI (0.760 [0.617-0.904]). CONCLUSIONS: FG showed a high mortality rate. Independent predictive factors were peripheral vasculopathy, potassium and severe sepsis criteria creating a predictive model that performed better than those previously described.

[Appendiceal diverticulitis: comparative study of 7 cases versus 442 acute appendicitis]. / Diverticulitis apendicular: Estudio comparativo de 7 casos versus 442 apendicitis agudas.

BACKGROUND: Appendiceal diverticulitis (AD) is a rare cause of acute appendicitis (AA) which is most frequently diagnosed after appendectomy in pathological study. OBJECTIVE: To compare AA versus AD. METHODS: Retrospective analytic study in avperiod of 51 months fom January 2009 to March 2013 in the Hospital Universitario San Juan de Alicante (Spain), including patients with clinical or radiological suspicious of acute appendicitis which was confirmed intraoperatively and with the pathological study. RESULTS: We included 449 patients, 442 typical AA (98.5%) and 7AD (1.5%). DA was more frequent in women (57%) with a median age of 44 years old (range 37 to 57 years old), whereas AA was more frequent in men (61%) with a median age of 28 years old (range 15 to 46 years old). Leukocyte count, neutrophils and C-reactive protein were respectively 13,300 per mm3 (range 10,700 to 15,700 per mm3), 87.1% (range 84.6 to 89.6%) and 1.82 mg/dL (range 0.59 to 5.31 mg/dL) in AD versus 14,700 per mm3 (range 12,300 to 17,600 per mm), 81.6% (range 75.1 to 86.4%) and 2.71 mg/dL (range 0.67 to 75 mg/dL) in AA. Alvarado score and appendicitis diagnostic score were respectively 7 (range 6 to 8) and 6 (range 5 to 7) in AD and 7 (range 5 to 7) and 6 (range 5 to 6) in AA. An appendiceal perforation was seen in 3 AD (43%) and 80 AA (18%). CONCLUSION: AD appeared in older patients with a clinical and blood test profile similar to AA but with a higher perforation rate.

Sentinel node biopsy for melanoma. Analysis of our experience (125 patients).

INTRODUCTION: The objective of this study is to analyze our experience in the use of sentinel node biopsy (SNB) in melanoma and identify the predictive factors of positive SNB and multiple drainage. MATERIAL AND METHODS: Retrospective study of patients who underwent SNB for melanoma between August of 2000 and February of 2013. RESULTS: SNB was performed in 125 patients with a median of age of 55,6 (±15) years. The anatomic distribution was: 44 (35,2%) in legs, 24 (19,2%) in arms, 53 (42,4%) trunk and 3 (2,4%) in head and neck. The median Breslow index was 1,81 (0,45-5). Between 1 and 6 nodes were isolated. The drainage was unique in 98 (78,4%) and multiple in 27 (21,6%). The trunk was the localization of 25 (92,6%) nodes with multiple drainage. The definitive result of sentinel node (SN) was positive in 18 cases (7,1%). Breslow thickness (p=0,01) was statistically significant predictor of a positive SNB. CONCLUSIONS: The SNB allows patients to be selected for lymphadenectomy. Melanoma of the trunk was the principle location of multiple drainage. The only predictive factor of positive SNB was Breslow thickness.

[Surgical complications in drug body-packers: an uncommon but potentially lethal emergency]. / Complicaciones quirúrgicas en los body-packers: una urgencia infrecuente pero potencialmente letal.

INTRODUCTION: Drug trafficking by means of introducing packets of illegal substances in body cavities carries a risk of suffering from a gastrointestinal obstruction and/or severe poisoning in the person who transports them. Spain is considered as the port of entry to Europe for drugs, and some Spanish hospitals have experience in managing these types of patients. Two hospitals in Madrid, including the Gregorio Marañón University General Hospital (HGUGM), received these potential patients from the Madrid Barajas airport. OBJECTIVE: To analyse the results of the conservative treatment and the need for surgery in "body-packers". MATERIAL AND METHODS: A retrospective, observational study of patients diagnosed as a body-packer between January 2000 and December 2008. Those with gastrointestinal symptoms, signs of poisoning, or positive for drugs of abuse, were admitted to the Custodial Unit of our hospital. The conservative treatment consisted of digestive rest and imaging studies until expulsion from the body. Asymptomatic patients were discharged from the Emergency Department. RESULTS: A total of 549 patients, with a median age of 31 years, and of whom 81% were males, were hospitalised during this period. Less than half (40%) showed positive for drugs in the urine, with cocaine in 80% of the cases. Of the 549 patients with initial conservative treatment, 27 (4.9%) had serious complications (16, bowel obstruction, and 11 with signs of poisoning). Of these, 23 required surgery (the 16 obstructions and 7 of the poisonings); 2 were successfully treated in ICU, and 2 died before surgery (0.4%) of the cases. The most frequent surgical treatment was enterotomy and/or gastrostomy to extract the packets. Thirteen (56%) of those operated on had associated morbidity (11 abdominal infections and 2 nosocomial infections). CONCLUSIONS: Conservative treatment is safe in 95% of the patients. A small percentage required surgical treatment, basically for gastrointestinal obstruction or severe poisoning.

Prognostic and predictive value of neutrophil-to-lymphocyte ratio after curative rectal cancer resection: A systematic review and meta-analysis.

BACKGROUND: Neutrophil-to-lymphocyte ratio (NLR) has been shown to be associated with poor prognosis in numerous solid malignancies. Here, we quantify the prognostic value of NLR in rectal cancer patients undergoing curative-intent surgery, and compare it with platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR). METHODS: A comprehensive search of several electronic databases was performed through January 2021, to identify studies evaluating the prognostic impact of pretreatment NLR in patients undergoing curative rectal cancer resection. The endpoints were overall survival (OS), disease-free survival (DFS), and clinicopathologic parameters. The pooled hazard ratio (HR) or odds ratio with 95% confidence interval (CI) were calculated. RESULTS: Thirty-one studies comprising 7553 patients were assessed. All studies evaluated NLR; thirteen and six evaluated PLR and LMR, respectively. High NLR was associated with worse OS (HR 1.92, 95% CI 1.60-2.30, P < 0.001) and DFS (HR 1.83, 95% CI 1.51-2.22, P < 0.001), and the results were consistent in all subgroup analyses by treatment modality, tumor stage, study location, and NLR cut-off value, except for the subgroups limited to cohorts with cut-off value ≥ 4. The size of effect of NLR on OS and DFS was greater than that of PLR, and similar to that of LMR. Finally, high NLR was associated with lower rate of pathologic complete response. CONCLUSIONS: In the setting of curative rectal cancer resection, pretreatment NLR correlates with tumor response to neoadjuvant therapy, and along with LMR, is a robust predictor of poorer prognosis. These biomarkers may thus help risk-stratify patients for individualized treatments and enhanced surveillance.

[Thoracic empyema due to subphrenic appendicitis: an infrequent presentation]. / Empiema pleural secundario a apendicitis subdiafragmática: una extraña presentación.

Acute appendicitis is the most common abdominal surgical emergency. Atypical presentations lead to a late diagnosis with a higher complication rate. Given its rarity, we report a case of a thoracic empyema due to subphrenic appendicitis.

Incisional Surgical Site Infection after Abdominal Fascial Closure with Triclosan-Coated Barbed Suture vs Triclosan-Coated Polydioxanone Loop Suture vs Polydioxanone Loop Suture in Emergent Abdominal Surgery: A Randomized Clinical Trial.

BACKGROUND: Triclosan-coated sutures have been shown to reduce surgical-site infection (SSI) in emergent operation for fecal peritonitis. Barbed sutures provoke a homogeneous distribution of tension throughout the suture, implying better blood supply to the wound edges and healing. The aim of this study was to evaluate the effect, on SSI and evisceration, of using triclosan-coated and barbed sutures for fascial closure in patients undergoing emergent surgery. STUDY DESIGN: A prospective, randomized clinical trial was performed. Patients were randomized into 3 groups: those undergoing aponeurotic closure with triclosan-coated barbed suture (Stratafix Symmetric [Johnson & Johnson]), patients undergoing closure with triclosan-coated polydioxanone loop suture (PDS plus [Johnson & Johnson]), and patients undergoing closure with polydioxanone loop suture (PDS [Johnson & Johnson]). Primary investigated outcomes were SSI and evisceration rates during a follow-up period of 30 days. The primary analysis plan was based on a per-protocol approach. RESULTS: Incisional SSI was 6.4% (3 of 47) in the Stratafix Symmetric group, 8.9% (4 of 45) in the PDS plus group, and 23.4% (11 of 47) in PDS group (p = 0.03). The evisceration rate was 0% in Stratafix Symmetric, 8.9% (4 of 45) in PDS plus, and 12.8% (6 of 47) in PDS (p = 0.05). Median hospital stay was 4 days (range 2 to 14 days) in Stratafix Symmetric, 5 days (range 2 to 21 days) in PDS plus, and 8 days (range 2 to 60 days) in PDS (p = 0.012). The use of triclosan-coated sutures (Stratafix Symmetric and PDS plus) was associated with a lower risk of incisional SSI (p = 0.009), and the use of barbed suture was associated with a lower risk of evisceration (p = 0.019). Comparing Stratafix Symmetric with PDS plus, there were no significant differences in SSIs, but the evisceration rate was significantly higher in the PDS plus group (p = 0.036). CONCLUSIONS: The use of triclosan-coated sutures (Stratafix Symmetric and PDS plus) in emergent surgery reduces the incidence of incisional SSIs. The use of barbed sutures reduces the incidence of evisceration.

[Safety and efficiency of ambulatory treatment of acute diverticulitis]. / Eficiencia y seguridad del tratamiento ambulatorio de la diverticulitis aguda.

INTRODUCTION: The treatment of acute diverticulitis is currently being modified, showing a tendency to limit surgical treatment and favor conservative management. OBJECTIVE: To analyze the safety and efficiency of ambulatory treatment of acute diverticulitis in a selected group of patients. METHODS: We performed a prospective study of domiciliary oral antibiotic therapy for acute diverticulitis in a cohort of patients in the Emergency Surgery Section of our hospital. Seventy-four patients (44 men and 30 women) were included between 2000 and 2006. Patients with Hinchey stage 1 diverticulitis and those with Hinchey stage 2 diverticulitis and abscesses of less than 3cm, who were clinically and biochemically stable, were selected. The patients were treated with oral ciprofloxacin and metronidazole for 7-10 days. Follow-up was performed in the outpatients unit with clinical evaluation at 10 days and an imaging test at 1 month. RESULTS: The mean age of the patients was 55 years. The most frequent clinical presentation was spontaneous abdominal pain associated with leukocytosis. The mean duration of treatment was 8.8 days. Four patients (5.4%) required subsequent hospital admission for intravenous antibiotic administration and 70 (94.6%) completed treatment without complications. During follow-up, two cases of colonic adenocarcinoma and six cases of polyposis were diagnosed. Only 13 patients underwent elective surgery. CONCLUSIONS: In most of the patients studied, ambulatory conservative management was safe and effective in the treatment of uncomplicated acute diverticulitis. Moreover, this approach reduces length of hospital stay and lowers costs.

[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.

Microbiologic Analysis of Complicated and Uncomplicated Acute Appendicitis.

BACKGROUND: Microbiologic studies suggest that complicated (CAA) and uncomplicated (UAA) acute appendicitis are different entities. Routine peritoneal fluid cultures continue to be controversially related to a low positive rate, found mainly in UAA; to isolation of typical micro-organisms with expected susceptibilities; and to a community-acquired intra-abdominal infection. The aim of this study was to describe microbiologic isolates in CAA and UAA and the usefulness of peritoneal fluid cultures to determine the susceptibilities to our antibiotic therapy guidelines. METHODS: This study was a retrospective review of a prospective database collected at University San Juan Hospital (Spain) between June 2014 and June 2017. Complicated acute appendicitis was defined as gangrenous or perforated, whereas UAA was defined as phegmonous or suppurative. Our antibiotic recommendations are amoxicillin-clavulanic acid and in patients with ß-lactam allergies, metronidazole plus aztreonam, and an aminoglycoside (gentamicin or tobramycin). Microbiologic cultures were performed in 264 patients, 157 with a CAA and 107 with a UAA. RESULTS: The positive culture rate was significantly higher in CAA (59%) than in UAA (24.3%). Gram-positive cocci (51.6% CAA; 23.1% UAA), including Streptococcus constellatus (29% CAA; 3.8% UAA), and anaerobes (67.7% CAA; 42.3% UAA) were significantly more common in CAA. The rates of antibiotic resistance were amoxicillin-clavulanic acid 14% (17.2% CAA; 3.8% UAA), gentamicin or tobramycin 8.4% (9.7% CAA; 3.8% UAA), ciprofloxacin 5.9% (6.5% CAA; 3.8% UAA), and ertapenem 10.9% (14% CAA; 0 UAA). CONCLUSIONS: The culture-positive rate was higher in CAA, with different isolates and susceptibilities than in UAA, identifying a higher frequency of gram-positive cocci (including S. constellatus) and anaerobes. We recommend obtaining peritoneal fluid cultures in CAA, which frequently will lead to a change in the antimicrobial drug therapy guidelines, creating specific recommendations in AA.

[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.

[Epiploic appendagitis: a rare cause of abdominal pain]. / Apendagitis epiploica, causa poco frecuente de dolor abdominal.

BACKGROUND: Epiploic appendagitis is an atypical cause of abdominal pain whose knowledge could avoid diagnostic or treatment errors. Diagnosis has been performed with abdominal ultrasound or tomography with the only treatment being nonsteroidal anti-inflammatory drugs. OBJECTIVE: To analyze patients diagnosed in our hospital. METHODS: We performed a 4-year retrospective and descriptive study (March 2009-March 2013) of patients diagnosed with epiploic appendagitis in our hospital. RESULTS: Seventeen patients were included, 14 females and three males with a median age of 57 years. Symptom delay was 72 h. Abdominal pains were located in the left lower quadrant in 64.7% and right lower quadrant in 35.3% of patients. Blood test demonstrated leukocytes 6,300 (5,000-9,500), neutrophils 61.6% (57-65.8), and C reactive protein 1.5 (0.85-2.92). Diagnosis was confirmed with abdominal ultrasound or tomography in 88.2% and intraoperatively in 11.8%. CONCLUSIONS: Epiploic appendagitis was more frequent in women. Abdominal pain was located in the lower quadrant, more predominant in left than right. Blood tests were normal except for increased levels of C-reactive protein. Diagnosis was made mostly preoperatively due to imaging tests, avoiding unnecessary surgical intervention.

ANTECEDENTES: la apendagitis epiploica es una causa poco frecuente de dolor abdominal cuyo conocimiento podría evitar errores diagnósticos y terapéuticos. El diagnóstico suele establecerse mediante ecografía o tomografía abdominal; el tratamiento es sintomático, con antiinflamatorios. OBJETIVO: analizar los casos diagnosticados en nuestro centro. MATERIAL Y MÉTODOS: estudio retrospectivo y descriptivo de pacientes con diagnóstico de apendagitis epiploica durante 4 años (marzo 2009 a marzo 2013). RESULTADOS: se incluyeron 17 pacientes, 14 mujeres y 3 hombres, con una mediana de edad de 57 años. El periodo de latencia de los síntomas fue 72 horas. En 64.7% de los pacientes el dolor abdominal se localizó en el cuadrante inferior izquierdo y en 35.3% en el derecho. Laboratorio: leucocitos 6,300 (5,000-9,500), neutrófilos 61.6% (57- 65.8), proteína C reactiva 1.5 (0.85-2.92). El diagnóstico se confirmó mediante ecografía o tomografía abdominal en 88.2%, e intraoperatorio en 11.8%. CONCLUSIONES: la apendagitis epiploica fue más frecuente en mujeres. La clínica fue dolor abdominal en los cuadrantes inferiores, más frecuente en el lado izquierdo, con RESULTADOS de laboratorio normales, excepto la elevación de la proteína C reactiva. En la mayoría de los casos el diagnóstico se estableció preoperatoriomente, gracias al uso de pruebas radiológicas que evitó las intervenciones quirúrgicas innecesarias.

[Lumbar abscess secundary to retained gallstones]. / Absceso Lumbar Secundario a Colelitiasis Retenida.

Lost gallstones after accidental opening of the gallbladder during cholecystectomy usually under laparoscopy, can cause late complications. Intra-abdominal abscess is the most frequent and the diagnosis is based on imaging techniques (abdominal ultrasound or computed tomography scan). Surgical drainage with gallstones removal seems to be the best approach, due to the fact that a simple percutaneous drainage has a high failure rate. However, a posterior abdominal wall abscess as the initial manifestation of intra-abdominal abscess due to retained gallstones is uncommon, and this prompted us to report this case.

[Predictive factors of mortality in severe ischaemic colitis: post-operative analysis of 101 patients]. / Factores predictores de mortalidad en la colitis isquémica grave: análisis de 101 pacientes intervenidos.

INTRODUCTION: Ischaemic colitis (IC) is the most common form of bowel ischaemia and is often under-diagnosed. OBJECTIVES: To report the results obtained in patients with IC who required surgical intervention in our Hospital, and to evaluate the predictive factors of mortality. METHODS: The data were obtained from the Gregorio Marañon Hospital CI database. The demographic and clinical characteristics, diagnostic methods, surgical techniques employed and mortality were analysed statistically, using the chi(2) and Student t test. RESULTS: One-hundred and one patients with CI were operated on between 1991 and 2006. The majority of them had cardiovascular histories and 35 cases were diagnosed during their hospital stay due to another cause. The signs and the symptoms were non-specific in 40% of the cases. Total morbidity and mortality was 39.6% and 41.6% respectively. In the post-operative IC cases, the death rate increased to 68% (p<0.01); 93% of the patients who died had transmural necrosis during the surgery (p<0.05) and 69% had a metabolic acidosis. CONCLUSIONS: The death rate in patients with IC that requires surgery is high, particularly if the diagnosis is made in the post-operative period after surgery for another cause, or if there is evidence of transmural necrosis during the intervention. Early diagnosis is the best tool to improve these results.