Paraganglioma gangliocítico metastásico: una rara entidad histológica diagnosticada tras una duodenopancreatectomía / Metastatic gangliocytic paraganglioma: a rare histological entity diagnosed after duodenopancreatectomy

Introducción. El paraganglioma gangliocítico es una entidad histológica infrecuente, siendo el duodeno su principal localización extra ganglionar. Caso clínico. Se trata de un varón de 54 años que consulta por dolor abdominal y hemorragia digestiva alta. Se diagnosticó una lesión sospechosa de ampuloma por lo que se realizó una duodenopancreatectomía cefálica. En el análisis histológico, se confirmó el diagnóstico de paraganglioma gangliocítico metastásico por la presencia patognomónica de tres estirpes celulares (epiteliales, ganglionares y Schwann-like). Dado su buen pronóstico, asociado con baja quimiosensibilidad, no recibió tratamiento adyuvante. Resultados. Durante el seguimiento, el paciente no presentó complicaciones tardías, ni signos de recidiva después de un año de la intervención. Conclusión. El paraganglioma gangliocítico es una entidad potencialmente maligna, que requiere un correcto estudio de extensión y un seguimiento estrecho a largo plazo

Introduction. Gangliocytic paraganglioma is a rare histological entity, with the duodenum being its main extra-nodal location. Clinical case. This is a 54-year-old man who presented with abdominal pain and upper gastrointestinal bleeding. A suspicious ampuloma lesion was diagnosed, for which a pancreaticoduodenectomy was performed. In the histological analysis, the diagnosis of metastatic gangliocytic paraganglioma was confirmed by the pathognomonic presence of three cell lines (epithelial, ganglionic, and Schwann-like). Given his good prognosis associated with low chemosensitivity, he did not receive adjuvant treatment. Results. During follow-up, the patient did not present late complications or signs of recurrence one year after the intervention. Conclusion. Gangliocytic paraganglioma is a potentially malignant entity that requires a correct extension study and close long-term follow-up

The use of seton as a bridge to definitive ligation of the intersphincteric fistula tract procedure for fistula-in-ano: a systematic review and meta-analysis

Background: There is still controversy over the usefulness of seton placement prior to the ligation of the intersphincteric fistula tract (LIFT) surgery in the management of anal fistula. Objective: To evaluate the impact of preoperative seton placement on the outcomes of LIFT surgery for the management of fistula-in-ano. Design: systematic review and meta-analysis. Data Sources: A search was performed on the MEDLINE (PubMed), EMBASE, Scopus, Web of Science, Cochrane Library and Google Scholar databases. Study Selection: Original studies without language restriction reporting the primary healing rates with and without seton placement as a bridge to definitive LIFT surgery were included. Intervention: The intervention assessed was the LIFT with and without prior seton placement. Main Outcome Measures: The main outcome was defined as the primary healing rate with and without the use of seton as a bridge to definitive LIFT surgery. Results: Ten studiesmet the criteria for systematic review, all retrospective,with a pooled study population of 772 patients. There were no significant differences in the percentages of recurrence between patients with and without seton placement (odds ratio [OR] 1.02; 95% confidence interval [CI] 0.73-1.43: p=0.35). The I2 value was 9%, which shows the homogeneity of the results among the analyzed studies. The 10 included studies demonstrated a weighted average overall recurrence of 38% (interquartile range [IQR] 27-42.7%), recurrence with the use of setonwas 40%(IQR26.6-51.2%), and without its use, the recurrence rate was 51.3% (IQR 31.3-51.3%) Limitations: The levels of evidence found in the available literature were relatively fair, as indicated after qualitative evaluation using the Newcastle-Ottawa scale and the Attitude Heading Reference System (AHRS) evidence levels. Conclusions: Our meta-analysis suggests that the placement of seton as a bridge treatment prior to LIFT surgery does not significantly improve long-term anal fistula healing outcomes. Ligation of the intersphincteric fistula tract surgery can be performed safely and effectively with no previous seton placement. International prospective register of systematic reviews-PROSPERO registration number: CDR42020149173. (AU)

Malrotación intestinal en adultos: causa infrecuentede obstrucción intestinal / Intestinal malrotation in adults: An uncommon cause of intestinal obstruction

La malrotación intestinal es una malformación congénita que afecta hasta al 1 % de la población. Aproximada-mente, el 90 % de los casos se presenta en la edad pediátrica y, rara vez, en la población adulta, lo que convierte a esta alteración en un reto para los profesionales sanitarios. Se presenta el caso de una paciente que se inició con un cuadro de obstrucción intestinal y abdomen agudo; se le diagnosticó malrotación intestinal, vólvulo y obstrucción por bridas, durante la laparotomía exploradora ur-gente. El conocimiento de condición patológica es imprescindible para poder brindarle un correcto tratamiento quirúrgico

The intestinal malrotation is a congenital malformation that affects up to 1% of the population. Approximately 90% of cases are diagnosed in the pediatric age and rarely in the adult population, which makes this pathology a challenge for health professionals.This is a case of a patient who presented with intestinal obstruction and acute abdomen that was diagnosed during the emergency exploratory laparotomy with intestinal malrotation, volvulus and obstruction. The knowledge of this pathology is essential to perform its correct surgical treatment