Revista espanola de las enfermedades del aparato digestivo最新文献

We made a retrospective analysis of 43 cases of primary tumor of the small intestine, 28 benign and 15 malignant, diagnosed and treated in our hospital over a period of 18 years. A preoperative diagnosis was reached in 13 cases (30%), while in 37.2% the tumor was a casual finding during operation by other methods. The remaining 32.5% debuted as acute abdomen and were an emergency surgical indication. Simple tumoral resection was practiced in 19 cases (44.1%) of benign tumor, intestinal resection with end-to-end anastomosis in 22 cases (51%) and only biopsy in two cases (4.6%). Coadjuvant chemotherapy was given to five patients (11.5%) and radiotherapy to one (2.3%). The one-year survival for malignant tumors was 73%, and only 18% (2 cases) survived more than 5 years after the operation).

We made a bacteriological study of bile in a consecutive study of 210 patients studied in the General Surgery Department of the General Hospital of Elche (Spain) who underwent cholecystectomy for acute lithiasic cholecystitis, as a prognostic factor in the clinical evolution of these patients. The results obtained led us to the following conclusions. 1. The presence of positive bile culture is a risk factor predisposing to postoperative septic complications. 2. Bile cultures were more frequently positive in patients over 60-years-old. 3. In the early stages of the disease, positive cultures were more frequent. 4. The organism most often isolated was E. coli, so antibiotic treatment should be directed mainly against this agent.

The authors present 5 cases of congenital aganglionar megacolon in patients over 12 years of age. They were diagnosed and treated in the Digestive System Service and Surgery Department of the "Virgen del Rocío" University Hospital of Seville (Spain). After describing the infrequent incidence of this pathology outside early childhood, the different procedures proposed for its diagnosis are described. Once clinical suspicion of megacolon was established, a careful clinical history with special reference to bowel habit from birth was made, as well as a barium enema, anorectal manometry and rectal endoscopy and biopsy for histological and histochemical studies. Once diagnosed, all patients underwent surgery consisting in excision of the aganglionar colorectal segment, retrorectal lowering of the healthy colon and exteriorization through the fibers of the internal anal sphincter. A side-to-side transanal anastomosis between the healthy colon and diseased rectum (Duhamel II) was fashioned. All the patients had a satisfactory evolution with little immediate morbidity. Five to ten years after performing the operations, the patients remained asymptomatic, without bowel habit disturbances and showed an adequate development.

Extrapulmonary locations of undifferentiated small cell carcinoma of the "oat cell" type are uncommon. In spite of its rarity, the appearance of this type of tumor has been described in various organs of the economy. Of these, the esophagus is the most common location, constituting 0.05 to 7.6% of esophageal carcinomas. Of uncertain histopathologic origin, these tumors are characterized by their extreme aggressiveness, which carries a poor short term prognosis. Surgery, radiotherapy and chemotherapy, separately or in combination, have produced discouraging results in the treatment of primitive esophageal "oat cell" carcinoma. In this paper are presented four cases of esophageal "oat cell" carcinoma treated in the Hospital de la Santa Cruz y San Pablo in 1979-1988, out of a total of 260 carcinomas in the same location. The clinical evolution and pathological findings of this type of tumor are commented. The literature on this unusual histological type of carcinoma is reviewed.

Four cases are presented of surgical compresses retained in the abdominal cavity that were studied by simple radiology, gastrointestinal transit, echography and/or computerized tomography. Depending on their location, they appeared as heterogeneous intra- or extraluminal masses, often containing air or calcifications. The radiological findings, as well as the existence of surgical antecedents, allowed the preoperative diagnosis of the lesion in all the cases.

Hernial strangulation of Meckel's diverticulum (Littre's hernia) is a rare anatomoclinical form. It represents 10% of all complications of Meckel's diverticulum (8.8% of our cases), and complications like hemorrhage, perforation and diverticulitis are fairly frequent. Four cases of Littre's hernia are presented: two males and two females, with an average age of 67 years (range 50-83 years), representing 0.08% of all the inguinal-crural hernias operated in the department. The clinical manifestations were those of intestinal obstruction because a mixed type Littre's hernia was involved, with compromise of the diverticulum and its intestinal loop. Preoperative diagnosis is unlikely in strangulation without disturbances in the intestinal transit and, in fact, is even less likely if it is accompanied by obstruction. The diagnosis is thus almost always intraoperative. The correct treatment is surgery after restoring the patient's hemodynamic equilibrium. Simple and/or loop diverticulectomy via herniotomy, herniolaparotomy or laparotomy are debated. We think that this disorder can generally be resolved using the inguinal approach, as in any strangled hernia, with the technical option of using a larger, more comfortable and safer approach in cases of important obesity and/or deterioration of the loop (necrosis, perforation). In elderly patients with uncomplicated Littre's hernia and Meckel's diverticulum, abstention from diverticular exeresis may be justifiable. Of the four patients, the first two died from cardiogenic shock and pulmonary embolism, respectively; the last two evolved well (except for a wound abscess).

Isolated obstruction of the splenic vein leads to the appearance of a relatively uncommon form of portal hypertension, the diagnosis of which depends on a high rate of awareness, and it can be successfully treated by splenectomy. A case is described of segmental portal hypertension, with special emphasis on the difficulty of its diagnosis and the measures used. Therapeutic possibilities are commented.

A case is presented of massive lower intestinal bleeding due to typhoid fever. Because of uncontrollable bleeding, emergency right hemicolectomy and resection of the last 50 cm of the distal ileum was performed after endoscopy and arteriography, both of which were negative. The histology of the lesions typical of this disease is described.