HighlightsActinomycosis represents only the 0.02% of causes of acute apendicitis.We present the first case of appendiceal actinomycosis reported in México.As to our knowledge, this is the first case in the literature with appendiceal actinomycosis without been perforated.

HighlightsThe spontaneous perforation of the biliary tract is an extremely rare cause of peritonitis.We present a case of spontaneous perforation of the biliary tract in a patient with a history of 4 previous ERCP, a current diagnosis of choledocholithiasis and a probable cholangitis.This is the first case of spontaneous perforation of the biliary tract treated with ultrasound-guided drainage and ERCP successfully reported in México.

Cholecystectomy is the only definitive management of pancreatitis secondary to gallstone disease. Approximately 20% to 30% of patients with acute biliary pancreatitis (ABP) will have persistent common bile duct (CBD) stones. Therefore, choosing a method for the early diagnosis of choledocholithiasis is essential to reduce waiting days for surgery and hospital stay in these patients.The aim of this study was to compare the use of magnetic resonance cholangiography (MRC) and intraoperative cholangiography (IOC), and its impact on the length of the hospital stay in patients with mild ABP and an intermediate probability of choledocholithiasis.We prospectively evaluated all patients diagnosed with mild ABP and an intermediate probability of choledocholithiasis at admission and 48 hours after, from June, 2017 to December, 2017. Study subjects were identified upon admission and were classified into 2 groups of patients according to their choledocholithiasis predictors; a MRC was performed in the group 1, and an IOC was done in group 2.In all, 47 patients were enrolled in the final analysis of this study. Hospital stay in group 1 (CMR) patients was 8.29 (±2.69) days compared with 6.43 (±2.57) days in the group 2 (IOC) (P = .007). Mean waiting days for cholecystectomy was 17.14 (±26.04) days for group 1 and 5 (±2.69) days for group 2.We suggest an IOC as the election method for the diagnosis of CBD stones in patients with mild ABP in medical centers similar to ours because it reduces waiting days for surgery and hospital stay compared to the MRC.