BACKGROUND: The benign lesion of the bile duct is a complication of difficult diagnosis and treatment; which has increased due to the use of laparoscopic cholecystectomy (LC) in the management of cholecystolithiasis. Rates of 0.2 to 0.4% of bile duct injuries have been reported, becoming a significant cause of mortality at the time of repair. METHODS: This is an observational, descriptive study, a retrospective case series, based on primary sources of information. The universe of the study are the patients who underwent surgery for bile duct injury from 1989 to 2020, in a private clinic in the city of Cuenca-Ecuador. RESULTS: In more than 30 years, 24 bile duct injury repairs were performed, which occurred: 6 during conventional surgery and 18 during laparoscopic surgery. 54.2% of the lesions occurred less than two centimeters from the confluence of the hepatic ducts. 58.4% of lesions were repaired with Roux-en-Y anastomosis. Antibiotic therapy and drainage were administered to 100% of the patients; 45.83% of the drains placed were tubular drains. 70.8% of the patients didn´t have complications after the repair procedure; the complications that occurred are: bilioma, fistulas, stenosis, cholangitis. CONCLUSION: In most patients who had bile duct injury, the injury occurred during laparoscopic surgery. The injury was most often located less than two centimeters from the confluence of the hepatic ducts. The most frequently performed repair procedure was the Roux-en-Y anastomosis. The most frequent complication after repair was cholangitis.

Introducción: la colitis colagenosa es un subtipo de colitis microscópica, que se presenta como un cuadro de diarrea sin sangre, de inicio insidioso con períodos de remisión, exacerbación y dolor abdominal. Tiene una prevalencia de 10 a 15 por 100b000 habitantes. Caso clínico: paciente de 27 años con cuadro de diarrea acuosa de 1 año 6 meses de evolución, asociado al consumo de alimentos y acompañado de malestar abdominal, presenta incremento de la frecuencia evacuatoria. Se realiza calprotectina fecal con resultado de 516 ug/g por lo que se decide endoscopia digestiva alta y baja, con hallazgo endoscópico normal y de histopatología con reporte de colon compatible con colitis colagenosa. Se aplican restricciones dietéticas y de medicamentos desencadenantes; se inicia terapia con subsalicilato de bismuto obteniendo mejoría. Conclusión: en caso de diarrea crónica no filiada, el estudio debe ser exhaustivo para un diagnóstico certero, como en este caso de colitis colagenosa para definir un tratamiento específico.

BACKGROUND: Hyponatremia is the most frequent hydroelectrolytic disorder; it has multiple etiologies, and it is important to study in order to define an adequate treatment. Thus the aim of this study is to determine the prevalence, classification and factors associated with hyponatremia in patients hospitalized in the clinical service of Hospital José Carrasco Arteaga. METHODS: an observational, cross-sectional, analytical study was carried out with a sample of 347 patients, calculated with 95% confidence, 10% prevalence, inference error of 3%, in a population of 1 426 patients. Data was obtained from the institutional medical system (AS400) and analyzed with PSPP software. To determine the prevalence, hyponatremia was considered with sodium less than 135mEq/l, which was corrected according to glucose value. We calculated the prevalence ratio with a 95% confidence interval, statistical significance was estimated when p value was <0.05. RESULTS: the average age was 62 years, the female sex represented 53.3% of the sample. The prevalence of hyponatremia was 25.9%. According to severity, mild forms represented 72.22%, moderate 16.67% and severe 11.11%; in terms of osmolarity, 98.89% were hypotonic. Associated factors with hyponatremia were: decompensated hypothyroidism (PR: 3.39, 95% CI = 2.42 - 4.75, p= < 0.001), liver cirrhosis (PR: 3.18, 95% CI = 2.25 - 4.48, p= < 0.001), kidney failure (PR: 2.46, 95% CI = 1.70 - 3.55, p= < 0.001), disorders that produce third space: sepsis or pancreatitis (PR: 2.00, 95% CI = 1.29 - 3.09, p = 0.006) and use of diuretics (PR: 1.86, 95% CI = 1.29 - 2.68, p = 0.001). CONCLUSION: a quarter of the hospitalized patients presented hyponatremia, the mild form was the most frequent. Hyponatremia had a statistically significant association with decompensated hypothyroidism, liver cirrhosis, kidney failure, disorders that produce third space and use of diuretics.

BACKGROUND: Primary pericardial mesothelioma is an extremely rare mesodermal tumor, among oncological diseases, with a very low incidence. About 350 cases have been described around the world, most of them diagnosed post-mortem. The short term prognosis is poor, regardless of the treatment, which is mostly palliative. We present a case report regarding this pathology. CASE REPORT: 69 year old patient hospitalized with dyspnea and severe anemia. Complementary workup showed pleural effusion and pericardial effusion. Histopathology report of the pericardial fluid revealed pericardial mesothelioma. EVOLUTION: Due to recurrence of pericardial effusion, it was decided to perform pericardiectomy and left pleurectomy as palliative treatment, to alleviate the patient’s symptoms. Chemotherapy was planned after the procedure, but the patient’s general condition deteriorated severely leading to his death. CONCLUSION: Primary pericardial mesothelioma is a rare tumor, whose symptoms are characterized by the associated pericardial effusion, making the diagnosis difficult due to it low incidence. The prognosis is poor in short- term, and there isn’t an established protocol for the treatment with results that showed improve in mortality. KEYWORDS: MESOTHELIOMA, PERICARDIAL EFFUSION, PERICARDIECTOMY, PLEUROTOMY.