No abstract

Se presenta el caso de una paciente de 68 años con un cuadro de colangitis recurrente y presencia de divertículo duodenal que comprime la vía biliar. El síndrome de Lemmel es una afección infrecuente en la literatura, debido a que los divertículos duodenales rara vez presentan síntomas (10%) y en general se diagnostican de manera incidental. El 75% de estos divertículos son periampulares. Si se localizan a 2.5 cm del ámpula de Vater son yuxtapapilares. Solo el 1% presentan complicaciones. Debe ser considerado en caso de ictericia intermitente y colangitis, y tenerlo en cuenta como diagnóstico diferencial de pseudoquistes, tumor de cabeza de páncreas o metástasis.

Small bowel bleeding (SBB) accounts for 5-10% of patients with gastrointestinal bleeding and its association is unusual in patients with histoplasmosis. The incidence of gastrointestinal histoplasmosis is unknown since only 3-12% present symptoms, predominantly in immunocompromised patients. However, in immunocompetent hosts, it is reported only in 0.05% of cases. A clinical case of an immunocompetent patient with massive SBB, Grade IV hypovolemic shock associated with systemic histoplasmosis and treated with intestinal resection and amphotericin B is hereby discussed.

Background: Wound management with negative pressure therapy has been used in the treatment of complex wounds in both inpatient and outpatient settings, and is increasingly used in primary care and outpatient management, as it helps to reduce patient days of hospital stay. We describe the initial 4-year experience in the use of negative pressure therapy in the management of complex wounds.Methods: A retrospective, cross-sectional and descriptive study of our experience of the use of negative pressure therapy for the management of complex wounds in 5 years.Results: A total of 89 patients with complex wounds managed with TPN were analysed, of which 53 were men (62.9%) and 33 were women (37.1%). Suprafacial therapy was used in 64 cases (73%). The ABTHERA® system was used in 25 cases (27%). Among the etiology of complex wounds, vulvar abscess was recorded in 1 case (1.1%), firearm wound in 1 case (1.1%), Fournier's gangrene in 1 case (1.1%), septic arthritis in 1 case (1.1%), burn wounds in 1 case (1.1%), septic arthritis in 1 case (1.1%), and burn wounds in 1 case (1.1%). 1%), burn wounds in 5 cases (5.6%), pressure ulcer wound in 6 cases (6.7%), necrotizing fasciitis in 19 cases (21.3%), abdominal sepsis in 26 cases (29.2%), surgical wound infection in 29 cases (32.5%).Conclusions: The use of negative pressure therapy and protocolized management has provided patients in our institution with a viable therapeutic option.

Background: Intestinal surgery can present multiple complications that can lead to patient death; therefore, it is important to design early detection strategies to reduce complications in patients with intestinal anastomosis and thus avoid patient death. The aim of this work is to evaluate the diagnostic performance of the Dutch leakage score in 125 patients with intestinal anastomosis as a predictor of anastomotic leakage.Methods: In a sample of 125 patients undergoing intestinal anastomosis, demographic variables were identified and the Dutch leakage score was applied. Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were obtained using a 2×2 table.Results: The Dutch leakage score was positive in 23.2% (29 patients) of whom 24 had anastomotic leakage and 5 had no anastomotic leakage. It presents a sensitivity in the test of 100%, a specificity of 95%, a positive predictive value of 82.7%, a negative predictive value of 100%. The diagnostic accuracy is 96%.Conclusions: The Dutch leakage score is a versatile tool, inexpensive, easy to apply and available in any hospital center. It is capable of early diagnosis of anastomotic leakage. It favors early re-intervention, improves prognosis and survival, decreases hospital stay and health care costs.