Mauricio de la Fuente-Lira

Background: Abdominal infections in neutropenic patients are complications with a high risk of mortality. Patients with leukemia who are under aggressive chemotherapy are more frequently affected. It is a diagnostic challenge for the physician to dissect the cause of abdominal symptoms. Acute neutropenic cholecystitis, a rare entity, is life threatening. Clinical case: We present the case of a 29 year old female patient with myeloid leukemia undergoing chemotherapy as part of a protocol for autologous bone marrow transplantation, developing severe sepsis and acute neutropenic alitiasic cholecystitis. She was managed conservatively until the end of neutropenia. Cholecystec-tomy was delayed (19 days), and was outpatient from surgery ward on the third day. Conclusions: We consider that the best treatment choice for neutropenic patients is a conservative approach with delayed surgery once neu-tropenia ceased.

El hígado es uno de los órganos más afectados por metástasis de diferentes tumores malignos, pueden observarse éstas entre el 10 y el 23% de todos los tumores. Gracias a los avances en cirugía hepática y quimioterapia, así como métodos ablativos, ha cambiado la actitud frente a la enfermedad metastásica del hígado; de considerar a los pacientes en fase terminal, ahora se piensa en intervenir quirúrgicamente a muchos de ellos debido a la disminución considerable de las tasas de morbilidad y mortalidad de la cirugía hepática. Las metástasis hepáticas no colorrectales no neuroendocrinas son poco frecuentes, para éstas el único tratamiento que puede ampliar la sobrevida para este padecimiento es la resección hepática, con sobrevida hasta del 55% a 5 años, a diferencia de los pacientes tratados exclusivamente con quimioterapia, en los cuales la sobrevida global no va más allá de los 3 años. De acuerdo a su etiología, los tumores primarios más frecuentes que pueden dar metástasis hepática...

OBJECTIVE To describe the clinical presentation and treatment of one patient with a neuroendocrine pancreatic neoplasm and gastrointestinal hemorrhage. BACKGROUND Neuroendocrine pancreatic tumors are relatively rare neoplasms. When the tumor does not have endocrine function, clinical manifestations are non-specific and show symptoms when the tumor is quite large. Massive upper gastrointestinal hemorrhage is an infrequent clinical manifestation of these tumors. METHOD A case of gastrointestinal hemorrhage, which required a pancreaticoduodenectomy to control bleeding of an ulcerated pancreatic head neoplasm, is presented. CONCLUSION Pancreaticoduodenectomy is the procedure of choice to control duodenal massive bleeding secondary to an ulcerated neuroendocrine tumor of the pancreas.

Intestinal obstruction is one of the most frequently abdominal problems that concern general surgeons. One of the infrequent causes of mechanical obstruction is sclerosing encapsulating peritonitis (SEP); this entity causes intense fibrosis of the components in the peritoneal layer, resulting in adhesion of abdominal organs. SEP can be primary or secondary; both are a type of peritoneal fibrosclerosis that causes intestinal obstruction with difficult resolution and a great number of complications. In terms of frequency and etiology, there are few data, and the problem is considerated a multifactorial disease with association to neoplasms, toxics, drugs, and idiopathic form. This article presents three cases of sclerosing encapsulating peritonitis and the possible factors that play an important role in the development of this infrequent entity.

We present a case report of appendiceal mucocele and gangrenous cholecystitis. Hospital de Especialidades, Centro Médico Nacional Siglo XXI, México, D.F. An 80-year-old man was admitted to the hospital with diagnosis of acute cholecystitis and abdominal tumor under study, with complaints of abdominal pain for 10 days located in the right upper quadrant, without fever or significant weight loss. Laboratory analyses revealed moderate leucocytosis. CT of the abdomen revealed thickening of the gallbladder wall and acute local inflammation, as well as the presence of abdominal tumor in the right lower quadrant. The patient was surgically explored with the following findings: gangrenous cholecystitis and appendiceal tumor of 20 cm length. Cholecystectomy and appendectomy was performed. The postoperative period was normal. The final histological report was appendiceal mucocele and the patient was discharged after 5 days. The patient is currently without complaints at 5 months postoperatively.

We report on a patient with gallstone ileus and cholecystoduodenal fistula at the Hospital de Especialidades, Centro Medico Nacional Siglo XXI (IMSS) Mexico City, Mexico. A 54-year-old male patient was admitted to the hospital with a diagnosis of acute cholecystitis. He had undergone an appendectomy at 34 years of age. There was no history of biliary disease. He was afebrile, with moderate abdominal distention and right upper quadrant pain, Murphy (+). His white blood cell count was 8,900/mm(3) with 40% bands. His liver function tests, amylase and lipase, were all within normal limits. Ultrasound revealed edema and thickening of the gallbladder wall with calculi. He underwent exploratory surgery, which provided the following findings: sclerotrophic gallbladder with intense surrounding inflammation. We therefore decided to perform a cholecystostomy. Two days postoperatively the patient presented abdominal distention and vomiting as well as the presence of intestinal material through ...

Ascaris lumbricoides is the most common nematode found in the human gastrointestinal tract with a greater prevalence found in developing tropical and subtropical countries. Most cases of ascariasis follow a benign course. In some cases the adult parasite can invade the biliary or pancreatic ducts and cause obstruction with development of cholecystitis, cholangitis, pancreatitis, and hepatic abscesses. We report a case of a patient with biliary ascariasis. A 40-year-old woman, born and residing in San Cristobal de las Casas, Chiapas, was admitted with right upper quadrant pain of 2-week duration. Pain was accompanied by nausea, vomiting and fever. Exploration revealed pain upon deep palpation of right hypochondria. Laboratory examinations demonstrated elevation of alkaline phosphatase without jaundice, leukocyte count of 14,300 and ultrasonography with ascaris within the gallbladder and intra- and extrahepatic ducts without evidence of dilatation. Medical treatment with mebendazol wa...

To compare two techniques of open abdomen management in patients with abdominal sepsis. Some patients with abdominal sepsis will require open abdomen management to avoid abdomen compartment syndrome. We compare use of the Bogota bag with a technique developed at our Institution with a subcutaneous polyethylene bag. Thirty nine consecutive patients with abdominal sepsis who were managed with open abdomen. Twenty one patients with Bogota bag and 18 patients with subcutaneous polyethylene bag. Patients with Bogota bag had more report surgery intrabdominal complications compared with patients with subcutaneous polyethylene bag (p = 0.04, p = 0.037, respectively). Mortality was the same. Use of subcutaneous polyethylene bag in patient with abdominal sepsis and open abdomen appears safer when compared with Bogota bag.

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Despite recent advances in diagnosis, antimicrobial therapy, and intensive care support, operative treatment remains the foundation of the management of patients with severe secondary peritonitis (SSP). This management is based on three fundamental principles: (1) Elimination of the source of infection; (2) reduction of bacterial contamination of the peritoneal cavity; and (3) prevention of persistent or recurrent intra-abdominal infection. Although recent studies have emphasized the role of open management of the abdomen and planned re-laparotomies to fulfill these principles, controversy surrounds the optimal approach because no randomized studies exist. Patients with SSP, documented clinically, with calculated Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE II) scores and appropriate ancillary studies, were allocated randomly to two groups for the management of the abdomen after operation for SSP (group A: open; group B: closed). Both surgical strategies were standardized, and patients were followed up until cure or death. During a 24-month period, 40 patients with SSP were admitted for treatment. Patients in group A (n = 20) and group B (n = 20) did not differ in sex, age, site of origin (etiology), APACHE II score (24 vs. 22), SOFA score (15 vs. 15), or previous operative treatment (< or =1: 20 vs. 20). Postoperatively, there were no differences in the likelihood of acute renal failure (25% vs. 40%), duration of mechanical ventilatory support (10 vs. 12 days), need for total parenteral nutrition (80% vs. 75%), or rate of residual infection or need for reoperation because of the latter (15% vs. 10%). Although the difference in the mortality rate (55% vs. 30%) did not reach statistical significance (p < 0.05; chi-square and Fisher exact test), the relative risk and odds ratio for death were 1.83 and 2.85 times higher in group A. This clinical finding, as evidenced by the clear tendency toward a more favorable outcome for patients in group B, led to termination of the study at the first interim analysis. This randomized study from a single institution demonstrates that closed management of the abdomen may be a more rational approach after operative treatment of SSP and questions the recent enthusiasm for the open alternative, which has been based on observational studies.