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We present the case of a 34 years old female patient who presents with abdominal pain and elevated total and direct bilirrubins, so she underwent ERCP Reporting: a) successful sphincterotomy without complications, b) choledocholithias is endoscopically resolved, c) secondary cholangitis. She developed significant abdominal pain at 72 h, with hypovolemic shock and peritoneal irritation. She was taken to the surgery, finding a grade III liver laceration. This one was resolved with liver raffia and packing, during the same operative time cholecystectomy was performed. A second look was performed at 24 h, achieving adequate control of bleeding after placing hemostatic (Nexstat®). The patient developed a subdiaphragmatic abscess which needed drainage by another laparotomy. After which the patient had a satisfactory evolution, so she was discharged.

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La intususcepción en el adulto presenta una baja incidencia. Se puede observar en diferentes localizaciones y dentro de las menos frecuentes se encuentra la íleo-sigmoidea. Su etiología es diversa, siendo más frecuentes las causas malignas cuando se presenta a nivel del colon en edad adulta. La sospecha diagnóstica apoyada de la tomografía computada de abdomen, puede, además de corroborar el diagnóstico, esclarecer la etiología de la misma y orientar sobre la opción terapéutica más adecuada para el paciente

Intussusception in adults has low incidence. It can be seen at different locations and within less frequent ileosigmoid is. The etiology is diverse, being more frequent causes malignant when it occurs in the colon into adulthood. The suspected diagnosis supported by computed tomography of the abdomen, may also corroborate the diagnosis, clarify the etiology of it and guidance on the most appropriate treatment option for the patient

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Presentamos el caso de un paciente femenino de 34 años que inicia con cuadro de dolor abdominal, así como elevación de bilirrubinas a expensas de la directa, por lo que se le realiza una colangiopancreatografía retrograda endoscópica (CPRE), reportando: a) esfinterotomía exitosa sin complicaciones, b) coledocolitiasis resuelta endoscópicamente, c) colangitis secundaria. Presentó dolor abdominal importante a las 72 h, con cuadro clínico de choque hipovolémico e irritación peritoneal. Se realizó una laparotomía exploradora observando una laceración hepática grado III. Se realizó rafia hepática y colecistectomía y se deja empaquetada a la paciente, para ser reintervenida quirúrgicamente a las 24 h, logrando un adecuado control del sangrado posterior a la colocación de hemostático (Nexstat®). Se realizó una nueva laparotomía debido a la formación absceso subdiafragmático residual; posterior a la cual, la paciente presentó una evolución satisfactoria, por lo que fue dada de alta

We present the case of a 34 years old female patient who presents with abdominal pain and elevated total and direct bilirrubins, so she underwent ERCP Reporting: a) successful sphincterotomy without complications, b) choledocholithias is endoscopically resolved, c) secondary cholangitis. She developed significant abdominal pain at 72 h, with hypovolemic shock and peritoneal irritation. She was taken to the surgery, finding a grade III liver laceration. This one was resolved with liver raffia and packing, during the same operative time cholecystectomy was performed. A second look was performed at 24 h, achieving adequate control of bleeding after placing hemostatic (Nexstat®). The patient developed a subdiaphragmatic abscess which needed drainage by another laparotomy. After which the patient had a satisfactory evolution, so she was discharged

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BACKGROUND: The most severe complication following an intestinal anastomosis is the dehiscence with the consequent development of sepsis, fistulas, stenosis, and death. For this reason the compression anastomosis (NiTi) system was developed, with the aim of reducing these complications. MATERIAL AND METHODS: A retrospective study was conducted, from 1 June 2012 to 30 August 2014, on total of 14 patients operated on the Humanitas Hospital Medical Group Coyoacán, the ASMED, and Clínica Médica Sur. The subjects were predominantly male 65%, a mean age of 58 years, with range 30-79 years. RESULTS: A total of 14 patients were included. The indication for surgery was complicated diverticular disease Hinchey II-III (36%), and the procedures performed were: 6 (43%) left hemicolectomy with primary end to end compression anastomosis, 2 (14%) major complications (dehiscence wall and anastomosis), 1 (7%) minor complication (infection of the soft tissues). There was a mean 98ml (range 20-300ml) of intraoperative bleeding, with start of oral feeding on the second day, a mean hospital stay of 4 days (range 2-10), one patient with ileo-rectal anastomosis dehiscence presented on the 4th post-operative day, and performing anastomosis with stapling device and loop ileostomy. Stenosis developed in 7% during follow-up and was resolved with a new anastomosis stapler. CONCLUSIONS: The NiTi device is an additional alternative for colorectal anastomosis, mainly in low anastomosis, obtaining good results in this study without major complications.

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Intussusception in adults has low incidence. It can be seen at different locations and within less frequent ileosigmoid is. The etiology is diverse, being more frequent causes malignant when it occurs in the colon into adulthood. The suspected diagnosis supported by computed tomography of the abdomen, may also corroborate the diagnosis, clarify the etiology of it and guidance on the most appropriate treatment option for the patient.

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BACKGROUND: Rectourethral fistula is a rare disease with a difficult surgical treatment. The etiology of rectourethral fistula is iatrogenic, secondary to prostate surgery, pelvic radiotherapy and a rare complication of rectal surgery. Surgical treatment options for rectourethral fistula are diverse. Interposition of gracilis muscle has a curative index of 100% with close surveillance, as reported by Nyham. CLINICAL CASE: We present a case of a 58-year-old male with iatrogenic rectourethral fistula secondary to radical prostatectomy and who was treated with interposition of the gracilis muscle. Eight weeks after surgery and with colostomy closed, no evidence of recurrence was detected. CONCLUSIONS: Interposition of the gracilis muscle requires a multidisciplinary approach and demonstrates good shortterm results.

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BACKGROUND: Obesity in Mexico appears with a frequency of 38.4% in men and 43.3% in women. Within the therapeutic options, bariatric surgery is defined as the only effective treatment in the long term, and the number of procedures is increasing. Postoperative complications are sometimes challenging for those who are evaluating them. We undertook this study to describe and to correlate endoscopic findings with gastrointestinal symptoms in patients who have undergone a bariatric procedure. METHODS: This was a descriptive, prospective and longitudinal study that included all patients who underwent bariatric surgery between January 2004 and October 2006 and who presented gastrointestinal symptoms requiring postoperative endoscopic evaluation. RESULTS: Thirty-six patients were subjected to 45 videoendoscopies between January 2004 and October 2006. The most frequent endoscopic findings were normal postsurgical anatomy (18 patients, 50%), marginal ulcer (5 patients, 13.8%), stomal stenosis (8 patients, 22.2%), and migration of gastric band (1 patient, 2.7%). Abdominal pain was the most frequent symptom, appearing in 58.3% of patients, mainly in those with normal endoscopy. Nausea and vomiting were reported in 55.5% of the cases; 25% of the procedures done in the first 6 months were normal as compared with 75% of the cases that were done after 6 months. CONCLUSIONS: Normal videoendoscopy was the most frequent finding among patients who had undergone a bariatric procedure. Stomal stenosis was the most frequent abnormality. The presence of abdominal pain beginning 6 months postoperatively is a characteristic that predicts normal videoendoscopy.

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BACKGROUND: Obesity in Mexico appears with a frequency of 38.4% in men and 43.3% in women. Within the therapeutic options, bariatric surgery is defined as the only effective treatment in the long term, and the number of procedures is increasing. Postoperative complications are sometimes challenging for those who are evaluating them. We undertook this study to describe and to correlate endoscopic findings with gastrointestinal symptoms in patients who have undergone a bariatric procedure. METHODS: This was a descriptive, prospective and longitudinal study that included all patients who underwent bariatric surgery between January 2004 and October 2006 and who presented gastrointestinal symptoms requiring postoperative endoscopic evaluation. RESULTS: Thirty-six patients were subjected to 45 videoendoscopies between January 2004 and October 2006. The most frequent endoscopic findings were normal postsurgical anatomy (18 patients, 50%), marginal ulcer (5 patients, 13.8%), stomal stenosis (8 patients, 22.2%), and migration of gastric band (1 patient, 2.7%). Abdominal pain was the most frequent symptom, appearing in 58.3% of patients, mainly in those with normal endoscopy. Nausea and vomiting were reported in 55.5% of the cases; 25% of the procedures done in the first 6 months were normal as compared with 75% of the cases that were done after 6 months. CONCLUSIONS: Normal videoendoscopy was the most frequent finding among patients who had undergone a bariatric procedure. Stomal stenosis was the most frequent abnormality. The presence of abdominal pain beginning 6 months postoperatively is a characteristic that predicts normal videoendoscopy.

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OBJECTIVE: To analyze the results of Longo stapled mucosectomy for hemorrhoidal disease in a 1 to 3 years follow up. PATIENTS AND METHODS: Clinical response and complications where analyzed in patients treated for grade II to IV non-complicated hemorrhoidal disease with Longo stapled hemorrhoidectomy. RESULTS: In a 27 months period, 160 patients were treated (105 men and 55 women), mean age was 44.1 years (range: 24 to 72 years), and 110 patients had grade III hemorrhoid disease. Non procedure complications were noted, early complications were detected in 5% of patients and late complications were detected in 10% of patients. In a mean follow-up of 18.8 months, 82.5% of the patients remained asymptomatic and 94.4 of the patients reported a good satisfaction score. A second surgery was required in three patients because of recurrence. CONCLUSION: Longo stapled mucosectomy is a safe treatment for non complicated hemorrhoid disease. In a 18 month follow up most patients were asymptomatic.

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BACKGROUND AND AIM: Obesity is closely associated with the increased morbidity and mortality of many common diseases in the Western world, including coronary heart disease (CHD) and gallstone diseases (GD). We have investigated the association between GD and CHD in a cross-sectional study. METHODS AND RESULTS: Subjects who had gallstones visible by ultrasound were considered as cases and subjects negative for gallstones were classified as controls. Positive CHD was defined when the stress test was positive. Body mass index (BMI), waist circumference, blood pressure, serum lipid concentrations, and insulin resistance were measured. The association was estimated by odds ratios using logistic regression models adjusted for confounders. Four hundred and seventy-three subjects (292 males and 181 females) were included, comprising 354 controls and 119 cases. Subjects with GD had higher prevalence of CHD (15.96%) than controls (4.52%) (p < 0.0001). In univariate unconditional logistic regression analysis CHD, BMI >/= 30 kg/m(2), waist circumference, high blood pressure, and HOMA-IR > 2.5 were the most important risk factors for GD. In multivariate analysis (adjusted for age and gender, and BMI) the risk for GD in subjects with CHD was higher (OR 2.84, 95% CI: 1.33-6.07, p < 0.007). CONCLUSIONS: Subjects with CHD have an increased risk to have GD, both diseases are strongly associated and the main characteristics of these subjects are those frequently involved as part of the metabolic syndrome.

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Nonalcoholic fatty liver disease (NAFLD) is a medical condition that may progress to end-stage liver disease. The spectrum of NAFLD is wide and ranges from simple fat accumulation in hepatocytes (steatosis), to fat accumulation plus necroinflammatory activity with or without fibrosis (steatohepatitis). In addition, NAFLD is the most common cause of abnormal liver-test results among adults with a prevalence of 13%-23%. This case report is an example of a patient with asymptomatic hypertransaminasemia and severe hepatic steatosis without inflammation in which the diagnosis was made by liver biopsy.

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