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El objetivo del trabajo es presentar 4 casos de perforaciones intestinales cuya causa es la ingestión de cuerpos extraños, que originan problemas intestinales, concretamente oclusión de intestino delgado o intestino grueso, perforación de víscera hueca y peritonitis. En todos los casos los pacientes no relacionaban sus síntomas con la ingestión de cuerpos extraños, ya que el período de evolución fue superior a las 2 semanas. La actitud quirúrgica y el tratamiento antibiótico son imprescindibles en la perforación intestinal. La demora en su diagnóstico ocasiona una cirugía tardía, con un aumento de la morbimortalidad, por lo que creemos que el adecuado conocimiento de esta afección quirúrgica es importante, aunque su frecuencia es inferior al 1 por ciento del total de las perforaciones del tracto digestivo (AU)

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Se presentan 6 casos de cuerpos extraños en el rectosigma, siendo la vía de entrada la introducción endoanal. Por causa de sus potenciales complicaciones, los cuerpos extraños en el recto y el sigma deben ser considerados como una patología relevante y deben ser tratados de forma expeditiva. A pesar de su poca frecuencia es una posibilidad a tener en cuenta ante un dolor pélvico o anal en un paciente que no admite libremente la introducción del objeto transanal (AU)

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Introducción. La gangrena de Fournier es una infección necrosante subcutánea de origen urogenital o anorrectal, que afecta a la zona genital, perineo y pared anterior del abdomen en la que están implicados gérmenes aerobios y anaerobios. Es una enfermedad poco frecuente, pero potencialmente letal. Pacientes y métodos. Estudiamos de forma retrospectiva 10 casos de gangrena de Fournier, desde 1994 hasta 1999. En la recogida de datos figuran: filiación, edad y sexo, antecedentes patológicos, factores predisponentes, causas, clínica, analítica, tratamiento médico y quirúrgico, gérmenes, antibioterapia, estancia, ingreso en UCI y resultados. Resultados. Todos los pacientes eran varones, con una edad media de 65 años. Todos tenían importante patología orgánica de base y presentaban factores predisponentes, destacando la diabetes mellitus (6 casos) seguida del consumo crónico de alcohol (5 casos). La etiología fue: absceso perianal (3 casos), instrumentación urológica o rectal (2 casos), enfermedades genitourinarias (2 casos), idiopática (2 casos) y traumatismo (un caso). La clínica fue similar, con una zona de celulitis inicial, con dolor local en el escroto y posterior diseminación perineal, con crepitación y cuadro febril. Todos presentaban leucocitosis franca. En todos los pacientes se instauró antibioterapia y se realizó desbridamiento en una o varias sesiones, así como medidas de soporte metabólico y nutricional. En 3 casos se realizó íleo-colostomía derivativa y en 2 casos cistostomía suprapúbica. El germen más aislado fue E. coli, seguido de Bacteroides. En la antibioterapia destaca el uso de piperacilina/tazobactam. La estancia media fue d 27 días. Cinco pacientes requirieron su ingreso en la UCI. Fallecieron 4 pacientes (40 por ciento), con un denominador común de sepsis; de ellos dos llevaban estoma (colostomía).Conclusiones. La gangrena de Fournier es una enfermedad de alta morbimortalidad, especialmente en pacientes mayores, con factores predisponentes como diabetes y alcoholismo y cuya causa desencadenante es una enfermedad perirrectal o urogenital, que no ha sido tratada correctamente. El pronóstico es incierto, llegando nuestra serie a una mortalidad del 40 por ciento, por lo que el diagnóstico precoz y la terapéutica temprana y agresiva son esenciales (desbridamiento quirúrgico, antibióticos de amplio espectro y cuidados intensivos) (AU)

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We report 12 cases of thoracic esophageal perforation diagnosed during the last seven years. Management was nonsurgical in 2 patients and the rest were treated surgically. Primary repair and drainage were performed in 2 patients, and 7 patients underwent suture of the perforation and bipolar exclusion using nonresorbable staples. The remaining patient was treated with proximal unipolar exclusion. The approach was always through a posterolateral thoracotomy. The result was optimal in 8 patients; the most important postsurgical complications were 2 esophageal fistulas that required surgery, and only one of the patients died of fulminating sepsis. Bipolar exclusion is a procedure that needs only one operation and provides excellent morbidity-mortality rates compared with other exclusion techniques with later reconstruction. We consider suturing with nonresorbable staples to be a simple and safe procedure, with spontaneous recanalization of the esophageal lumen in 2 weeks.

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AIM: The aim of this study is to analyse the quality of life in patients with ileoanal pouch respect to a diverting loop ileostomy. MATERIALS AND METHODS: Fifteen patients (8 women and 7 men) with mean average age of 33 years who underwent mucosal proctectomy, colectomy, ileal-pouch-anal anastomosis and temporary loop ileostomy. Quality of life was studied when the patients had an ileostomy and follow-up evaluation, one year after restitution of anal defecation. The surgeons' evaluation was done using a health scale. RESULTS: Among the patients with temporary ileostomy, 40% reported bad tolerance, 53% leakage of stoma bag and 26% skin problems. The mean stool frequency among ileoanal anastomosis was four per day, 87% reported total continence, 13% had major complications and they needed pouch removal. 67% patients with ileostomy reported dietary restrictions against 13% patients functioning with pelvic pouch (p = 0.004). 13% patients with ileostomy had restricted sport activities. Social activities were restricted for 40% and 26% had limitations in their ability to work. Sex life was affected in 20% of patients with ileostomy and 13% of patients with ileal pouch anastomosis. 73% of patients presented an excellent level of satisfaction with pouch. CONCLUSION: Quality of life after ileoanal pouch anastomosis is higher than ileostomy.

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OBJECTIVE: To determine whether a relationship exists between bowel perforation and seat belt use in patients presenting abdominal trauma after traffic accidents. EXPERIMENTAL DESIGN: We prospectively studied every patient admitted to the emergency room with abdominal trauma after a traffic accident. PATIENTS AND METHODS: We included every patient diagnosed (clinically, by ultrasound or computerized tomography or at laparotomy) as suffering intraabdominal injury. The degree of trauma was classified according to the Injury Severity Score, taking into account the number of abdominal injuries associated with mortality and seat belt use. RESULTS: A total of 146 patients were studied. The spleen was the most frequently injured organ (n = 56). The mean Injury Severity Score was 19. Head injuries were more common among patients not wearing the seat belt. Thirteen cases of bowel perforation in patients who had been using the seat belt (p < 0.0001) were observed. CONCLUSION: Seat belt use can decrease the mortality rate associated with traffic accidents. However, a significant increase exists in the incidence of bowel perforations among seat belt wearers, probably as a result of improper use.

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Mesenteric panniculitis is an infrequent pathology; the diagnosis is made by the pathologist and it is characterized by inflammation, fibrosis and retraction of the mesenteric fat. We report three new cases of retractile mesenteritis or mesenteric panniculitis, two cases presented with intestinal obstruction and the other had an abdominal tumour. In all cases the pathological diagnosis was retractile mesenteritis.

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Cytomegalovirus disease is an opportunistic infection that is seen in patients with inmunodeficiencies. The group most commonly affected are AIDS and transplanted patients. Only a few cases of cytomegalovirus disease in non-immunocompromised patients have been reported. In localized disease, the gastrointestinal tract is the most frequently affected. We report two cases of acute abdomen caused by cytomegalovirus enteritis and colitis (histopathological diagnosis) without any underlying immune disorder. The role that the cytomegalovirus infection might play in the development of the clinical manifestations in these two cases is discussed. Without an established immunodeficiency we must be careful to attribute to cytomegalovirus infection the direct responsibility of the lesions. In the reported cases, the existence of intestinal ischemia is more than just a clinical hypothesis and pathological examination is inconclusive. The absence of an immunocompromised state, the presentation as an acute abdomen and the clinical course forwards intestinal occlusion in the first case are not characteristic of cytomegalovirus enteritis and colitis. We conclude that the two reported cases are in fact an ischemic enteritis upon which cytomegalovirus enteritis and colitis was superimposed, an association that has not been reported before.

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We present a retrospective study of 360 patients with surgically treated colorectal neoplasm between 1982 and 1990, in order to determine the incidence of synchronous colorectal carcinomas; and to analyze diagnosis procedures, detection time, pathology and treatment strategies. The incidence of synchronous carcinomas was 5.5% (20 cases). Only 30% of them were diagnosed preoperatively, and up to 40% were discovered in the pathological examination. In 2 patients 3 synchronous tumors were well found. All the synchronous neoplasms were differentiated, 65% of them were Dukes stage A. Synchronous colorectal polyps were found in 80% of patients. Complete exploration of the colon preoperatively by a routine pan-colonoscopy is recommended. In regard to the treatment of patients with synchronous colorectal carcinomas, partial colectomies are indicated as long as oncological criteria are followed, and the colon had been fully explored.

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Retroperitoneal haematoma during anticoagulant therapy is a rare cause of abdominal pain. Over the past five years, five cases of retroperitoneal haemorrhage, two of them due to heparin and three to oral anticoagulant, were diagnosed in our hospital. All patients presented with abdominal pain and a mass. The authors conclude that a high degree of suspicion is mandatory when patients on anticoagulant therapy present with abdominal pain.

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