RESUMEN
Introducción: el divertículo de Zenker es un saco que se produce como resultado del aumento de presión a nivel de la pared posterior de la hipofaringe que lleva a la protrusión de mucosa y submucosa a través de los músculos constrictor inferior de la faringe y cricofaríngeo. Discusión: es característico de los pacientes adultos mayores en la séptima y octava década de la vida, con una discreta predilección por el sexo masculino. El síntoma principal es la disfagia y en casos severos episodios de broncoaspiración. Tiene diferentes opciones de tratamiento, entre las que se encuentran el abordaje quirúrgico y endoscópico, siendo esta última la técnica más recomendada dado sus buenos resultados y menores tasas de complicaciones descritas.
Introduction: Zenker Ìs diverticulum is a saccular formation in the posterior wall of the hypopharynx due to increased pressure, leading to mucosal and sub-mucosal herniation between the cricopharyngeus muscle and the inferior pharyngeal constrictor muscle. Discussion: it is primarily seen in elderly individuals in the seventh and eighth decades of life, with a discrete higher predominance in men. Dysphagia is the main symptom and episodes of pulmonary aspiration may present in severe cases. There are several treatment options, among which is endoscopic surgical approach. The latter constitutes the most recommended technique for it has shown good results and lower complication rates.
Asunto(s)
Humanos , Deglución , TerapéuticaRESUMEN
INTRODUCTION: deep cannulation of the common bile duct is essential in endoscopic retrograde cholangiopancreatography (ERCP). However, cannulation is not possible in approximately 20 % of the cases with the usual techniques. Pre-cutting is an alternative that allows cannulation in difficult cases although its success is not guaranteed. Repeating the ERCP within three days of a failed pre-cut is an acceptable option. OBJECTIVE: to determine if an ERCP performed three days after a failed pre-cut papillotomy allows the bile duct to be cannulated without increasing complication rates. PATIENTS AND METHODS: patients who underwent an ERCP plus pre-cut were included, in whom the common bile duct could not be cannulated and who also underwent a new ERCP three days after the initial pre-cut. The primary objective was a successful biliary cannulation in the second ERCP and the secondary objective were the complications of the initial pre-cut. RESULTS: forty patients with an average age of 65 years were identified and 57 % were male. The indications for ERCP were choledocholithiasis in 95 %, biliary fistula in 2.5 % and pancreatic neoplasia in 2.5 %. The ERCP was repeated three days later in 92.5 % of the cases and the biliary cannulation was successful in 78.3 %. CONCLUSIONS: a new ERCP performed within three days of a failed pre-cut is justifiable since it has a significant success rate. Bile duct cannulation is achieved in three out of four patients, with an acceptable percentage of complications.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica , Esfinterotomía Endoscópica , Anciano , Conductos Biliares , Cateterismo , Conducto Colédoco , Humanos , MasculinoRESUMEN
La endometriosis (EMT) es una patología que afecta principalmente a mujeres en edad reproductiva, siendo el tracto intestinal es el sitio extragenital más comúnmente afectado. Su presentación clínica es variada y raramente se presenta con obstrucción intestinal, que es difícil diferenciar de la malignidad antes de la cirugía. Cuando hay compromiso colorrectal, las manifestaciones pueden imitar o coexistir con diferentes enfermedades gastrointestinales crónicas que dificultan el diagnóstico. Se presenta un caso clínico de una mujer de 48 años, que ingresó con cuadro de obstrucción intestinal secundaria a endometriosis en colon sigmoide. Se realiza una revisión de la literatura de endometriosis intestinal, haciendo énfasis en el diagnóstico diferencial, y la participación de infecciones bacterianas en la etiología y reactivación de endometriosis.
Endometriosis is a condition that primarily affects women of reproductive age since the intestinal tract is the most commonly affected extra-genital site. Its clinical presentation varies, but since it rarely presents together with intestinal obstruction, it is difficult to differentiate from malignancy prior to surgery. Colorectal compromises can mimic or coexist with different chronic gastrointestinal diseases thus hindering diagnosis. We report the case of a 48 -year-old patient with box intestinal obstruction secondary to endometriosis in the sigmoid colon. In addition, we present a literature review of intestinal endometriosis with emphasis on differential diagnosis and the involvement of bacterial infections in the etiology and reactivation of endometriosis.