RESUMEN

INTRODUCTION: The technique of open abdomen refers to a surgical procedure that intentionally involves leaving an opening in the abdominal wall. This study aimed to evaluate the clinical outcomes, mortality, and morbidity of patients undergoing open abdomen in a public hospital in Brazil and investigate associated risk factors associated with the outcome. METHODS: Data from electronic medical records were collected from 2017 to 2022. The variables were used for descriptive analyses, association analysis, and survival analysis using the Kaplan-Meier curve. RESULTS: The sample included 104 patients, with 84 presenting with acute abdomen and 20 with trauma, having highly variable ages and comorbidities. Peritonitis and the need for early reoperation were the most common indication for the procedure, each accounting for 34%, and negative pressure wound therapy was the most commonly used technique. Fistula was the most frequent complication, with the majority forming in the early days after the surgery. The number of interventions and open abdomen time obtained statistical significance in comparison with the outcome. The overall mortality rate was 62,5%. CONCLUSION: Despite open abdomen being a technique that can have benefits in controlling intraabdominal contamination and preventing abdominal compartment syndrome, its implementation is associated with complications. The mortality and complication rates were high in this sample. The decision to use the technique should be individualized and based on several factors, including the indications and the patient's clinical status.

Asunto(s)

RESUMEN

El vólvulo cecal es una causa rara de abdomen oclusivo agudo. Cada año, aproximadamente 2,8-7,1 personas por millón se ven afectadas por esta patología. Se estima que el vólvulo cecal representa el 25-40% de todo el vólvulo del colon. Causa alrededor del 1-1,5% de las oclusiones intestinales en adultos. La mayoría de los pacientes presentan síntomas de hinchazón, estreñimiento, náuseas y vómitos. Hasta el 50% puede tener síntomas intermitentes antes de la torsión. Su baja prevalencia dificulta su diagnóstico preoperatorio, siendo diagnosticado frecuentemente durante la cirugía. Presentamos el caso de un hombre de 66 años que ingresa por dolor abdominal, cuyos métodos de imagen complementarios iniciales fueron diagnósticos de abdomen agudo oclusivo y finalmente durante la cirugía se observó un vólvulo cecal

The cecal volvulus is a rare cause of an acute occlusive abdomen. Each year, approximately 2.8-7.1 people per million are affected by this pathology. It is estimated that the cecal volvulus represents 25-40% of all the colon volvulus. Causing about 1-1.5% of intestinal occlusions in adults. Most patients have symptoms of bloating, constipation, nausea, and vomiting. Up to 50% may have intermittent symptoms before torsion. Its low prevalence hinders its preoperative diagnosis, being frequently diagnosed during surgery. We present a case of a 66-year-old man admitted for abdominal pain, whose initial complementary imaging methods were diagnostic of acute occlusive abdomen and finally a cecal volvulus was observed during surgery

Asunto(s)

RESUMEN

Introducción: En Cuba, la oclusión intestinal mecánica es una de las causas más frecuentes de abdomen agudo y constituye la segunda causa de cirugía de urgencia. Objetivo: Caracterizar una serie de pacientes intervenidos quirúrgicamente, con diagnóstico de obstrucción intestinal mecánica. Métodos: Se realizó un estudio observacional descriptivo transversal en sujetos atendidos durante el año 2022 en el servicio de cirugía general del Hospital Docente Clínico - Quirúrgico Miguel Enríquez. Se estudiaron 81 pacientes; se recogieron las variables sexo, edad, antecedentes patológicos personales, hábitos tóxicos, estadía hospitalaria, causa de la oclusión intestinal, complicaciones y estado al egreso. Se realizó análisis de frecuencias. Resultados: Hubo mayor porcentaje del sexo femenino (50,6 por ciento), de las edades comprendidas de 31 a 40 años (23,5 por ciento), los pacientes con hipertensión arterial (14,8 por ciento) y los fumadores (18,5 por ciento). La causa más frecuente de oclusión fueron las bridas y adherencias (44,4 por ciento) y la complicación más frecuente fue la bronconeumonía (8 por ciento). Falleció solo el 3,7 por ciento de los pacientes. Conclusiones: Los pacientes se caracterizaron por estar entre la tercera y cuarta décadas de la vida, con predominio del sexo femenino, con antecedentes de salud, sin hábitos tóxicos, con estadía hospitalaria entre 1 y 5 días, presencia de bridas y adherencias como causa de la obstrucción y baja frecuencia de complicaciones y fallecimientos(AU)

Introduction: In Cuba, mechanical intestinal obstruction is one of the most frequent causes of acute abdomen, and is the second cause of emergency surgery. Objective: To characterize a series of patients undergoing surgery with a diagnosis of mechanical intestinal obstruction. Methods: A cross-sectional descriptive observational study was carried out in the population treated during the year 2022 in the general surgery service of the Miguel Enríquez Clinical-Surgical Teaching Hospital. The population was made up of 81 patients with whom we worked in its entirety. The variables sex, age, personal pathological history, toxic habits, hospital stay, cause of intestinal obstruction, complications, and status at discharge were studied. A study of absolute and relative frequencies was carried out. Methods: A cross-sectional descriptive observational study was carried out on subjects treated during 2022 in the general surgery service of the Miguel Enríquez Clinical-Surgical Teaching Hospital. 81 patients were studied; The variables sex, age, personal pathological history, toxic habits, hospital stay, cause of intestinal obstruction, complications and status at discharge were collected. Frequency analysis was performed. Results: There was a higher percentage of females (50.6 percent), aged between 31 and 40 years (23.5 percent), patients with high blood pressure (14.8 percent) and smokers (18.5 percent). The most common cause of occlusion was flanges and adhesions (44.4 percent), and the most common complication was bronchopneumonia (8 percent). Only 3.7 percent of patients died. Conclusions: The patients are characterized by being between the third and fourth decades of life, with a predominance of the female sex, with a health history, without toxic habits, with a hospital stay between 1 and 5 days, presence of flanges and adhesions as a cause of obstruction and low frequency of complications and deaths(AU)

Asunto(s)

RESUMEN

OBJECTIVE: we intend to demonstrate the clinical alterations and the postoperative evolution in patients with acute abdomen non-traumatic in conservative or surgical treatment during the pandemic compared to a similar period in the last year. METHOD: a single-center retrospective study, including patients who received clinical-surgical treatment at Hospital do Trabalhador diagnosed with acute abdomen between March and August 2020 and a similar period in 2019.Variables studied ranged from demographic data to indices of social isolation. RESULTS: 515 patients were included, 291 received treatment in a pre-pandemic period and 224 during. There was not statistical difference in relation to comorbidities (p=0.0685), time to diagnosis and seeking medical help. No statistical differences were observed in terms of days of hospitalization (p = 0.4738) and ICU need (p=0.2320). Regarding in-hospital deaths, there was statistical relevance in the age above 60 years (p=0.002) and there were more deaths during the pandemic period (p=0.032). However, when we analyze the factors associated with the number of days until diagnosis by a physician, there was no statistical difference. CONCLUSION: the analyzed data showed that the pandemic period and age over 60 years were the variables that increased the odds ratio for the in-hospital death outcome. However, the length of stay, days in intensive care unit and postoperative surgical complications showed no significant difference.

Asunto(s)

RESUMEN

Las enfermedades reumáticas constituyen un grupo de afecciones cuyo mecanismo patogénico se enfoca en la persistencia de un proceso inflamatorio que origina manifestaciones articulares y sistémicas. Aunque no es frecuente, en ocasiones el proceso inflamatorio genera complicaciones graves que requieren intervención quirúrgica como es el caso de la colecistitis aguda. Se presenta el caso de una paciente femenina de 36 años de edad, con diagnóstico de lupus eritematoso sistémico de 5 años de evolución que ingresa con COVID-19 y a los 6 días de hospitalización comienza con un cuadro franco de abdomen agudo que requirió intervención quirúrgica de urgencia. Se presenta el cuadro por la coexistencia de la enfermedad reumática, la infección por COVID-19 y el evento agudo secundario al proceso inflamatorio que causan ambas afecciones(AU)

Rheumatic diseases constitute a group of conditions whose etiopathogenic mechanism focuses on the persistence of an inflammatory process that generates joint and systemic manifestations. Although it is not frequent, sometimes the inflammatory process generates serious complications that require surgical intervention, as is the case with acute cholecystitis. The case of a 36-year-old female patient is presented, with a diagnosis of systemic lupus erythematosus of 5 years of evolution who was admitted due to symptoms compatible with COVID-19 and after 6 days of hospitalization she began with a clear picture of acute abdomen that required emergency surgical intervention. The picture is presented due to the coexistence of rheumatic disease, COVID-19 infection and the acute event secondary to the inflammatory process that both conditions generate(AU)

Asunto(s)

RESUMEN

INTRODUCTION: Omental infarction describes ischemic torsion of the distal portion of the omentum and constitutes an infrequent cause of acute abdominal pain in childhood of which few cases are known. Objec tive: To analyze through a clinical case the characteristics and management of this pathology, to consider this entity in the differential diagnosis of acute abdominal pain. CLINICAL CASE: An 11-year- old child consulted the emergency department due to a 48-hour history of continuous abdominal pain, which had progressively increased. On the physical examination, the patient presented pain in the right side of the abdomen and the epigastric area, with no signs of peritoneal irritation, and was overweight (BMI 91st percentile). Biochemical analysis showed a slight increase in c-reactive protein (CRP) 41.31 mg/L (reference value < 3.0 mg/L) without leukocytosis and normal ultrasound study, without visualization of the appendix. Due to persistent pain, increased CRP, and absence of appen dix visualization in the ultrasound, the study was completed with an abdomen and pelvis CT scan which showed trabeculation of the fat of the anterior right subhepatic space, thus diagnosing omental infarction. The patient was hospitalized for conservative management with analgesia, anti-inflamma tory drugs, and fluid therapy, presenting good evolution in the first 48 hours. CONCLUSION: Omental infarction is an infrequent cause of acute abdominal pain in childhood. Imaging studies play a funda mental role in the differential diagnosis of this entity with other clinical conditions of similar course, thus avoiding unnecessary surgical interventions.

Asunto(s)

RESUMEN

Introducción: El abdomen catastrófico o abdomen hostil es una entidad quirúrgica de gran importancia por la pérdida de los distintos espacios entre los órganos de la cavidad abdominal y las estructuras de la cavidad abdominal. Estas alteraciones producen cambios anatómicos grandes por un síndrome adherencial severo. Objetivo: Demostrar la presentación de un abdomen catastrófico posterior a manejo de íleo biliar en un paciente adulto. Caso clínico: Paciente masculino de 43 años que producto de un abdomen agudo obstructivo por íleo biliar evolucionó tórpidamente en otra casa asistencial. Se realizaron 3 intervenciones quirúrgicas, hasta llegar a nuestra casa asistencial donde se le trata de manera multidisciplinaria e integral. Estuvo 120 días hospitalizado y se le realizó 5 intervenciones quirúrgicas para aplicación y recambio de terapia de presión negativa abdominal abierta (ABThera). Durante la última intervención al encontrar una cavidad limpia y sin fugas se realiza gastroentero anastomosis en Y de Roux con una buena evolución clínico-quirúrgica hasta el alta, con seguimiento dos meses posteriores por consulta externa. Conclusiones: El abdomen catastrófico es un reto para el manejo por los cirujanos porque se requiere aparte de un vasto conocimiento también el apoyo de otras especialidades para poder combatir esta entidad(AU)

Introduction: Catastrophic abdomen or hostile abdomen is a surgical entity of great significance due to the loss of the different spaces between organs and the structures of the abdominal cavity. These alterations produce major anatomical changes due to a severe adhesive syndrome. Objective: To show the presentation of a catastrophic abdomen following gallstone ileus management in an adult patient. Clinical case: A 43-year-old male patient who, as a consequence of an acute obstructive abdomen due to gallstone ileus, had a torpid evolution into another care facility. Three surgical interventions were performed before he arrived at our care facility, where he was treated in a multidisciplinary and comprehensive way. He was hospitalized for 120 days and underwent five surgical interventions for application and replacement of the open abdomen negative pressure therapy (ABThera). During the last intervention, upon finding a clean cavity without leaks, a Roux-en-Y gastroenteric anastomosis was performed, with a good clinical-surgical evolution until discharge and follow-up of two months thereafter in the outpatient clinic. Conclusions: Catastrophic abdomen is a challenge to be managed by surgeons because it requires, apart from vast knowledge, the support of other specialties to combat this entity(AU)

Asunto(s)

Asunto(s)

RESUMEN

Introducción: durante las últimas décadas se han desarrollado diversos modelos predictivos de mortalidad, pero solo un limitado número de ellos se han diseñado específicamente para estimar la mortalidad quirúrgica en el adulto mayor. Objetivo: analizar las características de los modelos predictivos de mortalidad utilizados en el adulto mayor con abdomen agudo quirúrgico. Desarrollo: la revisión se realizó con la utilización de motores de búsqueda como el Google Académico, fueron consultados 112 artículos en español e inglés en las bases de SciELO, Pubmed y Dialnet. Conclusiones: El score APACHE II y la escala POSSUM son los modelos predictivos de mortalidad más fiables, difundidos y utilizados a nivel mundial en el adulto mayor con abdomen agudo quirúrgico. Será necesario unificar variables de estos modelos y agregar la fragilidad fisiológica del adulto mayor para así lograr un modelo más fiable y seguro en esta población de pacientes específica(AU)

Introduction: during the last decades, various predictive models of mortality have been developed, but only a limited number of them have been specifically designed to estimate surgical mortality in the elderly. Objective: analyze the characteristics of the predictive models of mortality used in the elderly with acute abdomen surgical. Development: the review was carried out using search engines such as Google Scholar, were consulted 112 articles in spanish and english in the databases of SciELO, Pubmed and Dialnet. Conclusions: APACHE II score and the POSSUM scale are the more reliable mortality predictive models, disseminated and used worldwide in the older adult with acute surgical abdomen. It will be necessary to unify variables of these models and add the physiological fragility of the elderly in order to achieve a more reliable and safe in this specific patient population(EU)

Asunto(s)

RESUMEN

RESUMEN Los quistes hepáticos simples (QHS) son las lesiones hepáticas más frecuentes. Cursan habitualmente asintomáticas, aunque cuando alcanzan gran tamaño pueden causar síntomas. El objetivo del presente artículo es presentar una complicación excepcional de los QHS. Presentamos a una mujer de 61 años con historia de QHS múltiples que acude a Urgencias por dolor abdominal brusco sin antecedente traumático. Ante la sospecha de rotura quística espontánea, se realiza tomografía computarizada (TC) abdominal que confirma el diagnóstico. Se decide tratamiento conservador con buena evolución. Tras el episodio agudo es intervenida quirúrgicamente realizándose destechamiento de los quistes. a rotura de los QHS es una complicación excepcional que habitualmente cursa con dolor abdominal. Debido a su baja frecuencia no existe un tratamiento estándar. Se acepta que el tratamiento conservador es una buena opción en pacientes sin signos de peritonitis, mientras que la cirugía urgente está indicada en pacientes con abdomen agudo.

ABSTRACT Simple liver cysts (SLC) are the most common liver tumors. They are usually asymptomatic but large cysts may produce symptoms. The aim of this article is to report a rare complication of SLC. We report the case of a 61-year-old woman with a history of multiple SLCs who sought medical care due to sudden abdominal pain not associated with trauma. A probable diagnosis of spontaneous rupture was made, and the patient underwent computed tomography (CT) scan of the abdomen which confirmed the suspicion. Conservative treatment was decided, with favorable outcome. After the acute episode the patient underwent surgery and the cysts were unroofed. Rupture of SLC is a rare complication that usually presents with abdominal pain. There is no standard of care due to the low incidence of this complication. The conservative approach is a good option in patients without signs of peritonitis, while emergency surgery is indicated in patients with acute abdomen.

Asunto(s)

RESUMEN

PURPOSE: COVID-19 is associated with high morbidity and mortality in patients undergoing surgery. Contrary to elective procedures, emergency operations should not be postponed. We aim to evaluate the profile and outcomes of COVID-19 patients who underwent emergency abdominal surgery. METHODS: We performed a retrospective analysis of perioperative data of COVID-19 patients undergoing emergency surgery from April 2020 to August 2020. RESULTS: Eighty-two patients were evaluated due to abdominal complaints, yielding 22 emergency surgeries. The mean APACHE II and SAPS were 18.7 and 68, respectively. Six patients had a PaO2/FiO2 lower than 200 and more than 50% of parenchymal compromise on chest tomography. The most common indications for emergency surgery were hernias (6; 27.2%). The median length of stay was 30 days, and only two patients required reoperation. Postoperatively, 10 (43.3%) patients needed mechanical ventilation for a mean of 6 days. The overall mortality rate was 31.8%. CONCLUSION: Both postoperative morbidity and mortality are high in COVID-19 patients with respiratory compromise and abdominal emergencies.

Asunto(s)

RESUMEN

RESUMEN Introducción: El abdomen agudo es causa frecuente de ingreso hospitalario en pacientes geriátricos. Objetivo: Caracterizar el comportamiento del abdomen agudo quirúrgico en el paciente geriátrico en un servicio de cirugía general. Métodos: Se realizó un estudio observacional descriptivo longitudinal de corte transversal en 169 pacientes. Los datos procedieron de las historias clínicas del Hospital Universitario "Manuel Ascunce Domenech" de Camagüey, desde enero de 2014 a diciembre de 2016 y se procesaron mediante estadística descriptiva, relacionándose algunas variables de manera no inferencial. Resultados: El 52,2 por ciento de los pacientes eran hombres. El 42,6 por ciento tenía edades entre 60 y 69 años. El 28,9 por ciento presentaron la oclusión intestinal como etiología. Hubo un 39,5 por ciento de complicaciones, el 54,5 por ciento de ellas fueron infecciosas. La mortalidad fue de un 22,5 por ciento. El 26,6 por ciento de los fallecidos presentaba oclusión intestinal. Conclusiones: Casi una décima parte de los pacientes fallecieron, la peritonitis fibropurulenta y el choque séptico fueron las causas más frecuentes de los decesos. La oclusión intestinal como causa de abdomen agudo pareció influir en la mortalidad de la muestra estudiada(AU)

ABSTRACT Introduction: Acute abdomen is a frequent cause of hospital admission in geriatric patients. Objective: To characterize the occurrence of acute surgical abdomen in the geriatric patient in a general surgery service. Methods: An observational, descriptive, longitudinal and cross-sectional study was carried out with 169 patients. The data were obtained from the medical records of Manuel Ascunce Domenech University Hospital in Camagüey, from January 2014 to December 2016, and were processed using descriptive statistics, relating some variables in a noninferential way. Results: 52.2 percent of the patients were men. 42.6 percent were aged between 60 and 69 years. 28.9 percent presented intestinal occlusion as an etiology. There were 39.5 percent of complications, 54.5 percent of which were infectious. Mortality was 22.5 percent. 26.6 percent of the deceased had intestinal obstruction. Conclusions: Almost one tenth of the patients died, with fibrinopurulent peritonitis and septic shock being the most frequent causes of death. Intestinal occlusion as a cause of acute abdomen appeared to influence mortality in the sample studied(AU)

Asunto(s)

RESUMEN

La enteritis eosinofílica, es una patología rara, caracterizada por infiltración de eosinófilos en una o más capas histológicas en diferentes niveles del tracto gastrointestinal, siendo el estómago e intestino delgado los más afectados; su cuadro clínico, inespecífico, caracterizado por dolor abdominal, náusea, vómito, diarrea o estreñimiento, pérdida de peso y ascitis, con presencia o ausencia de eosinofilia en la biometría. Reporte de caso Paciente masculino de 51 años de edad, acudió a emergencia por distensión abdominal y náusea, al examen físico en la palpación intenso dolor y distención abdominal, percusión timpánico y abolición de ruidos hidroaéreos. La analítica reportó leucocitosis con neutrofilia, radiografía de abdomen íleo adinámico, en la ecografía abdominal presencia de imágenes tubulares con aspecto de diana, asociado a líquido libre purulento en fosa ilíaca derecha y fondo de saco vésico rectal. Un cuadro clínico compatible con abdomen agudo de resolución quirúrgica, se realizó laparotomía exploratoria (AU);

The eosinophilic enteritis is a rare pathology, characterized by infiltration of eosinophils in one or more histological layers at different levels of the gastrointestinal tract, the stomach and small intestine being the most affected; its nonspecific clinical picture, characterized by abdominal pain, nausea, vomiting, diarrhea or constipation, weight loss and ascites, with the presence or absence of eosinophilia in the biometry. Enteritis eosinofílica, una causa extraña de abdomen agudo. reporte de caso clínico Eosinophilic enteritis, a strange cause of acute abdomen year-old male patient came to the emergency room due to abdominal distention and nausea, to physical examination on palpation, intense abdominal pain and distention, tympanic percussion and abolition of air-fluid sounds. Laboratory analysis reported leukocytosis with neutrophilia, abdominal ileus adynamic radiography, abdominal ultrasound presence of tubular images with a target appearance, associated with free purulent fluid in the right iliac fossa and rectal vesicum fundus. A clinical picture compatible with an acute abdomen with surgical resolution, an exploratory laparotomy was performed (AU);

Asunto(s)

RESUMEN

Resumen Introducción: Es importante mantener programas de vigilancia bacteriana para disminuir resistencia y definir esquemas farmacológicos adecuados. Los pacientes con abdomen agudo representan un grupo microbiológico especial. Objetivos: Hacer una revisión de agentes patógenos en pacientes adultos operados en nuestro Servicio de Urgencia por patología abdominal con líquido libre y analizar los resultados obtenidos de cultivos respecto a las cepas y la susceptibilidad a los antibióticos. Materiales y Método: Estudio de cohorte prospectiva con estadística descriptiva. Se incluyen pacientes consecutivos, mayores de 18 años, operados por abdomen agudo que presentan líquido libre intraperitoneal entre noviembre de 2017 y abril de 2018. Se excluyen casos con terapia antimicrobiana, hospitalización y/o cirugía en los 3 meses previos. Se registran los cultivos positivos, cepas aisladas, susceptibilidad antimicrobiana, datos demográficos y evolución clínica. Resultados: De 63 pacientes 55% fueron hombres, edad promedio 52,2 años. Las patologías más frecuentes fueron de origen apendicular (62%) y de causa entérica (30%). En un 44% el cultivo fue positivo y en 36% con más de un germen. Escherichia coli fue el patógeno más frecuente (64,2%) seguidos de Enterococcus faecium y Streptococcus anginosus (7,1%). De los otros patógenos cultivados sólo se observó resistencia múltiple en un caso aislado de Morganella Morganii. Conclusiones: Estos datos constituyen la realidad microbiológica local en abdomen agudo. La Escherichia Coli sigue siendo el germen más frecuente, debe enfrentarse con profilaxis y tratamiento antibiótico adecuado. Es necesario mantener vigilancia microbiología local para un manejo acorde.

Introduction: It is important to maintain bacterial surveillance programs to decrease resistance and define adequate pharmacological schemes. Patients with abdomen represent a special microbiological group. Objetives: Make a review of pathogens in adult patients operated in our Emergency Service for abdominal pathology with free fluid and analyze the results obtained from cultures with respect to the strains and susceptibility to antibiotics. Materials and Method: Prospective cohort study with descriptive statistics. We include consecutive patients, older than 18 years old, operated on by abdomen who present free intraperitoneal fluid between November 2017 and April 2018. Cases with antimicrobial therapy, hospitalization and/or surgery 3 months prior are excluded. Positive cultures, isolated strains, antimicrobial susceptibility, demographic data and clinical evolution are recorded. Results: Of 63 patients, 55% were men and the average age was 52.2 years. The most frequent pathologies were of appendicular origin (62%) and of enteric origin (30%). In 44% the crop was positive and in 36% with more than one germ. Escherichia coli was the most frequent pathogen (64.2%) followed by Enterococcus faecium and Streptococcus anginosus (7.1%). Of the others, cultivated pathogens have only observed multiple resistance in an isolated case of Morganella Morganii. Conclusions: These data include the local microbiological reality in acute abdomen. Escherichia coli is still the most frequent germ that must be faced with the profile and the appropriate treatment. It is necessary to maintain local microbiology surveillance for a proper management.

Asunto(s)

RESUMEN

RESUMEN La pandemia actual COVID-19 ha afectado la población mundial con cifras alarmantes de contaminados y fallecidos, con un agotamiento de los recursos logísticos de los sistemas de salud. No serán pocos los pacientes sospechosos o confirmados de esta enfermedad que necesitarán tratamiento quirúrgico impostergable. El objetivo del estudio es exponer un conjunto de medidas para garantizar la mejor atención de estos pacientes, reducir la posibilidad de contagio entre pacientes, del personal sanitario y el desarrollo de complicaciones postoperatorias. Se realizó una revisión de la literatura actualizada sobre el tema en formato digital, en publicaciones en idioma inglés y español. La reorganización de los servicios quirúrgicos es necesaria para garantizar la mejor atención a los pacientes, salvaguardar al personal sanitario y utilizar adecuadamente los recursos del sistema de salud(AU)

ABSTRACT The current COVID-19 pandemic has affected the world population with alarming numbers of contaminated and fatalities, with a depletion of the logistical resources of health systems. There will be few suspected or confirmed patients of this disease who will need urgent surgical treatment. The objective of the study is to present a set of measures to guarantee the best care of these patients, reduce the possibility of contagion between patients, health personnel and the development of postoperative complications. A review of the updated literature on the subject was carried out in digital format, in publications in English and Spanish. The reorganization of surgical services is necessary to guarantee the best care for patients, safeguard health personnel, and use the resources of the health system properly(AU)

Asunto(s)

RESUMEN

El término infección puerperal se utiliza para describir cualquier infección bacteriana del aparato genital después del parto. Durante gran parte del siglo XX las infecciones puerperales, la preeclampsia y la hemorragia obstétrica formaron parte de la tríada letal de mortalidad materna. La ecografía, la resonancia magnética y la tomografía axial computarizada son la triada de elección para el diagnóstico del abdomen agudo en el puerperio. El mismo resulta difícil debido a factores intrínsecos y es entonces, cuando el radiólogo adquiere un papel crucial. Se presentó un caso de una mujer de 30 años, con 8 días de habérsele practicado una cesárea con un puerperio inmediato normal. Posteriormente presentó dolor abdominal, fiebre, escalofríos y masa palpable en fosa iliaca izquierda. Se practicaron técnicas de imágenes se plantea una masa ovárica izquierda, se realizó laparotomía exploradora y se concluyó como absceso ovárico (AU).

The term puerperal infection is used to describe any bacterial infection of the genital tract after delivery. During much of the twentieth century puerperal infections, preeclampsia and obstetric hemorrhage were part of the lethal triad of maternal mortality. Ultrasonography, magnetic resonance imaging and computed tomography are the triad of choice for the diagnosis of acute abdomen in the puerperium, which is difficult due to intrinsic factors and it is when radiologist plays a vital role. The authors present the case of a woman, aged 30 years, at the 8th day after undergoing a cesarean section with a normal immediate puerperium, who later presented abdominal pain (AU).

Asunto(s)

RESUMEN

La isquemia mesentérica aguda (IMA) es consecuencia de la oclusión de la arteria mesentérica superior (AMS) por trombosis o embolia, es considerada como la más letal del síndrome de abdomen agudo. Se presenta el caso de paciente femenina de 69 años con clínica difusa y confirmación diagnóstica radiológica, El objetivo de este caso clínico es proporcionar una revisión bibliográfica actual del tema y facilitar la adecuada actuación ante este problema de salud de amplio compromiso sistémico, de aparición no tan infrecuente.

Acute mesenteric ischemia (IMA) is a consequence of occlusion of the superior mesenteric artery (AMS) by thrombosis or embolism, it is considered the most lethal of acute abdomen syndrome. The case of a 69-year-old female patient with diffuse clinic and radiological diagnostic confirmation is presented. The objective of this clinical case is to provide a current bibliographic review of the topic and facilitate adequate action in the face of this health problem with a broad systemic commitment, with no appearance. so infrequent.

Asunto(s)

RESUMEN

Se ha observado que la población mayor de 65 años requiere con mayor frecuencia procedimientos quirúrgicos y en ellos las presentaciones clínicas de las entidades responsables de un abdomen agudo son atípicas. En situaciones de emergencia, el diagnóstico resulta más difícil que en el adulto debido a diversos factores. Objetivo: Evaluar características clínicas, edad y sexo de pacientes adultos mayores con diagnóstico de abdomen agudo quirúrgico en el Hospital Universitario "Dr. Manuel Núñez Tovar" de Maturín, estado Monagas, período enero-septiembre 2019. Método: Se realizó un tipo de investigación no experimental, prospectiva, descriptiva, transversal, de campo, donde se estudiaron a todos los pacientes mayores de 60 años con diagnóstico de abdomen agudo quirúrgico según criterios clínicos, en el servicio de Cirugía General, con una muestra de 53 pacientes que cumplieron los criterios de inclusión. Resultados: Se evaluaron 790 pacientes adultos, con diagnóstico de abdomen agudo quirúrgico en el período señalado, de los cuales 53 pacientes correspondían a adultos mayores, 30 pacientes (56.60%) de sexo femenino con una edad promedio general de 71.33 años. La principal causa de abdomen agudo quirúrgico en adultos mayores fue la obstrucción intestinal con 26 pacientes (49.06%). La principal comorbilidad fue la hipertensión arterial (41.50%). Un 16.98% de los pacientes se complicaron con sepsis (complicación más frecuente) con mortalidad de 15.09% y más de la mitad (54.71%) ameritaron más de 4 días de hospitalización incluyendo a los complicados (90%)(AU)

It has been observed that the population over 65 years of age requires more and more surgical procedures and in them the clinical presentations of the entities responsible for an acute abdomen are atypical. In emergency situations, diagnosis is more difficult than in adults due to various factors. Objectives: Evaluate clinical characteristics, age and sex of older adult patients with diagnosis of acute surgical abdomen at the "Dr. Manuel Núñez Tovar" Hospital from Maturín, Monagas state, January-September 2019 period. Method: A non-experimental type, prospective descriptive, cross-sectional, field research was carried out, where all patients older than 60 years with a diagnosis of acute surgical abdomen according to clinical criteria, in the General Surgery service, with a sample of 53 patients who met the inclusion criteria. Results: 790 adult patients were evaluated, with a diagnosis of acute surgical abdomen in the indicated period, of which 53 patients corresponded to older adults, 30 female patients (56.60%) with a general average age of 71.33 years. The main cause of acute surgical abdomen in older adults was intestinal obstruction with 26 patients (49.06%). The main comorbidity was arterial hypertension (41.50%). 16.98% of the patients were complicated by sepsis (the most frequent complication) with mortality of 15.09% and more than half (54.71%)(AU)

Asunto(s)

RESUMEN

BACKGROUND: Colonic vascular lesion secondary to verapamil overdose is mediated by free radicals, forming vascular microtrombos and endotoxin generation, being a difficult diagnosis. CLINICAL CASE: A 27-year-old female is admitted with an acute abdomen of 4 days after an event referred for a suicidal attempt due to an overdose of verapamil, operating surgically where there is a right transmural colon necrosis, performing a right hemicolectomy with terminal ileostomy. CONCLUSIONS: Recognize and properly treat an acute abdomen, not always reach an adequate diagnosis, so a thorough history could conclude.

ANTECEDENTES: La lesión vascular colónica secundaria a la sobredosis de verapamilo, es mediada por radicales libres, formando microtrombos vasculares y generación de endotoxinas, siendo un diagnostico difícil. CASO CLÍNICO: Femenino de 27 años, ingresa con abdomen agudo de 4 días posteriores a un evento remitido de intento suicida por sobredosis de verapamilo, interviniéndose quirúrgicamente donde se halla necrosis colónica transmural derecha, realizando hemicolectomía derecha con ileostomía terminal. CONCLUSIONES: Reconocer y tratar de forma adecuada un abdomen agudo, no siempre se suele llegar a un adecuado diagnostico, por lo cual una minuciosa anamnesis lograría concluirlo.

Asunto(s)

RESUMEN

La cirugía abdominal se ha incrementado notablemente en cantidad y complejidad debido al desarrollo tecnológico de los últimos años. En este contexto se observa con mayor frecuencia en los servicios de cuidados críticos las denominadas catástrofes abdominales. Actualmente, en el ámbito de la cirugía general, es atribuido principalmente a un paciente crítico, afectado por una patología severa y con Abdomen Abierto (AA), condición que conlleva una elevada mortalidad (20 a 60 por ciento). Sobre el manejo del AA trata esta revisión(AU)

Abdominal surgery has increased significantly in quantity and complexity due to the technological development of recent years. In this context, the so-called abdominal catastrophes are observed more frequently in critical care services. Currently, in the field of general surgery, it is mainly attributed to a critical patient, affected by a severe pathology and with Open Abdomen (AA), a condition that carries a high mortality (20 to 60 percent). On the management of AA, this review is addressed(EU)

Asunto(s)