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INTRODUCTION: Mandibular canine impaction is infrequent in dental eruption anomalies and treatment is very challenging. The aim of this multicenter retrospective panoramic study in Latin America was to evaluate panoramic radiographic imaging characteristics of mandibular canine impaction (impaction area, mandibular base contact, transmigration, impaction height and sex) and their associations. MATERIAL AND METHODS: This cross-sectional study evaluated 212 digital panoramic radiographs from three radiological centres in Tingo Maria (Peru), Bogota and Tunja (Colombia). The study included children of both sexes with impacted mandibular canines. Mandibular alpha angle, contact with mandibular basal bone (MBB), impacted sector according to 10 sectors with an adaptation of the Ericson and Kurol method, presence of transmigration and the impacted height were measured and the relationship among these measures was analyzed. Fisher's exact test, Chi-square and binary logistic regression were used. (P<0.05). RESULTS: The mandibular canine impaction showed contact with the MBB (32.08%), dental transmigration (36.79%), mainly located at an apical (40.09%) and sub-apical (36.79%) level. Transmigration mainly occurred in sectors 6 (33.30%) and 10 (25.60%) (P<0.001). It was found that for each year of increase in age, the possibility of contact with the MBB decreased (ß=0.89, P=0.010), and as the alpha angle increased by one degree the probability of contact with the MBB decreased (ß=0.97, P=0.001) and the probability of transmigration increased (ß=1.05, P<0.001). CONCLUSIONS: One third of the impacted canines were in contact with the MBB, while another third presented dental transmigration and were mainly located apically and subapically of the incisor roots. These imaging features should be taken into account when planning orthodontic treatment.

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Introduction Lips play a fundamental role in facial attractiveness and in decisions pertaining to orthognathic surgery. Objective To assess the upper lip changes following Le Fort I osteotomy for maxillary advancement and/or impaction. Methods In the present retrospective non-randomized clinical trial, we evaluated 3 groups of patients who underwent Le Fort I osteotomy of the maxilla. Group 1 (n = 35) underwent maxillary advancement, group 2 (n = 14), maxillary impaction, and group 3 (n = 11) was submitted to both maxillary advancement and impaction. The lip thickness of all patients was measured preoperatively, and the participants in each group were categorized into two subgroups: thin (< 12 mm) and thick (> 12 mm) lip. The primary (before orthognathic surgery) and final (after orthodontic bracket removal) lateral cephalograms of the patients were analyzed using the Dolphin software. Comparisons were made using the paired t -test and linear regression in the IBM SPSS Statistics for Windows software. Results The length of the upper lip increased by 1 mm ( p = 0.012) on average following maxillary advancement, and it decreased by 0.43 mm ( p = 0.24) on average following maxillary impaction. In the maxillary advancement group, the change in angulation of the incisors predicted the incisal display ( p = 0.03). In the maxillary impaction group, skeletal changes in the vertical dimension predicted changes in upper lip length ( p = 0.033). Conclusions Le Fort I osteotomy for maxillary advancement significantly increases the length of the upper lip. The assessment of lip thickness prior to surgery can help predict the postoperative results. Changing the angulation of the incisors can predict the incisal display. In maxillary impaction, skeletal changes in the vertical dimension can predict the changes in the length of the upper lip.

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Abstract Introduction Lips play a fundamental role in facial attractiveness and in decisions pertaining to orthognathic surgery. Objective To assess the upper lip changes following Le Fort I osteotomy for maxillary advancement and/or impaction. Methods In the present retrospective non-randomized clinical trial, we evaluated 3 groups of patients who underwent Le Fort I osteotomy of the maxilla. Group 1 (n = 35) underwent maxillary advancement, group 2 (n = 14), maxillary impaction, and group 3 (n = 11 ) was submitted to both maxillary advancement and impaction. The lip thickness of all patients was measured preoperatively, and the participants in each group were categorized into two subgroups: thin (< 12 mm) and thick (> 12 mm) lip. The primary (before orthognathic surgery) and final (after orthodontic bracket removal) lateral cephalograms of the patients were analyzed using the Dolphin software. Comparisons were made using the paired t-test and linear regression in the IBM SPSS Statistics for Windows software. Results The length of the upper lip increased by 1 mm (p = 0.012) on average following maxillary advancement, and it decreased by 0.43 mm (p = 0.24) on average following maxillary impaction. In the maxillary advancement group, the change in angulation of the incisors predicted the incisal display (p = 0.03). In the maxillary impaction group, skeletal changes in the vertical dimension predicted changes in upper lip length (p = 0.033). Conclusions Le Fort I osteotomy for maxillary advancement significantly increases the length of the upper lip. The assessment of lip thickness prior to surgery can help

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La enfermedad de Hirschsprung (EH) es infrecuente y la mayoría de los escasos casos se presentan en neonatos, raramente se diagnostica durante la adolescencia y menos son los casos documentados. Se presenta el caso de un varón de 16 años quien experimentó 15 días de estreñimiento, anorexia, vómitos postprandiales y distensión abdominal. Los exámenes imagenológicos mostraron un fecaloma masivo que obstruía el colon, y el examen anatomopatológico señaló EH. Ante el fracaso de medidas conservadoras de evacuación se realizó una hemicolectomía izquierda ampliada y una colostomía, más apendicectomía por obstrucción intestinal. El paciente fue dado de alta con antibioticoterapia. Este caso resalta la importancia de considerar EH en adolescentes con estreñimiento crónico y masas abdominales. Aunque los pacientes pueden experimentar problemas postoperatorios, la cirugía es el tratamiento más efectivo para la EH.

Hirschsprung's disease (HD) is uncommon, and most of the cases occur in neonates. It is rarely diagnosed during adolescence, and even fewer cases are documented. We present the case of a 16-year-old male who had 15 days of constipation, anorexia, postprandial vomiting and abdominal distension. Imaging examinations showed a massive fecaloma obstructing the colon, and histopathological examinations showed HD. Given the failure of conservative evacuation measures, an extended left hemicolectomy and colostomy were performed, plus appendectomy for bowel obstruction. The patient was discharged with antibiotic therapy. This case highlights the importance of considering HD in adolescents with chronic constipation and abdominal masses. Although patients may experience postoperative problems, surgery is the most effective treatment for HD.

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OBJECTIVE: The diagnosis of impacted upper permanent canines (IUPC) is a relatively common clinical finding. The aim of this study was to investigate the association of the buccal impaction of upper permanent canines with their dimensions and the maxilla bone base. MATERIAL AND METHODS: Cone beam computed tomography files of 66 patients were allocated into: impaction group (ICG/n=33/mean age 15.7±3.9 years), with 44 impacted canines by the buccal side; control group (CG/n=33/mean age 15.66±3.99 years), matched for age and sex, with 66 canines normally erupted. The following measurements were obtained from ICG and CG groups: linear and volumetric canine dimensions, linear measurements of upper permanent central and lateral incisors, measurements of the anterior perimeter and transverse segments of the maxilla. Independent Student's t-test was used for intergroup analysis with correction of Bonferroni (α=0,005). RESULTS: Higher values were found in the means of the variables regarding to the anterior teeth crowns in the ICG group, however, without a significant difference (P<0,005). The upper arch anterior perimeter of the individuals with canine impaction through buccal area was reduced compared to CG (P=0.001). CONCLUSIONS: It can be concluded that individuals with upper buccal impacted permanent canine showed a significantly smaller anterior perimeter of the maxillary arch when compared to the control group. Although greater canine mesiodistal diameter was found in this group, there is no statistical association with the occurrence of this condition.

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OBJECTIVE: The diagnosis of impacted upper permanent canines (IUPC) is a relatively common clinical finding. The aim of this study was to investigate associations between the upper permanent canines palatal impaction, lateral incisors morphology and the maxilla bone base. MATERIAL AND METHODS: Cone-beam tomography files from 62 subjects were divided into 2 groups: impaction group (ICG/n=31; mean age 14.3±2.4) with 45 canines impacted on the palatal side and age- and sex-matched control group (CG/n=31; mean age 14.3±2.3), with 62 normally erupted canines. Linear and volumetric measurements of the lateral incisors, linear transversal measures and the maxillary anterior perimeter were taken. Independent Student's t-test was used for intergroup analysis with correction of Bonferroni. RESULTS: Significant differences were found for crown length and root diameter (buccal-palatal) (P<0.005). The maxillary anterior perimeter in the ICG was reduced in relation to the GC but not significantly (P=0.008). The transverse skeletal variables of the maxilla were equivalent in the intergroup comparison (P>0.005). CONCLUSION: Smaller dimensions in the crown length and in the upper permanent lateral incisors root buccal-palatal diameter were associated with the impaction of upper permanent canines on the palatal side. The maxillary transverse morphology did not show any association with the occurrence of this condition.

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Introducción: La impactación fecal se caracteriza por la presencia de heces fecales compactas en el recto o colon, que no pueden ser evacuadas. La ingestión del fruto del árbol maboque (Strychnos spinosa Lam), que contiene numerosas semillas, es un hábito alimentario en algunos países africanos. Objetivo: Describir las particularidades del diagnóstico y tratamiento de la impactación fecal por la ingestión de semillas de maboque. Caso clínico: Varón de 12 años, que ingirió gran cantidad de semillas de maboque; no conseguía defecar ni expulsar gases; presentaba dolor abdominal y anal. Al examen físico se constató taquicardia, distensión abdominal y aumento de los ruidos hidroaéreos. A la exploración rectal se constató impactación, de consistencia pétrea. Al no conseguir la extracción, en el salón de urgencias, se fragmentó y extrajo la masa fecal, por vía anal, con sedación anestésica. Conclusiones: La ingestión de semillas de maboque es un hábito alimentario en África y los bezoares o impactación fecal que puede producir este hábito, no se consideran un problema de salud. Para el diagnóstico es necesario el antecedente de la ingestión del fruto, realizar un exhaustivo examen físico de las regiones abdominales, ano-rectal y finalmente, la extracción de la masa fecal.

Introduction: Fecal impaction is characterized by the presence of compact feces in the rectum or colon, which cannot be evacuated. Eating the fruit of the Spiny Monkey-orange tree (Strychnos spinosa Lam), which contains numerous seeds, is a dietary habit in some African countries. Objective: To describe the particularities of the diagnosis and treatment of fecal impaction due to the ingestion of Spiny Monkey-orange seeds. Clinical case: 12-year-old male, who ingested a large quantity of Spiny Monkey-orange seeds; he couldn't defecate or pass gas; She had abdominal and anal pain. Physical examination revealed tachycardia, abdominal distension, and increased air-fluid noises. A rectal examination revealed impaction with a stony consistency. When the extraction was not possible, in the emergency room, the fecal mass was fragmented and extracted, through the anus, with anesthetic sedation. Conclusions: The ingestion of Spiny Monkey-orange seeds is a dietary habit in Africa and the bezoars or fecal impaction that this habit can produce are not considered a health problem. For the diagnosis it is necessary the antecedent of the ingestion of the fruit, to carry out an exhaustive physical examination of the abdominal and anorectal regions and finally, the extraction of the fecal mass.

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El íleo biliar es una rara complicación de la litiasis vesicular, que se comporta como un cuadro de obstrucción intestinal mecánica, cuya causa es la impactación de uno o más cálculos biliares en su luz. Es evidente que, por lo infrecuente de esta entidad en los servicios quirúrgicos, el diagnóstico de la misma es demorado o no se realiza, incidiendo en la evolución del paciente de manera desfavorable. El objetivo de este trabajo es considerar que un diagnóstico precoz del íleo biliar -basado en el análisis de los antecedentes del enfermo, las manifestaciones clínicas y la interpretación correcta en busca de los signos de la tríada de Rigler- permite una mejor evolución de los pacientes. Los estudios imagenológicos y su interpretación son fundamentales en el diagnóstico de esta entidad.

Biliary ileus is a rare complication of gallbladder lithiasis, which behaves like a mechanic intestinal obstruction, the cause of which is the impaction of one or more gallstones in its lumen. It is evident that because of the infrequency of this entity in the surgical services, its diagnosis is delayed or not carried out, affecting the patient's evolution in an unfavorable way. The aim of this paper is to consider that a precocious diagnosis of biliary ileus-based on the analysis of the patient's history, the clinical manifestations and correct interpretation in search of the signs of Rigler's triad-allows a better evolution of patients. Imaging studies and their interpretation are fundamental in the diagnosis of this entity.

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El apendicolito libre postapendicectomía es una complicación rara que puede ocurrir como consecuencia de la salida del apendicolito del apéndice debido a una perforación previa o al no identificar el apendicolito. El fecalito generalmente se vuelve sintomático con el tiempo, debido a la formación de un absceso, obstrucción intestinal, trayecto fistuloso o inflamación del muñón apendicular. Se describen dos casos de apendicolito libre postapendicectomía. Caso 1: mujer de 23 años, que fue sometida a una apendicectomía un día antes, ingresó por emergencia por presentar dolor en el hipogastrio. En la tomografía computarizada (TC) se evidenció un apendicolito libre en la fosa iliaca derecha, y en la laparoscopía diagnóstica se observaron abscesos intraabdominales y un apendicolito libre en el muñón apendicular. Caso 2: varón de 77 años de edad, que fue operado de apendicitis aguda causada por apendicolitos, presentó distensión abdominal al sexto día del posoperatorio. La TC reveló obstrucción intestinal y la presencia de apendicolito libre a nivel de las interasas intestinales; en la reintervención quirúrgica se evidenció erosión del mesenterio por causa del apendicolito. En ambos casos, los pacientes evolucionaron favorablemente después de las reoperaciones. Se desconoce actualmente la incidencia del apendicolito libre después de una apendicectomía, pues se dispone de pocos datos en la literatura a nivel mundial. Por tal motivo es importante la presentación de estos casos, para poder ampliar la casuística y contribuir al conocimiento de los apendicolitos libres postapendicectomía. Asimismo, permite evidenciar sus complicaciones si no son removidos precozmente y cómo prevenirlos. Conclusión: los apendicolitos libres postapendicectomía deben extraerse precozmente para evitar complicaciones.

Dropped appendicolith following an appendectomy is a rare complication which may occur as a consequence of appendicolith expulsion from the appendix due to a previous perforation or failure to identify the appendicolith. A fecalith generally becomes symptomatic over time, as a result of abscess formation, intestinal obstruction, fistula tract or inflammation of the appendiceal stump. Two cases of dropped appendicolith following an appendectomy are described hereinbelow. Case 1: A 23-year-old female patient, who underwent an appendectomy the previous day, was admitted to the emergency room due to hypogastric pain. A computed tomography (CT) scan revealed a dropped appendicolith in the right iliac fossa, and a diagnostic laparoscopy showed intra-abdominal abscesses and a dropped appendicolith in the appendicular stump. Case 2: A 77-year-old male patient, who underwent surgery for acute appendicitis caused by appendicoliths, showed abdominal distension on the sixth postoperative day. The CT scan revealed intestinal obstruction and a dropped appendicolith at bowel loops. In the surgical reintervention, erosion of the mesentery caused by the appendicolith was evidenced. Both patients progressed after the reoperations. The incidence of dropped appendicolith following an appendectomy is currently unknown since few data are available in the literature worldwide. Therefore, it is important to present these cases to expand the casuistry, learn more about dropped appendicoliths following an appendectomy, demonstrate their complications if they are not removed early and show how to prevent them. In conclusion, dropped appendicoliths following an appendectomy must be removed early to avoid complications.

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Objective: To evaluate the null hypothesis that there is no difference in a set of clinical predictors of potentially impacted canines between low-risk patients with and without displaced canines. Methods: The normal canine position group consisted of 30 patients with 60 normally erupting canines ranked in sector I (age, 9.30 ± 0.94 years). The displaced canine group comprised 30 patients with 41 potentially impacted canines ranked in sectors II to IV (age, 9.46 ± 0.78 years). Maxillary lateral incisor crown angulation, inclination, rotation, width, height, and shape, as well as palatal depth, arch length, width, and perimeter composed a set of clinical predictors, which were evaluated on digital dental casts. Statistical analyses consisted of group comparisons and variable correlations (p < 0.05). Results: There was a significant association between sex and mesially displaced canines. Unilateral canine displacement was more prevalent than bilateral displacement. The crown of the maxillary lateral incisors was significantly angulated more mesially and rotated mesiolabially in low-risk patients with displaced canines, who also had a shallower palate and shorter anterior dental arch length. Lateral incisor crown angulation and rotation, as well as palatal depth and arch length, were significantly correlated with the canine displacement severity. Conclusions: The null hypothesis was rejected. Maxillary lateral incisor angulation inconsistent with the "ugly duckling" stage as well as a shallow palate and short arch length are clinical predictors that can significantly contribute to the early screening of ectopic canines in low-risk patients.

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This was a retrospective case study of colic syndrome of cecal origin in 159 horses treated at a reference Veterinary Center between June 2015 and July 2021. The data studied were breed, age, sex, clinical examinations of the initial emergency care, treatment protocols (clinical and/or surgical) and resolution (hospital discharge, euthanasia or death). It was observed that 7.55% (n = 12) of the cases corresponded to colic syndrome of cecal origin, where 75% (n = 9) had heart rate within the physiological range for the species, as well as 50% (n = 6) for capillary refill time values, 33.33% (n = 4) for pink mucosa, 41.67% (n = 5) for rectal temperature, and 16.67% (n = 2) on abdominal auscultation. In 58.34% (n = 7) of patients, pain could be controlled with analgesics, with recurrence in 41.67% (n = 5). All treated cases were cecal impaction, where 58.33% (n = 7) ruptured the cecum. In 75% (n = 9) of the cases, surgical treatment was performed. Regarding the general resolution of cases, 41.67% (n = 5) of the animals were discharged. Therefore, it is concluded that despite the increase in the diagnosis of colic of cecal origin, this disease is still rare (7.55%) and has a high potential for death since there are few clinical alterations, making its early diagnosis difficult.(AU)

Este foi um estudo retrospectivo dos casos de síndrome cólica de origem cecal em 159 cavalos atendidos em um Centro Veterinário de referência entre junho de 2015 e julho de 2021. Os dados estudados foram raça, idade, sexo, exames clínicos do atendimento inicial de emergência, protocolos de tratamento (clínico e/ou cirúrgica) e resolução (alta hospitalar, eutanásia ou óbito). Observou-se que 7,55% (n = 12) dos casos correspondiam à síndrome cólica de origem cecal, onde 75% (n = 9) apresentavam frequência cardíaca dentro da faixa fisiológica para a espécie, assim como 50% (n = 6) para valores de tempo de enchimento capilar, 33,33% (n = 4) para mucosa rosada, 41,67% (n = 5) para temperatura retal e 16,67% (n = 2) para ausculta abdominal. Em 58,34% (n = 7) dos pacientes, a dor pôde ser controlada com analgésicos, com recidiva em 41,67% (n = 5). Todos os casos tratados foram de impactação cecal, onde 58,33% (n = 7) romperam o ceco. Em 75% (n = 9) dos casos, o tratamento cirúrgico foi realizado. Em relação à resolução geral dos casos, 41,67% (n = 5) dos animais tiveram alta. Portanto, conclui-se que apesar do aumento do diagnóstico de cólica de origem cecal, esta enfermidade ainda é rara (7,55%) e apresenta um alto potencial de óbito visto que há poucas alterações clínicas dificultando seu diagnóstico precoce.(AU)

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Context: Postoperative, critically ill, and elderly patients often have fecal loading or impaction. In a few such patients, disimpaction of fecalomas and colon cleansing are difficult. Bowel obstruction, megacolon, lower gastrointestinal bleeding, and gut perforation are complications that may ensue. Oral laxatives or enemas may only be partially effective. Surgical intervention may be needed for salvage or to treat complications. Series and Design: Fourteen hospitalized cases with defecation disorder due to fecal loading of the colon were enrolled for retrospective analysis. Colonoscopic instillation of mannitol and/or lactulose was undertaken as an intervention when the use of oral laxatives was either ineffective or unfeasible, and enema had yielded poor results. Results: Ten patients had satisfactory outcomes for fecal clearance, whereas four patients with poor or incomplete responses underwent repeat interventions or surgery. No significant complications were encountered due to this therapy. Conclusion: Colonoscopic instillation of mannitol or lactulose in fecal-loaded critically ill patients results in a safe and satisfactory fecal clearance. (AU)

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Amelogenesis imperfecta (AI) is a collection of rare genetic disorders affecting the quantity and/or quality of the tooth enamel. AI can be classified into three major types according to the clinical phenotype: hypoplastic, hypocalcified, and hypomatured. Among them, the hypocalcified type shows the weakest physical properties, leaving rough and discolored enamel surfaces after tooth eruption. To date, mutations in the FAM83H gene are responsible for the autosomal-dominant hypocalcified AI. In this study, we recruited a four-generation Colombian family with hypocalcified AI and identified a recurrent nonsense mutation in the FAM83H gene (NM_198488.5:c.1289C>A, p.(Ser430 *)) by candidate gene sequencing. Cephalometric analyses revealed the anterior open bite that occurred in the proband is not correlated with the AI in this family.

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OBJECTIVE: To describe and assess the available evidence of prediction methods of maxillary canine impaction (MCI). MATERIAL AND METHODS: A systematic search was conducted through PubMed, Cochrane Library, Embase, EBSCOhost, Scopus, ScienceDirect, Bireme and Scielo until December 2020. This systematic review was conducted according to the PRISMA statement. The methodology of the selected studies was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2). RESULTS: A total of 2391 articles were identified in the first approach and after a 2-phase selection, 11 studies were included in qualitative analysis. Prediction methods were constructed using equation-based models, geometric measurements and computational methods from clinical and imaging data to predict palatal/buccal MCI. The quality of evidence was low to moderate due to the presence of risk of bias in most of the studies included. Three cohort studies with the best methodological quality proposed prediction models based on geometric measurements, canine position and facial growth pattern that would allow predicting MCI from CBCT, lateral and panoramic radiographs. CONCLUSIONS: The evidence is limited and most of the studies present a low methodological quality. However, it is possible to suggest that some prediction methods based on the position of the canine and facial growth pattern could predict palatal/buccal MCI in mixed dentition. Cohort studies with better methodological quality and long-term follow-up are needed to better validate a prediction model.

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Objetivo: O objetivo deste estudo é avaliar sistematicamente as evidências disponíveis para recidiva do tratamento da mordida aberta esquelética usando dispositivos de ancoragem temporária e cirurgia ortognática. Material e Métodos: Cinco bases de dados eletrônicas como MEDLINE, COCHRANE, SCIELO, GOOGLE SCHOLAR, EMBASE foram pesquisadas sistematicamente até junho de 2020. Os estudos de qualidade metodológica foram classificados por meio da Ferramenta de Avaliação de Qualidade do Projeto de Práticas de Saúde Pública Eficazes (EPHPP). Resultados: No total, 1.005 estudos foram identificados para triagem e 6 estudos foram elegíveis. O instrumento de avaliação da qualidade apresentou qualidade moderada para todos os estudos. A correção imediata pós-tratamento da mordida aberta foi melhor nos estudos cirúrgicos do que nos estudos tratados com TADs. Conclusão: A estabilidade dos resultados do tratamento da mordida aberta anterior foi comparável nos casos tratados em ambas as modalidades de tratamento. A recidiva da mordida aberta anterior foi associada a casos em que a sobremordida pós-tratamento foi mínima. A sobremordida parece ser mais estável quando apenas a maxila foi operada do que com cirurgias bimaxilares. A rotação anti-horária da mandíbula com subsequente redução da altura facial anterior foi melhor na correção cirúrgica do que através de TADs (AU)

Objective: The purpose of this study is to systematically assess the available evidence for relapse of skeletal open bite treatment using temporary anchorage devices and orthognathic surgery. Materials and Methods: Five electronic databases such as MEDLINE, COCHRANE, SCIELO, GOOGLE SCHOLAR, EMBASE were systematically searched up to June 2020. Methodological quality studies were graded by means of the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool. Results: In total, 1005 studies were identified for screening, and 6 studies were eligible. The quality assessment tool showed moderate quality for all the studies. The immediate post treatment correction of open bite was better in the surgical studies than in the studies treated with TADs. Conclusion: Stability of treatment results of anterior openbite was comparable in cases treated in both the treatment modalities. Relapse of anterior open bite was associated with cases in which the posttreatment overbite was minimal. Overbite seems to be more stable when only the maxilla has been operated on than with bi-maxillary surgeries. Counterclockwise rotation of the mandible with subsequent reduction of anterior facial height was better in surgical correction than through TADs. (AU)

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Abstract Case description: A 5-year-old girl presented to the emergency department with a history of foreign body ingestion. A cervico-thoracoabdominal radiograph demonstrate a foreign body in the esophagus, which seemed to show a double rim sign suspecting a button battery. After an emetic episode and expelling a coin, the child became asymptomatic. Close inspection of the X-ray demonstrated that the image was formed by superimposition of 3 circumferential objects of different sizes. Another X-ray observed the persistence of two superimposed objects. Clinical findings: The girl presented with sialorrhea, odynophagia, and nausea. Vital signs and physical examination were normal. There was no significant medical history. Treatment and Outcome: With the suspicion of multiple impacted esophageal objects, the patient was then taken to the operating room. During the flexible esophagoscopy 2 coins were found in the esophagus, both were removed without difficulty. The patient had an uneventful postoperative recovery and there have been no long-term complications. Clinical relevance: Unusual radiographic findings regarding esophageal foreign bodies have been reported, however, we describe the first case of a child with 3 coins impacted in the esophagus and a new radiological finding in foreign bodies ingestions that allow to avoid misdiagnosis and improve outcomes.

Resumen Descripción del caso: Una niña de 5 años es llevada a urgencias tras la ingesta de un cuerpo extraño. La radiografía cérvico-toraco-abdominal evidenció un cuerpo extraño esofágico con signo de doble halo, lo que hizo sospechar una pila de botón. Tras un vómito con expulsión de una moneda los síntomas desaparecieron. Una inspección minuciosa de la radiografía demostró que la imagen estaba formada por la superposición de 3 objetos circunferenciales de diferentes tamaños. Una nueva radiografía mostró persistencia de dos objetos superpuestos. Hallazgos clínicos: La niña refería odinofagia, náuseas y tenía sialorrea. Los signos vitales y el examen físico eran normales. No tenía antecedentes médicos relevantes. Tratamiento y desenlace: Con la sospecha de impactación esofágica múltiple, la paciente fue llevada al quirófano. Durante la esofagoscopia se encontraron 2 monedas en el esófago que fueron extraídas sin dificultad. La evolución postoperatoria fue favorable y no hubo complicaciones a largo plazo. Relevancia clínica: Aunque se han reportado hallazgos radiográficos inusuales en cuerpos extraños esofágicos, describimos el primer caso de un niño con 3 monedas impactadas en el esófago y un nuevo hallazgo radiológico en la ingesta de cuerpos extraños que permite evitar diagnósticos erróneos y mejorar los desenlaces.

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Case description: A 5-year-old girl presented to the emergency department with a history of foreign body ingestion. A cervico-thoracoabdominal radiograph demonstrate a foreign body in the esophagus, which seemed to show a double rim sign suspecting a button battery. After an emetic episode and expelling a coin, the child became asymptomatic. Close inspection of the X-ray demonstrated that the image was formed by superimposition of 3 circumferential objects of different sizes. Another X-ray observed the persistence of two superimposed objects. Clinical findings: The girl presented with sialorrhea, odynophagia, and nausea. Vital signs and physical examination were normal. There was no significant medical history. Treatment and Outcome: With the suspicion of multiple impacted esophageal objects, the patient was then taken to the operating room. During the flexible esophagoscopy 2 coins were found in the esophagus, both were removed without difficulty. The patient had an uneventful postoperative recovery and there have been no long-term complications. Clinical relevance: Unusual radiographic findings regarding esophageal foreign bodies have been reported, however, we describe the first case of a child with 3 coins impacted in the esophagus and a new radiological finding in foreign bodies ingestions that allow to avoid misdiagnosis and improve outcomes.

Descripción del caso: Una niña de 5 años es llevada a urgencias tras la ingesta de un cuerpo extraño. La radiografía cérvico-toraco-abdominal evidenció un cuerpo extraño esofágico con signo de doble halo, lo que hizo sospechar una pila de botón. Tras un vómito con expulsión de una moneda los síntomas desaparecieron. Una inspección minuciosa de la radiografía demostró que la imagen estaba formada por la superposición de 3 objetos circunferenciales de diferentes tamaños. Una nueva radiografía mostró persistencia de dos objetos superpuestos. Hallazgos clínicos: La niña refería odinofagia, náuseas y tenía sialorrea. Los signos vitales y el examen físico eran normales. No tenía antecedentes médicos relevantes. Tratamiento y desenlace: Con la sospecha de impactación esofágica múltiple, la paciente fue llevada al quirófano. Durante la esofagoscopia se encontraron 2 monedas en el esófago que fueron extraídas sin dificultad. La evolución postoperatoria fue favorable y no hubo complicaciones a largo plazo. Relevancia clínica: Aunque se han reportado hallazgos radiográficos inusuales en cuerpos extraños esofágicos, describimos el primer caso de un niño con 3 monedas impactadas en el esófago y un nuevo hallazgo radiológico en la ingesta de cuerpos extraños que permite evitar diagnósticos erróneos y mejorar los desenlaces.

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ABSTRACT The internal hemorrhoid, rectal tumor, hypertrophic anal papilla, and secret fecal mass are regarded as the blocks embedded in the rectum. The above blocks hinder defecation, which will inevitably lead to excessive opening of the anal caliber. Once the limit is exceeded, the skin of the anal canal will tear and form anal fissure. Based on the study of historical evolution, hypothesis reasoning, clinical verification and comparison with other theories, a new concept of anal fissure etiology-impaction theory is proposed. The so-called impaction theory refers to the impaction (various primary lesions) in anorectum, which hinders defecation. When defecating, the anal canal expands beyond the limit, and the whole layer of anal canal skin splits, that is to say, anal fissure is formed.

RESUMO A hemorroida interna, o tumor retal, a papila anal hipertrófica e a massa fecal secreta são considerados os blocos incrustados no reto. Os bloqueios acima impedem a defecação, o que inevitavelmente levará a uma abertura excessiva do calibre anal. Uma vez que o limite é excedido, a pele do canal anal rasga e forma uma fissura anal. Com base no estudo da evolução histórica, raciocínio de hipóteses, verificação clínica e comparação com outras teorias, um novo conceito de etiologia da fissura anal - a teoria da impactação - é proposto. A chamada teoria da impactação refere-se à impactação (várias lesões primárias) no anorreto, o que dificulta a defecação. Na defecação, o canal anal se expande além do limite e toda a camada da pele do canal anal rasga, ou seja, forma-se a fissura anal.

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Magnesium sulphate (MS) and dioctyl sodium sulphosuccinate (DSS) are laxative drugs frequently used for the treatment of impactions. The aim of this study was to compare the effects of MS and DSS in fecal hydration, output and systemic hydration in healthy horses. Five healthy horses received 3 treatments with a 21-day interval. Treatment 1 was performed with administration of 4 liters of warm water; treatment 2: administration of 4 liters of warm water associated with 1g/kg of MS; and treatment 3: administration of 4 liters of warm water associated with 20mg/kg DSS. General and specific physical examination of the digestive system were performed, alongside with packed cell volume and total plasma protein measurement, abdominal ultrasonography and quantification of the amount and hydration of feces, before and 6, 12, 24, 36 and 48 hours after the treatments. No adverse effects were observed. The administration of laxatives promoted greater fecal output and hydration without resulting in systemic dehydration, yet no differences were observed between treatments. The absence of adverse effects of DSS demonstrates the safety of its use as a laxative drug at a dose of 20mg/kg. Studies comparing the effects of the laxative drugs in horses with large colon impaction are needed.(AU)

O sulfato de magnésio (SM) e o dioctil-sulfossuccinato de sódio (DSS) são drogas laxativas frequentemente utilizadas no tratamento da compactação. O objetivo deste estudo foi comparar os efeitos do SM e do DSS na hidratação e eliminação fecal, e na hidratação sistêmica de cavalos saudáveis. Cinco cavalos receberam três tratamentos, com intervalo de 21 dias. O tratamento 1 consistiu na administração de quatro litros de água morna; o tratamento 2: administração de quatro litros de água morna associada a 1g/kg de SM; e o tratamento 3: administração de quatro litros de água morna associada a 20mg/kg de DSS. Foram realizados exames físicos gerais e específicos do trato digestivo, hematócrito e proteína plasmática total, ultrassonografia abdominal e mensuração da quantidade e hidratação das fezes antes e após seis, 12, 24, 36 e 48 horas dos tratamentos. Não foram observados efeitos adversos. A administração de ambos os laxantes promoveu maior produção fecal e hidratação, sem resultar em desidratação sistêmica, entretanto não houve diferença entre os tratamentos. A ausência de efeitos adversos do DSS demonstra a segurança de seu uso como medicamento laxante na dose de 20mg/kg. São necessários estudos que comparem o efeito dos laxantes em equinos portadores de compactação de cólon.(AU)

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Equine colic is one of the most common cause of death in horses, but few studies have investigated specifically the conditions at the necropsy. This study aimed to describe the epidemiological and pathological features of noninfectious diseases of the gastrointestinal tract in horses. A retrospective study was conducted in search of cases of these diseases affecting horses from 2005 to 2017. During this period, 114 horses died of noninfectious diseases of the gastrointestinal tract, and the main causes were: primary gastric dilation (27/114), volvulus (27/114), enterolithiasis (20/114), rectal (colonic) perforation (15/114), gastric or cecocolonic impaction (10/114), incarcerations (6/114), intussusception (4/114), and others (5/114). Mixed breeds horses (56/114) and males (69/114) were mostly affected. The horses had a median and mean age of 10 and 10.9-years old, respectively. Primary gastric dilation was characterized by distension of the stomach by moderate to large amounts of content, which in 21 cases caused tearing of the stomach wall at the greater curvature (peritonitis), and the main predisposing factor was alimentary overload (17/27). Intestinal volvulus occurred within the small intestine (14 cases) and within the large intestines (13 cases). Grossly, there was intestinal ischemia with reddened to deep-black serosa and diffusely red mucosae. Enterolithiasis caused partial or complete obstruction of the right dorsal colon (9/20), transverse colon (4/20), small colon and right dorsal colon (3/20), rectum and right dorsal colon (2/20), and small colon (2/20). Viscera perforation and peritonitis occurred in 11 cases. Rectal (colonic) perforation involved the rectum (10/15), rectum/small colon (4/15), and the small colon (1/15). It was characterized by a focally extensive transmural tearing, associated with reddened borders, and retroperitoneal to diffuse peritonitis. Palpation related iatrogenic injuries (11/15) were the main cause. Impactions affected the large colon (7/10), the cecum (2/10), and the stomach (1/10). Incarcerations consisted of inguinoscrotal hernias (2/6), small intestine entrapment by a mesenteric failure (2/6), diaphragmatic hernia, and umbilical eventration. Grossly, the organs were constricted by a hernial ring, with intestinal ischemia and reddened to dark-red serosa. Predisposing factors included previous surgeries (2/6) and patent inguinal ring (1/6). Intussusception involved the small intestine (3/4) and ileocecum (1/4). Foals with lack of colostrum intake and concomitant pneumonia was a characteristic presentation (3/4). Grossly, the intussusceptum slipped into intussuscipiens, with diffuse deep black-red discoloration. Other causes included large colon displacement (2/5), extrinsic and intrinsic obstruction of the small intestine (2/5), and an intestinal adenocarcinoma. Noninfectious gastrointestinal diseases are major causes of death in horses. Epidemiological and gross features of the conditions should be accounted to obtain a final diagnosis of the cause of the colic.(AU)

A cólica em equinos é considerada como a principal causa de morte de cavalos, porém poucos estudos têm investigado especificamente as condições envolvidas através da necropsia. O objetivo desse estudo foi descrever os aspectos epidemiológicos e patológicos de doenças não infecciosas do trato gastrointestinal de equinos. Foi conduzido um estudo retrospectivo em busca de casos dessas doenças envolvendo cavalos de 2005 a 2017. Durante esse período, 114 equinos morreram devido a doenças não infecciosas do trato gastrointestinal, e as principais causas foram: dilatação gástrica (27/114), vólvulos (27/114), enterolitíase (20/114), ruptura retal (colônica) (15/114), compactação gástrica ou cecocolônica (10/114), encarceramentos (6/114), intussuscepções (4/114), e outros (5/114). Animais sem raça definida (56/114) e machos (69/114) foram mais afetados. Os equinos apresentavam uma média e mediana de idade de 10 e 10,9 anos, respectivamente. A dilatação gástrica primária era caracterizada por distensão do estômago por moderada a grande quantidade de conteúdo, que em 21 casos provocava ruptura da parede gástrica na curvatura maior (peritonite), e o principal fator predisponente foi sobrecarga alimentar (17/27). Vólvulo intestinal ocorreu no intestino delgado e no intestino grosso (14 e 13 casos, respectivamente). Macroscopicamente, havia isquemia intestinal com serosa avermelhada a enegrecida e mucosa difusamente avermelhada. A enterolitíase causou obstrução parcial ou completa do cólon dorsal direito (9/20), cólon transverso (4/20), cólon menor e cólon dorsal direito (3/20), cólon menor (2/20), e reto e cólon maior direito (2/20). Perfuração de vísceras e peritonite foram observadas em 11 casos. A ruptura retal (colônica) envolveu o reto (10/15), reto/cólon menor (4/15) e cólon menor (1/15). Essa era caracterizada por ruptura transmural focalmente extensa, com bordos avermelhados e peritonite retroperitoneal a difusa. Traumas relacionados à palpação (11/15) foram a principal causa. Compactações afetaram o cólon maior (7/10), ceco (2/10) e estômago (1/10). Encarceramentos consistiram em hérnias inguinoescrotais (2/6), encarceramento de alças intestinais por falha no mesentério (2/6), hérnia diafragmática e eventração umbilical. Macroscopicamente, os órgãos estavam constritos por um anel hernial, com isquemia intestinal e serosa avermelhada a vermelho-escura. Fatores predisponentes incluíram cirurgias prévias (2/6) e anel inguinal patente (1/6). Intussuscepções envolveram o intestino delgado (3/4) e íleoceco (1/4). A apresentação característica foi em potros com falta de colostro e concomitante pneumonia. Macroscopicamente, o intussuscepto deslizava em direção ao intussuscepiente, exibindo coloração vermelho-enegrecida difusa. Outras causas incluíram deslocamento de cólon maior (2/5), obstrução extrínseca e intrínseca do intestino delgado (2/5), e um caso de adenocarcinoma intestinal. Doenças não infecciosas são importantes causas de morte em equinos. Os aspectos epidemiológicos e macroscópicos das condições devem ser considerados para o que o diagnóstico final da causa da cólica seja obtido.(AU)

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