Snapshots Quiz

A middle-aged man presents with a long history of rectal bleeding and intermittent constipation. What is shown in this intra-operative image?

Role of laparoscopic in abdominal trauma

Resumen

Introducción: el abordaje laparoscópico en los pacientes politraumatizados continúa siendo infrecuente. Su empleo es aceptado en el traumatismo abdominal penetrante (TAP), si bien constituye objeto de controversia en el traumatismo abdominal cerrado (TAC). El objetivo de este estudio es analizar nuestra experiencia del abordaje laparoscópico en el paciente con traumatismo abdominal y revisar la literatura.

Material y métodos: estudio observacional, descriptivo, retrospectivo de pacientes admitidos en los Hospitales Universitarios Virgen del Rocío y Virgen Macarena (Sevilla) que fueron sometidos a una laparoscopia diagnóstica y/o terapéutica tras sufrir un traumatismo abdominal. Se recogen variables demográficas, tipo de trauma, pruebas diagnósticas, tipo de lesión, tratamientos realizados y resultados.

Posteriormente se realizó una revisión de la literatura a través del motor de búsqueda PubMed, empleando las palabras "laparoscopy AND abdominal trauma" y "laparoscopic management AND trauma".

Resultados: se describieron trece pacientes (seis y siete casos en cada centro), con una media de edad de 41 años. Nueve pacientes sufrieron un TAP por herida por arma blanca (70%), siendo el resto TAC (4, 30%). En tres pacientes (23%), se requirió conversión a laparotomía debido a hallazgos de lesiones complejas. En cuatro casos (30%) la exploración laparoscópica no demostró lesiones. Los procedimientos realizados incluyeron reparación diafragmática, sutura primaria de intestino delgado, lavado de la cavidad abdominal, y sutura de perforación gástrica.

Conclusión: el abordaje laparoscópico puede ser considerado en pacientes con traumatismo abdominal, en casos de estabilidad hemodinámica. Su realización debe ser llevada a cabo por cirujanos con experiencia en el manejo del paciente politraumatizado, así como en la cirugía laparoscópica.

Causes and predisposing factors of de novo tumors in our series of liver transplant recipients

INTRODUCTION

Liver transplant recipients suffer a high risk of developing cancer, mainly as a consequence of immunosuppressant treatment, although a variety of other factors are involved. Our purposes were to evaluate the frequency of de novo tumours and to determine predisposing factors.

MATERIAL AND METHODS

We analyzed all of the transplantations performed during 1990, with a total of almost 700 cases. We analyzed the frequency of de novo tumors, their location, time since transplantation, survival, and recurrence rates and factors that may influence their appearance.

RESULTS

The series included 64 cases in 50 patients with a frequency of 7%. Skin tumors were the most frequent (39.06%), followed by those in the otolaryngologic (ear, nose, and throat) region (15.62%) and the lung (14.06%). The average time to progression between the transplantation and diagnosis was less than 4 years (47.74 months). The recurrence rate was 16%. The factors with the greatest influence on their appearance were age and gender of the recipient, alcohol consumption, and Child-Pugh score. Plasma transfusion was statistically, although not clinically, significant.

DISCUSSION

Our frequency of de novo tumors was consistent with that described in the literature. Despite some factors that influence their appearance, the main predisposing factor was immunosuppression and its duration.

Influence of donor age on survival in liver transplantation due to hepatitis C virus

Cirrhosis secondary to hepatitis C virus (HCV) is one of the most frequent indications for liver transplantation. During recent years, the age of donors has increased, which has led to a worse prognosis for persons undergoing transplantations because of this virus. In this study, we analyzed the 93 transplantations performed during a 6-year period (2000-2005) due to HCV, dividing them into 2 groups according to donor age: <60 years (group A) and >/=60 years (group B). We examined graft and recipient survivals with a mean follow-up of 34 months. Recipient survival among group A was 61% compared with 57% among Group B, the difference being greater if we excluded the initial months after transplantation, since this eliminated the complications inherent to the intervention. Graft survival, according to the Knodell histological activity index, was summarized as: 55.7% histological recurrence, 16.7% fibrosis, and 21% cirrhosis among group A versus 65.6%, 25%, and 18.7%, respectively, among group B. In conclusion, there was improved survival and disease progression was slower among group A compared with group B, suggesting that donor age was an important factor; patient and graft survivals fell progressively with increased donor age.

Liver transplantation consequential to Caroli's syndrome: a case report

Caroli's disease is a rare condition that includes fibrocystic malformations of the bile duct. It consists of multifocal congenital dilatations of the intrahepatic bile ducts, which may be diffuse or limited, presenting in sack form that produces cystic structures which communicate with the biliary tree. Herein we have presented the case of a 44-year-old woman with recurrent cholangitis consequential to Caroli's syndrome. The distinctive feature of this case was that it was the first and only liver transplantation performed to date for this cause at our center among 700 procedures that had been performed over 19 years. The hepatectomy sample from the liver transplantation showed large cystic dilatations at the level of segments VII and VIII. The pathological study reported congenital dilatation of the intrahepatic bile ducts, associated with congenital hepatic fibrosis (Caroli's syndrome). Caroli's syndrome is a complex association of conditions which usually presents together with polycystic kidney lesions. Orthotopic liver transplantation is still the only therapeutic option for diffuse, uncontrollable cases or those with significant portal hypertension, as well as being the final option in the other cases in the event of a lack of response to other therapeutic options or as an alternative to them.