Ciencias de la Salud
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Item Fístula biliar iatrogénica post colecistectomía por síndrome de mirizzi a propósito de un caso(Universidad Técnica de Ambato/Facultad de Ciencias de la Salud/Carrera de Medicina, 2021-06-01) Tixilema Arias, Cynthia Michelle; Guanuchi Quito, Franklin Hernán Dr. Esp.Introduction: The biliary fistula is an abnormal communication between the biliary tract and other organs, its incidence is between 1 and 2%. They are grouped into internal and external. The diagnosis can be carried out during surgery; however most are detected in the early or late postoperative period. Surgical treatment is a challenge that requires knowledge of the pathology, bile duct injury, and digestive tract involvement. Mirizzi syndrome is a rare complication of gallstone pathology, which is caused by inflammation caused by extrinsic compression of a stone that is impacted in the Hartmann's bag with a partial or complete obstruction of the bile duct. ERCP is a diagnostic and therapeutic method, either temporarily or permanently. Objective: Characterize patients with post-laparoscopic cholecystectomy biliary fistula due to Mirizzi Syndrome and determine its management. Materials and methods: A descriptive cross-sectional study based on clinical case analysis is carried out. Discussion: This is a 25-year-old female patient, who was admitted with cholecystitis, for which a laparoscopic cholecystectomy was performed. Patient is discharged but after 11 days of surgical treatment he is admitted to a private hospital in a fair general condition, where they diagnose: post-surgical uncontrolled biliary fistula plus bilioperitoneum for which they perform diagnostic laparoscopy, lavage and drainage. However, his condition does not improve because of what he undergoes endoscopic cholangiography, papillotomy and trying to place a biliary prosthesis, which is the definitive treatment. Patient evolves favorably so she is discharged in good condition. Conclusions: Cholecystectomy is the gold standard for the treatment of stone disease. Iatrogenic lesions at the level of the bile ducts constitute a serious complication not only because of the difficulty in diagnosis, but also because of the high risk of morbidity and mortality. Mirizzi syndrome is an infrequent complication but should be suspected in patients with a history of lithiasic disease, its diagnosis in most cases is postoperative.Item Pancreatitis Aguda Necrótica Infectada con Fistula Enterocutánea(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Rodríguez Conza, Diana Karolina; Rodas Álvarez, Fausto Patricio Dr.Acute pancreatitis is a relatively common disease. With an incidence of 35-80 cases for 100.000 people every year. The clinical results of the AP depend of the presence of necrosis and systematic complications. Among the facts that are associated with the worst prognosis are precisely necrosis, infection and multiple organ failure, which can have a mortality rate as high as 50%. In the case of infected pancreatic necrosis the Guidelines by the International Association of Pancreatology recommended that surgery should be performed between the third and fourth week of the onset of symptoms, there is an association between mortality and time of pancreatic surgery. Necrosectomy within two weeks of admission, is associated with a mortality of 100%, probably because of hemorrhage, in a situation where the obliteration of arterioles is not total, the longer allows areas of necrosis are organized demarcate and thus achieving a better debridement of necrotic tissue in a single surgical procedure, reducing complications and costs. This clinical case corresponds to a male patient of 65 years with personal medical history of hypertension treated with Losartan 100 mg orally QD, Diabetes Mellitus type 2 in treatment with Vildagliptin 50 mg orally QD, habits: Alcohol: every 15 days to arrive drunkenness, until 30 years ago, snuff: from age 18, smoking two cigarettes a day. Who came for presenting abdominal pain high intensity, 7 days evolution, Omeprazole 20 mg orally BID self-medicate with what pain partially stopped, 6 hours ago the problem is exacerbated and nausea is added that arrives vomiting, more apparently blackish deposition, the physical examination reveals slightly tense abdomen, nonpitting, painful on palpation in epigastric and right upper quadrant, decreased bowel sounds, laboratory test results report amylase: 3110 U/L and lipase 786.7 U/L besides neutrophilic leukocytosis, abdominal CAT reports acute pancreatitis type C, so he is interned in ICU, within 72 hours of hospitalization is repeated abdominal CAT scan reporting acute pancreatitis type E, abdominal ultrasound reports: cholelithiasis, RX ray shows bilateral pleural effusion, antibiotic treatment is started, the 5th day refers to patient General Surgery where he remained hospitalized for a period of 15 days after presenting a favorable evolution of its case of pancreatitis, tolerate oral doses, asymptomatic way, it is decided high and surgery on an outpatient basis is planned, the 5th day of patient discharge is hospitalized for abdominal + vomiting + jaundice pain again, ultrasound reporting choledocholithiasis so it is sent to ERCP, it is realized that it failed due to elimination of purulent fluid in the second portion of duodenum and not identify papilla is planned TAC + drain intrapancreatic collection, it reports necrosis >50% + multiple intrapancreatic collections so that no drainage is due to risk of gastric perforation, is transferred to a unit of third level where abdominal sepsis is diagnosed by infected pancreatic necrosis + pancreatic abscess + acute cholecystitis and drainage of pancreatic abscess + necrosectomy + cholecystectomy and the patient is transferred to the ICU of the English Hospital, where it remains hospitalized for three weeks; 4 months later is interned again in the Department of General Surgery for opening enterocutaneous fistula (pancreatic), which is progressing well and achieves the closure of fistula by conservative treatment.Item Fístula Enterocutánea Secundaria a Apendicectomía(Universidad Técnica de Ambato-Facultad de Ciencias de la Salud-Carrera Medicina, 2016-10-01) Beltrán Guachón, Grace Estefanía; Pancho Zela, Marlon Mauricio Dr.It is defined as enterocutaneous fistula (FEC) to the existing pathological communication of a portion of the gastrointestinal tract into the skin. As an important complication of gastroenterological surgery, 75-90% of fistulas is presented as a postoperative complication in most cases, with an incidence of 0.8-2% in abdominal surgery.1-4-11 The development of an enterocutaneous fistula is a serious problem that can face any surgeon during the exercise of their profession, bringing physical and emotional repercussions for both the patient and family and physician and health institution where it is. 3-4-10 They are associated with high morbidity and mortality forcing a prolonged hospital stay, complications and electrolyte mainly as sepsis, malnutrition and metabolic imbalance.1-2-9 Therefore it requires a multidisciplinary intervention adapted by each particular case.3-4 Increased life expectancy and the advancement of surgery in the treatment of increasingly complex conditions, should contribute in the near future, to a considerable increase in their frequency. It is attributed to enterocutaneous fistulas mortality 15-37%, which rises further and can exceed 60% when associated to complications and mencionadas.4-12 Reviewing the case of a 29-year-old it was held intervened on January 26, 2016 in the Yerovi Mackuart Hospital of Salcedo, which comes because of abdominal pain, cramping, high intensity, about 5 hours evolution, located in mesogastrio and lower abdomen, accompanied by nausea that comes vomiting for 5 times, in which complementary studies is done reaching a diagnosis of acute appendicitis, surgery is decided by performing an exploratory laparotomy and found multiple perforations in cecum and colon with mesenteric thrombosis signs so appendectomy is performed more right hemicolectomy more lateral anastomosis term transverse loop ileostomy ileus more drainage and placement; it remains hospitalized for eight days, start to have purulent liquid drainage site, so it was decided to transfer to Provincial General Hospital in Latacunga on February 4, 2016 with a diagnosis of enterocutaneous fistula. Provincial General Hospital in Latacunga is received to the patient at the Department of General Surgery, it is decided to maintain hydration, antibiotic therapy, laboratory tests and imaging studies, which remains hospitalized for 21 days. Given patient is discharged with good performance and has surgery scheduled reentry, return of intestinal transit. The patient is progressing well from his second surgery without presenting complication, it is decided discharged on April 21, 2016. On April 24, 2016 was readmitted for an intestinal partial obstruction the same that resolves spontaneously and is discharged the May 2, 2016.