Introduction: The imaging test have become an important piece on the diagnosis of the acute abdomen in emergency, nevertheless medical conduct should be based on contextualized iconographic findings. The tomographic "whirlpool sign" establishes a surgical paradigm for its association with the bowel volvulus. Objetive: To register patients with diagnosis of acute abdomen looking for the "whirlpool sign" in the computed tomography and identify who needed surgical intervention. Methods: Analytical cross-sectional study. 115 tomographies of acute obstructive abdomen have being evaluated. Results: 15 tomographies were excluded. The prevalence of the whirlpool sign was 5%. Diagnoses were intestinal malrotation (2%), midgut volvulus (1%), sigmoid volvulus (1%) and enterocolitis (1%). Only 60% of the patients required surgery. Discussion: The presence of the "whirlpool sign" not always determines a surgical resolution. It is not a pathognomonic sign of a punctual entity; it could represent an ordinary finding in the context of several pathologies. To apply the correct treatment, surgical or medical, for these patients it was important to recognize "whirlpool sign" variants.
Resumen
El carcinoma escamoso de piel y mucosas presenta un riesgo potencial de metástasis ganglionares, con la posibilidad de que este suceso preceda la presentación clínica del tumor primario. El objetivo del presente trabajo es describir un caso de linfadenectomía inguinal por metástasis de carcinoma escamoso de origen primario desconocido y realizar una revisión bibliográfica de los casos presentados en la literatura médica.
Se describió el caso de un hombre de 84 años con una tumoración inguinal correspondiente a una neoplasia escamosa, se le realizó una evaluación multidisciplinaria con dermatología, urología y coloproctología, sin encontrar el tumor primario. Se efectuó un vaciamiento inguinal con radioterapia postoperatoria. En la base de datos de Medline informaron solo 49 casos en los últimos 10 años.
Las metástasis inguinales de carcinomas escamosos representan un grupo heterogéneo de neoplasias que pueden originarse a partir de la región anogenital o de territorios cutáneos de la zona perineal, miembros inferiores o parte baja del tronco. El manejo diagnóstico y terapéutico de estas lesiones continúa siendo un desafío al que se debe enfrentar con todas las herramientas disponibles y de forma multidisciplinaria.
Heister valves are mucosal folds located on the endoluminal surface of the cystic duct (CD) and were first described by Lorenz Heister in 1732. Their presence could represent an obstacle that impedes transcystic exploration. It has been suggested that the distribution of Heister valves follows a steady rhythmic pattern in a spiral disposition; however, there is no conclusive data to support this claim. The aim of this study was to describe the main characteristics of the CD and Heister valves in adult human cadavers. A descriptive cross-sectional study was performed on 46 extrahepatic biliary tracts. The CD has an average length of 25.37 mm and diameter of 4.53 mm. The most frequent level of junction was the middle union. Heister valves were present on 32 CDs; in most cases, they were distributed uniformly on the duct and presented an oblique disposition. A nonreticular pattern was the most frequent reticular pattern. The most frequent type of the nonreticular type was the B1 subtype. The most frequent type of distribution was the nonreticular type, particularly the B1 type. The cystic fold could hinder transcystic exploration. The cysticotomy incision should not be determined by the distribution of the fold on the CD. The morphology of the Heister valves does not show evidence of a steady systematic pattern.
A CHS of variable length was identified in a large percentage of cadaveric dissections. This finding has important implications for surgical interventions on the biliary tract such as choledochotomy for common bile duct exploration, transcystic bile duct exploration, or bilioenteric anastomosis. The presence of a CHS may also represent an anatomic factor predisposing to Mirizzi's syndrome.
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