Resumen Introducción: El íleo biliar es una emergencia quirúrgica y causa de abdomen agudo en pacientes de edad avanzada, con alta morbimortalidad que comúnmente pasa desapercibida debido a su baja incidencia, por lo cual es necesario una alta sospecha diagnóstica para realizar un abordaje oportuno de esta patología. Objetivos: Realizar una revisión bibliográfica actualizada sobre el diagnóstico y tratamiento adecuado, así como conocer las diferentes opciones terapéuticas, riesgos, beneficios e indicaciones de los procedimientos quirúrgicos. Material y Métodos: Se realizó una búsqueda de bibliografía exhaustiva en distintas fuentes bibliográficas y artículos de 1997 a 2020, se utilizaron palabras clave como Íleo biliar, oclusión intestinal, abdomen agudo, fístula biliar, fístula colecisto-duodenal, colecistitis crónica, utilizando los motores de búsqueda como PUBMED y EMBASE. Resultados: Se obtuvo información acerca de la incidencia, etiología, cuadro clínico, métodos diagnósticos y opciones terapéuticas para esta patología, así como el pronóstico de esta, para realizar una actualización bibliográfica adecuada. Conclusiones: El íleo biliar es una rara causa de oclusión intestinal, con una alta morbimortalidad en pacientes de edad avanzada, es necesario tener una alta sospecha diagnóstica para realizar el diagnóstico y manejo oportuno.
A case report of a 65-year-old female with a history of right total hip arthroplasty (THA) in 2007 and left THA in 2009 was presented. She consulted with our institution for the first time, on December 2013, for right hip pain and fistula on the THA incision. It was managed as a chronic infection, so a two-stage revision was performed. First-time intraoperative cultures were positive for Staphylococcus aureus (3/5) and Proteus mirabilis (2/5). Three weeks after the second half of the review, it evolved with acute fever and pain in relation to right hip. No antibiotics were used, arthrocentesis was performed, and a coagulase-negative staphylococci multisensible was isolated at the 5th day. Since the germ was different from the first revision, it was decided to perform a one-stage revision. One year after the first review, the patient has no local signs of infection and presents ESV and RPC in normal limits. The indication and management of periprosthetic infections are discussed.
Resumen El íleo biliar es una emergencia quirúrgica que comúnmente pasa desapercibida debido a su baja incidencia, es necesaria una alta sospecha diagnóstica para realizar un abordaje y tratamiento oportuno. Se realizó una revisión bibliográfica sobre diagnóstico y tratamiento de esta entidad, para ejemplificarlo mediante caso clínico de un paciente femenino que se presenta con un cuadro de abdomen agudo, se somete a laparotomía exploradora evidenciando íleo biliar, por lo que se realiza enterolitotomía. Existe discrepancia en la literatura en cuanto al manejo quirúrgico inicial de esta patología, especialmente si la enterolitotomía se debe de asociar a resección de fístula biloenterica.
Purpose To describe patient-reported outcomes, radiological results, and revision to total hip replacement in patients with hip dysplasia that underwent periacetabular osteotomy as isolated treatment or concomitant with hip arthroscopy. Methods Case series study. Between 2014 and 2017, patients were included if they complained of hip pain and had a lateral center-edge angle ≤ of 20°. Exclusion criteria included an in-maturate skeleton, age of 40 or older, previous hip surgery, concomitant connective tissue related disease, and Tönnis osteoarthritis grade ≥ 1. All patients were studied before surgery with an anteroposterior pelvis radiograph, false-profile radiograph, and magnetic resonance imaging. Magnetic resonance imaging was used to assess intraarticular lesions, and if a labral or chondral injury was found, concomitant hip arthroscopy was performed. The non-parametric median test for paired data was used to compare radiological measures (anterior and lateral center-edge angle, Tönnis angle, and extrusion index) after and before surgery. Survival analysis was performed using revision to total hip arthroplasty as a failure. Kaplan Meier curve was estimated. The data were processed using Stata. Results A total of 15 consecutive patients were included; 14 (93%) were female patients. The median follow-up was 3.5 years (range, 2 to 8 years). The median age was 20 (range 13 to 32). Lateral center-edge angle, Tönnis angle, and extrusion index correction achieved statistical significance. Seven patients (47%) underwent concomitant hip arthroscopy; three of them (47%) were bilateral (10 hips). The labrum was repaired in six cases (60%). Three patients (15%) required revision with hip arthroplasty, and no hip arthroscopy-related complications are reported in this series. Conclusion To perform a hip arthroscopy concomitant with periacetabular osteotomy did not affect the acetabular correction. Nowadays, due to a lack of conclusive evidence, a case by case decision seems more appropriate to design a comprehensive treatment.
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