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ResumenAntecedentesEl hematoma duodenal intramural es una rara entidad que ocurre en pacientes con alteraciones de la coagulación; un mínimo porcentaje ocurre en procesos como los tumores pancreáticos o la pancreatitis.Caso clínicoPresentamos el caso de un varón de 45 años, con antecedentes de pancreatitis alcohólica que acudió a Urgencias por dolor abdominal y síndrome tóxico. La tomografía computada abdominal evidenció un aumento de la segunda y la tercera porciones duodenales. Después de la esofagogastroscopia presentó choque hemorrágico. Se realizó cirugía urgente, que evidenció hemoperitoneo, tumor duodenopancreático con intensa reacción inflamatoria, así como perforación de la tercera porción duodenal. Se realizó duodenopancreatectomía cefálica con preservación pilórica y reconstrucción en Y de Roux.DiscusiónEl tratamiento de esta entidad debe ser conservador; consiste en sonda nasogástrica, reposo digestivo y corrección de las anomalías de la coagulación. Solamente está indicada la cirugía ante el fracaso del tratamiento médico, sospecha de malignidad o complicaciones.ConclusionesLos hematomas intramurales duodenales secundarios a pancreatitis crónica son excepcionales, si bien su diagnóstico debe realizarse con pruebas de imagen, y si se sospecha se debe iniciar tratamiento conservador, y realizar cirugía solo en los casos complicados.AbstractBackgroundIntramural duodenal haematoma is a rare entity that usually occurs in the context of patients with coagulation disorders. A minimum percentage is related to processes such as pancreatitis and pancreatic tumours.Clinical caseThe case is presented of a 45 year-old male with a history of chronic pancreatitis secondary to alcoholism. He was seen in the emergency room due to abdominal pain, accompanied by toxic syndrome. The abdominal computed tomography reported increased concentric duodenal wall thickness, in the second and third portion. After oesophageal-gastro-duodenoscopy, he presented with haemorrhagic shock. He had emergency surgery, finding a hemoperitoneum, duodenopancreatic tumour with intense inflammatory component, as well a small bowel perforation of third duodenal portion. A cephalic duodenopancreatectomy was performed with pyloric preservation and reconstruction with Roux-Y.Discussion: Treatment of a duodenal haematoma is nasogastric decompression, blood transfusion and correction of coagulation abnormalities. Surgery is indicated in the cases in which there is no improvement after 2 weeks of treatment, or there is suspicion of malignancy or major complications arise.ConclusionsDuodenal intramural haematoma secondary to chronic pancreatitis is rare, although the diagnosis should be made with imaging and, if suspected, start conservative treatment and surgery only in complicated cases.

Introducción: Existen distintas estrategias para el tratamiento de las metástasis hepáticas de origen colorrectal sincrónicas (MHCRS): cirugía secuencial, según respuesta a quimioterapia, intervención simultánea del tumor y las metástasis o cirugía hepática previa al tumor primario; el uso de una u otra estrategia es aún controvertido. Objetivo: Comparar la morbimortalidad y supervivencia en dos grupos de pacientes con MHCRS intervenidos de forma simultánea versus secuencial. Pacientes y Métodos: Definimos las MHCRS como aquellas que se diagnostican antes o durante la intervención del tumor primario. Se comparan dos grupos de pacientes con MHCRS, 25 sometidos a intervención simultánea (grupo 1) y 51 tras quimioterapia (intervención secuencial: grupo 2). La cirugía hepática la realizó el mismo cirujano. Revisamos datos del paciente, del tumor primario, intervención quirúrgica, transfusión perioperatoria, morbimortalidad y supervivencia. Resultados: 76 pacientes, con edad media de 62,79 ± 11,3 años. El número de metástasis y la invasión ganglionar del tumor primario fueron mayores en el grupo 2 de forma estadísticamente significativa. índice de resecabilidad: 77,6%: 18 resecciones hepáticas mayores y 28 menores, con diferencias significativas entre ambos grupos (p = 0,05). La estancia media (10,89 días), índice de morbilidad (19,7%) y supervivencia actuarial a 1,3 y 5 años fueron similares (75%, 45% y 36% en el grupo 1 y de 76%, 49% y 29% en el grupo 2). Mortalidad: 1,6%. Conclusiones: Las MHCRS pueden ser intervenidas de forma simultánea al tumor primario en pacientes seleccionados siempre que el equipo sea especializado. La morbimortalidad y la supervivencia son similares tanto en la intervención simultánea como en la secuencial.

espanolObjetivo: el objetivo de este estudio es evaluar la resecabilidad y efectividad de las rehepatectomias en metastasis hepaticas de origen colorrectal recidivadas en terminos de morbimortalidad, supervivencia global y libre de enfermedad. Metodos: se realizo un estudio retrospectivo de una cohorte prospectiva de pacientes con metastasis hepaticas de origen colorrectal con cirugia de repeticion en el Hospital Universitario San Cecilio de Granada de marzo de 2003 hasta junio de 2013. Las variables principales de resultado fueron la supervivencia y la morbilidad antes de los 30 dias del postoperatorio. Resultados: un total de 147 pacientes con metastasis hepaticas de origen colorrectal se sometieron a la extirpacion quirurgica durante el periodo de estudio; 61 pacientes presentaron una recidiva hepatica de los cuales 34 se sometieron a una cirugia de repeticion. La tasa global de supervivencia a 5 y 10 anos para los pacientes resecados fue del 48 y el 48%. La estancia media hospitalaria fue de 8,9 ± 3,5 dias, la morbilidad del 9% y la mortalidad del 0%. Conclusion: las resecciones hepaticas repetidas para las metastasis hepaticas de origen colorrectal constituyen una operacion segura y eficaz, con resultados similares a los obtenidos tras una primera reseccion hepatica. EnglishObjective: The purpose of this study was to assess the resectability and effectiveness of repeat hepatectomy for relapsing liver metastases of colorectal origin in terms of morbidity, mortality, overall survival, and disease-free survival. Methods: A retrospective study was performed on a prospective cohort of patients with colorectal liver metastases who underwent repeat surgery at Hospital Universitario San Cecilio, Granada (Spain), from March 2003 to June 2013. Primary outcome variables included survival and morbidity within 30 days post-surgery. Results: A total of 147 patients with colorectal liver metastases underwent surgical excision during the study period; 61 patients had liver recurrence, and 34 of these received repeat surgery. The overall survival rate at 5 and 10 years for resected patients (n = 27/34) was 48% and 48%. Mean hospital stay was 8.9 ± 3.5 days, morbidity was 9%, and mortality was 0%. Conclusion: Repeat liver resection for colorectal liver metastases is a safe, effective surgical procedure whose results are similar to those obtained after initial liver resection.

The aim of this study was to estimate the effectiveness of surgery in liver metastasis from colorectal cancer.We conducted a prospective and observational study of patients with colorectal liver metastasis operated on at the San Cecilio University Hospital of Granada from March 2003 until June 2013. The primary variables of the result were survival and morbidity before 30 days of the post-operative period. We also measured preoperative and surgical variables.A total of 147 patients with liver metastasis of colorectal origin underwent surgical removal during the period of study, 38 of whom had repeat surgery. 34 had a second resection, 3 had a third one and one only patient had a fourth one, for a total of 185 registered operations. The global 5-year survival rate was 38 and 17 % after 10 years. There were 115 patients who had neither radiofrequency nor exploratory laparotomy, 38 % of them survived over 60 months. The average disease-free time was 23.6 months ± 47.3, with significant differences observed between types of procedures. Patients that were operated on just once (n = 25) had a five-year actuarial survival rate of 35 %, a morbidity rate of 24 % and a mortality rate of 0.6 % (1 patient only). The average hospital stay was 13.8 days and the disease-free time was 15.8 months.The results obtained in our surgical unit in terms of morbidity, mortality and five-year actuarial survival rates are comparable to those of other units at large institutions, which are currently considered the standards of quality.

Intramural duodenal haematoma is a rare entity that usually occurs in the context of patients with coagulation disorders. A minimum percentage is related to processes such as pancreatitis and pancreatic tumours.The case is presented of a 45 year-old male with a history of chronic pancreatitis secondary to alcoholism. He was seen in the emergency room due to abdominal pain, accompanied by toxic syndrome. The abdominal computed tomography reported increased concentric duodenal wall thickness, in the second and third portion. After oesophageal-gastro-duodenoscopy, he presented with haemorrhagic shock. He had emergency surgery, finding a hemoperitoneum, duodenopancreatic tumour with intense inflammatory component, as well a small bowel perforation of third duodenal portion. A cephalic duodenopancreatectomy was performed with pyloric preservation and reconstruction with Roux-Y.Treatment of a duodenal haematoma is nasogastric decompression, blood transfusion and correction of coagulation abnormalities. Surgery is indicated in the cases in which there is no improvement after 2 weeks of treatment, or there is suspicion of malignancy or major complications arise.Duodenal intramural haematoma secondary to chronic pancreatitis is rare, although the diagnosis should be made with imaging and, if suspected, start conservative treatment and surgery only in complicated cases.

Background Intramural duodenal haematoma is a rare entity that usually occurs in the context of patients with coagulation disorders. A minimum percentage is related to processes such as pancreatitis and pancreatic tumours. Clinical case The case is presented of a 45 year-old male with a history of chronic pancreatitis secondary to alcoholism. He was seen in the emergency room due to abdominal pain, accompanied by toxic syndrome. The abdominal computed tomography reported increased concentric duodenal wall thickness, in the second and third portion. After oesophageal-gastro-duodenoscopy, he presented with haemorrhagic shock. He had emergency surgery, finding a hemoperitoneum, duodenopancreatic tumour with intense inflammatory component, as well a small bowel perforation of third duodenal portion. A cephalic duodenopancreatectomy was performed with pyloric preservation and reconstruction with Roux-Y. Discussion Treatment of a duodenal haematoma is nasogastric decompression, blood transfusion and correction of coagulation abnormalities. Surgery is indicated in the cases in which there is no improvement after 2 weeks of treatment, or there is suspicion of malignancy or major complications arise. Conclusions Duodenal intramural haematoma secondary to chronic pancreatitis is rare, although the diagnosis should be made with imaging and, if suspected, start conservative treatment and surgery only in complicated cases.

La metástasis hepática es frecuente en el curso de diversos tumores primarios y, en ocasiones, esta es la primera en ser diagnosticada. Lograr una certera descripción del hígado metastásico desde el punto de vista funcional y anatómico es indispensable para indicar un tratamiento oportuno. Sobre la base de tales reflexiones se exponen algunos aspectos relacionados con los principales medios de diagnóstico empleados en pacientes con este proceso morboso