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Background: Gallstone-related conditions affect a significant portion of the population, with varying prevalence among different ethnic groups. Complications such as pancreatitis and cholangitis are associated with the presence of common bile duct (CBD) stones. Existing guidelines for diagnosing choledocholithiasis lack precision, leading to excessive use of invasive procedures like endoscopic retrograde cholangiopancreatography (ERCP)., Methods: A prospective study was conducted at Hospital Central "Dr. Ignacio Morones Prieto," involving 374 patients in the development cohort and 154 patients in the validation cohort. Patients meeting inclusion criteria underwent biochemical testing and ultrasonography. A predictive scoring system was developed using logistic regression and validated in an independent cohort. Clinical and laboratory variables were collected, and model performance was assessed using receiver-operator characteristic (ROC) curves., Results: The predictive model incorporated variables such as age, pancreatitis, cholangitis, bilirubin levels, and CBD stone presence on ultrasound. The model demonstrated an area under the ROC curve (AUC) of 93.81% in the validation dataset. By adjusting the threshold defining high-risk probability to 40%, the model improved specificity and sensitivity compared to existing guidelines. Notably, the model reclassified patients, leading to a more accurate risk assessment., Conclusions: The developed algorithm accurately predicts choledocholithiasis non-invasively in patients with symptomatic gallstones. This tool has the potential to reduce reliance on costly or invasive procedures like magnetic resonance cholangiopancreatography and ERCP, offering a more efficient and cost-effective approach to patient management. The user-friendly calculator developed in this study could streamline diagnostic procedures, particularly in resource-limited healthcare settings, ultimately improving patient care., (© 2024 International Society of Surgery/Société Internationale de Chirurgie (ISS/SIC).)

Introduction: Amebiasis can mimic cecal tumors. Unless this infection is diagnosed in a timely manner, affected individuals may undergo extensive surgery., Material and Methods: We carried out a retrospective analytical study of the therapeutic approach to amebiasis in a second-level hospital in an area of central Mexico with a high prevalence of this infection. Records from 2005-2011 were reviewed. There were 261 cases of amebiasis. Twenty cases were diagnosed by the histopathologist or on the basis of serological results. Sixteen patients underwent surgery due to acute abdomen, and four received medical treatment with metronidazole. Three treatment groups were analyzed: 1. hemicolectomy, 2. appendicectomy and antiamebic therapy, and 3. antiamoebic therapy alone. In the non-surgical group, imaging studies showed improvement with medical therapy., Results: Length of hospital stay was higher in the group undergoing extensive surgery (p < 0.0133). There were no statistically significant differences among the remaining variables., Conclusions: The incidence of ameboma in our environment is higher (7.6%) than that reported in the literature. We believe that, in endemic regions, ameboma should be ruled out in patients with a cecal mass. As part of the therapeutic approach, patients should be tested for amebiasis or receive antiamebic therapy with monitoring of the mass to avoid extensive resective surgery., (Copyright © 2014 Elsevier España, S.L.U. and AEEH y AEG. All rights reserved.)

Background: Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality., Methods: This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis., Results: There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI <25. Complications associated with the surgical procedure were observed in 28.57% (n = 22). Reoperation was necessary in 10% (n = 8). Average hospital stay was 11.4 days. Mortality was 3.8% (n = 3); none of these were related to colon injury., Conclusions: Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

Background: Thoracic trauma accounts for 25% of deaths due to trauma. Chest trauma patients generally present to the emergency room with pneumo- or hemothorax. According to the majority of the studies, management of closed thoracostomy for trauma includes the use of antimicrobial drugs to prevent infectious complications, but this has not been proven to be beneficial. We undertook this study to evaluate antimicrobial use in thoracic trauma patients with closed thoracostomy and its impact on the development of infectious complications., Methods: We carried out a prospective, randomized, double blind, comparative study. Patients with isolated chest trauma requiring closed thoracostomy were divided into two groups. Group A received cefalotin, and group B received placebo. Ages ranged from 15-65 years. Results were analyzed with chi(2) and Fisher exact test., Results: One hundred twenty six patients were included in this study. There were 63 patients in each group with similar demographic characteristics. The mean length of hospital stay with the tube was 6.56 days, but the average stay was 11 days for patients who developed empyema. Eight patients developed empyema, three patients with empyema belonged to group A patients and five patients with empyema belonged to group B. For empyema management, five cases were resolved by chest drainage, two cases required thoracoscopic cleaning and drainage and one patient was resolved with thoracotomy and pleural decortication. Bivariate analysis comparing antimicrobial use vs. empyema and length of drainage vs. antimicrobials did not show a statistically significant difference., Conclusions: The present study did not demonstrate that antimicrobial use was beneficial in the prevention of pleural infections in the management of chest trauma patients requiring closed thoracostomy.

Introduction: Omental torsion is an uncommon cause of acute abdomen, usually mimicking acute appendicitis; almost all described cases are diagnosed with laparotomy. It can be a primary or secondary condition. Primary torsion occurs without evidence of intrabdominal abnormalities., Material and Methods: Retrospective, observational, longitudinal, descriptive study carried out between January 2001 and December 2005. Patients diagnosed as acute appendicitis were included and we assessed diagnostic accuracy by means of anatomopathology and omental torsion incidence., Results: 2135 patients were included; diagnostic accuracy was 91.71%. Eight omental torsion cases were identified, with an incidence of 0.37% and all diagnosed with laparotomy. Patients in the first and fourth decades of life were mostly affected; 75% of the cases were observed in adults, and 62.5% displayed secondary torsion., Discussion: Omental torsion is a rare cause of acute abdomen. Acute appendicitis is a frequent differential diagnosis that should be taken into account. In our series, we found a two-fold higher incidence of omental torsion, compared with previously reported incidence data. We also found a difference in age and sex distribution among patients with this diagnosis.

Background: The abdomen ranks in third place of body areas injured by trauma. Evaluation and stabilization of these patients form the cornerstone in emergency medicine. Diagnostic approach and treatment outcome are influenced by several factors. Injury mechanism and pattern vary according to geography and there is an association with drugs and alcohol. Physical examination remains the most reliable indicator for surgery. Associated injuries are present in up to 26% of cases. We undertook this study to determine penetrating abdominal trauma incidence and frequency, demographic factors, rate of immediate and delayed laparotomies, and associated complications as well as to define the usefulness of penetrating abdominal trauma index (PATI)., Methods: An observational, prospective, longitudinal descriptive study was carried out at the Hospital Central "Ignacio Morones Prieto," San Luis Potosi, Mexico from January 1, 2005 to December 31, 2005 on patients who underwent exploratory laparotomy for penetrating abdominal trauma. Twenty one variables were studied. Basic statistical analysis, ANOVA, chi(2) and Student's t-test were used., Results: Of the 79 patients who were included, 93.67% were males. The third decade of life was the most affected, with a night presentation being predominant as a result of personal violence. Drug use was observed in 50.6%; stab wounds in 63.3%. The most frequent locations were the left upper and right lower quadrants and epigastrium; solitary wounds were predominant. Associated injuries were most common in the thorax and limbs. Of the laparotomies performed, 92.4% were urgent and 60.53% were therapeutic; 15.19% required reoperations; complications were observed in 39.24%; and mortality rate was 3.9%., Conclusions: Due to high non-therapeutic and negative laparotomies rates, a more selective approach is needed, including repetitive physical examination and the appropriate use of auxiliary diagnostic studies.

Background: Spontaneous pneumothorax is a rare condition during pregnancy. The most common cause is the rupture of a subpleural apical bulla or bleb, due to the increased respiratory demand of the peripartum period. The main risk for the mother is respiratory compromise; fetal risks include reduction in oxygen supply and preterm labor. The risk of recurrence is 30-40%, particularly during labor. Treatment is based on the magnitude of pneumothorax. Up to 75% of patients are treated with chest tube drainage. We present the case report of a previously healthy patient., Case Report: Our patient was a 22-year-old female at 24.2 weeks of her second pregnancy. The patient was a non-smoker, had no history of any drug addictions, and no history of previous pulmonary disease. The patient presented with sudden onset of pleuritic right-sided pleuritic chest pain associated with dyspnea. Chest examination was notable for decreased breath sounds and hyperresonance over the right hemithorax. Chest radiography showed right spontaneous pneumothorax with total lung collapse., Conclusions: Diagnosis of pneumothorax should be considered in any pregnant woman with chest pain and dyspnea. The presented case was successfully treated with closed intercostal chest tube thoracostomy for 7 weeks.

Objective: To determine the frequency of gallstone ileus as a cholelithiasis complication and likely cause of intestinal obstruction, as well as the factors that can influence morbidity and mortality of these patients in our hospital., Material and Methods: The files of patients undergoing cholecystectomy, as well as of those patients surgically treated for intestinal obstruction between January 2001 and December 2003, were reviewed. We analyzed the files of patients with gallstone ileus for the following characteristics: age, sex, time of evolution, signs and symptoms, diagnosis, APACHE II, concomitant diseases, mode of treatment, obstruction/fistula site and morbidity and mortality., Results: A total of 1054 patients for cholelithiasis and 189 for intestinal obstruction were treated surgically. Of these, there were seven cases of gallstone ileus: six females (85.7%) and one male (14.3%). Average age was 62.85 years (range: 39 to 89 years). Average time of evolution was 4.85 days until the surgical intervention. Preoperative diagnosis ws carried out in five of seven cases (71.42%). APACHE II for severity was present in all patients >60 years old; 71.42% of the cases presented some associated chronic illness. Surgical procedure was enterolithotomy without dismantlement of the fistula in five of seven cases and in two of seven cases surgery was carried out in a single stage. Obstruction occurred in ileum (four of seven cases), jejunum (two of seven cases), and one in the duodenum; the fistula occurred in duodenum in five cases and two cases in the stomach. Morbidity and general mortality were, respectively, 28.57% and 14.28%., Conclusions: We found a frequency of 0.66% of gallstone ileus as a complication of cholelithiasis (7/1054 cases) and 3.70% as a case of intestinal obstruction (7/189 cases), increasing to 12% in patients >60 years. The factors that elevated the morbidity and mortality were a delay in seeking medical care, patients > 60 years, associated chronic illnesses and an APACHE II for severity.

Objective: We describe our experience in the management of esophageal perforation., Material and Methods: Retrolective study of the esophageal perforation patients, managed from January 1999 to December 2003. Analyzed variables were age, sex, aetiology, time of diagnosis and treatment, as well as ancillary methods employed, mode of treatment and morbidity and mortality., Results: We found 13 patients: eight males (61.54%) and five females (38.46%), with an average age of 36.07 years with standard deviation of 19.77. Penetrating trauma was the leading cause in six cases, continued by iatrogenic perforation in four, Boerhaave's syndrome in one, foreign body in one, and blunt abdominal trauma in one. The principal symptom was pain in 84.61% of the cases. The esophagogram confirmed diagnosis in six cases (46.15%). The diagnosis was accomplished early in eight patients (61.54%) and late in five patients (38.46%). Nonsurgical treatment was carried out in two cases (15.38%) and surgical in 11 patients (84.62%). The average hospital stay was 22.45 days. Mortality in general was 15.38%, 0% for those with an early diagnosis and management and 40% for those delayed., Conclusions: An early diagnosis of esophageal perforation with the appropriate management (surgical or nonsurgical) will considerably diminish patient morbidity and mortality. A treatment choice could not be defined for the early or late diagnosis, but if surgical treatment is undertaken, adequate drainage for the perforation should be instituted as one of its principles.