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Introduction:Endoscopic retrograde cholangiopancreatography (ERCP) has become the gold standard for diagnosis and treatment of choledocholithiasis. The American Society for Gastrointestinal Endoscopy (ASGE) in 2010 proposed stratifying patients into 3 risk levels; however, studies have found controversial results about the predictive parameters of these diagnostic criteria. The objective of this study is to determine the performance of the high-risk predictive criteria of the ASGE 2010 in the diagnosis of choledocholithiasis in a Colombian Caribbean population.Methods:Retrospective cross-sectional study, which included patients with suspected choledocholithiasis, and who were taken for evaluation by ERCP, meeting the criteria proposed by the ASGE of high probability. The result obtained was compared with the presence of choledocholithiasis on ERCP, from which values and 95% confidence intervals were estimated for sensitivity, specificity, positive and negative predictive value, and positive and negative likelihood ratio.Results:A total of 118 patient data were included in this study. The median age of the patients was 46 years (IQR= 31; 17- 89); 78% (n= 92) were female. 65.3% (n= 77) were older than 55 years. The ERCP result was positive in 81.4% (n= 96) of the patients. The presence of an altered liver profile (90%) was found to be the most sensitive test, clinical cholangitis (86%) the most specific, the presence of duct lithiasis by US (85%) was the test with the highest positive predictive value, and the presence of duct lithiasis by US (35%) was the test with the highest negative predictive value.Conclusions:The predictive parameters of the ASGE 2010 criteria for the diagnosis of choledocholithiasis show variability with respect to the performance proposed in the guidelines. Introducción:La colangiopancreatografía retrógrada endoscópica (CPRE) se ha convertido en el estándar de oro para el diagnóstico y tratamiento de la coledocolitiasis. La Sociedad Americana de Endoscopia Gastrointestinal (ASGE) propuso en 2010 estratificar a los pacientes en 3 niveles de riesgo; sin embargo, los estudios han encontrado resultados controvertidos sobre los parámetros predictivos de estos criterios diagnósticos. El objetivo de este estudio consiste en determinar el desempeño de los criterios predictivos de alto riesgo de la ASGE 2010 en el diagnóstico de coledocolitiasis en una población del Caribe colombiano.Métodos:Estudio transversal retrospectivo, en el que se incluyeron pacientes con sospecha de coledocolitiasis, y que fueron llevados a evaluación por CPRE, cumpliendo los criterios propuestos por la ASGE de alta probabilidad. El resultado obtenido se comparó con la presencia de coledocolitiasis en la CPRE, a partir de la cual se estimaron los valores y los intervalos de confianza del 95% para la sensibilidad, la especificidad, el valor predictivo positivo y negativo, y la razón de probabilidad positiva y negativa.Resultados:En este estudio se incluyeron los datos de 118 pacientes. La edad media de los pacientes era de 46 años (RIQ= 31; 17- 89); el 78% (n= 92) eran mujeres. El 65,3% (n= 77) eran mayores de 55 años. El resultado de la CPRE fue positivo en el 81,4% (n= 96) de los pacientes. La presencia de un perfil hepático alterado (90%) resultó ser la prueba más sensible, la colangitis clínica (86%) la más específica, la presencia de litiasis ductal por US (85%) fue la prueba con mayor valor predictivo positivo, y la presencia de litiasis ductal por US (35%) fue la prueba con mayor valor predictivo negativo.Conclusiones:Los parámetros predictivos de los criterios de la ASGE 2010 para el diagnóstico de coledocolitiasis muestran variabilidad con respecto al rendimiento propuesto en las guías.

Introduction and importance The Potter sequence is defined as a series of congenital defects related to severe oligohydramnios, associated with polycystic kidney disease, bilateral renal agenesis, pulmonary hypoplasia, obstructive uropathy and premature rupture of membrane, which compromises the life of the neonate sometime after birth. Within the evidence published so far, which is very little, no perforation of the gastrointestinal tract has been reported as a complication of this condition. Case presentation Male neonate born preterm with prenatal diagnosis of pulmonary hypoplasia, polycystic renal dysplasia and severe oligohydramnios (Potter sequence), presented acute respiratory distress syndrome 10 min after birth, requiring mechanical ventilation and admission to the intensive care unit. During her stay in intensive care, he developed abdominal distension and presence of biliary content in the nasogastric tube. An abdominal X-ray was performed and showed signs of pneumoperitoneum, evidencing gastric perforation on exploratory laparotomy. Clinical discussion Gastric perforation in neonates is a condition that causes high health costs, morbidity, high risk of mortality and disability, regardless of the cause. The management of gastric perforation in Potter syndrome, as well as any other complication, represents a challenge due to the prognosis of these patients. Renal failure and acute respiratory distress syndrome are disorders that compromise the function of various structures and organs such as the heart and brain. Conclusion Gastric perforation is a possible complication of the Potter sequence or syndrome. In addition, there is no literature describing the benefits or disadvantages of specific surgical techniques in the resolution of perforation., Highlights • Spontaneous perinatal gastric perforation is a complication of Potter's syndrome. • Pathophysiological mechanism of gastric perforation in these cases is unknown. • There is a lack of evidence on the management of potter's syndrome.

We present a case of distal ileum perforation after the ingestion of a fish bone. This case report includes the symptomatology, studies conducted for reaching a concise diagnosis, abdominal ultrasound results, and description of the operative technique. In addition, a discussion of the topic and information gathered from the literature is carried out.

El empalamiento es una causa grave y rara de lesion anorrectal, pudiendo darse en multitud de contextos, ya sea de indole accidental, psiquiatrica o por practicas sexuales o criminales. El objetivo de este manuscrito es mostrar al autoempalamiento como agente causante de lesion anorrectal, de presentacion extraordinaria. Se presenta un caso de empalamiento autoinfligido con perforacion intestinal en un hombre de 44 anos, que acudio al servicio de urgencias sin el objeto causante de la lesion y con un cuadro de abdomen agudo, debido a hemoperitoneo, peritonitis fecal y perforacion en la union rectosigmoidea. The impalement is a severe and rare cause of the anorectal lesion and can occur in a multitude of contexts, whether accidental, psychiatric or due to sexual or criminal practices. The objective of this manuscript is to show self-packing as the causative agent of anorectal lesion, being of extraordinary presentation. We present the case of self-inflicted impalement with intestinal perforation in a 44-year-old man, who attends the emergency department without the cause of the injury and with an acute abdomen, due to hemoperitoneum, fecal peritonitis and a perforation in the rectosigmoid junction.

Introduction and importance Congenital hernias occur 70% on the right side, 25% on the left side, and approximately 5% bilaterally. The finding of a congenital Amyand's hernia is of interest, especially in patients who do not present risk factors associated with connective tissue disorders, ascitic conditions, fetal developmental disorders or any condition that increases abdominal pressure. Case presentation Male patient, 6 months old, was brought to the pediatric surgery department due to a visible mass in the bilateral inguinal region, which protruded with crying. The parents report that he was a 36-week preterm, low birth weight, monochorionic monoamniotic twin with bilateral congenital inguinal hernia. An open herniorrhaphy was performed, showing a left communicating hydrocele with an indirect left inguinal hernia and right communicating hydrocele with indirect inguinal hernia containing cecal appendix with no signs of inflammation. Clinical discussion The most common clinical presentation is the presence of a reducible or irreducible mass, erythema and/or inguino-scrotal edema, irritability manifested by crying and recurrent pain in older infants. This condition may be associated with cryptorchidism, intrauterine structural developmental disorder, and the presence of fistulas. Appendectomy and traditional hernia reduction are the most common surgical approach. The evolution of this condition is favorable with extremely low complication rates. Conclusion Amyand's hernia in the neonate is a rare presenting condition, which frequently involves nearby structures with risk of inflammation, incarceration and perforation, so repair should be performed early., Highlights • Currently there are controversies in the approach of congenital inguinal hernias. • The overall outcome in the management of congenital hernia is favorable. • Traditional hernia management for congenital Amyand's hernia has good results.