Tesis Especializaciones (Ciencias Médicas)

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Eficacia y seguridad de la vacuna COVID-19 en pacientes mayores de 18 años. Revisión sistemática exploratoria-Scoping review
(Universidad de Cuenca, 2025-05-15) Garzón Orellana, Paul Armando; Molina Matute, Marcos Fernando
Background: The ultra-rapid development of COVID-19 vaccines generated serious controversies in the evaluation of their effectiveness and safety, since given their “justified” emerging approval, these biological products were certified in record time. General objective: to evaluate the efficacy and safety parameters of COVID-19 vaccines in patients over 18 years of age. Methodology: exploratory systematic review-scoping review, without meta-analysis. Controlled Clinical Trials (RCTs), cohort studies and case-control studies were included, published since 2020, in english and spanish, carried out on people over 18 years of age, referenced in journals quartile 1 to 4 according to the Scimago portal. Descriptors in health sciences and in english medical subject headings were applied, “vaccine efficacy”, “safety”, “coronavirus disease 2019 virus vaccines”, “COVID-19 vaccine”. Boolean operators and, or and not were applied. The results will be presented in customized tables. Results: COVID-19 vaccines are effective, especially in preventing complications. The results indicate the importance of booster doses. Regarding safety, it was assessed according to the frequency of adverse effects that vary between vaccines and studies. Thus, the frequency of pain at the injection site varies from 61% to 88% for AstraZeneca, while for Pfizer-BioNTech it is 71% for the first dose and 66% for the second dose. This analysis shows that, although all vaccines have adverse effects, most are mild and temporary. Serious adverse effects are rare.
Influencia del bajo peso al nacer en la morbilidad y mortalidad neonatal en el Hospital Vicente Corral Moscoso durante el periodo noviembre 2023 a octubre 2024. Estudio de Cohorte
(Universidad de Cuenca, 2025-01-13) Pacheco Álvarez , Marcia Jaqueline; Guerrero Quiroz, Enmanuel Isidoro
Background: Birth weight is one of the main predictors of neonatal mortality and morbidity. In recent years, the comprehensive management of low birth weight newborns has become one of the most significant challenges in neonatology. Objective: To determine the influence of low birth weight on neonatal morbidity and mortality in the neonatology department of Hospital Vicente Corral Moscoso. Methods: A cohort study was conducted in which 92 low birth weight neonates (exposed) were selected and compared with 280 normal birth weight neonates (unexposed) matched by gestational age. Descriptive statistics such as frequencies, percentages, means, and standard deviations were obtained. To determine the association of low birth weight with comorbidity and mortality, relative risk, 95% confidence intervals, and p-values were calculated. Results: The majority of patients (58.1%) were male. The median gestational age in the low birth weight group was 38 weeks. There was no significant difference between exposed and unexposed groups regarding sex and gestational age (median 38 vs 38 weeks; p: 0.818). A statistically significant association was found between low birth weight and the variables hypoglycemia (p: 0.002), bronchopulmonary dysplasia (p: 0.025), and hyaline membrane disease (p: 0.019). Conclusions: These results highlight the association of low birth weight with hypoglycemia and respiratory complications. No association was found with mortality, sepsis, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity, or anemia.
Factores asociados a displasia broncopulmonar en recién nacidos del Hospital Vicente Corral Moscoso. Estudio de casos y controles
(Universidad de Cuenca, 2025-01-08) López López, Cristian Rubén; Siguencia Astudillo, Héctor Fabián
Background: bronchopulmonary dysplasia is one of the most important chronic morbidities associated with prematurity, with a multifactorial cause, due to prenatal and postnatal factors that, independently or in combination, have an additive or synergistic effect on its development. Objectives: determine the factors associated with bronchopulmonary dysplasia in newborns at the Vicente Corral Moscoso Hospital. Methods: case-control study in Neonatology at the Vicente Corral Moscoso Hospital. 3 matched controls were selected for each case. The information was recorded in a form and analyzed in SPSS 23. Descriptive statistics, OR, 95% CI and p values were obtained. Results: in total 188 patients were included, 47 with bronchopulmonary dysplasia (cases) and 141 without dysplasia (controls); 84 (44.7%) were men. The association between hypertensive states of pregnancy, antenatal corticosteroid, prematurity, low weight, endotracheal intubation, assisted mechanical ventilation, received surfactant, anemia, blood transfusions, hyaline membrane, patent ductus arteriosus, sepsis showed a statistically significant association with bronchopulmonary dysplasia, while those with pneumothorax did not have a statistically significant association, also those who received caffeine did not present an association in relation to its prevention. Conclusion: hypertensive states of pregnancy, antenatal corticosteroid, prematurity, low weight, endotracheal intubation, assisted mechanical ventilation, use of surfactant, anemia, transfusions, hyaline membrane, patent ductus arteriosus, sepsis can increase the risk of bronchopulmonary dysplasia.
Factores asociados a enterocolitis necrotizante en recién nacidos del Hospital Corral Moscoso. Estudio de casos y controles
(Universidad de Cuenca, 2024-12-09) Barona Zamora, Marco Antonio; Tipán Barros, Jonathan Maximiliano
Background: necrotizing enterocolitis is one of the most prevalent and devastating gastrointestinal pathologies in newborns, since there is controversy regarding risk factors for its development and thus achieving a better understanding for its prevention. Objectives: determine the factors associated with necrotizing enterocolitis in newborns at the Vicente Corral Moscoso Hospital. Methods: case-control study in Neonatology at the Vicente Corral Moscoso Hospital. Three controls were selected for each case, matched by sex and month of birth. Descriptive statistics, OR, 95%CI and p values were obtained. Results: 47 cases and 141 controls were obtained. The two groups were similar in terms of sex and month of birth. The association between prematurity, respiratory distress, hyaline membrane disease, pneumonia, mechanical ventilation, apnea, sepsis, anemia, blood transfusion, patent ductus arteriosus, artificial breastfeeding, preterm formula feeding, umbilical catheterization with necrotizing enterocolitis was statistically significant. Conclusion: prematurity, respiratory distress, hyaline membrane disease, pneumonia, mechanical ventilation, apnea, sepsis, anemia, blood transfusion, patent ductus arteriosus, artificial breastfeeding, preterm formula feeding and umbilical catheterization may increase the risk of necrotizing enterocolitis in neonates.
Hallazgos ultrasonográficos en hepatopatías de niños y adolescentes en el Hospital José Carrasco Arteaga. Cuenca, 2016-2019
(2024-09-10) Brito Tola, María Auxiliadora; Astudillo Peralta, Carlos Fernando
Background: Childhood liver diseases are diverse. An important point mentioned in the literature regarding treatment is that it will differ between diseases, but its main basis is the performance of liver transplant in 60 to 80% of patients who develop the disease in early childhood. Liver diseases depending on the duration of their evolution, can be acute and chronic, with infectious hepatitis being the most common in the first group and hepatic steatosis in the second. Its incidence is expected to increase over time, generating greater morbidity and mortality, as well as future complications. Objetive: to determine the ultrasonographic findings in liver disease of children and adolescents treated at José Carrasco Arteaga Hospital. Cuenca, from to 2016-2019. Methods: descriptive, cross-sectional study. Was analized the clinical history of 220 patients between 5 to 19 years of age, who underwent an abdominal ultrasound in the period 2016-2019, once de inclusion criteria were met, a form was prepared with the sociodemographic variables (age, sex, nutritional status calculated using the BMI and the qualitative variables resulting from the abdominal ultrasound (parenchyma echogenicity, hepatomegaly, portal wall hyperechogenicity, ascites, thickening of the gallbladder wall). The statistical analysis was carried using the SPSS program and Microsoft Excel 2010. Frequencies and percentages were used for the qualitative variables and mean, standard deviation, asymmetry, kurtosis and the Kolmogórov-Smirnov test for the quantitative ones. Conclusions: the prevalence of liver disease was 39,10%.
Satisfacción de la recuperación anestésica en pacientes sometidos a anestesia general en el Hospital de Especialidades José Carrasco Arteaga, Cuenca 2023
(Universidad de Cuenca, 2024-08-27) Deleg Guartán, Ruth Carolina; Espinoza Juela, Miguel Ignacio
Background: the quality of anesthetic recovery is a crucial process during the postoperative period, since various complications may occur during this period; its success will depend on operational, physiological and psychological dimensions. Objective: determine the level of satisfaction of anesthetic recovery in patients undergoing general anesthesia, José Carrasco Arteaga Specialty Hospital, Cuenca 2023. Methods: descriptive, cross-sectional study. 275 patients who met the inclusion criteria were surveyed; non-probabilistic convenience sampling was applied. To evaluate anesthetic recovery satisfaction, the validated QoR-40 form was used. Descriptive statistics were used. Results: gynecological surgery was the most frequent with 24%, 64.4% received balanced general anesthesia, 59.6% had surgery lasting between 30 to 60 minutes, 87.3% were categorized as ASA II, 7.6 % present transoperative complications. 38.4% of patients were dissatisfied, 57.8% partially satisfied and only 3.3% satisfied. The highest prevalence of dissatisfied patients was seen in gynecological surgeries, total intravenous anesthesia, with operating time between 30 to 60 min, and ASA II. with 12%, 25.5%, 21.5% and 36.7% respectively. The highest scores according to the QoR40 questionnaire were evident in the dimension of comfort, support received and emotions. According to the perception of the quality of care of all the participants, they indicated that the care was of good quality. Conclusions: according to the QoR-40 assessment, the majority of participants were dissatisfied or partially satisfied with anesthesia care.
Caso clínico 1: miopatía inflamatoria idiopática. Reporte de caso, Caso clínico 2: disección de aorta. Reporte de caso
(Universidad de Cuenca, 2023-09-04) Ortega Nivelo, Italo Ismael; Guevara Pacheco, Sergio Vicente
Background: Idiopathic inflammatory myopathies (IIM) are a group of diseases characterized by muscle weakness and inflammatory infiltrates in muscle tissue, which can affect different organs. Clinical case: a 40-year-old female patient who presented with musculoskeletal pain and muscle weakness in the upper limbs accompanied by scaly papular lesions on the back of the hands and erythema on the eyelids, with increased serum muscle enzymes, suspected IIM, and a muscle biopsy was performed. Reporting perivascular infiltrate, with abnormal electromyography, the Bohan and Peter criteria are applied with a diagnosis of dermatomyositis; Immunosuppressive treatment was started with favorable clinical evolution, medical discharge and outpatient follow-up were decided Clinical case: A 40-year-old female patient who attended for musculoskeletal pain and muscle weakness in the upper limbs accompanied by scaly papular lesions on the back of the hands and erythema at the level of the eyelids, with increased serum muscle enzymes, suspected IIM, a muscle biopsy was performed reporting perivascular infiltrate , with abnormal electromyography, the Bohan and Peter criteria are applied with a diagnosis of dermatomyositis; Immunosuppressive treatment was started with favorable clinical evolution, medical discharge and outpatient follow-up were decided Conclusions: In patients presenting with musculoskeletal pain and muscle weakness associated with skin lesions, IM should be clinically suspected, so the Bohan and Peter criteria should be applied to define the diagnosis. Introducción: la disección de aorta (DA) consiste en una rotura de la capa íntima de la pared del vaso permitiendo el paso de sangre a la capa media separando la luz verdadera de la falsa, es una patología poco frecuente, que puede presentarse en pacientes con antecedentes de traumatismo torácico. Caso clínico: paciente masculino de 35 años, con antecedente de accidente en vehículo motorizado hace 18 meses, acude al servicio de emergencia por un cuadro de hemiparesia derecha más disartria de 4 horas de evolución, se realiza tomografía de cráneo sin encontrarse lesión, catalogándose como evento cerebrovascular isquémico, con recuperación neurológica espontánea, posterior presenta disnea de grandes esfuerzos, se realiza ecocardiograma reportando DA ascendente más aneurisma, se instaura tratamiento mediante medidas de soporte, con derivación para cirugía cardiotorácica. Conclusión: en pacientes con antecedentes de traumatismo torácico, debe realizárseles valoración cardiológica temprana, para detectar cuadros de DA.
Caso clínico 1: arteritis de Takayasu, diagnóstico infrecuente. Reporte de caso / Caso clínico 2: Síndrome de Guillain-Barré en el contexto de infección por COVID-19. Reporte de caso
(Universidad de Cuenca, 2023-09-01) Guaraca Cárdenaz, Karla Teresa; Ojeda Orellana, Marco Ribelino
Background: vasculitis are multisystem pathologies of the blood vessels that are defined by the presence of inflammatory leukocytes in the vessel wall. Among these, Takayasu Arteritis is a vasculitis that affects large vessels, mainly the aorta and its branches. Clinical case: a 33-year-old female patient with left carotidinia of 6-month evolution. On physical examination, a discrepancy in the systolic blood pressure values of both arms stands out; in imaging studies, angiotomography of the neck and doppler ultrasound of the carotids show 87% stenosis of the left common carotid artery. The patient meets 3 diagnostic criteria for Takayasu Arteritis, so that, she starts treatment with corticosteroids and immunosuppressants and an aorto-carotid bypass with placement of a prosthetic graft is performed. Conclusions: Takayasu Arteritis is a rare inflammatory disease, so the diagnosis can go unnoticed, increasing the risk of complications that endanger patients’ lives. It is important to know the manifestations of this vasculitis since timely treatment can prevent the progression of the disease and the appearance of potentially fatal complications. Antecedentes: la infección por COVID-19 causa, predominantemente, enfermedad respiratoria. Sin embargo, están descritas diversas complicaciones extrapulmonares, dentro de las cuales se describen alteraciones neurológicas como el síndrome de Guillain-Barré, reportado en algunos informes de casos alrededor del mundo. Presentación del caso clínico: paciente femenina de 74 años ingresada en UCI con diagnóstico de infección por COVID-19 y síndrome de distrés respiratorio agudo que requiere ventilación mecánica invasiva por 12 días. En las 24 horas posteriores a extubación, presenta paro respiratorio en el contexto de debilidad muscular y arreflexia de miembros inferiores, se solicita punción lumbar evidenciando LCR compatible con síndrome de Guillain-Barré. Inicia tratamiento con inmunoglobulina intravenosa durante 5 días con buena respuesta, indicándose alta médica a los 26 días de hospitalización. Conclusiones: la infección por COVID-19 asociada a síndrome de Guillain-Barré es una afección poco común que puede quedar infradiagnosticada, es necesario considerar esta patología; tomando en cuenta que, la presentación, los estudios diagnósticos y el tratamiento son los mismos que en el Guillain-Barré de otras etiologías.
Prevalencia de la estancia hospitalaria prolongada en pacientes adultos mayores con neumonía adquirida en la comunidad y factores asociados. Hospital Vicente Corral Moscoso, Cuenca, 2021
(Universidad de Cuenca, 2023-07-31) Torres Arévalo, Janina Tatiana; Mejía Almeida, Julia Alexandra
Introduction: community-acquired pneumonia (CAP), which occurs outside the hospital environment, is a frequent cause of morbidity and mortality, mainly in older adults. Objective: to determine the prevalence of prolonged hospital stay and its associated factors in older adults with CAP, at the Vicente Corral Moscoso Hospital (HVCM) in Cuenca. Materials and methods: cross-sectional analytical study, with 129 older adults admitted to the Internal Medicine service of the HVCM for CAP during the year 2021, was made. To collect the information, the observational method was used, using direct interviews and the patients' clinical histories as instruments. Through the Chi-Square test, categorical associations were made, while the risk was determined with OR, in 2x2 tables. The significance of 5% (p<0.05) was obtained through the Mann-Whitney U-test. Data processing was performed using SPSS v.27. Results: the prevalence of prolonged hospital stay was 65.89%, with a median of 11 days and an average of 17.5 days; and its associated factors were age, severity of pneumonia (69.4% of patients presented class IV), cognitive impairment and dependence in instrumental activities of daily living (severe and moderate). Conclusions: the main factors associated with prolonged hospital stay were the severity of CAP, dependence on instrumental activities of daily living. In addition, it was determined that the lower the cognitive impairment and the more advanced the age, the shorter the hospitalization.
Prevalencia y factores asociados al desarrollo de COVID severo
(Universidad de Cuenca, 2023-07-31) Fernández Collahuazo, Cristina Nataly; Guevara Pacheco, Sergio Vicente
Introduction: The SARS-CoV2 coronavirus disease (COVID-19) has a variable lethality due to the wide spread of the virus worldwide. Factors associated with severity are reported, such as age, sex and different comorbidities such as arterial hypertension, cardiovascular diseases, diabetes, chronic kidney disease and obesity. Objective: to establish the prevalence of COVID-19 and factors associated with severe COVID in patients admitted to the Vicente Corral Moscoso Hospital (HVCM). Methodology: An analytical, cross-sectional study was carried out with patients treated in the internal medicine service; The variables analyzed were age, sex, COVID-19 diagnosis, comorbidities: arterial hypertension (HBP), cardio vascular diseases (CVD), diabetes, chronic kidney disease (CKD), obesity, severe COVID; descriptive statistics with percentages and frequencies, measures of dispersion and central tendency were performed. Association was determined with the chi-square statistic and to establish the direction and intensity of the relationship the OR together with its confidence intervals. The processing of the information was analyzed in the statistical program SPSS 25 and a significance of 5% (p<0.05) was considered. Conclusions: a prevalence of 28.87 COVID-19 was observed in the HVCM, being more frequent in males. Older adults and comorbidities such as arterial hypertension, chronic kidney disease, and obesity are risk factors related to severity.
Anemia asociada a la inflamación: prevalencia y factores asociados en pacientes ingresados en el Hospital Vicente Corral Moscoso Cuenca 2021
(Universidad de Cuenca, 2023-07-21) Idrovo Macancela, Mayra Estefania; Dita Salabert, Liermis Michael
Introduction: Inflammatory Anemia (IA) is the impaired production of erythrocytes associated with chronic immune activation, it is mainly a disorder of iron distribution and the second cause of anemia in the world.Objectives: to determine the prevalence of anemia due to inflammation and its associated factors in patients admitted to the Vicente Corral Moscoso Hospital (HVCM) during the year 2021.Methodology: A cross-sectional analytical study was carried out in a sample of 440 patients hospitalized in the Internal Medicine area of the HVCM, the sample calculation was performed with 95% confidence, 50% probability of occurrence and 4.2% error, for data collection, a form designed and prepared by the author was applied, for the analysis the Chi Square was applied for association between variables and OR to measure the intensity of association, with a significance level of 5% (p<0.05 ), processing performed in the SPSS V27.Results: a prevalence of IA of 18.18% was found in all hospitalized patients. Associated factors were: age (p=0.018); diabetes (p=0.003), infection (p=0.001) and chronic kidney disease (p=0.025). The presence of IA was not related to mortality in this study. Conclusions: the prevalence of IA was 18.18% and is mainly associated with the age of the patients and the presence of chronic diseases such as diabetes mellitus, infections and chronic kidney disease.
Caso clínico 1: vía aérea difícil en neonato con síndrome de artrogriposis múltiple congénita, Caso clínico 2: edema agudo de pulmón perioperatorio por asociación de nifedipino y sulfato de magnesio en gestación gemelar
(Universidad de Cuenca, 2023-07-04) Guaman Azuero, Diana Elizabeth; Cevallos Sacoto, Francisco Antonio
Introduction: The association of various drugs is capable of creating both beneficial and counterproductive effects by synergy or addition, factors such as: dose, speed and intervals of administration must be taken into account, since they can trigger complications from mild to severe; Within these, drugs that share similar mechanisms of action deserve special care; In the same way, characteristics of each individual or stages that are taking place, such as gestational, generate physiological changes that must be taken into account since they can precipitate said complications. Materials and methods: The case of a pregnant twin with a threat of preterm labor is presented, who is administered tocolytic treatment with nifedipine, betamethasone for lung maturation, and magnesium sulfate (MgSO4) as a neuroprotectant, which by various mechanisms such as Fluid retention and cardiopulmonary alterations can trigger acute cardiogenic or non-cardiogenic pulmonary edema, a rare complication that puts maternal-fetal well-being at risk. The use of pulmonary ultrasonography in the perioperative period made it possible to make both a rapid diagnosis and to guide an adequate treatment. Conclusions: It is important to take measures to prevent this complication taking into account the independent risk factors for Acute Pulmonary Edema (APE) during pregnancy and thus individualize pharmacotherapy, recommendation of important guidelines is not to use MgSO4 together with nifedipine.
Frecuencia del VIH en pacientes atendidos en los servicios de hospitalización y consulta externa de obstetricia de los hospitales "Vicente Corral M." del Seguro Social, de las Fuerzas Armadas y de la Fundación pablo Jaramillo de Cuenca, 1992
(Universidad de Cuenca, 1993) Barros V., Vilma; García R., Kléber; Cárdenas Haro, Xavier Ricardo; Barros Ch., Arturo
Determinación del tipo de anticuerpos anti A y/o anti B maternos en el suero de la madre y del recién nacido
(Universidad de Cuenca, 2003) Vanegas Coveña, Diana Patricia; Abril Saavedra, Hernán; Quizhpe Peralta, Arturo Octavio; Morales, Jaime; Ulloa A., César
Detección de lesiones cérvico uterinas con el uso del papette hisopillo y espátula de Ayre
(Universidad de Cuenca, 1997) Daquilema Miranda, Mariana de Jesús; Togra, Mélida; Molina, Xavier; Morales, Jaime
Maduración cervical e inducción con prostaglandina E1 intracervical
(Universidad de Cuenca, 1997-09) Espinoza Cerda, Fernando; Zambrano Ureña, Milton; Molina Novillo, Javier Alonso
Caso clínico 1: trauma penetrante cardiaco manejado mediante ventana pericárdica subxifoidea. Caso clínico 2: vólvulo de colon transverso
(Universidad de Cuenca, 2023-06-23) Ulloa Aguilar, Boris Javier; Reinoso Naranjo, Jeovanni Homero
Abstract 1 Penetrating cardiac trauma is a type of injury that presents a high mortality rate, even conditioning the victim not to reach an emergency department for management. Depending on the hemodynamic status of the patient, it has been observed the different management that could be provided in a hospital center, from the need for thoracotomy in severe patients or the practice of pericardial window for confirmation and treatment of cardiac trauma in a clinically stable patient, without neglecting the importance of complementary examinations that we have today. We present a single case of a 43-year-old male patient who was admitted with a diagnosis of cardiac tamponade following penetrating chest trauma with a stab wound. The patient presented with lesion in the anterior precordial face, with tendency to hypotension and tachycardia; in addition to psychomotor agitation. A subxiphoid pericardial window was performed where a hemopericardium of approximately 200cc of blood plus clots was found. It was also necessary to perform pleural drainage for presenting grade II pneumothorax. The patient remained hospitalized for 5 days, and due to his favorable evolution and the absence of complications, he was discharged from hospital. The management and treatment of patients with penetrating cardiac trauma depends on their hemodynamic status and the anatomical site of injury. It has been observed that starting with aggressive surgical treatment such as a thoracotomy may not always be necessary, thus committing the patient to greater comorbidity and hospital stay. The new diagnostic methods that we have in the emergency rooms of the hospital centers, help us a lot nowadays to take a more effective course of action. According to these results, the surgeon could choose the pericardial window as a good first option for this type of management. Abstract 2 Introduction: Volvulus of the gastrointestinal tract are an important cause of acute abdomen, both because of their frequency and the severity of their potential complications. (1) They are difficult to diagnose clinical entities that can occur in any tract of the gastrointestinal tract and with high complication value (1). Volvulus occurs when parts of the intestine become entangled in a mesenteric axis, which can lead to impairment of the blood supply or can cause total or partial obstruction of the intestinal lumen (2). We present the clinical case of a 17-year-old male patient with acute obstructive abdomen due to volvulus of the transverse colon, where exploratory laparotomy was performed plus intestinal resection plus end terminal anastomosis of the transverse colon, who was also diagnosed with a malformation in the form of sequential dilatation of the middle third of the transverse colon (intestinal duplication), including malformation of the mesentery (lax tissue). Patient presented favorable evolution and after 5 days of hospitalization was discharged. Volvulus of the gastrointestinal tract is an important cause of acute abdomen, its late diagnosis can lead to complications even compromising the patient's life. There are several anatomical sites of the colon that could be affected by this pathology, being the transverse colon the one with the lowest incidence with 1-4%. At present, depending on the clinical condition of the patient, less invasive management such as decompression by colonoscopy is decided in the absence of peritoneal signs, but in the presence of findings such as suspected intestinal necrosis, perforation and shock, surgical treatment is the first choice.
Caso clínico 1: vía biliar accesoria en colecistectomía laparoscópica de emergencia, Caso clínico 2: intususcepción de ciego sobre colon ascendente en cáncer de ciego
(Universidad de Cuenca, 2023-06-19) Preciado Vásquez, Jimmy Vinicio; Reinoso Naranjo, Jeovanni Homero
Introduction: Anatomical anomalies and variations of the bile ducts constitute surgical challenges and a risk of intra- and postoperative complications. These types of anatomical abnormalities of the biliary tract do not have to be evidenced by specific symptoms and their discovery is generally accidental, during gallbladder or bile duct surgery. Clinical case: The case of a patient of 59 years is presented, that it refers suffering since 72 hours abdominal pain accompanied of nausea. The patient to surgery for laparoscopic cholecystectomy decides to move to the not much hours of the income, with presumptive diagnosis of cholelithiasis. Findings were: The gall bladder of fine walls with two litos in its inside of 0.7cm, in cystic duct of 0.5 mm, next to cystic duct becomes evident hepatic aberrant leaving of common bile duct to 1 cm of the bifurcation, enter along with cystic again to common bile duct, confirmed for intraoperative cholangiography. Conclusion: When accomplishing the laparoscopic cholecystectomy they should have in account important aspects like the possible presence of anatomic variants that can drive an iatrogenic injury. The finding if it becomes evident in not much proportion in the present-day population and for that reason revert importance. The surgical and laparoscopic- imaging courses of action were the adequate and with this complications were avoided for the patient and he received its certificate of discharge in less than 72 hours after the income. Introducción: Las intususcepciones en adultos, son raras y representan <5% de los casos de todas las invaginaciones y 1-5% de todas las obstrucciones intestinales. La intususcepción colónica en adultos ocurre principalmente en el colon sigmoide, el colon transverso y el ciego. Caso clínico: Se presenta el caso de una paciente que tras sufrir trauma superficial de abdomen, presenta dolor tipo opresivo a nivel de epigastrio, sin otro síntoma acompañante; dicho dolor se exacerba dos semanas antes de la consulta, acompañado de náusea y vómito de características alimenticias. Se decide el ingreso de la paciente con diagnóstico de abdomen oclusivo parcial, se realiza una ecografía observándose imagen sugestiva de invaginación intestinal, por lo que para corroborar información se solicita tomografía simple y contrastada de abdomen corroborando resultados. Se le practica laparotomía exploratoria, encontrando una masa en ciego de 6 x 6 cm, aplanada con intususcepción de intestino delgado y apéndice, múltiples ganglios a nivel de mesenterio. Además, se realizó una hemicolectomía derecha, anastomosis ileotransversa termino lateral, y colocación de drenaje de Jackson Pratt. Conclusión: La laparotomía exploratoria es la técnica de primer orden para la detección de las anomalías intestinales. En este caso la intususcepción de intestino delgado y apéndice a partir de un cáncer de ciego. El tratamiento óptimo para la invaginación intestinal en adultos sigue siendo el quirúrgico, el definitivo depende de la etiología y la localización subyacentes. Debido a que la invaginación intestinal en estos pacientes está altamente correlacionada con tumores malignos.
Caso clínico 1: hernia diafragmática postraumática, Caso clínico 2: hernioplastia insicional lumbar
(Universidad de Cuenca, 2023-06-15) Castro Palaguachi, Verónica Graciela; Quichimbo Sangurima, Fausto Marcelo
Introduction: Diaphragmatic hernias are defined as the passage of abdominal organs into the thoracic cavity through a defect in the diaphragm, sometimes resulting from severe trauma, constituting a surgical challenge. Thoracoabdominal incisions are commonly used for various thoracic and vascular cases, although they are rarely used for diaphragmatic hernias, which are usually repaired by laparotomy, thoracotomy or minimally invasive approaches. Case report: We present the clinical case of a 25-year-old patient with a history of penetrating stab wound trauma 4 years ago, who came to the emergency room with diffuse abdominal pain diagnosed on admission as acute partial subocclusive abdomen treated surgically by exploratory laparotomy with surgical findings of non-diseased appendix and ileus, with torpid evolution 5 days later he presented respiratory difficulty, chest x-ray was performed showing left pleural effusion, treated with pleural drainage obtaining fecaloid liquid of approximately 1500ml volume, so it was decided to perform an urgent thoracotomy finding perforated diaphragmatic hernia + pleural empyema + necrosis of the splenic angle of the colon, diaphragmatic herniorraphy + pleural cavity lavage + decortication + pleural drainage + laparotomy + resection of the splenic angle of the colon + end-to-end anastomosis + peritoneal peritoneal cavity lavage + peritoneal cavity lavage + pleural drainage + peritoneal anastomosis + peritoneal anastomosis terminal anastomosis + peritoneal cavity lavage + Jackson Pratt drain placement Results: Patient remained hospitalized for 43 days, presented as a complication pachyepleuritis left empyema reintervened by left lateral thoracotomy, evolving favorably after receiving treatment with intravenous is discharged home in good condition. Introduction: Lumbar hernia is the rarest of all abdominal wall hernias and represents only 0.2% of all hernias. About 20% are congenital, mainly secondary to embryonic development defects, while 80% are acquired.1,2 The most recent literature recommends the laparotomy approach with the use of prosthetic materials as the most appropriate, so the procedure is fast, easy, and safe.2,3 Clinical case: A 46-year-old patient with a history of left radical nephrectomy by lumbotomy approach in 2021, who presents moderate intensity pain and sensation of mass protrusion in the left lumbar region. The physical examination showed a wall defect of approximately 10 cm diameter throughout abdominal content protruded at repose and before Valsalva maneuvers, but it was also reducible by external compression. Simple and contrast-enhanced computerized axial tomography (CAT) of the abdomen and pelvis reported a hernial defect at the left lumbar level with omental content of approximately 8x7cm without compromise of vascularization. A lumbar insicional hernioplasty was performed with a double mesh technique, “sandwich” type, one of them placed intraperitoneal and the second retromuscular. Conclusion: Surgical repair by open approach of hernial defects at the lateral level, using double mesh (intraperitoneal and inframuscular) “sandwich” type, is a safe technique and with satisfactory results in those patients with a defect greater than 5 cm with a bad quality aponeurosis.
Caso clínico 1: obstrucción de la vía biliar secundario a síndrome de Lemmel: reporte de caso clínico; y, Caso clínico 2: pancreatectomía distal por trauma pancreático grado iii: reporte de caso clínico
(Universidad de Cuenca, 2023-06-14) Medina Sigüenza, Cristian Geovanny; Flores Lazo, Nube Lucía
Lemmel syndrome is a not well known cause of secondary bile duct obstruction that can cause cases of cholangitis and acute pancreatitis in addition to bile duct dilatation in the absence of choledocholithiasis and neoplasia. There are few case reports worldwide and its etiopathogenesis is still unclear. We present an 88-year-old woman who was admitted with abdominal pain of 48 hours of evolution located at the epigastric level accompanied by elevated pancreatic enzymes, biliary tract dilatation and cholestatic syndrome. After performing a simple and contrasted tomography of the abdomen, the absence of lithiasis and the presence of a peri ampullary diverticulum that compresses the biliary tract can be evidenced. Due to the patient's age and comorbidities, conservative treatment was decided, with good clinical evolution. In conclusion, adding differential diagnoses in the case of pancreatitis and cholangitis helps to raise clinical suspicion, improve diagnosis and optimize treatment. El trauma pancreático genera alta morbilidad y mortalidad si no se realiza un adecuado diagnóstico de manera temprana, esto asociado a lesiones de otros órganos que generan distracción al momento de abordar el trauma de abdomen. Presentamos un varón de 16 años que ingresa tras sufrir trauma cerrado de abdomen secundario a golpe contuso con timón de bicicleta posterior a caída, el paciente ingresa estable sin alteración hemodinámica, se decide realizar una tomografía simple y contrastada donde se evidencia lesión pancreática grado III (sección distal o daño parenquimatoso con lesión ductal) según la clasificación de la American Association for Surgery of Trauma (AAST) motivo por el cual se decide tratamiento quirúrgico realizándose una pancreatectomía distal más conservación de bazo. El paciente es dado de alta 78 horas posteriores a la cirugía con evolución favorable. En conclusión, diagnosticar de forma temprana las lesiones pancreáticas posterior a un traumatismo abdominal y conocer el manejo de las mismas puede prevenir sus complicaciones y disminuir su morbilidad y mortalidad.

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