Información del artículo
Se presenta un caso de tumor rectal de colisión el adenocarcinoma adyacente a tumor carcinoide junto con un tumor carcinoide sincrónico en el intestino delgado. La multicentricidad y el riesgo elevado de presentar una segunda neoplasia maligna se asocian al tumor carcinoide.
Se analizan las posibles implicaciones terapéuticas de dichas características a través de un estudio retrospectivo de nuestra serie de tumores carcinoides, así como de la bibliografía existente.
Se analizan las posibles implicaciones terapéuticas de dichas características a través de un estudio retrospectivo de nuestra serie de tumores carcinoides, así como de la bibliografía existente.
Palabras clave:
Tumor carcinoide multicéntrico
Neoplasia primaria secundaria
Objective. To determine, in the interests of quality control, the correlation between the clinical and pathological diagnosis in women subjected to appendectomy.
Patients and methods. In our center, 60.3% of all emergency laparotomies performed in women in 1995 were carried out to treat acute appendicitis. Patient age and level of experience of the surgeon (resident or specialist) were recorded as objective parameters that can lead to erroneous diagnoses. The agreement between the preoperative and pathologic diagnoses was analyzed by the proportion test, where a p value of less than 0.05 was considered to indicate statistical significance.
Results. Microscopic study confirmed 90 cases (70.8%) of acute appendicitis and 37 (29.1%) in which no changes were observed. There were no appreciable differences in the parameters analyzed in terms of the surgeon in charge of diagnosis and treatment. The distribution according to age groups showed a significantly greater error (p = 0.01) and a high incidence of gynecological pathology as the cause of the clinical picture during the third decade of life.
Conclusions.. The rate of diagnostic error associated with appendectomy is accepted by the majority of authors to be 15% to 20%, reaching 30% to 50% in young women according to some series. We observe a significantly greater error in patients aged 21 to 30 years (48% versus 29%, p = 0.01) which points out the need for a protocol for more thorough clinical assessment involving gynecologists and radiologists. These findings also support the systematic use of ultrasound and the performance of laparoscopy as possible approaches in this group of patients
Patients and methods. In our center, 60.3% of all emergency laparotomies performed in women in 1995 were carried out to treat acute appendicitis. Patient age and level of experience of the surgeon (resident or specialist) were recorded as objective parameters that can lead to erroneous diagnoses. The agreement between the preoperative and pathologic diagnoses was analyzed by the proportion test, where a p value of less than 0.05 was considered to indicate statistical significance.
Results. Microscopic study confirmed 90 cases (70.8%) of acute appendicitis and 37 (29.1%) in which no changes were observed. There were no appreciable differences in the parameters analyzed in terms of the surgeon in charge of diagnosis and treatment. The distribution according to age groups showed a significantly greater error (p = 0.01) and a high incidence of gynecological pathology as the cause of the clinical picture during the third decade of life.
Conclusions.. The rate of diagnostic error associated with appendectomy is accepted by the majority of authors to be 15% to 20%, reaching 30% to 50% in young women according to some series. We observe a significantly greater error in patients aged 21 to 30 years (48% versus 29%, p = 0.01) which points out the need for a protocol for more thorough clinical assessment involving gynecologists and radiologists. These findings also support the systematic use of ultrasound and the performance of laparoscopy as possible approaches in this group of patients
Keywords:
Diagnostic error
Acute appendicitis in women
Ultrasonography
Laparoscopy
