Instituto de Seguridad y Servicios Sociales de los Trabajador

Bouveret's syndrome is a rare disorder that causes upper gastrointestinal obstruction, typically in elderly patients with a history of chronic cholelithiasis. We present an unusual case of a 58-year-old woman with untreated vesicular lithiasis who developed Bouveret's syndrome. She presented with severe abdominal pain, nausea, vomiting, and abdominal distension. Imaging studies confirmed the presence of an impacted gallstone in the duodenum, causing obstruction. The patient underwent successful surgery with removal of the stone and repair of the bilioenteric fistula. Early diagnosis and prompt surgical intervention are essential to prevent complications such as bowel perforation and sepsis. This case highlights the importance of considering Bouveret's syndrome in the differential diagnosis of bowel obstruction, particularly in elderly patients with a history of cholelithiasis.

To compare reinforced tension line (RTL) and mesh techniques in the onlay position for preventing abdominal wound dehiscence (AWD) in a noninferiority clinical trial.

Patients > 18 years old who underwent midline laparotomy and who were considered at high risk on the modified Rotterdam risk scale were included. The outcomes analyzed were the incidence of AWD and surgical site occurrence (SSO).

239 patients were included: 121 mesh group and 118 RTL group. Five (4.1%) of the 121 patients in the mesh group and 7 (5.9%) of the 118 patients in the RTL group presented with AWD (p = 0.56, RR = 0.69, 95% CI = 0.22-2.13) in the per-protocol analysis. The median time of presentation was 6 days. The 95% CI (-0.0567, 0.0231) for the difference in incidence between the two groups was entirely within the predefined noninferiority margin of 5%. The incidence of complications did not significantly differ between the two groups: the mesh group (27, 22.3%) and the RTL group (16, 12.8%) (p = 0.09, RR (95% CI) = 1.64 (0.93-2.89)).

The use of the RTL technique for preventing AWD was not inferior to the use of mesh in the onlay position, nor did it increase the risk of complications. This study was registered on clinicaltrials.gov: Mesh-RTL Project (NCT04134455).

Mammary hypertrophy, or macromastia, is an increase in breast tissue volume due to multiple etiologies and still unknown pathophysiology. We report the case of a 45-year-old patient with juvenile macromastia, which caused cervical pain and decreased quality of life. It was decided to perform a reduction mammoplasty with a modified McKissock technique with a free nipple graft; the resected glandular tissue was 1039 grams in the right breast and 1029 grams in the left breast. An adequate projection of the upper pole was achieved with a good aesthetic result and clinical improvement of the patient.