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Introducción: El infarto esplénico es una de las enfermedades que se presentan secundarias al fallo de aclimatación. En la literatura revisada se relaciona con la presencia de un rasgo sicklémico y desde la década del 50 se tienen reportes de casos a nivel mundial. Objetivo: Describir un caso de infarto esplénico por exposición a la altura. Presentación del caso: Se expuso un paciente que presentó un infarto esplénico después de su exposición a la altura, el cual fue intervenido quirúrgicamente y se presentaron un grupo de complicaciones en el posoperatorio. En la literatura internacional esta enfermedad se relaciona con la presencia de la hemoglobina S, lo cual no concuerda con nuestro paciente, a pesar de no ser el estudio de elección. Sus antecedentes pudieron contribuir a la ocurrencia de esta complicación. Las complicaciones que aparecieron en el posoperatorio coincidieron con las comentadas por otros autores. Conclusiones: El infarto esplénico por exposición a la altura es una complicación que debe tenerse en cuenta cuando se presenta un paciente a su llegada a este ecosistema, aparece con dolor abdominal, donde la inmediatez en la conducta es fundamental para evitar complicaciones de mayor gravedad(AU)

Introduction: Splenic infarction is one of the diseases that occur secondary to failure of acclimatization. In the reviewed literature, it is related to the presence of a sicklemic trait and since the 1950s there have been case reports worldwide. Objective: To describe a case of splenic infarction due to exposure to high altitude. Case report: We report the case of a patient who had a splenic infarct after exposure to high altitude. This patient, who underwent surgery, had a group of complications during the postoperative period. The international literature associates this disease with the presence of hemoglobin S, which does not coincide with the case of our patient, despite not being the study of choice. His history could have contributed to the occurrence of this complication. Those that appeared in the postoperative period did agree with those commented by other authors. Conclusions: Splenic infarction due to exposure to altitude is a complication that must be taken into account when a patient has abdominal pain. Immediacy in behavior is essential to avoid more serious complications(AU)

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Background: Sickle cell trait (SCT) is an autosomal recessive blood disorder in which patients are heterozygous carriers for hemoglobin S (HbAS) and are usually asymptomatic. We performed a descriptive analysis of clinical manifestations and outcomes associated with SCT. Methods: This was a descriptive, cross-sectional study that included patients with SCT from 2014 to 2020 at Hospital Militar Central, the reference center of the Military forces in Bogota, Colombia. Results: Of 647 hemoglobin electrophoresis analyzed, we identified 51 patients with SCT, including 43 males (84.3%) and eight females (15.7%), with a median age of 22 years (IQR 15-36 years). Of these, 28 (54.8%) were Afro-Colombian, 23 (45.1%) were Colombian mestizos, and 31/51 (60.8%) of patients were active military members. Twenty-four patients (47.1%) were asymptomatic, and Twenty-seven patients (52.9%) were symptomatic (systemic complications); Most of the patients who presented symptoms were active military members of the Colombian military forces. Splenic complications were the most important (85.2%), p=0.0005, and there was a wide spectrum of splenic complications. In addition, we found significant elevations in leukocytes, bilirubin, LDH, and CRP. Eighteen patients (66.7%) received medical management, five (18.5%) required splenectomy, and only 5.9% of patients were sent for genetic counseling. Conclusions: Military Personnel is a population with a high risk of developing symptoms, and splenic complications were the most relevant in symptomatic patients. Most patients received medical treatment, and 18.5% of patients required splenectomy. Our results reflect the absence of redirection of these patients to genetic counseling.

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RESUMEN Los infartos esplénicos son una causa infrecuente de dolor abdominal. Son causados por una amplia variedad de patologías. Presentamos el caso de un paciente en el que se hizo diagnóstico de infarto esplénico masivo secundario a una compresión extrínseca de un tumor quístico de páncreas.

ABSTRACT Splenic infarctions, a rare cause of abdominal pain, may be due to several conditions. We report the case of a male patient with a massive splenic infarction secondary to extrinsic compression from a pancreatic cystic tumor.

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Wandering spleen is a rare condition, generally due to congenital abnormalities of the dorsal mesogastrium or splenic suspensory ligaments and not traumatic events. The most frequent complication is torsion of the splenic hilus with ischemia or splenic infarction and its association with pancreatic volvulus is extremely rare. There are no reported cases of wandering spleen with pancreatic volvulus in association with a post traumatic Grynfelt-Lesshaft haernia. We present a case of a 43-year-old female patient with an association of these three entities and a history of abdominal trauma.

El bazo errante es una afección rara que en general se debe a anomalías congénitas del mesogastrio dorsal o de los ligamentos suspensores esplénicos, y no a traumatismos. La complicación más frecuente es la torsión del hilio esplénico con isquemia o infarto esplénico, y su asociación a vólvulo pancreático es extremadamente rara. No existen ningún otro caso reportado de bazo errante con vólvulo pancreático en un paciente que presenta una hernia lumbar de Grynfelt-Lesshaft postraumática. Presentamos el caso de una paciente de 43 años con asociación de estas tres afecciones y antecedente de traumatismo abdominal.

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RESUMEN Se reporta el primer caso en Perú de una fístula gastroesplénica (FGE) secundaria a adenocarcinoma gástrico penetrante al hilio esplénico que ocasionó infarto esplénico maligno y peritonitis difusa. Se discute la racionalidad del tratamiento quirúrgico. Varón de 84 años con peritonitis difusa secundario a un adenocarcinoma gástrico Borrmann III (BIII) fístulizado al bazo y en comunicación con la cavidad peritoneal. Se hallaron en la literatura cuatro casos de FGE asociadas a cáncer gástrico. La gastrectomía con intención curativa en un solo tiempo estaría indicada para casos con buena condición general y criterios de curabilidad. La gastrectomía en un segundo tiempo se reserva para casos con mala condición general y criterios de curabilidad. Las resecciones locales o paliativas estarían indicadas para los casos con mala condición general e incurabilidad.

ABSTRACT The first case in Peru of a gastro-splenic fistula (GSF) secondary to gastric adenocarcinoma penetrating the splenic hilum, causing malignant splenic infarction and diffuse peritonitis, is reported. The rationale for surgical treatment is discussed. An 84-year-old man with diffuse peritonitis secondary to a Borrmann III (BIII) gastric adenocarcinoma fistulized to the spleen and in communication with the peritoneal cavity. Four cases of GSF associated with gastric cancer were found in the literature. The gastrectomy with curative intention in a single stage, would be indicated for cases with good general condition and criteria of curability. A second stage gastrectomy is reserved for cases with poor general condition and curability criteria. Local or palliative resections would be indicated for cases with poor general condition and incurability.

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Resumen La tuberculosis es una enfermedad de importancia en la salud pública a nivel mundial, con una alta incidencia a nivel del territorio colombiano. Principalmente, afecta el parénquima pulmonar; sin embargo, en un porcentaje elevado de casos se diagnostica en su forma extrapulmonar y el tracto gastrointestinal es uno de los sitios más frecuentes. Así mismo, la región ileocecal y el íleon terminal son las regiones con más predilección por la bacteria Mycobaterium tuberculosis. Las manifestaciones en esta rara presentación de la enfermedad están dadas por dolor abdominal y sensación de masa principalmente, lesiones ulcerosas en la mucosa intestinal y hallazgos histológicos correspondientes a granulomas caseificantes de gran tamaño y de morfología confluente, que se diferencian de otras entidades como la enfermedad de Crohn. La búsqueda de la enfermedad dentro del tracto gastrointestinal se realiza con ayuda de métodos invasivos como la colonoscopia y de ayudas diagnósticas de laboratorio como cultivos, tinciones o reacción en cadena de la polimerasa (PCR). Dada la complejidad en el diagnóstico de esta forma de tuberculosis, el conocimiento y la manera en que se aborda un paciente con un cuadro sugestivo de esta enfermedad son factores importantes para establecer el manejo terapéutico oportuno. Se comparte un caso inusual de tuberculosis ileocecal como manifestación de síndrome febril prolongado con desenlace fatal.

Abstract Tuberculosis is a disease of public health importance worldwide with a high incidence in Colombia. It mainly affects the lung parenchyma. However, in a large number of cases, it is diagnosed in its extrapulmonary form, with the gastrointestinal tract being one of the most frequent sites. Mycobacterium tuberculosis has a strong predilection for the ileocecal region and the terminal ileum. Manifestations of this rare form of the disease are abdominal pain and mass sensation mainly, as well as ulcerative lesions in the intestinal mucosa and histological findings corresponding to large caseating granulomas of confluent morphology, which distinguish it from other entities such as Crohn's disease. Invasive procedures, such as colonoscopy, and diagnostic laboratory aids, such as cultures, stains, and PCR, are used to find the disease in the gastrointestinal tract. Given the difficulty of diagnosing this type of tuberculosis, knowledge and how a patient with symptoms suggestive of the disease is approached are critical factors for establishing timely treatment. The following is an unusual case of ileocecal TB as a manifestation of prolonged febrile illness with a fatal outcome.

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INTRODUCTION: Multiple studies suggest that SARS-CoV-2 infection is associated with a pro-thrombotic state and thrombotic events have been recorded in several organs and systems. We report a patient with no respiratory symptoms, presented with abdominal pain and an extensive splenic infarction after COVID-19. CASE REPORT: A 67 year-old man was admitted to the emergency department with a moderate, dull, left-sided abdominal pain. The patient denied respiratory symptoms but referred contact with family members positive for COVID-19. He tested positive for COVID-19 and had increased D-dimer levels. Imaging studies revealed splenic infarcts and ground-glass opacities in bilateral pulmonary bases. He was treated with full-dose anticoagulation and was discharged home on oral Rivaroxaban. DISCUSSION: Although rare in the literature, cases of acute abdomen in COVID-19 patients associated with vascular infarctions have increased. Coagulopathy may be present even without clinical respiratory manifestations of the disease. Patients meeting disseminated intravascular coagulation criteria or with markedly elevated D-dimer may benefit from anticoagulant therapy. CONCLUSION: Clinicians should suspect of abdominal visceral infarctions in COVID-19 patients presented with acute abdominal pain, despite the absence of respiratory symptoms.

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INTRODUCTION: Sickle cell trait (SCT) is a rare and underdiagnosed disorder in the Argentinian population. In this condition, individuals carry the mutation of the HbS gene in one of the two beta-globin genes. In general, SCT does not present with the typical manifestations of sickle cell anemia. However, under certain circumstances, some clinical characteristics of the disease may develop. METHODS: We discussed the case of a 39-Year old man who presented with persistent abdominal pain of unknown origin after traveling to a high-altitude place. He underwent laparotomy without a definite diagnosis. After that, the patient developed signs of splenic infarction and pulmonary thromboembolism that were confirmed by computed tomography. RESULTS: A sickling test was positive, and a hemoglobin electrophoresis revealed an abnormal fraction at the HbS level. In this context a diagnosis of SCT was made. Additional, tests revealed a strongly positive lupus anticoagulant. CONCLUSION: SCT presentation as abdominal pain and thromboembolic disease in adult patients after exposure to high altitudes is a rarely suspected diagnosis.

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