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1. Verfasser:	Helmut Alfredo Segovia-Lohse
Format:	Artículo científico
Sprache:	es
Veröffentlicht:	Academia Mexicana de Cirugía, A.C. 2011
Schlagworte:	Medicina peritonitis Intususcepción pólipos intestinales obstrucción intestinal invaginación intestinal
Online-Zugang:	https://www.redalyc.org/articulo.oa?id=66220802011
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Intususcepción intestinal en un adulto con perforación y peritonitis secundaria. Informe de un caso Helmut Alfredo Segovia-Lohse Medicina peritonitis Intususcepción pólipos intestinales obstrucción intestinal invaginación intestinal Introducción: La invaginación intestinal es una enfermedad poco frecuente en adultos y la mayoría de las veces es secundaria a una causa orgánica; puede ser maligna. En general se presenta como una oclusión intestinal incompleta que requiere intervención quirúrgica. Es muy difícil llegar al diagnóstico exacto en el preoperatorio, por lo cual se decidió presentar un caso y una breve revisión sobre el tema. Caso clínico: Mujer de 24 años de edad con 36 horas de dolor insidioso en hipogastrio acompañado de náuseas, vómitos y diarrea, y un cuadro similar ocho días antes del ingreso. Se observó neumoperitoneo en la radiografía de tórax, por lo que se decidió realizar laparotomía. En el acto quirúrgico se constató peritonitis aguda causada por invaginación intestinal ileoileal por un pólipo fibroide inflamatorio con microperforaciones; se realizó una resección intestinal sin desinvaginación y anastomosis término-terminal, con evolución favorable. Conclusiones: La invaginación intestinal en los adultos es poco frecuente, además, se manifiesta con signos y síntomas inespecíficos de dolor, náuseas y vómitos. Con el uso de la tomografía en los cuadros de dolor abdominal se podría llegar al diagnóstico correcto. El tratamiento consiste en resección intestinal sin reducción en la mayoría de las ocasiones. 2011 artículo científico 0009-7411 https://www.redalyc.org/articulo.oa?id=66220802011 es http://www.redalyc.org/revista.oa?id=662 Cirugía y Cirujanos application/pdf Academia Mexicana de Cirugía, A.C. Cirugía y Cirujanos (México) Num.3 Vol.79

if (filemtime($filename) + $maxlifetime < time()) { unlink($filename); $count++; } } return $count; } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ protected function saveSession($sessId, $data): bool { $sessFile = $this->path . '/sess_' . $sessId; if ($handle = fopen($sessFile, 'w')) { $return = false; // Lock the file for exclusive access to avoid issues with multiple // processes writing session simultaneously: if (flock($handle, LOCK_EX)) { $return = fwrite($handle, $data); // Make sure that there's no trailing data by truncating the file to // the correct length: ftruncate($handle, strlen($data)); fflush($handle); flock($handle, LOCK_UN); } fclose($handle); if ($return !== false) { return true; } } // If we got this far, something went wrong with the file output... // It is tempting to throw an exception here, but this code is called // outside of the context of exception handling, so all we can do is // echo a message.

// Anecdotal testing Today and Yesterday seems to indicate destroy() // is called by the garbage collector and everything is good. // Something to keep in mind though. return 0; } /** * Write function that is called when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ public function write($sessId, $data): bool { if ($this->writesDisabled) { return true; } return $this->saveSession($sessId, $data); } /** * A function that is called internally when session data is to be saved. * * @param string $sessId The current session ID * @param string $data The session data to write * * @return bool */ abstract protected function saveSession($sessId, $data): bool; }

* * @return void */ public function writeClose() { // The assumption is that we're using PHP's ext/session. // session_write_close() will actually overwrite $_SESSION with an // empty array on completion -- which leads to a mismatch between what // is in the storage object and $_SESSION. To get around this, we // temporarily reset $_SESSION to an array, and then re-link it to // the storage object. // // Additionally, while you _can_ write to $_SESSION following a // session_write_close() operation, no changes made to it will be // flushed to the session handler. As such, we now mark the storage // object isImmutable. $storage = $this->getStorage(); if (! $storage->isImmutable()) { $_SESSION = $storage->toArray(true); session_write_close(); $storage->fromArray($_SESSION); $storage->markImmutable(); } } /** * Attempt to set the session name * * If the session has already been started, or if the name provided fails * validation, an exception will be raised. * * @param string $name * @return SessionManager * @throws Exception\InvalidArgumentException */ public function setName($name) { if ($this->sessionExists()) { throw new Exception\InvalidArgumentException( 'Cannot set session name after a session has already started'

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