Agenesia de vena cava infrarrenal como causa no habitual de trombosis venosa reiterativa en el paciente joven

Las anomalías congénitas que afectan a la vena cava inferior son relativamente frecuentes y muy diversas debido a su complejo desarrollo embriológico. La agenesia de la vena cava inferior infrarrenal es un tipo de malformación congénita poco frecuente y, por lo general, se asocia a otras malformaciones como anomalías en la posición del corazón y alteraciones esplénicas. Presentamos el caso de un varón de 27 años, que en el pe ríodo de un año, presenta tres episodios de trombosis venosa profunda de miembro inferior izquierdo y que tras realización de diferentes pruebas complementarias fue diagnosticado de agenesia de vena cava inferior infrarrenal.
El interés del caso que presentamos radica en la presentación clínica de la agenesia de vena cava inferior como trombosis venosa de repetición. Creemos que ante todo paciente joven con clínica reiterativa de trombosis venosa profunda y sin factores de riesgo se debe realizar una TAC con el objetivo de identificar posibles alteraciones en el sistema venoso profundo.

Introduction. The incidence of cholelithiasis increases with age, and the symptoms it produces become more frequent and severe in elderly patients. On the other hand, emergency surgery is associated with elevated morbidity and mortality rates. The objective of this study is to compare the results of emergency surgery with those of elective surgery to treat cholelithiasis in patients over 70 years of age, to determine whether these patients should be considered a high-risk group in whom elective surgery must be performed with the least possible delay.
Patients and methods. A retrospective study was made of 407 patients over 70 years of age who underwent elective or emergency surgery to treatment cholelithiasis over a four-year period. Age, sex, the number and type of organic constituents, the incidence of choledocholithiasis, intraoperative findings, surgical technique, histological findings, morbidity and mortality were recorded in each case.
Results. Elective surgery was performed in 233 patients and emergency surgery in 174. The mean patient age was 76.87 years in the former group and 77.35 years in the latter. Two members of the emergency surgery group underwent cholecystostomy under local anesthesia; 286 patients (62.89%) were subjected total cholecystectomy (126 patients in the emergency group and 130 in the elective group); and in 149 cases (36.6%), cholecystectomy was accompanied by bile duct involvement (46 emergency cases and 103 elective cases).
The rate of complications was 13.7% in the group that underwent elective surgery and 22.4% among the emergency cases (p < 0.05). The rates of mortality were 0.4% and 7.5%, respectively (p < 0.001).
Conclusion. The risks of elective cholecystectomy are relatively low, while those associated with emergency surgery are considerable greater. Thus, elderly patients with symptomatic gallstones should be considered candidates for early elective cholecystectomy.