Professional Documents
Culture Documents
Atresia Duedenal
Atresia Duedenal
ARTCULO DE REVISIN
Obstruccin duodenal en
pacientes peditricos
RESUMEN
'HSDUWDPHQWRGH5DGLRORJtDH,PDJHQGHO+RVSLWDO6DQ-RVp7HFGH0RQWHUUH\
$Y,JQDFLR0RURQHV3ULHWR3WH&RO'RFWRUHV0RQWHUUH\1/
&RSLDVcopies'U,JQDFLR&DQR0XxR](PDLOLFDQRPL#KRWPDLOFRP
Objetivo
3UHVHQWDUODVGLIHUHQWHVDIHFFLRQHVTXHFRQGLFLRQDQ
REVWUXFFLyQGXRGHQDOHQSHGLDWUtDDVtFRPRVXVFRUUHODFLRQHVFOtQLFDUDGLROyJLFD\TXLU~UJLFD
Introduccin
/DREVWUXFFLyQFRQJpQLWDGHOWUDFWRGLJHVWLYRHQORV
QHRQDWRV HV XQ SUREOHPD KDELWXDO ODV FDXVDV PiV
IUHFXHQWHVGHREVWUXFFLyQLQWHVWLQDOVRQODVPDOIRUPDFLRQHVDQDOHVODREVWUXFFLyQHVRIiJLFD\
ODREVWUXFFLyQGXRGHQDO1
/DREVWUXFFLyQGXRGHQDOFRQJpQLWDHUDFRQVLGHUDGD
XQD PDOIRUPDFLyQ IDWDO HQ ORV UHFLpQ QDFLGRV2 KDVWD
TXH VH GHVDUUROODURQ SURFHGLPLHQWRV TXLU~UJLFRV TXH
GLVPLQX\HURQODPRUWDOLGDGGHIRUPDFRQVLGHUDEOH
/DVREVWUXFFLRQHVGXRGHQDOHVSXHGHQVHUGHRULJHQ
LQWUtQVHFRRH[WUtQVHFR'HQWURGHODYDULHGDGGHDQRPDOtDVLQWUtQVHFDVVHHQFXHQWUDQODDWUHVLDRHVWHQRVLV
GXRGHQDO\HOGLDIUDJPDRPHPEUDQD/DVDIHFFLRQHV
2 5 8 Octubre-Diciembre 2011
SURGXFWRUDVGHREVWUXFFLyQGXRGHQDOH[WUtQVHFDVRQHO
SiQFUHDVDQXODUODYHQDSRUWDSUHGXRGHQDORODPDOURWDFLyQLQWHVWLQDOSRUYyOYXORRSRUEDQGDVGH/DGG
HQWUHRWUDV
'HQWUR GH ODV FDXVDV PiV IUHFXHQWHV GH REVWUXFFLyQGXRGHQDOVHHQFXHQWUDQODDWUHVLD\HOGLDIUDJPD
GXRGHQDO)RQNDOVUXGHQVXUHSRUWHGHSDFLHQWHV
FRQREVWUXFFLyQGXRGHQDOHQFRQWUyDWUHVLDGXRGHQDO
HQGLDIUDJPDGXRGHQDOFRQREVWUXFFLyQSDUFLDO
HQ\HVWHQRVLVGXRGHQDOHQ3(QWpUPLQRVJHQHUDOHVQRVHUHFRQRFHXQDSUHGLOHFFLyQGHVH[RSDUD
ODREVWUXFFLyQLQWHVWLQDOVLQHPEDUJRDOJXQRVDXWRUHV
UHHUHQFLHUWDSUHGLOHFFLyQSRUSDFLHQWHVPDVFXOLQRV
/DHGDGPHGLDGHDSDULFLyQGHORVVtQWRPDVRFXUUH
HOSULPHUGtDGHYLGDKDVWDHQGHORVSDFLHQWHV3
/DSUHVHQWDFLyQFOtQLFDKDELWXDOLQFOX\HDOYyPLWRSHUR
ODGLVWHQVLyQDEGRPLQDOQRVXHOHVHUXQVtQWRPDFRQVWDQWH(OYyPLWRVHSUHVHQWDDOPRPHQWRGHODLQJHVWD
GHO SULPHU DOLPHQWR \ VX JUDYHGDG SURJUHVD FRQ HO
SDVRGHOWLHPSR6XHOHVHUYyPLWRELOLDUGHELGRDTXH
ODJUDQPD\RUtDGHODVREVWUXFFLRQHVVHSUHVHQWDQSRU
GHEDMRGHODiPSXODGH9DWHU(QDOJXQRVSDFLHQWHV
HV SRVLEOH HQFRQWUDU RQGDV SHULVWiOWLFDV YLVLEOHV GH
ABSTRACT
OXFKDGLVPLQXFLyQHQODIUHFXHQFLD\YROXPHQGHODV
HYDFXDFLRQHVPHFRQLDOHVSpUGLGDSURJUHVLYDGHSHVR\
GHVKLGUDWDFLyQ/DH[SORUDFLyQItVLFDGHHVWRVSDFLHQWHV
UHYHODUiGLVWHQVLyQDEGRPLQDODQLYHOGHOHSLJDVWULRHQ
DOJXQRVFDVRVGHSUHVLyQYLVLEOHDQLYHOGHKLSRJDVWULR
$ODSDOSDFLyQSRGUiGHWHFWDUVHXQDPDVDVXDYHHQHO
FXDGUDQWH VXSHULRU GHUHFKR FRQ UHODFLyQ DO GXRGHQR
GLVWHQGLGR/DSHUtVWDVLVGHOHVWyPDJR\HOGXRGHQRVRQ
YLVLEOHV HQ XQ SRUFHQWDMH FRQVLGHUDEOH GH SDFLHQWHV
8Q KDOOD]JR LPSRUWDQWH HV OD UHYHUVLELOLGDG GH HVWRV
KDOOD]JRVDODH[SORUDFLyQSRVWHULRUDOYyPLWR
(QODJUDQPD\RUtDGHORVSDFLHQWHVQHRQDWRVFRQ
REVWUXFFLyQ GHO WUDFWR LQWHVWLQDO OD UDGLRJUDItD VLPSOH
VXHOHGDUHOGLDJQyVWLFRGHQLWLYRORVHVWXGLRVEDULWDGRV
HVWiQFRQWUDLQGLFDGRVULHVJRGHYyPLWRFRQEURQFRDVSLUDFLyQGHOFRQWUDVWH\ORVHVWXGLRVDGLFLRQDOHVFRPR
HOXOWUDVRQLGR\ODWRPRJUDItDQRVRQQHFHVDULRV
/D LPDJHQ UDGLRJUiFD FOiVLFD HV OD OODPDGD GREOH EXUEXMD VLJQR SURGXFLGR SRU XQ HVWyPDJR \ XQ
GXRGHQRSUR[LPDOGLODWDGRVODFDXVDHVSHFtFDGHOD
DQRPDOtDGXRGHQDOGHWHUPLQDUiODDSDULHQFLDSURPLQHQFLD\SUHVHQFLDGHDLUHGLVWDODODREVWUXFFLyQ(Q
ODV SUR\HFFLRQHV DEGRPLQDOHV HQ SRVLFLyQ HUHFWD VH
REVHUYDQQLYHOHVKLGURDHUHRVHQHVWyPDJR\GXRGHQR
6LODKLVWRULDFOtQLFD\ORVKDOOD]JRVDODH[SORUDFLyQVXJLHUHQIXHUWHPHQWHXQDREVWUXFFLyQLQWHVWLQDODOWD\VL
HOXOWUDVRQLGRLPDJHQD\ODUDGLRJUDItDGHDEGRPHQ
LPDJHQ E PXHVWUDQ HO VLJQR GH GREOH EXUEXMD VH
SXHGHQUHDOL]DUHVWXGLRVFRQDLUHSULPHURDVSLUDQGR
HOFRQWHQLGRJiVWULFRHLQ\HFWDQGRFP de aire en
HOHVWyPDJR(QORVFDVRVHQORVTXHHOGLDJQRVWLFRHV
GXGRVRVHKDUHFRPHQGDGRHOXOWUDVRQLGRFRQXLGR
SDUDXQDUHYDORUDFLyQ(VWHPpWRGRGLDJQyVWLFRSHUPLWH
XQDHYDOXDFLyQGLQiPLFDGHOHVWyPDJR\GHOGXRGHQR
DOWLHPSRTXHVHDGPLQLVWUDDJXDHVWpULOSRUPHGLRGH
XQDVRQGDQDVRJiVWULFD&RKHQ\VXVFRODERUDGRUHV
UHSRUWDURQXQDVHQVLELOLGDG\HVSHFLFLGDGGHHQWUH
\UHVSHFWLYDPHQWHSDUDDQRUPDOLGDGHVGXRGHQDOHVHQSDFLHQWHVSHGLiWULFRV
/D REVWUXFFLyQ GXRGHQDO SXHGH SUHVHQWDUVH FRQ
PDOIRUPDFLRQHVUHQDOHVFRQFRPLWDQWHVHQGHORV
FDVRVVLHQGRODVPiVIUHFXHQWHVHOULxyQSROLTXtVWLFROD
KLGURQHIURVLVHOULxyQHQKHUUDGXUD\ODDJHQHVLDUHQDO
6HKDUHSRUWDGRREVWUXFFLyQGXRGHQDOHQWUH\
GHORVSDFLHQWHVFRQDWUHVLDHVRIiJLFDFRQFRPLWDQWH
/D HQIHUPHGDG FDUGLDFD FRQJHVWLYD SXHGH HVWDU
DVRFLDGDKDVWDHQ\HVODFDXVDGHPXHUWHPiV
IUHFXHQWHHQHVWRVSDFLHQWHV/DVDQRPDOtDVFDUGLDFDV
PiVIUHFXHQWHVVRQHOGHIHFWRVHSWDOYHQWULFXODUODSHUVLVWHQFLDGHFRQGXFWRDUWHULRVR\HOGHIHFWRGHOUHOLHYH
HQGRFiUGLFR WRGDV HOODV SRWHQFLDOPHQWH UHSDUDEOHV
3RUHVWDUD]yQHVWDQLPSRUWDQWHFRQRFHUODVDVRFLDFLRQHVGHODREVWUXFFLyQGXRGHQDOFRQRWUDVDIHFFLRQHV
'HELGRDTXHODREVWUXFFLyQGXRGHQDOHQORVQHRQDWRV VLQ LPSRUWDU VX FDXVD FRQVWLWX\H XQ PRWLYR
REOLJDGRGHFLUXJtDHVLPSRUWDQWHFRQRFHUVXVIRUPDV
GH SUHVHQWDFLyQ FOtQLFD \ ORV VLJQRV UDGLROyJLFRV GH
IRUPDWHPSUDQD
Atresia duodenal
/DSULQFLSDOFDXVDGHREVWUXFFLyQLQWHVWLQDODOWDHQ
SDFLHQWHV QHRQDWRV HV OD DWUHVLD LQWHVWLQDO QR VH KD
UHFRQRFLGRXQDGLIHUHQFLDVLJQLFDWLYDHQVXLQFLGHQFLD
FRQUHVSHFWRDOVH[R2FXUUHHQXQRGHFDGD
D QDFLPLHQWRV \ HO GXRGHQR HV VX VLWLR PiV
IUHFXHQWHGHSUHVHQWDFLyQ/DDWUHVLDGXRGHQDOFRQVLVWH
HQODREOLWHUDFLyQWRWDOGHOOXPHQLQWHVWLQDODOFRQWUDULR
TXHHQODHVWHQRVLVGRQGHVyORVHREVHUYDXQDREVWUXFFLyQSDUFLDOGHOPLVPR6HKDUHSRUWDGRTXHKDVWD
HQGHORVFDVRVODREVWUXFFLyQHVGHORFDOL]DFLyQ
Octubre-Diciembre 2011
259
Imagen 1. (a)8OWUDVRQLGRSUHQDWDOGHDEGRPHQFRQGREOH
EXUEXMD (b) 5DGLRJUDItD GH DEGRPHQ HQ SRVLFLyQ HUHFWD
PRVWUDQGRGREOHEXUEXMDFRQQLYHOKLGURDpUHRHQHVWyPDJR
\GXRGHQR
SRVDPSXODU3SRUHVWDUD]yQXQLPSRUWDQWHSRUFHQWDMH
GHORVSDFLHQWHVSUHVHQWDUiQDOWHUDFLRQHVGLYHUVDVGH
ORVFRQGXFWRVELOLDUHV\GHOSiQFUHDV
/DDWUHVLD\ODHVWHQRVLVGXRGHQDORFXUUHQFRQLJXDO
IUHFXHQFLD HQ DPERV VH[RV1 (Q ORV SDFLHQWHV FRQ
DWUHVLDGXRGHQDOVHKDHQFRQWUDGRXQDUHODFLyQGLUHFWDFRQODSUHPDWXUH]\HOSROLKLGUDPQLRVPDWHUQRHQ
XQDUHYLVLyQGHSDFLHQWHVFRQHVWHQRVLVRDWUHVLD
GXRGHQDO)RQNDOVUXG\VXVFRODERUDGRUHVPRVWUDURQ
TXHGHORVSDFLHQWHVHUDQSUHPDWXURV\SUHVHQWDEDQXQSHVRPHQRUGHJDGHPiVUHSRUWDURQ
TXHGHQWURGHODVFRPSOLFDFLRQHVPDWHUQDVGXUDQWHHO
HPEDUD]RODPiVFRP~QSDUDODDWUHVLDGXRGHQDOGH
ORVSURGXFWRVHUDHOSROLKLGUDPQLRVSUHVHQWHHQ
GHORVHPEDUD]RV3
2 6 0 Octubre-Diciembre 2011
FDPHQWHODVRVSHFKD&RPRVHPHQFLRQyODSUHVHQFLD
GHO VLJQR GH OD GREOH EXUEXMD HQ OD PD\RUtD GH ORV
FDVRVFRQUPDHOGLDJQyVWLFRGHREVWUXFFLyQGXRGHQDO
VLQ QHFHVLGDG GH UHDOL]DU HVWXGLRV FRPSOHPHQWDULRV
DOHUWDQGRDOFLUXMDQRDFHUFDGHXQDLQWHUYHQFLyQREOLJDGD
GDGRTXHWRGDVODVFDXVDVFRQJpQLWDVGHREVWUXFFLyQ
GXRGHQDOUHTXLHUHQLQWHUYHQFLyQTXLU~UJLFD
(QFDVRGHTXHODUDGLRJUDItDVLPSOHQRVHDVXFLHQWH
VHSXHGHQUHDOL]DUHVWXGLRVFRQWUDVWDGRVFRQPDWHULDO
KLGURVROXEOHHQDXVHQFLDGHSDVRGHOPDWHULDOGHFRQWUDVWHDWUDYpVGHOGXRGHQRHQXQFRQWUROGHKRUDV
DGHPiVGHDXVHQFLDGHJDVGLVWDOTXHSXHGHFRQUPDUHO
GLDJQyVWLFRGHDWUHVLDGXRGHQDO&XDQGRODREVWUXFFLyQ
VHDLQFRPSOHWDVHREVHUYDUiHOSDVRPtQLPRGHPDWHULDO
GHFRQWUDVWHDWUDYpVGHOGXRGHQR2LPiJHQHVD\E
Imagen 2. (a)5DGLRJUDItDGHDEGRPHQFRQSDVRGHFRQWUDVWH
DHVWyPDJRDWUDYpVGHVRQGDQDVRJiVWULFD(b)'REOHLPDJHQ
GHFRQWUDVWHGLODWDQGRHOHVWyPDJR\HOGXRGHQRVLJQRGH
GREOHEXUEXMD
Tratamiento
$OJXQRVDXWRUHVUHSRUWDQTXHH[LVWHXQUHWUDVRGH
DSUR[LPDGDPHQWHGtDVHQWUHHOLQLFLRGHORVVtQWRPDV
HQSDFLHQWHVFRQDWUHVLDGXRGHQDO\HOPRPHQWRTXLU~UJLFRHVWHUHWUDVRLQGLFDODLPSRUWDQWHQHFHVLGDGGHO
UHFRQRFLPLHQWRWHPSUDQRGHORVVtQWRPDVGHODDWUHVLD
GXRGHQDO/RVWUDWDPLHQWRVTXLU~UJLFRVSUHIHULGRVVRQ
OD GXRGHQRGXRGHQRVWRPtD GXRGHQRGXRGHQRVWRPtD
ODSDURVFySLFD \ OD GXRGHQR\H\XQRVWRPtD FRQ HVWDV
WpFQLFDV TXLU~UJLFDV VH KD UHSRUWDGR VREUHYLYHQFLD
SRVTXLU~UJLFDGHKDVWD3 /DPD\RUtDGHODVGHIXQFLRQHVRFXUUHDSUR[LPDGDPHQWHWUHVGtDVGHVSXpVGH
ODFLUXJtD\ODVSULQFLSDOHVFDXVDVGHPXHUWHUHSRUWDGDV
SRU )RQNDOVUXG IXHURQ FRPSOLFDFLRQHV UHVSLUDWRULDV
PDOIRUPDFLRQHVDVRFLDGDVSUHPDWXUH]
\FRPSOLFDFLRQHVGHODDQDVWRPRVLV3
'LDIUDJPDRPHPEUDQDGXRGHQDO
(VXQDFDXVDGHREVWUXFFLyQGXRGHQDOFRPSOHWDR
LQFRPSOHWD6HFRQVLGHUDTXHDOUHGHGRUGHGHODV
REVWUXFFLRQHV GXRGHQDOHV VRQ SRU HVWD FDXVD sin
HPEDUJRVHKDUHSRUWDGRXQDLQFLGHQFLDGHPHPEUDQD
GXRGHQDOGHKDVWDFRPRIDFWRUGHREVWUXFFLyQSDUFLDOHQSDFLHQWHVFRQREVWUXFFLyQGXRGHQDO(OFXDGUR
FOtQLFRFDUDFWHUtVWLFRGHOSDFLHQWHVHUHODFLRQDFRQODV
PDQLIHVWDFLRQHV FOtQLFDV GH OD REVWUXFFLyQ GXRGHQDO
FRQHOYyPLWRFRPRVtQWRPDSULQFLSDO8QDSDUWLFXODULGDGGHHVWDIRUPDGHSUHVHQWDFLyQGHODREVWUXFFLyQ
GXRGHQDOVRQYyPLWRVLQWHUPLWHQWHVUHODFLRQDGRVFRQ
LQJHVWDVDEXQGDQWHV
+DOOD]JRVUDGLRJUiFRV
/RVKDOOD]JRVUDGLRJUiFRVGHSHQGHUiQGHOWLSRGH
PHPEUDQD TXH HVWH FDXVDQGR OD REVWUXFFLyQ (Q OD
UDGLRJUDItD VLPSOH GH DEGRPHQ VH REVHUYDUi GLODWDFLyQJiVWULFD\GXRGHQDOGHGLIHUHQWHVJUDGRV(QORV
HVWXGLRVFRQWUDVWDGRVVHUiSRVLEOHREVHUYDUHOSDVRGHO
PDWHULDOGHFRQWUDVWHHQIRUPDIUDJPHQWDGDDWUDYpVGHO
VLWLRGHREVWUXFFLyQFRPRXQSDVRGHOJDGR\FXUYLOtQHR
TXHVHH[WLHQGHXQDGLVWDQFLDYDULDEOHDORODUJRGHOD
OX]GXRGHQDO(OYDFLDPLHQWRJiVWULFRHVOHQWR\WDUGtR9
LPiJHQHVDEF\G
Tratamiento
(O WUDWDPLHQWR GH ODV PHPEUDQDV GXRGHQDOHV HV
TXLU~UJLFR \D VHD PHGLDQWH DERUGDMH GLUHFWR R GHO
WLSRbypass/DVXSHUYLYHQFLDSRVTXLU~UJLFDHQHVWRV
SDFLHQWHVHVGHKDVWD3/DVSULQFLSDOHVWpFQLFDV
XWLOL]DGDVGHOWLSRbypassVRQODJDVWUR\H\XQRVWRPtD
\ODGXRGHQR\H\XQRVWRPLDVLQHPEDUJRVRQSRFRIUHFXHQWHVGHELGRDVXDOWDLQFLGHQFLDGHFRPSOLFDFLRQHV
(O DERUGDMH GLUHFWR SRU RWUR ODGR FRQVLVWH HQ OD
HVFLVLyQ DELHUWD FRPSOHWD R SDUFLDO R HQ OD LQFLVLyQ
DWUDYpVGHGXRGHQRVWRPtD\UHVHFFLyQHQGRVFySLFD
(VWD ~OWLPD WpFQLFD KD WRPDGR DXJH UHFLHQWHPHQWH
Octubre-Diciembre 2011
261
&
Imagen 3. (a)5DGLRJUDItDGHWyUD[GRQGHLQFLGHQWDOPHQWHVHLGHQWLFDGLODWDFLyQGHOHVWyPDJR\GHOGXRGHQR6HUHDOL]D
VHULHJDVWURGXRGHQDOGRQGHVHREVHUYDLPDJHQGHOGXRGHQRHQIRUPDGHVHxDOGHFRQRGHDLUH(b)(OHVWXGLRHQGRVFySLFR
PXHVWUHDODGLODWDFLyQSUR[LPDOGHOGXRGHQR(c)\ODHVWUHFKH]GHELGRDXQDPHPEUDQDLGHQWLFDGDFRQPD\RUDIHFFLyQHQ
ODSDUWHVXSHULRU(d)
2 6 2 Octubre-Diciembre 2011
Hallazgos radiolgicos
5DGLRJUDItD DEGRPLQDO GHSHQGLHQGR GHO SDWUyQ
REVWUXFWLYRSXHGHPRVWUDUGLYHUVRVJUDGRVGHGLODWDFLyQGHOHVWyPDJR\GHOGXRGHQRDVtFRPRHOVLJQR
GHGREOHEXUEXMD
(OXOWUDVRQLGRSXHGHPRVWUDUODGLODWDFLyQGHOHVWyPDJR\GHOGXRGHQRHLGHQWLFDUXQDLPDJHQKLSRHFRLFD
HQVXLQWHULRUGHELGRDODSUHVHQFLDGHXQGLYHUWtFXOR
LQWUDOXPLQDO
(Q ORV HVWXGLRV GH XRURVFRSLD \ FRQ PDWHULDO GH
FRQWUDVWHSXHGHREVHUYDUVHXQDLPDJHQGHVHxDOGH
PDQJDGHYLHQWRRVLJQRGHOKDORGHELGRDODSUR\HFFLyQGHODPHPEUDQDIRUPDQGRHOGLYHUWtFXORFDXGDOD
ODOX]GXRGHQDOLPDJHQ
'HEHKDFHUVHGLDJQyVWLFRGLIHUHQFLDOFRQRWURVGHIHFWRVLQWUDOXPLQDOHVFRPRSyOLSRVDGHQRPDVTXLVWHV
GHGXSOLFDFLyQ\OLSRPDVHQWUHRWURV11
Tratamiento
/D H[WLUSDFLyQ TXLU~UJLFD PHGLDQWH GXRGHQRWRPtD
KDFHSRVLEOHODUHPLVLyQGHORVVtQWRPDV\SHUPLWHOD
UHFXSHUDFLyQFRPSOHWD
Pncreas anular
(VWDFRQGLFLyQIXHGHVFULWDSRU7LHGHPDQQHQ
(FNHUOHGLRHOQRPEUHGHDQLOORRSiQFUHDVDQXODUHQ
(VXQDDQRPDOtDFRQJpQLWDUDUDHQODTXHH[LVWH
URWDFLyQLQFRPSOHWDGHOHVER]RYHQWUDOORTXHSURYRFD
TXHXQVHJPHQWRGHSiQFUHDVURGHpODVHJXQGDSRUFLyQ
GHOGXRGHQR6HKDQIRUPXODGRYDULDVKLSyWHVLVSDUDHO
GHVDUUROORGHOSiQFUHDVDQXODUODVSULPHUDVPHQFLRQDQ
OD DGKHVLyQ GHO HVER]R YHQWUDO GHUHFKR HQ OD SDUHG
GXRGHQDOWHRUtDGH/HFFR\ODSHUVLVWHQFLDGHOHVER]R
YHQWUDOL]TXLHUGRWHRUtDGH%DOGZLQ8QDWHUFHUDWHRUtD
VXJLHUHTXHODSXQWDGHOHVER]RYHQWUDOL]TXLHUGRVH
DGKLHUHDOGXRGHQR\TXHODURWDFLyQGXRGHQDOSURYRFD
TXHpVWDTXHGHMDDOERUGHODWHUDOGXRGHQDOSDUDOXHJR
FUHFHUSRUGHODQWH\SRUGHWUiVIXVLRQiQGRVHSRVWHULRU-
PHQWHFRQHOHVER]RGRUVDOHOUHVXOWDGRHVHODQLOOR
GHWHMLGRSDQFUHiWLFRFDUDFWHUtVWLFRGHHVWDDIHFFLyQ
7DPELpQVHKDVXJHULGRTXHKLSHUWURDVGHORVEURWHV
YHQWUDO\GRUVDOVREUHSDVDUtDQORVOtPLWHVGHOGXRGHQR
SRUGHODQWH\SRUGHWUiVFUHDQGRXQDQLOORSDQFUHiWLFR
&XDQGRH[LVWHXQDQLOORFRPSOHWRGHWHMLGRVHREWHQGUiXQDREVWUXFFLyQWRWDOGHOGXRGHQRDOPRPHQWRGHO
QDFLPLHQWR VL DQLOOR HV LQFRPSOHWR OD REVWUXFFLyQ VH
SUHVHQWDUiHQHWDSDVPiVDYDQ]DGDVGHODLQIDQFLDH
LQFOXVRVLQSURGXFLUQXQFDVtQWRPDV
(VWDDOWHUDFLyQFRQJpQLWDWLHQHXQDSUHYDOHQFLDGH
XQRHQFDGDDUHFLpQQDFLGRVYLYRV
3XHGH RFXUULU GH IRUPD DLVODGD R HQ DVRFLDFLyQ FRQ
RWUDVDQRPDOtDVFRQJpQLWDV6HKDUHSRUWDGRDVRFLDFLyQ
FRQRWUDVPDOIRUPDFLRQHVFRQJpQLWDVGHOWXERGLJHVWLYR
KDVWDHQGHORVFDVRVLQFOX\HQGRDWUHVLDRHVWHQRVLVGXRGHQDOPDOURWDFLyQLQWHVWLQDODWUHVLDHVRIiJLFD
FRQItVWXODWUDTXHRHVRIiJLFDGLVWDOWLSR$\DQRUPDOLGDGHVFDUGLRYDVFXODUHV207DPELpQVHKDDVRFLDGRFRQ
DOWHUDFLRQHVFURPRVyPLFDVFRPRHOVtQGURPHGH-DFREVHQVLQHPEDUJRVHKDHQFRQWUDGRXQDUHODFLyQPiV
HVWUHFKDFRQHOVtQGURPHGH'RZQFRQLQFLGHQFLDGH
KDVWDGHFDGDQLxRVFRQHVWDFURPRVRPRSDWtD19
$XQTXHODDWUHVLDGXRGHQDOHVODFDXVDPiVFRP~QGH
ODREVWUXFFLyQGXRGHQDOHOSiQFUHDVDQXODUQRSXHGH
VHUFRPSOHWDPHQWHLJQRUDGRFRPRSRVLELOLGDGGLDJQyVWLFDHQSDFLHQWHVFRQHVWHVtQGURPHTXHVHSUHVHQWDQ
FRQXQFXDGURGHREVWUXFFLyQGXRGHQDO21
(Q OD PD\RUtD GH ORV SDFLHQWHV FRQ REVWUXFFLyQ
GXRGHQDO FRQGLFLRQDGD SRU SiQFUHDV DQXODU QR VH
SUHVHQWDQVtQWRPDVVLQRKDVWDODHGDGDGXOWD,QFOXVR
SXHGHODREVWUXFFLyQSXHGHVHUGHVFXELHUWDFRPRXQ
KDOOD]JRLQFLGHQWDODOPRPHQWRGHODDXWRSVLD/DFODVLFDFLyQGH6KLSSHQSDUDHOSiQFUHDVDQXODUVHJ~Q
VXHYROXFLyQPHQFLRQDWUHVJUXSRVTXHFRQGLFLRQDQ
ODYDULDELOLGDGGHVXSUHVHQWDFLyQFOtQLFD
D2EVWUXFFLyQGXRGHQDOFRPSOHWDFRQFLUXJtDQHFHVDULDDOQDFLPLHQWR
E2EVWUXFFLyQGXRGHQDOGHDSDULFLyQWDUGtDFRQVtQWRPDVGHSURJUHVLyQOHQWD\REVWUXFFLyQGXRGHQDO
PtQLPD
F 3UHVHQWDFLyQ DVLQWRPiWLFD GHVFXELHUWD HQ OD DXWRSVLD
(O FXDGUR FOtQLFR VH KDFH HYLGHQWH HQ HO SHULRGR
QHRQDWDOHQWUH\GHORVFDVRV+D\YyPLWRV
SHUVLVWHQWHV SRVWHULRUHV DO LQLFLR GH OD DOLPHQWDFLyQ
TXHSXHGHQVHUGHWLQWHELOLRVRRQRGHSHQGLHQGRGHO
QLYHOGHODREVWUXFFLyQKDVWDHQGHORVFDVRVVH
SUHVHQWDDQLYHOSUHDPSXODUSRUORTXHHOYyPLWRVXHOH
VHUQRELOLRVR
(VLPSRUWDQWHFRQRFHUTXHKDVWDGHORVFDVRV
VLQWRPiWLFRV GH SiQFUHDV DQXODU VH SUHVHQWDUiQ HQ
HO SHULRGR QHRQDWDO FRPR XQ FXDGUR GH REVWUXFFLyQ
JDVWURLQWHVWLQDO R GH ODV YtDV ELOLDUHV SRVLEOHPHQWH
HQ DVRFLDFLyQ FRQ SDQFUHDWLWLV (Q ORV DGXOWRV VH
PDQLIHVWDUiFRQVtQWRPDVVXJHVWLYRVGHHQIHUPHGDG
XOFHURSpSWLFDREVWUXFFLyQGXRGHQDORSDQFUHDWLWLV
(OSiQFUHDVDQXODUFRQVWLWX\HXQSRUFHQWDMHVLJQLFDWLYRGHORVFDVRVGHREVWUXFFLyQGXRGHQDO8QHVWXGLR
HQFRQWUySiQFUHDVDQXODUHQSDFLHQWHVGHO
WRWDO\PRVWUDEDQREVWUXFFLyQFRPSOHWDPLHQWUDV
TXHHQHUDLQFRPSOHWD
Octubre-Diciembre 2011
263
([LVWHQGRVWLSRVGHSiQFUHDVDQXODUH[WUDPXUDOH
LQWUDPXUDO (Q HO WLSR H[WUDPXUDO HO GXFWR SDQFUiWLFR
YHQWUDOURGHDHOGXRGHQRSDUDXQLUVHDOFRQGXFWRSDQFUHiWLFR SULQFLSDO (Q OD YDULHGDG LQWUDPXUDO HO WHMLGR
SDQFUHiWLFRGLVHFDKDFLDODVEUDVPXVFXODUHVGHOD
SDUHGGXRGHQDO\ORVGXFWRVSHTXHxRVGUHQDQGHIRUPD
GLUHFWDKDFLDHOGXRGHQR
Hallazgos radiolgicos:
(OGLDJQyVWLFRHVSUHVXQWLYR\DTXHODVLQWRPDWRORJtD
\ORVKDOOD]JRVUDGLRJUiFRVVRQVLPLODUHVHQWRGRVORV
FDVRVGHREVWUXFFLyQGXRGHQDO6HKDFRQVLGHUDGRLPSRUWDQWHUHDOL]DUHVWXGLRVGHFDVRSDUDYHULFDUVLH[LVWHQ
SDUWLFXODULGDGHVHQORVSDFLHQWHVFRQSiQFUHDVDQXODU
)UHH UHDOL]y XQ HVWXGLR FRQ SDFLHQWHV FRQ GLDJQyVWLFR GH SiQFUHDV DQXODU 5HJLVWUy ORV KDOOD]JRV
UDGLRJUiFRVSUHTXLU~UJLFRV\REVHUYyHQODVSODFDV
VLPSOHVGHDEGRPHQGHGHORVSDFLHQWHVXQDSHTXHxDFDQWLGDGGHJDVGLVWDODODSRUFLyQSUR[LPDOGHO
GXRGHQRGLVWHQGLGD(OORLQGLFDEDODQDWXUDOH]DSDUFLDO
GHODREVWUXFFLyQSRUORTXHVROLFLWyUDGLRJUDItDVGHDEGRPHQHQSRVLFLyQVXSLQDGHSLH\ODWHUDOSDUDPRVWUDU
HO VLWLR GH REVWUXFFLyQ OD VHJXQGD SRUFLyQ GXRGHQDO
GLVFUHWDPHQWHGLVWDODOEXOERGXRGHQDO21
6KDSLUR\VXVFRODERUDGRUHVUHSRUWDURQFDVRVGH
SiQFUHDVDQXODUHQHOPRPHQWRTXLU~UJLFR,QWHQWDURQ
HQFRQWUDUSDUWLFXODULGDGHVHQODIRUPDGHSUHVHQWDFLyQ
\ VLJQRV UDGLROyJLFRV FDUDFWHUtVWLFRV 6LQ HPEDUJR
PHQFLRQDURQTXHODLPDJHQUDGLRJUiFDIXHLQGLFDWLYD
GHREVWUXFFLyQGXRGHQDOHQWRGRVORVSDFLHQWHVVLQGLIHUHQFLDVVLJQLFDWLYDVFRQODVLPiJHQHVGHREVWUXFFLyQ
GHELGDDRWUDVFDXVDV(QHVWHUHSRUWHVHFRQUPyTXH
ODSUHVHQFLDGHJDVHQHOLQWHVWLQRGHOJDGRGLVWDODOD
OHVLyQGHSHQGHGHODWRWDOLGDGRQRGHODREVWUXFFLyQ
(Q DOJXQRV FDVRV VH SXHGH SUHVHQWDU QHXPDWRVLV
JiVWULFD HQ OD UDGLRJUDItD VLPSOH GH DEGRPHQ FRPR
FRPSOLFDFLyQ GHO SiQFUHDV DQXODU GHELGR DO SDVR GH
DLUHDODSDUHGJiVWULFDHVWRDFRQVHFXHQFLDGHXQD
URWXUDGHELGDDODXPHQWRGHODSUHVLyQJiVWULFDLQWUDOXPLQDOFRPRFRQVHFXHQFLDGHODREVWUXFFLyQGXRGHQDO
GHVHQFDGHQDGD SRU HO HVIXHU]R TXH UHSUHVHQWDQ ORV
YyPLWRVGHUHSHWLFLyQ
(O SiQFUHDV DQXODU SXHGH VHU GLDJQRVWLFDGR FRQ
WRPRJUDItD FRPSXWDGD \ FRQ UHVRQDQFLD PDJQpWLFD
GRQGHVHREVHUYDUiWHMLGRSDQFUHiWLFR\XQGXFWRDQXODUURGHDQGRDOGXRGHQRGHVFHQGHQWH22LPiJHQHVD
E\F
Tratamiento
1RH[LVWHXQPpWRGRTXLU~UJLFRHVSHFtFRSDUDWUDWDUHOSiQFUHDVDQXODU6HWUDWDGHXQDFLUXJtDGHDOWD
FRPSOHMLGDGGHELGRDTXHH[LVWHULHVJRVLJQLFDWLYRGH
OHVLRQDUGHOGXFWRSDQFUHiWLFRPD\RU\SURYRFDUXQD
ItVWXOD6KDSLUR\VXVFRODERUDGRUHVHQFRQWUDURQTXH
HQ QLQJXQR GH ORV SDFLHQWHV FRQ SiQFUHDV DQXODU
2 6 4 Octubre-Diciembre 2011
&
Imagen 5. (a)5DGLRJUDItDGH6(*'\GHOWUiQVLWRLQWHVWLQDO
VH LGHQWLFD GLVWHQVLyQ GHO HVWyPDJR \ GHO GXRGHQR FRQ
SDVRJUDGXDODOLQWHVWLQRGHOJDGR(b)(OXOWUDVRQLGRPXHVWUD
ODHVWUXFWXUDHFRJpQLFDGHOSiQFUHDVURGHDQGRODHVWUXFWXUD
DQHFRLFDGHOGXRGHQR(c)/DWRPRJUDItDPXHVWUDSDUWHGHO
SiQFUHDVURGHDQGRDOGXRGHQR
TXHUHSRUWDURQKXELHUDVLGRVXFLHQWHODUHPRFLyQGHO
WHMLGRSDQFUHiWLFRFLUFXODU&XDWURGHVXVSDFLHQWHVSUHVHQWDEDQHVWHQRVLVGXRGHQDOFRQHOWHMLGRSDQFUHiWLFR
DGKHULGRDODSDUHGGXRGHQDO\FLQFRPRVWUDURQDWUHVLD
FRPSOHWD3RUHVWDUD]yQODFLUXJtDQRVyORFRQVLVWH
HQODUHPRFLyQGHOWHMLGRSDQFUHiWLFRVLQRHQODFRUUHFFLyQGHXQGXRGHQRHVWHQRVDGRRDWUpVLFR/DtQWLPD
UHODFLyQHQWUHHOWHMLGRSDQFUHiWLFR\ODSDUHGGXRGHQDO
FRQGLFLRQDXQLPSRUWDQWHULHVJRGHVDQJUDGRGXUDQWH
ODFLUXJtD\HQDOJXQDVRFDVLRQHVREOLJDDUHVHFDUXQ
VHJPHQWRGHOGXRGHQRLPSOLFDGR7DPELpQVHKDUHSRUWDGRTXHHQODPD\RUtDGHORVFDVRVHOiPSXODGH9DWHU
VHHQFXHQWUDDVyORPPGHOiUHDHVWHQyVLFDSRUOR
TXHXQSURFHGLPLHQWRHQHVWHVLWLRSXHGHOOHJDUDRFOXLU
HOFRQGXFWRELOLDUFRP~Q/RVDQWHULRUHVVHFRQVLGHUDQ
DUJXPHQWRVGHSHVRHQFRQWUDGHODWDTXHTXLU~UJLFR
GLUHFWRGHOWHMLGRSDQFUHiWLFRFLUFXODU
(O DERUGDMH TXLU~UJLFR DFHSWDGR HV HO PLVPR TXH
SDUDODREVWUXFFLyQGXRGHQDOSRUFXDOTXLHUFDXVDLPiJHQHVD\E6HUHDOL]DXQFRUWRFLUFXLWRTXHGHSHQGH
GLUHFWDPHQWH GH ODV FRQGLFLRQHV DQDWyPLFDV TXH VH
REVHUYDQ DO PRPHQWR /D UHJOD LQGLFD TXH PLHQWUDV
PiVFRUWRVHDHOFRUWRFLUFXLWRHOSURQyVWLFRHVPHMRU
$FWXDOPHQWHVHFRQVLGHUDFRPRFLUXJtDGHHOHFFLyQOD
DQDVWRPRVLVGXRGHQRGXRGHQDOWpFQLFDGH.LPXUD
Quiste de duplicacin duodenal
/DV GXSOLFDFLRQHV GHO WUDFWR JDVWURLQWHVWLQDO VRQ
DQRPDOtDVFRQJpQLWDVSRFRFRPXQHVTXHVHSXHGHQ
ORFDOL]DU HQ FXDOTXLHU VHJPHQWR HO WXER GLJHVWLYR HQ
VXUHJLyQPHVHQWpULFDGHVGHODOHQJXDKDVWDHODQR
$~QQRVHFRQRFHSRUFRPSOHWRODFDXVDGHORVTXLVWHVGHGXSOLFDFLyQVLQHPEDUJRODPLJUDFLyQDQRUPDO
GHYDFXRODVRKLSyWHVLVGHODUHFDQDOL]DFLyQDQRUPDO
HVXQDWHRUtDDFHSWDGD'XUDQWHODVH[WDVHPDQDGHO
GHVDUUROORIHWDOODSUROLIHUDFLyQGHOHSLWHOLRRFOX\HSRU
FRPSOHWR HO OXPHQ LQWHVWLQDO SRVWHULRUPHQWH DSDUHFHQP~OWLSOHVYDFXRODVDSDUWLUGHOOXPHQRFOXLGR(Q
VLWXDFLRQHVQRUPDOHVODVYDFXRODVVHIXQGHQ\SDUDOD
QRYHQDVHPDQDGHJHVWDFLyQHOOXPHQLQWHVWLQDOHVXQD
HVWUXFWXUD FRPSOHWDPHQWH UHFDQDOL]DGD /D KLSyWHVLV
GHODUHFDQDOL]DFLyQDQRUPDOVRVWLHQHTXHORVTXLVWHV
GHGXSOLFDFLyQVHGHVDUUROODQDSDUWLUGHODSHUVLVWHQFLD
DQRUPDOGHGLFKDVYDFXRODV
/RVTXLVWHVGHGXSOLFDFLyQVRQHVWUXFWXUDVTXtVWLFDV
HVIpULFDVRWXEXODUHVDG\DFHQWHVDODSDUHGGHOWXER
GLJHVWLYRFRQWLHQHQP~VFXOROLVRHQVXSDUHG\HVWiQ
UHFXELHUWRVSRUPXFRVDLQWHVWLQDO6XFXELHUWDPXFRVD
QRQHFHVDULDPHQWHFRLQFLGHFRQODGHODUHJLyQGHOWXER
JDVWURLQWHVWLQDODIHFWDGRSXHVSXHGHQFRQWHQHUWHMLGR
HFWySLFR JiVWULFR HVFDPRVR WUDQVLFLRQDO R PXFRVD
FLOLDGD LQFOXVR WHMLGR SDQFUHiWLFR 6H KD UHSRUWDGR
TXHODVGXSOLFDFLRQHVJDVWURLQWHVWLQDOHVFOtQLFDPHQWH
UHOHYDQWHVVRQ~QLFDPHQWHODVTXHFRQWLHQHQPXFRVD
JiVWULFD\WHMLGRSDQFUHiWLFRFRPRWHMLGRHFWySLFR
Imagen 6. (a),PDJHQTXLU~UJLFDFRQGLODWDFLyQGHOGXRGHQR
SUR[LPDO
(b)/LEHUDFLyQGHODHVWHQRVLVGXRGHQDOFRQVHFFLyQGHOEURWHGRUVDOTXHIRUPDEDHODQLOOR!DQDVWRPRVDQGR
DPERVEURWHVGHOSiQFUHDV
Octubre-Diciembre 2011
265
QDWXUDOH]DTXtVWLFDGHODOHVLyQVLQHPEDUJRWDPELpQ
EULQGDQLQIRUPDFLyQFRPRORFDOL]DFLyQ\H[WHQVLyQDVt
FRPR FRPSOLFDFLRQHV \ DQRPDOtDV DVRFLDGDV (Q OD
WRPRJUDItDORVTXLVWHVGHGXSOLFDFLyQVRQWXPRUHVTXtVWLFRVFRQSDUHGHQJURVDGD\OLJHUDPHQWHKLSHUFDSWDQWH
SXHGHQWHQHUVXRULJHQHQODSDUHGJDVWURLQWHVWLQDOR
VHUDMHQRVDHOODLPiJHQHVD\E
(QUHODFLyQFRQORVDQiOLVLVGH0HGLFLQD1XFOHDUHO
HVWXGLR FRQ SHUWHFQHWDWR GH WHFQHFLRP EULQGD OD
HYLGHQFLDGHQLWLYDGHGXSOLFDFLyQVLHPSUHTXHH[LVWD
PXFRVDJiVWULFDHFWySLFD
Vena porta preduodenal
Embriologa
/DORFDOL]DFLyQSUHGXRGHQDOGHODYHQDSRUWDHVXQD
DQRPDOtDFRQJpQLWDUDUDUHVSRQVDEOHGHXQSHTXHxR
SRUFHQWDMHGHORVFDVRVGHREVWUXFFLyQGXRGHQDO6X
H[LVWHQFLDHVUHOHYDQWHGHELGRDODVGLFXOWDGHV\ULHVJRVTXHDFDUUHDHQFLUXJtDVTXHLQYROXFUDQDOGXRGHQR
RDODYtDELOLDU(QDOJXQDVRFDVLRQHVVXORFDOL]DFLyQ
DQyPDOD\VXUHODFLyQFHUFDQDFRQHVWUXFWXUDVDG\DFHQWHVSXHGHOOHJDUDFRPSOLFDUODVLQWHUYHQFLRQHV
Desarrollo de la vena porta
(QHOHVWDGLRGHPPODVGRVYHQDVYLWHOLQDVHVWiQ
FRQHFWDGDVSRURUDPDVFRPXQLFDQWHVHOLQWHVWLQR
VHORFDOL]DHQWUHHVWDVUDPDV1RUPDOPHQWHODUDPD
FRPXQLFDQWHGRUVDOSHUVLVWHMXQWRFRQHOVHJPHQWRFDXGDOGHOVHJPHQWRFHIiOLFR\GHUHFKRGHODYHQDYLWHOLQD
GHUHFKD8QDYHQDSRUWDSUHGXRGHQDOUHVXOWDFXDQGR
ODUDPDFRPXQLFDQWHFDXGDORYHQWUDOSHUPDQHFHHQ
FRPXQLFDFLyQFRQODUDPDGHODYHQDYLWHOLQDGHUHFKD
\FRQODXQLyQGHHVWDUDPDKDFLDHOKtJDGR29
3DULVDWR \ VXV FRODERUDGRUHV UHSRUWDURQ XQ FDVR
GH YHQD SRUWD SUHGXRGHQDO GLDJQRVWLFDGD GXUDQWH
XQDLQWHUYHQFLyQTXLU~UJLFDSRUFROHFLVWHFWRPtD\SRU
FROHFLVWROLWLDVLV6HHQFRQWUyODYHQDSRUWDSRUGHODQWH
GHOFROpGRFRRFXOWiQGRORSRUFRPSOHWRORTXHREOLJy
DXQDGLVHFFLyQ\OLEHUDFLyQFXLGDGRVDGHOFtVWLFR
&
Imagen 7. (a)6(*'GRQGHVHLGHQWLFDFRPSUHVLyQ\DSHUWXUDGHODUFRGXRGHQDOFRQGLFLRQDGDSRUXQDLPDJHQGHWHMLGR
EODQGR8OWUDVRQLGRGRQGHVHREVHUYDODFiPDUDJiVWULFD\HOGXRGHQRGLVWHQGLGRVFRQOtTXLGR(b),PDJHQTXtVWLFDDG\DFHQWH(c)'XSOLFDFLyQ
2 6 6 Octubre-Diciembre 2011
Imagen 8. (a)5HVSLUDFLyQGHOSDFLHQWHGRQGHVHLGHQWLFDHQHOODWRPRJUDItDODLPDJHQGHTXLVWHVSRUGHWUiVGHEDMR\
SRVWHULRUHVDOHVWyPDJR(b)(QODLPDJHQLQIHULRUVHLGHQWLFDTXLVWHFRQPD\RUWDPDxRGHVSOD]DQGRODWHUDOPHQWHDOGXRGHQR
/DVPDQLIHVWDFLRQHVFOtQLFDVFXDQGRVHSUHVHQWDQ
VRQODVGHXQDREVWUXFFLyQLQWHVWLQDOSDUFLDOGHELGRD
ODFRPSUHVLyQH[WUtQVHFDGHODYHQDSRUWDSUHGXRGHQDO
VREUHHOLQWHVWLQRVLQHPEDUJRHQODPD\RUtDGHORVFDVRVHVWiFRQGLFLRQDGDSRUDQRPDOtDVDVRFLDGDVFRPR
GLDIUDJPDVGXRGHQDOHVEDQGDVFROLFRGXRGHQDOHVGH
/DGGPDOURWDFLyQRSiQFUHDVDQXODU
(QWUH ODV DQRPDOtDV DVRFLDGDV PiV IUHFXHQWHV VH
HQFXHQWUDQ OD HQIHUPHGDG FDUGLDFD FRQJpQLWD SiQFUHDVDQXODU\RWUDVDOWHUDFLRQHVGHODYHQDSRUWDFRPR
HVWHQRVLVRGXSOLFDFLyQ\HVSOHQRVLV6HPHQFLRQDTXH
KDVWDHQGHORVFDVRVGHYHQDSRUWDSUHGXRGHQDO
VHKDSUHVHQWDGRsitus inversusRMDFLRQHVPHVHQWpULFDV DQRUPDOHV %ROHV \ VXV FRODERUDGRUHV HQ XQ
UHSRUWHGHFXDWURFDVRVHQFRQWUDURQGH[WURFDUGLDHQ
FDVRVsitus inversusFRPSOHWRHQXQRsitus inversusGHO
KtJDGRHQ\PDOURWDFLyQGHLQWHVWLQRGHOJDGR\FRORQ
HQ29(OUHFRQRFLPLHQWRGHODGH[WURFDUGLDFRPRXQ
FRQMXQWRGHDQRPDOtDVFRQJpQLWDVREOLJDDTXHWDQWRHO
SHGLDWUDFRPRHOFLUXMDQRFRQVLGHUHQODSRVLELOLGDGGH
YHQDSRUWDSUHGXRGHQDOHQSDFLHQWHVFRQFLHUWRJUDGR
de situs inversus R PDOURWDFLyQ 6H KD UHSRUWDGR TXH
KDVWDHQGHORVUHFLpQQDFLGRVFRQHVWHFRQMXQWRGH
DQRUPDOLGDGHVFRQJpQLWDVFRH[LVWHODDWUHVLDFRQJpQLWD
GHODVYtDVELOLDUHV(OSULPHURGHORVFDVRVUHSRUWDGRV
FRQVLVWLyHQXQDH[SORUDFLyQTXLU~UJLFDSDUDGLDJQyVWLFR
\FRUUHFFLyQGHXQDDWUHVLDELOLDUHQGRQGHDGHPiVGH
ODDWUHVLDFRQJpQLWDGHODVYtDVELOLDUHV\ODSUHVHQFLDGH
YHQDSRUWDSUHGXRGHQDODWUDYpVGHODVHJXQGDSRUFLyQ
GHO GXRGHQR VH HQFRQWUDURQ FLUURVLV ELOLDU H LFWHULFLD
REVWUXFWLYDPDOURWDFLyQGHOLQWHVWLQRGHOJDGR\FRORQ
SiQFUHDVDQXODULQFRPSOHWRGHODFLUFXQIHUHQFLD
\ HVSOHQRVLV (O VHJXQGR FDVR UHSRUWDGR SUHVHQWDED
PHPEUDQDGXRGHQDOLQFRPSOHWDFRPRODSULQFLSDOFDXVD
GHREVWUXFFLyQGXRGHQDOLQWUtQVHFDDGHPiVGHP~OWLSOHV
EDQGDVSUH\SHULGXRGHQDOHV'HQWURGHODVSULQFLSDOHV
FRPSOLFDFLRQHVGHODYHQDSRUWDSUHGXRGHQDOVHLQFOX\HQODKHPRUUDJLDSRUPDOIRUPDFLRQHVRHVWHQRVLVGHO
VLVWHPDYHQRVRSRUWDOVDQJUDGRGH~OFHUDVGXRGHQDOHV
\QHXPDWRVLVTXtVWLFDLQWHVWLQDO
Hallazgos radiolgicos
6HSXHGHQGLYLGLUHQORVGHOSHULRGRQHRQDWDO\ORV
TXHVHSUHVHQWDQHQHWDSDVDYDQ]DGDVGHODYLGD(QHO
SHULRGRQHRQDWDOH[LVWHXQDJUDQYDULHGDGGHKDOOD]JRV
$PHQRVTXHH[LVWDFRQWDFWRGHODYHQDSRUWDFRQ
HOFRQWRUQRLQWHVWLQDOQRH[LVWLUiVRVSHFKDGHREVWUXFFLyQGXRGHQDO
/DREVWUXFFLyQLQWHVWLQDOSDUFLDOSRUODYHQDSRUWD
GHEH VHU FRQVLGHUDGD HQ OD OLVWD GH FDXVDV SRVLEOHV
GH REVWUXFFLyQ GXRGHQDO SUR[LPDO R JiVWULFD GLVWDO
/DV FDUDFWHUtVWLFDV GH LPSUHVLyQ GXRGHQDO DQWHULRU
DQJXODFLyQGXRGHQDOMDFLyQ\GLODWDFLyQFRQUHWHQFLyQ
SUR[LPDO D OD LPSUHVLyQ SXHGHQ HVWDU SUHVHQWHV HQ
YDULRVJUDGRVODVDQJXODFLRQHVVXSHULRURPHGLDOGHO
GXRGHQRSUR[LPDOJHQHUDOPHQWHQRVRQVHYHUDV\SXHGHQHVWDUUHHMDGDVHQHOHVWyPDJRGLVWDOUHVXOWDQGR
HQUHWHQFLyQDQWUDO
/DREVWUXFFLyQGHODVHJXQGDSRUFLyQGHOGXRGHQRSURGXFLGDSRUSiQFUHDVDQXODUHQDVRFLDFLyQFRQ
ODYHQDSRUWDDQyPDODVHUiVLPLODUDORVFXDGURVTXH
QRHVWpQDVRFLDGRVFRQODDOWHUDFLyQGHODYHQDSRUWD
LPiJHQHVD\E
(Q DOJXQRV FDVRV VH KD HQFRQWUDGR XQD YHQD
PHVHQWpULFD FRP~Q R XQD DQRPDOtD HQ OD ILMDFLyQ
Octubre-Diciembre 2011
267
Imagen 9. (a),PDJHQWRUDFRDEGRPLQDOVLPSOHTXHPXHVWUDGREOHEXUEXMDSRUREVWUXFFLyQGXRGHQDO(b)'XUDQWHODFLUXJtD
VHLGHQWLFyTXHODFDXVDREVWUXFWLYDHVWDEDFRQGLFLRQDGDSRUYHQDSRUWDSUHGXRGHQDOVHxDODGDFRQODSLQ]D
PHVHQWpULFD8QDGLIHUHQFLDHQHOFXDGURFOtQLFRGHOD
REVWUXFFLyQGXRGHQDOSUR[LPDOSRUYHQDSRUWDSUHGXRGHQDO\PHVHQWpULFDFRP~QUDGLFDHQODSUHVHQFLDR
DXVHQFLDGHFLUURVLVELOLDUHQDWUHVLDELOLDU(QHOFDVRGH
XQFXDGURGHFLUURVLVELOLDUODKHSDWRPHJDOLDGHVSOD]DUi
DOGXRGHQRSRUIXHUDGHOFXDGUDQWHVXSHULRUGHUHFKR
VLWLR GRQGH HVSHUDUtDPRV HQFRQWUDUOR HQ FDVRV GH
PHVHQWpULFDFRP~Q6LHOFXDGURFRH[LVWHFRQDWUHVLD
ELOLDUVHUHFRQRFHUiQVLJQRVGHUDTXLWLVPRELOLDUPDOQXWULFLyQ\HGHPD
)RUPDVPiVFRPSOHMDVGHREVWUXFFLyQGXRGHQDO
PHFiQLFD HVWiQ DVRFLDGDV FRQ GLDIUDJPD YyOYXOR R
DWUHVLD
/DVPDQLIHVWDFLRQHVUDGLRJUiFDVWDUGtDVLQFOX\HQ
0DQLIHVWDFLRQHV GH REVWUXFFLyQ GXRGHQDO FUyQLFD
FRQGLODWDFLyQSUR[LPDO
OFHUDVJDVWURGXRGHQDOHVQHXPDWRVLVRYiULFHV
0HVHQWpULFDFRP~Q
(QORVFDVRVDVRFLDGRVFRQDQRPDOtDVGHODVYtDV
ELOLDUHV VH REVHUYDUiQ PDQLIHVWDFLRQHV GH XQD FLUURVLVKHSiWLFD
/DFRUUHODFLyQHQWUHORVGDWRVFOtQLFRV\ORVKDOOD]JRV
UDGLRJUiFRVGHEHREOLJDUDODVRVSHFKDGHYHQDSRUWD
SUHGXRGHQDOPDOURWDFLyQYLVFHUDOFRPRGH[WURFDUGLD\
PDOURWDFLyQGHLQWHVWLQRGHOJDGR\FRORQGHIRUPLGDG
GXRGHQDO SUR[LPDO REVWUXFFLyQ DQWHULRU H[WUtQVHFD \
SDUFLDORDQJXODFLyQ\DWUHVLDGHODVYtDVELOLDUHV
2 6 8 Octubre-Diciembre 2011
FRPSUHVLyQGXRGHQDOhQDO\VXVFRODERUDGRUHVUHDOL]DURQXQHVWXGLRHQHOTXHHYDOXDURQSDFLHQWHVFRQ
FXDGUR FOtQLFR FRPSDWLEOH FRQ HO VtQGURPH GH :LONLH
GRORU HSLJiVWULFR SRVSUDQGLDO VDFLHGDG WHPSUDQD
YyPLWR\SpUGLGDGHSHVRSRUPHGLRGHWRPRJUDItD\
XOWUDVRQLGR
(OVtQGURPHGHODDUWHULDPHVHQWpULFDVXSHULRUSXHGH
WUDWDUVHGHIRUPDFRQVHUYDGRUDFRQJUDQp[LWRKDVWD
HQXQVLQHPEDUJRHQFLHUWDVRFDVLRQHVSXHGH
UHTXHULUVHHOWUDWDPLHQWRTXLU~UJLFR
Tratamiento
(O WUDWDPLHQWR FRQVHUYDGRU FRQVLVWH HQ DOLYLDU OD
GLVWHQVLyQ JiVWULFD 3XHGHQ VHU GH XWLOLGDG ODV GHVFRPSUHVLRQHVJiVWULFDVFRQVRQGDQDVRJiVWULFDROD
UHVWDXUDFLyQGHODJUDVDUHWURSHULWRQHDO\PHVHQWpULFD
SRUPHGLRGHSHTXHxDV\P~OWLSOHVWRPDVGHDOLPHQWR
(QORVFDVRVHQORVTXHHVWDVKHUUDPLHQWDVQRVHDQVDWLVIDFWRULDVDOJXQRVDXWRUHVUHFRPLHQGDQPHGLGDVPiV
GUiVWLFDVFRPRHOVRSRUWHQXWULFLRQDOHQWHUDOXWLOL]DQGR
XQDVRQGDGHDOLPHQWDFLyQGLVWDODOVLWLRGHREVWUXFFLyQ
0pWRGRVPiVUDGLFDOHVFRQVLVWHQHQODQXWULFLyQSDUHQWHUDOHQFDVRGHTXHWRGRORDQWHULRUIUDFDVH
(OWUDWDPLHQWRTXLU~UJLFRVHUHVHUYDSDUDSDFLHQWHVHQ
TXLHQHVODVDOWHUQDWLYDVFRQVHUYDGRUDVUHSUHVHQWDURQ
IUDFDVR$OJXQDVRSFLRQHVWHUDSpXWLFDVVRQODGXRGHQR\H\XQRVWRPtD JDVWUR\H\XQRVWRPtD R OD UHVHFFLyQ
GHOOLJDPHQWRGH7UHLW]LPDJHQ(OSURFHGLPLHQWR
GH6WURQJPRYLOL]DHOGXRGHQRDOGLYLGLUHOOLJDPHQWR
GH7UHLW]HVWHSURFHGLPLHQWRKDPRVWUDGRDOWDVWDVDV
GHIUDFDVRSRUORTXH$EORZUHFRPLHQGDTXHVHGHEH
UHDOL]DUGLYLVLyQOLJDPHQWDULDPRYLOL]DFLyQFRPSOHWDGHO
GXRGHQRDVtFRPRSDVRGHODPD\RUSDUWHGHO\H\XQRH
tOHRQSRUGHEDMRGHORVYDVRVPHVHQWpULFRVVXSHULRUHV
KDFLDODFDYLGDGDEGRPLQDOGHUHFKDSRVWHULRUPHQWH
HOFRORQDVFHQGHQWHVHVHSDUDGHOUHWURSHULWRQHR\VH
FRORFDHQHOODGRL]TXLHUGRGHODEGRPHQ
/DV FRPSOLFDFLRQHV GHO VtQGURPH GH OD DUWHULD
PHVHQWpULFD VXSHULRU LQFOX\HQ GHVKLGUDWDFLyQ GHVHTXLOLEULR PHWDEyOLFR GHVQXWULFLyQ \ HQ PX\ UDUDV
RFDVLRQHVPXHUWH
0DOURWDFLyQLQWHVWLQDO\EDQGDVGHLADD
/DPDOURWDFLyQLQWHVWLQDOHVXQDDOWHUDFLyQFRQJpQLWD
FDUDFWHUL]DGD SRU XQD SRVLFLyQ DQyPDOD GH OD XQLyQ
GXRGHQR\H\XQDOHQODFDYLGDGSHULWRQHDODFRPSDxDGD
GHXQJUDGRGHMDFLyQPHVHQWpULFDDQRUPDO2FXUUH
DSUR[LPDGDPHQWHHQXQRGHFDGDQDFLPLHQWRV
(QODPD\RUtDGHORVSDFLHQWHVHOLQLFLRGHORVVtQWRPDV
RFXUUHHQODVSULPHUDVKRUDVGHYLGDGHHVWDIRUPDGHORVFDVRVVLQWRPiWLFRVRFXUUHQHQUHFLpQ
QDFLGRV \ KDVWD GH ORV FDVRV VLQWRPiWLFRV VH
SUHVHQWDQGHQWURGHOSULPHUDxRGHYLGD3DUDHQWHQGHU
HVWDDIHFFLyQHVQHFHVDULRFRQRFHUHOGHVDUUROORHPEULROyJLFRGHOLQWHVWLQR'XUDQWHHOSHULRGRJHVWDFLRQDO
Octubre-Diciembre 2011
269
Imagen 10./DLPDJHQTXLU~UJLFDFRQUPDHOGLDJQyVWLFR\
PXHVWUDODFDXVDGHODREVWUXFFLyQSRUODDUWHULDPHVHQWpULFD
WHPSUDQRHOWUDFWRLQWHVWLQDOHVXQDHVWUXFWXUDWXEXODU
\HORQJDGDTXHVHGLYLGHHQLQWHVWLQRDQWHULRULUULJDGR
SRUODDUWHULDFHOtDFDLQWHVWLQRPHGLRTXHVHH[WLHQGH
GHVGHHOWHUFLRPHGLRGHOGXRGHQRKDVWDODUHJLyQGLVWDO
GHOFRORQWUDQVYHUVR\TXHVHHQFXHQWUDLUULJDGRSRUOD
DUWHULDPHVHQWpULFDVXSHULRUHLQWHVWLQRSRVWHULRUDEDVWHFLGRSRUPHGLRGHODDUWHULDPHVHQWpULFDLQIHULRU(O
LQWHVWLQRSULPLWLYRVXIUHXQDVHULHGHPRYLPLHQWRVTXH
OHGDQVXSRVLFLyQKDELWXDOHQODHGDGDGXOWD'XUDQWH
HOGHVDUUROORHPEULRQDULRHOLQWHVWLQRVHLQWURGXFHKDFLD
HODEGRPHQ\WDQWRORVVHJPHQWRVSUHDUWHULDOGXRGHQR\H\XQDOHtOHRQWHUPLQDO\SRVDUWHULDOtOHRQGLVWDOFRORQ
GHUHFKR\GRVWHUFLRVSUR[LPDOHVGHOFRORQWUDQVYHUVR
OODPDGRVDVtSRUVXUHODFLyQFRQODDUWHULDPHVHQWpULFD
VXSHULRUURWDQ$HQFRQWUDGHODVPDQHFLOODVGHOUHORM
DSUR[LPDGDPHQWH D ODV VHPDQDV GH JHVWDFLyQ
WHQLHQGRFRPRHMHORVYDVRVRQIDORPHVHQWpULFRVKDVWD
ORJUDUVXUHODFLyQDQDWyPLFDQRUPDO
$QWHVGHODVVHPDQDVGHJHVWDFLyQHOVHJPHQWR
SUHDUWHULDOURWD$HQFRQWUDGHODVPDQHFLOODVGHOUHORMGHIRUPDTXHVHORFDOL]DDODGHUHFKDGHODDUWHULD
PHVHQWpULFDVXSHULRU3RURWURODGRVHSUHVHQWDXQD
URWDFLyQGH$FRQWUDODVPDQHFLOODVGHSDUWHGHOD
SRUFLyQ SRVDUWHULDO GH WDO IRUPD TXH VH ORFDOL]D D OD
L]TXLHUGDGHODDUWHULDPHVHQWpULFDVXSHULRU(QHVWH
SXQWRHOLQWHVWLQRPHGLRVHKHUQLDDWUDYpVGHOFRUGyQ
XPELOLFDOSDUDFRQWLQXDUVXSURFHVRGHFUHFLPLHQWR
+DFLDODVVHPDQDVGHJHVWDFLyQHOVHJPHQWRSUHGXRGHQDOVXIUHRWUDURWDFLyQGH$HQFRQWUDGHODV
PDQHFLOODVGHOUHORMORFDOL]iQGRVHSRVWHULRUDODDUWHULD
PHVHQWpULFDVXSHULRU(QWUHODV\VHPDQDVGH
JHVWDFLyQHOWXERLQWHVWLQDOVHGHVSOD]DGHQXHYRKDFLD
ODFDYLGDGSHULWRQHDOGRQGHVHOOHYDDFDERODXOWLPD
2 7 0 Octubre-Diciembre 2011
URWDFLyQGH$GHODSRUFLyQSUHDUWHULDOKDVWDTXHOD
XQLyQGXRGHQR\H\XQDOVHHQFXHQWUDDODL]TXLHUGDGH
ODFROXPQD\GH$GHOVHJPHQWRSRVDUWHULDOORFXDO
OHSHUPLWHDOFLHJRGHVFHQGHUDVXVLWLRDQDWyPLFRKDELWXDO3RU~OWLPRODURWDFLyQHVVHJXLGDGHXQSURFHVRGH
MDFLyQSHULWRQHDOHOPHVHQWHULRTXHVHVLW~DGHVGHHO
OLJDPHQWRGH7ULHW]KDVWDODYiOYXODtOHRFHFDOSUHYLHQH
TXHHOLQWHVWLQRGHOJDGRVXIUDWRUVLyQDOUHGHGRUGHOD
DUWHULDPHVHQWpULFDVXSHULRU
'HQWURGHODVDOWHUDFLRQHVGHODURWDFLyQ\MDFLyQ
LQWHVWLQDOVHHQFXHQWUDQODQRURWDFLyQPDOURWDFLyQ
\ URWDFLyQ UHYHUVD OD PDOURWDFLyQ LQWHVWLQDO SXHGH
SUHVHQWDUVHFRPRXQFXDGURGHREVWUXFFLyQGXRGHQDO
SRUHVDUD]yQVyORDERUGDUHPRVHVWHHOHPHQWRGHQWUR
GHHVWHJUXSRGHDIHFFLRQHV/DPDOURWDFLyQLQWHVWLQDO
LPSOLFDTXHWRGRHOSURFHVRGHURWDFLyQSUHYLDPHQWH
GHVFULWRRFXUUDSHURGHIRUPDLQFRPSOHWD(OJUDGR
GHDOWHUDFLyQHQHVWDPDOIRUPDFLyQHVWiGHWHUPLQDGR
SRU OD SRVLFLyQ GHO FLHJR HQ OD FDYLGDG DEGRPLQDO
GHSHQGLHQGRGHOPRPHQWRFURQROyJLFRHQTXHRFXUULy
ODDOWHUDFLyQSXHGHHQFRQWUDUVHDODL]TXLHUGDRDOD
GHUHFKDSHURHQXQDORFDOL]DFLyQPiVVXSHULRURHQ
XQD SRVLFLyQ LQWHUPHGLD (O FXDGUR GH REVWUXFFLyQ
LQWHVWLQDO HV VHFXQGDULR D YyOYXOR LQWHVWLQDO EDQGDV
EURVDVSHULWRQHDOHVGH/DGGRKHUQLDVLQWHUQDVORV
VtQWRPDVVHSUHVHQWDQFXDQGRODSRVLFLyQ\MDFLyQ
DQRUPDOGHOPHVHQWHULRIDFLOLWDODWRUVLyQLQWHVWLQDORFDVLRQDQGRREVWUXFFLyQGHOWXERGLJHVWLYR(QSDFLHQWHV
FRQPDOURWDFLyQHOFRPSRQHQWHPHVHQWpULFRGHVGH
ODXQLyQGXRGHQR\H\XQDOKDVWDHOFLHJRHVDQRUPDOPHQWHFRUWRSRUHVWDUD]yQHOLQWHVWLQRSUHVHQWDXQD
FODUDSUHGLVSRVLFLyQDODWRUVLyQDOUHGHGRUGHORVYDVRV
PHVHQWpULFRVFRQHOGHVDUUROORGHYyOYXORLQWHVWLQDO
JHQHUDOPHQWHRFXUUHHQORVSULPHURVGtDVGHYLGD\
HVXQDFRQGLFLyQSHOLJURVDTXHSRQHHQULHVJRODYLGD
GHOSDFLHQWH
/DVEDQGDVEURVDVSHULWRQHDOHVREDQGDVGH/DGG
VHKDQUHSRUWDGRHQHQWUH\GHORVSDFLHQWHV
FRQPDOURWDFLyQVHH[WLHQGHQGHVGHHOFLHJRDQRUPDOPHQWHSRVLFLRQDGRDWUDYpVGHOGXRGHQR\WLHQHQ
VXLQVHUFLyQHQHOKtJDGRHOSHULWRQHRSRVWHULRUROD
SDUHG DEGRPLQDO (O HIHFWR GH FRPSUHVLyQ TXH ODV
EDQGDVHMHUFHQVREUHHOLQWHVWLQRSURGXFHREVWUXFFLyQ
WRWDORSDUFLDOGHODOX]LQWHVWLQDO(OVtQWRPDPiVIUHFXHQWHHVODHPHVLVTXHSXHGHVHUGHWLQWHELOLRVRR
QRGHSHQGLHQGRGHOVLWLRGHODREVWUXFFLyQFRPR\DVH
KDPHQFLRQDGR(QODPD\RUtDGHORVFDVRVQRH[LVWH
GLVWHQVLyQDEGRPLQDODVRFLDGDDPHQRVGHTXHH[LVWDQ
EDQGDV GH /DGG REVWUXFWLYDV R XQ YyOYXOR LQWHVWLQDO
DJUHJDGR'HELGRDOFDUiFWHUREVWUXFWLYRGHHVWDDIHFFLyQ\DOULHVJRGHFRPSURPLVRYDVFXODUODVSULQFLSDOHV
FRPSOLFDFLRQHV VRQ QHFURVLV LQWHVWLQDO VtQGURPH GHO
LQWHVWLQRFRUWR\GHSHQGHQFLDGHQXWULFLyQSDUHQWHUDO
WRWDO$FWXDOPHQWHODPRUWDOLGDGHVGHD
+DOOD]JRVUDGLRJUiFRV
/DUDGLRJUDItDVLPSOHGHDEGRPHQSXHGHVHUQRUPDO
VLQHPEDUJRHQDOJXQRVSDFLHQWHV\GHSHQGLHQGRGHO
JUDGRGHVHYHULGDGGHODREVWUXFFLyQSRGUiREVHUYDUVH GLVWHQVLyQ JiVWULFD \ GHO GXRGHQR SUR[LPDO FRQ
HVFDVDFDQWLGDGGHJDVGLVWDO/RVHVWXGLRVEDULWDGRV
VRQORVHVWXGLRVGHHOHFFLyQSDUDHOGLDJQyVWLFRGHOD
PDOURWDFLyQFRQRVLQYyOYXORLQWHVWLQDODJUHJDGR/D
LPSRUWDQFLDGHVXHVWXGLRFRQVLVWHHQGLDJQRVWLFDUOD
SUHVHQFLDGHYyOYXOR\VXVFRPSOLFDFLRQHVLQFOX\HQGR OD SRVLELOLGDG GH QHFURVLV LQWHVWLQDO (O KDOOD]JR
FDUDFWHUtVWLFRHVODSRVLFLyQDQRUPDOGHODXQLyQGXRGHQR\H\XQDO OD SRVLFLyQ DQDWyPLFD QRUPDO HV D OD
L]TXLHUGD GH ORV SHGtFXORV YHUWHEUDOHV L]TXLHUGRV DO
PLVPR QLYHO TXH HO EXOER GXRGHQDO HQ SUR\HFFLyQ
DQWHURSRVWHULRU \ SRVWHULRU HQ SUR\HFFLRQHV ODWHUDOHV
LPiJHQHVD\E
/RVVLJQRVHQORVHVWXGLRVEDULWDGRVUHDOL]DGRVHQ
SDFLHQWHV SHGLiWULFRV FRQ REVWUXFFLyQ GXRGHQDO GH
FDUiFWHUDJXGRDXQDGDDPDOURWDFLyQLQWHVWLQDOGHSHQGHUiQGHODHWLRORJtDFDXVDQWHGHODREVWUXFFLyQ(QHO
FDVRGHTXHODREVWUXFFLyQVHDVHFXQGDULDDEDQGDV
SHULWRQHDOHVVHSUHVHQWDUiXQDFRQJXUDFLyQGXRGHQDO
HQIRUPDGH=SRURWURODGRVHSXHGHHYLGHQFLDUXQ
GXRGHQRHQIRUPDGHVDFDFRUFKRVHQSUHVHQFLDGHXQ
YyOYXORLQWHVWLQDO
/DFRQJXUDFLyQHQ=GHOGXRGHQRGLVWDO\\H\XQR
SUR[LPDOHVXQVLJQRFDUDFWHUtVWLFRGHODPDOURWDFLyQ
LQWHVWLQDOVHDGTXLHUHHVWDFRQJXUDFLyQPRUIROyJLFD
HQOXJDUGHODFXUYDJUDGXDOGXRGHQR\H\XQDODQLYHO
GHOOLJDPHQWRGH7UHLW](VWHVLJQRUDGLROyJLFRYLVXDOL]DGRWDQWRHQSUR\HFFLRQHVDQWHURSRVWHULRUHVFRPR
ODWHUDOHV HV HO UHVXOWDGR GHO FRPSRUWDPLHQWR GH OD
FXDUWDSRUFLyQGXRGHQDOHQHVWRVSDFLHQWHVHQOXJDU
GH GHVSOD]DUVH HQ GLUHFFLyQ FHIiOLFD FUX]D GH IRUPD
DJXGDDODGHUHFKD\HQGLUHFFLyQFDXGDOIRUPDQGR
XQDLPDJHQHQ=FRQODWHUFHUDSRUFLyQGHOGXRGHQR
SRUHQFLPD\HO\H\XQRSUR[LPDOSRUGHEDMR
(OVLJQRGHOVDFDFRUFKRVKDFHUHIHUHQFLDDOYyOYXOR
LQWHVWLQDO\UHSUHVHQWDODFRQJXUDFLyQHQHVSLUDOGH
ODFXDUWDSRUFLyQGHOGXRGHQR\GHO\H\XQRSUR[LPDO
(Q FDVR GH PDOURWDFLyQ FRQ YyOYXOR LQWHVWLQDO ODV
WHUFHUD\FXDUWDSRUFLRQHVGHOGXRGHQR\HO\H\XQR
SUR[LPDOVHPDQWLHQHQDODGHUHFKDGHODOtQHDPHGLD
\HQSRVLFLyQPiVEDMDGHORQRUPDOHQSUR\HFFLRQHV
DQWHURSRVWHULRUHV \ HQ SRVLFLyQ DQWHULRU HQ SUR\HFFLRQHVODWHUDOHVHVWDVDVDVLQWHVWLQDOHVSXHGHQURWDU
GDQGR FRPR UHVXOWDGR HO VLJQR GHO VDFDFRUFKR
LPiJHQHVD\E
(Q OD PD\RUtD GH ODV RFDVLRQHV ORV HVWXGLRV EDULWDGRVVRQXQDKHUUDPLHQWDGLDJQyVWLFDVXFLHQWHVLQ
HPEDUJRHQDOJXQRVFDVRVVHUiQHFHVDULRUHFXUULUD
RWURVHVWXGLRVGHLPDJHQ(OGLDJQyVWLFRGHPDOURWDFLyQLQWHVWLQDOGHEHKDFHUVHFRQFDXWHODGHELGRDTXH
H[LVWHQYDULDFLRQHVDQDWyPLFDVQRUPDOHVTXHSXHGHQ
LPLWDUHVWDDOWHUDFLyQFRQJpQLWDFRPRODOD[LWXGGHORV
OLJDPHQWRVSHULWRQHDOHVTXHSXHGHQRFDVLRQDUKDVWD
GHIDOVRVSRVLWLYRV
8QDWpFQLFDSUiFWLFDTXHKDGHPRVWUDGRVHU~WLOSDUD
HOGLDJQyVWLFRGHODPDOURWDFLyQHVODSDOSDFLyQDEGRPLQDOGXUDQWHHOHVWXGLREDULWDGRGHHVWDIRUPDODXQLyQ
GXRGHQR\H\XQDO QRUPDO PRVWUDUi PRYLPLHQWR FRQ OD
PDQLSXODFLyQPLHQWUDVTXHODXQLyQGXRGHQR\H\XQDO
HQXQSDFLHQWHFRQPDOURWDFLyQSUHVHQWDUiOLPLWDFLyQDO
PRYLPLHQWRGHELGRDOPHVHQWHULRFRUWRTXHORPDQWLHQH
HQVXSRVLFLyQ
(O XOWUDVRQLGR 'RSSOHU D\XGDUi D UHFRQRFHU OD
DQDWRPtDGHORVYDVRVPHVHQWpULFRVPLHQWUDVTXHOD
WRPRJUDItDFRPSXWDGD\ODUHVRQDQFLDPDJQpWLFDVRQ
~WLOHVHQHOUHFRQRFLPLHQWRGHODUHODFLyQHQWUHODYHQD
&
271
2 7 2 Octubre-Diciembre 2011
Referencias
-RQHV 7: 6KXWW 53$OLPHQWDU\ WUDFW
REVWUXFWLRQ LQ WKH QHZERUQ LQIDQW $
UHYLHZDQG$QDO\VLVRIFDVHV3HGLDWULFV
.DXW])*/LVD-5.UDIW(&RQJHQLWDO
'XRGHQDO 2EVWUXFWLRQ 5HSRUW RI VL[
FDVHVDQGUHYLHZRIWKHOLWHUDWXUH-RLQW
0HHWLQJRIWKH$PHULFDQ5RHQWJHQ5D\
6RFLHW\DQGWKH5DGLRORJLFDO6RFLHW\RI
1RUWK$PHULFD&KLFDJR,OO
)RQNDOVUXG(:GH/RULPLHU$$+D\V
'0&RQJHQLWDO$WUHVLDDQGVWHQRVLVRI
WKHGXRGHQXP$UHYLHZFRPSLOHGIURP
WKH0HPEHUVRIWKH6XUJLFDO6HFWLRQRI
WKH$PHULFDQ$FDGHP\ RI 3HGLDWULFV
3HGLDWULFV
$GDPHV$5*UXOOyQ,7&DVWUR0HWDO
)DFWRUHVFDXVDOHVGHREVWUXFFLyQLQWHVWLQDOGHOQHRQDWRHQHO+RVSLWDOGH1LxRV
'U$UWXUR*UXOOyQSHUtRGR
5HY0HG'RP
&RKHQ+/+DOOHU-20HVWHO$/&RUHQ
&K 6FKHFKWHU 6 5HH ' 1HRQDWXP
'XRGHQXP)OXLGDLGHG86([DPLQDWLRQ
5DGLRORJ\
0F &RRN 7$ )HOPDQ$+ (VRSKDJHDO
$WUHVLD 'XRGHQDO$WUHVLD DQG *DVWULF
'LVWHQWLRQ5HSRUWRI7ZR&DVHV$P-
5RHQWJHQRO
7UDELFL-7KH'RXEOH%XEEOH6LJQ5DGLRORJ\
&KDQLV$5(VSLQRVD+5HVHFFLyQGH
0HPEUDQD'XRGHQDO9tD(QGRVFySLFD
5HSRUWHGHXQ&DVR5HYLVWDGHO+RSLWDO
GHO1LxR
0HOHN 00 (GLUQH <( 7ZR FDVHV RI
GXRGHQDOREVWUXFWLRQGXHWRDFRQJHQLWDO
ZHE:RUOG-*DVWURHQWHURO
<DJL08KVDZD<8FKL\DPD01DOWR
0(PXUD,,QWUDOXPLQDOGXRGHQDOGLYHUWLFXOXPLQDQHRQDWH3HGLDWULF6XJ,QW
)XMLZDUD 7 .LPR 0 7DNRQND . .RED\DVKL < +DPDGD < ,QWUDOXPLQDO
GXRGHQDO GLYHUWLFXOXP LQ D FKLOG LQFLGHQWDO RQVHW SRVVLELO\ DVVRFLDWHG ZLWK
WKHLQJHVWLyQRIDIRUHLJQERG\(XU-
3HGLDWU
'DH+ZDP.LP+\XQ6HRQJ.LP<RQJ
+RRQ&KR,QWUDOXPLQDO'XRGHQDO'LYHUWLFXOXPFDXVLQJ&KURQLFJDVWURLQWHVWLQDO
%OHHGLQJ LQ$GXOWV .RUHDQ 6XUJ 6RF
+XDQ)X-HQ-LLQ+DXU.6KHXQJ)
,QWUDOXPLQDOGLYHUWtFXORGXRGHQDOVHSUHVHQWDFRPRODSDQFUHDWLWLVFUyQLFDREVWUXFWLYD 5HYLVWD GH *DVWURHQWHURORJtD
3HGLiWULFD\1XWULFLyQ
%ROHV(76PLWK%3UHGXRGHQDO3RUWDO
9HLQ3HGLDWULFV
3DWKDN ' 6DULQ <. &RQJHQLWDO 'XRGHQDO REVWUXFWLRQ GXH WR D SUHGXRGHQDO 3RUWD 9HLQ ,QGLDQ - 3HGLDWU
%LDQN9DQG:HUOLQ66XSHULRU0HVHQWHULF$UWHU\6\QGURPHLQ&KLOGUHQ$
<HDU([SHULHQFH-3HGLDWU*DVWURHQWHURO
1XWU
2NXJDZD < ,QRXH 0 8FKLGD . HW DO
6XSHULRU 0HVHQWHULF$UWHU\ 6\QGURPH
LQDQ,QIDQW&DVH5HSRUWDQG/LWHUDWXUH
5HYLHZ -RXUQDO RI 3HGLDWULF 6XUJHU\
((
$KPHG$5 7D\ORU , 6XSHULRU 0HVHQWHULF$UWHU\6\QGURPH3RVWJUDG0HG-
$OWPDQ'3XUDQLN66XSHULRU0HVHQWHULF$UWHU\6\QGURPHLQ&KLOGUHQ$-5
$OYDUDGR*DUFtD 5 3RQFH5RVDV $
*DUFtD6iQFKH] ' HW DO &RPSUHVLyQ
9DVFXODUGHO'XRGHQR HQXQ1HRQDWR
$FWD3HGLDWU0H[
hQDO%$NWDV$.HPDO*HWDO6XSHULRU
0HVHQWHULF$UWHU\ 6\QGURPH &7 DQG
8OWUDVRQRJUDSK\)LQGLQJV'LDJQ,QWHUY
5DGLRO
.RQHQ($PLWDL0$SWHU6HWDO&7$QJLRJUDSK\RI6XSHULRU0HVHQWHULF$UWHU\
6\QGURPH$-5
$SSOHJDWH .( $QGHUVRQ -0 .ODWWH
(&,QWHVWLQDO0DOURWDWLRQLQ&KLOGUHQ$
3UREOHPVROYLQJ$SSURDFKWRWKH8SSHU
*DVWURLQWHVULQDO 6HULHV 5DGLRJUDSKLFV
%HUURFDO7/DPDV0*XWLpUUH]-7RUUHV
, 3ULHWR & 'HO +R\R 0/ &RQJHQLWDO
$QRPDOLHVRI6PDOO,QWHVWLQHFRORQDQG
UHFWXP 5DGLRJUDSKLFV
2UWL]1HLUD&/7KH&RUNVFUHZ6LJQ0LGJXW9ROYXOXV5DGLRORJ\
)ULHGODQG*:0DVRQ5-RVHSK3RROH
* /DGGV %DQGV LQ 2OGHU &KLOGUHQ
$GROHVFHQWV DQG $GXOWV 5DGLRORJ\
$EORZ5&+RIIHU)$6HDVKRUH-+HW
DO=6KDSHG'RGHQRMHMXQDO/RRS6LJQ
I0HVHQWHULF)L[DWLRQ$QRPDO\DQG&RQJHQLWDO%DQGV$-5
(SHOPDQ07KH:KLUOSRRO6LJQ5DGLRORJ\
5XHVV/)UD]LHU$$6LYLW&-&7RIWKH
0HVHQWHU\2PHQWXPDQG3HULWRQHXP
LQ&KLOGUHQ5DGLRJUDSKLFV
Octubre-Diciembre 2011
273