<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2011-7582</journal-id>
<journal-title><![CDATA[Revista Colombiana de Cirugía]]></journal-title>
<abbrev-journal-title><![CDATA[rev. colomb. cir.]]></abbrev-journal-title>
<issn>2011-7582</issn>
<publisher>
<publisher-name><![CDATA[Asociación Colombiana de Cirugía]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2011-75822021000100144</article-id>
<article-id pub-id-type="doi">10.30944/20117582.547</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Escudo de Blumer: signo diagnóstico de la diseminación a distancia del cáncer gástrico difuso]]></article-title>
<article-title xml:lang="en"><![CDATA[Blumer&#8217;s shelf: diagnostic sign of distant spread of diffuse gastric cancer]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Sarriugarte-Lasarte]]></surname>
<given-names><![CDATA[Aingeru]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García-Alberdi]]></surname>
<given-names><![CDATA[Eva]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gutierrez-Grijalba]]></surname>
<given-names><![CDATA[Oihane]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Mifsut-Porcel]]></surname>
<given-names><![CDATA[Patricia]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Gómez-Cruzado]]></surname>
<given-names><![CDATA[Laura Fernández]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Hospital universitario de Cruces  ]]></institution>
<addr-line><![CDATA[Vizcaya ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Hospital universitario de Cruces  ]]></institution>
<addr-line><![CDATA[Vizcaya ]]></addr-line>
<country>España</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital universitario de Cruces  ]]></institution>
<addr-line><![CDATA[Vizcaya ]]></addr-line>
<country>España</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>03</month>
<year>2021</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>03</month>
<year>2021</year>
</pub-date>
<volume>36</volume>
<numero>1</numero>
<fpage>144</fpage>
<lpage>149</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_arttext&amp;pid=S2011-75822021000100144&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_abstract&amp;pid=S2011-75822021000100144&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.co/scielo.php?script=sci_pdf&amp;pid=S2011-75822021000100144&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen  Introducción. Se conoce como escudo de Blumer al engrosamiento neoplásico del fondo de saco de Douglas, palpable al tacto rectal como una protrusión en forma de resalte, presente en pacientes afectados por carcinomas con infiltración difusa. A pesar de haber sido descrito hace más de un siglo, se trata de un proceso diagnosticado infrecuentemente y con escasa mención en la literatura científica. Es preciso tener un alto nivel de sospecha clínica para correlacionar los síntomas pélvicos con la presencia de un tumor, habitualmente gástrico.  Casos clínicos. Presentamos dos pacientes con hallazgo de escudo de Blumer, asociado a cáncer gástrico difuso, uno como diagnóstico primario de enfermedad metastásica y otro como recidiva de la enfermedad, meses después de ser operado. Ambos casos presentan un complejo proceso diagnóstico, en el que prima la sospecha clínica, apoyado sobre pruebas de imagen como tomografía computarizada y resonancia nuclear magnética, ya que tanto las biopsias obtenidas por endoscopia, como las biopsias intraoperatorias fueron negativas.  Discusión. En el escudo de Blumer, las células tumorales infiltran el fondo de saco de Douglas de forma difusa por debajo de la serosa, sin necesidad de que existan implantes macroscópicamente visibles en el peritoneo visceral. La infiltración tumoral puede afectar extrínsecamente al recto, causando una estenosis del mismo, lo que produce sintomatología pélvica inespecífica, como tenesmo rectal y proctalgia. Por lo tanto, este ominoso proceso debe ser sospechado en pacientes con sintomatología pélvica, que presenten o hayan presentado cáncer gástrico.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract  Introduction.  The neoplastic thickening of the cul-de-sac of Douglas is known as &#8220;Blumer&#8217;s shelf&#8221;. It is palpable on rectal examination as a protrusion in the form of a projection, and it presents in patients affected by carcinomas with diffuse infiltration. Despite being described more than a century ago, it is a rare process with little mention in the scientific literature. A high level of clinical suspicion is required to correlate pelvic symptoms with the presence of a typically gastric tumor.  Clinical cases.  We present two patients with a Blumer&#8217;s shelf finding associated with diffuse gastric cancer, one as a primary diagnosis of metastatic disease and the other as a recurrence of the disease, months after being operated on. Both cases present a complex diagnostic process, in which clinical suspicion prevails, supported by imaging tests such as computed tomography and magnetic resonance imaging, since both endoscopic biopsies and intraoperative biopsies were negative.  Discussion.  In Blumer&#8217;s shelf, tumor cells infiltrate the cul-de-sac of Douglas in a diffuse and subserous manner, without the need for macroscopically visible implants in the visceral peritoneum. Tumor infiltration can extrinsically affect the rectum, causing its stenosis, which produces nonspecific pelvic symptoms such as rectal tenesmus and proctalgia. Therefore, this ominous process should be suspected in patients with pelvic symptoms, who present or have presented gastric cancer.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[estómago]]></kwd>
<kwd lng="es"><![CDATA[neoplasias gástricas]]></kwd>
<kwd lng="es"><![CDATA[adenocarcinoma]]></kwd>
<kwd lng="es"><![CDATA[linitis plástica]]></kwd>
<kwd lng="es"><![CDATA[escudo de Blumer]]></kwd>
<kwd lng="en"><![CDATA[stomach]]></kwd>
<kwd lng="en"><![CDATA[gastric neoplasms]]></kwd>
<kwd lng="en"><![CDATA[adenocarcinoma]]></kwd>
<kwd lng="en"><![CDATA[plastic linitis]]></kwd>
<kwd lng="en"><![CDATA[Blumer shelf]]></kwd>
</kwd-group>
</article-meta>
</front><back>
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