Asunto(s)
Neoplasias Gastrointestinales/cirugía , Intestino Delgado/cirugía , Nevo Azul/cirugía , Neoplasias Cutáneas/cirugía , Adolescente , Colonoscopía , Femenino , Neoplasias Gastrointestinales/diagnóstico por imagen , Neoplasias Gastrointestinales/patología , Gastroscopía , Humanos , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/patología , Nevo Azul/diagnóstico por imagen , Nevo Azul/patología , Radiografía , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patologíaAsunto(s)
Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/terapia , Endosonografía , Hemobilia/diagnóstico por imagen , Hemobilia/terapia , Arteria Hepática , Adhesivos/administración & dosificación , Aneurisma Roto/complicaciones , Enbucrilato/administración & dosificación , Hemobilia/etiología , Humanos , Inyecciones/métodos , Masculino , Persona de Mediana EdadAsunto(s)
Ascariasis/complicaciones , Ascariasis/terapia , Ascaris lumbricoides , Pancreatitis/parasitología , Pancreatitis/terapia , Adulto , Animales , Antinematodos/uso terapéutico , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Masculino , Mebendazol/uso terapéutico , Esfinterotomía EndoscópicaAsunto(s)
Coristoma/diagnóstico por imagen , Endosonografía/métodos , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Páncreas , Neoplasias Gástricas/diagnóstico por imagen , Anciano , Biopsia con Aguja , Coristoma/diagnóstico , Coristoma/cirugía , Trastornos de Deglución/diagnóstico , Trastornos de Deglución/etiología , Diagnóstico Diferencial , Femenino , Tumores del Estroma Gastrointestinal/diagnóstico , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Inmunohistoquímica , Medición de Riesgo , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirugía , Tomografía Computarizada por Rayos X , Pérdida de PesoAsunto(s)
Apéndice , Enfermedades del Ciego/diagnóstico , Neoplasias del Ciego/diagnóstico , Tumores del Estroma Gastrointestinal/diagnóstico , Mucocele/diagnóstico , Dolor Abdominal/diagnóstico , Dolor Abdominal/etiología , Apendicectomía/métodos , Enfermedades del Ciego/cirugía , Neoplasias del Ciego/cirugía , Ciego , Colonoscopía/métodos , Diagnóstico Diferencial , Endosonografía/métodos , Estudios de Seguimiento , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Mucocele/cirugía , Medición de Riesgo , Resultado del TratamientoAsunto(s)
Enfermedades de la Aorta/diagnóstico , Implantación de Prótesis Vascular/efectos adversos , Prótesis Vascular/efectos adversos , Fístula Esofágica/diagnóstico , Esofagoscopía , Aneurisma Infectado/diagnóstico por imagen , Aneurisma Infectado/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Aneurisma de la Aorta Torácica/cirugía , Enfermedades de la Aorta/etiología , Enfermedades de la Aorta/terapia , Implantación de Prótesis Vascular/métodos , Tratamiento de Urgencia/métodos , Fístula Esofágica/etiología , Fístula Esofágica/terapia , Resultado Fatal , Femenino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiología , Humanos , Persona de Mediana Edad , Falla de Prótesis , Radiografía , Choque Hemorrágico/etiología , Choque Hemorrágico/fisiopatología , Insuficiencia del Tratamiento , Procedimientos Quirúrgicos Vasculares/métodosRESUMEN
STUDY AIMS: The aims of this study were to evaluate the efficacy and safety of precut sphincterotomy in relation to the experience of a single endoscopist, and to establish the number of procedures required before achieving an effective and safe precut sphincterotomy. METHODS: A total of 200 consecutive patients underwent precut sphincterotomy carried out by a single endoscopist (T.A.) between January 2003 and December 2005. All of the procedures were divided into four chronological groups of 50 (Group I, II, III, and IV). Medical records and patient data were retrospectively reviewed and included procedure indications, outcomes, and complications. All patients were admitted for observation after the procedure in case of complications. RESULTS: A total of 200 patients (23.3%) (mean age 58.5 years; 101 men) underwent precut sphincterotomy (161 with needle-knife technique, 32 with septotomy technique, and seven with Erlangen technique). There was no mortality. The success rates of prompt bile duct cannulation after precut sphincterotomy were 88%, 86%, 94%, and 82%, respectively ( P > 0.05). Immediate bleeding requiring a submucosal adrenaline injection was observed in combined group I - II (28%) and combined group III - IV (7%) ( P < 0.05). One patient (2%) from each of group I, III, and IV required further endoscopic treatment for rebleeding. Duodenal perforation (2%) was detected and conservatively treated in one patient from group II. Mild pancreatitis was found in one patient (2%) in group III. CONCLUSIONS: The success rates of bile duct cannulation by precut sphincterotomy were not associated with the experience of the endoscopist. The postprocedural complications significantly decreased after the first 100 procedures. An experience of at least 100 procedures is suggested to achieve a safe precut sphincterotomy.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestasis/cirugía , Esfinterotomía Endoscópica/métodos , Adulto , Anciano , Colestasis/diagnóstico , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Complicaciones Posoperatorias , Cuidados Preoperatorios/métodos , Probabilidad , Estudios Retrospectivos , Medición de Riesgo , Índice de Severidad de la Enfermedad , Esfinterotomía Endoscópica/efectos adversos , Resultado del TratamientoRESUMEN
OBJECTIVE: Bile Duct Injury (BDI) is one of the most serious complications of cholecystectomy. The authors analyzed the clinical presentation, surgical management and long-term outcome of 19 patients presenting with iatrogenic major BDIs (Straburg type E) following cholecystectomy who underwent Roux-en-Y hepaticojejunostomy. MATERIAL AND METHOD: Between 1992 and 2005, 19 patients with major BDIs (Strasberg type E) following cholecystectomy were included. Operative notes and charts of all patients were reviewed systematically. A follow-up examination of each patient was performed after a median of 22 months (range 1-120). RESULTS: Twelve patients presented with ascending cholangitis, two patients were referred to the hospital with biliary-cutaneous fistula and five patients (26.3%) were identified at the time of operations. All patients were treated with Roux-en-Y hepaticojejunostomy with at least 2 cm of the diameter of the biliary-enteric anastomosis. There was no postoperative mortality. Postoperative complication was found in 5 patients (26.3%). Until now, during the follow-up, neither clinical nor biochemical evidence of recurrent cholangitis has been found. CONCLUSION: Major BDIs are associated with high morbidity rate and prolonged hospitalization. Early detection and referral to an experienced center is crucial in the management of these patients. Roux-en-Y hepaticojejunostomy with large diameter of the biliary-enteric anastomosis is the surgical procedure of choice with good long-term outcome.
Asunto(s)
Anastomosis en-Y de Roux , Anastomosis Quirúrgica , Conductos Biliares/lesiones , Conductos Biliares/cirugía , Colecistectomía/efectos adversos , Enfermedad Iatrogénica , Yeyunostomía , Complicaciones Posoperatorias , Adulto , Anciano , Anastomosis en-Y de Roux/métodos , Anastomosis Quirúrgica/métodos , Femenino , Conducto Hepático Común/cirugía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
A new mechanical puncture video echoendoscope (GF-UMD-240P 270 degrees image field parallel to the endoscope axis) has been used for puncture and drainage of a symptomatic pancreatic pseudocyst. It is equipped with a 2.8 mm working channel and an elevator allowing single step drainage with passage of a 7F nasocystic catheter.
Asunto(s)
Endoscopios Gastrointestinales , Seudoquiste Pancreático/cirugía , Grabación en Video , Adulto , Diseño de Equipo , Humanos , Masculino , Seudoquiste Pancreático/diagnóstico por imagen , Punciones/instrumentación , Tomografía Computarizada por Rayos X , Ultrasonografía/instrumentaciónRESUMEN
Clofazimine-induced crystal-storing histiocytosis is a rare but well-recognized condition in the literature. Besides the common reddish discoloration of the skin, clofazimine produces gastrointestinal disturbances-sometimes severe abdominal pain, prompting exploratory laparotomy, because pathologic and radiologic findings can produce diagnostic difficulties if the pathologic changes caused by clofazimine are not recognized. The authors report such a case in a leprosy patient to emphasize the importance of history taking, the radiologic abnormalities of the small intestine, and the pathologic findings in small intestine and lymph node biopsies. Clofazimine crystals are red in the frozen section and exhibit bright-red birefringence. However, they are clear in routinely processed histologic sections because they dissolve in alcohol and organic solvents. They also appear as clear crystal spaces during electron microscopic study, but some osmiophilic bodies can be observed. Histiocytosis caused by clofazimine crystals produces infiltrative lesions in radiologic studies mimicking malignant lymphoma or other infiltrative disorders. Associated plasmacytosis in the histologic sections can simulate lymphoplasmacytic lymphoma or multiple myeloma with crystal-storing histiocytosis. With the knowledge of this rare condition caused by clofazimine, appropriate management to avoid an unnecessary laparotomy is possible.
Asunto(s)
Dolor Abdominal/inducido químicamente , Clofazimina/efectos adversos , Histiocitosis/inducido químicamente , Leprostáticos/efectos adversos , Lepra/complicaciones , Dolor Abdominal/diagnóstico , Adulto , Biopsia , Enfermedad Crónica , Cristalización , Citoplasma/ultraestructura , Diagnóstico Diferencial , Secciones por Congelación , Histiocitos/patología , Histiocitosis/diagnóstico , Humanos , Mucosa Intestinal/citología , Mucosa Intestinal/patología , Yeyuno/citología , Yeyuno/diagnóstico por imagen , Yeyuno/patología , Lepra/tratamiento farmacológico , Ganglios Linfáticos/citología , Ganglios Linfáticos/patología , Masculino , Microscopía Electrónica , RadiografíaRESUMEN
Owing to its rarity, solitary rectal ulcer syndrome (SRUS) is often misdiagnosed as malignant ulcer, or ulcer in association with inflammatory bowel disease. We present two adult females with anorectal symptoms (i.e. pain, tenesmus and bowel habit changes). Both had normal levels of serum carcinoembryonic antigen. Barium enema revealed irregular mucosa with stricture of the lower rectum. An ulcer, 2.7 cm in diameter, was found in one patient but not the other. Rectal biopsy under sigmoidoscopy demonstrated non-specific inflammation, without evidence of malignancy. Because of the intractable symptoms and the inability to discriminate between malignant and benign conditions, exploratory laparotomy was performed, followed by low anterior resection of the rectum. Histological examination of both specimens showed submucosal rectal fibrosis with a non-specific ulceration in one. These findings were compatible with SRUS. The patients' symptoms improved dramatically after the resection and they remain well, five months and one year after surgery. Awareness of this rare anorectal condition is necessary for appropriate management particularly to avoid unnecessary abdomino-perineal resection.