RESUMEN
We have read the article by Pérez-Santiago L et al. on the conservative or surgical management of pneumatosis intestinalis (PI). Recently we saw a case of a 18-year-old female diagnosed with anorexia nervosa who presented due to general malaise, asthenia, and inability to walk following an episode of abdominal pain, vomiting and diarrhea (10-15 stools daily, some of them bloody). Physical examination revealed signs of malnutrition and dehydration, and a distended, tender abdomen with no signs of peritoneal irritation. Laboratory chemistry tests revealed macrocytic anemia and metabolic alkalosis. An abdominal CT scan showed pancolonic pneumatosis, with greater involvement of the cecum, ascending and transverse colon, as well as pneumoperitoneum and gas in branches of the superior mesenteric and portal veins.
Asunto(s)
Anorexia Nerviosa , Neumatosis Cistoide Intestinal , Neumoperitoneo , Adolescente , Anorexia Nerviosa/complicaciones , Femenino , Humanos , Neumatosis Cistoide Intestinal/diagnóstico por imagen , Neumatosis Cistoide Intestinal/etiología , Vena Porta , Tomografía Computarizada por Rayos XAsunto(s)
Adenocarcinoma/secundario , Neoplasias del Colon/patología , Neoplasias Hepáticas/secundario , Neoplasias Primarias Múltiples/patología , Tumores Neuroendocrinos/secundario , Adenocarcinoma/cirugía , Anciano , Anemia/etiología , Neoplasias del Ciego/complicaciones , Neoplasias del Ciego/patología , Neoplasias del Ciego/cirugía , Colectomía , Neoplasias del Colon/complicaciones , Neoplasias del Colon/cirugía , Femenino , Hemorragia Gastrointestinal/etiología , Hepatectomía/métodos , Humanos , Neoplasias Hepáticas/cirugía , Neoplasias Primarias Múltiples/cirugía , Tumores Neuroendocrinos/cirugíaRESUMEN
OBJECTIVE: To find out if the patients' age affects the treatment of abdominal hernias and the results in relation of the age increase. DESIGN: Retrospective and prospective study. SETTING: University hospital, Spain. SUBJECTS: 664 patients aged 70 years or more operated on for abdominal hernia between 1986-1998. Patients were divided into three groups: 443 aged 70-79; 202 aged 80-89; and 19 patients aged 90 years or more. MAIN OUTCOME MEASURES: Perioperative risk, type of surgery and deaths. RESULTS: 117 women (52%) had femoral hernias, compared with 32 men (7%) (p = 0.0001). The incidence of femoral hernia over 80 years of age was 79/221 (36%) compared with 70/443 (16%) among patients in their seventies (p = 0.0001). 97 of the patients aged 70-79 (22%) were operated on as emergencies, 107 of those aged 80-89 (53%), and 17 in patients 90 or older (89%, p = 0.0001). The mortality rate was 1% in the 70-79 group (n = 6), 5% (n = 10) in the 80-89 group, and 3/19 died in the over 90 group (p = 0.0001). No deaths were reported after elective surgery. CONCLUSION: Emergency operations in elderly patients with abdominal wall hernias are increasingly more common as the patient get older. As result, there is an unacceptable increase in postoperative mortality.