RESUMEN
Internal hernias, in particular, hernia of the foramen of Winslow, are rare and occur in typical sites. Laparotomy is common in these cases while laparoscopic surgery is rarely used in such urgent cases. However, modern diagnosis and treatment including computed tomography and laparoscopy allowing minimally invasive interventions are not an exception for patients with hernia of the foramen of Winslow. This approach is effective for this problem and prevents adverse outcomes of disease.
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Obstrucción Intestinal , Laparoscopía , Tomografía Computarizada por Rayos X , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico , Laparoscopía/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Herniorrafia/métodos , Masculino , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Enfermedades del Colon/diagnóstico , Laparotomía/métodos , Hernia Interna/complicaciones , Hernia Interna/cirugía , Hernia Interna/diagnóstico , Hernia Interna/etiología , Femenino , Enfermedad Aguda , Persona de Mediana EdadRESUMEN
INTRODUCTION: Splenic artery aneurysm (SAA) is a focal dilation of the splenic artery with varying etiologies including atherosclerosis, arteritis, or trauma. Giant SAAs with a diameter of 10 cm is rare and can lead to severe complications like rupture and fistulas. Therefore, an accurate and timely diagnosis and treatment are important. PATIENT CONCERNS: A 50-year-old male presented with acute epigastric pain and hemorrhagic shock. Considering his symptoms and examination, ultrasound, multi-slice computed tomography and digital subtraction angiography results, a ruptured giant splenic artery aneurysm complicated with an exceptional gastric and transverse colonic fistula was suspected. DIAGNOSIS: Ruptured giant splenic artery aneurysm. INTERVENTIONS: Left anterolateral thoracotomy to control the severe aortic bleeding just above the diaphragm, aneurysmectomy, splenectomy, and closing the gastric and transverse colon perforations. OUTCOMES: Multi-slice computed tomography demonstrated the presence of splenic artery aneurysm in the distal third measuring (10â ×â 12 cm) in diameter with a true lumen measuring (7â ×â 3.5 cm) and a large hematoma extending to the greater and lesser gastric curvature. Intraoperatively, a large pulsating mass was detected occupying the epigastrium and the left hypochondrium with severe adhesions with the stomach and transverse colon. CONCLUSION: Giant SAA with a diameter of 10 cm is rare and is associated with severe complications. Therefore, successful treatment of splenic artery aneurysms involves prompt diagnosis, immediate surgical intervention to control bleeding, and tailored approaches like thoracotomy to control the thoracic aorta for better hemodynamic stabilization, aiming to eliminate the aneurysm and reduce complications effectively.
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Aneurisma Roto , Arteria Esplénica , Humanos , Masculino , Arteria Esplénica/diagnóstico por imagen , Arteria Esplénica/cirugía , Persona de Mediana Edad , Aneurisma Roto/cirugía , Aneurisma Roto/complicaciones , Aneurisma Roto/diagnóstico por imagen , Aneurisma Roto/diagnóstico , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Enfermedades del Colon/diagnóstico por imagen , Fístula Gástrica/etiología , Fístula Gástrica/cirugía , Fístula Gástrica/diagnóstico , Fístula Intestinal/cirugía , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/diagnóstico , Fístula Intestinal/complicaciones , Colon Transverso/cirugía , Colon Transverso/diagnóstico por imagenAsunto(s)
Epiplón , Colgajos Quirúrgicos , Infección de la Herida Quirúrgica , Humanos , Epiplón/trasplante , Epiplón/cirugía , Masculino , Mediastino/cirugía , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Colon Transverso/cirugía , Esternón/cirugía , Anciano , Hernia/etiologíaRESUMEN
Arteriovenous malformations (AVMs) in mesenteric vessels are exceptionally rare. These congenital vascular anomalies lead to direct vascular flow between the highly pressured arterial system and the low-pressure venous system. We describe the case of a patient with prior left colectomy for splenic flexure colonic adenocarcinoma presenting with persistent abdominal pain after developing multiple mesenteric thromboses. CT and colonoscopy showed left hemicolon congestion, anastomotic stenosis and mucosal oedema. Mesenteric angiogram revealed AVMs in the right colic and left colic arteries. Embolisation of the left colic AVM led to symptom resolution without recurrence at interval follow-up.
Asunto(s)
Malformaciones Arteriovenosas , Humanos , Malformaciones Arteriovenosas/complicaciones , Malformaciones Arteriovenosas/diagnóstico por imagen , Trombosis/diagnóstico por imagen , Trombosis/etiología , Masculino , Neoplasias del Colon/complicaciones , Neoplasias del Colon/cirugía , Embolización Terapéutica , Colectomía , Adenocarcinoma/complicaciones , Enfermedades del Colon/etiología , Enfermedades del Colon/diagnóstico por imagen , Enfermedades del Colon/cirugía , Dolor Abdominal/etiología , Colon/irrigación sanguínea , Tomografía Computarizada por Rayos X , Colonoscopía , Oclusión Vascular Mesentérica/diagnóstico por imagen , Oclusión Vascular Mesentérica/etiologíaRESUMEN
INTRODUCTION: Patients presenting with large bowel obstruction (LBO) frequently undergo emergency surgery that is associated with significant morbidity. In malignant LBO, endoscopic approaches with placement is a self-expanding metal stent (SEMS), have been proposed to prevent emergency surgery and act as a bridge to an elective procedure-with the intention of avoiding a stoma and reducing morbidity. This systematic review aims to assess the quality and outcomes of data available on the use of SEMS in benign causes of colonic obstruction. METHODS: This systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, and the protocol was registered on Prospero (ID: CRD42021239363). PUBMED, MEDLINE, HMIC, CINAHL, AMED, EMBASE, APA and Cochrane databases were searched. Studies were assessed for quality utilising the MINORS criteria. Pooled odds ratios with 95% confidence intervals (95% CI) were calculated using random effects models. RESULTS: Sixteen studies were included for analysis. 300 patients were included with an average age of 68, and a male predominance of 57%. The quality of the papers included were at risk of bias. The pooled rate of technical success of procedure was 94.4% (95% CI 90.5-96.8%) The pooled rate of clinical success was 77.6% (95% CI: 66.6-85.7%). Adverse effects were low, with perforation 8.8% (4.5-16.6%), recurrence 26.5% (17.2-38.5%) and stent migration 22.5% (14.1-33.8%). DISCUSSION: This systematic review demonstrated that SEMS for benign colonic obstruction can be a safe and successful procedure. The utilisation of SEMS in malignant disease as a bridge to surgery has been well documented. Whilst the limitations of the data interpreted are appreciated, we postulate that SEMS could be utilised to decompress patients acutely and allow pre-operative optimisation, leading to a more elective surgery with less subsequent morbidity.
Asunto(s)
Enfermedades del Colon , Obstrucción Intestinal , Stents Metálicos Autoexpandibles , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Femenino , Masculino , Resultado del Tratamiento , Anciano , Persona de Mediana EdadAsunto(s)
Fístula Cutánea , Diarrea , Gastrostomía , Fístula Intestinal , Tomografía Computarizada por Rayos X , Humanos , Gastrostomía/efectos adversos , Gastrostomía/métodos , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Fístula Intestinal/diagnóstico por imagen , Fístula Cutánea/etiología , Fístula Cutánea/cirugía , Fístula Cutánea/diagnóstico por imagen , Diarrea/etiología , Masculino , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Endoscopía Gastrointestinal/métodos , Femenino , Persona de Mediana EdadAsunto(s)
Enfermedades del Colon , Fístula Gástrica , Enfermedad Iatrogénica , Fístula Intestinal , Humanos , Fístula Gástrica/etiología , Fístula Gástrica/cirugía , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Instrumentos Quirúrgicos/efectos adversos , Masculino , Femenino , Colonoscopía/efectos adversos , Colonoscopía/instrumentación , Colonoscopía/métodosRESUMEN
Gastrocolic fistula (GCF) is defined as an abnormal pathological communication between the epithelialized mucosal layers of the stomach and colon. In rare cases, complications following gastric bypass surgery, such as leakage or complicated marginal ulcers, may contribute to the development of a GCF. The laparoscopic approach for managing GCF involves a one-stage procedure that includes resection of the fistula and reconstruction of the gastrointestinal tract.
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Derivación Gástrica , Fístula Gástrica , Fístula Intestinal , Laparoscopía , Humanos , Derivación Gástrica/métodos , Fístula Gástrica/cirugía , Fístula Gástrica/etiología , Laparoscopía/métodos , Fístula Intestinal/cirugía , Fístula Intestinal/etiología , Femenino , Obesidad Mórbida/cirugía , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Complicaciones Posoperatorias/cirugía , Resultado del Tratamiento , Persona de Mediana EdadAsunto(s)
Poliposis Adenomatosa del Colon , Neoplasias del Colon , Intususcepción , Humanos , Intususcepción/etiología , Intususcepción/diagnóstico , Intususcepción/diagnóstico por imagen , Neoplasias del Colon/complicaciones , Neoplasias del Colon/diagnóstico , Poliposis Adenomatosa del Colon/complicaciones , Poliposis Adenomatosa del Colon/diagnóstico , Colonoscopía , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/etiología , Enfermedades del Colon/microbiología , Enfermedades del Colon/diagnóstico por imagen , Masculino , Femenino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
An aortoenteric fistula (AEF) is an uncommon cause of gastrointestinal bleeding that requires prompt diagnosis and intervention owing to its high mortality rate. Moreover, iliac aneurysmo-colonic fistula is an exceptionally infrequent presentation. We report a unique case of a 71-year-old male presenting with hematochezia, later diagnosed with a primary fistula between a common iliac artery aneurysm and the sigmoid colon. Initially, the patient was misdiagnosed as having a gastrointestinal stromal tumor, leading to delayed and emergent surgical intervention due to massive bleeding 2 days later. This case is particularly notable for its rarity, misinterpretation of the initial diagnosis, complicated surgical procedures, and development of complications including ischemic myopathy. This case highlights the criticality of accurate diagnosis with a high index of suspicion, significance of consultation with a vascular surgeon for vascular abnormalities, and importance of considering ischemic time in the sequence of surgical treatments to ensure timely and appropriate management.
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Errores Diagnósticos , Hemorragia Gastrointestinal , Aneurisma Ilíaco , Fístula Intestinal , Fístula Vascular , Humanos , Masculino , Anciano , Fístula Intestinal/cirugía , Fístula Intestinal/diagnóstico por imagen , Fístula Intestinal/etiología , Aneurisma Ilíaco/cirugía , Aneurisma Ilíaco/diagnóstico por imagen , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/cirugía , Fístula Vascular/etiología , Resultado del Tratamiento , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/cirugía , Valor Predictivo de las Pruebas , Tumores del Estroma Gastrointestinal/cirugía , Tumores del Estroma Gastrointestinal/diagnóstico por imagen , Tumores del Estroma Gastrointestinal/complicaciones , Tiempo de Tratamiento , Factores de Tiempo , Diagnóstico Tardío , Angiografía por Tomografía Computarizada , Colectomía , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Enfermedades del Colon/diagnóstico por imagen , Retraso del TratamientoAsunto(s)
Angiodisplasia , Hemorragia Gastrointestinal , Humanos , Angiodisplasia/complicaciones , Enfermedades del Colon/etiología , Colonoscopía/métodos , Hemorragia Gastrointestinal/etiología , Hemorragia Gastrointestinal/terapia , Hemostáticos/administración & dosificación , Péptidos/administración & dosificación , Enfermedades del Recto/etiologíaRESUMEN
The ability to experience pleasurable sexual activity is important for human health. Receptive anal intercourse (RAI) is a common, though frequently stigmatized, pleasurable sexual activity. Little is known about how diseases of the colon, rectum, and anus and their treatments affect RAI. Engaging in RAI with gastrointestinal disease can be difficult due to the unpredictability of symptoms and treatment-related toxic effects. Patients might experience sphincter hypertonicity, gastrointestinal symptom-specific anxiety, altered pelvic blood flow from structural disorders, decreased sensation from cancer-directed therapies or body image issues from stoma creation. These can result in problematic RAI - encompassing anodyspareunia (painful RAI), arousal dysfunction, orgasm dysfunction and decreased sexual desire. Therapeutic strategies for problematic RAI in patients living with gastrointestinal diseases and/or treatment-related dysfunction include pelvic floor muscle strengthening and stretching, psychological interventions, and restorative devices. Providing health-care professionals with a framework to discuss pleasurable RAI and diagnose problematic RAI can help improve patient outcomes. Normalizing RAI, affirming pleasure from RAI and acknowledging that the gastrointestinal system is involved in sexual pleasure, sexual function and sexual health will help transform the scientific paradigm of sexual health to one that is more just and equitable.
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Enfermedades del Recto , Humanos , Enfermedades del Recto/fisiopatología , Enfermedades del Recto/terapia , Enfermedades del Recto/etiología , Enfermedades del Recto/diagnóstico , Enfermedades del Colon/terapia , Enfermedades del Colon/fisiopatología , Enfermedades del Colon/etiología , Conducta Sexual/fisiología , Enfermedades del Ano/terapia , Enfermedades del Ano/fisiopatología , Enfermedades del Ano/etiología , Enfermedades del Ano/diagnóstico , Placer/fisiología , Disfunciones Sexuales Fisiológicas/etiología , Disfunciones Sexuales Fisiológicas/terapia , Disfunciones Sexuales Fisiológicas/fisiopatologíaRESUMEN
Magnet ingestion in children can lead to serious complications, both acutely and chronically. This case report discusses the treatment approach for a case involving multiple magnet ingestions, which resulted in a jejuno-colonic fistula, segmental intestinal volvulus, hepa-tosteatosis, and renal calculus detected at a late stage. Additionally, we conducted a literature review to explore the characteristics of intestinal fistulas caused by magnet ingestion. A six-year-old girl was admitted to the Pediatric Gastroenterology Department pre-senting with intermittent abdominal pain, vomiting, and diarrhea persisting for two years. Initial differential diagnoses included celiac disease, cystic fibrosis, inflammatory bowel disease, and tuberculosis, yet the etiology remained elusive. The Pediatric Surgery team was consulted after a jejuno-colonic fistula was suspected based on magnetic resonance imaging findings. The physical examination revealed no signs of acute abdomen but showed mild abdominal distension. Subsequent upper gastrointestinal series and contrast enema graphy confirmed a jejuno-colonic fistula and segmental volvulus. The family later reported that the child had swallowed a magnet two years prior, and medical follow-up had stopped after the spontaneous expulsion of the magnets within one to two weeks. Surgical intervention was necessary to correct the volvulus and repair the large jejuno-colonic fistula. To identify relevant studies, we conducted a detailed literature search on magnet ingestion and gastrointestinal fistulas according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We identified 44 articles encompassing 55 cases where symptoms did not manifest in the acute phase and acute abdomen was not observed. In 29 cases, the time of magnet ingestion was unknown. Among the 26 cases with a known ingestion time, the average duration until fistula detection was 22.8 days (range: 1-90 days). Fistula repairs were performed via laparotomy in 47 cases.
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Fístula Intestinal , Humanos , Femenino , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Niño , Cuerpos Extraños/complicaciones , Cuerpos Extraños/cirugía , Cuerpos Extraños/diagnóstico por imagen , Imanes/efectos adversos , Síndromes de Malabsorción/etiología , Síndromes de Malabsorción/diagnóstico , Enfermedades del Yeyuno/etiología , Enfermedades del Yeyuno/cirugía , Enfermedades del Yeyuno/diagnóstico , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/etiología , Vólvulo Intestinal/diagnóstico , Enfermedades del Colon/etiología , Enfermedades del Colon/cirugíaAsunto(s)
Terapia por Acupuntura , Hematoma , Obstrucción Intestinal , Humanos , Hematoma/etiología , Hematoma/terapia , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/terapia , Terapia por Acupuntura/efectos adversos , Terapia por Acupuntura/métodos , Colonoscopía , Masculino , Enfermedades del Colon/etiología , Enfermedades del Colon/terapia , Enfermedades del Colon/cirugía , Persona de Mediana EdadRESUMEN
BACKGROUND: Ventricular bigeminy due to myocardial ischemia has been reported in humans as well as in canine patients with obstructive gastrointestinal diseases. This is the first case report of ventricular bigeminy in a dog with a colonic torsion that resolved after fluid resuscitation and restoration of myocardial perfusion. CASE PRESENTATION: An 11-year-old, male neutered mixed breed dog presented with a one day history of vomiting, tenesmus, and lethargy. Physical examination identified an irregular heart rhythm and intermittent pulse deficits. A ventricular arrhythmia represented by ventricular premature complexes (VPCs) organized in bigeminy, was appreciated on a 3-lead electrocardiogram (ECG) with a single lead (II) view. Abdominal radiographs confirmed a colonic torsion. Prior to anesthetic induction, ventricular bigeminy was non responsive to fentanyl or lidocaine. The patient was anesthetized and intravascular volume deficit was identified by dampened plethysmographic wave amplitude (plethysomographic variability), audible softening of the Doppler sound, and more pronounced pulse deficits. Fluid resuscitation was achieved with a combination of intravenous crystalloid and colloid fluid therapy comprising 7.2% hypertonic saline and 6% hetastarch. The patient's cardiac rhythm converted to normal sinus after fluid resuscitation. The colonic torsion was surgically corrected. The patient recovered well from anesthesia and was ultimately discharged from the hospital 5 days later. CONCLUSIONS: The present case report highlights that myocardial ischemia can lead to ventricular arrythmias, such as ventricular bigeminy. This is the first documented case of ventricular bigeminy in the canine patient with a colonic torsion. Assessment of patient volume status and appropriate fluid resuscitation along with continuous electrocardiogram (ECG) monitoring are vital to patient stability under general anesthesia.
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Enfermedades de los Perros , Fluidoterapia , Isquemia Miocárdica , Perros , Animales , Masculino , Enfermedades de los Perros/terapia , Fluidoterapia/veterinaria , Isquemia Miocárdica/veterinaria , Enfermedades del Colon/veterinaria , Enfermedades del Colon/terapia , Enfermedades del Colon/etiología , Electrocardiografía/veterinaria , Complejos Prematuros Ventriculares/veterinaria , Complejos Prematuros Ventriculares/etiología , Complejos Prematuros Ventriculares/terapia , Anomalía Torsional/veterinariaAsunto(s)
Enfermedades del Colon , Enfermedad de Crohn , Enfermedades Duodenales , Hallazgos Incidentales , Fístula Intestinal , Adulto , Humanos , Enfermedades del Colon/etiología , Enfermedad de Crohn/complicaciones , Anomalías del Sistema Digestivo/complicaciones , Anomalías del Sistema Digestivo/diagnóstico por imagen , Anomalías del Sistema Digestivo/cirugía , Enfermedades Duodenales/etiología , Enfermedades Duodenales/complicaciones , Fístula Intestinal/etiología , Fístula Intestinal/cirugía , Vólvulo Intestinal/cirugía , Vólvulo Intestinal/etiología , Vólvulo Intestinal/complicacionesRESUMEN
Adult-onset intussusception, particularly associated with colonoscopy, is extremely rare. A 78-year-old man, referred to our hospital for colonic endoscopic mucosal resection (EMR), experienced subsequent dull abdominal pain, as well as elevated peripheral blood leukocytosis and C-reactive protein levels. Abdominal computed tomography (CT) revealed a colocolonic intussusception at the hepatic flexure. Emergency colonoscopy revealed ball-like swollen mucosa distal to the EMR site of the ascending colon. The mucosa was intact without necrosis. The endoscopic approach was able to temporarily release the intussusception. A transanal drainage tube was inserted through the endoscope to prevent relapse. Both CT and colonoscopy showed release of the intussusception. Our case underscores the importance of considering colocolonic intussusception in post-colonoscopy abdominal pain, advocating for endoscopic management after excluding mucosal necrosis.
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Enfermedades del Colon , Resección Endoscópica de la Mucosa , Intususcepción , Humanos , Anciano , Masculino , Intususcepción/cirugía , Intususcepción/etiología , Intususcepción/diagnóstico por imagen , Resección Endoscópica de la Mucosa/efectos adversos , Resección Endoscópica de la Mucosa/métodos , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Colonoscopía/métodos , Tomografía Computarizada por Rayos X , Mucosa Intestinal/cirugía , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: The objective of this report is to identify and characterize cases of fibrosing colonopathy, a rare and underrecognized adverse event, associated with cysteamine delayed-release (DR) in patients with nephropathic cystinosis. METHODS: We searched the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS) and the medical literature for postmarketing reports of fibrosing colonopathy associated with cysteamine through August 2, 2023. RESULTS: We identified four cases of fibrosing colonopathy reported with the use of cysteamine DR. The time to onset ranged from 12 to 31 months. In one case, the patient required surgery to have a resection of a section of the strictured colon and a diverting ileostomy. Fibrosing colonopathy was diagnosed by histopathology in two of the cases. CONCLUSIONS: Our case series identified the risk of fibrosing colonopathy in patients taking cysteamine DR and prompted regulatory action by the FDA. As outlined in changes to the U.S. prescribing information for cysteamine DR, healthcare professionals should be aware of the potential risk of fibrosing colonopathy with cysteamine DR, especially as symptoms can be non-specific leading to misdiagnosis or delayed diagnosis. If the diagnosis of fibrosing colonopathy is confirmed, consideration should be given to permanently discontinuing cysteamine DR and switching to cysteamine immediate-release treatment.
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Cisteamina , Cistinosis , Preparaciones de Acción Retardada , Humanos , Cisteamina/efectos adversos , Cisteamina/administración & dosificación , Cistinosis/complicaciones , Cistinosis/diagnóstico , Cistinosis/tratamiento farmacológico , Preparaciones de Acción Retardada/efectos adversos , Femenino , Masculino , Niño , Enfermedades del Colon/inducido químicamente , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/patología , Enfermedades del Colon/etiología , Adolescente , Depletores de Cistina/administración & dosificación , Depletores de Cistina/efectos adversos , Estados Unidos , Fibrosis , Colon/patología , Colon/efectos de los fármacos , Colon/diagnóstico por imagen , Cápsulas , Preescolar , Sistemas de Registro de Reacción Adversa a MedicamentosRESUMEN
Introduction: Introduction: gastrocolic fistula is an infrequent but severe complication of percutaneous gastrostomy. Clinical suspicion in the presence of chronic diarrhea of unknown etiology manifesting after percutaneous radiological gastrostomy (PRG) tube replacement is key to early detection and treatment. Case report: we report the case of a patient with PRG that began with chronic diarrhea after tube replacement and developed severe malnutrition. Initial treatment was not effective, studies were extended with the finding of this complication in a CT image. The use of this tube was discontinued with resolution of diarrhea and a favorable nutritional outcome. Discussion: this case report shows the importance of considering gastrocolic fistula in the differential diagnosis of persistent diarrhea in a patient with a gastrostomy tube.
Introducción: Introducción: la fístula gastrocólica supone una complicación infrecuente pero potencialmente grave de las sondas de gastrostomía. La sospecha clínica ante una diarrea de origen incierto que comienza tras el recambio de la sonda es clave para la detección y el tratamiento precoces. Caso clínico: se presenta el caso de un paciente portador de gastrostomía radiológica percutánea (PRG) que comienza con diarrea persistente tras el primer recambio de la sonda y desnutrición grave secundaria. Tras el fracaso de las medidas terapéuticas iniciales se amplían los estudios, con hallazgo de esta complicación en la imagen de TC. Se suspende el uso de esta sonda con resolución de la diarrea y evolución nutricional favorable. Discusión: este caso pone de manifiesto la importancia de incluir la fístula gastrocólica en el diagnóstico diferencial de la diarrea persistente en un paciente portador de sonda de gastrostomía.
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Diarrea , Fístula Gástrica , Gastrostomía , Fístula Intestinal , Humanos , Masculino , Enfermedad Crónica , Enfermedades del Colon/etiología , Enfermedades del Colon/terapia , Diarrea/etiología , Fístula Gástrica/etiología , Gastrostomía/efectos adversos , Fístula Intestinal/etiología , Fístula Intestinal/terapia , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Tomografía Computarizada por Rayos X , AncianoRESUMEN
Successful surgical management of a chronic complex abdominal fistula requires thoughtful pre-operative evaluation and planning and often benefits from a multi-disciplinary approach. Initially, attention is focused on controlling sepsis and ensuring adequate hydration and electrolyte replacement. Next, efforts to optimize nutrition and engage the patient in prehabilitation are prioritized. Simultaneously, imaging is used to gain detailed assessment of anatomy. We present a challenging case involving a Jackson-Pratt (JP) drain from prior surgery causing a complex intra-abdominal fistula. The JP drain traversed multiple small bowel loops and the sigmoid colon before terminating in the bladder. Management required multi-disciplinary coordination involving colorectal surgery and urology. The patient's definitive surgery included anterior resection, colostomy takedown, right colectomy, three small bowel resections, and bladder repair. The use of JP drains after abdominal surgery is not without risk. Clinicians should have standardized indications for placement of JP drains and consistent protocols regarding timing of removal.