RESUMO
UNLABELLED: We report a case who developed a small bowel ulceration in a long segment of distal duodenum and proximal jejunum, a few days after he had taken high doses of diclofenac. After a month, it was complicated by a stenosis of the same segment. Nonsteroidal antiinflammatory drugs have recently been recognised as a possible etiologic factor of small bowel ulcerations. Clinical findings are aspecific. Complications of small bowel ulcerations are: obstruction, perforation or bleeding. Those have to be treated by surgery. We proposed a physiopathologic model and correlated it with histological findings. CONCLUSION: careful prescription of those drugs has to be pursued and one should think about a small bowel ulceration in a patient with an abdominal syndrome, who takes non-steroidal antiinflammatory drugs.
Assuntos
Diclofenaco/efeitos adversos , Úlcera Duodenal/induzido quimicamente , Obstrução Intestinal/induzido quimicamente , Doenças do Jejuno/induzido quimicamente , Idoso , Diclofenaco/farmacologia , Humanos , Mucosa Intestinal/efeitos dos fármacos , Obstrução Intestinal/cirurgia , Masculino , Úlcera/induzido quimicamenteRESUMO
Leiomyomas and leiomyosarcomas of the gastro-intestinal tract are quite uncommon tumours. Clinical findings are aspecific: abdominal pain and gastrointestinal bleeding. Diagnosis is made by X-ray with contrast, endoscopy and CT-scan. Although biopsies taken during endoscopy are considered to be useless, our experiences showed an accurate diagnosis with biopsies. Surgery is the only treatment. The aim is to reduce the mass of tumour as much as possible; second look operations with careful debulking enhances the survival in case of recidive. Resection of lymph-nodes is useless. Radiotherapy nor chemotherapy are proven to be useful. The grade of malignity determines the prognosis. The liver and the abdominal cavity are the predilected localisation for metastasis. Metastasis in lymph-nodes is uncommon. Five year survival is about 50%.
