Superior mesenteric artery syndrome as a complication of ileal pouch-anal anastomosis. Report of a case.

PURPOSE: Duodenal compression by the superior mesenteric artery following total proctocolectomy and ileal pouch-anal anastomosis is a rare occurrence. Previous surgical treatment involved duodenal division. The aim of this report was to describe a case with such a complication and to discuss an operative alternative. METHODS: Case report. RESULTS: Mobilization of the duodenum from its retroperitoneal attachments, without transection and reanastomosis, allowed the free passage of gas through the duodenum and recovery for the patient. CONCLUSION: This case report suggests that a more conservative approach may be successful in managing this complication.

The two-chamber ileal pelvic reservoir--an alternative design.

A new ileal pouch design, combining an upper triplicate ileum with a lower duplicate ileum, is described. The physical characteristics of this two-chamber reservoir would lead to better functional results by delaying the filling time of the reservoir.

[Cytopathological test performed during colonoscopy in the diagnosis of colorectal stenosis]. / Exame citopatológico realizado durante colonoscopia no diagnóstico das estenoses colorretais.

The etiological diagnosis for the colorectal strictures can be very difficult. With the colonoscopy, it was possible to obtain samples with direct vision of the lesion. Consequently, the cytologic efficiency improved, with similar or even better results than histopathology. In the present study (107 patients) it was used the cytopathology performed during colonoscopy. After a specimen was obtained, it was smeared on glass slide, fixed in 95% alcohol, stained by HE, and examined microscopically, with conclusions during the procedure. The results were compared and further correlated to the histopathology of surgical specimen or based on clinical follow-up in those case not submitted to operation. The results showed a striking degree of correlation between both exams. For the cytopathology there were no inconclusive results, false-negative were less frequent than with histopathology, and only one case of false-positive (rectal villus adenoma) was observed. Considering the type, localization and perviousness of the lesion, similar conclusions were drawn, and did not affect the results, except that there were more false-negatives in both exams when the lesions were impervious. The cytopathological and histopathological studies were both highly sensitive and specific for the diagnosis of carcinoma. In conclusion, cytopathology performed during colonoscopy is safe and efficient in the study of colorectal strictures, which contributes to improve the orientation of these patients.

Septo da vesicula biliar. / Gallbladder septum

Os autores apresentam 12 casos de vesicula biliar com septos e sintomatologia tipica de colecistopatia cronica calculosa, submetidos a colecistectomia. A anomalia e facilmente reconhecida ao exame radiologico contrastado e os sintomas sao causados nao pela inflamacao, mas pelo aumento da pressao dentro da vesicula biliar, pela relativa demora no esvaziamento. Em todos os casos, nao foram encontradas reacoes inflamatorias evidentes no orgao, a despeito da dor e quadro clinico tipico. A colecistectomia, nestes casos, foi indicada, tendo em vista a queixa clinica evidente e a piora da dor da ingestao de alimentos gordurosos; todos os doentes beneficiaram-se com a operacao. Concluem que os pacientes portadores de septo da vesicula biliar devem ser operados sempre que apresentarem queixa da colecistopatia, principalmente colicas biliares e quando o colecistograma mostrar septo, com retardo no seu esvaziamento

Mucocele do apendice. / Mucocele of the appendix

Os autores apresentam quatro casos de uma rara alteracao do apendice vermiforme: "mucocele do apendice". Mostram quatro classificacoes de mucoceles de acordo com os achados microscopicos e lembram que mucocele e um dos diagnosticos diferenciais de dor abdominal

O emprego da nutricao parenteral no tratamento das fistulas digestivas.Analise de 78 doentes. / Use of parenteral nutrition in the treatment of digestive fistula

Os autores apresentam 78 doentes com fistulas digestivas, sendo 19 esofagicas, 24 gastroduodenais, 14 jejuno iliais, 5 colonicas, 14 das vias biliares e 2 pancreaticas. Foi empregada a nutricao parenteral alem dos cuidados no controle das infeccoes e do local da fistula. Sobreviveram 64,2% dos pacientes e o fechamento parcial ocorreu em 8 pacientes, 2 dos quais apresentavam obstrucao distal, e outro, implante de carcinoma no trajeto fistuloso.Nenhum destes requereu reoperacao pelos pequenos debitos apresentados. O tempo variou de 5 a 90 dias, em media 21, sendo de 32 dias para os sobreviventes. A complicacao principal foi de intolerancia a glicose em doentes infectados. Os resultados obtidos permitiram a insistenica em periodos longos de nutricao parenteral, sem cirurgia associada, a nao ser em casos especiais

Emprego do bisturi eletrico na seccao das tunicas e na hemostasia dos vasos da submucosa nas anastomoses do tubo digestivo. / Use of eletric cautery in section of the tunicae and in the hemostasis of submucous veins in the anastomosis of digestive tube

Os autores analisam os resultados obtidos com o emprego do bisturi eletrico, tanto na seccao das tunicas do tubo digestivo a serem anastomosadas ou suturadas, quanto na hemostasia dos vasos da submucosa, no preparo da boca anastomotica, em 183 doentes submetidos a cirurgia do tubo digestivo, com justaposicao das bordas. O metodo oferece a seguranca necessaria a sua utilizacao rotineira, sendo a principal vantagem a simplicidade, reduzido sensivelmente o tempo operatorio e tornado a sutura em plano unico mais simples e portanto mais acessivel a todos os cirurgioes que a praticam

Carcinoide do reto. / Carcinoid tumor of the rectum

Os autores apresentam um caso de tumor carcinoide de reto. Tecem consideracoes quanto ao diagnostico, tratamento e prognostico. A paciente foi tratada com resseccao de seguimento, clinico e endoscopico mensal

[Treatment of injuries of the duodenum and pancreas]. / Tratamento dos ferimentos do duodeno e do pancreas.

The authors study 84 patients that had damages of the duodenum and or pancreas and underwent different types of surgery. In 39 patients who had damage only in the duodenum; there were 2 (4.0%) duodenal fistulas, and 3 (6.0%) intraperitoneal abscess. In 38 patients who had injuries only in the pancreas; there were 6 (13.1%) acute pancreatities, pancreatic fistulas and 1 (2.2%) pancreatic pseudocyst. In 7 cases, injuries were found to both pancreas and duodenum. The author reports 1 case of duodenal fistula (14.3%) 1 case of acute pancreatitis (14.3%) and 3 cases of pancreatic fistula (43.0%). Only 7 patients died (8.3%), and of these 2 died for reasons not directly related to the operatory technic used. A simple suture can be performed in those cases where a complete section of the duodenum is unnecessary and there is no injury to the duodenal papilla. A burying suture of the stomas associated with a side-to-side duodenojejunal anastomosis should be preferred in the complete section of the duodenum localized beyond the ampulla of Vater. In all superficial wounds of small extension a suture of the pancreas should be performed. Distal pancreatectomy of body or tail should be made in the wounds with a possible lesion to the Wirsung duct and when there is an extensive glandular lesion. The associate wounds of duodenum and pancreas should be treated as if they were isolated lesions.

[Treatment of acute pancreatitis by glucagon. Experimental studies in dogs]. / Tratamento da pancreatite aguda pelo glucagon. Estudo experimental em caes.

The authors made a comparative study of the use of glucagon (4 mg/day IV) in 30 dogs with acute pancreatitis. They found that the mortality and amylasemia were significantly lower in the glucagon-treated group than in the control groups (saline and glucose solution 5%). In the glucagon group, the areas of necrosis were smaller (1.5 cm) and rarely found; microscopically, the areas of necrosis and the inflammatory reaction were much smaller than in the other groups. These findings lead to the conclusion that the beneficial action of glucagon is due to another mechanism other than its hyperglycemic effect and that the administration of hypertonic solutions of glucose does not have a beneficial effect in acute pancreatitis.