RESUMO
Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD.
Assuntos
Fundoplicatura , Refluxo Gastroesofágico/cirurgia , Complicações Pós-Operatórias , Fundoplicatura/métodos , Humanos , Laparoscopia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Recidiva , Resultado do TratamentoRESUMO
The urachal mucinous adenocarcinoma is a rare malignant neoplasm located between the bladder and the umbilicus. It is usually found in an advanced stage at the moment of diagnosis. We have analyzed a clinical case in which the PET-CT study provided valuable morphological and metabolic information for diagnosis and staging.
Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Adenocarcinoma Mucinoso/diagnóstico por imagem , Imagem Multimodal , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios X , Úraco/diagnóstico por imagem , Neoplasias Abdominais/complicações , Neoplasias Abdominais/tratamento farmacológico , Neoplasias Abdominais/metabolismo , Neoplasias Abdominais/patologia , Adenocarcinoma Mucinoso/complicações , Adenocarcinoma Mucinoso/tratamento farmacológico , Adenocarcinoma Mucinoso/metabolismo , Adenocarcinoma Mucinoso/patologia , Feminino , Radioisótopos de Flúor , Fluordesoxiglucose F18 , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Cuidados Paliativos , Compostos Radiofarmacêuticos , Úlcera Cutânea/etiologia , Úraco/metabolismo , Úraco/patologiaRESUMO
Autoimmune pancreatitis represents a chronic inflammatory pancreatic disease with distinct clinical, morphologic and histopathological features. We report the case of a 64 year old man with obstructive jaundice in whom the imaging studies showed diffuse enlargement of the pancreas, and a mass in its head. Fine needle aspiration biopsy of the mass guided by endoscopic ultrasound showed lymphocytic infiltration and fibrosis. The size of the pancreas, laboratory abnormalities, and clinical manifestations subsided promptly after treatment with steroids. Autoimmune pancreatitis should be included in the differential diagnosis of patients with obstructive jaundice and/or pancreatic masses.