RESUMO
We report a case of pneumothorax, subcutaneous emphysema and pneumoretroperitoneum after an endoscopic sphincterotomy. A 40-yr-old woman presented with dyspnea immediately after she had undergone an endoscopic retrograde cholangiopancreatogram for a residual stone in common bile duct. On arrival to our hospital, she complained about severe dyspnea and on examination subcutaneous emphysema was discovered. A CT scan was conducted and showed a right-sided pneumothorax, a pneumoretroperitoneum in the peritoneal cavity. We recommended to the patient an immediate laparotomic exploration. We discovered a duodenal perforation in which we sutured it with accompanying pyloric exclusion, double truncular vagotomy and gastroenteroanastomosis. Endoscopic retrograde cholangiopancreatogram (ERCP) is a popular procedure for biliary and pancreatic diseases, but it can cause severe complications such as intestinal perforation. Besides perforations, air can spread through the abdominal cavity, retroperitoneum, mediastinum, and the soft tissues of the neck, eventually causing pneumothorax. Early recognition and appropriate management is crucial for optimal results.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Pneumotórax/etiologia , Retropneumoperitônio/etiologia , Esfinterotomia Endoscópica/efeitos adversos , Enfisema Subcutâneo/etiologia , Adulto , Feminino , Humanos , Retropneumoperitônio/diagnóstico por imagem , Enfisema Subcutâneo/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
The aim of this study is to consider the parietal complications of the hydatid cyst of the liver: the subcutaneous rupture of the cyst and spontaneous cutaneous fistula of liver hydatid cyst. 1(st) case: A 24-year-old woman, who underwent surgery 10 years ago for hydatid cyst of the liver, was admitted for a right hypochondrium mass and a fistula draining clear liquid containing cystic elements. Computed tomography (CT) showed a large cystic lesion in the subcutaneous tissue communicating with another cystic mass in the liver. The diagnosis of a cyst-cutaneous fistula due to a peritoneal hydatid cyst was established. The patient underwent surgical treatment and recovered uneventfully. 2(nd) case: A 40-year-old woman presented with a mass in her right hypochondrium. The diagnosis of subcutaneous rupture of a hydatid cyst of liver was established by ultrasonography and CT-scan. The patient underwent surgical treatment and recovered uneventfully. Parietal complications of hydatid cyst of the liver are extremely rare, clinical presentation can be derailing. The diagnosis is usually established by ultrasonography and CT-scan.
Assuntos
Fístula Cutânea/etiologia , Equinococose Hepática/complicações , Fístula/etiologia , Hepatopatias/etiologia , Parede Abdominal/parasitologia , Adulto , Albendazol/uso terapêutico , Animais , Anti-Helmínticos/uso terapêutico , Terapia Combinada , Fístula Cutânea/diagnóstico por imagem , Equinococose Hepática/diagnóstico por imagem , Equinococose Hepática/tratamento farmacológico , Equinococose Hepática/cirurgia , Feminino , Fístula/diagnóstico por imagem , Fístula/cirurgia , Humanos , Hepatopatias/diagnóstico por imagem , Hepatopatias/cirurgia , Radiografia , Ruptura Espontânea , Tela Subcutânea/parasitologia , Tunísia , Ultrassonografia , Adulto JovemRESUMO
AIM: Several techniques have been proposed for reconstructing pancreatico-digestive continuity, which the first goal is reducing the rate of pancreatic leakage after pancreaticoduodenectomy. Only a limited number studies have been carried out. Our objective is to compare the results of pancreaticojejunostomy versus pancreaticogastrostomy following pancreaticoduodenectomy. METHODS: This is a retrospective and comparative study about 80 patients who underwent pancreaticoduodenectomy. These patients were divided into two groups: pancreaticojejunostomy (group PJ) and pancreaticogastrostomy (group PG). RESULTS: The PJ group included 39 patients, while 41 patients were included in the PG group. There were no differences between the two groups concerning: patients' demographics, risk factors, indication, mean duration of surgery, texture of pancreatic tissue, need for intraoperative blood transfusion and postoperative prophylactic octreotide. Overall, the mortality postoperative rate was 7.5% (N.=6), the incidence of surgical complications was 50% (51.3% in PJ, 48.8% in PG; P=0.823, not significant). Pancreatic fistula was the most frequent complication, occurring in 17.5% of patients (25.6% in PJ and 9.8% in PG; P=0.062, almost significant). 7.7% of patients who underwent PJ and 14.6% of patients who underwent PG required a second surgical intervention (P=0.326, not significant). There were no differences between the two groups PG and PJ concerning: Postoperative hemorrhage (P=0.63), biliary fistula (P=0.09), acute pancreatitis (P=0.95), delayed gastric emptying (P=0.33). The mean postoperative hospitalisation period stay was similar in both groups (P=0.63) CONCLUSION: There were not any significant differences between the two groups in the overall postoperative complication rate, the incidence of postoperative haemorrhage, biliary fistula, acute pancreatitis, and delayed.
Assuntos
Fístula Biliar/etiologia , Gastrostomia/efeitos adversos , Hemorragia/etiologia , Fístula Pancreática/etiologia , Neoplasias Pancreáticas/cirurgia , Pancreaticoduodenectomia , Pancreaticojejunostomia/efeitos adversos , Doença Aguda , Adulto , Idoso , Algoritmos , Anastomose Cirúrgica/métodos , Fístula Biliar/mortalidade , Fístula Biliar/cirurgia , Feminino , Esvaziamento Gástrico , Gastrostomia/mortalidade , Hemorragia/mortalidade , Hemorragia/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Fístula Pancreática/mortalidade , Fístula Pancreática/cirurgia , Pancreaticojejunostomia/mortalidade , Pancreatite/etiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Resultado do TratamentoRESUMO
Amoeboma is an inflammatory mass of the colon. It can be an inaugural symptom and thus pose the problem of differential diagnosis with colon cancer. The purpose of this report is to describe the case of a 43-year-old patient who presented with acute abdomen. Physical examination revealed a perforated circumferential mass in the sigmoid colon. Based on a presumptive diagnosis of colonic cancer complicated by perforation, segmental colectomy was performed. Histological examination of the surgical specimen demonstrated colonic amoeboma. The patient was treated using metronidazole. Although rare, amoeboma must be considered in differential diagnosis of cancer of any colonic mass.
Assuntos
Colo Sigmoide/patologia , Disenteria Amebiana/diagnóstico , Perfuração Intestinal/etiologia , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/parasitologia , Antiprotozoários/uso terapêutico , Colectomia , Colo Sigmoide/cirurgia , Disenteria Amebiana/terapia , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Masculino , Metronidazol/uso terapêutico , Pessoa de Meia-Idade , Necrose , Radiografia , Doenças do Colo Sigmoide/terapiaRESUMO
Echinococcosis/hydatidosis caused by Echinococcus granulosus has a widespread distribution in the human population of Tunisia, particularly in the north-west and centre-west of the country. In a recent study, the morphological features, fertility and viability of hydatid cysts that had been excised from patients in Tunis were explored, and the E. granulosus strain or genotype involved in each case was identified from morphology of the protoscolex hooks and the results of molecular genotyping. The hepatic cysts investigated came from 41 patients [31 women and 10 men, with a mean (S.E.) age of 43.41 (14.25) years] who were treated for cystic echinococcosis, by surgery but rarely with chemotherapy, at the La Rabta Hospital in Tunis, in the 12 months ending in June 2008. Most (56%) of these patients originated from rural areas in endemic governorates. Of the 60 hepatic cysts that were studied, 38.3% were located in the right lobe of the liver and 35.0% each involved both hepatic lobes. Almost a third (31.7%) of the excised cysts were degenerating, with the rest considered viable and either multivesicular (38.3%) or univesicular (30.0%). Almost all (93.3%) of the cysts were categorized as fertile, with a mean protoscolex viability of 21.8%. Protoscolex viability was relatively high in the viable univesicular cysts with a visible cyst wall and in the multivesicular and multiseptate cysts with daughter cysts, and lowest in the cysts that appeared to be solid calcified masses. The observed variation in protoscolex viability with cyst type, in cysts excised from patients before any chemotherapy, supports the cyst classification recommended by the World Health Organization but could also be compatible with the imaging-based 'Gharbi' classification. The results of the molecular genotyping showed that all 23 cysts investigated (which came from 20 of the patients) were caused by E. granulosus of the G1 genotype (also known as the 'sheep' or 'sheep-dog' strain).
Assuntos
Equinococose Hepática/parasitologia , Echinococcus granulosus , Adolescente , Adulto , Idoso , Animais , Doenças do Cão/parasitologia , Cães , Equinococose Hepática/cirurgia , Equinococose Hepática/veterinária , Echinococcus granulosus/anatomia & histologia , Echinococcus granulosus/genética , Echinococcus granulosus/fisiologia , Feminino , Fertilidade , Genótipo , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Ovinos , Doenças dos Ovinos/parasitologia , Tunísia , Adulto JovemRESUMO
BACKGROUND: Parosteal osteosarcoma is a rare, well-differentiated, predominantly fibro-osseous variant of osteosarcoma. It is regarded as a distinct form of osteosarcoma with better prognosis than conventional osteosarcoma. AIM: We report an unusual case of abdominal mass recurrence of parosteal osteosarcoma of the left distal femur treated eight years previously with wide resection, hip disarticulation and chemotherapy, which presented as an acute abdomen: we discuss the clinical outcomes of this rare entity. CASE PRESENTATION: We present a 54-year-old patient with low-grade parosteal osteosarcoma of the left distal femur. Left total hip disarticulation was indicated after several local relapses of the tumour following extensive resection and chemotherapy. Eight years later, he presented with an acute large bowel obstruction secondary to a compression of the large bowel by an abdominal mass. Abdominal computed tomography showed a large abdominal calcified mass with dilated large bowel loops. During laparotomy, the mass was unresectable. So, the patient underwent emergent colostomy of diversion. Biopsy of the lesion yielded grade III parosteal osteosarcoma material. The patient received adjuvant chemotherapy, but the response was poor: six months later, the patient presented with a peristomal mass and two pulmonary metastases. CONCLUSION: Abdominal recurrence of parosteal osteosarcoma of the distal femur eight years after definitive surgery is rare. This case emphasises the importance of the long-term follow-up of patients with parosteal osteosarcoma.
Assuntos
Neoplasias do Colo/secundário , Neoplasias Femorais/patologia , Obstrução Intestinal/etiologia , Osteossarcoma/secundário , Colostomia , Feminino , Humanos , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
Enterosalpingeal fistula is a rare complication of Crohn's disease which is rarely diagnosed preoperatively. We describe a new case of this complication suspected by CT scan and confirmed by hysterosalpingogram and contrast from the ileum. This case is about a 50-year-old woman suffering from ileal Crohn's disease diagnosed two years previously and actually complicated by stenosis and entero-salpingeal fistula. The treatment consisted on resection of the ileocaecal region with salpingectomy. Postoperative course was uneventful.
Assuntos
Doença de Crohn/complicações , Doenças das Tubas Uterinas/etiologia , Fístula/etiologia , Doenças do Íleo/etiologia , Fístula Intestinal/etiologia , Meios de Contraste , Doença de Crohn/cirurgia , Doenças das Tubas Uterinas/cirurgia , Feminino , Fístula/cirurgia , Humanos , Histerossalpingografia , Doenças do Íleo/cirurgia , Fístula Intestinal/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
UNLABELLED: Phytobezoars are a rare cause of acute bowel obstruction. The purpose of this work was to identify the predisposing factors and diagnostic difficulties of this rare entity. MATERIAL AND METHODS: This was a retrospective study including all cases of small-bowel obstruction secondary to phytobezoars observed between April 2001 and August 2007. The diagnosis of bezoars was established by surgical exploration or by computed tomography (CT). RESULTS: During the study period, 375 patients were hospitalized at our institution with a diagnosis of bowel obstruction that, in 15 (4%) cases, was secondary to phytobezoars. The average patient age was 55 years, with a gender ratio of 1.7, favoring men. The predisposing factors were gastroduodenal surgery for peptic ulcer in nine patients, and excessive consumption of prickly pears (cactus figs) in 12. The diagnosis was established by CT scans in three patients, who were successfully treated with gastric aspiration, thereby avoiding surgery. Laparotomy was performed in 12 patients to allow digital fragmentation of the bezoar, which was then washed into the colon. There were no postoperative deaths and morbidity was about 13%. CONCLUSION: An abdominal CT scan should be obtained for patients with small-bowel obstruction. This examination offers a precise diagnosis of bezoars, reducing the number of unnecessary surgical procedures, and helping to guide the approach if surgery is needed.
Assuntos
Bezoares/complicações , Obstrução Intestinal/etiologia , Intestino Delgado , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
The pancreas is an uncommon site of a hydatid cyst, even in countries where echinococcal disease is endemic. We report three cases of primary hydatid cysts of the pancreas revealed by abdominal pain. The diagnosis was based on ultrasound and CT-scan, which showed a cystic mass in the tail of the pancreas in the two first cases. In the third case, the diagnosis was determined preoperatively and a pancreatic fistula was found in the head of the pancreas during peroperative cholangiography. The echinococcal immunological test (Elisa) was positive in all cases. Surgical treatment included resection of the prominent lump in two patients and a cystogastric anastomosis in the third. Based on these three cases and a study of the literature, the difficulties of diagnosing this rare disease and the surgical procedures are discussed.
Assuntos
Equinococose/diagnóstico , Pancreatopatias/parasitologia , Dor Abdominal/parasitologia , Anastomose Cirúrgica , Colangiografia , Equinococose/cirurgia , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pancreatectomia , Pancreatopatias/cirurgia , Ductos Pancreáticos/cirurgia , Fístula Pancreática/parasitologia , Tomografia Computadorizada por Raios XRESUMO
The psoas muscle is an uncommon location for hydatid cyst accounting for only 1 to 3% of cases. The purpose of this report is to describe the epidemiologic, clinical, paraclinical, and therapeutic features of primary hydatid cyst of the psoas muscle. A retrospective study conducted in Surgery Department A at the Rabta Hospital in Tunisia compiled a total of 9 cases of primary hydatid cyst of the psoas muscle treated between 1980 and 2006. There were 6 men and 3 women with a mean age of 42.8 years. Symptomatology was nonspecific with pain in 6 cases. Discovery was coincidental in two cases. Clinical examination detected a mass in the presents of an abdominal mass in 7 cases. Radiologic findings (ultrasound and/or CT scan) confirmed diagnosis in 8 cases. In one case a mistaken diagnosis of psoas muscle abscess was made in a patient with an infected hydatid cyst. Serological tests were performed in 4 cases and were positive in 3. All patients underwent surgical treatment. The extraperitoneal approach (Leriche) was used in 7 cases and the transperitoneal approach via median laparotomy in 2. In all cases the surgical procedure consisted of partial cystectomy leaving a part of the pericystic against neurovascular structures. There was no operative mortality. The only postoperative complication was urinary infection in one patient. Mean follow-up was 2.5 years. One local recurrence was observed 4 years after surgical treatment and required reoperation.
Assuntos
Equinococose/diagnóstico , Músculos Psoas/parasitologia , Adulto , Idoso , Diagnóstico por Imagem , Equinococose/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculos Psoas/cirurgia , TunísiaRESUMO
INTRODUCTION: Anastomotic leak or disruption is a grave complication of colorectal surgery. Protection of an at-risk anastomosis by an upstream open diverting colostomy (OC) reduces this gravity. An unopened upstream loop colostomy is a surgical alternative which may diminish the unpleasant consequences of an open colostomy while maintaining the option of diversion in case of need. The aim of this study is to report the results of this approach and to define its indications. MATERIAL AND METHODS: [corrected] We report a retrospective series of 34 cases of unopened diverting loop colostomy to protect an at-risk colorectal anastomosis. Indications for this procedure were stool-laden bowel (59%), low serum albumin (11.5%), local inflammation (11.5%), and very low placed anastomosis (17.5%). RESULTS: The loop colostomy was eventually opened after surgery in six cases because of anastomotic leakage diagnosed clinically and/or detected by water soluble contrast opacification which was performed routinely on the sixth post-operative day. In all six cases, there was no need for an urgent surgical intervention. In 28 cases, the anastomosis healed without complication and the exteriorized loop was returned to the abdominal cavity seven days after the initial surgery. This was a short, simple procedure with an average operating time of ten minutes. Average hospital stay after returning the unopened colostomy to the abdomen was two days. CONCLUSION: Unopened loop colostomy offers the advantages of protection of a colorectal anastomosis without proper morbidity or mortality, shorter hospitalization, and improved psychological comfort for the patient. It's principal indication is to minimize the risks related to leakage from an at-risk colorectal anastomosis.
Assuntos
Adenocarcinoma/cirurgia , Colo/cirurgia , Colostomia/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Anastomose Cirúrgica/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/prevenção & controle , Estudos RetrospectivosRESUMO
We report the case of a 23 year old woman, treated for Crohn's disease for 11 years. She was operated on for multiple obstructing jejuno-ileal strictures using strictureplasty technique. Nine stricturoplasties of Heineke-Mikulicz type and one Finney type were performed without immediate postoperative complication. The patient received Imurel(R) and remained in remission for 15 months. Peritonitis due to a perforation of the Finney strictureplasty required re-operation; an ileostomy was performed. Such a late complication of a strictureplasty has not previously been reported in the literature. Although this complication was severe, the indication for this procedure in the surgical management of Crohn's complications should not be modified.
Assuntos
Doença de Crohn/cirurgia , Complicações Pós-Operatórias , Adulto , Constrição Patológica/cirurgia , Feminino , Humanos , Doenças do Íleo/cirurgia , Ileostomia , Obstrução Intestinal/cirurgia , Doenças do Jejuno/cirurgia , Peritonite/etiologia , ReoperaçãoRESUMO
We report a case of intraductal papillary mucinous tumor of the pancreas (IPMT) degenerated and fistulized into the stomach, the duodenum and the colon. Diagnoses of malignancy and fistulization were proven preoperatively. Pancreaticoduodenectomy extended to the body was performed. Pathological examination revealed a malignant IPMT with an invasive component. Of the 3 fistulizations tracts, both gastric and duodenal ones were malignant. To our knowledge, this is the first reported case of IPMT with colonic fistulization. Twelve months later, the patient is alive without signs of recurrence.
Assuntos
Doenças do Colo/etiologia , Cistadenoma Mucinoso/complicações , Duodenopatias/etiologia , Fístula Gástrica/etiologia , Fístula Intestinal/etiologia , Pancreatopatias/etiologia , Neoplasias Pancreáticas/complicações , Idoso , Fístula do Sistema Digestório/etiologia , Humanos , MasculinoRESUMO
Amyloidosis is an abnormal extracellular deposition of insoluble proteins, which is associated with an involvement of the gastrointestinal tract in 50 to 70% of cases. In primary amyloidosis (light chain amyloidosis), localized gastric involvement is a rare finding which can mimic malignancy. We report the case of a 56-year-old man, admitted with upper digestive outlet obstruction. Linitis plastica with lymph node involvement was suspected by gastroscopy, barium meal and endoscopic ultrasonography but was not confirmed by gastric biopsies. The patient was treated with total gastrectomy with lymph node dissection. Pathological examination demonstrated gastric and lymph nodes amyloidosis and no malignant tumor was found. The patient died 9 months later from cardiac failure due to amyloidosis.
Assuntos
Amiloidose/diagnóstico , Gastropatias/diagnóstico , Amiloidose/diagnóstico por imagem , Amiloidose/patologia , Amiloidose/cirurgia , Biópsia , Diagnóstico Diferencial , Gastrectomia , Gastroscopia , Humanos , Linite Plástica/diagnóstico , Masculino , Pessoa de Meia-Idade , Estômago/patologia , Gastropatias/diagnóstico por imagem , Gastropatias/patologia , Gastropatias/cirurgia , Neoplasias Gástricas/diagnóstico , UltrassonografiaRESUMO
Laparoscopic cholecystectomy is the standard approach to manage symptomatic gallbladder stones. However, only twelve patients with total situs invertus have been previously reported in the literature. We report a new case of a 58-year-old patient hospitalized for acute pain of the left hypochondrium with fever. The diagnosis of acute cholecystitis with situs inversus totalis was made following clinical examination and radiological investigations. Laparoscopic cholecystectomy was subsequently performed through a modification of the technique to adapt to the mirror image anatomy.
Assuntos
Colecistectomia Laparoscópica , Colecistite Aguda/cirurgia , Situs Inversus/complicações , Dextrocardia/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia Torácica , Situs Inversus/diagnóstico por imagem , Resultado do TratamentoAssuntos
Granuloma de Células Plasmáticas/diagnóstico , Abscesso Hepático Amebiano/diagnóstico , Hepatopatias/diagnóstico , Idoso , Diagnóstico Diferencial , Granuloma de Células Plasmáticas/patologia , Granuloma de Células Plasmáticas/cirurgia , Humanos , Abscesso Hepático Amebiano/patologia , Abscesso Hepático Amebiano/cirurgia , Hepatopatias/patologia , Hepatopatias/cirurgia , Masculino , Radiografia Abdominal , Tomografia Computadorizada por Raios X , TunísiaRESUMO
Hydatid cyst of liver is a parasitosis of endemic proportions in Tunisia. The purpose of this report is to describe a case involving subcutaneous rupture of a hydatid cyst of liver in a 41-year-old patient. Diagnosis was established by ultrasonography and CT-scan. The patient underwent surgical treatment and recovered uneventfully. Subcutaneous rupture remains an uncommon complication. This is only the second case reported in the literature up to now.