Assuntos
Neoplasias Gastrointestinais/cirurgia , Intestino Delgado/cirurgia , Nevo Azul/cirurgia , Neoplasias Cutâneas/cirurgia , Adolescente , Colonoscopia , Feminino , Neoplasias Gastrointestinais/diagnóstico por imagem , Neoplasias Gastrointestinais/patologia , Gastroscopia , Humanos , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Nevo Azul/diagnóstico por imagem , Nevo Azul/patologia , Radiografia , Neoplasias Cutâneas/diagnóstico por imagem , Neoplasias Cutâneas/patologiaAssuntos
Aneurisma Roto/diagnóstico por imagem , Aneurisma Roto/terapia , Endossonografia , Hemobilia/diagnóstico por imagem , Hemobilia/terapia , Artéria Hepática , Adesivos/administração & dosagem , Aneurisma Roto/complicações , Embucrilato/administração & dosagem , Hemobilia/etiologia , Humanos , Injeções/métodos , Masculino , Pessoa de Meia-IdadeAssuntos
Ascaríase/complicações , Ascaríase/terapia , Ascaris lumbricoides , Pancreatite/parasitologia , Pancreatite/terapia , Adulto , Animais , Antinematódeos/uso terapêutico , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Masculino , Mebendazol/uso terapêutico , Esfinterotomia EndoscópicaAssuntos
Coristoma/diagnóstico por imagem , Endossonografia/métodos , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Pâncreas , Neoplasias Gástricas/diagnóstico por imagem , Idoso , Biópsia por Agulha , Coristoma/diagnóstico , Coristoma/cirurgia , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/etiologia , Diagnóstico Diferencial , Feminino , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Imuno-Histoquímica , Medição de Risco , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirurgia , Tomografia Computadorizada por Raios X , Redução de PesoAssuntos
Apêndice , Doenças do Ceco/diagnóstico , Neoplasias do Ceco/diagnóstico , Tumores do Estroma Gastrointestinal/diagnóstico , Mucocele/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Apendicectomia/métodos , Doenças do Ceco/cirurgia , Neoplasias do Ceco/cirurgia , Ceco , Colonoscopia/métodos , Diagnóstico Diferencial , Endossonografia/métodos , Seguimentos , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Mucocele/cirurgia , Medição de Risco , Resultado do TratamentoAssuntos
Doenças da Aorta/diagnóstico , Implante de Prótese Vascular/efeitos adversos , Prótese Vascular/efeitos adversos , Fístula Esofágica/diagnóstico , Esofagoscopia , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/cirurgia , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/diagnóstico por imagem , Aneurisma da Aorta Torácica/cirurgia , Doenças da Aorta/etiologia , Doenças da Aorta/terapia , Implante de Prótese Vascular/métodos , Tratamento de Emergência/métodos , Fístula Esofágica/etiologia , Fístula Esofágica/terapia , Evolução Fatal , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Humanos , Pessoa de Meia-Idade , Falha de Prótese , Radiografia , Choque Hemorrágico/etiologia , Choque Hemorrágico/fisiopatologia , Falha de Tratamento , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
STUDY AIMS: The aims of this study were to evaluate the efficacy and safety of precut sphincterotomy in relation to the experience of a single endoscopist, and to establish the number of procedures required before achieving an effective and safe precut sphincterotomy. METHODS: A total of 200 consecutive patients underwent precut sphincterotomy carried out by a single endoscopist (T.A.) between January 2003 and December 2005. All of the procedures were divided into four chronological groups of 50 (Group I, II, III, and IV). Medical records and patient data were retrospectively reviewed and included procedure indications, outcomes, and complications. All patients were admitted for observation after the procedure in case of complications. RESULTS: A total of 200 patients (23.3%) (mean age 58.5 years; 101 men) underwent precut sphincterotomy (161 with needle-knife technique, 32 with septotomy technique, and seven with Erlangen technique). There was no mortality. The success rates of prompt bile duct cannulation after precut sphincterotomy were 88%, 86%, 94%, and 82%, respectively ( P > 0.05). Immediate bleeding requiring a submucosal adrenaline injection was observed in combined group I - II (28%) and combined group III - IV (7%) ( P < 0.05). One patient (2%) from each of group I, III, and IV required further endoscopic treatment for rebleeding. Duodenal perforation (2%) was detected and conservatively treated in one patient from group II. Mild pancreatitis was found in one patient (2%) in group III. CONCLUSIONS: The success rates of bile duct cannulation by precut sphincterotomy were not associated with the experience of the endoscopist. The postprocedural complications significantly decreased after the first 100 procedures. An experience of at least 100 procedures is suggested to achieve a safe precut sphincterotomy.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colestase/cirurgia , Esfinterotomia Endoscópica/métodos , Adulto , Idoso , Colestase/diagnóstico , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Complicações Pós-Operatórias , Cuidados Pré-Operatórios/métodos , Probabilidade , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Esfinterotomia Endoscópica/efeitos adversos , Resultado do TratamentoRESUMO
OBJECTIVE: Bile Duct Injury (BDI) is one of the most serious complications of cholecystectomy. The authors analyzed the clinical presentation, surgical management and long-term outcome of 19 patients presenting with iatrogenic major BDIs (Straburg type E) following cholecystectomy who underwent Roux-en-Y hepaticojejunostomy. MATERIAL AND METHOD: Between 1992 and 2005, 19 patients with major BDIs (Strasberg type E) following cholecystectomy were included. Operative notes and charts of all patients were reviewed systematically. A follow-up examination of each patient was performed after a median of 22 months (range 1-120). RESULTS: Twelve patients presented with ascending cholangitis, two patients were referred to the hospital with biliary-cutaneous fistula and five patients (26.3%) were identified at the time of operations. All patients were treated with Roux-en-Y hepaticojejunostomy with at least 2 cm of the diameter of the biliary-enteric anastomosis. There was no postoperative mortality. Postoperative complication was found in 5 patients (26.3%). Until now, during the follow-up, neither clinical nor biochemical evidence of recurrent cholangitis has been found. CONCLUSION: Major BDIs are associated with high morbidity rate and prolonged hospitalization. Early detection and referral to an experienced center is crucial in the management of these patients. Roux-en-Y hepaticojejunostomy with large diameter of the biliary-enteric anastomosis is the surgical procedure of choice with good long-term outcome.
Assuntos
Anastomose em-Y de Roux , Anastomose Cirúrgica , Ductos Biliares/lesões , Ductos Biliares/cirurgia , Colecistectomia/efeitos adversos , Doença Iatrogênica , Jejunostomia , Complicações Pós-Operatórias , Adulto , Idoso , Anastomose em-Y de Roux/métodos , Anastomose Cirúrgica/métodos , Feminino , Ducto Hepático Comum/cirurgia , Humanos , Masculino , Pessoa de Meia-IdadeAssuntos
Cateterismo/métodos , Stents , Doenças Biliares/cirurgia , Desenho de Equipamento , HumanosRESUMO
A new mechanical puncture video echoendoscope (GF-UMD-240P 270 degrees image field parallel to the endoscope axis) has been used for puncture and drainage of a symptomatic pancreatic pseudocyst. It is equipped with a 2.8 mm working channel and an elevator allowing single step drainage with passage of a 7F nasocystic catheter.
Assuntos
Endoscópios Gastrointestinais , Pseudocisto Pancreático/cirurgia , Gravação em Vídeo , Adulto , Desenho de Equipamento , Humanos , Masculino , Pseudocisto Pancreático/diagnóstico por imagem , Punções/instrumentação , Tomografia Computadorizada por Raios X , Ultrassonografia/instrumentaçãoRESUMO
Clofazimine-induced crystal-storing histiocytosis is a rare but well-recognized condition in the literature. Besides the common reddish discoloration of the skin, clofazimine produces gastrointestinal disturbances-sometimes severe abdominal pain, prompting exploratory laparotomy, because pathologic and radiologic findings can produce diagnostic difficulties if the pathologic changes caused by clofazimine are not recognized. The authors report such a case in a leprosy patient to emphasize the importance of history taking, the radiologic abnormalities of the small intestine, and the pathologic findings in small intestine and lymph node biopsies. Clofazimine crystals are red in the frozen section and exhibit bright-red birefringence. However, they are clear in routinely processed histologic sections because they dissolve in alcohol and organic solvents. They also appear as clear crystal spaces during electron microscopic study, but some osmiophilic bodies can be observed. Histiocytosis caused by clofazimine crystals produces infiltrative lesions in radiologic studies mimicking malignant lymphoma or other infiltrative disorders. Associated plasmacytosis in the histologic sections can simulate lymphoplasmacytic lymphoma or multiple myeloma with crystal-storing histiocytosis. With the knowledge of this rare condition caused by clofazimine, appropriate management to avoid an unnecessary laparotomy is possible.
Assuntos
Dor Abdominal/induzido quimicamente , Clofazimina/efeitos adversos , Histiocitose/induzido quimicamente , Hansenostáticos/efeitos adversos , Hanseníase/complicações , Dor Abdominal/diagnóstico , Adulto , Biópsia , Doença Crônica , Cristalização , Citoplasma/ultraestrutura , Diagnóstico Diferencial , Secções Congeladas , Histiócitos/patologia , Histiocitose/diagnóstico , Humanos , Mucosa Intestinal/citologia , Mucosa Intestinal/patologia , Jejuno/citologia , Jejuno/diagnóstico por imagem , Jejuno/patologia , Hanseníase/tratamento farmacológico , Linfonodos/citologia , Linfonodos/patologia , Masculino , Microscopia Eletrônica , RadiografiaRESUMO
Owing to its rarity, solitary rectal ulcer syndrome (SRUS) is often misdiagnosed as malignant ulcer, or ulcer in association with inflammatory bowel disease. We present two adult females with anorectal symptoms (i.e. pain, tenesmus and bowel habit changes). Both had normal levels of serum carcinoembryonic antigen. Barium enema revealed irregular mucosa with stricture of the lower rectum. An ulcer, 2.7 cm in diameter, was found in one patient but not the other. Rectal biopsy under sigmoidoscopy demonstrated non-specific inflammation, without evidence of malignancy. Because of the intractable symptoms and the inability to discriminate between malignant and benign conditions, exploratory laparotomy was performed, followed by low anterior resection of the rectum. Histological examination of both specimens showed submucosal rectal fibrosis with a non-specific ulceration in one. These findings were compatible with SRUS. The patients' symptoms improved dramatically after the resection and they remain well, five months and one year after surgery. Awareness of this rare anorectal condition is necessary for appropriate management particularly to avoid unnecessary abdomino-perineal resection.