RESUMO
A 72-year-old woman presented to the emergency department with recurrent vomiting without abdominal pain. On physical examination, the patient was afebrile and her abdomen was soft and nontender with a giant abdominal-wall hernia. Upper endoscopy showed a deep, 3-cm ulcer at the gastric angulus. Computed tomography (CT) of the abdomen showed gastric dilatation with gas in the wall and a large part of the digestive tract within the hernia sac. CT imaging also revealed gas throughout the portal venous system. The patient declined surgery. Management was conservative and included correction of fluid and electrolyte balance, and nasogastric drainage for gastric decompression with good response.
Assuntos
Embolia Aérea/etiologia , Gases , Úlcera Péptica/complicações , Sistema Porta , Gastropatias/etiologia , Idoso , Feminino , HumanosRESUMO
BACKGROUND: Diagnostic delay in patients with colorectal cancer (CRC) is a quality indicator and its reduction could improve prognosis of the disease. OBJECTIVE: To analyze the diagnostic value of different colonoscopy indications in CRC and to select the signs or symptoms that, if prioritized in a rapid diagnostic circuit, would be most efficient. MATERIAL AND METHODS: A retrospective analysis of 2219 outpatients who underwent colonoscopy from 2000 to 2007 was performed. For each indication we calculated the sensitivity (S), positive predictive value (PPV), positive likelihood ratio (LR+), and number of colonoscopies needed to diagnose a case of CRC (NND). RESULTS: A total of 179 patients were diagnosed with CRC. The indications with greatest PPV were liver metastases (35.3%), suspicious radiological image (20.8%), and non-distal rectal bleeding (22%). Iron deficiency anemia (11%), constitutional syndrome (10%), any rectal bleeding (9.4%) and rectal syndrome (9%) had intermediate PPV. Constipation (6.3%), alternating constipation-diarrhea (3.3%), changes in bowel habits (3%), distal rectal bleeding (2.1%), diarrhea (1.8%) and abdominal pain (1.1%) had low PPV. The NND was 4 in liver metastases, 7 in non-distal bleeding and 8 in suspicious radiological image. Distal bleeding (13), diarrhea (14), abdominal pain (14), changes in bowel habits (15) and alternating constipation-diarrhoea (21) had negative NND. The subgroup of patients aged >or= 50 years showed lower NND in non-distal rectal bleeding (5), suspicious radiological image (5) and any rectal bleeding (16). CONCLUSIONS: Patients with non-distal rectal bleeding should be prioritized over other indications in a strategy of rapid diagnosis of CRC. Age equal to or more than 50 years should also be considered because this factor seems to reduce NND. Distal bleeding, abdominal pain and changes in bowel habits had low PPV and were associated with other diagnoses than CRC. Consequently, prioritization of these factors would be inefficient.
Assuntos
Colonoscopia , Neoplasias Colorretais/patologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Detecção Precoce de Câncer , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Biliary diseases represent particular diagnostic and therapeutic problems in elderly patients. METHODS: Patients 90 years of age or older who underwent ERCP from January 1993 to September 2001 were studied retrospectively. RESULTS: A total of 126 patients underwent 147 ERCP procedures (range 1-5 per patient). Twelve additional ERCPs were performed in 9 of the patients during follow-up because of recurrent symptoms. A total of 159 procedures were, therefore, available for analysis. The most frequent indications were suspicion of bile duct stones (46.8%) and obstructive jaundice (35.7%). Midazolam (95.6%) was used for conscious sedation and hyoscine (74.8%) for duodenal ileus. Patient tolerance of the procedure was good in 92.4% of sessions. Diagnoses included bile duct stones (54%), bile duct dilatation without any apparent obstruction (11.9%), and malignant stenosis (9.5%). Therapeutic procedures were indicated in 95.6% of diagnosed patients and completed in 96.3% of cases. Complications occurred in association with 2.5% of the ERCP procedures; the procedure-related mortality rate was 0.7%. CONCLUSIONS: ERCP in elderly patients is practicable. The complication rate is low, and therapeutic efficacy is good.