Assuntos
Sistema Biliar , Colestase , Neoplasias Pancreáticas , Humanos , Pâncreas , Colestase/etiologia , Colestase/cirurgia , StentsRESUMO
We report a patient with significant dysphagia from hypercontractile "jackhammer" esophagus and a midesophageal pulsion diverticulum. This was treated with a thoracoscopic diverticulectomy and a long esophageal myotomy sparing the lower esophageal sphincter (LES). We describe the clinical diagnosis and surgical treatment of this uncommon esophageal motility disorder. To our knowledge, this is the first report in the literature of a midesophageal diverticulum caused by jackhammer esophagus. We propose that in the setting of normal LES function, successful treatment should include diverticulectomy with an LES-sparing myotomy.
Assuntos
Divertículo Esofágico/complicações , Divertículo Esofágico/cirurgia , Transtornos da Motilidade Esofágica/etiologia , Esôfago/cirurgia , Anastomose Cirúrgica , Divertículo Esofágico/diagnóstico por imagem , Transtornos da Motilidade Esofágica/cirurgia , Esofagoscopia/métodos , Esôfago/anormalidades , Feminino , Seguimentos , Humanos , Manometria/métodos , Pessoa de Meia-Idade , Doenças Raras , Recuperação de Função Fisiológica , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
The critical care management of patients before liver transplantation is aimed at optimizing hepatic and extrahepatic organ function before the transplant operation, with a goal to favorably influence perioperative and postoperative graft and patient outcomes. Critical illness in liver disease can present in the context of acute liver failure or acute on chronic liver failure. The differing pathophysiologic processes underlying these 2 types of liver failure necessitate specific approaches to their intensive care management. In their extreme presentations, both types of liver failure present as multiorgan system failure; and therefore, the critical care management of these entities requires a systematic multiorgan system approach to address hepatic and extrahepatic organ dysfunction. This review provides a multiorgan system-based description of critical care management of acute liver failure and acute on chronic liver failure before liver transplantation.
Assuntos
Transplante de Fígado/métodos , Cuidados Pré-Operatórios/normas , Acetaminofen/toxicidade , Acetilcisteína/toxicidade , Edema Encefálico/complicações , Overdose de Drogas/complicações , Doença Hepática Terminal/cirurgia , Doença Hepática Terminal/terapia , Síndrome Hepatopulmonar/cirurgia , Síndrome Hepatopulmonar/terapia , Homeostase , Humanos , Falência Hepática Aguda/induzido quimicamente , Falência Hepática Aguda/etiologia , Falência Hepática Aguda/cirurgia , Falência Hepática Aguda/terapia , Período Pós-Operatório , Cuidados Pré-Operatórios/métodos , Resultado do TratamentoRESUMO
Wells' syndrome, also termed eosinophilic cellulitis, is a dermatologic condition of unknown etiology that occurs as recurrent patches or plaques mimicking infectious cellulitis. Histopathology reveals an eosinophilic infiltrate and characteristic flame figures. Previous reports have associated this syndrome with parasitic infections, arthropod bites, pharmacologic agents, surgery, and hematologic disorders. We present a case report of a patient with Wells' syndrome associated with newly diagnosed ulcerative colitis. The dermatosis erupted concurrently with flares of ulcerative colitis. Furthermore, treatment of the ulcerative colitis led to resolution of the skin lesions. To our knowledge this describes the first association between inflammatory bowel disease and Wells' syndrome and argues for a distinct relationship between the two.