RESUMO
RATIONALE: Diffuse intestinal and mesenteric lipomatosis is a rare condition characterized by the overgrowth of adipose tissue in the intestines and mesentery. This case report aims to highlight the rare occurrence of chronic abdominal distention caused by this disease and its unique invasion into the muscle layer, which has not been previously reported. PATIENT CONCERNS: A 36-year-old woman with a 7-year history of abdominal distension was admitted to our hospital's Department of Gastrointestinal Surgery. DIAGNOSE: Abdominal and pelvic computed tomography revealed diffuse small intestinal lipomatosis. INTERVENTIONS: The patient underwent surgery. We performed an open-field ilectomy involving removal of all lipomatous intestines (250 cm). OUTCOMES: During the surgery, diffuse nodular ileal and mesenteric lipomatosis was confirmed, characterized by the presence of multiple nodular lipomas within the submucosal and muscular layers. The surgical intervention involved the resection of 250 cm of the affected ileum, followed by jejunoileal anastomosis. Postoperative pathology confirmed the diagnosis, with lesions observed in both the submucosa and muscle layers. The patient showed significant improvement in symptoms, with normal intestinal function and weight gain observed over a 10-month follow-up period, and no signs of recurrence. LESSONS: Diffuse intestinal and mesenteric lipomatosis can lead to long-term abdominal distension. Additionally, it may be involved in the muscle layer of the intestinal wall. Surgery is the primary treatment option for symptomatic intestinal lipomatosis.
Assuntos
Lipomatose , Mesentério , Humanos , Feminino , Adulto , Lipomatose/cirurgia , Lipomatose/patologia , Lipomatose/complicações , Lipomatose/diagnóstico , Mesentério/patologia , Mesentério/cirurgia , Doenças do Íleo/cirurgia , Doenças do Íleo/etiologia , Doenças do Íleo/diagnóstico , Íleo/cirurgia , Íleo/patologia , Tomografia Computadorizada por Raios X , Doença CrônicaRESUMO
BACKGROUND: Heterotopic gastric mucosa (HGM) can be located in various parts of the gastrointestinal tract. As a rare anomaly in the small intestine, it can become complicated by intussusception, obstruction, gastrointestinal bleeding, and even peritonitis, leading to death. CASE PRESENTATION: This case report focuses on a 12-year-old Middle Eastern boy who presented with hematochezia and abdominal pain for a couple of days. A tagged Red blood cell (RBC) scan and Technetium scan revealed gastrointestinal bleeding at the lower abdomen, highly suggestive of the diagnosis of Meckel's diverticulum. Subsequently, exploratory laparotomy revealed contiguous and scattered mucosal lesions with multiple polyps of various sizes in the terminal ileum. Meckel's diverticulum was absent, and the patient was treated with resection and primary anastomosis. The resected tissue revealed extensive ectopic gastric mucosa and polypoid tissues. The patient recovered uneventfully and was discharged four days after the surgery. The symptoms did not recur within six months after his surgery. CONCLUSION: Our case demonstrated that despite the rarity of multiple polypoid gastric heterotopias in the terminal ileum, it should be considered as one of the differential diagnoses of gastrointestinal tract bleeding.
Assuntos
Coristoma , Mucosa Gástrica , Hemorragia Gastrointestinal , Divertículo Ileal , Humanos , Masculino , Hemorragia Gastrointestinal/etiologia , Mucosa Gástrica/patologia , Coristoma/complicações , Coristoma/cirurgia , Coristoma/patologia , Divertículo Ileal/complicações , Divertículo Ileal/cirurgia , Criança , Doenças do Íleo/cirurgia , Doenças do Íleo/etiologia , Diagnóstico Diferencial , Íleo/patologia , Íleo/cirurgia , Íleo/diagnóstico por imagem , Dor Abdominal/etiologia , Resultado do TratamentoRESUMO
We report the case of ileo-ileal intussusception secondary to a Peutz-Jeghers syndrome (PJS) hamartomatous polyp in a male infant. The patient presented with non-bilious vomiting and a single episode of passing blood in his stool. An upper gastrointestinal contrast study showed proximal bowel obstruction. At laparotomy, ileo-ileal intussusception was identified with a papillary mass acting as a lead point. The mass was resected, and a primary anastomosis was performed. The patient recovered well and was discharged on postoperative day 5. Histological assessment diagnosed a PJS hamartoma. The patient was well at 1 month follow-up. This case report describes a rare cause of intussusception in an infant that should be considered in the differential diagnosis. The diagnosis of PJS in infancy is uncommon and requires long-term follow-up.
Assuntos
Hamartoma , Doenças do Íleo , Intussuscepção , Síndrome de Peutz-Jeghers , Humanos , Intussuscepção/etiologia , Intussuscepção/cirurgia , Intussuscepção/diagnóstico , Síndrome de Peutz-Jeghers/complicações , Síndrome de Peutz-Jeghers/cirurgia , Síndrome de Peutz-Jeghers/diagnóstico , Masculino , Lactente , Doenças do Íleo/cirurgia , Doenças do Íleo/etiologia , Doenças do Íleo/diagnóstico , Hamartoma/cirurgia , Hamartoma/complicações , Hamartoma/diagnóstico , Diagnóstico Diferencial , Pólipos Intestinais/complicações , Pólipos Intestinais/cirurgiaAssuntos
Anastomose Cirúrgica , Colectomia , Constipação Intestinal , Intussuscepção , Laparoscopia , Reto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Anastomose Cirúrgica/métodos , Colectomia/métodos , Colectomia/efeitos adversos , Constipação Intestinal/cirurgia , Constipação Intestinal/etiologia , Doenças do Íleo/cirurgia , Doenças do Íleo/etiologia , Íleo/cirurgia , Intussuscepção/cirurgia , Laparoscopia/métodos , Complicações Pós-Operatórias/etiologia , Reto/cirurgia , Resultado do TratamentoAssuntos
Neoplasias do Íleo , Intussuscepção , Humanos , Intussuscepção/cirurgia , Intussuscepção/etiologia , Intussuscepção/diagnóstico por imagem , Neoplasias do Íleo/complicações , Neoplasias do Íleo/cirurgia , Neoplasias do Íleo/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Doenças do Íleo/cirurgia , Doenças do Íleo/etiologia , Doenças do Íleo/diagnóstico por imagem , Feminino , MasculinoRESUMO
A 47-year-old woman was referred to our hospital with recurring lower abdominal pain persisting for more than 2 weeks. Imaging modalities showed small bowel obstruction caused by a mass lesion in the terminal ileum. Despite undergoing fasting, rehydration, and decompression through an ileus tube, her symptoms persisted. Furthermore, the condition deteriorated on day 4, with the onset of her menstrual period. An emergency surgery was conducted on the 7th day after hospitalization. Surgical observations indicated severe stenosis around the ileocecal valve and ileal perforation approximately 40cm from the oral stricture. As a result, ileocecal resection was performed. Pathological examination revealed endometrial tissue infiltration through the mucosal lamina propria to the ileal subserosa. Thus, the patient was identified with intestinal endometriosis of the ileocecum. Endometriosis of the small bowel is an uncommon condition that eventually causes intractable bowel obstruction. Although preoperative diagnosis is considered challenging, intestinal endometriosis should be included in the differential diagnosis in cases of bowel obstruction in women of childbearing age.
Assuntos
Endometriose , Doenças do Íleo , Obstrução Intestinal , Perfuração Intestinal , Humanos , Feminino , Endometriose/complicações , Pessoa de Meia-Idade , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/diagnóstico por imagem , Doenças do Íleo/etiologia , Doenças do Íleo/cirurgia , Doenças do Íleo/diagnóstico por imagemAssuntos
Divertículo , Doenças do Íleo , Intussuscepção , Divertículo Ileal , Adulto , Humanos , Intussuscepção/etiologia , Intussuscepção/cirurgia , Divertículo Ileal/complicações , Divertículo Ileal/diagnóstico por imagem , Divertículo Ileal/cirurgia , Divertículo/complicações , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/etiologia , Doenças do Íleo/cirurgiaRESUMO
Typhoid ileal perforation (TIP) is a common surgical emergency in low-middle income countries (LMICs). Its high surgical morbidity and mortality is due to its often late presentation or diagnosis, the patient's malnutrition, severe peritoneal contamination and unavailability of intensive care in most peripheral hospitals. This prompted the philosophy of minimizing the crisis by avoiding any repair or anastomosis, limiting the surgery in these physiologically compromised patients and performing only a temporary defunctioning ileostomy (DI) which could then be closed 10-12 weeks later.
Assuntos
Ileostomia , Perfuração Intestinal , Febre Tifoide , Humanos , Perfuração Intestinal/cirurgia , Perfuração Intestinal/etiologia , Febre Tifoide/complicações , Doenças do Íleo/cirurgia , Doenças do Íleo/etiologia , Doenças do Íleo/microbiologia , Íleo/cirurgiaRESUMO
BACKGROUND: Bowel obstruction is a mechanical or functional blockade of intestinal contents from evacuation to the adjacent distal bowel or external environment. It poses significant morbidity and mortality in both high-income and low-to-middle-income countries. Ileosigmoid knotting is a special form of obstruction where the small bowel often ileum wraps around the sigmoid colon or vice versa. It is the severest form of bowel obstruction, involving both the small and large bowels in a compound manner. It is common where sigmoid volvulus is common and geographic areas with a bulky diet. METHODS: An institution-based retrospective cohort study was employed among purposively selected 40 surgical patients with ileosigmoid knotting records from July 2020 to July 2023 at Jimma University Medical Center. To estimate and compare the survival probabilities, the Kaplan-Meir method and log-rank test were used. A Cox-regression analysis was fitted to identify independent predictors of time to death. RESULTS: Among a cohort of 40 patients followed for 347 person-days at Jimma University Medical Center, 11 (27.5%) had died. The overall incidence rate of death was 3.2 (95% CI 1.8, 5.7) per 100 person-days. In multivariable Cox-regression analysis, age (AHR = 1.15; 95% CI: 1.04-1.28), shock at presentation (AHR = 30.50: 95% CI 1.25-742.54), comorbidities (AHR = 5.81; 95% CI 1.19-28.23), pulse rate intraoperatively (AHR = 1.19; 95% CI: 1.01-1.40), postoperative pulse rate (AHR = 1.07; 95% CI: 1.01-1.14) were independently associated with time to death. CONCLUSION: The incidence of death among surgical patients with ileosigmoid knotting was high and also had a shorter median survival time. Age, shock at presentation, comorbidities, pulse rate intraoperatively, and postoperative pulse rate were found to be statistically significant predictors of time to death and outcome among surgical patients with Ileosigmoid knotting.
Assuntos
Volvo Intestinal , Humanos , Estudos Retrospectivos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Volvo Intestinal/cirurgia , Volvo Intestinal/mortalidade , Obstrução Intestinal/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/mortalidade , Doenças do Colo Sigmoide/cirurgia , Doenças do Colo Sigmoide/mortalidade , Doenças do Íleo/cirurgia , Doenças do Íleo/mortalidade , Centros Médicos Acadêmicos , Idoso , Países em Desenvolvimento , Resultado do Tratamento , Estudos de Coortes , Adulto JovemAssuntos
Doenças do Íleo , Obstrução Intestinal , Doenças do Colo Sigmoide , Humanos , Doenças do Íleo/cirurgia , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Doenças do Colo Sigmoide/cirurgia , Doenças do Colo Sigmoide/etiologia , Doenças do Colo Sigmoide/complicaçõesAssuntos
Doença de Crohn , Doenças do Jejuno , Humanos , Constrição Patológica/cirurgia , Constrição Patológica/etiologia , Doença de Crohn/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Doenças do Íleo/cirurgia , Íleo/cirurgia , Obstrução Intestinal/cirurgia , Obstrução Intestinal/etiologia , Doenças do Jejuno/cirurgia , Jejuno/cirurgia , Tratamentos com Preservação do Órgão/métodosRESUMO
A pathology well known by pediatric surgeons, ileal duplication is in rare instances a cause of acute surgical abdomen in adults; that said, its atypical presentation often leads it to be mistaken for other etiologies. Even though it is benign in children, the risk of malignant transformation in adults should be taken into account in surgical procedures.
Assuntos
Íleo , Humanos , Íleo/anormalidades , Íleo/cirurgia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Doenças do Íleo/cirurgia , Doenças do Íleo/diagnóstico , Feminino , Masculino , AdultoRESUMO
BACKGROUND: Immunoglobulin A (IgA) vasculitis with intussusception is acute and severe vasculitis combined with acute abdomen in children. The diagnosis of the disease depends on the results of imaging examinations, and its treatment mainly includes enema and surgery. The literature summarized the detailed diagnosis and treatment data in previous literature reports. METHODS: We described the clinical manifestations, ultrasonic features, and treatment of patients admitted to a single center and reviewed previous literature regarding cases with detailed clinical data in the PubMed database within the past 20 years. RESULTS: The review included 36 patients, including 22 boys and 14 girls. A total of 32 patients were diagnosed using ultrasound (88.9%). The main sites of intussusception were the ileum and ileocolon in 16 (44.4%) and 11 (30.6%) cases, respectively. Thirteen patients (36.1%) were treated with enema, with 6 responding to the treatment. 26 patients (72.2%) underwent surgical treatment. Patients with ileal intussusception were more likely to be treated with surgery than those with colonic intussusception (P < .05). The single-center clinical data of 23 patients showed that there was no significant difference in laboratory test findings between patients with and without surgical treatment (P > .05). Patients with long insertion lengths were more likely to require surgery and resection (P < .05). CONCLUSIONS: Ultrasonography is the first-line investigation for diagnosis. The main sites of intussusception were ileum and ileocolon. The length of intubation was related to surgery; treatment is according to the intussusception site. Air enema is not suitable for intussusception of the small intestine.
Assuntos
Intussuscepção , Humanos , Intussuscepção/diagnóstico , Intussuscepção/cirurgia , Intussuscepção/etiologia , Intussuscepção/terapia , Masculino , Feminino , Criança , Pré-Escolar , Lactente , Doenças do Íleo/diagnóstico , Doenças do Íleo/terapia , Doenças do Íleo/etiologia , Doenças do Íleo/cirurgia , Estudos Retrospectivos , Ultrassonografia , Vasculite por IgA/complicações , Vasculite por IgA/diagnóstico , Adolescente , Enema , Imunoglobulina ARESUMO
An inflammatory fibroid polyp is a rare benign lesion of the gastrointestinal tract, which can cause obstruction or intussusception when it reaches a large diameter. We present a case of a 46-year-old female admitted to our clinic with recurrent ileus attacks. We performed segmental resection of the small bowel due to a 3-cm pedunculated polypoid lesion located in the terminal ileum that caused ileo-ileal intussusception and whose pathology was reported as an inflammatory fibroid polyp. In adults presenting with ileus, the possibility of intussusception should be kept in mind.
Assuntos
Neoplasias Gastrointestinais , Doenças do Íleo , Íleus , Obstrução Intestinal , Intussuscepção , Leiomioma , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Intussuscepção/cirurgia , Intussuscepção/complicações , Pólipos Intestinais/complicações , Pólipos Intestinais/cirurgia , Pólipos Intestinais/patologia , Doenças do Íleo/diagnóstico , Doenças do Íleo/etiologia , Doenças do Íleo/cirurgia , Íleo/patologia , Íleus/complicações , Íleus/patologiaRESUMO
Objetivo: Realizar un análisis retrospectivo de una serie de casos de diverticulitis yeyuno-ileal complicadas tratadas quirúrgicamente en nuestro servicio durante el periodo comprendido entre los años 2002 al 2015. Materiales y métodos: Se trató quirúrgicamente 12 casos de diverticulosis yeyuno-ileal complicadas, 7 mujeres y 5 varones. La edad media fue 76 años. La presentación clínica en todos los casos fue dolor abdominal agudo, uno de ellos con hemorragia digestiva. Todos presentaron leucocitosis, neutrofilia y aumento de reactantes de fase aguda. A todos los pacientes se les realizó TAC abdominal urgente. Resultados: En 11 casos hubo congruencia entre estudio de imagen y hallazgos quirúrgicos. La localización de los divertículos fue yeyuno (9) e íleon (3). Siempre se realizó laparotomía exploradora urgente encontrándose perforación diverticular con peritonitis (7 casos), perforación diverticular con absceso (4 casos) y en un caso un área isquémica con perforación diverticular tras embolización. Se realizó siempre resección intestinal y anastomosis. En ningún caso se conocía previamente el diagnóstico de diverticulosis yeyuno-ileal. Nuestras complicaciones fueron: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusiones: La diverticulitis yetuno-ileal es una entidad infrecuente, suele ser la forma de debut de una enfermedad diverticular no conocida previamente. El TAC abdominal es de gran utilidad diagnóstica. La resección del segmento afecto es el tratamiento de elección
Objective: To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015. Materials and methods: We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT. Results: In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusions: Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diverticulite/complicações , Doenças do Íleo/complicações , Doenças do Jejuno/complicações , Estudos Retrospectivos , Seguimentos , Resultado do Tratamento , Diverticulite/cirurgia , Diverticulite/diagnóstico , Doenças do Íleo/cirurgia , Doenças do Íleo/diagnóstico , Doenças do Jejuno/cirurgia , Doenças do Jejuno/diagnósticoRESUMO
El íleo biliar es una rara complicación de la colelitiasis, que se caracteriza por presentar clínicamente una obstrucción intestinal mecánica intraluminal, secundaria a la impactación de un cálculo biliar en el tubo digestivo, debido a la existencia de una fístula bilio-entérica. El diagnóstico preoperatorio es difícil, ya que presenta síntomas y signos de obstrucción intestinal, los cuales son muy inespecíficos para sospechar un íleo biliar. El tratamiento de elección en el manejo del íleo biliar es el quirúrgico. Habitualmente se realiza una cirugía en dos tiempos, enterolitotomía como único gesto, sin embargo no hay una técnica quirúrgica definitiva estandarizada. Presentamos el caso de una paciente de 70 años que acude al Departamento de Urgencias con el diagnóstico clínico de obstrucción intestinal mecánica baja, de cuatro días de evolución, como consecuencia de un cálculo impactado en colon sigmoides.
Gallstone ileus is a rare complication of cholelithiasis, which is characterized by clinically presenting as an intraluminal mechanical intestinal obstruction secondary to the impaction of a gallstone in the digestive tract, due to the existence of a biliary-enteric fistula. The preoperative diagnosis is difficult, since it presents symptoms and signs of intestinal obstruction, which are very unspecific to suspect a Biliary Ileus. The treatment of choice in the management of gallstone ileus is surgery; usually is performed in two stages, whole lithotomy as the only gesture, however there is no standardized definitive surgical technique. We present the case of a 70-year-old patient, who attended the emergency department with the clinical diagnosis of low mechanical bowel obstruction, four days of evolution, as a result of a stone impacted in the sigmoid colon.
Assuntos
Humanos , Feminino , Idoso , Doenças do Colo Sigmoide/etiologia , Cálculos Biliares/complicações , Doenças do Íleo/complicações , Obstrução Intestinal/etiologia , Doenças do Colo Sigmoide/cirurgia , Doenças do Colo Sigmoide/diagnóstico por imagem , Cálculos Biliares/cirurgia , Cálculos Biliares/diagnóstico por imagem , Doenças do Íleo/cirurgia , Doenças do Íleo/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Obstrução Intestinal/diagnóstico por imagemRESUMO
La oclusión intestinal es una causa frecuente de abdomen agudo quirúrgico. Dentro de sus múltiples casusas se encuentra el nudo ileosigmoideo, entidad rara en el mundo, pero puede verse con relativa frecuencia en algunas latitudes geográficas como Asia, Medio Oriente y otros países del continente africano. El objetivo de este trabajo es presentar cuatro casos de pacientes con oclusión intestinal por nudo ileosigmoideo en los hospitales Souro Sanu de Bobo Diulaso, Burkina Faso y Wa Regional Hospital, de Gana. Se intervinieron quirúrgicamente, se hizo resección en bloque de los segmentos ileales y sigmoideos gangrenados con anastomosis íleo-ascendente y colostomía de tipo Hartman. Los pacientes evolucionaron satisfactoriamente y luego de tres meses se restableció definitivamente el tránsito intestinal. Se realizó una revisión de la literatura(AU)
Intestinal occlusion is a frequent cause of surgical acute abdomen. Among its multiple causes are the ileosigmoid knot, a rare entity worldwide, which is relatively frequent in some geographic areas such as Asia, Middle East and Africa. The objective of this paper was to present four patients with intestinal occlusion due to ileosigmoid knot in Souro Sanu of Bobo Diulaso hospitals in Burkina Faso and Wa Regional Hospital in Ghana. They were operated on through block resection of gangrenous ileal and sigmoid segments with ascending ileoanastomosis and Hartrman-type colostomy. The patients recovered satisfactorily and three months later, the intestinal transfer was finally re-established. A literature review on the topic was made(AU)