Evisceración vaginal espontánea en paciente con antecedente de histerectomía: reporte de caso y revisión de la literatura / Spontaneous vaginal evisceration in woman with prior pelvic surgery: case report and literature review

Reportar un caso de evisceración vaginal espontánea en paciente con antecedentes quirúrgicos de histerectomía vaginal y hacer una revisión de la literatura sobre los principales factores de riesgo asociados a la presentación de este evento. Se presenta el caso de una paciente de 74 años multípara de 12 partos vaginales con antecedente ginecológico de histerectomía vaginal en 2012, en el año 2014 una sacroespinocolpopexia con colocación de cinta transobturadora más colporrafia anterior, en 2018 presenta cuadro con asas intestinales protruyendo con signos de isquemia a través de defecto en cúpula vaginal, se realiza resección de intestino delgado y anastomosis termino-terminal, con posterior cierre de defecto por vía abdominal. Se realizó una búsqueda en las bases de datos PubMed, Scielo, Google Scholar y Science Direct para artículos publicados en inglés y español, de los últimos 22 años. Se identificaron 16 títulos que cumplieron con los criterios de selección, los resultados de la revisión muestran factores de riesgo comunes. La evisceración vaginal por dehiscencia de la cúpula vaginal es una patología poco prevalente, el abordaje mínimamente invasivo, que ha aumentado en los últimos años, ha conllevado un aumento de la incidencia, siendo la histerectomía por laparoscopia el de mayor riesgo.

To report a case of spontaneous vaginal evisceration in a patient with a surgical history of vaginal hysterectomy, and to review the literature on the main risk factors associated with the presentation of this event. We present the case of a 74-year-old multiparous patient with 12 vaginal deliveries with a gynecological history of vaginal hysterectomy in 2012, in 2014 a sacrospinocolpopexy with placement of transobturator tape plus anterior colporrhaphy, in 2018 she presented with intestinal loops protruding with signs of ischemia through a defect in the vaginal vault, resection of the small intestine and end-to-end anastomosis were performed, with subsequent closure of the defect through the abdomen. A search was made in the PubMed, Scielo, Google Scholar and Science Direct databases for articles published in English and Spanish, from the last 22 years. 16 titles that met the selection criteria were identified; the results of the review show common risk factors. Vaginal evisceration due to dehiscence of the vaginal vault is a rare pathology, the minimally invasive approach, which has increased in recent years, has led to an increase in incidence, with laparoscopic hysterectomy being of greater risk.

A prospective study of effectiveness of Mannheim peritonitis index scoring system in predicting the morbidity and mortality in peritonitis due to hollow viscous perforation

Background: Peritonitis is defined as inflammation of the peritoneal cavity, caused by a number of etiologic agents including bacteria, fungi, viruses, chemical irritants, and foreign bodies. The Mannheim peritonitis index (MPI) is one of the simple scoring systems in use that allows the surgeon to easily determine outcome risk. Aims and objective: To estimate outcome of patients with perforation peritonitis. To evaluate effect of MPI score in identification of high risk cases.Methods: A prospective study was conducted in 100 patients with peritonitis due to hollow viscous perforation at surgical unit of tertiary care unit. The duration of study was 2 years. All the data was recorded. Written informed consent was obtained and data was analyzed using appropriate analysis strategy.Results: In this study, total 100 patients enrolled, out of which 54 % patients were in the age group <50 years and 46% patients were in the age group >50 years. Mortality was higher among patients with age group more than 50 years (21%) and in female patients (37.93%). 18 patients had organ failure. 87 patients had preoperative duration was >24 hours. 93% patients had non-colonic origin of sepsis. In 52 (52%) patients total MPI score was <21 while 25 (25%) patients total score was 21-29 and it was >29 in 23 (23%) patients. Mortality was higher among patients with MPI Score more than 29 (95.65%).Conclusions: MPI is accurate to be used with patients with peritonitis and should be considered reliable and simple reference for estimating their risk of death. This study differs in one adverse outcome variables, non-colonic origin of sepsis, we advocate need for further studies on Mannheim peritonitis index to include colonic origin of sepsis.

Transcutaneous electrical acupoint stimulation on inflammatory response and intestinal permeability in perioperative period of laparoscopic intestinal surgery / 中国针灸

OBJECTIVE@#To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on the inflammatory response and intestinal permeability after laparoscopic radical surgery for colon cancer, so as to explore the protective mechanism for perioperative organs.@*METHODS@#Sixty patients with laparoscopic intestinal resection were randomly assigned into an observation group and a control group, 30 cases in each group. TEAS at Zusanli (ST 36), Neiguan (PC 6) and Hegu (LI 4) was used in the observation group on the day of operation and within 3 days after surgery, 2 Hz, within 2 mA. The interventions in the control group were the same as those in the observation group, except opening the current source. Central venous blood was collected before TEAS and 12 h, 24 h, 48 h, 72 h after surgery. The level of the inflammatory indexes of tumor necrosis factor-α(TNF-α), interleukin-1 (IL-1), interleukin-6 (IL-6) and intestinal mucosal barrier response indexes of endotoxin (LPS) and D-lactate were detected.@*RESULTS@#Compared with the control group, the levels of IL-1, IL-6 and TNF-α decreased in the observation group 24 h, 48 h and 72 h after surgery (all 0.05).@*CONCLUSION@#TEAS can reduce the inflammatory reaction after laparoscopic radical surgery for colon cancer, but has no effect on the intestinal permeability.

Effect of transcutaneous electrical acupoint stimulation on gastrointestinal function in perioperative period of laparoscopic intestinal surgery / 临床麻醉学杂志

Objective To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on the recovery of gastrointestinal function after laparoscopic intestinal operation.Methods Sixty patients of the selective laparoscopic intestinal resection, 28 males and 32 females, aged 18-65 years, ASA physical status Ⅰ or Ⅱ, were enrolled and randomly allocated into two groups: TEAS group and control group, 30 in each group.Patients in TEAS group accepted transcutaneous electrical acupoint stimulation treatment at Neiguan, Hegu, Zusanli points from the time before induction of anesthesia to 3 days after surgery, and patients in the control group were treated with transcutaneous electrical acupoint stimulation, but the electrode pads were just attached on the related points with no electric stimulation.Plasma motilin concentrations preoperatively, postoperatively 12, 24, 48 and 72 h were measured in the two groups.The recovery time of intestinal peristalsis, anal flatus time, in-hospital time and the incidence of nausea and vomiting within 3 days after operation were observed.Results Compared with the control group, serum motilin concentration postoperative 24 h increased significantly [(218.5±52.3) pg/ml vs (141.8±45.8) pg/ml, P<0.05], the time of intestinal peristalsis recovery [(19.4±3.2) h vs (29.6±7.8) h, P<0.05] and flatus [(23.2±4.7) h vs (36.5±8.9) h, P<0.05] were shorter, the incidence of postoperative nausea and vomiting within 3 days after operation decreased significantly in TEAS group (16.7% vs 36.7%, P<0.05).There was no statistically significant difference of the in-hospital time between the two groups.Conclusion TEAS can promote the recovery of gastrointestinal function in patients undergoing laparoscopic intestinal surgery.

Reparación de defectos complejos de la pared abdominal y cirugía intestinal en un tiempo / Repair of complex abdominal wall defects and intestinal surgery at a time

Introducción: La reparación de la pared abdominal, presenta escenarios complejos, como los abdómenes abiertos con ostomías o fístulas intestinales, que para su tratamiento el cirujano debe buscar la táctica quirúrgica y el manejo ideal para cada caso. Objetivo: Describir los resultados en la reparación de defectos complejos de la pared abdominal y restitución de tránsito intestinal en un solo tiempo. Pacientes y método: Estudio observacional, descriptivo, prospectivo y longitudinal, de una serie de casos de 30 pacientes, ambos sexos, mayores a 18 años, portadores de defectos complejos de la pared abdominal (abdomen abierto cicatrizado por segunda intención y hernias paraestomales) y ostomías que ingresaron para cirugía electiva en la II Cátedra de Clínica Quirúrgica del Hospital de Clínicas de marzo del 2011 a diciembre del 2015. Todos los pacientes fueron evaluados con tomografía axial computarizada, según el caso sometidos a preparación con neumoperitoneo progresivo pre operatorio y manejados por equipo multidisciplinario...

Introduction: Abdominal wall repair, presents complex scenarios, as the bellies open with ostomy or intestinal fistulas, that treatment the surgeon should seek surgical tactics and ideal management for each case. Objective: To describe the results in repair of complex defects of the abdominal wall and return of intestinal transit in a single time. Patients and methods: observational, descriptive, prospective and longitudinal study, a series of 30 patients, both sexes, over 18 years, carriers of complex defects of the abdominal wall (open abdomen healed by second intention and paraestomales herniations) and ostomy admitted for elective surgery at the surgical clinic of the Hospital de Clínicas of March 2011 to2015 December II. All patients were evaluated with axial computed tomography, according to the case subject to progressive pneumoperitoneumprogressive pre operative and managed by a multidisciplinary team...

Characteristic Phenotypes in Korean Crohn's Disease Patients Who Underwent Intestinal Surgery for the Treatment

There are no previous large scale studies which have evaluated the phenotypes and clinical characteristics of Korean Crohn's disease patients who underwent intestinal resection. The purpose of this multicenter retrospective cohort study was to evaluate the clinical characteristics of Korean Crohn's disease patients who underwent intestinal resection during the study period. A total of 686 patients were enrolled in this study. The study period was over a 20-yr period (1990-2009). The patients were divided into the first-10-yr group and the second-10-yr group. The phenotypes and clinical characteristics were compared between the groups. The most common site of the disease was the ileal area (37.8%) and stricturing behavior was observed in 38.3% patients. The most common type of surgery was segmental resection of the small bowel (30.6%). These phenotypes showed a similar pattern in both the first and second study period groups and did not show any significant differences between the groups. The number of registered patients increased continuously. The phenotypes of Korean Crohn's disease patients who underwent intestinal resection are different compared with previously reported clinical characteristics of general Crohn's disease patients.

Pedicled Ileal Seromuscular Flap-A New Technique for Protection of Intestinal Anastomosis in Patients with Peritonitis

Pedicled ileal seromuscular flap- a new technique for protection of intestinal anastomosis in patients with peritonitis. This method involves raising a seromuscular flap on a pedicle from the stump of intestine to be anastomosed. The anastomosis is performed, and then covered with seromuscular flap. The submucosa due to its inherent properties, promotes better healing and reduces the tension on the anastomosis. There has been no previous study to assess the usefulness of this technique. We used a pedicled ileal seromuscular flap in twenty consecutive patients with peritonitis who required an ileo-ileal or an ileo-colic anastomosis. Anastomotic leak occurred in two out of twenty patients. The safety and efficacy of this technique involving autologous tissues to reinforce intestinal anastomosis has been demonstrated.

Hypocaloric nutrition support after intestinal surgery / 肠外与肠内营养

Objectives:To observe the role of hypocaloric nutrition support after major intestinal surgery. Methods:Forty cases after intestinal surgical procedure were randomly divided into hypocaloric group ( n =20),peripheral parenteral nutrition support of 15 kcal/(kg?d)+3 g Nitrogen/d) for 5 days and control group ( n =20,general infussion supports). Postoperative nitrogen balance, plasma proteins and body composition were detected. Results: Nitrogen balance of hypocaloric group was found to be improved, plasma proteins increased and body composition loss decreased. Conclusions:The hypocaloric nutrition support is a selected method for postoperative support.