RESUMO
Colocolic intussusception is a variation of intussusception that is rarely encountered in pediatric patients and as such can prove to be a diagnostic challenge for both the emergency clinician and radiologist. Knowledge of the presentation and imaging findings in these cases can expedite diagnosis and guide the patient to appropriate treatment. The demographics, clinical symptoms, imaging findings, and eventual surgical and pathologic outcomes of 8 children with colocolic intussusception will be presented in this pictorial essay, with a review of the available literature.
Assuntos
Doenças do Colo/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Doenças do Colo/terapia , Diagnóstico Diferencial , Feminino , Humanos , Lactente , Intussuscepção/terapia , MasculinoRESUMO
BACKGROUND: Anal sphincter injury leads to fecal incontinence. Based on the regenerative capability of laser and human adipose-derived stem cells (hADSCs), this study was designed to assess the effects of co-application of these therapies on anal sphincter recovery after injury. DESIGN: Male rabbits were assigned to equal groups (n = 7) including control, sphincterotomy, sphincterotomy treated with laser (660 nm, 90 s, immediately after sphincterotomy, daily, 14 days), hADSCs (2 × 106 hADSCs injected into injured area of the sphincter immediately after sphincterotomy), and laser + hADSCs. Ninety days after sphincterotomy, manometry and electromyography were performed, sphincter collagen content was evaluated, and Ki67, myosin heavy chain (MHC), skeletal muscle alpha-actin (ACTA1), vascular endothelial growth factor A (VEGFA), and vimentin mRNA gene expression were assessed. RESULTS: The laser + hADSCs group had a higher resting pressure compared with the sphincterotomy (p < 0.0001), laser (p < 0.0001), and hADSCs (p = 0.04) groups. Maximum squeeze pressure was improved in all treated animals compared with the sphincterotomized animals (p < 0.0001), without a significant difference between treatments (p > 0.05). In the laser + hADSCs group, motor unit numbers were higher than those in the laser group (p < 0.0001) but did not differ from the hADSCs group (p = 0.075). Sphincterotomy increased collagen content, but the muscle content (p = 0.36) and collagen content (p = 0.37) were not significantly different between the laser + hADSCs and control groups. Laser + hADSCs increased ACTA1 (p = 0.001) and MHC (p < 0.0001) gene expression compared with laser or hADSCs alone and was associated with increased VEGFA (p = 0.009) and Ki67 mRNA expression (p = 0.01) and decreased vimentin mRNA expression (p < 0.0001) compared with laser. CONCLUSION: The combination of laser and hADSCs appears more effective than either treatment alone for promoting myogenesis, angiogenesis, and functional recovery after anal sphincterotomy.
Assuntos
Doenças do Colo/terapia , Terapia com Luz de Baixa Intensidade , Transplante de Células-Tronco , Actinas/genética , Actinas/metabolismo , Adipócitos/citologia , Canal Anal/lesões , Canal Anal/patologia , Animais , Colágeno/genética , Colágeno/metabolismo , Doenças do Colo/patologia , Eletromiografia , Regulação da Expressão Gênica , Humanos , Antígeno Ki-67/genética , Antígeno Ki-67/metabolismo , Lasers Semicondutores/uso terapêutico , Masculino , Coelhos , Esfincterotomia , Células-Tronco/citologia , Células-Tronco/metabolismoAssuntos
Doenças do Colo/diagnóstico por imagem , Pólipos do Colo/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Pré-Escolar , Doenças do Colo/etiologia , Doenças do Colo/terapia , Pólipos do Colo/complicações , Pólipos do Colo/cirurgia , Colonoscopia , Enema , Humanos , Intussuscepção/etiologia , Intussuscepção/terapia , Masculino , UltrassonografiaRESUMO
We performed a prospective study to explore a diagnosis and treatment protocol of transient intussusception in children (TIC). Totally, 143 children with intussusception who met the inclusion criteria were firstly divided into intussusception involving only the small bowel and intussusception involving the colon group. And in each group, they were further divided into short-segment (≤ 3.0 cm) and long-segment (> 3.0 cm) groups according to the length of intussusception. After a period of conservative treatment, the incidence of TIC, the incidence of surgery, and recurrence were collected and analyzed. Finally, we found that the incidence of TIC in the short-segment group of small bowel intussusception (96.29%) was significantly higher than that in other groups (P ≤ 0.001). Besides, the incidence of surgery and recurrence in this group was relatively low too. Therefore, we summarized the inclusion criteria and treatments to the short-segment group of small bowel intussusception as the suggested protocol to TIC.Conclusion: For cases of small bowel intussusception with no identified pathologic lead point, a short duration of symptoms, a length of ≤ 3.0 cm, a relatively abundant vascular flow signal, and a stable general condition, the spontaneous reduction could be expected and a period of conservative treatment with careful monitoring is recommended. What is Known: ⢠The phenomenon of spontaneous reduction in intussusception (transient intussusception) among pediatric patients has been widely reported. ⢠To distinguish the transient intussusception from the other types is important for the transient ones only need conservative treatment rather than enema reduction or surgery. What is New: ⢠This is the first prospective study to explore a diagnosis and treatment protocol of transient intussusception in children. ⢠Short-segment small bowel intussusceptions have a higher rate (96.29%) to get spontaneous reduction than the other types of intussusception.
Assuntos
Doenças do Colo/terapia , Tratamento Conservador/métodos , Intestino Delgado , Intussuscepção/terapia , Pré-Escolar , Enema/efeitos adversos , Feminino , Humanos , Lactente , Intussuscepção/diagnóstico por imagem , Masculino , Estudos Prospectivos , Remissão Espontânea , UltrassonografiaRESUMO
BACKGROUND: Ileocolic intussusception occurs when the terminal ileum "telescopes" into the colon. We observed that ileocolic intussusception lengths are similar regardless of location in the colon. OBJECTIVE: To examine the uniformity of ileocolic intussusception length and its relationship to colon location, symptom duration and reducibility. MATERIALS AND METHODS: We retrospectively reviewed ultrasound-diagnosed pediatric ileocolic intussusceptions initially treated with pneumatic reduction at the Mayo Clinic or Texas Children's Hospital. We recorded demographic, imaging and surgical findings including age, gender, symptom duration, location of the ileocolic intussusception, reducibility with air enema and, if fluoroscopically irreducible, surgical findings. RESULTS: We identified 119 ileocolic intussusceptions (64% boys), with 81% in the right colon. There was no significant relationship between ileocolic intussusception length and colon location (P=0.15), nor ileocolic intussusception length and symptom duration (P=0.36). Ileocolic intussusceptions were more distal with increasing symptom duration (P=0.016). Successful reductions were unrelated to symptom duration (P=0.84) but were more likely with proximal versus distal locations (P=0.02). CONCLUSION: Ileocolic intussusception lengths are relatively uniform regardless of location along the course of the colon where they present. Our findings suggest that most of the apparent distal propagation of ileocolic intussusceptions is not caused by increasing telescoping of small bowel across the ileocecal valve but rather by foreshortening of the right colon. This implies poor cecal fixation and confirms fluoroscopic and surgical observations of cecal displacement from the right lower quadrant with ileocolic intussusceptions. The movement of the leading edge of the ileocolic intussusception during reduction is first due to "relocating" the cecum into the right lower quadrant after which the reduction of small bowel back across the ileocecal valve then occurs.
Assuntos
Doenças do Colo/diagnóstico por imagem , Doenças do Íleo/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Ultrassonografia/métodos , Doenças do Colo/terapia , Feminino , Humanos , Doenças do Íleo/terapia , Lactente , Intussuscepção/terapia , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Both non-invasive and invasive electroneurostimulation (ENS) modalities for bladder bowel dysfunction have been studied and reported in children. A summary of the proposed mechanism of actions and the more commonly used and recently reported techniques and outcomes are described. This includes transcutaneous electrical nerve stimulation, functional electrical nerve stimulation, intravesical electrical nerve stimulation, percutaneous tibial nerve stimulation and sacral neuromodulation in conditions including overactive bladder, enuresis, dysfunctional voiding, constipation, combined bladder bowel dysfunction and neuropathic bladder and bowel dysfunction. There is a need for further high quality randomised trials as well as long-term outcomes to establish whether ENS is able to alter the long-term trajectory for an individual child with bladder bowel dysfunction.
Assuntos
Doenças do Colo/terapia , Defecação/fisiologia , Terapia por Estimulação Elétrica/métodos , Sintomas do Trato Urinário Inferior/terapia , Doenças Retais/terapia , Bexiga Urinaria Neurogênica/terapia , Transtornos Urinários/terapia , Criança , Ensaios Clínicos como Assunto , Doenças do Colo/fisiopatologia , Constipação Intestinal/fisiopatologia , Constipação Intestinal/terapia , Feminino , Humanos , Sintomas do Trato Urinário Inferior/fisiopatologia , Doenças Retais/fisiopatologia , Estimulação da Medula Espinal/métodos , Estimulação Elétrica Nervosa Transcutânea/métodos , Bexiga Urinaria Neurogênica/fisiopatologia , Bexiga Urinária Hiperativa/fisiopatologia , Bexiga Urinária Hiperativa/terapia , Transtornos Urinários/fisiopatologiaRESUMO
BACKGROUND: This study aimed to evaluate the therapeutic effects of abdominal manual therapy (AMT) on bowel dysfunction after spinal cord injury (SCI), investigating interstitial cells of Cajal (ICCs) and related c-kit expression. METHODS: Model rats were divided as SCI and SCI with drug treatment (intragastric mosapride), low-intensity (SCI + LMT; 50 g, 50 times/min), and high-intensity AMT (SCI + HMT; 100 g, 150 times/min). After 14 days of treatment, weight, improved Basso-Beattie-Bresnahan (BBB) locomotor score, and intestinal movement were evaluated. Morphological structure of spinal cord and colon tissues were examined. Immunostaining, RT-PCR, and western blot were used to assess c-kit expression. RESULTS: In SCI rats, AMT could not restore BBB, but it significantly increased weight, shortened time to defecation, increased feces amounts, and improved fecal pellet traits and colon histology. AMT improved the number, distribution, and ultrastructure of colonic ICCs, increasing colonic c-kit mRNA and protein levels. Compared with the SCI + Drug and SCI + LMT groups, the SCI + HMT group showed better therapeutic effect in improving intestinal transmission function and promoting c-kit expression. CONCLUSIONS: AMT is an effective therapy for recovery of intestinal transmission function. It could repair ICCs and increase c-kit expression in colon tissues after SCI, in a frequency-dependent and pressure-dependent manner.
Assuntos
Doenças do Colo , Células Intersticiais de Cajal , Manipulações Musculoesqueléticas , Proteínas Proto-Oncogênicas c-kit/metabolismo , Traumatismos da Medula Espinal/complicações , Animais , Colo/química , Colo/citologia , Colo/patologia , Colo/fisiopatologia , Doenças do Colo/etiologia , Doenças do Colo/terapia , Modelos Animais de Doenças , Feminino , Células Intersticiais de Cajal/citologia , Células Intersticiais de Cajal/metabolismo , Masculino , Proteínas Proto-Oncogênicas c-kit/análise , Proteínas Proto-Oncogênicas c-kit/genética , Ratos , Ratos Sprague-Dawley , Medula Espinal/citologia , Medula Espinal/patologiaRESUMO
Computed tomographic colonography (CTC) is a minimally invasive, patient-friendly, safe and robust colonic imaging modality. The technique is standardized and consolidated evidence from the literature shows that the diagnostic performances for the detection of colorectal cancer and large polyps are similar to colonoscopy (CS) and largely superior to alternative radiological exams, like barium enema. A clear understanding of the exact role of CTC will be beneficial to maximize the benefits and minimize the potential sources of frustration or disappointment for both referring clinicians and patients. Incomplete, failed, or unfeasible CS; investigation of elderly, and frail patients and assessment of diverticular disease are major indications supported by evidence-based data and agreed by the endoscopists. The use of CTC for symptomatic patients, colorectal cancer screening and colonic surveillance is still under debate and, thus, recommended only if CS is unfeasible or refused by patients.
Assuntos
Colo/diagnóstico por imagem , Doenças do Colo/diagnóstico por imagem , Colonografia Tomográfica Computadorizada/tendências , Seleção de Pacientes , Doenças do Colo/terapia , Contraindicações , Previsões , Humanos , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Fatores de RiscoRESUMO
OBJECTIVE: To observe the dynamic distribution of the extravasated Evans Blue (EB) dye points at the skin after acute colorectal mucosal injury (AIMI) so as to reveal characteristics of acupoint sensitization. METHODS: Forty adult male SD rats were randomly divided into control (n= 10), AIMI (n=20) and AIMI-recovery (n= 10) groups. According to the reaction state (EB-dye extravasation), each group was further divided into resting state (control), sensitized state (appearance of extravasated EB points), recovery state (disappearance of the extravasated EB points), non-sensitization (NS, no extravasated EB points) state and NS recovery state. The AIMI model was induced by perfusion of 2. 5% mustard oil into the colorectum via a thin tube. Evans blue dye was injected into the caudal vein 4 h after AIMI modeling. The distribution of plasma extravasated EB dye points at the skin of the lower limbs was observed. The C-fiber discharge of the separated ipsilateral sciatic nerve was induced by electrical stimulation of the EB-extravasated acupoints and non-acupoint at the threshold and double-fold threshold using an electric stimulator and recorded using a bicelectric amplifier-computer system. RESULTS: In AIMI rats, the extravasated EB-dye points were found to overlap the "Xiqian" and "Zusanli" (ST 36)-"Shangjuxu"(ST 37) regions. Moreover, the thresholds of C-fiber discharges induced by electrical stimulation of "Xiqian" and "Zusanli" (ST 36)-"Shangluxu"(ST 37) regions were significantly lower than those of the regions without extravasated EB dye acupoint and non-acupoint(P<0. 01, P<0. 05). The numbers of C-fiber discharges evoked by 2-fold threshold electro-stimulation at the "Xiqian" and "Zusanli" (ST 36)-"Shangjuxu" (ST 37) regions were obviously more than those of stimulation of non-acupoint which were experiencing sensitized state(P<0. 01, P<0. 05). CONCLUSION: In rats with acute colorectal mucosal injury, electrical stimulation of the acupoints where the extravasated EB-dye points appear may produce an obvious increase of C-fiber discharges under lower electro-stimulation threshold, suggesting a larger action of the sensitized acupoint.
Assuntos
Pontos de Acupuntura , Doenças do Colo/terapia , Eletroacupuntura , Mucosa Intestinal/lesões , Animais , Colo/metabolismo , Doenças do Colo/metabolismo , Humanos , Mucosa Intestinal/metabolismo , Masculino , Fibras Nervosas Amielínicas/metabolismo , Ratos , Ratos Sprague-DawleyRESUMO
Distal intestinal obstruction syndrome (DIOS) - the incomplete of complete intestinal obstruction by intestinal contents in the terminal ileum and proximal colon- is frequently seen in cystic fibrosis (CF) patients. Diagnosis is based on suggestive symptoms of abdominal pain in the right lower quadrant, a palpable mass on examination and signs of obstruction on plain radiography. Treatment consists of intensive laxative treatment with oral laxatives and enemas. Surgery only serves as the last resort for patients not responding to medical therapy, because of the well-known high rate of peri- and postoperative morbidity of surgery in CF patients. In this article we present 3 cases of DIOS, followed by a review of the relevant literature.
Assuntos
Doenças do Colo/terapia , Fibrose Cística/complicações , Enema , Doenças do Íleo/terapia , Obstrução Intestinal/terapia , Laxantes/uso terapêutico , Adulto , Doenças do Colo/etiologia , Feminino , Humanos , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Muco , Adulto JovemRESUMO
This project was focused on the study of the effect of the different acupoints on visceral hypersensitivity and the correlation with the brain-gut axis. By using a mouse model of zymosan-induced colorectal hypersensitivity, and observing the response of hypersensitivity model to colorectal distension stimulation in acupuncture at different acupoints, we selected the specific acupoints. With immunohistochemical staining method, we observed c-fos expression, distribution and changes after acupuncture on sensory pathway, including colorectum, spinal dorsal horn and different regions of brain center in the model with colorectal distension stimulation, and evaluated the acupuncture effect on brain-gut axis. The results revealed that the effectiveness of acupuncture for alleviating visceral hypersensitivity was different at individual acupoint, meaning Tianshu (ST25), Zusanli (ST36) and Shangjuxu (ST37) > Quchi (LI11) and Dachangshu (BL25) > Ciliao (BL32). C-fos expression was concentrated in anterior cingulate cortex, hypothalamus, spinal dorsal horn and colorectum in model of zymosan-induced colorectal hypersensitivity and it was down-regulated after acupuncture. The results demonstrates that the acupoint specificity presents in acupuncture for relieving visceral hypersensitivity and the effects are more predominated at the acupoints on stomach meridian innervated by the same or adjacent spinal ganglion segments. The model of zymosan-induced colorectal hypersensitivity can be the animal model simulating brain-gut interaction.
Assuntos
Pontos de Acupuntura , Terapia por Acupuntura/métodos , Encéfalo/fisiopatologia , Doenças do Colo/terapia , Gastroenteropatias/fisiopatologia , Hiperalgesia/terapia , Doenças Retais/terapia , Animais , Doenças do Colo/induzido quimicamente , Doenças do Colo/genética , Eletromiografia , Expressão Gênica , Genes fos , Hiperalgesia/induzido quimicamente , Hiperalgesia/genética , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Estimulação Física , Doenças Retais/induzido quimicamente , Doenças Retais/genética , ZimosanRESUMO
STUDY OBJECTIVE: To evaluate the diagnostic contribution of the computed tomography (CT) enema and magnetic resonance imaging (MRI) for multifocal (multiple lesions affecting the same segment) and multicentric (multiple lesions affecting several digestive segments) bowel endometriosis. DESIGN: Prospective cohort study (Canadian Task Force classification II-2). PATIENTS: Eighty-five patients. SETTING: Tenon University Hospital, Paris, France. INTERVENTION: All patients received a preoperative CT enema and underwent MRI interpreted by 2 radiologists. MEASUREMENTS AND MAIN RESULTS: Patients underwent colorectal resection for colorectal endometriosis from February 2009 to November 2012. Nineteen patients (22%) had multifocal lesions, and 11 patients (13%) had multicentric lesions. Six patients (7%) had both multifocal and multicentric lesions. The sensitivity, specificity, and positive and negative likelihood ratios (LRs) of MRI for the diagnosis of multifocal lesions were 0.58, 0.84, 3.55, and 0.5, respectively. The sensitivity, specificity, and positive and negative LRs of the CT enema for the diagnosis of multifocal lesions were 0.64, 0.86, 4.56, and 0.4, respectively. The sensitivity, specificity, and positive LR of MRI for the diagnosis of multicentric lesions were 1, 0.88, and 8.4, respectively. The sensitivity, specificity, and positive and negative LRs of MRI for the diagnosis of multicentric lesions were 0.46, 0.92, 5.6, and 0.59, respectively. No difference was observed between MRI and the CT enema for the diagnosis of multifocal and multicentric colorectal endometriosis. The interobserver agreement was good for MRI and the CT enema (κ = 0.45 and 0.45) for multifocality, and it was poor for both MRI and the CT enema (κ = 0.32 and 0.34) for multicentricity. CONCLUSIONS: Both MRI and the CT enema were able to diagnose multifocal and multicentric bowel endometriosis with similar accuracy.
Assuntos
Doenças do Colo/diagnóstico , Endometriose/diagnóstico , Enema , Imageamento por Ressonância Magnética , Doenças Retais/diagnóstico , Tomografia Computadorizada por Raios X , Adulto , Idoso , Doenças do Colo/patologia , Doenças do Colo/terapia , Endometriose/patologia , Endometriose/terapia , Enema/métodos , Feminino , França , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Doenças Retais/patologia , Doenças Retais/terapiaRESUMO
OBJECTIVE: A prospective pilot study to evaluate the potential role of osteopathic manipulative therapy (OMT) on quality of life (QOL) of patients with Deep Infiltrating Endometriosis (DIE) and colorectal involvement. STUDY DESIGN: Twenty patients with DIE and colorectal infiltration completed the SF-36 QOL questionnaire before and after undergoing OMT. RESULTS: The median age (range) of the patients was 30.4 years (22-39). Thirty-five percent of the patients had undergone previous surgery for endometriosis and 70% were on medical treatment. Fifteen of the 20 patients (75%) completed the protocol. There was no difference in the epidemiological characteristics or in the pre-OMT Physical Component Summary (PCS) and Mental Component Summary (MCS) of the SF-36 questionnaire between patients who completed the protocol or not. After a mean period of 24 days (15-53), a significant improvement in PCS (p=0.03) and MCS (p=0.0009) compared to pre-OMT values was observed giving a success rate of 80% and 60% in intention-to-treat, respectively. CONCLUSION: Our results support that OMT can improve QOL of patients with DIE and colorectal involvement. Moreover, this pilot study can serve to determine power calculations for future randomized trials.
Assuntos
Doenças do Colo/terapia , Endometriose/terapia , Osteopatia , Qualidade de Vida , Doenças Retais/terapia , Adulto , Doenças do Colo/diagnóstico por imagem , Endometriose/diagnóstico por imagem , Feminino , Humanos , Análise de Intenção de Tratamento , Imageamento por Ressonância Magnética , Projetos Piloto , Estudos Prospectivos , Doenças Retais/diagnóstico por imagem , Inquéritos e Questionários , Ultrassonografia , Adulto JovemRESUMO
OBJECTIVE: To explore the mechanism of acupuncture on promoting the restoration of interstitial cells of Cajal (ICCs). METHODS: Thirty SD rats were randomly divided into a blank group, a model group and an acupuncture group, ten rats in each one. The rats in the model group and acupuncture group were treated with colonic anastomosis to establish the model. After successful establishment of the model, the rats in the acupuncture group were treated with acupuncture at bilateral "Zusanli" (ST 36), "Sanyinjiao" (SP 6) and "Taichong" (LR 3) for 15 min, once a day for 10 days. Rats in the model group and blank group were put into the fixator for 15 min at the same time daily. The propulsive rate of small intestine was measured in each group. Colonic tissues were collected to detect c-kit expression by using immunohistochemistry. The nitricoxide (NO) content was measured by nitrate reductase method and nitric oxide synthase (NOS) activity was measured by method of L-arginine. RESULTS: Compared with the blank group, the propulsive rate of small intestine in the model group was decreased; NO content was increased; iNOS activity was elevated; cNOS activity was declined; total NOS (tNOS) activity was increased and the counting of c-kit positive ICCs was decreased (all P < 0.05). Compared with the model group, the propulsive rate of small intestine in the acupuncture group was increased; NO content was decreased; iNOS activity was reduced; cNOS activity was elevated; NOS activity was decreased and the counting of c-kit positive ICCs was increased (all P < 0.05). CONCLUSION: Acupuncture can regulate NO content and NOS activity in postoperative restoration environment of ICCs, which may participate in the process of acupuncture promoting the restoration of ICCs.
Assuntos
Terapia por Acupuntura , Colo/cirurgia , Doenças do Colo/terapia , Células Intersticiais de Cajal/metabolismo , Óxido Nítrico/metabolismo , Pontos de Acupuntura , Anastomose Cirúrgica , Animais , Colo/metabolismo , Doenças do Colo/enzimologia , Doenças do Colo/metabolismo , Doenças do Colo/cirurgia , Feminino , Humanos , Células Intersticiais de Cajal/enzimologia , Masculino , Óxido Nítrico Sintase Tipo II/metabolismo , Ratos , Ratos Sprague-DawleyRESUMO
We highlight a potentially lethal complication of acute severe pancreatitis that may not be suspected in severely ill patients. A 41-year-old woman developed acute severe pancreatitis following endoscopic retrograde cholangiopancreatography (ERCP) for suspected choledocholithiasis. When her condition deteriorated dramatically after 2 weeks of intensive medical management, a computed tomography scan and water-soluble contrast enema examination revealed a large colonic perforation and associated collection in the right flank. Surgical management included an extended right hemicolectomy and a second laparotomy to attend to soiling at the surgical site. She survived and was discharged. Colonic perforation is a recognised complication of pancreatitis that carries a high mortality. It may result from a combination of ischaemia to the colon and a direct effect of noxious pancreatic enzymes. Almost all cases are only diagnosed at laparotomy. In view of the current trend of non-surgical management of pancreatitis and associated complications, colonic perforation should be considered in patients who deteriorate or fail to improve. To our knowledge this is the first case of a secure pre-operative diagnosis of colonic perforation due to to pancreatitis.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Doenças do Colo/etiologia , Perfuração Intestinal/etiologia , Pancreatite/complicações , Adulto , Doenças do Colo/diagnóstico , Doenças do Colo/terapia , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/terapia , Pancreatite/diagnóstico , Pancreatite/terapiaRESUMO
BACKGROUND: Intussusception is one of the important causes of intestinal obstruction in children. Hydrostatic reduction under ultrasound guidance is a popular treatment method for intussusception. In the present study, we aimed to explain the demographic characteristics of and treatment approaches in patients diagnosed with intussusception by ultrasound. METHODS: Forty-one patients diagnosed with intussusception by ultrasound between August 2011 and May 2013 were retrospectively analyzed. Twenty-four of these patients who had no contraindications had been treated with ultrasound-guided hydrostatic reduction. RESULTS: Twenty-four of the patients were male and 17 were female, a 1.4/1 male-to-female ratio. The majority of the patients were between the ages of 6-24 months and 2-5 years. The mean age was 31.12±26.32 months (range 3-125). Patients were more frequently diagnosed in April and May. Seventeen patients who had clinical contraindications enrolled directly for surgery. In 20 of the 24 patients who underwent ultrasound-guided hydrostatic reduction, reduction was achieved. Three experienced recurrence. In two of these patients, successful reduction was achieved with the second attempt. The remaining patient was enrolled for surgery. Hydrostatic reduction was performed 26 times on these 24 patients, and in 22, success was achieved (84.6%). No procedure-related complications occurred in the patients. CONCLUSION: Ultrasound-guided hydrostatic reduction, with its high success rates and lack of radiation risk, should be the first choice therapeutic approach for children diagnosed with intussusception.
Assuntos
Doenças do Colo/terapia , Enema/métodos , Intussuscepção/terapia , Criança , Pré-Escolar , Doenças do Colo/diagnóstico por imagem , Feminino , Humanos , Pressão Hidrostática , Lactente , Intussuscepção/diagnóstico por imagem , Masculino , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção , Adulto JovemRESUMO
Milk curd syndrome was first reported in the 1960s, but was gradually forgotten because of its low incidence thereafter. This condition in pre-term infants has been reported over the last decade and has again attracted neonatologists' attention. The present report describes a pre-term infant with milk curd syndrome. Abdominal distension was evident 14 days after the start of feeding with fortified expressed milk. Abdominal X-ray showed multiple intraluminal masses surrounded by a halo of air, and ultrasound indicated hyperechoic masses. Along with that history and the appearance of fecal impaction, the diagnosis of milk curd syndrome was confirmed. This baby was treated with olive oil enemas and successive colonic lavage for 3 days, and the symptoms were relieved. Olive oil enema, which softens hard stools and induces smooth movement of these stools, may be an effective and safe first-line treatment in pre-term infants with milk curd syndrome.