RESUMEN
Inflammatory bowel diseases are associated with a state of hypercoagulability secondary to several mechanisms, protein S deficiency being one of these. It can be revealed by spontaneous skin necrosis in children. This condition is rare in adults with Crohn's disease. We are reporting a case of a 35-year-old woman with active Crohn's disease who presented a protein S deficiency responsible for an extensive spontaneous skin necrosis. The evolution was favourable after vascular filling, curative anticoagulation, antibiotic therapy, as well as a high-dose of corticosteroid therapy. We are reporting this case in order to emphasize the importance of considering skin necrosis as a possible cutaneous manifestation of inflammatory bowel diseases.
Asunto(s)
Enfermedad de Crohn/complicaciones , Deficiencia de Proteína S/complicaciones , Enfermedades de la Piel/etiología , Piel/patología , Corticoesteroides/administración & dosificación , Adulto , Antibacterianos/administración & dosificación , Anticoagulantes/administración & dosificación , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/tratamiento farmacológico , Femenino , Humanos , Necrosis , Deficiencia de Proteína S/diagnóstico , Deficiencia de Proteína S/tratamiento farmacológico , Piel/efectos de los fármacos , Enfermedades de la Piel/tratamiento farmacológico , Enfermedades de la Piel/patología , Resultado del TratamientoRESUMEN
INTRODUCTION: Timing of major elective operations is a potentially important outcome variable. This study examined the impact of operative start time (OST) on pathologic and short-term outcomes of minimally invasive rectal surgery (MIRS). METHODS: All rectal tumors patients who underwent MIRS from May 2012 to April 2016 were identified. Peroperative outcomes and the oncological quality of surgical excision were compared between patients with OST before 13.00h and after. RESULTS: A total of 137 patients were included in the study (71 Romarobot-assisted and 66 conventional laparoscopic). Ninety-nine (72%) patients were operated before 13.00h and 38 after 13.00h. The majority of cases were low/middle rectal tumors (69%). Patient's baseline characteristics were quite similar in both groups. The rate of severe complication (p=0.460) or reoperation (p=0.614) was the same. Pathologic criteria (T or N stage, number of harvested lymph nodes, and presence of any positive margin) were the same between groups except for the quality of mesorectal excision (ME) that was significantly poorer for cases beginning after 13.00h (complete 91% vs 74%; p=0.016). The OST was found to be the only parameter associated with a poor quality of ME [OR 2.55 (1.08 - 6.36)]. CONCLUSION: Perioperative outcome after MIRS does not appear to be influenced by OST. Poorer quality of ME was observed and may thus raise important questions about the timing and sequence of case scheduling.