RESUMEN
We report a case of a 73-year-old woman affected by Lemmel's syndrome, a rare type of obstructive jaundice caused by a periampullary duodenal diverticulum. The patient was admitted to the Emergency Department for pneumonia associated with mild epigastric pain and vomiting. While hospitalized for antibiotic treatment, the appearance of jaundice led us to discover a periampullary duodenal diverticulum by endoscopy and CT scan. The jaundice was successfully managed endoscopically with removal of food debris from the diverticulum.
Asunto(s)
Divertículo , Enfermedades Duodenales , Ictericia Obstructiva , Ictericia , Dolor Abdominal/etiología , Anciano , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Divertículo/cirugía , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/diagnóstico por imagen , Femenino , Humanos , Ictericia Obstructiva/etiología , SíndromeRESUMEN
Biliary lithiasis is common worldwide, affecting almost 20% of the general population, though few experience symptoms. The frequency of choledocholithiasis in patients with symptomatic cholelithiasis is estimated to be 10-33%, depending on patients' age. Unlike gallbladder lithiasis, the medical and surgical treatment of common bile duct stones is uncertain, having changed over the last few years. The prior gold standard treatment for cholelithiasis and choledocholithiasis was open cholecystectomy with bile duct clearance, choledochotomy, and/or surgical sphincterotomy. In the last 10-15 years, new treatment approaches to the complex pathology of choledocholithiasis have emerged with the advent of endoscopic retrograde cholangiopancreatography (ERCP), laparoscopic surgery, and advanced diagnostic procedures. Although ERCP followed by laparoscopic cholecystectomy is the preferred mode of management, a single-step strategy (laparo-endoscopic rendezvous) has gained acceptance due to lesser morbidity and a lower risk of iatrogenic damage. Given the above, a tailored approach relying on careful evaluation of the disease is necessary in order to minimize complication risks and overall costs. Yet, the debate remains open, with no consensus on the superiority of laparo-endoscopic rendezvous to more conventional approaches.
Asunto(s)
Colecistectomía Laparoscópica , Coledocolitiasis , Cálculos Biliares , Colangiopancreatografia Retrógrada Endoscópica , Colecistectomía Laparoscópica/efectos adversos , Colecistectomía Laparoscópica/métodos , Coledocolitiasis/diagnóstico por imagen , Coledocolitiasis/cirugía , Cálculos Biliares/complicaciones , HumanosRESUMEN
Duodenal follicular lymphoma (DFL) is a rare variety of non-Hodgkin's lymphoma of the gastrointestinal tract that usually carries a favorable course, recognized as a new entity in 2016. It is usually diagnosed at an early stage located predominantly in the second portion of the duodenum. We report the case of a 74-year-old male patient with epigastric pain in whom gastroscopy revealed white mucosal nodules that were pathologically diagnosed as grade 1-2 DFL. Staging investigations revealed secondary lesions in the spleen and at the base of the tongue together with latero-cervical adenopathy. The tumor was stage IV according to the Lugano staging system. We reviewed the recent (last five years) literature defining the importance of combination therapy in the advanced stage. The patient achieved complete remission of the disease through chemoimmunotherapy following the Rituximab-Bendamustine scheme.
Asunto(s)
Linfoma Folicular , Linfoma no Hodgkin , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Duodeno/patología , Humanos , Linfoma Folicular/diagnóstico , Linfoma Folicular/tratamiento farmacológico , Linfoma Folicular/patología , Masculino , Inducción de Remisión , Rituximab/uso terapéuticoRESUMEN
Adenocarcinoma as the primary cause of bowel intussusception is uncommon. We describe the case of a 86-year-old patient admitted for ileocecal intussusception due to the presence of adenocarcinoma, located in the ileocecal valve and right colon. The etiologies of intussusception, its diagnosis, and conservative or surgical treatments are discussed, with attention placed on the indications for reduction of the invagination prior to surgical resection.
Asunto(s)
Adenocarcinoma/complicaciones , Enfermedades del Íleon/etiología , Neoplasias del Íleon/complicaciones , Válvula Ileocecal , Intususcepción/etiología , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano de 80 o más Años , Femenino , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/cirugía , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/patología , Neoplasias del Íleon/cirugía , Válvula Ileocecal/diagnóstico por imagen , Válvula Ileocecal/patología , Válvula Ileocecal/cirugía , Intususcepción/diagnóstico por imagen , Intususcepción/cirugía , Estadificación de Neoplasias , Resultado del TratamientoRESUMEN
Giant colonic diverticulum, defined as a single diverticulum ≤ 4 cm, is rarely encountered. Due to the high incidence of complications related to the disease, obtaining the correct diagnosis early in the disease course is essential. Diagnosis is usually reached by conventional and cross-sectional abdominal radiography. Treatment decisions should be ideally made by a multidisciplinary discussion among surgeons, interventional radiologists, and the patient. The treatment of choice is the surgical management by open or laparoscopic approach.
Asunto(s)
Divertículo del Colon/complicaciones , Divertículo del Colon/diagnóstico por imagen , Obstrucción del Cuello de la Vejiga Urinaria/diagnóstico por imagen , Obstrucción del Cuello de la Vejiga Urinaria/etiología , Anciano , Divertículo del Colon/cirugía , Femenino , Humanos , Vejiga Urinaria/diagnóstico por imagen , Vejiga Urinaria/cirugía , Obstrucción del Cuello de la Vejiga Urinaria/cirugíaRESUMEN
INTRODUCTION: Pelvic schwannomas are rare, mostly benign tumors. They are usually asymptomatic until their massive growth compresses adjacent organs. We describe the case of a 53-year-old man with a pelvic schwannoma who initially complained of constipation and urinary retention. AREAS COVERED: We analyzed the clinical presentation, histopathology, diagnostic imaging tools, and the treatment options for pelvic schwannomas, compared with the few other cases reported in the literature. EXPERT COMMENTARY: Pelvic schwannomas are masses that can grow to considerable size, producing symptoms over time. Due to their size and localization, surgery, although difficult, is the only available treatment.
Asunto(s)
Neurilemoma/patología , Neoplasias Pélvicas/patología , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Pancreatic pseudocysts commonly complicate acute pancreatitis. They can evolve either asymptomatically or with important symptoms. Treatment can be surgical, endoscopic, or percutaneous. The authors present a case report of a 78-year-old man who developed symptoms of an acute abdomen during hospitalization. A CT scan showed two pancreatic pseudocysts (diameters 10 cm and 7.5 cm) that were successfully drained endoscopically. Multiple pancreatic pseudocysts can be treated successfully via an endoscopic approach.
Asunto(s)
Drenaje/métodos , Endoscopía del Sistema Digestivo , Seudoquiste Pancreático/terapia , Anciano , Antibacterianos/uso terapéutico , Drenaje/instrumentación , Endoscopía del Sistema Digestivo/instrumentación , Enterobacter/aislamiento & purificación , Humanos , Masculino , Seudoquiste Pancreático/diagnóstico por imagen , Seudoquiste Pancreático/microbiología , Pseudomonas aeruginosa/aislamiento & purificación , Stents , Resultado del TratamientoRESUMEN
Dedifferentiated liposarcomas are rare; localization of these tumors in the descending colon is extremely uncommon. We describe the case of a 75-year-old man with a dedifferentiated liposarcoma originating from the descending colon that manifested as partial bowel obstruction. The very uncommon presentation of this rare disease contributed to a challenging diagnostic process. The patient was successfully treated by surgical resection of the mass through left hemicolectomy. Although exceptionally unusual, soft tissue sarcomas should be considered in the differential diagnosis for bowel obstruction. Currently, radical resection of the mass is considered to be the first-line treatment.
Asunto(s)
Neoplasias del Colon/diagnóstico , Liposarcoma/diagnóstico , Anciano , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Humanos , Liposarcoma/patología , Liposarcoma/cirugía , MasculinoRESUMEN
INTRODUCTION: Isolated heterotopic pancreas (HP) as the primary cause of bowel intussusception is extremely rare. We report a case of a 33-year-old female patient with spina bifida admitted to the Emergency Surgical Department for ileal intussusception due to the presence of heterotopic pancreas associated with endometriosis. AREAS COVERED: Symptomatic ileal intussusception for ectopic pancreas is usually associated with overt gastrointestinal blood loss (predominantly melena), abdominal pain, vomiting, and weight loss. Treatment is universally surgical. EXPERT COMMENTARY: Isolated heterotopic pancreas is a rare condition; it should be considered in the differential diagnosis of bowel intussusception.
Asunto(s)
Coristoma/complicaciones , Endometriosis/complicaciones , Enfermedades del Íleon/complicaciones , Intususcepción/etiología , Páncreas , Disrafia Espinal/complicaciones , Adulto , Coristoma/diagnóstico por imagen , Coristoma/cirugía , Endometriosis/diagnóstico por imagen , Endometriosis/cirugía , Femenino , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/cirugía , Intususcepción/diagnóstico por imagen , Intususcepción/cirugía , Disrafia Espinal/diagnóstico , Resultado del TratamientoRESUMEN
INTRODUCTION: Amyloidosis is an uncommon disease caused by the deposition of amyloid fibrils in tissues. This disease does not usually require surgical intervention, which could be warranted in the presence of complications such as bleeding, obstruction, or perforation. We present a case of primary amyloidosis of the colon in a patient affected by polymyositis who underwent Hartmann's procedure after a spontaneous colonic perforation. After 2 months of well-being, the patient underwent two consecutive surgical procedures for stenosis of the ostomy orifice. AREAS COVERED: A review of the literature has been performed, gathering case reports highlighting the distribution of this disease by age, gender, location, and treatment when available. EXPERT COMMENTARY: Gastrointestinal amyloid disease is a rare condition, and it could be considered among the rare causes of intestinal perforation. Timely surgical management is often necessary.
Asunto(s)
Amiloidosis/patología , Colectomía , Colitis/patología , Colostomía , Perforación Intestinal/cirugía , Anciano , Amiloidosis/complicaciones , Amiloidosis/diagnóstico , Colitis/diagnóstico , Colitis/etiología , Enfermedades del Colon/complicaciones , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/patología , Constricción Patológica , Femenino , Humanos , Perforación Intestinal/diagnóstico , Perforación Intestinal/etiología , Complicaciones Posoperatorias/cirugía , Reoperación , Estomas Quirúrgicos/patologíaRESUMEN
INTRODUCTION: Myelolipomas are rare, benign neoplasms usually arising from the retroperitoneum. They represent an unusual diagnostic challenge due to their vague GI symptoms. We present a case of an 81-year-old patient complaining of severe dyspepsia. An abdominal CT scan and a fine needle biopsy lead to a diagnosis of giant retroperitoneal myelolipoma. A complete surgical resection was performed; no evidence of recurrent tumor was noted after 10 months. AREAS COVERED: Giant myelolipomas are very rare lesions. Clinical diagnosis of myelolipomas can be problematic due to their indefinite symptoms. CT scan and fine needle biopsy can be useful to reach a diagnosis, although they cannot be used to exclude malignancy in giant lesions. Surgery is the principal treatment if the tumor is symptomatic or > 7 cm. Follow-up is not mandatory due to the lack of any example of recurrence described in literature. EXPERT COMMENTARY: Despite the size of the neoplasms, since most of the complaints are vague, patients with this diagnosis should be considered among patients with unexplained gastrointestinal symptoms. Since malignancy cannot be excluded based on preoperative and intraoperative biopsy, an aggressive surgical approach is essential.
Asunto(s)
Neoplasias de las Glándulas Suprarrenales/diagnóstico por imagen , Mielolipoma/diagnóstico por imagen , Neoplasias Retroperitoneales/diagnóstico por imagen , Neoplasias de las Glándulas Suprarrenales/patología , Neoplasias de las Glándulas Suprarrenales/cirugía , Anciano de 80 o más Años , Dispepsia , Humanos , Masculino , Mielolipoma/patología , Mielolipoma/cirugía , Neoplasias Retroperitoneales/patología , Neoplasias Retroperitoneales/cirugía , Carga Tumoral , UltrasonografíaRESUMEN
Although the diagnosis of visceral pseudoaneurysm is unusual, it requires emergent attention due to the risk of rupture. We describe a 70-year-old man with a gastroduodenal artery pseudoaneurysm that manifested as recurrent hemorrhage. We highlight the possible etiologies, clinical presentations, diagnostic tools, and treatment options for this condition. In this instance, the patient was successfully treated by selective angioembolization. A visceral pseudoaneurysm should be considered in patients with abdominal pain and GI hemorrhage. At present, angioembolization is a first-line therapy.
Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Aneurisma Falso/cirugía , Artería Gástrica/diagnóstico por imagen , Artería Gástrica/cirugía , Hemorragia Gastrointestinal/diagnóstico por imagen , Hemorragia Gastrointestinal/cirugía , Anciano , Duodeno/irrigación sanguínea , Duodeno/diagnóstico por imagen , Duodeno/cirugía , Endoscopía Gastrointestinal/métodos , Humanos , Masculino , RecurrenciaRESUMEN
INTRODUCTION: Stent placement in the distal duodenum can be difficult. We describe a case report of a 94-year-old man with metastatic pancreatic head cancer compressing the third and fourth portions of the duodenum, treated by endoscopic stent placement using a colonoscope. AREAS COVERED: A literature review highlighted two possible procedures for stent placement in the distal duodenum, namely forward-viewing and side-viewing endoscopies. Gastroscopes, duodenoscopes, enteroscopes, and colonoscopes have all been suggested for the purpose. For distal lesions, especially when the duodenal wall is stiffened due to compression or infiltration by neoplastic lesions, a conventional upper endoscope can be too short to reach the narrowed site in "push mode," necessitating the use of a longer endoscope. EXPERT COMMENTARY: A colonoscope can be safely and effectively used to accomplish distal duodenal stent placement.
Asunto(s)
Colonoscopios , Enfermedades Duodenales/cirugía , Duodenoscopía/instrumentación , Obstrucción Intestinal/cirugía , Neoplasias Pancreáticas/complicaciones , Implantación de Prótesis/instrumentación , Anciano de 80 o más Años , Enfermedades Duodenales/etiología , Humanos , Obstrucción Intestinal/etiología , Masculino , Cuidados Paliativos , Neoplasias Pancreáticas/secundario , Stents Metálicos AutoexpandiblesRESUMEN
INTRODUCTION: Pneumatosis cystoides intestinalis (PCI) is a rare condition characterized by the presence of intramural gas cysts within the small and large intestines. We describe a case of a 70-year-old man admitted to the Emergency Surgery Department for PCI who was treated conservatively. AREAS COVERED: We reviewed 60 cases of PCI described in the international literature over the last 5 years. From our analysis, it appears that the etiology of the gas production within the submucosa or the subserosa of the gastrointestinal tract is still unknown. The rupture of the cysts can lead to pneumoperitoneum that can simulate a surgical emergency. EXPERT COMMENTARY: For patients with PCI, a conservative approach is the treatment of choice, with surgery mandatory only for complicated disease.
Asunto(s)
Abdomen Agudo/diagnóstico , Tratamiento Conservador/métodos , Neumatosis Cistoide Intestinal , Neumoperitoneo , Tomografía Computarizada por Rayos X/métodos , Anciano , Colonoscopía/métodos , Diagnóstico Diferencial , Humanos , Masculino , Neumatosis Cistoide Intestinal/complicaciones , Neumatosis Cistoide Intestinal/diagnóstico , Neumatosis Cistoide Intestinal/fisiopatología , Neumatosis Cistoide Intestinal/terapia , Neumoperitoneo/diagnóstico por imagen , Neumoperitoneo/etiología , Radiografía Abdominal/métodos , Resultado del Tratamiento , Procedimientos InnecesariosRESUMEN
INTRODUCTION: Hepatic hematoma is a rare but possible complication of ERCP. We describe the case of a 75-year old man with a large, 8 × 12 cm, sub-capsular and intra-parenchymal hematoma post ERCP, affecting the right liver segments and treated conservatively. AREAS COVERED: A review of literature has been performed, highlighting two possible mechanisms: hematoma may occur as the result of accidental laceration of a small intrahepatic vessel by the guidewire, whereas the other hypothesis posits that the hepatic damage is secondary to traction on the biliary system exerted by the balloon. We speculate that in case of anomalies of the biliary tree, the incidence of this complication is higher than expected. EXPERT COMMENTARY: In case of hepatic hematoma post ERCP, a conservative approach should always be considered before proceeding to interventional radiologic procedures or to surgical therapy.
Asunto(s)
Colangiopancreatografia Retrógrada Endoscópica , Hematoma/diagnóstico por imagen , Anciano , Antibacterianos/uso terapéutico , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Tratamiento Conservador , Medios de Contraste , Hematoma/tratamiento farmacológico , Humanos , Hepatopatías/diagnóstico por imagen , Hepatopatías/tratamiento farmacológico , Masculino , Tomografía Computarizada por Rayos X , UltrasonografíaAsunto(s)
Toma de Decisiones Clínicas/métodos , Tratamiento Conservador/métodos , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Divertículo , Enfermedades Duodenales , Perforación Intestinal , Tomografía Computarizada por Rayos X/métodos , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Diagnóstico Diferencial , Divertículo/complicaciones , Divertículo/diagnóstico por imagen , Drenaje/métodos , Enfermedades Duodenales/complicaciones , Enfermedades Duodenales/diagnóstico por imagen , Endoscopía del Sistema Digestivo/métodos , Humanos , Perforación Intestinal/diagnóstico , Perforación Intestinal/fisiopatología , Perforación Intestinal/terapia , Masculino , Nutrición Parenteral Total/métodos , Ajuste de Riesgo/métodos , Medición de Riesgo , Rotura Espontánea/diagnóstico , Rotura Espontánea/fisiopatología , Rotura Espontánea/terapia , Resultado del TratamientoRESUMEN
Surveys on Serial Transverse Enteroplasty (STEP) published in international literature (1 January 2003- 31 May 2021) were searched. Articles were included from 17 countries: 1/23 comparative and 22/23 cohort studies. STEP was performed on 308 patients: pediatrics, adults, and mixed ages. Pediatric group included 16 studies and the adult 6. Pre-STEP residual small bowell (SB) length for pediatrics and adults ranged from 18 to 26 cm and from 30 to 70 cm, respectively. Post-STEP increased SB length for pediatrics and adults ranged between 42 and 100% and 50% and 176%, respectively. For pediatrics, enteral autonomy was reached in 32.22% of cases, parenteral nutrition (PN) dependence was 36.11%, a repeated STEP procedure (Re-STEP) was needed in 17.22%, and a bowel transplant was performed in 6.11%. In adults, enteral autonomy was achieved in 52.38%, while PN dependence was 37.1%, and no Re-STEP or transplantation were required. For the mixed group, post-STEP bowel length increased from 2 to 50 cm, enteral autonomy was obtained in 43%, PN dependence was 57%, without reported Re-STEP or transplantation. Mortality rates were between 5.55% (pediatric) and 7.14% (adults). Preoperative length with preservation of ileocecal valve represented the main predictive factors to achieve enteral autonomy.
Asunto(s)
Procedimientos Quirúrgicos del Sistema Digestivo , Síndrome del Intestino Corto , Adulto , Niño , Procedimientos Quirúrgicos del Sistema Digestivo/métodos , Objetivos , Humanos , Nutrición Parenteral , Estudios Retrospectivos , Síndrome del Intestino Corto/cirugía , Resultado del TratamientoRESUMEN
The question of whether health care inequities occur before patients with end-stage liver disease (ESLD) are waitlisted for transplantation has not previously been assessed. To determine the impact of gender, race and insurance on access to transplantation, we linked Pennsylvania sources of data regarding adult patients discharged from nongovernmental hospitals from 1994 to 2001. We followed the patients through 2003 and linked information to records from five centers responsible for 95% of liver transplants in Pennsylvania during this period. Using multinomial logistic regressions, we estimated probabilities that patients would undergo transplant evaluation, transplant waitlisting and transplantation itself. Of the 144,507 patients in the study, 4361 (3.0%) underwent transplant evaluation. Of those evaluated, 3071 (70.4%) were waitlisted. Of those waitlisted, 1537 (50.0%) received a transplant. Overall, 57,020 (39.5%) died during the study period. Patients were less likely to undergo evaluation, waitlisting and transplantation if they were women, black and lacked commercial insurance (p < 0.001 each). Differences were more pronounced for early stages (evaluation and listing) than for the transplantation stage (in which national oversight and review occur). For early management and treatment decisions of patients with ESLD to be better understood, more comprehensive data concerning referral and listing practices are needed.
Asunto(s)
Accesibilidad a los Servicios de Salud , Hepatopatías/terapia , Trasplante de Hígado/métodos , Adolescente , Adulto , Anciano , Etnicidad , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Pennsylvania , Clase Social , Listas de EsperaRESUMEN
Immunoglobulin-mediated suppression of immune checkpoint pathways may lead to a considerable activation of host immune responses against malignancies. Substantial therapeutic benefits were reported among patients who participated in cancer immunotherapy clinical trials which utilized monoclonal antibodies against cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4), programmed cell death protein 1 (PD-1) and programmed cell death 1 ligand 1 (PD-L1). In a subsequent stage, immune checkpoint inhibitors were used in various clinical trials in combination with other therapeutic agents, such as immunomodulatory factors, chemotherapeutics, oncolytic viruses and radiation therapy. Interestingly, local antitumor interventions based either on radiation therapy or oncolytic viruses resulted in systemic immune responses in a number of oncological patients. The elimination of untreated cancer tissues that may follow a localized therapeutic intervention was termed abscopal effect, which represents a major achievement in the field of cancer therapy.
Asunto(s)
Neoplasias/terapia , Viroterapia Oncolítica , Antígeno B7-H1/antagonistas & inhibidores , Antígeno CTLA-4/antagonistas & inhibidores , Terapia Combinada , Humanos , Inmunoterapia , Neoplasias/radioterapia , Virus Oncolíticos , Receptor de Muerte Celular Programada 1/antagonistas & inhibidoresRESUMEN
Induction with the use of interleukin-2 receptor monoclonal antibodies may avoid many of the adverse events associated with polyclonal antibodies and significantly impact on rejection-free long-term survival in orthotopic liver transplantation (OLTx). We describe our experience with the use of basiliximab induction therapy in adult OLTx recipients on tacrolimus-based immunosuppression. Forty-six consecutive deceased donor primary OLTx were analyzed. All patients received standard doses of basiliximab, tacrolimus, and steroids. Mycophenolate mofetil was also used as indicated. The mean follow-up period was 17.9 months. Forty-three patients remained rejection-free during follow-up. The actuarial patient and graft survival rate at 2 years was 93%. The rate of histology-proven hepatitis C virus (HCV) recurrence was 24%, with two progressing to severe cholestatic recurrent HCV. None of the study patients developed (cytomegalovirus (CMV) infection or posttransplant lymphoproliferative disease (PTLD). Results were compared to a historical group of 46 OLTx recipients on tacrolimus-based immunosuppression without basiliximab induction. The historical group had a rejection rate of 34% with lower patient and graft survival rates of 71.74% and 69.5%, respectively, at 24 months as well as a higher histological HCV recurrence rate of 77% (17/22), with three patients progressing to graft failure within 2 years. CMV infection and disease developed in 4.5% of the patients. Although PTLD was not observed, three recipients with hepatocellular carcinoma (HCC) developed and died of metastatic HCC. Induction with basiliximab in combination with tacrolimus-based immunosuppressive regimen reduces the incidence of rejection and improves rejection-free survival rate after OLTx without increasing the incidence of CMV, PTLD, or HCV recurrence.