RESUMEN
Introducción: las estrategias actuales de diagnóstico y tratamiento del paciente con hemorragia digestiva incluyen la identificación de los factores clínicos y/o endoscópicos que permitan identificar los pacientes con una hemorragia grave y quiénes no. Objetivo: identificar aquellos parámetros clínicos, analíticos y endoscópicos que posibiliten predecir la gravedad en la hemorragia digestiva alta no varicosa. Métodos: estudio descriptivo de una serie de casos, que incluyó a 188 pacientes que presentaron hemorragia digestiva alta no varicosa en el Hospital Dr. Luis Díaz Soto desde el 1ro. de enero hasta el 31 de diciembre de 2014. Se realizó medición de variables clínicas y endoscópicas. Se practicó análisis uni y multivariante, por método de regresión logística, para identificar las que pudieron predecir la gravedad del sangrado. Resultados: los predictores de hemorragia grave son: el consumo de AINES (RR 2,28), poseer más de una enfermedad asociada (RR 1,01), la presencia de melena como signo de presentación clínica (RR 9,53) y su constatación en el examen rectal (RR 2,87); así como las cifras de hemoglobina menores de 10o g/L (RR: 4,39) y la FC mayor de 100 latidos por minuto (RR 5,49). Esta probabilidad es 3,4 veces mayor si la hemoglobina está por debajo de 100 g/L y 2,4 veces si la frecuencia cardiaca aumenta por encima de 100 latidos por minuto. Conclusiones: se confirma el valor de los síntomas y signos clínicos que acompañan la pérdida hemática aguda y las alteraciones hemodinámicas para predecir la probabilidad de presentar una hemorragia grave(AU)
Introduction: The current strategies for diagnosis and treatment of patients with gastrointestinal bleeding include the identification of clinical and / or endoscopic factors to distinguish between those with severe bleeding and those who do not. Objective: Identify clinical, analytical, and endoscopic parameters that predict the severity of non-varicose upper gastrointestinal bleeding. Methods: A descriptive study of a series of cases was carried out in 188 patients treated with non-varicose upper gastrointestinal bleeding at the Dr. Luis Díaz Soto hospital from January 1st to December 31st, 2014. Measurement of clinical and endoscopic variables were taken. Univariate and multivariate analysis were performed by logistic regression method to identify those that could predict the severity of bleeding. Results: Predictors of severe bleeding are: the consumption of NSAIDs (RR 2.28), having more than one associated disease (RR 1.01), the presence of melena as a sign of clinical presentation (RR 9,53) rectal examination (RR 2.87);as well as hemoglobin levels below 10 g/L (RR: 4.39) and HR greater than 100 beats per minute (RR 5.49). This probability is 3.4 times higher if hemoglobin is below 100 g/L and 2.4 times if the heart rate increases above 100 beats per minute. Conclusions: The value of clinical signs and symptoms accompanying acute blood loss and haemodynamic changes to predict the likelihood of severe bleeding is confirmed(AU)
Asunto(s)
Humanos , Endoscopía Gastrointestinal/métodos , Enfermedades del Colon/epidemiología , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Índice de Severidad de la Enfermedad , Epidemiología DescriptivaRESUMEN
BACKGROUND: Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis. AIM: To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is a predictor of age of onset, complications, and need for surgery. METHODS: Was conducted a retrospective review of the charts of all patients diagnosed with a first episode of diverticulitis in our hospital between 2005 and 2012. RESULTS: Were found 638 patients with a first episode of acute diverticulitis in the eight year interval. Israeli Arabs developed a first episode of diverticulitis at a younger age compared to Jews (51.2 vs 63.8 years, p<0.01). Arabs living in rural areas developed diverticulitis at a younger age than Arabs living in urban centers (49.4 vs 54.5 years, P=0.03). Jewish and Arabic men developed diverticulitis at younger age compared to their female counterparts (59.9 vs 66.09, p<0.01, and 47.31 vs 56.93, p<0.01, respectively). Arabs were more likely [odds ratio (OR)=1.81 ,95% confidence interval (CI)1.12-2.90, p=0.017] than Jews to require surgical treatment (urgent or elective) for diverticulitis. CONCLUSIONS: Israeli Arabs tend to develop diverticulitis at a younger age and are more likely to require surgical treatment for diverticulitis compared to Jews. Arabs living in rural areas develop diverticulitis at a younger age than Arabs living in urban centers. These findings highlight a need to address the root cause for ethnic differences in onset, course and outcome of acute diverticulitis.
Asunto(s)
Enfermedades del Colon/epidemiología , Enfermedades del Colon/cirugía , Diverticulitis/epidemiología , Diverticulitis/cirugía , Enfermedad Aguda , Factores de Edad , Anciano , Árabes , Femenino , Humanos , Israel , Judíos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis. AIM: To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is a predictor of age of onset, complications, and need for surgery. METHODS: Was conducted a retrospective review of the charts of all patients diagnosed with a first episode of diverticulitis in our hospital between 2005 and 2012. RESULTS: Were found 638 patients with a first episode of acute diverticulitis in the eight year interval. Israeli Arabs developed a first episode of diverticulitis at a younger age compared to Jews (51.2 vs 63.8 years, p<0.01). Arabs living in rural areas developed diverticulitis at a younger age than Arabs living in urban centers (49.4 vs 54.5 years, P=0.03). Jewish and Arabic men developed diverticulitis at younger age compared to their female counterparts (59.9 vs 66.09, p<0.01, and 47.31 vs 56.93, p<0.01, respectively). Arabs were more likely [odds ratio (OR)=1.81 ,95% confidence interval (CI)1.12-2.90, p=0.017] than Jews to require surgical treatment (urgent or elective) for diverticulitis. CONCLUSIONS: Israeli Arabs tend to develop diverticulitis at a younger age and are more likely to require surgical treatment for diverticulitis compared to Jews. Arabs living in rural areas develop diverticulitis at a younger age than Arabs living in urban centers. These findings highlight a need to address the root cause for ethnic differences in onset, course and outcome of acute diverticulitis. .
RACIONAL: Somente poucos estudos examinaram o impacto das diferenças raciais na idade de início, curso e os resultados da diverticulite. OBJETIVO: Fornecer dados sobre a epidemiologia da diverticulite no norte de Israel, e determinar se a etnia é preditor de idade de início, complicações e necessidade de tratamento cirúrgico. MÉTODOS: Foi realizado estudo retrospectivo dos prontuários de todos os pacientes diagnosticados com um primeiro episódio de diverticulite em nosso hospital entre 2005 e 2012. RESULTADOS: Foram encontrados 638 pacientes com um primeiro episódio de diverticulite aguda no intervalo de oito anos. Os árabes israelenses desenvolveram o primeiro episódio de diverticulite em idade mais jovem em comparação com os judeus (51,2 vs 63,8 anos, p<0,01). Árabes que vivem em áreas rurais a diverticulite foi desenvolvida em idade mais jovem do que os árabes que vivem em centros urbanos (49,4 vs 54,5 anos, p=0,03). Homens judeus e árabes desenvolveram diverticulite em idade mais jovem em comparação com os seus homólogos do sexo feminino (59,9 vs 66,09, p<0,01, e 47,31 vs 56,93, p<0,01, respectivamente). Os árabes eram mais prováveis do que os judeus de necessitar de tratamento cirúrgico (urgência ou eletiva) para a diverticulite [odds ratio (OR)=1,81, intervalo de confiança de 95% (CI) 1,12-2,90, p=0,017]. CONCLUSÕES: Os árabes israelenses tendem a desenvolver diverticulite em idade mais jovem e são mais propensos a necessitar de tratamento cirúrgico para a diverticulite em comparação com os judeus. Árabes que vivem em áreas rurais desenvolvem diverticulite em idade mais jovem do que os árabes que vivem em centros urbanos. Estes resultados destacam a necessidade de abordar a causa raiz para diferenças étnicas em início, o curso e o resultado da diverticulite aguda. .
Asunto(s)
Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades del Colon/epidemiología , Enfermedades del Colon/cirugía , Diverticulitis/epidemiología , Diverticulitis/cirugía , Enfermedad Aguda , Factores de Edad , Árabes , Israel , Judíos , Estudios RetrospectivosRESUMEN
Introducción: los procederes endoscópicos con sedación consciente ocupan un lugar importante en el diagnóstico y tratamiento de las enfermedades del aparato digestivo. Objetivos: identificar si existen diferencias entre el uso de ketamina o fentanyl asociados a propofol en la colonoscopia ambulatoria. Métodos: se realizó un estudio de serie de casos en pacientes electivos para colonoscopia ambulatoria. Se dividieron en dos grupos: En ambos, se administró propofol en la inducción. En el Grupo F, se administró 50 µg de fentanyl y en el Grupo K, ketamina 0,3 mg/kg-1. El mantenimiento se realizó con infusiones continuas. El comportamiento intraoperatorio hemodinámico se evaluó en cinco momentos. Se determinaron las características de la recuperación, satisfacción del paciente y efectos secundarios posoperatorios. Resultados: la edad y el sexo se comportaron de forma homogénea. Fue más frecuente ASA II. La frecuencia cardiaca presentó diferencias significativas, con relación al momento y al grupo. La TAS y TAD se mantuvieron estables. La recuperación de ambos grupos fue rápida; sin embargo, en el Grupo K tuvo mucha mejor calidad. El grado de satisfacción no tuvo diferencias significativas entre grupos (p = 0.337). Los efectos adversos fueron leves y más frecuentes en el Grupo F. Conclusiones: las colonoscopias constituyen un proceder que se debe realizar bajo sedación consciente, pues existe estabilidad de la frecuencia cardiaca y la tensión arterial. La recuperación anestésica fue más rápida y la satisfacción mejor en el Grupo K. Los efectos secundarios posoperatorios y las complicaciones fueron más frecuentes en el Grupo F(AU)
Introduction: endoscopic procedures with conscious sedation play an important role in the diagnosis and treatment of digestive system diseases.Objectives: Identify whether there are differences between the use of ketamine or fentanyl associated with propofol in outpatient colonoscopy. Methods: A case series study was conducted in patients for elective outpatient colonoscopy. They were divided into two groups. In both, propofol was administered in induction. In Group F, 50 µg of fentanyl was administered and patients in Group K had ketamine 0.3 mg / kg-1. Maintenance was performed with continuous infusions. The intraoperative hemodynamic performance was evaluated in five moments. Recovery characteristics, patient satisfaction and postoperative side effects were determined. Results: Age and sex behaved homogeneously. ASA II was more frequent. Heart rate showed significant differences with respect to time and group. SBP and DBP were stable. Recovery was rapid both groups; however, Group K had much better quality. The degree of satisfaction was not significantly different between groups (p = 0.337). Adverse effects were mild and more frequent in Group F. Conclusions: colonoscopy is a procedure to be performed under conscious sedation, as there is stability in heart rate and blood pressure. Anesthetic recovery was faster and better satisfaction in Group K. Postoperative side effects and complications were more frequent in Group F(AU)
Asunto(s)
Humanos , Colonoscopía/métodos , Enfermedades del Colon/epidemiología , Sedación Consciente/métodos , Ketamina/uso terapéuticoRESUMEN
BACKGROUND: Management of portal hypertensive colopathy (PHC) has been challenged by controversial results in its prevalence and clinical relevance. OBJECTIVE: To describe the PHC prevalence and to evaluate the variability in diagnosis, the relation to severity of liver disease, and the incidence of severe outcomes. DESIGN: Cross-sectional study. SETTING: Endoscopic unit of a tertiary-care academic center in Rio de Janeiro, Brazil. PATIENTS: Patients with cirrhosis with portal hypertension and controls paired for age and sex. INTERVENTIONS: All patients were submitted to standard and image-enhanced colonoscopies, which were recorded in a coded video file and analyzed twice by a blinded endoscopist. MAIN OUTCOME MEASUREMENTS: The prevalence of PHC. RESULTS: A total of 51 patients with cirrhosis (55% male, mean age 59 years) and 51 healthy controls (43% male, mean age 61 years) were included. The top ranking colonoscopic findings were angiodysplasia-like lesions, nonspecific vascular pattern, red spots, and colorectal varices, all significantly more frequent in patients with cirrhosis compared with controls. PHC prevalence was 71% in patients with cirrhosis. For PHC, interobserver and intraobserver agreement (k values [standard error]) were 0.68 (0.09) and 0.63 (0.10), respectively. Intraobserver agreement for colonoscopic findings was satisfactory. PHC was not related to more severe liver disease or liver stiffness. Only 5 patients developed severe outcomes during follow-up. LIMITATIONS: The exclusion of patients with cirrhosis without esophageal varices and the absence of an interobserver agreement analysis by double-blinded endoscopists. CONCLUSION: PHC was highly prevalent in patients with cirrhosis, and its diagnostic agreement was satisfactory. PHC is not associated with relevant severe outcomes in a 12-month follow-up.
Asunto(s)
Angiodisplasia/epidemiología , Enfermedades del Colon/epidemiología , Hipertensión Portal/epidemiología , Cirrosis Hepática/epidemiología , Várices/epidemiología , Anciano , Angiodisplasia/etiología , Brasil/epidemiología , Estudios de Casos y Controles , Enfermedades del Colon/etiología , Colonoscopía , Estudios Transversales , Várices Esofágicas y Gástricas/epidemiología , Várices Esofágicas y Gástricas/etiología , Femenino , Humanos , Hipertensión Portal/complicaciones , Cirrosis Hepática/complicaciones , Masculino , Persona de Mediana Edad , Prevalencia , Várices/etiologíaRESUMEN
STUDY OBJECTIVE: To evaluate the external validity of the validated French model of the quality-of-life questionnaire (QOL) SF-36 in predicting improvement after colorectal resection for endometriosis. DESIGN: Italian and Brazilian cohort studies (Canadian Task Force classification II-3). SETTING: Tertiary referral university hospital in Brazil and expert center in endometriosis in Italy. PATIENTS: Patients with colorectal endometriosis from an Italian population (n = 63) and a Brazilian population (n = 151). INTERVENTION: Laparoscopic colorectal resection for treatment of endometriosis. MEASUREMENTS AND MAIN RESULTS: Preoperative and postoperative evaluations of the Physical Component Summary (PCS) and the Mental Component Summary (MCS) of the SF-36 were performed. Substantial improvement in PCS and MCS was observed after colorectal resection in both populations. In the Brazilian population, the receiver operating curve (ROC) (area under the curve [AUC]) was 0.83 (95% confidence interval [CI], 0.77-0.89) for MCS and 0.78 (95% CI, 0.71-0.83) for PCS, demonstrating good discrimination performance. The mean difference between the predicted and calibrated probabilities was 19.6% for MCS and 32.8% for PCS. In the Italian population, the ROC curve (AUC) was 0.65 (95% CI, 0.52-0.78) for PCS and 0.67 (95% CI, 0.55-0.78) for MCS. The model demonstrated poor discrimination and calibration performance for PCS (p < .001) and MCS (p = .003). The mean difference between the predicted and calibrated probabilities was 17.5% for MCS and 21.8% for PCS. CONCLUSION: Despite the use of validated translations of the SF-36, our results underline the limits of this tool in selection of patients for colorectal resection due to underestimation of predicted quality of life, possibly because of variations in epidemiologic characteristics of the populations.
Asunto(s)
Colon/patología , Enfermedades del Colon/psicología , Endometriosis/psicología , Calidad de Vida , Enfermedades del Recto/psicología , Recto/patología , Encuestas y Cuestionarios , Adulto , Brasil/epidemiología , Estudios de Cohortes , Colectomía , Colon/cirugía , Enfermedades del Colon/epidemiología , Enfermedades del Colon/cirugía , Endometriosis/epidemiología , Endometriosis/cirugía , Femenino , Humanos , Italia/epidemiología , Laparoscopía , Masculino , Persona de Mediana Edad , Selección de Paciente , Periodo Posoperatorio , Calidad de Vida/psicología , Enfermedades del Recto/epidemiología , Enfermedades del Recto/cirugía , Recto/cirugía , Medición de Riesgo , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios/normas , Resultado del TratamientoRESUMEN
BACKGROUND: Readmission after colectomy has become an important metric for measuring quality of care. Our aim was to investigate the impact of patient and hospital characteristics on 30-d readmission rates among patients undergoing colectomies in Pennsylvania. METHODS: Data were obtained from the Pennsylvania Health Care Cost Containment Council, which included all patients undergoing colectomy during 2011 (n = 10,155). Characteristics of non-readmitted and readmitted patients were compared with univariate tests. The primary outcome was 30-d readmission, which was modeled using multivariable logistic regression. RESULTS: Of the 10,155 patients who underwent colectomy, 1492 (14.7%) were readmitted within 30 d of discharge. Readmission was influenced by the underlying diagnosis (P < 0.001). Additionally, readmission was more likely with a Charlson comorbidity index ≥ 2 (odds ratio [OR] = 1.57, P < 0.001), emergent admission (OR = 1.26, P = 0.001), an in-hospital complication (OR = 1.46, P < 0.001), lowest quartile for surgeon volume (OR = 1.24, P = 0.01), and construction of an ileostomy (OR = 2.31, P < 0.001). Factors associated with decreased likelihood of readmission included laparoscopic surgery (OR = 0.73, P < 0.001). No association with hospital volume was found. CONCLUSIONS: A 30-d readmission after colectomy is influenced by numerous patient- and surgeon-related factors. Reducing in-hospital complications, and improving patient education after ileostomy construction, provide substantial targets for intervention. Our data also suggest that there may be a critical range of colectomies performed annually by surgeons, greater than which no additional benefit is conferred in reducing readmissions, but below which there is an increased risk of readmission. Further research is needed to determine the influence of laparoscopic surgery in reducing readmission in equally matched patient populations.
Asunto(s)
Colectomía/estadística & datos numéricos , Enfermedades del Colon/cirugía , Readmisión del Paciente/estadística & datos numéricos , Adulto , Anciano , Enfermedades del Colon/epidemiología , Comorbilidad , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Pennsylvania/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND/AIMS: This paper aimed to review experience with diagnostic and therapeutic colonoscopies performed by a colorectal surgeon with special interest in colonoscopy over a 10-yr period and to assess incidence and management of colonic perforations. METHODOLOGY: All colonoscopies performed between 1997 and 2007 were studied. Data on patients, colonoscopic reports and procedure-related complications were collected from computerized database. Medical records of patients with colonic perforation were reviewed. RESULTS: 7,804 colonoscopies were performed. Five colonoscopic perforations were identified (0.06%). Three occurred during diagnostic and two during therapeutic colonoscopy. All were suspected during or immediately after colonoscopy except for one therapeutic perforation diagnosed two days after the procedure. All perforations were surgically managed by the author. Surgery included conventional and laparoscopic repair, colectomy and proctocolectomy. There was need for stoma in one patient with pancolonic Crohn's disease with sigmoid colon stenosis. This patient underwent total proctocolectomy. There were no deaths. CONCLUSIONS: The rate of perforation during colonoscopy is low and can be managed with no mortality. Early diagnosis and treatment are essential. Early operative intervention through primary repair represents is safe and effective. Managing colonic pathology demanding resection in the urgent setting may benefit selected patients with colonoscopy perforation.
Asunto(s)
Enfermedades del Colon/epidemiología , Colonoscopía/efectos adversos , Perforación Intestinal/epidemiología , Anciano , Enfermedades del Colon/cirugía , Femenino , Humanos , Incidencia , Perforación Intestinal/cirugía , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Enterovesical fistula, also known as vesicoenteric fistula, is an abnormal communication of the vesical bladder with a segment of the digestive tract. We undertook this study to describe diagnostic and therapeutic methods to treat colovesical fistula (CVF) in patients who attended the Coloproctology Unit of the Gastroenterology Service of the General Hospital in Mexico City. METHODS: This is a descriptive study in CVF patients carried out from January 2001 to June 2006; descriptive statistics were used for analysis of information. RESULTS: Eleven patients were identified (10 males and 1 female). Average age was 54.72 years (range: 39-73 years). Time from onset of symptoms to diagnosis was on average 11.9 months. The most frequent signs and symptoms were fecaluria, pneumaturia, dysuria, hematuria and chronic abdominal pain in hypogastric and left iliac regions. Nine patients were submitted to sigmoidectomy and primary colorectal anastomosis. Hartmann procedure was carried out in one patient with restoration of intestinal transit 6 weeks later. In one patient, a loop colostomy was built as a first operation, with sigmoidectomy with fistula resection as a second operation, and restoration of intestinal transit as the third. CONCLUSIONS: Surgery is the only treatment that assures cure and avoids relapses. Sigmoidectomy and primary anastomosis must be considered as the treatment of choice. Mortality, although low, continues being a negative factor when surgery is indicated in these patients.
Asunto(s)
Enfermedades del Colon/diagnóstico , Enfermedades del Colon/cirugía , Fístula Intestinal/diagnóstico , Fístula Intestinal/cirugía , Fístula de la Vejiga Urinaria/diagnóstico , Fístula de la Vejiga Urinaria/cirugía , Adulto , Anciano , Enfermedades del Colon/epidemiología , Femenino , Humanos , Incidencia , Fístula Intestinal/epidemiología , Masculino , Persona de Mediana Edad , Fístula de la Vejiga Urinaria/epidemiologíaRESUMEN
Introducción: el procedimiento de Hartmann es una alternativa de tratamiento para cirugías colorrectales de emergencia, sin embargo, su reconexión es difícil y propensa a complicaciones. Se ha propuesto que un periodo de tiempo mayor entre el procedimiento inicial y la reconexión puede disminuir las complicaciones. El objetivo de esta investigación es determinar la morbilidad y mortalidad de la reconexión posHartmann, y analizar la presencia de factores de riesgo para complicaciones. Material y métodos: se analizaron retrospectivamente 48 pacientes cuyas edades oscilaron entre 57 ± 16 años, de los cuales 19 (40 %) eran mayores de 65 años y 21 (44 %) tenían enfermedades crónicas concomitantes. Se buscaron factores de morbilidad y mortalidad con prueba U de Mann- Whitney y prueba exacta de Fisher. Resultados: la indicación más frecuente del procedimiento fue la diverticulitis aguda (42 %). El periodo entre el procedimiento de Hartmann y la reconexión fue de ocho meses, con un rango de 1 a 46 meses. La duración aproximada de la cirugía de reconexión fue de 267 minutos (rango de 120 a 540). Se presentaron complicaciones en 29 pacientes (60 %), incluyendo fístulas de la anastomosis en seis (12 %) y muerte en cuatro (8 %). No se asociaron mayores complicaciones o más tiempo quirúrgico, con un intervalo de tiempo menor entre el procedimiento de Hartmann y la reconexión. Conclusiones: la reconexión posHartmann es un procedimiento con alta morbilidad y mortalidad, sin que se asocie al intervalo de tiempo entre el procedimiento y la reconexión.
BACKGROUND: Hartmann's operation is an alternative for emergency colorectal surgeries, but its reversal may be difficult and prone to complications. A longer interval for its reversal has been recommended to decrease complications. METHODS: In order to determine rates of morbi-mortality and to ascertain the association between the time interval for its reversal and presence of complications, we undertook a retrospective analysis of 48 patients with a mean age of 57 +/- 16 years. Nineteen patients (40%) were >65 years, and 21 (44%) had one or more underlying chronic disease. Perioperative factors associated with morbi-mortality were determined by means of the Mann-Whitney U test and Fisher exact test. RESULTS: Acute diverticulitis was the most frequent indication (42%). Mean interval between Hartmann's operation and its reversal was 8 months (range: 1 to 46 months). Mean duration of the reversal operation was 267 min (range: 120 to 540 min). There were complications in 29 patients (60%) including anastomotic leaks in 6 (12%) and operative deaths in 4 (8%). A shorter interval between Hartmann's operation and its reversal was not associated with more complications or longer surgical time. CONCLUSIONS: Hartmann's reversal operation has high rates of morbidity and mortality that are not influenced by the time interval from the original operation.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anastomosis Quirúrgica/métodos , Colostomía/métodos , Complicaciones Posoperatorias/epidemiología , Anastomosis Quirúrgica/mortalidad , Comorbilidad , Complicaciones Posoperatorias/mortalidad , Diverticulitis del Colon/epidemiología , Diverticulitis del Colon/cirugía , Enfermedades del Colon/epidemiología , Enfermedades del Colon/cirugía , Urgencias Médicas , Infección de la Herida Quirúrgica/epidemiología , Factores de RiesgoRESUMEN
BACKGROUND: Hartmann's operation is an alternative for emergency colorectal surgeries, but its reversal may be difficult and prone to complications. A longer interval for its reversal has been recommended to decrease complications. METHODS: In order to determine rates of morbi-mortality and to ascertain the association between the time interval for its reversal and presence of complications, we undertook a retrospective analysis of 48 patients with a mean age of 57 +/- 16 years. Nineteen patients (40%) were >65 years, and 21 (44%) had one or more underlying chronic disease. Perioperative factors associated with morbi-mortality were determined by means of the Mann-Whitney U test and Fisher exact test. RESULTS: Acute diverticulitis was the most frequent indication (42%). Mean interval between Hartmann's operation and its reversal was 8 months (range: 1 to 46 months). Mean duration of the reversal operation was 267 min (range: 120 to 540 min). There were complications in 29 patients (60%) including anastomotic leaks in 6 (12%) and operative deaths in 4 (8%). A shorter interval between Hartmann's operation and its reversal was not associated with more complications or longer surgical time. CONCLUSIONS: Hartmann's reversal operation has high rates of morbidity and mortality that are not influenced by the time interval from the original operation.
Asunto(s)
Anastomosis Quirúrgica/métodos , Colostomía/métodos , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Anastomosis Quirúrgica/mortalidad , Enfermedades del Colon/epidemiología , Enfermedades del Colon/cirugía , Comorbilidad , Diverticulitis del Colon/epidemiología , Diverticulitis del Colon/cirugía , Urgencias Médicas , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/mortalidad , Factores de Riesgo , Infección de la Herida Quirúrgica/epidemiologíaRESUMEN
This multicentric national registry reports the experience of 16 Brazilian surgical teams in laparoscopic colorectal surgery. Between 1992 and 2001, 1966 patients (941 men [47.8%] and 1025 women [52.1%]) were operated on, with ages ranging from 1 to 94 years (average, 55.9 years). Benign diseases were diagnosed in 1170 patients (59.5%). There were 82 (4.2%) reported intraoperative complications (range, 2.0-9.8%), 209 (10.6%) conversions to laparotomy (range, 1.4-23.5%), and 383 (19.4%) postoperative complications (8.0-29.6%). Mortality occurred in 29 patients (1.5%). During the early experience (first 50 operated patients in each surgical team), there were more intraoperative complications (8.1% x 1.7%), conversions (16.6% x 6.8%) and postoperative complications (25% x 16%). After an average follow-up of 26.5 months, 91 tumor recurrences (13.8%) were reported (0.45% parietal recurrences). There was no incisional recurrence in the ports used to withdraw the pathologic specimen. The Brazilian experience is significant, with complication and mortality rates similar to those reported in literature. The results indicate that experience reduces complication and mortality rates. Oncological results are satisfactory and the incidence of parietal recurrence is low and similar to other series.
Asunto(s)
Enfermedades del Colon/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Procedimientos Quirúrgicos del Sistema Digestivo/estadística & datos numéricos , Complicaciones Intraoperatorias , Laparoscopía/efectos adversos , Laparoscopía/estadística & datos numéricos , Complicaciones Posoperatorias , Enfermedades del Recto/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Brasil/epidemiología , Niño , Preescolar , Enfermedades del Colon/epidemiología , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Enfermedades del Recto/epidemiología , Estudios RetrospectivosRESUMEN
BACKGROUND: Lower gastrointestinal bleeding is usually self-limiting in about 80% of cases; however, surgical treatment may be required in selected cases. Preoperative precise identification of the bleeding source is crucial for a successful outcome. OBJECTIVE: To determine the most frequent diagnoses, as well as short and long-term results in a series of patients who underwent a surgical procedure for lower gastrointestinal bleeding. MATERIAL AND METHODS: Retrospective analysis of 39 patients operated upon for lower gastrointestinal bleeding from 1979 through 1997 in a referral center. Demographic data, history, physical examination, laboratory tests, resuscitative measures, preoperative work-up for identification of bleeding source, definitive cause of bleeding, surgical procedure, operative morbidity and mortality, as well as long-term status and recurrence of bleeding were recorded. RESULTS: There were 54% women and 46% men. Mean age was 56 years (range, 15-92). Most patients presented hematochezia (69%). Colonoscopy was the most used diagnostic procedure (69%). The bleeding source was located in 90% of patients. Diverticular disease was the most frequent cause of bleeding. A segmental bowel resection was the treatment in 97% of cases. Morbidity was 23% with 18% of mortality. Recurrence occurred in 9% of survivors. CONCLUSIONS: Morbidity and mortality were high. Patients who require a surgical operation should be carefully selected and evaluated with a complete work-up to determine the site and cause of bleeding.
Asunto(s)
Enfermedades del Colon/cirugía , Hemorragia Gastrointestinal/cirugía , Academias e Institutos/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anastomosis Quirúrgica/estadística & datos numéricos , Colectomía/métodos , Colectomía/estadística & datos numéricos , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/epidemiología , Enfermedades del Colon/etiología , Colonoscopía/estadística & datos numéricos , Colostomía/estadística & datos numéricos , Estudios Transversales , Diverticulitis/complicaciones , Femenino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/epidemiología , Hemorragia Gastrointestinal/etiología , Humanos , Masculino , México/epidemiología , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Recurrencia , Estudios RetrospectivosRESUMEN
BACKGROUND: Lower gastrointestinal bleeding is usually self-limiting in about 80 of cases; however, surgical treatment may be required in selected cases. Preoperative precise identification of the bleeding source is crucial for a successful outcome. OBJECTIVE: To determine the most frequent diagnoses, as well as short and long-term results in a series of patients who underwent a surgical procedure for lower gastrointestinal bleeding. MATERIAL AND METHODS: Retrospective analysis of 39 patients operated upon for lower gastrointestinal bleeding from 1979 through 1997 in a referral center. Demographic data, history, physical examination, laboratory tests, resuscitative measures, preoperative work-up for identification of bleeding source, definitive cause of bleeding, surgical procedure, operative morbidity and mortality, as well as long-term status and recurrence of bleeding were recorded. RESULTS: There were 54 women and 46 men. Mean age was 56 years (range, 15-92). Most patients presented hematochezia (69). Colonoscopy was the most used diagnostic procedure (69). The bleeding source was located in 90 of patients. Diverticular disease was the most frequent cause of bleeding. A segmental bowel resection was the treatment in 97 of cases. Morbidity was 23 with 18 of mortality. Recurrence occurred in 9 of survivors. CONCLUSIONS: Morbidity and mortality were high. Patients who require a surgical operation should be carefully selected and evaluated with a complete work-up to determine the site and cause of bleeding.
Asunto(s)
Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Hemorragia Gastrointestinal , Enfermedades del Colon/cirugía , Recurrencia , Colostomía , Estudios Transversales , Estudios Retrospectivos , Colonoscopía , Colectomía , Diverticulitis , Academias e Institutos , Hemorragia Gastrointestinal , México , Anastomosis Quirúrgica , Complicaciones Posoperatorias/epidemiología , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/epidemiología , Enfermedades del Colon/etiologíaRESUMEN
BACKGROUND: During the last 3 decades, colonoscopy has become the diagnostic study with greatest sensitivity and acuity in colonic pathology. AIMS: To know the most frequent diagnostic and colonoscopic disorders, and the pathology found, to establish certainty of the colonoscopic procedure. METHOD: Between 1987 and 1997, a descriptive, transversal, retrospective and observational study of the 2,000 colonoscopies that were carried out at on service was done, making a registry of the endoscopic search in colorectal pathology and their characteristics in on patients. RESULTS: Colonoscopies were done in 967 men (47.3%) and 1,053 women (52.6%) with a median age of 55.8 years (10 range (-) 93 years). In 1,780 of them (89.%), it was possible to arrive to cecum; 1,150 (57.5%) were pathologic. The most frequent finding was hemorrhage of the lower digestive tube in 525 (26.2%) patients; in addition cancer in 402 (20.1%), suspicion of intestinal inflammatory disease 292 (14.6%) and colorectal polyps 199 (10%) were found. The most frequent endoscopic diagnosis was colorectal polyps in 405 (35.7%) patients; in additions diverticular disease was found in 404 (35.1%) patients intestinal inflammatory disease in 185 (16%), colorectal cancer in 85 (7.4%), and vascular ectasias in 52 (4.5%) patients. There were four complicated cases (0.25%), three by resolved therapeutic colonoscopy and one diagnostically. CONCLUSION: The most frequent colonoscopic were findings hemorrhage of the lower digestive tube and the finding of cancer. The most frequent diagnoses were colorectal polyps and diverticular disease. Colonoscopy is a safe diagnostic and therapeutic procedure.
Asunto(s)
Enfermedades del Colon/diagnóstico , Colonoscopía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Enfermedades del Colon/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
A uma revisäo da literatura, abordando características epidemiológicas e evolutivas do trauma colônico, acresentam-se dados de um estudo realizado no Hospital de Pronto Socorro de Porto Alegre, envolvendo 160 pacientes operados entre janeiro de 1995 a dezembro de 1996...
Asunto(s)
Humanos , Colon/lesiones , Traumatismos Abdominales/complicaciones , Enfermedades del Colon/cirugía , Enfermedades del Colon/epidemiología , Enfermedades del Colon/etiologíaRESUMEN
Os autores revêem, retrospectivamente, 870 exames proctológicos realizados por um deles, como coloproctologista único de um hospital de referência em área metropolitana de Belo Horizonte, no decurso de quatro anos, em pacientes ambulatoriais (616 pacientes, 78,80 por cento) e internados (254 pacientes, 29,20 por cento), analisando fatores identificadores (idade, sexo, raça, alfabetizaçäo e níveis de escolaridade e instruçäo), resoluçäo do exame proctológico, diagnósticos proctológicos, diagnósticos definitivos e tratamentos instituídos. Verificam um baixo nível etário (519 pacientes ou 60 por cento com idades inferiores a 40 anos), semelhança de incidência por sexos (468 homens, 53,79 por cento e 412 mulheres, 46,21 por cento). No tocante à escolaridade, nota-se uma elevadíssima incidência de indivíduos analfabetos (223 pacientes, 25,63 por cento), que com os alfabetizados totalizam 650 pacientes (74,72 por cento) com baixos níveis de informaçäo e cultura. Chamam a atençäo para o elevado teor de resoluçäo do exame proctológico, que atingiu 624 (77,93 por cento) diagnósticos positivos e 192 (22,0 por cento) diagnósticos normais, totalizando 747 (85,86 por cento) resoluçöes na primeira consulta, e para os principais diagnósticos definitivos dos pacientes: parasitoses intestinais (452 casos, 51,95 por cento), hemorróida (367 casos, 42,18 por cento) e fissuras anais (136 casos, 15,63 por cento). Deixando-se de lado as parasitoses intestinais foram as seguintes as abordagens terapêuticas: tratamentos clínicos foram realizados em 348 pacientes, 40,00 por cento (além dos 452 casos de parasitoses intestinais), tratamentos cirúrgicos em 274 casos (31,50 por cento) e sem tratamento ou tratamentos sintomáticos 234 casos (26,90 por cento)
Asunto(s)
Humanos , Masculino , Femenino , Lactante , Preescolar , Niño , Adolescente , Adulto , Persona de Mediana Edad , Enfermedades del Colon/epidemiología , Enfermedades del Recto/epidemiología , Anciano de 80 o más Años , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/terapia , Enfermedades Parasitarias/diagnóstico , Enfermedades Parasitarias/epidemiología , Enfermedades del Recto/diagnóstico , Enfermedades del Recto/terapia , Infecciones Oportunistas Relacionadas con el SIDA/epidemiología , Zonas Metropolitanas , Prevalencia , Estudios Retrospectivos , Síndrome de Inmunodeficiencia Adquirida/epidemiologíaRESUMEN
We report a clinic-endoscopical study about 365 patients, both of sex, between 26-95 years old, with colonoscopic diagnosis of colorectal cancer. Results showed that 61,92% were men and 38,08% women; in 92,60% the disease ocurred over 40 years old. 13,42% had malignant personal history -colorectal cancer, uterus and breast cancer, and others-; 13,97% had bening personal history-colorectal adenoma, cholecystectomy, and others-; Abdomina pain, change in intestinal habits, and bleeding were the moist frequent symptoms, with differences depending of the tumors localization in the colon or rectum. 62,57% of patients had anemia under 10g% of hernoglobin; in 85,23% the fecal occult blood test was positive. On 199 patients, the simple barium enema diagnosed the tumor in 66,33% only; but in the same group, colonoscopy diagnosed the cancer in 96,49% at first examination. In all patients, colonoscopywas excellent for diagnosis of the principal lesion, and for the identification of synchronous neoplasia. On 365 patients, colonoscopy diagnosed the cancer in 98,08% at first examination. The localization of tumors was: 57,63% in left colon (49,47% in rectum and sigmoid colon); 34,21% in the right colon; and 8,16% in transverse. Pathology showed that adenocarcinoma was the most frequent tumor 95,23%; 1,06% mucoid carcinoma; 1,06% epidermoid carcinoma; and 2,65% lymphorna. In 32,05% of cases there were synchronous lesions; 3,01% had other cancer, and 54 patients had 112 polyps (62,50% adenomatous polyp, 6,25% adenoma with non invasive or invasive adenocarcinoma, and 31,25% hiperplastic polyp. Authors emphasize the value of the detection and early diagnosis to decrese the colorectal cancer mortality.
Asunto(s)
Colonoscopía , Neoplasias Colorrectales/epidemiología , Dolor Abdominal/etiología , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiología , Adenocarcinoma/patología , Adenocarcinoma Mucinoso/diagnóstico , Adenocarcinoma Mucinoso/epidemiología , Adenocarcinoma Mucinoso/patología , Adenoma/diagnóstico , Adenoma/epidemiología , Adenoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Bario , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/epidemiología , Carcinoma de Células Escamosas/patología , Enfermedades del Colon/diagnóstico , Enfermedades del Colon/epidemiología , Enfermedades del Colon/patología , Pólipos del Colon/diagnóstico , Pólipos del Colon/epidemiología , Pólipos del Colon/patología , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/patología , Enfermedad de Crohn/diagnóstico , Enfermedad de Crohn/epidemiología , Enfermedad de Crohn/patología , Divertículo del Colon/diagnóstico , Divertículo del Colon/epidemiología , Divertículo del Colon/patología , Humanos , Linfoma no Hodgkin/diagnóstico , Linfoma no Hodgkin/epidemiología , Linfoma no Hodgkin/patología , Persona de Mediana Edad , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/epidemiología , Neoplasias Primarias Múltiples/patología , Sangre Oculta , Perú/epidemiología , Estudios RetrospectivosRESUMEN
Se presentan dos casos de fistula gastrocolica como complicacion de ulcera peptica benigna; ademas se hace la revision de la literatura al respecto. Con los casos aqui registrados se eleva el numero de esta rara complicacion a 110. Se discuten su fisiopatologia, presentacion clinica y enfoque de tratamiento. La conducta que se sigue con mayor frecuencia es remover en bloque el estomago y el colon comprometidos, y restablecer la continuidad en forma primaria
Asunto(s)
Anciano , Humanos , Masculino , Enfermedades del Colon/epidemiología , Fístula , Úlcera Péptica/complicaciones , Fístula , Fístula/epidemiología , Fístula/terapiaRESUMEN
Intussusception is the commonest cause of intestinal obstruction in childhood in Trinidad. A review of 94 consecutive cases seen at the General Hospital, Port-of-Spain, over a 12-year period (1974-1985) indicates that there had been a very rapid increase in incidence of intussusception in the last 4 years. The majority were under 1 year of age (87%) and there was a predominance in the Negro child (62%). Male to female ratio was 1.2:1. A high misdiagnosis rate (55%) lead to inappropriate treatment and delay in surgical intervention. This resulted in a high case fatality (6.4%) and complication rate. In order to minimize morbidity and mortality from intussusception steps must be taken to ensure earlier diagnosis and treatment.