RESUMEN
Introduction: A urethral diverticulum can be defined as a pocket that forms from the lining of the urethra and protrudes into the surrounding tissue, a condition which causes voiding dysfunction and may result as a rare complication of hypospadias repair surgery. Case report: We report the case of a 2-year-old child who presented to us in 2019 complaining of a thin forceful stream, ballooning of the ventral aspect of the penis while voiding, and post-void dribbling. He has a history of undergoing a tubularised incised plate urethroplasty for distal penile hypospadias at 18-months-old. Ultrasound showed increased post-void residual volume and cystourethroscopy confirmed a urethral diverticulum extending from the subcorona to the base of the penis. The patient underwent partial excision of diverticulum, urethroplasty, and meatoplasty. He was followed-up 3 months later with complete resolution of his symptoms and a normal urinary stream with no urethral ballooning or dribbling. Conclusion: Urethral diverticulum may present as a complication post hypospadias repair. Although it is rare, we believe that it is important for the patient's parents to understand the possibility and know of the signs and symptoms in addition to attending regular outpatient clinic appointments in order to facilitate early management if needed. Furthermore, it is highly important for physicians to assess newborns for hypospadias before carrying out circumcision as it is a contraindication for the procedure.
Asunto(s)
Divertículo , Hipospadias , Enfermedades Uretrales , Humanos , Masculino , Hipospadias/cirugía , Divertículo/etiología , Divertículo/cirugía , Preescolar , Enfermedades Uretrales/etiología , Complicaciones Posoperatorias/etiología , Uretra/cirugíaRESUMEN
BACKGROUND We present an exceptional case of asystole and tracheal diverticulum rupture as a result of cardiopulmonary resuscitation (CPR) immediately following laparoscopic cholecystectomy performed at Riga 1st Hospital. Tracheal rupture after tracheal intubation is a severe but very rare complication that can be fatal. We present an incidental finding of the tracheal diverticulum and its rupture during CPR. CASE REPORT A 71-year-old woman (American Society of Anesthesiologists class II, body mass index 28.58) underwent a planned laparoscopic cholecystectomy. Preoperative chest X-ray showed no abnormalities. Endotracheal intubation was performed, with the first attempt with a 7-mm inner diameter cuffed endotracheal tube without an introducer. Five minutes after rapid desufflation of the pneumoperitoneum, severe bradycardia and hypotension occurred, followed by asystole. CPR was performed for a total of 2 min, until spontaneous circulation returned. Twenty hours after surgery, subcutaneous emphysema appeared on the chest. Computed tomography scan of the chest revealed subcutaneous neck emphysema, bilateral pneumothorax, extensive pneumomediastinitis, and a pocket-like, air-filled tissue defect measuring 10×32 mm in the distal third of the trachea, with suspected rupture. Two hours after the diagnosis was established, the emergent surgery was performed. The patient was completely recovered after 15 days. CONCLUSIONS Our case illustrates that tracheal diverticula is sometimes diagnosed by accident and too late, which then can lead to life-threatening situations. Tracheal rupture can be made not only by mechanical piercing by an endotracheal tube but also during interventions, such as CPR. Rapid desufflation of the pneumoperitoneum can lead to asystole, induced by the Bezold-Jarisch reflex.
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Colecistectomía Laparoscópica , Divertículo , Intubación Intratraqueal , Enfermedades de la Tráquea , Humanos , Anciano , Femenino , Colecistectomía Laparoscópica/efectos adversos , Divertículo/etiología , Enfermedades de la Tráquea/etiología , Intubación Intratraqueal/efectos adversos , Reanimación Cardiopulmonar/efectos adversos , Paro Cardíaco/etiología , Rotura/etiología , Rotura Espontánea/etiologíaRESUMEN
Most duodenal diverticula (DD) are asymptomatic and rarely develop perforations. Perforation is the most serious complication of DD and often requires emergency surgery. A 97-year-old woman who had undergone total gastrectomy and Roux-en-Y reconstruction 30 years ago was referred to our department with chief complaints of abdominal pain and fever during her hospitalization after femoral neck fracture surgery in the orthopedic department. Contrast-enhanced computed tomography showed free air and residue in the abdominal cavity and right retroperitoneum, and an emergency laparotomy was performed. The abdominal cavity was mildly contaminated, and a 6-cm DD with a 1-cm perforation in the wall of the diverticulum on the contralateral side of the mesentery of the duodenum was found. Diverticulectomy and duodenal closure were performed and a drainage tube was placed. The patient experienced no complications and was transferred to the orthopedic department on postoperative day 10. Reports of perforation of DD after gastrectomy are very rare. Particular attention should be paid to perforation of DD after Billroth-II and Roux-en-Y reconstructions as they involve the formation of a duodenal stump that differs from the normal anatomy and may be highly invasive surgical procedures, depending on the degree of inflammation and fistula formation.
Asunto(s)
Anastomosis en-Y de Roux , Divertículo , Enfermedades Duodenales , Gastrectomía , Perforación Intestinal , Humanos , Femenino , Anastomosis en-Y de Roux/efectos adversos , Anciano de 80 o más Años , Enfermedades Duodenales/etiología , Enfermedades Duodenales/cirugía , Enfermedades Duodenales/diagnóstico por imagen , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Gastrectomía/efectos adversos , Divertículo/etiología , Divertículo/cirugía , Divertículo/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Complicaciones Posoperatorias/etiologíaRESUMEN
BACKGROUND: Duodenal diverticulum occurs in approximately 20% of the population and can lead to life-threatening complications such as perforation. Most perforations are secondary to diverticulitis, with iatrogenic causes being exceptionally rare. This systematic review explores the aetiology, prevention and outcomes of iatrogenic perforation of duodenal diverticulum. METHODS: A systematic review was performed according to the PRISMA guidelines. Four databases were searched, including Pubmed, Medline, Scopus and Embase. The primary data extracted were clinical findings, type of procedure, prevention and management of perforation and outcomes. RESULTS: Forty-six studies were identified, of which 14 articles met inclusion criteria and comprised 19 cases of iatrogenic duodenal diverticulum perforation. Four cases identified duodenal diverticulum pre-intervention, nine were identified peri-intervention, and the remainder were identified post-intervention. Perforation secondary to endoscopic retrograde cholangiopancreatography (n = 8) was most common, followed by open and laparoscopic surgery (n = 5), gastroduodenoscopy (n = 4) and other (n = 2). Operative management with diverticulectomy was the most frequent treatment (63%). Iatrogenic perforation was associated with 50% morbidity and 10% mortality. CONCLUSION: Iatrogenic perforation of duodenal diverticulum is exceptionally rare and associated with high morbidity and mortality. There are limited guidelines surrounding standard perioperative steps to prevent iatrogenic perforations. A review of preoperative imaging helps identify potential aberrant anatomy, such as a duodenal diverticulum, to allow for recognition and prompt management initiation in the event of perforation. Intraoperative recognition and immediate surgical repair are safe options for this complication.
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Divertículo , Úlcera Duodenal , Perforación Intestinal , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Gastroscopía , Divertículo/diagnóstico , Divertículo/etiología , Divertículo/cirugía , Enfermedad Iatrogénica , Perforación Intestinal/diagnóstico , Perforación Intestinal/etiología , Perforación Intestinal/cirugíaRESUMEN
Background: Endoscopic retrograde cholangiopancreatography (ERCP) for patients with periampullary diverticulum (PAD) remains a challenge. This study aims to investigate the factors and techniques related to successful and safe ERCP in patients with PAD. Methods: We enrolled patients who underwent ERCP in a large tertiary center. The difficult cannulation rate, technical success rate, clinical success rate, and adverse events (AEs) rate were compared between patients with or without PAD. Three independent logistic regression models were established to identify factors and techniques associated with difficult cannulation, clinical success, and AEs. Results: Five thousand five hundred and ninety patients were included, of which 705 (12.6%) were diagnosed with PAD. Patients with PAD had a significantly higher difficult cannulation rate compared with patients without PAD (10.6% vs 8.0%, P < 0.0001), but the rates of technical success (clinical success (95.2% vs 95.2%, P = 0.951), and AEs (16.5% vs 14.4%, P = 0.156) were similar. Type I PAD (odds ratio [OR] = 2.114, 95% confidence interval [CI]:1.05-5.25) and ERCP indication for pancreatic diseases (OR = 1.196, 95%CI: 1.053-1.261) were independently associated with difficult cannulation. Small endoscopic sphincterotomy (EST) with balloon dilatation (OR = 1.581, 95%CI: 1.044-2.393) was independently associated with clinical success. Somatostatin injection showed no preventive effect on post-ERCP pancreatitis (OR = 1.144, 95%CI: 1.044-1.254). Moreover, the auxiliary cannulation techniques were safe for PAD patients. Conclusions: PAD did not affect ERCP outcomes. However, the choice of techniques and AE prophylactic measures should be more specific, especially for patients with type I PAD.
Asunto(s)
Ampolla Hepatopancreática , Divertículo , Enfermedades Duodenales , Humanos , Colangiopancreatografia Retrógrada Endoscópica/efectos adversos , Colangiopancreatografia Retrógrada Endoscópica/métodos , Ampolla Hepatopancreática/cirugía , Resultado del Tratamiento , Cateterismo/efectos adversos , Cateterismo/métodos , Esfinterotomía Endoscópica/efectos adversos , Esfinterotomía Endoscópica/métodos , Enfermedades Duodenales/etiología , Enfermedades Duodenales/cirugía , Divertículo/cirugía , Divertículo/etiología , Estudios RetrospectivosRESUMEN
INTRODUCTION: Retrograde intrarenal surgery (RIRS) is being actively implemented in the treatment of renal stones and other diseases. If necessary, RIRS can be combined with percutaneous procedures. AIM: To study the results of RIRS in patients with nephrolithiasis and various renal disorders. MATERIALS AND METHODS: A total of 106 patients who undergone RIRS were included in the study. There were 66 men (63.4%) and 40 women (36.6%). Mean age was 46.8+/-15.6 years. The indication for RIRS in 84 (79.2%) patients was renal stones. Calculus in calyceal diverticulum were diagnosed in 6 (5.7%), encrusted stents in 8 (7.7%), urinary fistulas after partial nephrectomy in 5 (4.7%), pelvis tumors in 2 (1.9%), pelvis perforation after marsupialization of parapelvic cyst in 1 (0.9%) patient, respectively. Simultaneous retro- and antegrade procedures were performed in 27 (25.5%) cases. In those with nephrolithiasis and encrusted stents, lithotripsy was done with the removal of stone fragments. Two patients underwent endoscopic resection of the pelvis tumor. In six patients, the neck of the diverticulum was incised after lithotripsy, while in five cases retrograde endoscopically controlled percutaneous treatment urinary fistulae was performed. In one case, laser fulguration of the pelvis defect with stenting was done. RESULTS: RIRS was effective in 72 (85.7%) of 84 patients with renal stones. The operation time was 70.8+/-10.2 minutes. In 12 (14.3%) cases with residual fragments, extracorporeal shock-wave lithotripsy (n=7) and repeated RIRS (n=5) were performed. The efficiency of RIRS after two sessions was 91.7%. Complications were observed in 11 (10.4%) patients. With encrusted stents, the operation time was 95.0+/-16.5 min. After laser fragmentation of encrustations in the lower part of the stent, percutaneous lithotripsy was performed with antegrade removal of its upper half. The time for RIRS in those with diverticula was 60.0+/-8.5 min, the average stone size was 8 mm (from 6 to 10 mm). In all cases lithotripsy with mucosal fulguration was successfully done. The procedures for urinary fistulae were also effective (operation time was 45.0 +/- 20.5 minutes) and there were no complications. CONCLUSION: RIRS is a safe and effective treatment for patients with nephrolithiasis and other kidney disorders. Modern flexible ureteroscopes allows to examine the collecting system and to perform lithotripsy and removal of stone fragments.
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Quistes , Divertículo , Cálculos Renales , Litotricia , Nefrolitotomía Percutánea , Fístula Urinaria , Masculino , Humanos , Femenino , Adulto , Persona de Mediana Edad , Litotricia/métodos , Cálculos Renales/terapia , Nefrolitotomía Percutánea/métodos , Resultado del Tratamiento , Divertículo/etiologíaRESUMEN
OBJECTIVE: To describe the etiology and presenting symptoms of periurethral and anterior vaginal wall masses in a large series of patients in an academic institution. METHODS: A retrospective chart review of 126 patients presenting and undergoing treatment for periurethral and anterior vaginal wall masses between November 2001 and July 2021 was completed. Clinicopathologic data were extracted. Ethics approval was obtained. The primary objective of this study was to determine the etiology of these masses; secondary objectives included determining the rates of presenting symptoms, complications, resolution of stress urinary incontinence (SUI), and de novo SUI. RESULTS: The median age of patients was 42 years. The most common etiology was urethral diverticula (39.7%), followed by Skene gland cysts or abscesses (30.2%). The rate of malignancy was 1.6%, and the rate of infection was 21.4%. The most common presenting symptoms were sensation of mass (78.6%), dyspareunia (52.4%), and discharge (46.0%). The rate of surgical complications was 9.5%. Three patients had recurrence on follow-up, but there were no recurrent urethral diverticula after excision. The rate of de novo SUI was 5.6%. The rate of resolution of SUI was 67.6%, and all patients who had slings reported resolution of SUI. CONCLUSION: Urethral diverticula and Skene gland cysts or abscesses accounted for 70% of periurethral and anterior vaginal wall masses in this series. Treatment by complete excision is usually successful.
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Quistes , Divertículo , Cabestrillo Suburetral , Enfermedades Uretrales , Incontinencia Urinaria de Esfuerzo , Humanos , Femenino , Adulto , Estudios Retrospectivos , Absceso/terapia , Absceso/complicaciones , Incontinencia Urinaria de Esfuerzo/cirugía , Incontinencia Urinaria de Esfuerzo/complicaciones , Enfermedades Uretrales/cirugía , Enfermedades Uretrales/complicaciones , Divertículo/diagnóstico , Divertículo/etiología , Divertículo/cirugía , Resultado del Tratamiento , Cabestrillo Suburetral/efectos adversosRESUMEN
INTRODUCTION AND OBJECTIVES: Proximal hypospadias repair is a challenge in the pediatric urology field. Although the previous reports showed that the Belt-Fuqua staged procedure is reliable with a low complication rate for midshaft hypospadias, this procedure has not been generally applied to more proximal hypospadias with severe ventral curvature due to technical limitations. To solve these technical limitations, we developed a modified Belt-Fuqua procedure using an asymmetric long skin sleeve looking like a Japanese long-sleeved Kimono called a "furisode". The aim of this study was to evaluate the outcomes of this new modification of the Belt-Fuqua procedure for the repair of proximal hypospadias with severe curvature in children. STUDY DESIGN: The study retrospectively reviewed consecutive patients with proximal hypospadias with severe curvature underwent this new technique. The major modifications included are proximal degloving beyond the urethral meatus, asymmetrical ventral transposition of dorsal preputial skin like a furisode sleeve, and circumferential proximal anastomosis of preputial skin to native meatus in the first stage. Hypospadias severity was evaluated objectively in two ways: preoperatively by the Glans-Urethral Meatus-Shaft score and intraoperative direct measurement of ventral curvature. The primary outcome was urethroplasty complications. RESULTS: A total of 66 patients completed both stages of the furisode technique. The median Glans-Urethral Meatus-Shaft score was 11. Overall, 60 (91%) patients showed ventral curvature greater than 60 degrees after degloving, and 35 (53%) underwent ventral grafting with a dermal graft in the first stage. Median urethral length constructed at the second stage was 41.5 mm. The median follow-up period was 25 months. Complications occurred in 9 patients (14%); 7 had urethral diverticula, 1 showed a fistula and 1 had a urethral stricture. Neither glans dehiscence nor meatal stenosis occurred. DISCUSSION: There are a couple of advantages of this furisode technique to other tunneled flap techniques like the Ulaanbaatar procedure. The first is the ease of glans reshaping with a Firlit collar at the first stage because of no urethra in the glans. The second is that a long neourethra could be made by the same skin flap with one anastomosis to the native urethra.The weakness of this procedure was that urethral diverticula were prone to occur less than one year after urethroplasty. CONCLUSION: The furisode technique, a new modification of the Belt-Fuqua procedure, provides an alternative staged repair of proximal hypospadias. This technique was easily applied for hypospadias with severe curvature requiring ventral grafting.
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Hipospadias , Trasplante de Piel , Procedimientos Quirúrgicos Urológicos Masculinos , Niño , Divertículo/etiología , Divertículo/cirugía , Humanos , Hipospadias/complicaciones , Hipospadias/cirugía , Lactante , Masculino , Estudios Retrospectivos , Trasplante de Piel/métodos , Resultado del Tratamiento , Uretra/anomalías , Uretra/cirugía , Estrechez Uretral/etiología , Estrechez Uretral/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodosRESUMEN
AIMS: Since October 2018, urinary bladder diverticulum resections at our Department of Urology have been carried out with robot assistance and with minimal invasivion, Paediatrical urological and robot-assisted minimally invasive urological surgery for the Bamberg Social Foundation were performed with the DaVinci robotic systemTM. The aim of the present study was to record the surgical results of our patients and to compare these if necessary with available data on optimal diagnostic and therapy. METHODS: In this retrospective analysis, we included all patients who received RAHDR between October 2018 and March 2020. The primary endpoints were postoperative blood loss (postoperative haemoglobin decrease), the operation time (min), complications according to the Clavien-Dindo classification, length of hospital stay (days), postoperative residual urine, postoperative urine extravasation at the anastomosis of the bladder, postoperative quality of life and postoperative satisfaction with micturition. RESULTS: We reviewed a total of 11 patients, all of whom were male. Mean age was 64.8 years (52-82). Average BMI was 26.5 (19-37). 3 patients were ranked with ASA score III, 5 with II and 3 with I. The average residual urine value preoperatively was 183âml (90-240). A cystogram to rule out extravasation was performed on day 6 postoperatively. The mean duration of surgery was 212âmin (148-294) and the mean duration of hospitalisation was 7.6 days (6-10). The mean residual urinary value after surgery was 25âml (10-60). The mean postoperative maximum of flow was measured at 27.7âml/s (11-55). No contrast agent extravasation in the cystogram was detected in any of the patients. The complications according to Clavien were not measurable. The mean postoperative haemoglobin decrease was 1.61âg/dl (0-3. 2). CONCLUSIONS: In most cases, the removal of one or more bladder diverticula is possible using the minimally invasive robotic technique. Various surgeries such as YV-bladder neck plastic, prostate adenoma enucleation, bladder stone restoration, and inguinal herniotomy can be carried out simultaneously. A robot-assisted urinary bladder diverticulum resection is an effective and gentle procedure. However, it must be considered that it brings financial disadvantages due to the lack of adequate representation within the German DRG-system (Diagnosis Related Groups).
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Divertículo , Laparoscopía , Procedimientos Quirúrgicos Robotizados , Robótica , Retención Urinaria , Divertículo/diagnóstico , Divertículo/etiología , Divertículo/cirugía , Femenino , Humanos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Calidad de Vida , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/métodos , Robótica/métodos , Resultado del Tratamiento , Vejiga Urinaria/anomalías , Vejiga Urinaria/cirugía , Retención Urinaria/etiologíaRESUMEN
Objective: To investigate the efficacy of two different surgical procedures in combined hysteroscopic and laparoscopic surgery-the "folding suture method" and the "muscle flap filling suture method"-in the treatment of cesarean scar diverticulum (CSD).Methods: The clinical data of 24 patients with CSD who underwent surgery in the Peking University First Hospital from August 2016 to December 2018 were retrospectively analyzed.Results: There was no difference in age, vaginal bleeding time, thickness of the lower uterine segment, operative time and intraoperative bleeding between the two groups. At three months after the operation, the patients of the folding suture and muscle flap groups had an average menstrual period of 6.9 ± 1.8 days and 7.5 ± 3.0 days, respectively, which was 5.8 ± 4.2 days and 4.4 ± 3.8 days, respectively, shorter than that before the operation, as well as a lower segment thickness of the uterus of 6.7 ± 1.8 mm and 6.3 ± 1.7 mm, respectively. Among the patients in the folding suture and muscle flap groups, 8 and 6 cases were cured, and 3 and 6 cases were improved, respectively, resulting in an effective rate of 100%. There was no significant difference in any indicator between the two groups.Conclusion: As two new surgical methods that preserve uterine integrity, the laparoscopic "muscle flap filling suture method" and "folding suture method" combined with hysteroscopic incision are safe and effective treatments for repairing CSD.
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Cesárea , Cicatriz , Divertículo , Laparoscopía , Cesárea/efectos adversos , Cicatriz/etiología , Cicatriz/cirugía , Divertículo/etiología , Divertículo/cirugía , Femenino , Humanos , Histeroscopía , Embarazo , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
BACKGROUND: We aimed to assess the outcome of staged transverse preputial island flap (TPIF) urethroplasty for repairing certain cases of primary proximal hypospadias with moderate-to-severe chordee in children. METHODS: Nighty-two consecutive boys who underwent either one-stage or staged TPIF urethroplasty for the repair of proximal hypospadias with moderate-to-severe chordee between August 2015 and December 2019 were evaluated retrospectively. Patients were divided into two groups: one-stage TPIF urethroplasty group (n = 44) and staged TPIF urethroplasty group (n = 48). We noted and compared the postoperative complications, including urethrocutaneous fistula, urethral diverticula, residual penile curvature, and urethral stricture in both groups. RESULTS: Both groups were followed up for 1-5 years, with an average of 3 years. No cases of residual or recurrence of penile chordee were reported in either group. In Group A, 9 patients (9/44, 20.4%) had postoperative urethrocutaneous fistula, and all patients underwent urinary fistula repair or urethroplasty. In Group B, postoperative urethrocutaneous fistula occurred in 2 cases (2/48, 4.1%), and one patient developed a urethrocutaneous fistula after the first operation, which was successfully repaired during the second operation. A urethrocutaneous fistula occurred in 1 case after completion of the second-stage operation; urethral fistula repair was performed successfully 6 months later. There were 2 cases of urethral stricture in Group A (2/44, 4.5%) and none in Group B. There were 6 cases of urethral diverticulum in Group A (6/44, 13.6%) and no cases of urethral diverticulum in Group B. The operative success rates were 61.3% and 95.8% in Group A and Group B, respectively (P < 0.001). CONCLUSIONS: Compared with one-stage TPIF urethroplasty, staged TPIF urethroplasty in the treatment of certain cases of primary proximal hypospadias with moderate-to-severe chordee resulted in fewer postoperative fistulas, urethral strictures and urethral diverticula. The staged TPIF urethroplasty procedure was effective in reducing the operation difficulty and complication rate of hypospadias, improving the curative effect of complex hypospadias and having good clinical application value.
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Hipospadias/cirugía , Pene/anomalías , Colgajos Quirúrgicos , Uretra/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Divertículo/etiología , Humanos , Lactante , Masculino , Pene/cirugía , Complicaciones Posoperatorias , Estudios Retrospectivos , Escroto/cirugía , Enfermedades Uretrales/etiología , Estrechez Uretral/etiología , Procedimientos Quirúrgicos Urológicos Masculinos/efectos adversosRESUMEN
ABSTRACT: The purpose of this study was to explore the relevant factors that affect the risk of cesarean scar diverticulum (CSD).A retrospective, case-control study was designed among women with a history of cesarean section (CS) who were admitted in Zhejiang Tongde Hospital from January 2017 to December 2019. Women with missing information were excluded. The basic clinical characteristics and the risk factors for CSD were assessed using univariate analysis and multivariate logistic regression analysis.A total of 216 women were analyzed, including 87 patients with CSD and 129 cases without CSD as control. Significant differences in number of CS, trial of labor (elective or urgent CS), CS interval, uterine position, intraoperative hemorrhage, and dysmenorrhea between CSD group and control group (Pâ<â.05). Multivariate logistic regression analysis showed that number of CS, trial of labor, interval of CS, and uterine position were independent risk factors of CSD.In women with a history of CS, multiple cesarean deliveries, elective CS, cesarean interval of less than 5âyears, and retroflexed position of the uterus may be associated with an elevated risk of CSD.
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Cesárea , Cicatriz , Divertículo , Adulto , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Estudios de Casos y Controles , Cesárea/efectos adversos , Cesárea/métodos , Cesárea/estadística & datos numéricos , China , Cicatriz/complicaciones , Cicatriz/etiología , Cicatriz/patología , Divertículo/diagnóstico , Divertículo/epidemiología , Divertículo/etiología , Procedimientos Quirúrgicos Electivos/métodos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Femenino , Humanos , Embarazo , Medición de Riesgo/métodos , Medición de Riesgo/estadística & datos numéricos , Factores de Riesgo , Esfuerzo de Parto , Técnicas de Cierre de HeridasRESUMEN
Although several studies have reported the multiple systemic effects of betel nut (BN) chewing, analyses performed on the colonic system have been few. To analyze the association between BN chewing and diverticulosis, we conducted a cross-sectional study of 5,586 eligible participants who underwent colonoscopy at a medical center in Taiwan from 2010 to 2016. BN chewing was recorded based on an assessment of personal history. Diverticulosis was categorized based on whether colonoscopies had been performed during health examinations by trained physicians at Tri-Service General Hospital. The association between different exposures, including cigarette, alcohol, BN, and diverticulosis, was also analyzed. Our study included 3,161 males and 2,425 females, and males have significantly higher prevalence rates of BN chewing than females (11.1% versus 0.3%, respectively). In the male group, BN chewing had an adjusted odd ratio (OR): 1.65(95% confident interval (CI): 1.12-2.44) with the presence of diverticulosis. Among the combination of exposures of cigarette, alcohol, and BN, the group with BN chewing combined with smoking and drinking showed significant association between diverticulosis with adjusted OR: 1.909 (95% CI, 1.188-3.065). Further subgroup analysis displayed adjusted OR: 2.310 (95% CI, 1.245-4.287) in obesity and OR: 2.406 (95% CI, 1.205-4.803) in elderly male. Thus, BN chewing is independently associated with diverticulosis in male.
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Areca/efectos adversos , Divertículo/etiología , Nueces/efectos adversos , Consumo de Bebidas Alcohólicas/epidemiología , Estudios Transversales , Divertículo/epidemiología , Femenino , Humanos , Masculino , Masticación , Persona de Mediana Edad , Obesidad/epidemiología , Oportunidad Relativa , Fumar/epidemiología , Taiwán/epidemiologíaRESUMEN
The traditional way to tackle Zenker's diverticulum (ZD) has been flexible endoscopic septum division (FESD). Recently, the concept of per oral endoscopic myotomy has been found useful for managing diverticular diseases of the esophagus and has been termed DPOEM. We performed a systematic review and meta-analysis to evaluate the efficacy and safety of D-POEM in diverticular disease of the esophagus and to compare it with FESD. We systematically searched PubMed and Embase, for studies reporting clinical success, technical success and adverse events in D-POEM alone or D-POEM comparing with FESD. We computed pooled prevalence for D-POEM alone and risk ratio for D-POEM vs FESD using random effect method with inverse variance approach. Subgroup analysis for ZD, non-ZD and mixed diverticulum was conducted. Totally 19 studies including 341 patients were identified reporting on D-POEM. The pooled clinical, technical success and adverse event rates for D-POEM were 87.07%, 95.19% and 10.22%, respectively. The clinical success was significantly better than FESD while the technical success, adverse event rate, procedure time and length of hospital stay were comparable with FESD. The recurrence rate was negligible for D-POEM compared to FESD. On subgroup analysis by dividing into three groups of ZD, non-ZD and mixed, there was no difference between clinical, technical success and adverse event rate among the three groups. D-POEM is an effective and safe technique among both ZD and non-ZD patients and has better clinical success than FESD.
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Divertículo , Miotomía , Divertículo de Zenker , Divertículo/etiología , Esofagoscopía/efectos adversos , Esofagoscopía/métodos , Esófago , Humanos , Miotomía/efectos adversos , Miotomía/métodos , Resultado del Tratamiento , Divertículo de Zenker/cirugíaRESUMEN
OBJECTIVE: To present the results of Koyanagi-Snow-Hayashi urethroplasty in severe hypospadias repair. METHODS: From June 2015 to December 2019, 43 patients with severe hypospadias associated with curvature underwent Koyanagi- Snow-Hayashi urethroplasty. All patients were treated for the first time and by a single surgeon. Thirty-five patients included in this study presented a form of disorders of sex development. The age of the patients at surgery varied from 12 to 120 months (mean age 21 months ± 6 months). The median follow-up was 28 months (range, 5-65 months). RESULTS: Functional and esthetic results were satisfactory with a straight and excellent appearance of the penis, without any complications in only ten patients (23%). While 30 of 43 patients (70 %) required additional procedures. Postoperative complications encountered in our patients were dominated by fistulas which were found in 17 of 43 patients (39.5%). Among them, 3 fistulas appeared in the penile shaft between 11 and 28 days and disappeared spontaneously. While proximal fistulas have been required surgical repair. Diverticulum seemed to be a significant complication of this technique, it was found in 4 of 43 (9%). This study also revealed the presence of a peculiar complication for this procedure, urethral meatus in the shape of fish lips. CONCLUSION: The use of Koyanagi-Snow-Hayashi urethroplasty in severe hypospadias repair gives a complete penile straightening in all cases. However, Despite the modifications added by Snow and Hayashi to Koyanagi urethroplasty to improve the vascular supply of the flap, the rate of complications encountered with this technique remains high.
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Hipospadias/cirugía , Procedimientos Quirúrgicos Urológicos Masculinos/métodos , Niño , Preescolar , Divertículo/etiología , Fístula/etiología , Humanos , Lactante , Masculino , Pene/cirugía , Complicaciones PosoperatoriasAsunto(s)
Divertículo , Cálculos Biliares , Derivación Gástrica , Obstrucción Intestinal , Divertículo/diagnóstico por imagen , Divertículo/etiología , Divertículo/cirugía , Cálculos Biliares/complicaciones , Cálculos Biliares/diagnóstico por imagen , Derivación Gástrica/efectos adversos , Humanos , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/cirugíaRESUMEN
Low grade appendiceal mucinous neoplasm (LAMN) is the primary source of pseudomyxoma peritonei (PMP). PMP may develop after seemingly complete resection of primary tumor by appendectomy, which is unpredictable due to lack of reliable prognostic indicators. We retrospectively reviewed 154 surgically resected LAMNs to explore if any of the macroscopic and microscopic characteristics may be associated with increasing risk of PMP development. Our major findings include: (1) As compared to those without PMP, the cases that developed PMP were more frequent to have (a) smaller luminal diameter (<1 cm) and thicker wall, separate mucin aggregations, and microscopic perforation/rupture, all suggestive of luminal mucin leakage; (b) microscopic acellular mucin presenting on serosal surface and not being confined to mucosa; and (c) neoplastic epithelium dissecting outward beyond mucosa, however, with similar frequency of neoplastic cells being present in muscularis propria. (2) Involvement of neoplastic cells or/and acellular mucin at surgical margin did not necessarily lead to tumor recurrence or subsequent PMP, and clear margin did not absolutely prevent PMP development. (3) Coexisting diverticulum, resulted from neoplastic or non-neoplastic mucosa being herniated through muscle-lacking vascular hiatus of appendiceal wall, was seen in a quarter of LAMN cases, regardless of PMP. The diverticular portion of tumor involvement was often the weakest point where rupture occurred. In conclusion, proper evaluation of surgical specimens with search for mucin and neoplastic cells on serosa and for microscopic perforation, which are of prognostic significance, should be emphasized.
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Adenocarcinoma Mucinoso/patología , Adenocarcinoma Mucinoso/cirugía , Apendicectomía/métodos , Neoplasias del Apéndice/patología , Seudomixoma Peritoneal/patología , Adenocarcinoma Mucinoso/complicaciones , Adenocarcinoma Mucinoso/ultraestructura , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Divertículo/etiología , Divertículo/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mucinas/ultraestructura , Clasificación del Tumor/métodos , Recurrencia Local de Neoplasia/prevención & control , Patología Quirúrgica/métodos , Pronóstico , Seudomixoma Peritoneal/diagnóstico , Seudomixoma Peritoneal/etiología , Estudios Retrospectivos , Gestión de Riesgos , Membrana Serosa/patología , Membrana Serosa/ultraestructura , Adulto JovenRESUMEN
OBJECTIVES: Although tracheobronchial diverticulum (DV) rarely cause problems, attention should be paid during esophagectomy, which requires careful dissection around the trachea and bronchi. Here, we retrospectively review cases of tracheobronchial DVs among esophageal cancer patients and report two cases of bronchial DV injury during thoracoscopic esophagectomy that were successfully repaired. METHODS: The thin-section CT images of esophageal cancer patients who underwent thoracoscopic esophagectomy from January 2013 to December 2015 were retrospectively reviewed. The localization, number, and size (largest axial diameter) of all detected DVs were recorded. RESULTS: A total of 180 patients were enrolled in this study. The incidence of tracheal DV was 5.0%, and that of bronchial DV was 40.0%. The median diameter of the tracheal diverticula was 2.45 [interquartile range (IQR) 2.00-8.17] mm and that of the bronchial diverticula was 1.90 (IQR 1.51-2.46) mm. All tracheal diverticula presented at the right tracheal wall 4.5-6.0 cm below the vocal cords; bronchial diverticula presented at the subcarinal lesions. We experienced two cases with bronchial diverticulum injuries during thoracoscopic esophagectomy, which were repaired by primary closure and confirmed that there was no air leak. No postoperative complications associated with bronchial injury occurred in either patient. CONCLUSION: Since tracheobronchial DVs are not as rare as previously thought, careful evaluation of thin-slice CT scans is necessary before thoracoscopic esophagectomy. If a tracheobronchial DV is injured during surgery, it is important to carefully repair it and confirm that there is no air leak to avoid complications.
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Enfermedades Bronquiales/epidemiología , Divertículo/epidemiología , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Complicaciones Posoperatorias , Enfermedades de la Tráquea/epidemiología , Anciano , Enfermedades Bronquiales/diagnóstico , Enfermedades Bronquiales/etiología , Divertículo/diagnóstico , Divertículo/etiología , Neoplasias Esofágicas/diagnóstico , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Enfermedades de la Tráquea/diagnóstico , Enfermedades de la Tráquea/etiologíaRESUMEN
Mounier-Kuhn syndrome (MKS) is a rare congenital disease with an autosomal recessive inheritance pattern, characterized by an enlargement of the trachea and bronchi. MKS is secondary to a thinning of the muscular mucosa and atrophy of the longitudinal muscle and elastic fibers of the tracheobronchial tree. As a consequence, tracheal diverticulosis and dilatations in the posterior membranous wall appear, along with bronchiectasis that tend to be cystic in appearance. Overall, there is an impairment of mucocilliary clearance, with an ineffective cough, which predisposes the patient to recurrent lower respiratory tract infections. Clinical manifestations vary from asymptomatic to respiratory failure and death, most patients being diagnosed between the third and fourth decades of life. It is an often undiagnosed disease, with a diagnostic algorithm that includes the use of radiological techniques, alone or in combination with bronchoscopy. Specific diagnostic criteria have been developed, based on patients' tracheal and main bronchi diameter on chest X-ray and thoracic computed tomography scan. We present the case of a 45-year-old African American man who presented with a history of multiples episodes of pneumonia that required management in the intensive care unit, on whom MKS was diagnosed.