ABSTRACT
INTRODUCTION: Intestinal malrotation is a congenital pathology with potentially catastrophic complications, such as volvulus, whose treatment has barely not changed in nearly 100 years (Ladd's procedure). Dr. Abu-Elmagd recently described a new technique that was applied in one of our patients. CLINICAL CASE: 12-year-old boy who had undergone Ladd's procedure as a result of intestinal volvulus secondary to malrotation when he was 2 days old. He had subocclusion and eventually obstruction, with intestinal volvulus compatible imaging. Intraoperative findings: duodenal subocclusion, volvulus and lymphangiectasias. Kareem's procedure: bowel positioning in normal rotation, duodenopexy (duodenal C posterior to the mesenteric vessels), formation of neo-Treitz, and fixation of the cecum, the ascending colon, and the mesenteric root. The patient was discharged on postoperative day 6 and remains asymptomatic after 1 year of follow-up. DISCUSSION: Kareem's procedure is a safe and effective malrotation repair technique. It can replace Ladd's procedure as it reduces the risk of re-volvulation and improves digestive symptoms.
INTRODUCCION: La malrotación intestinal es una patología congénita con complicaciones potencialmente catastróficas, destacando el vólvulo, cuyo tratamiento no ha variado significativamente en casi 100 años (procedimiento de Ladd). Recientemente el Dr. Abu-Elmagd describió una técnica que hemos aplicado en un paciente. CASO CLINICO: Varón de 12 años, intervenido con 2 días de vida por vólvulo intestinal secundario a malrotación realizándose procedimiento de Ladd. Presenta cuadros suboclusivos y finalmente obstructivo con imágenes compatibles con vólvulo intestinal. Hallazgos intraoperatorios: suboclusión duodenal, vólvulo y linfangiectasias. Procedimiento de Kareem: posicionando intestino en normorotación, duodenopexia (C duodenal posterior a vasos mesentéricos), formación de neoTreitz, fijación de ciego, colon ascendente y raíz mesentérica. Alta hospitalaria al 6º día postoperatorio, asintomático en 1 año de seguimiento. COMENTARIOS: El procedimiento de Kareem es una técnica segura y efectiva que corrige la malrotación, pudiendo reemplazar al procedimiento de Ladd al disminuir el riesgo de revolvulación y mejorar síntomas digestivos.
Subject(s)
Digestive System Surgical Procedures , Intestinal Volvulus , Laparoscopy , Male , Humans , Child , Intestinal Volvulus/surgery , Intestinal Volvulus/complications , Intestines/abnormalities , Digestive System Surgical Procedures/methods , Laparoscopy/methodsABSTRACT
Introducción: La malrotación intestinal es una patología congénitacon complicaciones potencialmente catastróficas, destacando el vólvulo,cuyo tratamiento no ha variado significativamente en casi 100 años(procedimiento de Ladd). Recientemente el Dr Abu-Elmagd describióuna técnica que hemos aplicado en un paciente.Caso clínico: Varón de 12 años, intervenido con 2 días de vidapor vólvulo intestinal secundario a malrotación realizándose procedimiento de Ladd. Presenta cuadros suboclusivos y finalmente obstructivo con imágenes compatibles con vólvulo intestinal. Hallazgosintraoperatorios: suboclusión duodenal, vólvulo y linfangiectasias.Procedimiento de Kareem: posicionando intestino en normorotación,duodenopexia (C duodenal posterior a vasos mesentéricos), formaciónde neoTreitz, fijación de ciego, colon ascendente y raíz mesentérica.Alta hospitalaria al 6º día postoperatorio, asintomático en 1 año deseguimiento. Comentarios: El procedimiento de Kareem es una técnica seguray efectiva que corrige la malrotación, pudiendo reemplazar al procedimiento de Ladd al disminuir el riesgo de revolvulación y mejorarsíntomas digestivos.(AU)
Introduction: Intestinal malrotation is a congenital pathology withpotentially catastrophic complications, such as volvulus, whose treatment has barely not changed in nearly 100 years (Ladds procedure). Dr. Abu-Elmagd recently described a new technique that was appliedin one of our patients. Clinical case. 12-year-old boy who had undergone Ladds procedure as a result of intestinal volvulus secondary to malrotation when hewas 2 days old. He had subocclusion and eventually obstruction, withintestinal volvulus compatible imaging. Intraoperative findings: duodenalsubocclusion, volvulus and lymphangiectasias. Kareems procedure:bowel positioning in normal rotation, duodenopexy (duodenal C posterior to the mesenteric vessels), formation of neo-Treitz, and fixationof the cecum, the ascending colon, and the mesenteric root. The patientwas discharged on postoperative day 6 and remains asymptomatic after1 year of follow-up. Discussion: Kareems procedure is a safe and effective malrotationrepair technique. It can replace Ladds procedure as it reduces the riskof re-volvulation and improves digestive symptoms.(AU)
Subject(s)
Humans , Male , Child , Intestinal Volvulus/complications , Intestinal Volvulus/surgery , Intestinal Obstruction/drug therapy , Intestinal Obstruction/surgery , Intestinal Obstruction/therapy , Inpatients , Physical Examination , Symptom Assessment , General Surgery , PediatricsABSTRACT
OBJECTIVES: The aim of this review is to present our experience in this emerging disease and mainly help improve diagnostic suspicion. MATERIAL AND METHODS: We reviewed the literature in order to analyze the epidemiology, pathophysiology, diagnosis and management of eosinophilic esophagitis (EE), we describe 4 cases diagnosed in our hospital during 2011 after an emergency admission by food impaction. RESULTS: The age of our patients was 7-11 years, males in all cases. All patients had a history of allergies, and the impaction had been preceded by episodes of dysphagia. In esophagoscopy we observed nonspecific macroscopic findings. The results of biopsies showed the presence of an infiltration of eosinophils in the mucosa over 15 per high power field. All patients were referred to the gastroenterology section of our hospital. DISCUSSION: Eosinophilic esophagitis is a primary disease of esophagus, defined as the presence of symptoms of esophageal dysfunction (mainly dysphagia and food impaction), associated to at least one esophageal biopsy with more than 15 eosinophils in high-power field and the exclusion of gastroesophageal reflux. The diagnosis is clinical, endoscopic and pathologic. It requires an upper endoscopy to evaluate characteristic findings and biopsies for histology. Current treatments include diet therapy based on avoiding exposure to certain food allergens.
