Estudo retrospectivo da prevalência de perfurações gastrointestinais em pacientes submetidos a colonoscopias no Hospital Regional Hans Dieter Schmidt / Retrospective study of the prevalence of gastrointestinal perforation in patients submitted to colonoscopies at Hans Dieter Schmidt Regional Hospital

Introdução: A colonoscopia é um instrumento padrão ouro para triagem e identificação precoce do câncer colorretal. Embora relativamente segura, está sujeita a complicações, como a perfuração de cólon, vinculando-se com altas taxas de morbidade e mortalidade. Objetivos: Avaliar a prevalência de perfuração intestinal em realização de colonoscopias entre os anos de 2012 e 2017 no Hospital Regional Hans Dieter Schmidt, em Joinville-SC e traçar um perfil dos sujeitos que sofreram perfuração, fatores de risco associados, caracterização do exame (diagnóstico ou terapêutico) e seus respectivos desfechos clínicos. Métodos: Estudo quantitativo, descritivo, retrospectivo e transversal, com coleta de dados realizada por análise de prontuários eletrônicos, resultados de colonoscopias e laudos anatomopatológicos. Resultados: Entre 2012 e 2017 foram realizadas 898 colonoscopias, sendo registradas 9 perfurações (1,00%), sendo 4 em mulheres e 5 em homens. Destas, 8 (0,89%) foram com intuito diagnóstico e 1 (0,11%) teve objetivo terapêutico. As faixas etárias variavam entre 46 e 76 anos, sendo a hipertensão arterial sistêmica (55,55%) e a realização de cirurgias prévias (55,55%) os fatores de risco mais encontrados. Os diagnósticos das perfurações foram realizados por meio de laparotomia, e o tratamento foi realizado conjuntamente ao diagnóstico. Cinco casos evoluíram a óbito após a realização do tratamento, um para sepse e outro para peritonite fecal. Conclusão: Perfurações secundárias a exame de colonoscopia apesar de escassas, porém cursar com complicações graves, como sepse, peritonite fecal e até mesmo óbito.

câncer diagnosis. Though it is a relatively safe exam, it is not free of complications, such as colon perforation, which presents a high morbimortality rate. Objectives: Investigate the prevalence of perforation in subjetcs who went through colonoscopy in the Regional Hospital Hans Dieter Schmidt, located in Joinville (SC) during 2012-2017 and their epidemiologic profile, including risk factors, exam intention (therapeutic or diagnosis) and respective outcomes. Methods: Cross-sectional, descriptive, quantitative and retrospective study, whose data were collected from medical registers of colonoscopy outcomes and anatomopathologic reports. Results: During 2012-2017 period, 898 colonoscopies were conducted and 9 perforations (1,00%) cases were observed, four in men and five in women. Among those, eight (0,89%) aimed diagnosis and one (0,11%) was therapeutic. Age of subjects who suffered perforation ranged from 46 to 76 years and systemic arterial hypertension and previous surgery were the most present risk factors (55,55% each). Perforation cases were detected by laparotomy and the management was instituted right after diagnosis. Five cases resulted in death after treatment, one progressed to sepsis and other to fecal peritonitis. Conclusion: Perforation due to colonoscopy, though rare, might progress to serious complications, like sepsis, fecal peritonitis and even death.

Perforación de sigma secundaria a migración de prótesis biliar / Sigma Perforation Secondary to Migration of Biliary Prosthesis

RESUMEN Introducción: La migración de una prótesis en la vía biliar es una complicación muy poco frecuente que normalmente se expulsa de forma natural, pero en raras ocasiones puede cursar con complicaciones severas. Objetivo: Describir una complicación rara por migración de una prótesis biliar. Caso clínico: Se presenta un paciente de sexo masculino de 75 años, portador de stent biliar que presenta una perforación de sigma secundaria a migración de la prótesis. Conclusiones: Las migraciones protésicas deben vigilarse y si no se eliminan de manera espontánea o el paciente presenta síntomas, se debe proceder a su retirada endoscópica o quirúrgica(AU)

ABSTRACT Introduction: Migration of a prosthesis in the bile duct is a very rare complication normally expelled in a natural way, but on rare occasions it can lead to severe complications. Objective: To describe a rare complication due to migration of biliary prosthesis. Clinical case: A case is presented of a 75-year-old male patient with a biliary stent who presented a sigmoid perforation secondary to migration of the prosthesis. Conclusions: Prosthetic migrations should be monitored and, if they are not eliminated spontaneously or the patient presents with symptoms, they should be removed endoscopically or surgically(AU)

Erosion of a Tenckhoff catheter to the sigmoid colon: an uncommon delayed complication.

Continuous ambulatory peritoneal dialysis is one of the most commonly used therapies for patients with impaired renal function. Most frequent complications directly related to the catheter usually present within the first weeks, and range from catheter dysfunction to dialysis-associated peritonitis; bowel perforation while placing the catheter is uncommon, and it is usually assessed in the same surgical event. There are, however, delayed complications, and one of the least frequently described is erosion of the catheter into the bowel. We present the case of a 65-year-old man, who shows up at the emergency room referring to "acute diarrhea" associated with his dialysis, it is quickly diagnosed as a bowel perforation and underwent emergency surgery. During the operation we found adhesions compromising small bowel and sigmoid colon, the far end of the dialysis catheter inside the sigmoid colon, with no signs of colonic leakage to the peritoneal space. We removed the dialysis catheter, resected the fibrous borders of the site of insertion and performed a primary closure. The patient evolved satisfactorily and was subsequently discharged to continue with hemodialysis for renal substitution therapy.

Extra luminal migration of ingested fish bone to the spleen as an unusual cause of splenic rupture: Case report and literature review.

INTRODUCTION: The ingestion of foreign bodies (FB) is a common problem worldwide and affects all ages; it is, however, particularly important in the pediatric population and in mentally impaired adults. The typical outcome of FB ingestion is good, since the majority of ingested material is passed spontaneously through the gastrointestinal tract. Serious complications can occur, however, including bowel perforation or obstruction and gastrointestinal bleeding, amongst others. Extraluminal migration of ingested foreign bodies is very rare and reported cases so far have shown, more commonly, migration to neck structures, with very few reported cases of migration to the abdomen. To date, there is no reported case of extraluminal migration of ingested FB to the spleen. CASE PRESENTATION: A 59-year-old man presented with acute abdominal pain and dyspnea. A CT scan revealed a FB within the spleen, with a ruptured capsule and perisplenic collection. Surgery was performed and a 3cm-long fishbone was extracted, with hemoperitoneum secondary to spleen rupture. The patient was discharged on the third postoperative day with good recovery and without any complications; pneumococcal polysaccharide vaccination was provided. CONCLUSION: FB ingestion is a relatively benign condition; however, some serious complications can arise infrequently. The patient reported herein is the first in the literature to present a splenic rupture due to extra luminal migration of an ingested fish bone.