Obstrucción intestinal secundaria a hematoma intramural espontáneo: Caso clínico / Bowel obstruction secondary to a spontaneous intramural hematoma. Report of one case

Spontaneous intramural hematoma (IMH) is an uncommon cause of bowel obstruction, generally secondary to trauma. Even rarer is the spontaneous hematoma, mainly described in anticoagulated patients. We report a 73-year-old female in anticoagulant therapy who presented with a bowel obstruction. A computed tomography (CT) of the abdomen showed a segmentary wall thickening of the distal jejunum, compatible with an IMH which obliterated the lumen and produced dilatation of the proximal bowel loops. Support management was initiated, achieving satisfactory evolution, allowing her discharge 12 days after admission.

Intususcepción intestinal por linfoma de Burkitt en un paciente adulto. Primer reporte en Latinoamérica.

Intestinal intussusception is a pathology in which an intestinal segment and its mesentery are telescoped into an adjacent intestinal segment as a result of peristalsis, and in many cases cause intestinal obstruction. Its etiology can be variable, including intestinal diverticula, adhesion bands, vascular malformations, neoplasms, among others. The vast majority occur in pediatric patients, however, up to 5% of these are documented in adult patients and their main etiology in this age group are neoplasms. We present a case of intestinal intussusception secondary to Burkitt's lymphoma that received management at fourth level hospital in Bogotá, Colombia.

La intususcepción intestinal es una patología en la que un segmento intestinal y su mesenterio se invaginan al segmento intestinal contiguo. Su etiología puede ser benigna, maligna o idiopática, dentro de las que se incluyen divertículos intestinales, bandas adherenciales, malformaciones vasculares y neoplasias, entre otras. La mayoría se presentan en pacientes pediátricos, pero hasta un 5% se documentan en pacientes adultos y su principal etiología en este grupo etario son las neoplasias. Presentamos un caso de intususcepción intestinal secundaria a linfoma de Burkitt que recibió manejo en un hospital de cuarto nivel en Bogotá, Colombia.

[Bowel obstruction secondary to a spontaneous intramural hematoma. Report of one case]. / Obstrucción intestinal secundaria a hematoma intramural espontáneo: Caso clínico.

Spontaneous intramural hematoma (IMH) is an uncommon cause of bowel obstruction, generally secondary to trauma. Even rarer is the spontaneous hematoma, mainly described in anticoagulated patients. We report a 73-year-old female in anticoagulant therapy who presented with a bowel obstruction. A computed tomography (CT) of the abdomen showed a segmentary wall thickening of the distal jejunum, compatible with an IMH which obliterated the lumen and produced dilatation of the proximal bowel loops. Support management was initiated, achieving satisfactory evolution, allowing her discharge 12 days after admission.

Disfunción ileostómica en pacientes sometidos a resección anterior baja por un cáncer del recto luego de neoadyuvancia / Ileostomic dysfunction in patients undergoing low anterior resection for rectal cancer after neoadjuvant treatment

Resumen Introducción: La resección anterior baja protegida con una ileostomía en asa (IA) luego de neoadyuvancia es el tratamiento estándar del cáncer del recto bajo localmente avanzado. Objetivos: Investigar la incidencia, características clínicas de la disfunción ileostómica (DI) en estos pacientes y, eventualmente, definir un perfil de riesgo. Materiales y Método: Se analizan 103 pacientes consecutivos. La DI se define como la eliminación por la ileostomía de más de 1,5 litros por día durante 3 o más días consecutivos asociado a distensión y dolor abdominal con intolerancia a la alimentación oral en ausencia de una complicación intraabdominal Clavien-Dindo grado III o mayor. Se comparan el grupo con DI del resto (no DI). Resultados: La DI se presentó en el 14,5% de los casos, se resolvió entre 12 y 70 días (en el 50% superó los 30 días), la tasa de reingreso fue 27% y no hubo reoperaciones en este grupo. No hubo diferencias estadísticamente significativas entre ambos grupos salvo en el tiempo de hospitalizarán y la tasa de reingresos. Discusión: La DI corresponde a un tipo de íleo posoperatorio de gravedad y duración variable que paradojalmente se asocia con la eliminación de altos volúmenes de contenido intestinal por la IA, requiere aporte vigoroso de volumen y electrolitos y en los casos más graves apoyo con nutrición parenteral. El cuadro revierte en plazos variables con manejo conservador. En este estudio no se ha logrado definir un perfil del paciente en riesgo de sufrir esta complicación o factores predictivos de ella.

Background: Diverting loop ileostomy (LI) is commonly performed to protect a distal anastomosis after a low anterior resection. Aim: To investigate the frecuency and clinical features of ileostomic dysfunction (ID) and, eventually, to define a profile of patients at risk of this complicaction. Materials and Method: 103 consecutive patients operated on for rectal cancer were included. ID is defined when the maxime output was more than 1,5 lt/day for three or more consecutive days with biochemical disturbances, associated to abdominal distension and the inability to tolerate oral feeding without postoperative severe complication. Patients with ID were compared with noID group. Results: ID developed in 15 patients, lasting between 12 and 70 days (50% for more then 30 days), the readmission rate was 27% without reoperation in this group. Except for inhospital time and readmission rate, no other difference between both groups were founded. Discussion: ID is a kind of paralitic ileus of variable intensity with paradox high output ileostomy leading to depletion of water and electrolyte imbalance. ID requires reposition of high volumen of fluids and electrolytes and sometimes parenteral nutrition with full recovery in variable periods without invasive treatment. In this study it was not possible to define a patient profile at risk or predictive factores of this complication.

Cirugía de urgencia en pacientes con cáncer de colon complicado en Hospital Universitario "General Calixto García" / Emergency Surgery in Patients with Complicated Colon Cancer at General Calixto García University Hospital

Introducción: El cáncer de colon mantiene un importante impacto social y una alta morbilidad a pesar de programas de detección precoz existentes. Ocupa el cuarto lugar entre los tumores malignos y un número importante de pacientes son operados de urgencia por las complicaciones de esta enfermedad, muchas veces desconocida hasta el momento de la cirugía. Objetivo: Caracterizar la cirugía de urgencia realizada a los pacientes con diagnóstico de cáncer de colon complicado. Método: Se realizó un estudio observacional, descriptivo, de corte transversal entre enero de 2014 y diciembre de 2016, en el Servicio de Cirugía General. La muestra fue de 96 pacientes portadores de esta entidad en el Hospital Universitario "General Calixto García". Resultados: Se analizó la incidencia según sexo, relación sexo/localización, relación localización/complicación, estadificación y mortalidad. Prevalecieron los tumores de colon en el sexo femenino y por ende fueron más frecuente las pacientes con complicaciones quirúrgicas por esta entidad en nuestro centro. Predominó la localización derecha globalmente, con predominio femenino. La oclusión intestinal fue la complicación más frecuente. Sobresalió el estadio II según TNM con un 37,5 por ciento y una mortalidad postoperatoria del 31 por ciento. Conclusiones: Nuestros datos coinciden con la tendencia nacional sobre la mayor incidencia del cáncer de colon en pacientes femeninas, son estas las que mayor tasa de morbilidad y mortalidad reportan. Seguir perfeccionando el programa de prevención y detección temprana de la entidad y su tratamiento oportuno causará la reducción de los índices que hoy se exhiben(AU)

Introduction: Colon cancer still has an important social impact and high morbidity despite existing early detection programs. It ranks fourth among malignant tumors, while a significant number of patients undergo emergency surgery for complications of this disease, many times unknown until the time of surgery. Objective: To characterize the emergency surgery performed to patients with a diagnosis of complicated colon cancer. Method: An observational, descriptive, cross-sectional study was carried out, between January 2014 and December 2016, in the general surgery service. The sample consisted of 96 patients with this entity and from General Calixto García University Hospital. Results: The incidence was analyzed according to sex, sex/location relationship, location/complication relationship, staging and mortality. Colon tumors prevailed in the female sex and, therefore, patients with surgical complications from this entity were more frequent in our center. There right location predominated globally, with a predominance in the female sex. Intestinal obstruction was the most frequent complication. Stage two, according to the TNM classification, stood out, accounting for 37.5 percent, together with a postoperative mortality of 31 percent. Conclusions: Our data coincide with the national trend on the highest incidence of colon cancer in female patients, who account for the highest morbidity and mortality rates. Continuing to improve the entity's prevention and early detection program, as well as its timely treatment, will bring about a reduction in the rates nowadays reported(AU)

Peutz-Jeghers syndrome: an unusual autopsy finding in pregnancy

Peutz-Jeghers syndrome (PJS) is a rare autosomal dominant polyposis entity that often remains undiagnosed. The major problems associated with PJS are acute complications due to (i) polyp-related intestinal obstruction, (ii) intussusception, and (iii) the risk of cancer in the long-term. We report the case of a 32-year-old female who presented at the emergency room with signs of acute abdomen and died during the clinical workup. She had a one-month history of nausea, vomiting, and diarrhea and was pregnant at about 30 weeks. There was no contributing past history except for undergoing small bowel resection in infancy. The postmortem examination revealed multiple arborizing polyps throughout the gastrointestinal tract, chiefly in the small bowel. Intestinal obstruction was found at the proximal jejunum with necrosis, perforation, and peritonitis. Histologically, the polyps were composed of tree branch-like bundles of smooth muscle covered by normal-appearing glandular epithelium, confirming the diagnosis of hamartomatous polyps. No malignant or premalignant lesions were detected in the gastrointestinal tract or other organs. This case was an opportunity to analyze the natural history and the pathological features of the Peutz-Jeghers syndrome in an adult and to investigate the presence of neoplastic lesions associated with this condition.

Abdomen agudo quirúrgico en el paciente geriátrico / Surgical Acute Abdomen in the Geriatric Patient

RESUMEN Introducción: El abdomen agudo es causa frecuente de ingreso hospitalario en pacientes geriátricos. Objetivo: Caracterizar el comportamiento del abdomen agudo quirúrgico en el paciente geriátrico en un servicio de cirugía general. Métodos: Se realizó un estudio observacional descriptivo longitudinal de corte transversal en 169 pacientes. Los datos procedieron de las historias clínicas del Hospital Universitario "Manuel Ascunce Domenech" de Camagüey, desde enero de 2014 a diciembre de 2016 y se procesaron mediante estadística descriptiva, relacionándose algunas variables de manera no inferencial. Resultados: El 52,2 por ciento de los pacientes eran hombres. El 42,6 por ciento tenía edades entre 60 y 69 años. El 28,9 por ciento presentaron la oclusión intestinal como etiología. Hubo un 39,5 por ciento de complicaciones, el 54,5 por ciento de ellas fueron infecciosas. La mortalidad fue de un 22,5 por ciento. El 26,6 por ciento de los fallecidos presentaba oclusión intestinal. Conclusiones: Casi una décima parte de los pacientes fallecieron, la peritonitis fibropurulenta y el choque séptico fueron las causas más frecuentes de los decesos. La oclusión intestinal como causa de abdomen agudo pareció influir en la mortalidad de la muestra estudiada(AU)

ABSTRACT Introduction: Acute abdomen is a frequent cause of hospital admission in geriatric patients. Objective: To characterize the occurrence of acute surgical abdomen in the geriatric patient in a general surgery service. Methods: An observational, descriptive, longitudinal and cross-sectional study was carried out with 169 patients. The data were obtained from the medical records of Manuel Ascunce Domenech University Hospital in Camagüey, from January 2014 to December 2016, and were processed using descriptive statistics, relating some variables in a noninferential way. Results: 52.2 percent of the patients were men. 42.6 percent were aged between 60 and 69 years. 28.9 percent presented intestinal occlusion as an etiology. There were 39.5 percent of complications, 54.5 percent of which were infectious. Mortality was 22.5 percent. 26.6 percent of the deceased had intestinal obstruction. Conclusions: Almost one tenth of the patients died, with fibrinopurulent peritonitis and septic shock being the most frequent causes of death. Intestinal occlusion as a cause of acute abdomen appeared to influence mortality in the sample studied(AU)

Migración de malla: una complicación temible / Mesh migration: a fearsome complication

RESUMEN La migración de malla en el posoperatorio alejado de la eventroplastìa y su consecuente infección es una complicación poco frecuente y peligrosa. La malla migrada genera reacción inflamatoria de tipo cuerpo extraño. Puede causar obstrucción intestinal, perforación intestinal o dolor abdominal cróni co. Solo se informan 4 casos en la literatura mundial de migración y uno con compromiso intestinal. Presentamos el caso de un tumor inflamatorio adherido a la pared abdominal, con contenido de poli propileno. El objetivo de esta carta científica es presentar una complicación poco habitual, destacando los aspectos más importantes de su manejo, definiendo algunas recomendaciones y remarcando la importancia del abordaje multidisciplinario.

ABSTRACT Mesh migration with subsequent infection years after incisional hernia repair is an uncommon and dangerous complication. Mesh migration produces an inflammatory foreign body reaction and can cause bowel obstruction, bowel perforation or chronic abdominal pain. Only four cases have been reported in the international literature, one of them with bowel involvement. We report a case of an inflammatory tumor containing polypropylene traces adhered to the abdominal wall. The aim of this scientific letter is to report a rare complication, emphasizing the most relevant aspects about its ma nagement, recommendations, and the relevance of a multidisciplinary approach.

Small intestine strangulating obstruction by mesenteric pedunculated lipoma in a criollo mare

Background: The abdominal lipomas are benign tumors of hyperplastic growth that originate from mesenteric adiposetissue, most commonly in the small intestine. Pedunculated lipoma strangulation occurs when the pedicle wraps aroundan intestinal loop and its mesentery, obstructing the intestinal lumen and blood supply of the affected segment. The aim ofthe present study is to report a case of a Criollo mare presenting a strangulating obstruction of the jejunum and ileum bya pedunculated lipoma, focusing the discussion in the causes and epidemiology of this alteration.Case: A 24-year-old Criollo mare with a body condition score 8 out of 9 was referred to the Veterinary Clinical Hospitalof the Federal University of Pelotas (HCV-UFPel) presenting acute abdominal pain. At the hospital, the mare was presenting mild signs of abdominal discomfort. At the initial clinical exam, the mare had an increased heart and respiratory rates,normal body temperature, hyperemic mucous membranes, capillary refil time of 3 s and absent gut sounds in all fourquadrants during auscultation. Mild dehydration was present, increased fibrinogen and serum lactate. Rectal palpationrevealed distention of the small intestine by gas, during abdominal ultrassonography the small intestinal wall thicknesswas increased Peritoneal lactate was 11 mmol/L and protein was 6 mg/dL. Due to the clinical findings during the exam, anexploratory celiotomy was performed. Necrosis of the final third of jejunum and the entire extension of ileum was found.Examining the compromised intestinal portion, it was observed a linear structure strangulating two segments of the smallintestine. Taking into account the extensive area of irreversible necrosis and the advanced age of the patient, euthanasiawas performed. The mare was then referred for necropsy and findings confirmed...(AU)

Appendicolith: an explicit factor leading to complicated appendicitis in childhood. / Apendicolito: factor explícito que ocasiona apendicitis complicada en la niñez.

OBJECTIVES: This study aims to assess the clinical risk of pediatric appendicitis with appendicolith and its guiding significance in therapeutic strategies' selection. METHODS: Children diagnosed with acute appendicitis from June 2011-January 2017 were analyzed retrospectively. Patient cohort was divided to appendicolith group (AG) and nonappendicolith group (NAG) based on whether the appendicolith presents or not in the open surgery. Clinical presentations, laboratory parameters, computed tomography findings, and pathological changes were reviewed and compared between two groups. RESULTS: Among 163 patients, 23 (mean age, 6.1 years old) were defined in AG and 140; mean age, 8.1 years old) in NAG. The patients in AG demonstrated prolonged length of stay (12.4 ± 5.6d vs. 8.7 ± 5.0d, P <0.05), higher body temperature (38.2 ± 0.8 ℃ vs. 37.3 ± 0.8 ℃, P <0.05), higher frequency of diarrhea (17 % vs. 3%, P <0.05), rebound tenderness (100 % vs. 87 %, P <0.05), increased neutrophil percentage (81.4 ± 8.0 % vs. 65.3 ± 22.8 %, P <0.05), C-reactive protein (33.13 ± 10.3 mg/L vs. 23.7 ± 13.7 mg/L, P <0.05), and great risk of perforation (78 % vs. 29 %, P <0.05). Alvarado score (8.3 ± 1.2 vs. 7.0 ± 1.3, P <0.05) and AIR score (10.7 ± 1.6 vs. 7.7 ± 1.9, P <0.05) of AG, were higher than NAG he presence of fever and appendicolith was associated with a high rate of perforated appendicitis. CONCLUSIONS: Pediatric appendicitis with appendicolith has greater clinical risk and tends to causing complicated appendicitis.

Objetivos. El objetivo de este estudio fue evaluar el riesgo clínico de la apendicitis con apendicolito y su importancia al elegir las estrategias terapéuticas. Métodos. Se analizó retrospectivamente a niños con diagnóstico de apendicitis aguda entre junio de 2011 y enero de 2017. Se dividió en un grupo con apendicolito(GA) y un grupo sin apendicolito (GSA) según la presencia o no de apendicolito durante la cirugía abierta. Se revisaron y compararon la presentación clínica, de laboratorios, los resultados de la tomografía computada y los cambios patológicos. Resultados. De 163 pacientes, se incluyó a 23 (media de edad: 6,1 años) en el GA y a 140 (media de edad: 8,1 años) en el GSA. Los pacientes en el GA tuvieron una hospitalización más extensa, mayor temperatura corporal, mayor frecuencia de diarrea, signo de Blumberg, aumento del porcentaje de neutrófilos, proteína C-reactiva y mayor riesgo de perforación. La puntuación en las escalas de Alvarado (8,3 ± 1,2 frente a 7,0 ± 1,3; P < 0,05) y de respuesta inflamatoria a apendicitis (10,7 ± 1,6 frente a 7,7 ± 1,9; P < 0,05) fue mayor en el GA que en el GSA; la presencia de fiebre y apendicolito se asoció con una mayor tasa de apendicitis perforada. Conclusiones. La apendicitis pediátrica con apendicolito representa un mayor riesgo clínico y tiende a causar apendicitis complicada.

Small intestine strangulating obstruction by mesenteric pedunculated lipoma in a criollo mare

Background: The abdominal lipomas are benign tumors of hyperplastic growth that originate from mesenteric adiposetissue, most commonly in the small intestine. Pedunculated lipoma strangulation occurs when the pedicle wraps aroundan intestinal loop and its mesentery, obstructing the intestinal lumen and blood supply of the affected segment. The aim ofthe present study is to report a case of a Criollo mare presenting a strangulating obstruction of the jejunum and ileum bya pedunculated lipoma, focusing the discussion in the causes and epidemiology of this alteration.Case: A 24-year-old Criollo mare with a body condition score 8 out of 9 was referred to the Veterinary Clinical Hospitalof the Federal University of Pelotas (HCV-UFPel) presenting acute abdominal pain. At the hospital, the mare was presenting mild signs of abdominal discomfort. At the initial clinical exam, the mare had an increased heart and respiratory rates,normal body temperature, hyperemic mucous membranes, capillary refil time of 3 s and absent gut sounds in all fourquadrants during auscultation. Mild dehydration was present, increased fibrinogen and serum lactate. Rectal palpationrevealed distention of the small intestine by gas, during abdominal ultrassonography the small intestinal wall thicknesswas increased Peritoneal lactate was 11 mmol/L and protein was 6 mg/dL. Due to the clinical findings during the exam, anexploratory celiotomy was performed. Necrosis of the final third of jejunum and the entire extension of ileum was found.Examining the compromised intestinal portion, it was observed a linear structure strangulating two segments of the smallintestine. Taking into account the extensive area of irreversible necrosis and the advanced age of the patient, euthanasiawas performed. The mare was then referred for necropsy and findings confirmed...

[Superior mesenteric artery syndrome in a 12-year-old adolescent. Clinical case]. / Síndrome de la arteria mesentérica superior en una adolescente de 12 años. Caso clínico.

The superior mesenteric artery syndrome is rarely seen in children. It results from an intestinal obstruction due to compression of the third portion of duodenum between the superior mesenteric artery and the abdominal aorta. In most of the cases there are predisposing factors such as rapid weight loss or extra-abdominal compression. We report a case of a superior mesenteric artery syndrome in a twelve-year-old female patient without predisposing factors. The girl began suddenly with nauseas, continuous vomiting and abdominal pain. The abdominal pain was postprandial and it decreased in left lateral decubitus position. Clinically, this characteristic suggested superior mesenteric artery syndrome. Angio-computed tomography scan confirmed the diagnosis. Given that conservative treatment ultimately failed, patient was subjected to surgery and the illness was resolved.

El síndrome de la arteria mesentérica superior es una enfermedad poco frecuente en pediatría. Se produce por la compresión de la tercera porción duodenal a su paso entre la arteria mesentérica superior y la aorta abdominal (compás aortomesentérico). La mayoría de los pacientes presentan factores predisponentes: pérdida de peso aguda o compresiones extraabdominales. Se presenta el caso de una niña de 12 años de edad a quien se le diagnosticó el síndrome sin presentar factores predisponentes. Comenzó de modo súbito con náuseas, vómitos incoercibles y dolor abdominal, que era posprandial y se aliviaba, llamativamente, en decúbito lateral izquierdo. Esto constituyó la sospecha clínica del síndrome, por lo que se solicitó una angio tomografía computada abdominal y se observó el estrechamiento del compás aortomesentérico. Se realizó un tratamiento médico conservador, sin respuesta clínica. Se decidió el tratamiento quirúrgico y se logró la resolución del cuadro clínico.

Descenso transanal endorrectal De la Torre como tratamiento de enfermedad de hirschsprung, Hospital Escuela, 2013-2015 / Transanal endorectal pull-through de la torre as treatment for Hirschsprung ́s disease, University Hospital, 2013-2015

. Antecedentes: La enfermedad de Hirschsprung (EH) es causa de obstrucción intestinal baja en neonatos. En 1998, De la Torre y Ortega publicaron una importante modificación a la técnica de Soave, realizando un descenso transanal endorrectal. Objetivo:Describir la experiencia en el tratamiento de la Enfermedad de Hirschsprung mediante la técnica descrita por De la Torre, Hospital Escuela, Tegucigalpa, 2013-2015. Metodología: Estudio descriptivo transversal. Se revisaron expedientes clínicos y se registró información sobre características sociodemográficas y clínicas de los pacientes. Los resultados se presentan como frecuencias y porcentajes de las variables estudiadas. La información personal de los pacientes se manejó confidencialmente. Resultados: Se identificó un total de26 casos intervenidos en el periodo del estudio. El 73.1% (19) pertenecía al sexo masculino, 46.2% (12) se diagnosticó antes de 12 meses de vida; sin enfermedades asociadas. La biopsia diagnosticó la enfermedad en el 100% de los casos. La longitud del colon resecado fue de 10-20 cm en 88.5% (23), con un tiempo quirúrgico de 4-5 horas 69.2% (18). El 19.2% (5) presentó complicaciones. Se inició alimentos en menos de 5 días en 96.1% (25), la estancia hospitalaria fue menor a 7 días en 88.5% (23). Discusión: El descenso endorrectal transanal es una operación segura con pocas complicaciones operatorias y postoperatorias. En este estudio, la estancia hospitalaria y el tiempo hasta la alimentación oral completa fueron más cortos que los procedimientos convencionales lo que generó menores costes hospitalarios. Consideramos que ésta es la técnica de elección para enfermos con la Enfermedad de Hirschsprung...(AU)

[Valor predictivo de la procalcitonina para la necesidad de cirugía y la presencia de isquemia y necrosis en pacientes con obstrucción del intestino delgado]. / Predictive value of procalcitonin for the need of surgery and the presence of ischemia and necrosis in patients with small bowel obstruction.

INTRODUCTION: The purpose of this prospective cohort study was to evaluate whether serum procalcitonin (PCT) levels predict the need for surgery and the presence of ischemia and/or necrosis (I/N) in small bowel obstruction. METHOD: Of 54 patients included, conservative management was performed in 31 (non-surgical group) and an exploratory laparotomy in 23 (surgical group). The reference value of the PCT was between 0.10 and 0.50 ng/mL. RESULTS: PCT levels were higher in the surgical group (7.05 ± 7.03 ng/mL) than in the non-surgical (0.37 ± 0.63 ng/mL), and in patients with I/N (10.06 ± 7.07 ng/mL) than without I/N (1.52 ± 1.45 ng/mL). In the ROC curve, the area under the curve was 0.91 for the need for surgery and 0.93 for I/N. PCT ≥ 0.80 ng/mL had the best sensitivity and specificity for surgery and ≥ 1.95 ng/mL for I/N. PCT was also an independent predictor for these events. CONCLUSIONS: The levels of PCT can recognize the need for surgery and the presence of I/N in small bowel obstruction. Additional studies are needed to affirm or invalidate our findings.

OBJETIVO: El propósito de este estudio de cohorte prospectivo fue evaluar si las concentraciones séricas de procalcitonina (PCT) predicen la necesidad de cirugía y la presencia de isquemia o necrosis (I/N) en la obstrucción del intestino delgado. MÉTODO: De 54 pacientes incluidos, se realizó manejo conservador en 31 (grupo no quirúrgico) y laparotomía exploradora en 23 (grupo quirúrgico). El valor de referencia de la PCT fue entre 0.10 y 0.50 ng/ml. RESULTADOS: Los valores de PCT fueron mayores en el grupo quirúrgico (7.05 ± 7.03 ng/ml) que en el no quirúrgico (0.37 ± 0.63 ng/ml), y en los pacientes con I/N (10.06 ± 7.07 ng/ml) que en aquellos sin I/N (1.52 ± 1.45 ng/ml). En la curva COR (Característica Operativa del Receptor), el área bajo la curva fue 0.91 para la necesidad de cirugía y 0.93 para la I/N. La PCT ≥ 0.80 ng/ml obtuvo las mejores sensibilidad y especificidad para una cirugía, y ≥ 1.95 ng/ml para I/N. La PCT también fue un predictor independiente para estos eventos. CONCLUSIONES: Los valores de PCT permiten reconocer la necesidad de cirugía y la presencia de I/N en la obstrucción del intestino delgado. Son necesarios estudios adicionales para reafirmar o invalidar nuestros hallazgos.

Specificities of presentation of Crohn's disease in childhood.

The incidence of inflammatory bowel disease in the pediatric population has increased in the last years. The most common form of inflammatory bowel disease is Crohn's disease and, according to its form and age of presentation, it is possible to predict the evolution of the disease.

Hipertrofia muscular intestinal da válvula íleo-ceco-cólica em cão / Intestinal muscular hipertrophy of ileus-cecal-colic valve in a dog

O presente relato tem o objetivo de alertar o clínico quanto à dificuldade diagnóstica e a importância da hipertrofia íleo-ceco-cólica em obstruções intestinais em cães. As obstruções intestinais são afecções frequentemente encontradas, sendo a ingestão de corpos estranhos a principal causa. A hipertrofia muscular intestinal pode ser causada por estenose ou por origem idiopática, sendo incomum na espécie canina. Os sinais clínicos são inespecíficos, havendo necessidade de exame histopatológico. Foi atendido um cão com quadro de vômito, anorexia e aquesia há 20 dias. Os estudos de imagem revelaram obstrução total na região do intestino delgado com distensão de alças, mas não foi possível elucidar a localização precisa e nem a causa da mesma. O paciente foi encaminhado para a celiotomia exploratória com suspeita de obstrução intestinal de origem a esclarecer. Durante a cirurgia, notou-se uma alteração na região da válvula íleo-ceco-cólica, e a mesma foi removida e encaminhada para análise histopatológica, que confirmou a hipertrofia muscular intestinal. No entanto, as sequelas da obstrução completa e crônica do intestino culminaram como óbito do paciente.

In the small animal clinical routine, intestinal obstructions are frequently encountrered, and foreign body intake is the main cause. However, there are other causes of digestive tract obstructions. The intestinal muscular hipertrophy can be caused by stenosis or idiopathic origin. It’s frequenly reported in horse ileus, but little reported in canines. The clinical signs include emesis, diarrhea and anorexia, among other signs of intestinal obstruction, but by having nonspecific signs, there is difficulty in closing diagnosis, requiring histopathological exam. A dog with vomiting, anorexia and dyskinesia about 20 days ago was seen at HUVet. A general physical examination, complete blood count, serious biochemistry, abdominal ultrasonography and simple and contrasting abdominal radiographs were performed. The patient was referred to an exploratory laparotomy with suspected intestinal obstruction and paralytic ileus. During surgery, a change was observed in the ileus-cecal-colic valve region, and it was removed and referred for histopathological analysis, which confirmed intestinal muscular hypertrophy.

Specificities of presentation of Crohn's disease in childhood / Especificidades da apresentação da doença de Crohn na infância

ABSTRACT The incidence of inflammatory bowel disease in the pediatric population has increased in the last years. The most common form of inflammatory bowel disease is Crohn's disease and, according to its form and age of presentation, it is possible to predict the evolution of the disease.

RESUMO A incidência de doença inflamatória intestinal aumentou na população pediátrica nos últimos anos. A forma mais comum de doença inflamatória intestinal é a doença de Crohn e, conforme sua forma e a idade de apresentação é possível prever a evolução da doença.

Hipertrofia muscular intestinal da válvula íleo-ceco-cólica em cão / Intestinal muscular hipertrophy of ileus-cecal-colic valve in a dog

O presente relato tem o objetivo de alertar o clínico quanto à dificuldade diagnóstica e a importância da hipertrofia íleo-ceco-cólica em obstruções intestinais em cães. As obstruções intestinais são afecções frequentemente encontradas, sendo a ingestão de corpos estranhos a principal causa. A hipertrofia muscular intestinal pode ser causada por estenose ou por origem idiopática, sendo incomum na espécie canina. Os sinais clínicos são inespecíficos, havendo necessidade de exame histopatológico. Foi atendido um cão com quadro de vômito, anorexia e aquesia há 20 dias. Os estudos de imagem revelaram obstrução total na região do intestino delgado com distensão de alças, mas não foi possível elucidar a localização precisa e nem a causa da mesma. O paciente foi encaminhado para a celiotomia exploratória com suspeita de obstrução intestinal de origem a esclarecer. Durante a cirurgia, notou-se uma alteração na região da válvula íleo-ceco-cólica, e a mesma foi removida e encaminhada para análise histopatológica, que confirmou a hipertrofia muscular intestinal. No entanto, as sequelas da obstrução completa e crônica do intestino culminaram como óbito do paciente.(AU)

In the small animal clinical routine, intestinal obstructions are frequently encountrered, and foreign body intake is the main cause. However, there are other causes of digestive tract obstructions. The intestinal muscular hipertrophy can be caused by stenosis or idiopathic origin. Its frequenly reported in horse ileus, but little reported in canines. The clinical signs include emesis, diarrhea and anorexia, among other signs of intestinal obstruction, but by having nonspecific signs, there is difficulty in closing diagnosis, requiring histopathological exam. A dog with vomiting, anorexia and dyskinesia about 20 days ago was seen at HUVet. A general physical examination, complete blood count, serious biochemistry, abdominal ultrasonography and simple and contrasting abdominal radiographs were performed. The patient was referred to an exploratory laparotomy with suspected intestinal obstruction and paralytic ileus. During surgery, a change was observed in the ileus-cecal-colic valve region, and it was removed and referred for histopathological analysis, which confirmed intestinal muscular hypertrophy.(AU)