RESUMO
Introduction : La perforation pharyngo-Åsophagienne par ingestion de corps étranger (CE) est une complication rare et grave. De ce fait, sa prise en charge n'est pas standardisée. Le but de ce travail est d'étudier les caractéristiques épidémiologiques et diagnostiques de ces complications et de discuter les modalités thérapeutiques. Patients et méthodes :Sur une période 17 ans (1998 - 2014), nous avons colligé 573 patients ayant ingéré des CE pharyngo-Åsophagiens et qui ont bénéficié d'une extraction endoscopique au tube rigide. Onze patients (1,9%) se sont compliqués d'une perforation. Résultats : Il s'agissait de 3 enfants et 8 adultes. Les corps étrangers étaient dominés par les fragments d'os (55% des cas). Les perforations étaient jugées liées aux manÅuvres d'extraction dans 54,5% et au CE dans 45,5%. Le diagnostic a été posé dans un délai maximal de 2 jours après extraction. La chirurgie a été réalisée d'emblée dans 2 cas devant la migration extra-viscérale du CE et devant la présence d'une abcédation péri-Åsophagienne, respectivement. Le geste opératoire consistait, respectivement, en l'ablation du CE avec suture de l'Åsophage et un simple drainage de l'abcès. Dans un autre cas, la chirurgie a été pratiquée en seconde intention après échec du traitement médical et devant l'apparition d'une pleurésie purulente. Le geste opératoire était une suture renforcée par un lambeau intercostal. Un traitement conservateur était instauré dans 8 cas (72,7%).L'évolution était favorable dans 10 cas (soit 90,9%) et fatale dans un seul cas, soit une mortalité de 9,1%. Conclusion : Le pronostic dépend essentiellement de la précocité diagnostique des perforations Åsophagiennes par CE. Le traitement conservateur serait suffisant et efficace en dehors d'un syndrome infectieux sévère
Assuntos
Perfuração Esofágica , Corpos Estranhos/complicações , Corpos Estranhos/epidemiologia , Corpos Estranhos/terapia , HipofaringeRESUMO
Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most commonly used procedure for elective treatment of patients with ulcerative colitis and familial adenomatous polyposis. Since its original description, the procedure has been modified in order to obtain optimal functional results with low morbidity and mortality, and yet provide a cure for the disease. In this review of the literature of restorative proctocolectomy with ileal pouch-anal anastomosis, we discuss these technical modifications, limiting our discussion to the current points of controversy. The current "hot topics" for debate are: indications for ileal pouch-anal or ileo-rectal anastomosis, indications for pouch surgery in the elderly, indeterminate colitis and Crohn's disease, the place of the laparoscopic approach, transanal mucosectomy with hand-sewn anastomosis vs. the double-stapled technique, the use of diverting ileostomy and the issue of the best route for delivery of pregnant women. Longer follow-up of patients and increased knowledge and experience with pouch surgery, coupled with ongoing prospective evaluation of the procedure are required to settle these issues.
Assuntos
Polipose Adenomatosa do Colo/cirurgia , Colite Ulcerativa/cirurgia , Bolsas Cólicas , Proctocolectomia Restauradora/métodos , Polipose Adenomatosa do Colo/diagnóstico , Idoso , Canal Anal/cirurgia , Anastomose Cirúrgica/métodos , Colite Ulcerativa/diagnóstico , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Íleo/cirurgia , Masculino , Seleção de Pacientes , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Gravidez , Proctocolectomia Restauradora/efeitos adversos , Prognóstico , Controle de Qualidade , Medição de Risco , Grampeamento Cirúrgico/métodos , Resultado do TratamentoRESUMO
Gastro-intestinal stromal tumors are uncommon mesenchymal tumors. There are localized preferentially in the stomach. The rectal localization is exceedingly rare. Through a new case of rectal stromal tumour as well as a review of the literature, we propose to focus on clinical, radiological and therapeutic particularities of this rare entity.
Assuntos
Tumores do Estroma Gastrointestinal/diagnóstico , Neoplasias Retais/diagnóstico , Feminino , Neoplasias Gastrointestinais/epidemiologia , Tumores do Estroma Gastrointestinal/epidemiologia , Humanos , Pessoa de Meia-Idade , Neoplasias Retais/epidemiologiaRESUMO
Duodenal diverticulum is a common occurrence but most are asymptomatic. However, in some cases, they can cause mechanical biliary compression. We report the case of a duodenal diverticulum in a 64-year-old woman revealed by severe cholangitis with septic shock and a liver abscess. Associated annular pancreas was found. We discuss the various investigations to diagnose these two entities as well as the therapeutic strategy in this unique combination of disease.
Assuntos
Colangite/etiologia , Divertículo/complicações , Duodenopatias/complicações , Pancreatopatias/complicações , Divertículo/diagnóstico , Duodenopatias/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Pâncreas/anormalidades , Pancreatopatias/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
Megalencephalic leukoencephalopathy with subcortical cysts or Van der Knapp disease is a rare entity that has recently been identified. It is characterized by the presence of macrocephaly, epilepsy and a slowly progressive spastic cerebellar syndrome. The culprit MLC1 gene is located on chromosome 22. MRI provides valuable data for diagnosis characterized by diffuse white matter lesions with subcortical cysts. We report four cases of megalencephalic leukoencephalopathy with subcortical cysts from two different families.
Assuntos
Gânglios da Base/patologia , Encefalopatias/patologia , Cerebelo/patologia , Cistos/patologia , Atrofia , Criança , Pré-Escolar , Feminino , Humanos , Imageamento por Ressonância Magnética , MasculinoRESUMO
BACKGROUND: The classical symptoms of congenital neurosyphilis include meningovascular lesions that are responsible for CSF abnormalities. Lesions of larger vessels are very unusual. CASE REPORT: A boy was born from a neglected pregnancy, weighing 2.7 kg. He was abandoned by his parents and was admitted to hospital at 40 days of age (weight: 2,220 g; height: 47 cm; head circumference: 22 cm) with axial hypotonia, peripheral spasticity and shock syndrome. The TORCH screen was negative but the Treponema Pallidium Hemagglutination Assay (TPHA) was positive. The infant died 4 days later. Brain pathological studies revealed meningoencephalitis and bilateral sylvian infarction. CONCLUSION: Local arteritis due to syphilis usually concerns small arteries, such as the meningeal and cortical vessels. The occlusion of the two middle cerebral arteries seen in this patient, which were responsible for atrophy of the parietal lobes, is uncommon in congenital syphilis.
Assuntos
Infarto Cerebral/etiologia , Sífilis Congênita/complicações , Artérias Cerebrais/patologia , Córtex Cerebral/patologia , Infarto Cerebral/patologia , Feminino , Humanos , Recém-Nascido , Masculino , GravidezRESUMO
In this study the authors report the cardiac complications seen in the course of sickle-cell disease. Among 41 homozygot patients the complications reported were as follow. Effort dyspnea in 15/32 (46% cases); systolic souffle in 36 patients (87.8% of cases); cardiomegaly in 30 patients (17% of cases) and electric abnormalities in 70% of cases. The echotomography practised in 27 cases was normal in 12 cases and showed a hyperkinetic aspect in 10 cases, a cardiomyopathy in four cases.