RESUMO
Diverticular disease is more frequently seen in our practice. The aim of this retrospective study was to evaluate our experience with complicated diverticular disease in our surgical emergency unit. Between 2004-2007 46 cases with complicated diverticular disease were registered in Surgical Emergency Clinical Hospital of Bucharest. A male preponderance (sex ratio M: F 1:1.4) and a medium age of 62.9 +/- 15 years were recorded. Perforation was the main complication encountered and sigmoid colon was the most frequent involved segment (71.7%). Diagnostic procedures relayed especially on CT-scan. Three cases were operated laparoscopically. Failure of conservative measures was the main cause for interventions. A Hartmann procedure was performed in 7 patients (15.2%). Global mortality was 8.1% (4 cases). There were no significant differences among the surgical procedures employed. Diverticular disease is more frequently encountered in our practice. CT-scan is the most efficient diagnostic tool but there are limitations. Conservative measures are not always successful and urgent operative treatment is the only choice. Hartmann procedure is still frequently employed in our practice.
Assuntos
Colectomia/métodos , Colostomia/métodos , Doença Diverticular do Colo/cirurgia , Perfuração Intestinal/cirurgia , Laparoscopia , Idoso , Idoso de 80 Anos ou mais , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/diagnóstico , Doença Diverticular do Colo/mortalidade , Procedimentos Cirúrgicos Eletivos , Serviço Hospitalar de Emergência , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Perfuração Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
Although laparoscopic cholecystectomy is considered to be the gold standard for treatment for symptomatic cholelithiasis, it is associated with an increased risk of biliary and vascular injury compared to the traditional technique. Massive hemobilia is a rare but potentially life-threatening cause of upper gastrointestinal hemorrhage. Arterio-biliary fistula is an uncommon cause of hemobilia. We describe a case of cystic artery pseudo-aneurysm causing arterio-biliary fistula and presenting as severe melaena and cholangitis that occurred 7 months after laparoscopic cholecystectomy. Gastroduodenoscopy failed to establish the exact source of bleeding and hepatic artery angiography and selective embolization of the pseudo-aneurysm successfully controlled the bleeding. Pseudo-aneurysm of the hepatic artery is mostly iatrogenic due to biliary intervention, as demonstrated in this case. Transarterial embolization is considered the first line of intervention to stop the bleeding for most causes of hemobilia. Hemobilia is a rare complication that should be considered when managing patients with bleeding or jaundice even several months after laparoscopic cholecystectomy.