Intussusception in adults: a retrospective study.

OBJECTIVE: Intestinal intussusception in adult patients is rare. In contrast with paediatric patients, it is usually secondary to a definable lesion, often malignant. The purpose of this study was to determine the causes and the management of intussusception in adult patients. METHOD: A retrospective review was performed looking at patients over 18 years with intestinal intussusception who were admitted to a tertiary university hospital from 1997 to 2007. RESULT: There were 16 patients (out of whom 10 were female subjects) of mean age 49 years (range 19-76). All presented with abdominal pain and in seven (46.6%) patients, this was acute. The diagnosis of intussusception was correctly made preoperatively in eight (50%) patients. Six (37.5%) patients had the lead point for the intussusception at the ileocaecal valve, five (31.25%) in the small bowel and five (31.25%) had a colonic lead point. An anatomical cause was found in 14 (87.5%). In two (12.5%), the intussusception occurred in the postoperative period without any definable lesion. Half the patients had a malignant neoplasm. All patients underwent surgery. In 14 (87.5%) patients, this was by resection and in two (12.5%), a reduction with no resection was carried out. CONCLUSION: The features of intussusception may be nonspecific and the diagnosis is often made only during laparotomy. An identifiable organic lesion is present in most cases. En bloc resection is recommended for ileocaecal and colocolic intussusception.

Actinomycosis of the colon: a rare form of presentation.

Actinomycosis is an uncommon entity, caused by an anaerobic bacterium, Actinomyces israelii, which is a component of the human oral and gastrointestinal flora. The cervicofacial region is the commonest site of disease, and the abdomen is the second commonest. In this situation the disease is almost always unifocal and restricted to the right colon, especially to the cecum. We report here the case of a patient with a very rare form of this entity, characterized by multiple foci of abdominal involvement with the most severe lesions localized in the transverse and sigmoid colon. The clinical presentation resembled a picture of colon perforation by cancer or diverticulitis, and the diagnosis was made by histopathologic examination of the lesions removed at surgery. No predisposing factor was found. The infection was successfully treated with a prolonged course of penicillin, after the surgical removal of the lesions.

[Rectal lymphoma: report of a case and considerations on its etiology, diagnosis, and therapy]. / Linfoma retal: apresentação de um caso e considerações sobre sua etiologia, diagnóstico e tratamento.

Primary rectal lymphomas are rare tumors representing less than 2% of the neoplasms of the colon. Common symptoms are the same that occur in carcinoma of the rectum. Patients treated surgically have a better prognosis. Chemotherapy and radiation therapy should be considered in some cases. A case of primary rectal lymphoma is presented and the literature reviewed.

Evaluation of the routine use of the nasogastric tube in digestive operation by a prospective controlled study.

This prospective, randomized controlled trial was undertaken to evaluate the effect of tube decompression of the stomach after surgical procedure on the digestive tract. One hundred and nine patients were randomly allocated to postoperative treatment with (57 patients) or without (52 patients) nasogastric tubes. No significant differences were found between the two groups in the duration of hospitalization, time to begin peroral fluid intake, occurrence of hiccups, vomiting, nausea, parotiditis, nasal septum necrosis, anastomotic leak and wound dehiscence. Moreover, abdominal distension, pyrosis, otalgia, dysphagia, odynophagia and atelectasis occurred more often in intubated patients as shown by chi-square analysis of the data with Yates correction, with the level of significance at p = less than 0.05. Tube decompression of the stomach does not relieve intestinal paralysis after digestive operations. These data seem to indicate that the routine prophylactic use of a nasogastric tube is unnecessary in gastrointestinal operations.

Tumor de Abrikossoff gigante localizado na parede abdominal. Tratamento cirurgico. / Giant Abrikossoff's tumor located in the abdominal wall. Surgical treatment

Apresentamos o caso de uma paciente portadora de tumor granulo-celular de Abrikossoff gigante, localizado na parede abdominal, dando-se enfoque especial ao precurso empregado para a reconstrucao da parede. Apos a resseccao alargada, envolvendo pele, aponeurose, musculo e peritonio, reconstruimos a parede abdominal com protese e mobilizacao de retalho de pele. O resultado foi bom no aspecto funcional e anatomico. A paciente encontra-se bem dois anos apos a ressecao do tumor