RESUMO
BACKGROUND: Complicated colonic diverticular disease in young patients is a rare entity, with an incidence <10% from all patients in the largest series. CLINICAL CASES: We present two cases of complicated diverticular disease in patients <35 years old treated at the Hospital Juárez of México City. Both patients had acute abdominal pain with several days of evolution. In both patients, emergency surgery was performed and postoperative evolution was favorable. CONCLUSIONS: Some authors have concluded that diverticulitis in younger patients demonstrates a more aggressive course than in older patients and with an increased risk of complications. Therefore, most physicians recommended elective resection after a single attack in such patients. Conversely, some recent reports highlighted that the clinical course and complications are similar in both age groups.
Assuntos
Diverticulose Cólica/complicações , Adulto , Diverticulose Cólica/cirurgia , Humanos , MasculinoRESUMO
Introducción: La enfermedad diverticular complicada del colon es rara en pacientes jóvenes, estimándose una incidencia menor a 10 % en las grandes series. Casos clínicos: Se describen dos pacientes menores de 35 años de edad con complicaciones de enfermedad diverticular, atendidos en el Hospital Juárez de México; ambos presentaron cuadro de abdomen agudo de pocos días de evolución y requirieron cirugía de urgencia, con buena evolución posoperatoria. Conclusiones: Algunos autores consideran que la diverticulitis en los pacientes jóvenes puede tener un comportamiento con más complicaciones que en lo mayores. Incluso se recomienda la resección electiva del segmento afectado después del primer episodio de diverticulitis. No obstante, informes recientes han señalado que el comportamiento de las complicaciones de la enfermedad diverticular puede ser el mismo en los pacientes jóvenes y en los de mayor edad.
BACKGROUND: Complicated colonic diverticular disease in young patients is a rare entity, with an incidence <10% from all patients in the largest series. CLINICAL CASES: We present two cases of complicated diverticular disease in patients <35 years old treated at the Hospital Juárez of México City. Both patients had acute abdominal pain with several days of evolution. In both patients, emergency surgery was performed and postoperative evolution was favorable. CONCLUSIONS: Some authors have concluded that diverticulitis in younger patients demonstrates a more aggressive course than in older patients and with an increased risk of complications. Therefore, most physicians recommended elective resection after a single attack in such patients. Conversely, some recent reports highlighted that the clinical course and complications are similar in both age groups.
Assuntos
Humanos , Masculino , Adulto , Diverticulose Cólica/complicações , Diverticulose Cólica/cirurgiaRESUMO
BACKGROUND: Rectovaginal fistulas account for <5% of all rectal fistulas. Obstetrical injuries are the most common cause of these types of fistulas. There have been a multitude of surgical approaches developed for operative repair. METHODS: Between January 1992 and December 2006, 16 patients with postobstetric rectovaginal fistula were treated at the Hospital Juárez of México. Age, type of obstetric trauma, time elapsed between delivery and beginning of symptoms, location, and size of the fistulas, rate of success and recurrence with the use of endorectal flap, and need for complementary sphincteroplasty were all evaluated. RESULTS: Median age of the patients was 25.6 years. All women reported that their symptoms began after a vaginal delivery that included an episiotomy or 4th degree laceration. All fistulas were low and small (<2.5 cm in diameter). Patients received bowel preparation and underwent rectovaginal repair using endorectal advancement flap. In two cases, additional overlap repair of the anal sphincter was performed. Result of repair was good to excellent in 15 patients (93.7%). There were no operative mortalities, and no covering stomas were used. CONCLUSIONS: Endorectal flap repair provides successful postobstetric rectovaginal fistula closure. Concomitant sphincteroplasty may be necessary in some cases.
Assuntos
Complicações do Trabalho de Parto/cirurgia , Períneo/lesões , Fístula Retovaginal/cirurgia , Retalhos Cirúrgicos , Adulto , Episiotomia/efeitos adversos , Feminino , Humanos , Gravidez , Fístula Retovaginal/etiologia , Estudos Retrospectivos , Adulto JovemRESUMO
Introducción: Las fístulas rectovaginales ocurren con una frecuencia menor a 5 % respecto a otros tipos de fístulas de la región anorrectal; el trauma obstétrico es la causa más común de este tipo de fístulas. Existen diversos procedimientos quirúrgicos para la reparación de las mismas. Material y métodos: Se realizó un estudio de 16 pacientes con diagnóstico de fístula rectovaginal posobtétrica, atendidas en el Hospital Juárez de México entre enero de 1992 y diciembre de 2006. Se analizó edad de las pacientes, tipo de trauma obstétrico, tiempo de inicio de la sintomatología después del parto, localización y tamaño de la fístula, índice de éxito y recidivas mediante el tratamiento con avance de colgajo endorrectal, y necesidad de esfinteroplastia complementaria. Resultados: La edad promedio fue de 25.6 años. En todas las pacientes, la sintomatología inició después de un parto vaginal durante el cual se realizó episiotomía o hubo desgarro perineal. Todas las fístulas fueron menores de 2.5 cm de diámetro y de localización baja. Con el colon preparado, en todas las pacientes se reparó la fístula rectovaginal mediante avance de colgajo endorrectal. En dos pacientes se llevó acabo, además, esfinteroplastia del esfínter anal. Los resultados fueron satisfactorios en 15 pacientes (93.7 %); no hubo mortalidad operatoria y no fueron utilizados estomas de protección. Conclusiones: El colgajo endorrectal es un procedimiento seguro para la reparación de fístulas rectovaginales de origen posobstétrico, algunos casos pueden requerir esfinteroplastia del esfínter anal.
BACKGROUND: Rectovaginal fistulas account for <5% of all rectal fistulas. Obstetrical injuries are the most common cause of these types of fistulas. There have been a multitude of surgical approaches developed for operative repair. METHODS: Between January 1992 and December 2006, 16 patients with postobstetric rectovaginal fistula were treated at the Hospital Juárez of México. Age, type of obstetric trauma, time elapsed between delivery and beginning of symptoms, location, and size of the fistulas, rate of success and recurrence with the use of endorectal flap, and need for complementary sphincteroplasty were all evaluated. RESULTS: Median age of the patients was 25.6 years. All women reported that their symptoms began after a vaginal delivery that included an episiotomy or 4th degree laceration. All fistulas were low and small (<2.5 cm in diameter). Patients received bowel preparation and underwent rectovaginal repair using endorectal advancement flap. In two cases, additional overlap repair of the anal sphincter was performed. Result of repair was good to excellent in 15 patients (93.7%). There were no operative mortalities, and no covering stomas were used. CONCLUSIONS: Endorectal flap repair provides successful postobstetric rectovaginal fistula closure. Concomitant sphincteroplasty may be necessary in some cases.
