RESUMO
BACKGROUND: Delayed cholecystectomy in patients with symptomatic gallstone disease is associated with recurrence. Limited data on the recurrence patterns and the factors that determine them are available. OBJECTIVE: We aimed to determine the pattern of relapse in each symptomatic gallstone disease (acute pancreatitis, cholecystitis, cholangitis, symptomatic choledocholithiasis, and biliary colic) and determine the associated factors. METHODS: RELAPSTONE was an international multicenter retrospective cohort study. Patients (n = 3016) from 18 tertiary centers who suffered a first episode of symptomatic gallstone disease from 2018 to 2020 and had not undergone cholecystectomy during admission were included. The main outcome was relapse-free survival. Kaplan-Meier curves were used in the bivariate analysis. Multivariable Cox regression models were used to identify prognostic factors associated with relapses. RESULTS: Mean age was 76.6 [IQR: 59.7-84.1], and 51% were male. The median follow-up was 5.3 months [IQR 2.1-12.4]. Relapse-free survival was 0.79 (95% CI: 0.77-0.80) at 3 months, 0.71 (95% CI: 0.69-0.73) at 6 months, and 0.63 (95% CI: 0.61-0.65) at 12 months. In multivariable analysis, older age (HR = 0.57; 95% CI: 0.49-0.66), sphincterotomy (HR = 0.58, 95% CI: 0.49-0.68) and higher leukocyte count (HR = 0.79; 95% CI: 0.70-0.90) were independently associated with lower risk of relapse, whereas higher levels of alanine aminotransferase (HR = 1.22; 95% CI: 1.02-1.46) and multiple cholelithiasis (HR = 1.19, 95% CI: 1.05-1.34) were associated with higher relapse rates. CONCLUSION: The relapse rate is high and different in each symptomatic gallstone disease. Our independent predictors could be useful for prioritizing patients on the waiting list for cholecystectomies.
Assuntos
Coledocolitíase , Pancreatite , Humanos , Masculino , Idoso , Feminino , Estudos Retrospectivos , Doença Aguda , Pancreatite/etiologia , Fatores de Risco , Coledocolitíase/diagnóstico , Coledocolitíase/epidemiologia , Coledocolitíase/cirurgia , RecidivaRESUMO
Portal hypertension, responsible for the formation of oesophageal varices, also generates intra-abdominal varicose dilations, especially of the perisplenic and mesenteric veins, which, like the oesophageal veins, are susceptible to rupturing and bleeding, in this case within the peritoneal cavity. However, the spontaneous rupture of these intraperitoneal varices is a rare complication, and poorly described in the literature. We present the case of a 72-year-old woman with CHILD B liver cirrhosis of unknown aetiology with portal hypertension on primary prophylaxis with carvedilol.
Assuntos
Varizes Esofágicas e Gástricas , Hipertensão Portal , Varizes , Feminino , Humanos , Idoso , Hemoperitônio/diagnóstico por imagem , Hemoperitônio/etiologia , Cirrose Hepática Alcoólica/complicações , Varizes/complicações , Varizes/diagnóstico por imagem , Cirrose Hepática/complicações , Varizes Esofágicas e Gástricas/complicações , Ruptura Espontânea/complicações , Hipertensão Portal/complicaçõesRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Colite/induzido quimicamente , Antirretrovirais/efeitos adversos , Fígado Gorduroso/diagnóstico por imagem , Apoptose/efeitos dos fármacos , Antirretrovirais/toxicidade , Diarreia/complicações , Diarreia/etiologia , Fígado Gorduroso/tratamento farmacológico , Loperamida/uso terapêutico , Doenças do Colo/complicações , Substituição de Medicamentos/métodos , Darunavir/uso terapêuticoRESUMO
No disponible
