RESUMO
Crohn's disease located in the esophagus is rare, being exceptional as the initial manifestation of the disease. Erosive ulcerative esophagitis, stricture and fistula are forms of presentation, as in other esophageal pathologies, so the differential diagnosis is broad. The histologic features of esophageal Crohn's disease can be nonspecific and increase the diagnostic challenge. Esophageal Crohn's disease should be included in the differential diagnosis of esophageal strictures and may require esophagectomy if medical-endoscopic treatment is not effective.
Assuntos
Doença de Crohn , Doenças do Esôfago , Estenose Esofágica , Esofagite , Doença de Crohn/patologia , Doenças do Esôfago/diagnóstico por imagem , Doenças do Esôfago/etiologia , Estenose Esofágica/diagnóstico por imagem , Estenose Esofágica/etiologia , Esofagite/diagnóstico , HumanosRESUMO
INTRODUCTION: Laparoscopic gastrectomy has emerged in recent years as an effective technique for the treatment of morbid obesity due to low mortality morbidity rates. Its complications include dehiscence suture line, and others such as splenic infarction. We discuss a case of splenic infarction after laparoscopic gastrectomy. CLINICAL CASE: 45 year old male with a BMI of 37.8 kg/m2, diabetes-II for 15 years, the last five in treatment with insulin, a fasting blood glucose around 140mg/dl, HbA1c of 7.3mg/dl and microangiopathy diabetic nephropathy. The patient underwent a laparoscopic sleeve gastrectomy and he was discharged from hospital 48hours later. 1 month later he presented at the hospital for epigastric pain and fever up to 40° C. An intra abdominal abscess was detected and there was no leakage. The spleen was normal. He was treated with radiological drainage. 9 months later the patient consulted again due to epigastric pain in upper left quadrant, associated with low-grade fever. Thoraco-abdominal CT images compatible with splenic infarction. Currently patient remains asymptomatic one year after surgery. DISCUSSION: Laparoscopic sleeve gastrectomy is one of the most popular procedures of bariatric surgery. Less common complications include abscess and the splenic infarction. Usually patients are asymptomatic, but sometimes cause fever and pain. Initial treatment should be conservative. Only in selected cases, would splenectomy be indicated. CONCLUSIONS: Splenic infarction is usually an early complication, but we should keep it in mind as a long term complication for patients with persistent fever and abdominal pain after laparoscopic gastrectomy.
Assuntos
Gastrectomia , Laparoscopia , Complicações Pós-Operatórias/etiologia , Infarto do Baço/etiologia , Tratamento Conservador , Diabetes Mellitus Tipo 2/complicações , Drenagem , Gastrectomia/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/cirurgia , Complicações Pós-Operatórias/terapia , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/terapia , Infecções Estreptocócicas/complicações , Tomografia Computadorizada por Raios XRESUMO
No disponible
Assuntos
Humanos , Feminino , Adulto Jovem , Fundoplicatura/efeitos adversos , Hipoglicemia/etiologia , Refluxo Gastroesofágico/cirurgia , Síndrome de Esvaziamento Rápido/diagnóstico , Complicações Pós-Operatórias , Fatores de RiscoAssuntos
Síndrome de Esvaziamento Rápido/etiologia , Fundoplicatura/efeitos adversos , Hipoglicemia/etiologia , Antiulcerosos/uso terapêutico , Terapia Combinada , Diagnóstico Diferencial , Carboidratos da Dieta/farmacocinética , Síndrome de Esvaziamento Rápido/diagnóstico , Síndrome de Esvaziamento Rápido/dietoterapia , Síndrome de Esvaziamento Rápido/fisiopatologia , Esomeprazol/uso terapêutico , Feminino , Esvaziamento Gástrico , Refluxo Gastroesofágico/tratamento farmacológico , Refluxo Gastroesofágico/cirurgia , Hormônios Gastrointestinais/metabolismo , Humanos , Insulinoma/diagnóstico , Período Pós-Prandial , Adulto JovemRESUMO
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Assuntos
Humanos , Malformações Arteriovenosas/patologia , Jejuno/irrigação sanguíneaRESUMO
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Assuntos
Humanos , Masculino , Idoso , Doenças do Esôfago/complicações , Doenças do Esôfago/patologia , Hematoma/complicações , Hematoma/patologia , Hemoperitônio/etiologia , Hemoperitônio/patologia , Doenças do Esôfago/cirurgia , Hematoma/cirurgia , Hemoperitônio/cirurgia , Ruptura Espontânea/cirurgia , Ruptura Espontânea/complicaçõesAssuntos
Doenças do Esôfago/complicações , Doenças do Esôfago/patologia , Hematoma/complicações , Hematoma/patologia , Hemoperitônio/etiologia , Hemoperitônio/patologia , Idoso , Doenças do Esôfago/cirurgia , Hematoma/cirurgia , Hemoperitônio/cirurgia , Humanos , Masculino , Ruptura Espontânea/complicações , Ruptura Espontânea/cirurgiaRESUMO
The majority of epiphrenic diverticula arise due to a peristaltic mechanism caused by an oesophageal motor disturbance that establishes a barrier effect and causes mucosal and submucosal herniation through a weak point in the muscular layer. Intraluminal oesophageal manometry and video-radiology are important in assessing these patients, since they define the characteristics of the functional disorder, as well as the true relationship between the symptoms of the patient and the diverticulum. Surgical treatment is indicated in symptomatic patients, more so if there are respiratory complications. Left posterolateral thoracotomy followed by diverticulotomy, oesophageal cardiomyotomy and anti-reflux have been considered the surgery technique of choice. Oesophageal myotomy must go beyond, in a proximal direction, the neck of the diverticulum, and, in a distal direction, must progress 1-2 cm into the gastric wall. The laparoscopic approach has won many followers since it has been shown to be both safe and effective as open surgery, adding to the advantages of minimally invasive surgery.
