RESUMO
RESUMEN Las hernias internas son una causa poco frecuente de obstrucción del intestino delgado (representan menos del 5 %). La hernia pericecal ocupa alrededor de la décima parte de las hernias internas; mientras que, la hernia paracecal constituye una de sus cuatro variantes, las que a su vez, pueden ser congénitas o adquiridas. Se presentó un paciente masculino de 98 años de edad, operado por obstrucción intestinal debido a hernia paracecal, que requirió resección de intestino y anastomosis, con evolución favorable. En la búsqueda realizada en Cochrane no se encontró ningún otro caso publicado por autores cubanos. Se revisó la literatura al respecto y se insistió en la necesidad de tener presente dicho diagnóstico en el actuar diario del cirujano, ya que se comporta con una alta mortalidad sino se sospecha, debido a que cursa generalmente con compromiso vascular.
ABSTRACT Internal hernias are an uncommon cause of small bowel obstruction (they represent less than 5%). The pericaecal hernia occupies about a tenth of the internal hernias while the paracaecal hernia is one of its four variants, which in turn can be congenital or acquired. We present a 98-year-old male patient operated on bowel obstruction due to paracaecal hernia, which required bowel resection and anastomosis, with favourable evolution. No other case published by Cuban authors was found when searching in Cochrane Library. Literature on this subject was also reviewed, insisting on the need for surgeons to bear this diagnosis in mind in their daily work, since it is manifested with a high mortality if it is not suspected, because it generally involves vascular compromise.
Assuntos
Hérnia/complicações , Obstrução Intestinal/etiologia , Intestino Delgado/cirurgiaRESUMO
RESUMEN Fundamento: la parasitosis más frecuente y cosmopolita de todas las helmintiasis humanas es la ocasionada por Áscaris lumbricoides. Se estima que, alrededor de un cuarto de la población mundial está infectada y cerca de 60 000 personas fallecen anualmente a consecuencia de ello. El ser humano se infecta al ingerir los huevos larvados del parásito. Objetivo: presentar un caso con el diagnóstico de obstrucción intestinal por Áscaris lumbricoides. Presentación del caso: paciente femenina de 19 años de edad, con antecedentes de salud, sin antecedentes quirúrgicos. Acudió al servicio de urgencias por presentar desde hace dos días vómitos, en número de entre cinco y seis diarios, al examen físico se constataron síntomas y signos de deshidratación, con cuadro de abdomen agudo oclusivo. Conclusiones: la oclusión intestinal por Áscaris lumbricoides es una enfermedad poco frecuente en adultos y muy rara en Cuba en la actualidad.
ABSTRACT Background: the most frequent and cosmopolitan parasitosis of all human helminthiasis is that caused by Ascaris lumbricoides. It is estimated that around a quarter of the world's population is infected and about 60,000 people die annually as a result. The human being becomes infected by ingesting the larvae eggs of the parasite. Objective: to present a case with the diagnosis of intestinal obstruction by Ascaris lumbricoides. Case report: a 19-years-old female patient with a health history, with no surgical history. He went to the emergency department for presenting two days vomiting, in number between five and six daily, physical examination was confirmed symptoms and signs of dehydration, with acute abdominal occlusive symptoms. Conclusions: intestinal occlusion by Ascaris lumbricoides is a rare disease in adults and very rare in Cuba at present.
RESUMO
Colorectal cancer (CRC) is the 3rd most common cancer in the United States with more than 10000 new cases diagnosed annually. Approximately 20% of patients with CRC will have distant metastasis at time of diagnosis, making them poor candidates for primary surgical resection. Similarly, 8%-25% of patients with CRC will present with bowel obstruction and will require palliative therapy. Emergent surgical decompression has a high mortality and morbidity, and often leads to a colostomy which impairs the patient's quality of life. In the last decade, there has been an increasing use of colonic stents for palliative therapy to relieve malignant colonic obstruction. Colonic stents have been shown to be effective and safe to treat obstruction from CRC, and are now the therapy of choice in this scenario. In the setting of an acute bowel obstruction in patients with potentially resectable colon cancer, stents may be used to delay surgery and thus allow for decompression, adequate bowel preparation, and optimization of the patient's condition for curative surgical intervention. An overall complication rate (major and minor) of up to 25% has been associated with the procedure. Long term failure of stents may result from stent migration and tumor ingrowth. In the majority of cases, repeat stenting or surgical intervention can successfully overcome these adverse effects.
