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1.
Zhongguo Zhen Jiu ; 42(1): 18-22, 2022 Jan 12.
Artigo em Chinês | MEDLINE | ID: mdl-35025152

RESUMO

OBJECTIVE: To compare the clinical effect of SUN 's abdominal acupuncture and conventional acupuncture in the treatment of depression after methamphetamine withdrawal. METHODS: A total of 80 female patients with depression after methamphetamine withdrawal were randomly divided into an observation group (40 cases, 1 case dropped off) and a control group (40 cases, 2 cases dropped off). The control group was treated with conventional acupuncture at Baihui (GV 20), Yintang (GV 29), Taichong (LR 3), Shenmen (HT 7), Neiguan (PC 6), Danzhong (GV 17), and the observation group was treated with SUN 's abdominal acupuncture at area 1 of the abdomen and area 8 of the abdomen. Both groups were treated once a day, 30 min each time, 6 days as a course of treatment, 1 day rest between treatment courses, a total of 4 courses of treatment. The scores of withdrawal symptoms, Hamilton depression scale (HAMD), Pittsburgh sleep quality index (PSQI) scale and serum serotonin (5-HT) level were compared between the two groups before and after treatment. RESULTS: After treatment, the scores of withdrawal symptoms, HAMD and the various scores and total score of PSQI scale in the two groups were all lower than before treatment (P<0.01), and the scores of withdrawal symptoms, HAMD and the sleep quality, time to fall asleep, sleep time scores and total score of PSQI in the observation group were lower than the control group (P<0.05, P<0.01). After treatment, the serum 5-HT level of the two groups was increased (P<0.01), and that in the observation group was higher than the control group (P<0.05). CONCLUSION: SUN 's abdominal acupuncture can improve withdrawal symptom, depression and sleep quality, increase serum 5-HT content in treatment of depression after methamphetamine withdrawal, and has better effect than conventional acupuncture.


Assuntos
Terapia por Acupuntura , Metanfetamina , Síndrome de Abstinência a Substâncias , Abdome , Pontos de Acupuntura , Depressão/etiologia , Depressão/terapia , Feminino , Humanos , Metanfetamina/efeitos adversos , Síndrome de Abstinência a Substâncias/etiologia , Síndrome de Abstinência a Substâncias/terapia , Resultado do Tratamento
2.
Niger J Clin Pract ; 25(1): 118-120, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35046206

RESUMO

Foreign body ingestion is a commonly encountered clinical challenge. Most of these objects pass spontaneously, but long objects could be retained leading to uncommon complications. There seem to be no record of percutaneous extrusion of ingested spoon in literature. We report a case of 20 year old lady who swallowed a long metallic spoon. It got retained in the stomach for a month without obstructive symptoms, until the tail end of it eroded onto the skin. It was retrieved through an open gastrotomy. Patient had an uneventful postoperative recovery. Clinicians should be mindful that ingested large foreign bodies may be delayed in presentation. Whereas our index patient had open surgery, minimally invasive retrieval approaches could be considered when comparable cases are encountered.


Assuntos
Corpos Estranhos , Abdome , Adulto , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Estômago , Adulto Jovem
3.
BMJ Case Rep ; 15(1)2022 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-34992056

RESUMO

Differential diagnosis of a new abdominal mass is broad and includes infection, malignancy and other inflammatory processes. Definitive diagnosis may be challenging without invasive biopsy, as history, physical exam and imaging may be non-specific. A 69-year-old man with a history of abdominal tuberculosis presented with a new painful abdominal cyst consistent with reactivation of tuberculosis versus new malignancy. Investigations revealed 4+ acid-fast bacilli from the aspirate suggestive of tuberculosis, but no improvement was noted on antituberculous therapy. Core needle biopsy noted c-KIT-positive spindle cells, diagnostic for a gastrointestinal stromal tumour, while cultures grew non-tuberculous mycobacteria.


Assuntos
Cistos , Tumores do Estroma Gastrointestinal , Tuberculose Gastrointestinal , Tuberculose , Abdome/diagnóstico por imagem , Idoso , Diagnóstico Diferencial , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Masculino , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose Gastrointestinal/complicações , Tuberculose Gastrointestinal/diagnóstico , Tuberculose Gastrointestinal/tratamento farmacológico
4.
Arq Bras Cir Dig ; 34(3): e1622, 2022.
Artigo em Inglês, Português | MEDLINE | ID: mdl-35019134

RESUMO

BACKGROUND: The incidence of abdominal hernia in cirrhotic patients is as higher as 20%; in cases of major ascites the incidence may increase up to 40%. One of the main and most serious complications in cirrhotic postoperative period (PO) is acute kidney injury (AKI). AIM: To analyze the renal function of cirrhotic patients undergoing to hernia surgery and evaluate the factors related to AKI. METHODS: Follow-up of 174 cirrhotic patients who underwent hernia surgery. Laboratory tests including the renal function were collected in the PO.AKI was defined based on the consensus of the ascite´s club. They were divided into two groups: with (AKI PO) and without AKI . RESULTS: All 174 patients were enrolled and AKI occurred in 58 (34.9%). In the AKI PO group, 74.1% had emergency surgery, whereas in the group without AKI PO it was only 34.6%.In the group with AKI PO, 90.4% presented complications, whereas in the group without AKI PO they occurred only in 29.9%. Variables age, baseline MELD, baseline creatinine, creatinine in immediate postoperative (POI), AKI and the presence of ascites were statistically significant for survival. CONCLUSIONS: There is association between AKI PO and emergency surgery and, also, between AKI PO and complications after surgery. The factors related to higher occurrence were initial MELD, basal Cr, Cr POI. The patients with postoperative AKI had a higher rate of complications and higher mortality.


Assuntos
Injúria Renal Aguda , Hérnia Abdominal , Abdome , Injúria Renal Aguda/epidemiologia , Injúria Renal Aguda/etiologia , Humanos , Incidência , Cirrose Hepática/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco
5.
Radiologe ; 62(1): 57-70, 2022 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-35024886

RESUMO

CLINICAL PROBLEM: Due to the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) asymptomatic incidental findings of the gastrointestinal tract (GI) are increasingly being recognized. Incidental findings are frequently not part of the primary inquiry from referring physicians but it is obligatory to make a diagnosis and to stipulate the need for further clarification. RADIOLOGICAL STANDARD PROCEDURES: A multitude of incidental findings in the intestinal lumen, in the intestinal wall and in the adjacent mesenterium or subperitoneal space are shown in CT and MRI. METHODOLOGICAL INNOVATIONS AND ASSESSMENT: The first part of the two-part overview addresses the intestinal incidental findings in the lumen, such as coproliths, invaginations, mucoceles and chronic dilatations. In the intestinal wall, thickenings of neoplastic and nonneoplastic origins are discussed. Many of the findings can be classified as benign and as "leave me alone lesions" do not necessitate any further clarification but in contrast others need a definitive clarification. The most important incidental findings in the GI tract are systematically classified, illustrated and evaluated with respect to the clinical relevance, depending on the localization (e.g. stomach, small and large intestines).


Assuntos
Trato Gastrointestinal , Tomografia Computadorizada por Raios X , Abdome , Trato Gastrointestinal/diagnóstico por imagem , Humanos , Achados Incidentais , Intestinos , Imageamento por Ressonância Magnética
6.
J Vet Emerg Crit Care (San Antonio) ; 32(S1): 72-80, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35044064

RESUMO

BACKGROUND: Abdominocentesis is commonly used to evaluate the abdominal cavity of the horse. This technique provides valuable diagnostic information as well as the means to monitor patients with abdominal diseases being managed medically and to determine their need for surgical management. Complications are uncommon and include trauma to the gastrointestinal tract or spleen, septic peritonitis, or abdominal wall infection. PROCEDURES: This review describes the indications, utility, patient preparation, and instructions for performing abdominocentesis as well as possible complications reported in horses. Step-by-step instructions are provided for the two most commonly used abdominocentesis techniques in horses, which include the use of a needle (18 Ga, 3.8 cm [1.5 in]) and a teat cannula (9.5 cm [3.75 in]). SUMMARY: Peritoneal fluid collection and fluid analysis can be used to confirm diagnosis of intraabdominal pathology including inflammatory, infectious, neoplastic, obstructive, and bowel strangulation, leading to additional diagnostic and therapeutic plans. KEY POINTS: Abdominocentesis is useful as a diagnostic procedure in horses suffering from colic, diarrhea, weight loss, or other conditions involving the abdominal cavity and is an integral component of diagnostic testing for colic at referral institutions or in the field. Abdominal fluid collection using an 18-Ga, 3.8-cm (1.5-in) needle is recommended for adult horses because the needle is long enough to penetrate the peritoneal cavity. The teat cannula technique is recommended for use in adult horses, foals, and miniature horses to reduce the risk of enterocentesis, even though this procedure is more traumatic than using an 18-Ga, 3.8-cm needle. Ultrasonography of the abdomen is a valuable tool in the assessment of any horse with signs of colic, but it is not essential for performing an abdominocentesis successfully.


Assuntos
Cólica , Doenças dos Cavalos , Peritonite , Abdome , Animais , Líquido Ascítico , Cólica/veterinária , Doenças dos Cavalos/diagnóstico , Cavalos , Peritonite/diagnóstico , Peritonite/veterinária
7.
Clin Anat ; 35(1): 103-115, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34658073

RESUMO

Surface anatomy is fundamental to clinical and surgical practices. As the surface anatomy varies with age, the purpose of this study is to provide age-standardized surface markings for the abdomen in children. A total of 155 abdominal computed tomography scans of healthy children aged 0-18 years were categorized into six groups, and the surface anatomy of the major vascular structures, solid viscera, and anatomical planes in the abdomen was analyzed. The vertebral levels of the celiac trunk, superior mesenteric artery, and hepatic portal vein formation were higher in the youngest age group, whereas the levels of the inferior mesenteric artery, formation of the inferior vena cava, and renal arteries did not differ with age. The right kidney lay between T12 and L3 and the left at T11-L3; however, both kidneys were in lower positions in younger children. The spleen was most commonly located between the 8th and 11th ribs except in toddlers. In all age groups, the hepatic portal vein formation was within the transpyloric plane and the aortic bifurcation was above the supracristal plane. In vivo reassessment of the surface anatomy enables the substantial variability of surface landmarks to be highlighted. This study demonstrates that taking account of age-related variations will increase the accuracy and therefore the clinical relevance of surface anatomy.


Assuntos
Abdome , Cavidade Abdominal , Abdome/diagnóstico por imagem , Aorta Abdominal , Humanos , Rim , Tomografia Computadorizada por Raios X
8.
Br J Radiol ; 95(1129): 20210796, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34767475

RESUMO

OBJECTIVE: To present the results following a UK national patient dose audit of paediatric CT examinations, to propose updated UK national diagnostic reference levels (DRLs) and to analyse current practice to see if any recommendations can be made to assist with optimisation. METHODS: A UK national dose audit was undertaken in 2019 focussing on paediatric CT examinations of the head, chest, abdomen/pelvis and cervical spine using the methods proposed by the International Commission on Radiological Protection. The audit pro-forma contained mandatory fields, of which the post-examination dosimetry (volume CT dose index and dose-length product) and the patient weight (for body examinations) were the most important. RESULTS: Analysis of the data submitted indicates that it is appropriate to propose national DRLs for CT head examinations in the 0-<1, 1-<5, 5-<10 and 10-<15 year age ranges. This extends the number of age categories of national DRLs from those at present and revises the existing values downwards. For CT chest examinations, it is appropriate to propose national DRLs for the first time in the UK for the 5-<15, 15-<30, 30-<50 and 50-<80 kg weight ranges. There were insufficient data received to propose national DRLs for abdomen/pelvis or cervical spine examinations. Recommendations towards optimisation focus on the use of tube current (mA) modulation, iterative reconstruction and the selection of examination tube voltage (kVp). CONCLUSION: Updated UK national DRLs are proposed for paediatric CT examinations of the head and chest. ADVANCES IN KNOWLEDGE: A national patient dose audit of paediatric CT examinations has led to the proposal of updated national DRLs.


Assuntos
Auditoria Médica , Doses de Radiação , Tomografia Computadorizada por Raios X/métodos , Abdome/diagnóstico por imagem , Adolescente , Vértebras Cervicais/diagnóstico por imagem , Criança , Pré-Escolar , Controle de Formulários e Registros , Cabeça/diagnóstico por imagem , Humanos , Lactente , Registros Médicos , Pescoço/diagnóstico por imagem , Pelve/diagnóstico por imagem , Valores de Referência , Tórax/diagnóstico por imagem , Reino Unido
9.
Anesth Analg ; 134(1): 102-113, 2022 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-34908548

RESUMO

BACKGROUND: Risk prediction models for postoperative mortality after intra-abdominal surgery have typically been developed using preoperative variables. It is unclear if intraoperative data add significant value to these risk prediction models. METHODS: With IRB approval, an institutional retrospective cohort of intra-abdominal surgery patients in the 2005 to 2015 American College of Surgeons National Surgical Quality Improvement Program was identified. Intraoperative data were obtained from the electronic health record. The primary outcome was 30-day mortality. We evaluated the performance of machine learning algorithms to predict 30-day mortality using: 1) baseline variables and 2) baseline + intraoperative variables. Algorithms evaluated were: 1) logistic regression with elastic net selection, 2) random forest (RF), 3) gradient boosting machine (GBM), 4) support vector machine (SVM), and 5) convolutional neural networks (CNNs). Model performance was evaluated using the area under the receiver operator characteristic curve (AUROC). The sample was randomly divided into a training/testing split with 80%/20% probabilities. Repeated 10-fold cross-validation identified the optimal model hyperparameters in the training dataset for each model, which were then applied to the entire training dataset to train the model. Trained models were applied to the test cohort to evaluate model performance. Statistical significance was evaluated using P < .05. RESULTS: The training and testing cohorts contained 4322 and 1079 patients, respectively, with 62 (1.4%) and 15 (1.4%) experiencing 30-day mortality, respectively. When using only baseline variables to predict mortality, all algorithms except SVM (area under the receiver operator characteristic curve [AUROC], 0.83 [95% confidence interval {CI}, 0.69-0.97]) had AUROC >0.9: GBM (AUROC, 0.96 [0.94-1.0]), RF (AUROC, 0.96 [0.92-1.0]), CNN (AUROC, 0.96 [0.92-0.99]), and logistic regression (AUROC, 0.95 [0.91-0.99]). AUROC significantly increased with intraoperative variables with CNN (AUROC, 0.97 [0.96-0.99]; P = .047 versus baseline), but there was no improvement with GBM (AUROC, 0.97 [0.95-0.99]; P = .3 versus baseline), RF (AUROC, 0.96 [0.93-1.0]; P = .5 versus baseline), and logistic regression (AUROC, 0.94 [0.90-0.99]; P = .6 versus baseline). CONCLUSIONS: Postoperative mortality is predicted with excellent discrimination in intra-abdominal surgery patients using only preoperative variables in various machine learning algorithms. The addition of intraoperative data to preoperative data also resulted in models with excellent discrimination, but model performance did not improve.


Assuntos
Abdome/cirurgia , Complicações Pós-Operatórias/mortalidade , Medição de Risco/métodos , Procedimentos Cirúrgicos Operatórios/mortalidade , Algoritmos , Área Sob a Curva , Coleta de Dados/métodos , Humanos , Período Intraoperatório , Modelos Logísticos , Aprendizado de Máquina , Curva ROC , Estudos Retrospectivos , Risco , Fatores de Risco , Máquina de Vetores de Suporte
12.
Vasc Endovascular Surg ; 56(1): 40-48, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34533371

RESUMO

Traumatic injuries to the mesenteric vessels are rare and often lethal. Visceral vessels, such as the superior mesenteric artery (SMA) and vein (SMV), supply blood to the small and large bowel by a rich system of collaterals. Because fewer than 100 such injuries have been described in the literature, they pose challenges in both diagnosis and management and can unfortunately result in high mortality rates. Prompt diagnosis, surgical intervention, and resuscitation can lead to improved outcomes. Here, we review the literature surrounding traumatic injuries of the SMA/SMV and discuss management strategies.


Assuntos
Artéria Mesentérica Superior , Lesões do Sistema Vascular , Abdome , Humanos , Artéria Mesentérica Superior/diagnóstico por imagem , Artéria Mesentérica Superior/cirurgia , Veias Mesentéricas/diagnóstico por imagem , Veias Mesentéricas/cirurgia , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/cirurgia
13.
Radiol Clin North Am ; 60(1): 113-129, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34836559

RESUMO

Pediatric abdominal masses are commonly encountered in the pediatric population, with a broad differential diagnosis that encompasses benign and malignant entities. The primary role of abdominal imaging in the setting of a suspected pediatric abdominal mass is to establish its presence, as nonneoplastic entities can mimic an abdominal mass, and to identify characteristic imaging features that narrow the differential diagnosis. In the setting of a neoplasm, various imaging modalities play an important role to characterize the mass, stage extent of disease, and assist in presurgical planning. The purpose of this article is to discuss a practical imaging algorithm for suspected pediatric abdominal masses and to describe typical radiological findings of the commonly encountered abdominal masses in neonates and children with emphasis on imaging guidelines and recommendations.


Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Diagnóstico por Imagem/métodos , Abdome/diagnóstico por imagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino
14.
Methods Mol Biol ; 2393: 683-699, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34837207

RESUMO

Ultrasound image quality is intrinsically linked to the hardware used to collect image data. For deep abdominal imaging, diffraction-limited resolution prevents the detection of small targets such as cancerous lesions. Larger ultrasound arrays produce finer lateral image resolution and improved image quality. We introduced a method called "swept synthetic aperture" (SSA) imaging to synthetically create large effective arrays with reduced complexity of both transducer and scanner hardware. A commercial 2-D transducer array and ultrasound scanner were used to form a large effective aperture. Array position and orientation were carefully prescribed throughout a sweep of the transducer using mechanical fixtures to rigidly control the motion. Calibration of the mechanical fixture was measured using a point target phantom and applied in post-processing. Improvements in resolution and contrast as functions of aperture size were measured from point and lesion target phantoms, respectively. SSA imaging presents a technique to both evaluate the performance of large array designs in the presence of clutter-inducing body wall targets and achieve high-quality imaging from reduced-complexity ultrasound hardware.


Assuntos
Ultrassonografia , Abdome , Imagens de Fantasmas , Transdutores
15.
Afr J Paediatr Surg ; 19(1): 32-35, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-34916349

RESUMO

Background: Mesenteric cysts are rare intra-abdominal masses and high index of suspicion is required to clinically suspect this pathology and make a definitive diagnosis. They are most commonly located in the ileal mesentery but can be located anywhere along the gastrointestinal tract mesentery and may extend into the retroperitoneum. The rarity of these anomalies and diversity of clinical picture pose challenges in the diagnosis and operative management. The objective of this study is to determine the demographic pattern, clinicopathological diagnosis and management outcome of mesenteric cysts in our hospital. Materials and Methods: This retrospective study was conducted on children operated for mesenteric cysts from October 2013 to September 2020. Statistical analysis was performed using Open Epi Version 3.01. Results: Out of 32 children with a diagnosis of mesenteric cyst, 78% were below 5 years of age. Small intestine was affected in 26 cases and large bowel mesentery was the site of origin in six cases. Complete excision of mesenteric cyst was possible in all cases. Bowel resection was required in ten cases (31%) to enable complete excision. Bowel resection was required more often in children operated on emergency than those with elective surgery, and is statistically significant (P = 0.04; confidence interval: 0.05-0.96, odds ratio: 0.23). An uncommon co-existence with ileal atresia and detection of rare chylolymphatic cyst in another infant were also remarkable findings. Histopathology proved the diagnosis in all cases. There was no mortality or recurrence during hospitalisation and follow-up, which ranged from 3 months to 3 years. Conclusions: Mesenteric cysts present with diverse clinical features and children below 5 years of age are most commonly affected. Complete surgical excision is the optimal treatment and may require bowel resection in significant number of cases, especially those operated during emergency. Histopathology is the gold standard for diagnosis.


Assuntos
Cistos , Cisto Mesentérico , Abdome , Criança , Humanos , Lactente , Cisto Mesentérico/diagnóstico , Cisto Mesentérico/cirurgia , Mesentério/cirurgia , Estudos Retrospectivos
16.
Khirurgiia (Mosk) ; (12): 111-117, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34941218

RESUMO

The authors describe successful treatment of a patient with consequences of a mine-explosive wound of the right thigh and abdomen, including damage to the duodenum. Staged surgical treatment made it possible to identify and eliminate defects in primary surgical treatment in time. Thus, favorable treatment results were obtained.


Assuntos
Traumatismos Abdominais , Traumatismos por Explosões , Abdome , Traumatismos Abdominais/complicações , Traumatismos Abdominais/diagnóstico , Traumatismos Abdominais/cirurgia , Traumatismos por Explosões/complicações , Traumatismos por Explosões/diagnóstico , Traumatismos por Explosões/cirurgia , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Humanos
17.
PLoS One ; 16(12): e0261171, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34905569

RESUMO

The use of "belly scoring" can offer a novel, non-invasive objective management tool to gauge food intake between individuals, groups, and populations, and thus, population fitness. As food availability is increasingly affected by predation, ecological competition, climate change, habitat modification, and other human activities, an accurate belly scoring tool can facilitate comparisons among wildlife populations, serving as an early warning indicator of threats to wildlife population health and potential population collapse. In social species, belly scores can also be a tool to understand social behavior and ranking. We developed and applied the first rigorous quantitative photogrammetric methodology to measure belly scores of wild painted dogs (Lycaon pictus). Our methodology involves: (1) Rigorous selection of photographs of the dorso/lateral profile of individuals at a right angle to the camera, (2) photogrammetrically measuring belly chord length and "belly drop" in pixels, (3) adjusting belly chord length as a departure from a standardized leg angle, and (4) converting pixel measurements to ratios to eliminate the need to introduce distance from the camera. To highlight a practical application, this belly score method was applied to 631 suitable photographs of 15 painted dog packs that included 186 individuals, all collected between 2004-2015 from allopatric painted dog populations in and around Hwange (n = 462) and Mana Pools National Parks (n = 169) in Zimbabwe. Variation in mean belly scores exhibited a cyclical pattern throughout the year, corresponding to biologically significant patterns to include denning demand and prey availability. Our results show significant differences between belly scores of the two different populations we assessed, thus highlighting food stress in the Hwange population. In the face of growing direct and indirect anthropogenic disturbances, this standardised methodology can provide a rapid, species-specific non-invasive management tool that can be applied across studies to rapidly detect emergent threats.


Assuntos
Abdome/anatomia & histologia , Processamento de Imagem Assistida por Computador/métodos , Fotogrametria/métodos , Abdome/diagnóstico por imagem , Animais , Animais Selvagens , Cães , Feminino , Masculino
18.
Colomb Med (Cali) ; 52(2): e4194809, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34908626

RESUMO

Damage control surgery is based on temporal control of the injury, physiologic recovery and posterior deferred definitive management. This strategy began in the 1980s and became a formal concept in 1993. It has proven to be a strategy that reduces mortality in severely injured trauma patients. Nevertheless, the concept of damage control in non-traumatic abdominal pathology remains controversial. This article aims to gather historical experiences in damage control surgery performed in non-traumatic abdominal emergency pathology patients and present a novel management algorithm. This strategy could be a surgical option to treat hemodynamically unstable patients in catastrophic scenarios such as hemorrhagic and septic shock caused by peritonitis, pancreatitis, acute mesenteric ischemia, among others. Therefore, damage control surgery is light amid better short- and long-term results.


La cirugía de control de daños es una estrategia de control temporal del daño tisular y recuperación fisiológica para un manejo definitivo diferido. Esta estrategia tiene antecedentes en el mundo del trauma desde la década de 1980, hasta su formalización conceptual en 1993. Hasta el momento ha demostrado ser una estrategia factible y que reduce la mortalidad en los pacientes críticamente enfermos. Sin embargo, el manejo de patologías abdominales no traumáticas aun es tema de discusión sobre su factibilidad y seguridad. El presente articulo tiene como objetivo realizar un relato histórico y experiencias en la aplicación de la cirugía de control de daños en emergencias quirúrgicas abdominales no asociadas a trauma y presentar un algoritmo de manejo usando los principios de la cirugía de control de daños. La aplicabilidad del control de daños en no trauma se enfrenta a los contextos de shock hemorrágico y séptico para patologías como peritonitis generalizada, peritonitis postquirúrgica, pancreatitis, isquemia mesentérica aguda, entre otras. Se ha demostrado que el uso de control de daños representa una luz para el cirujano ante la tormenta de la incertidumbre de la descompensación metabólica en el manejo de emergencias abdominales, para crear un puente para su manejo definitivo y permitir anastomosis como estrategia de reconstrucción intestinal y mejorar los resultados a corto y largo plazo.


Assuntos
Abdome/cirurgia , Humanos
19.
J Med Case Rep ; 15(1): 597, 2021 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-34915922

RESUMO

BACKGROUND: Pneumatosis cystoides intestinalis is a rare and usually benign condition in which multiple thin-walled cysts develop in the submucosa or subserosa of the gastrointestinal tract. While usually asymptomatic, severe cases can result in pneumoperitoneum, which can be managed surgically or medically depending on circumstances. We present a case of a patient with pneumatosis cystoides intestinalis, which presented as pneumoperitoneum following trauma. To our knowledge, there are no other published cases in which a trauma patient with pneumoperitoneum was found to have radiologic evidence of pneumatosis cystoides intestinalis. CASE PRESENTATION: We present the case of a 37-year-old Hispanic male admitted to the hospital after being involved in a motorcycle accident. Computed tomography imaging of the abdomen and pelvis with oral and intravenous contrast demonstrated trace pneumoperitoneum, possibly originating from the splenic flexure of the colon without evidence of extravasation of oral contrast. Laparoscopy with conversion to exploratory laparotomy revealed bowel abnormalities at the distal transverse colon and splenic flexure, which were identified as pneumatosis cystoides intestinalis by pathology. There was no evidence of bowel perforation. A panel of abdominal radiologists attended the computed tomography interpretation to note that incidental atraumatic or traumatic rupture of the cysts could have caused the pneumoperitoneum. The patient had an uncomplicated postoperative course and was transferred to another facility per insurance request. CONCLUSIONS: When presenting in the context of trauma, pneumatosis cystoides intestinalis can lead to difficult management decisions. To our knowledge, there are no existing evidence-based guidelines for the scenario of concurrent pneumatosis cystoides intestinalis, blunt abdominal trauma, and pneumoperitoneum in a patient with a benign abdominal exam. This patient's pneumoperitoneum was likely caused by rupture of preexisting cysts rather than frank bowel perforation. Patients who are asymptomatic, lack signs of clinically worrisome disease, and have a low pretest probability will likely not benefit from surgery and can be medically managed. Thorough discussion between surgeons and radiologists can be helpful when evaluating the clinical significance of a patient's pneumatosis cystoides intestinalis and aid in the decision to perform surgery.


Assuntos
Cistos , Perfuração Intestinal , Pneumatose Cistoide Intestinal , Pneumoperitônio , Abdome , Adulto , Humanos , Masculino , Pneumatose Cistoide Intestinal/complicações , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia
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