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1.
J Surg Res ; 246: 395-402, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31629495

RESUMO

BACKGROUND: Laparoscopic appendectomy is a preferred approach in children with appendicitis. Patient characteristics associated with open appendectomy are poorly characterized, although such information can help optimize the care. MATERIAL AND METHODS: To characterize the factors associated with open appendectomy, we performed a retrospective analysis using the 2014 Nationwide Readmissions Database, capturing 49.3% of US hospitalizations. We identified surgically managed appendicitis using International Classification of Diseases, Ninth Revision, Clinical Modification among patients aged 18 or younger. Factors associated with open appendectomy, 30-d readmission rate, and hospitalization length were assessed using logistic regression, Cox proportional hazards regression, and Poisson regression, respectively. RESULTS: Of 46,147 children with surgically managed appendicitis, 85.2% had laparoscopic appendectomy. Low-volume hospitals (odds ratio, OR: 3.01 [95% confidence interval, CI: 1.81-5.01]), rural hospitals (OR: 2.36 [95%CI: 1.63-3.40]), public insurance (OR: 1.19 [95%CI: 1.03-1.36]), lower-income neighborhood residence (OR: 1.40 [95%CI: 1.06-1.86]), younger age (OR: 5.00 [95%CI: 3.64-6.86] in <5 year-old), and abscess complicating appendicitis (OR: 1.91 [95%CI: 1.58-2.31]) were associated with open appendectomy. Laparoscopic appendectomy was associated with shorter hospitalization (incidence rate ratio: 0.77 [95%CI: 0.69-0.87]) and less readmission with wound infection, but not with 30-d readmission, or readmission with intraabdominal abscess. CONCLUSIONS: Along with clinical factors, non-clinical factors including appendicitis volume and rural/teaching status of the treating hospitals play a role in the choice of surgical approach. Awareness of the patient- and hospital-level factors associated with open appendectomy may allow for future resource distribution or improvement in access to care, resulting in population-level impact.


Assuntos
Abscesso Abdominal/epidemiologia , Apendicectomia/efeitos adversos , Apendicite/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Infecção da Ferida Cirúrgica/epidemiologia , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Adolescente , Fatores Etários , Apendicectomia/métodos , Apendicite/complicações , Criança , Pré-Escolar , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Fatores de Risco , Fatores Socioeconômicos , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/cirurgia
2.
Dis Colon Rectum ; 63(1): 26-28, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31804267

RESUMO

CASE SUMMARY: A 62-year-old previously healthy man presented with left lower quadrant pain and fever. Physical examination showed left lower quadrant peritonitis. Computed tomography scan showed a pelvic abscess with extraluminal air (). Intravenous antibiotics were started, and CT-guided percutaneous drainage was performed. The drain was removed 1 week after discharge. One week later, he presented with dysuria and pneumaturia and was started on antibiotics. Colonoscopy confirmed diverticulosis with no other mucosal abnormalities. He underwent a successful laparoscopic sigmoidectomy with colovesical fistula takedown.


Assuntos
Abscesso Abdominal/etiologia , Antibacterianos/administração & dosagem , Doença Diverticular do Colo/complicações , Drenagem/métodos , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/terapia , Administração Intravenosa , Colonoscopia , Doença Diverticular do Colo/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
3.
Medicine (Baltimore) ; 98(50): e18047, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852066

RESUMO

BACKGROUND: There currently exists no substantial evidence reporting the efficacy of peritoneal irrigation in reducing the incidence of postoperative intra-abdominal abscess in pediatric patients. The purpose of our study was to perform a meta-analysis to compare rates of intra-abdominal abscess after appendectomy between irrigation and suction alone groups. METHODS: We identified studies by a systematic search in EMBASE, PubMed, Web of Science, and the Cochrane Library to recognize randomized controlled trials and case control studies from the 1950 to May 2019. We limited the English language studies. We checked the reference list of studies to recognize other potentially qualified trials. We analyzed the merged data with use of the Review Manager 5.3. RESULTS: We identified 6 eligible papers enrolling a total of 1633 participants. We found no significant difference in the incidence of postoperative intraabdominal abscess, wound infection, and the length of hospitalization between 2 group, but duration of surgery is longer in irrigation group (MD = 6.76, 95% CI = 4.64 to 8.87, P < .001; heterogeneity, I = 25%, P = .26). CONCLUSION: Our meta-analysis did not provide strong evidence allowing definite conclusions to be drawn, but suggested that peritoneal irrigation during appendectomy did not decrease the incidence of postoperative IAA. This meta-analysis also indicated the need for more high-quality trials to identify methods to decrease the incidence of postoperative IAA in pediatric perforated appendicitis patients.Trial registration number Standardization of endoscopic treatment of acute abdomen in children: 14RCGFSY00150.


Assuntos
Abscesso Abdominal/prevenção & controle , Apendicectomia/métodos , Apendicite/cirurgia , Laparoscopia/métodos , Lavagem Peritoneal/métodos , Complicações Pós-Operatórias/prevenção & controle , Abscesso Abdominal/etiologia , Apendicite/complicações , Criança , Humanos , Período Intraoperatório , Complicações Pós-Operatórias/etiologia
4.
Int J Surg ; 71: 182-189, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31610284

RESUMO

BACKGROUND: Diverticulitis is one of the most common gastrointestinal diseases in western population. Colonic resection is recommended by international guidelines as a routinely used technique for purulent diverticulitis. Laparoscopic lavage was introduced as a non-resection alternative. The studies available so far have shown contradictory results. This meta-analysis aims to compare laparoscopic lavage versus colonic resection in patients with Hinchey Ⅲ-Ⅳ diverticulitis. METHODS: We did a systematic review of articles published before March 20, 2019, with no language restriction by searching PubMed, Cochrane library, EMBASE databases, clinicaltrials.gov, and Google Scholar databases. We included all RCTs and cohort studies comparing outcomes between patients with Hinchey Ⅲ-Ⅳ diverticulitis undergoing laparoscopic lavage versus colonic resection. Important outcomes were mortality, complications, length of stay, readmission and reoperation rates. We combined data to assess the outcomes using DerSimonian and Laird random-effects model. RESULTS: A total of 569 patients with diverticulitis of which more than 80% were Hinchey Ⅲ were enrolled from 3 RCTs and 5 cohort studies. Laparoscopic lavage was associated with shorter operative time (WMD -78.9, 95%CI -100.58 to -57.11, P < 0.0001) and total postoperative hospital stay (WMD -7.62, 95%CI -11.60 to -3.63, P = 0.0002) but a higher rate of intra-abdominal abscess (OR 2.69, 95%CI 1.39 to 5.21, P = 0.0032) and secondary peritonitis (OR 5.30, 95%CI 1.91 to 14.73, P = 0.0014). CONCLUSION: Laparoscopic lavage for patients with Hinchey Ⅲ to Ⅳ diverticulitis does provide similar mortality, shorter operative time and hospital stay. However, the evidence so far suggests that it might be inadequate for sepsis control and may result in more unplanned reoperations. Further studies are needed to standardize the formal indication for laparoscopic lavage.


Assuntos
Colectomia/efeitos adversos , Doença Diverticular do Colo/cirurgia , Laparoscopia/efeitos adversos , Lavagem Peritoneal/efeitos adversos , Complicações Pós-Operatórias/etiologia , Abscesso Abdominal/etiologia , Adulto , Idoso , Colectomia/métodos , Feminino , Humanos , Laparoscopia/métodos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Lavagem Peritoneal/métodos , Peritonite/etiologia , Complicações Pós-Operatórias/epidemiologia , Período Pós-Operatório , Reoperação/estatística & dados numéricos , Resultado do Tratamento
5.
Medicine (Baltimore) ; 98(39): e17149, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574819

RESUMO

RATIONALE: Appendiceal mucocele is a rare entity of mucinous cystic dilatation of the appendix. It has no typical clinical presentation and is considered a potentially premalignant condition. PATIENT CONCERNS: We present a case of accidental intraoperative finding of an appendiceal mucocele in a 54-year old woman that clinically presented with an exacerbated chronic tubo-ovarian abscess. DIAGNOSES: Trans-vaginal ultrasonography showed an encapsulated, oval, unilocular mass above the uterus with a heteroechogenic structure, homogeneous fluid content, and smooth regular walls without inner proliferation. The histopathologic diagnosis was consistent with an appendiceal cystadenoma. INTERVENTIONS: The patient underwent a simple appendectomy. OUTCOMES: There were no clinical, biochemical or imaging signs of the disease recurrence at 6 months follow up. LESSONS: To our knowledge, this is the only well-documented case of appendiceal mucocele mimicking exacerbated chronic tubo-ovarian abscess reported in the literature. Awareness of a rare entity such as an appendiceal mucocele, which is frequently misdiagnosed as a potential cause of acute abdomen, is necessary for the appropriate management strategy in order to prevent complications.


Assuntos
Abscesso Abdominal/etiologia , Neoplasias do Apêndice/complicações , Cistadenoma/complicações , Doenças das Tubas Uterinas/etiologia , Mucocele/complicações , Doenças Ovarianas/etiologia , Doença Crônica , Feminino , Humanos , Pessoa de Meia-Idade
7.
BMC Surg ; 19(1): 145, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619222

RESUMO

BACKGROUND: Retroperitoneal abscess (RA) is an unusual life-threatening disease that has insidious and occult presentations. Although the incidence of this disease is low, diagnosis and treatment are challenging due to its nonspecific presentation and the complex anatomy of the retroperitoneal space. Recently, we experienced one case of a RA with extensive thrombophlebitis of the portal venous system. CASE PRESENTATION: An 80-year-old male presented to the emergency room with symptoms and signs of septic shock; however, the decision making for diagnosis and treatment was difficult, as no clinical and radiological evidence supported key findings regarding the origin of sepsis. Although this patient eventually recovered after surgical drainage, we suggested that more straightforward diagnostic and treatment procedures were required in this patient to avoid possible critical complications. Through a retrospective review of operative findings, patient history, and microbiology, we found that the RA in this patient was caused by lumbar acupuncture, which is usually performed for the management of chronic back pain with long needles. CONCLUSION: Early surgical intervention should be considered for RA whenever the patient does not respond to broad-spectrum antibiotic treatment. Acupuncture is a possible cause of otherwise unexplained soft tissue infections, such as RA, especially in Asian countries.


Assuntos
Abscesso Abdominal/etiologia , Abscesso/etiologia , Terapia por Acupuntura/efeitos adversos , Tromboflebite/etiologia , Idoso de 80 Anos ou mais , Humanos , Região Lombossacral , Masculino , Espaço Retroperitoneal/patologia
8.
Medicine (Baltimore) ; 98(36): e17032, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490392

RESUMO

RATIONALE: Failure to pass though the gastrointestinal tract can result in inflammatory response, reactive fibrosis, and intestinal perforation. Fish bones, chicken bones, and toothpicks are the most common types of foreign substances that produce intestinal perforation during ingestion. PATIENT CONCERNS: Case 1: A 49-year-old female was hospitalized with abdominal pain and a fever. The fever lasted for 5 days before hospitalization. Case 2: A 72-year-old male was hospitalized with abdominal pain and fever. The fever lasted for 4 days before hospitalization. DIAGNOSES: Case 1: An abdominal pelvic computed tomography (APCT) scan revealed a large inflammatory mass formation and linear high-density material within the inflammatory mass. The presence of foreign bodies, including acupuncture needles or intrauterine devices was ruled out. Case 2: An APCT scan revealed that there was a small abscess formation measuring about 2.5 cm abutting the abdominal wall and a parasitic infestation was ruled out. INTERVENTIONS: Case 1: An exploratory laparotomy was performed. After removal of the abscess pocket, the sigmoid colon was found to be perforated, and there was a firm, sharp foreign body in the abscess pocket that measured about 5 cm and resembled a toothpick. Case 2: Laparoscopic exploration was then performed. When the abscess was removed from the abdominal wall using a harmony scalpel, a 4 cm foreign body that resembled a toothpick appeared in the abscess pocket. OUTCOMES: The patients recovered well after surgery and were discharged. LESSONS: Two of the above case reports describe the cases in which the presence of toothpicks was suspected clinically, resulting in the surgery of intra-abdominal abscess caused by intestinal perforations.


Assuntos
Abscesso Abdominal/etiologia , Colo Sigmoide/lesões , Reação a Corpo Estranho/diagnóstico por imagem , Perfuração Intestinal/etiologia , Abscesso Abdominal/diagnóstico por imagem , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
9.
J Laparoendosc Adv Surg Tech A ; 29(10): 1232-1238, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31524565

RESUMO

Background: Although previous studies have evaluated whether use of irrigation decreases postoperative intraabdominal abscess (PO-IAA) formation, these studies treated irrigation as a dichotomous variable and concluded that no irrigation resulted in a decreased incidence of PO-IAA formation. However, a recent study found decreased incidence with small aliquots to a total volume of 6 L. We hypothesized that higher volumes of irrigation would result in a lower incidence of PO-IAA. Materials and Methods: A postoperative template was developed as a quality improvement initiative and included descriptors for complex appendicitis and volume of irrigation. Data were prospectively collected from February 2016 to December 2018. Patients with complex appendicitis (fibropurulent exudate, extraluminal fecalith, well-formed abscess, visible hole in the appendix) were identified and analyzed by using standard statistical analysis. Volume of irrigation was categorized for analysis. Results: Two thousand three hundred six appendicitis patients were identified; 408 had complex appendicitis (17.7%). Three hundred eighty-four patients with complex appendicitis had documented irrigation volumes. The overall incidence of PO-IAA was 13.8%. Irrigation was commonly used (92.7%). The median amount of irrigation was 1000 mL (500 mL, 2500 mL), but it ranged from none to 9000 mL. There was no overall difference in the volume of irrigation used between those who developed a PO-IAA and those who did not (P = .34). No specific intraoperative finding was associated with the development of PO-IAA. Increasing volume of irrigation did not lower PO-IAA incidence (P = .24). Conclusions: The volume of irrigation did not appear to affect the rate of PO-IAA formation. The use of irrigation should be left to the discretion of the operating surgeon.


Assuntos
Abscesso Abdominal/prevenção & controle , Apendicectomia/métodos , Apendicite/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Abscesso Abdominal/epidemiologia , Abscesso Abdominal/etiologia , Adolescente , Apendicectomia/normas , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Melhoria de Qualidade , Estudos Retrospectivos , Irrigação Terapêutica/métodos , Irrigação Terapêutica/normas , Resultado do Tratamento
10.
Cir Cir ; 87(S1): 73-76, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501622

RESUMO

Gastric duplication cyst is a very rare congenital anomaly accounting up to 4-9% of all gastrointestinal tract duplications. It is a quite rare anomaly in adults, the majority of cases are diagnosed in the neonatal period. Gastric duplication cysts are usually asymptomatic in the adult. They are usually discovered incidentally in TAC or RMN, although the best specificity diagnostic test is the echoendoscopy. The best election treatment is the surgical complete extirpation. We describe a case of an adult patient who is diagnosed of the incidentally gastric cyst duplication.


Assuntos
Cistos/congênito , Estômago/anormalidades , Tomografia Computadorizada por Raios X , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/etiologia , Colecistectomia , Colelitíase/complicações , Colelitíase/diagnóstico por imagem , Cistos/diagnóstico por imagem , Cistos/cirurgia , Diagnóstico Diferencial , Endossonografia , Feminino , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Recidiva , Espaço Retroperitoneal , Estômago/diagnóstico por imagem , Estômago/cirurgia , Neoplasias Gástricas/diagnóstico , Infecção da Ferida Cirúrgica/diagnóstico por imagem , Infecção da Ferida Cirúrgica/etiologia , Infecções Urinárias/complicações
11.
Cir Cir ; 87(S1): 33-37, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501624

RESUMO

Background: Colonic vascular lesion secondary to verapamil overdose is mediated by free radicals, forming vascular microtrombos and endotoxin generation, being a difficult diagnosis. Clinical Case: A 27-year-old female is admitted with an acute abdomen of 4 days after an event referred for a suicidal attempt due to an overdose of verapamil, operating surgically where there is a right transmural colon necrosis, performing a right hemicolectomy with terminal ileostomy. Conclusions: Recognize and properly treat an acute abdomen, not always reach an adequate diagnosis, so a thorough history could conclude.


Assuntos
Abdome Agudo/cirurgia , Colectomia , Colo/patologia , Ileostomia , Isquemia/induzido quimicamente , Circulação Esplâncnica/efeitos dos fármacos , Abdome Agudo/induzido quimicamente , Abscesso Abdominal/etiologia , Adulto , Colo/irrigação sanguínea , Drenagem , Feminino , Humanos , Hipotensão/induzido quimicamente , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Isquemia/patologia , Necrose , Tentativa de Suicídio , Taquicardia/induzido quimicamente , Verapamil/envenenamento
12.
BMC Gastroenterol ; 19(1): 144, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416435

RESUMO

BACKGROUND: Splenic nodules are uncommon entities that occur rarely in the general population. Although an infectious etiology (primarily bacteria, followed by mycobacteria) is usually found, noninfectious diseases, including malignancies and autoimmune disorders, can also be involved. For instance, in course of inflammatory bowel diseases (IBDs), in particular Crohn's Disease, aseptic splenic abscesses have been reported in patients with a long history of illness, or in those unresponsive to medical treatments, while are only anecdotally reported in the early phase of the disease. Hence, we presented the case of aseptic splenic nodules as a first manifestation of Crohn's Disease. CASE PRESENTATION: A 21-year-old woman with a silent medical history was admitted to the Emergency Department of our hospital complaining of fever of 38-39 °C (mainly in the evening) for the past 10 days and left flank abdominal pain, accompanied by sweating and fatigue. An abdominal computed tomography showed multiple splenic nodules of unknown origin. Because of the absence of clinical improvement after several antibiotic therapiesand a positron emission tomography (PET) with hypercaptation strictly localized to spleen, she underwent splenectomy, in suspicion of lymphoma. For persistence of symptoms after splenectomy, she underwent many instrumental examination, including a colonoscopy with bowel and intestinal biopsies that poses diagnosis of Crohn's disease. A second PET confirmed this diagnosis showing this time also the gastrointestinal involvement. CONCLUSION: An unusual onset of Crohn's disease with multiple splenic nodules is reported. This case suggests that in light of splenic nodules of unknown etiology attention should be paid to all possible diagnoses of aseptic abscesses, including IBDs (primarily Crohn's Disease).


Assuntos
Abscesso Abdominal , Doença de Crohn , Intestinos/patologia , Linfoma/diagnóstico , Baço , Esplenectomia/métodos , Esplenopatias , Abscesso Abdominal/diagnóstico , Abscesso Abdominal/etiologia , Abscesso Abdominal/cirurgia , Biópsia/métodos , Colonoscopia/métodos , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Tomografia por Emissão de Pósitrons/métodos , Baço/diagnóstico por imagem , Baço/patologia , Baço/cirurgia , Esplenopatias/diagnóstico , Esplenopatias/etiologia , Esplenopatias/cirurgia , Adulto Jovem
13.
Cir Cir ; 87(5): 540-544, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448803

RESUMO

Introduction: Acute appendicitis is the main cause of emergency surgical care. Post-operative patients with complicated acute appendicitis present complications, many of them expected. The use of drains is one of the measures to prevent these complications; however, recent meta-analyzes do not justify this therapeutic measure. This study evaluates the relationship between use and non-use of drains, post-operative complications in patients with complicated peritonitis secondary to acute appendicitis. Methods: A retrospective observational cohort study was conducted. The outcomes were analyzed by Chi-square test and Student's t-test; Fisher exact test was performed. Results: The average operating time was 1.46 h (1.0-2.5) and 1.66 (1-3) for patients without drains and with drains, respectively, the difference was significant (p = 0.001). Post-operative fever was more prevalent in group with a drains odds ratio (OR) 3.4 (confidence interval [CI] 95% 1.4-7.9). The mean time of hospitalization was 7.3 (3-20) and 8.8 days (3-35) for patients without drains and with drains, respectively. (p = 0.01). The Chi-square analysis was significant for evisceration Grade III and residual collection p = 0.036, OR not evaluable. Reoperation was not significant among both groups, p = 0.108 OR 6.3 (CI 95% 0.6-62.4). Conclusions: There is a relationship between the non-use of drains and collections and evisceration in post-operative patients with open appendectomy, by complicated acute appendicitis.


Assuntos
Apendicite/complicações , Drenagem , Peritonite/etiologia , Complicações Pós-Operatórias/etiologia , Abscesso Abdominal/epidemiologia , Abscesso Abdominal/etiologia , Abscesso Abdominal/prevenção & controle , Antibacterianos/uso terapêutico , Apendicectomia , Apendicite/tratamento farmacológico , Apendicite/cirurgia , Terapia Combinada , Drenagem/efeitos adversos , Feminino , Febre/epidemiologia , Febre/etiologia , Hospitais Públicos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , México/epidemiologia , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/prevenção & controle , Utilização de Procedimentos e Técnicas , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Deiscência da Ferida Operatória/epidemiologia , Deiscência da Ferida Operatória/prevenção & controle , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/etiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Procedimentos Desnecessários
14.
World J Emerg Surg ; 14: 31, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31320921

RESUMO

Background: Diverticular abscess diameter of 3-6 cm is generally accepted as a cutoff determining whether percutaneous drainage is recommended in addition to antibiotics, but this is not based on high-quality evidence. The aim of this study was to analyze the treatment choices and outcomes of patients with diverticular abscesses. Methods: This was a retrospective cohort study conducted in an academic teaching hospital functioning as a secondary and tertiary referral center. Altogether, 241 patients with computer tomography-verified acute left-sided colonic diverticulitis with intra-abdominal abscess were collected from a database containing all patients treated for colonic diverticulitis in our institution during 2006-2013. The main measured outcomes were need of emergency surgery and 30-day mortality, and these were compared between antibiotics only and percutaneous drainage groups. Treatment choices, including surgery, were also analyzed for all patients. Results: Abscesses under 40 mm were mostly treated with antibiotics alone with a high success rate (93 out of 107, 87%). In abscesses over 40 mm, the use of emergency surgery increased and the use of antibiotics alone decreased with increasing abscess size, but the proportion of successful drainage remained at 13-18% regardless of the abscess size. There were no differences in failure rate, 30-day mortality, the need of emergency surgery, permanent stoma, recurrence, or length of stay in patients treated with percutaneous drainage vs. antibiotics alone, even when groups were adjusted for potential confounders. Conclusions: Percutaneous drainage as a treatment for large abscess does not seem to be superior to the treatment with only antibiotics.


Assuntos
Abscesso Abdominal/terapia , Doença Diverticular do Colo/terapia , Resultado do Tratamento , Abscesso Abdominal/etiologia , Idoso , Antibacterianos/uso terapêutico , Estudos de Coortes , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Doença Diverticular do Colo/complicações , Drenagem/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos
15.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289160

RESUMO

We describe a previously fit and well 54-year-old woman who presented with 3 weeks of right-sided lower abdominal pain with CT showing a non-specific thickening of the caecal/appendiceal wall. Although initially concerning for a neoplastic process, histology demonstrated yeast-like organisms colonising and invading into the appendiceal wall, confirming the diagnosis of fungal appendicitis. Fungal appendicitis is an important clinical entity that has previously been reported to affect immunocompromised individuals. Although uncommon among the non-immunocompromised individuals, it should not be neglected as a possible diagnosis in patients presented with non-specific abdominal pain.


Assuntos
Dor Abdominal/etiologia , Apendicite/microbiologia , Apêndice/microbiologia , Micoses/complicações , Abscesso Abdominal/etiologia , Apendicite/diagnóstico , Apendicite/patologia , Apendicite/cirurgia , Apêndice/diagnóstico por imagem , Apêndice/patologia , Diagnóstico Diferencial , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
16.
BMJ Case Rep ; 12(7)2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31324669

RESUMO

Many cases of appendicitis can be associated with appendicoliths. These may sometimes be lost during appendectomies and may be lodged in the body. Most of these cases lead to recurrent abscess formation, and these appendicoliths invariably need removal. Typically, this used to be done as an open surgery or laparoscopically. Here we describe the case of a transcutaneous removal of an appendicolith that was lodged between the liver and diaphragm that led to recurrent perihepatic abscess formation in a 24-year-old otherwise healthy man. The patient made a successful recovery without any recurrence. A transcutaneous approach to remove a retained appendicolith may be a feasible, a safe and an easy method to extract appendicoliths that are accessible for transcutaneous removal.


Assuntos
Abscesso Abdominal/cirurgia , Apendicectomia , Apendicite/cirurgia , Cálculos/cirurgia , Corpos Estranhos/cirurgia , Complicações Pós-Operatórias/cirurgia , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/etiologia , Cálculos/complicações , Diafragma/diagnóstico por imagem , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Humanos , Fígado/diagnóstico por imagem , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Recidiva , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
Int J Surg ; 68: 40-47, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31226406

RESUMO

BACKGROUND: Appendectomy is amongst the most common general surgical procedures and the laparoscopic approach is recognized and recommended by international guidelines as a valid option. The different closure techniques of the appendicular stump constitute a matter of debate since their possible implication in determining postoperative infectious complications. The aim of the present meta-analysis is to compare endostapler versus endoscopic loop ties for stump closure during laparoscopic appendectomy. METHODS: This is a systematic review with meta-analysis of randomized trials and cohort studies comparing endostapler with endoscopic loop ties for the closure of appendicular sump in laparoscopy appendectomy. Subgroup analysis of pediatric patients and patients with complicated appendicitis were performed when data were available. Complicated acute appendicitis was defined as in case of gangrenous/necrotic appendix or perforated appendix. Main outcomes were wound infection rate, intra-abdominal infection rate, length of stay, readmission and reoperation rates. RESULTS: a total of 5934 patients from 14 studies were included in the analysis. Endostapler was associated with a similar intra-abdominal abscess rate (RR 0.88, 95%C.I. 0.54-1.43) but a lower incidence of wound infection (RR 0.54, 95%C.I. 0.22-0.97) Length of stay, readmission and reoperation rates were similar. In subgroups analysis endostapler reduces significantly the wound infection rate in pediatric patients; no differences in main outcomes were observed in patients with complicated acute appendicitis. CONCLUSION: In complicated acute appendicitis the stump closure technique did not affect outcomes; the use of endostapler seems to be associated to a reduction of wound infection rate in pediatric patients with non-complicated acute appendicitis.


Assuntos
Apendicectomia/instrumentação , Apendicite/cirurgia , Complicações Pós-Operatórias/etiologia , Suturas/efeitos adversos , Técnicas de Fechamento de Ferimentos/instrumentação , Abscesso Abdominal/etiologia , Adulto , Apendicectomia/métodos , Apendicite/patologia , Criança , Feminino , Humanos , Infecções Intra-Abdominais/etiologia , Tempo de Internação , Masculino , Reoperação/estatística & dados numéricos , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos/efeitos adversos , Infecção dos Ferimentos/etiologia
18.
BMJ Case Rep ; 12(4)2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30967446

RESUMO

A man in his late 50s presented to the emergency room with a 1-month history of severe abdominal pain and an endoscopic fishbone retrieval from his rectum. Serial CT scans revealed a fishbone located in the patient's upper abdomen, which had migrated through the stomach wall, into the periportal space, causing a contained gastric perforation, development of a porta hepatis abscess and secondary portal vein thrombosis. Furthermore, the sharp tip of the fishbone lay 5 mm from the patient's hepatic artery. He was transferred to a hepatobiliary centre where he underwent urgent exploratory laparotomy, with surgical exploration of the porta, drainage of the abscess and retrieval of the fishbone. Postoperatively, he received further treatment with antibiotics and anticoagulation and recovered without further sequelae.


Assuntos
Abscesso Abdominal/etiologia , Migração de Corpo Estranho/complicações , Veia Porta , Trombose/etiologia , Abscesso Abdominal/diagnóstico por imagem , Abscesso Abdominal/cirurgia , Dor Abdominal , Idoso , Anticoagulantes/uso terapêutico , Diagnóstico Diferencial , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/etiologia , Migração de Corpo Estranho/diagnóstico , Heparina/uso terapêutico , Humanos , Masculino , Combinação Piperacilina e Tazobactam/uso terapêutico , Veia Porta/diagnóstico por imagem , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/etiologia , Trombose/diagnóstico por imagem , Trombose/tratamento farmacológico , Trombose/cirurgia , Tomografia Computadorizada por Raios X
19.
Rev. Rol enferm ; 42(4,supl): 55-59, abr. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-187202

RESUMO

Paciente que precisó someterse a una sigmoidectomía por neoplasia de colon y posterior reintervención por fuga anastomótica y peritonitis aguda difusa, que conllevó la realización de ileostomía terminal en fosa ilíaca derecha. La presencia de un absceso periestomal con exudado purulento propició la aparición de fugas continuas. Dado el mal estado general del paciente, no fue posible tratar el absceso hasta 33 días después, mediante un catéter Pig-Tail, por parte del servicio de radiología intervencionista. A esta complicación se le añadió la aparición de un alto débito por la ileostomía. Durante este periodo de tiempo, los cuidados de enfermería y la correcta elección de dispositivos y accesorios, han sido fundamentales para mantener el estoma y piel periestomal en buen estado, y de este modo, poder abordar con el paciente y familia el proceso de aceptación y cuidados de la ostomía


No disponible


Assuntos
Humanos , Masculino , Planejamento de Assistência ao Paciente , Ileostomia/efeitos adversos , Ileostomia/enfermagem , Abscesso Abdominal/etiologia , Abscesso Abdominal/enfermagem , Neoplasias do Colo/cirurgia , Seguimentos , Resultado do Tratamento
20.
World J Surg ; 43(7): 1766-1776, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-30820737

RESUMO

BACKGROUND: Obesity has been reported to be a prognostic factor for many diseases in epidemiological studies; however, the results of studies examining the relationship between obesity and gastric cancer (GC) prognosis are inconsistent. METHODS: A total of 460 patients with Stage II and III GC who underwent open R0 gastrectomy were included. Age, sex, body mass index (BMI classified into < 18.5, 18.5-25, and ≥ 25 kg/m2), stage, and postoperative adjuvant chemotherapy were analyzed to investigate the correlation with relapse-free survival (RFS). RESULTS: Five-year RFS was 51% for the study patients. Five-year RFS values were 47.6%, 54.3%, and 40.1% for patients with BMI < 18.5, 18.5-25, and ≥ 25 kg/m2, respectively. The forest plot for relapse risk according to BMI showed a U shape. Multivariate analysis for RFS showed significant differences in stage and BMI; the hazard ratio for recurrence in patients with BMI ≥ 25 kg/m2 was 1.42 (95% confidence interval: 1.01-2.02, p = 0.0423) with reference to patients with BMI < 25 kg/m2. BMI ≥ 25.0 was associated with longer operation times, more blood loss, fewer lymph nodes dissected, more frequent postoperative surgical site infection, and intra-abdominal abscesses. CONCLUSIONS: BMI ≥ 25 kg/m2 is an unfavorable prognostic factor for patients who underwent gastrectomy for Stage II and III GC.


Assuntos
Abscesso Abdominal/etiologia , Índice de Massa Corporal , Obesidade/complicações , Neoplasias Gástricas/complicações , Neoplasias Gástricas/cirurgia , Infecção da Ferida Cirúrgica/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Intervalo Livre de Doença , Feminino , Gastrectomia/efeitos adversos , Humanos , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Neoplasias Gástricas/patologia
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