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1.
Ann R Coll Surg Engl ; 102(1): e12-e14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31859525

RESUMO

Malrotation is part of a spectrum of small and large bowel positional and fixational abnormalities caused by the failure of the fetal intestine to complete a 270-degree rotation around the superior mesenteric artery axis. Rarely, it presents in the adult as a cause of acute small bowel obstruction. Chronic symptoms of malrotation in adults are subtle, and include intermittent abdominal pain, nausea and vomiting. We present two cases of malrotation in octogenarian men presenting acutely with small bowel obstruction. Both patients were treated with emergency surgery. In one case the chronic symptoms resolved postoperatively. Malrotation and midgut volvulus should be considered as a rare differential diagnosis for small bowel obstruction in adults. Suspicions should be increased when there is a history of recurrent presentations with similar symptoms.


Assuntos
Obstrução Intestinal/cirurgia , Volvo Intestinal/congênito , Intestino Delgado/cirurgia , Idoso de 80 Anos ou mais , Constipação Intestinal/etiologia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Volvo Intestinal/diagnóstico por imagem , Volvo Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Masculino , Náusea/etiologia , Período Pós-Prandial , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Vômito/etiologia
2.
Khirurgiia (Mosk) ; (12): 66-73, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825345

RESUMO

RELEVANCE: The leveling of postoperative pain, early activation of patients are the leading components of the fast-track program, providing fast recovery with good quality of life, minimizing postoperative problems. In colorectal surgery, the most important factor determining the early recovery of patients is the normalization of bowel function, the restoration of defecation rhythm. AIM: To assess the possibility of using dietary fiber (arabinogalactan) in combination with lactoferrin (the drug Fibraxin, Alfa Sigma) in the complex postoperative therapy of proctologic patients, as well as to determine the effectiveness of their influence on the dynamics of rehabilitation. MATERIAL AND METHODS: A non-randomized cohort comparative prospective study was conducted in two clinical groups of 100 patients operated on for proctological pathology. In the first (control) group, after the operation, venotonics were prescribed for 2-3 weeks, as well as topical preparations - for 2.5 weeks. In the second (main) group, this treatment is supplemented with the use of Fibraxin, at a dosage of 6g 1 time per day, the observation period is 4 weeks. A comparative analysis of the rates of relief of postoperative defecation disorders, as well as the effect of the drug on the dynamics of the relief of leading postoperative complaints, has been carried out. RESULTS: In the main group, the best results were obtained for the main parameters analyzed, early normalization of the frequency and rhythm of bowel movements was achieved, with adequate relief of complaints of pain during bowel movements and after it. Intolerance to the drug and pathological reactions associated with its use was not. The positive effect of Fibraxin in patients with concomitant diseases of the colon, including colitis, irritable bowel syndrome, diverticular disease and chronic colonic stasis, was noted. CONCLUSION: The use of the drug Fibraxin at a dose of 6g per day allows a significant influence on the course of the postoperative period in proctological patients. The inclusion of Fibraxin in the scheme of rehabilitation treatment allows to stabilize the immediate results of treatment and reliably improve long-term, due to the correction of rectal dysfunction, elimination of dysbiosis, normalization of motility, as well as potentiation of reparative and restorative processes.


Assuntos
Defecação/fisiologia , Galactanos/administração & dosagem , Fármacos Gastrointestinais/administração & dosagem , Intestinos/fisiopatologia , Lactoferrina/administração & dosagem , Protectomia/reabilitação , Protocolos Clínicos , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Humanos , Intestinos/cirurgia , Laxantes/administração & dosagem , Protectomia/efeitos adversos , Estudos Prospectivos , Qualidade de Vida , Fatores de Tempo , Resultado do Tratamento
3.
Medicine (Baltimore) ; 98(45): e17855, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702647

RESUMO

Botulinum toxin (Botox) was introduced for the management of internal anal sphincter (IAS) achalasia after a pull-through procedure in Hirschsprung disease (HD). We conducted a prospective evaluation of the efficacy and safety of this Botox treatment.Our study group included 15 patients with HD (median age, 4.8 years; range, 1.7-7.4 years) who experienced persistent constipation after pull-through surgery. Rectal biopsy and colon study were performed before Botox injection to exclude agangliosis. Intersphincteric Botox injections (dose, 4 IU/kg) were performed at 3 sites, (3, 6, and 9 o'clock) under general anesthesia. Measured outcomes of efficacy included anorectal manometry, Wexner constipation score and the quality of life score for defecation, measured at baseline and at 2 weeks and 3 months after injection. The Holschneider incontinence score and an assessment of pain, bleeding, heating sensation, and swelling were also performed at follow-up as outcomes of safety.There was no significant change in measured outcomes with Botox treatment. Botox did decrease the number of patients who experienced abdominal distension at 3 months, compared to 2-weeks, post-injection. No major complications were identified, with only 2 cases of anal bleeding that resolved spontaneously. Local tenderness at the injection site was reported by 4 patients, recovering without treatment.The efficacy of Botox, injected into the IAS, for the treatment of achalasia is questionable on short-term follow-up. Larger studies with a longer follow-up period and the use of repeated injections are required to evaluate the evidence for this treatment.


Assuntos
Canal Anal/anormalidades , Toxinas Botulínicas Tipo A/administração & dosagem , Constipação Intestinal/tratamento farmacológico , Doença de Hirschsprung/cirurgia , Doenças Musculares/tratamento farmacológico , Fármacos Neuromusculares/administração & dosagem , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Feminino , Humanos , Lactente , Injeções , Masculino , Doenças Musculares/complicações , Complicações Pós-Operatórias/tratamento farmacológico , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento
4.
Acta Gastroenterol Belg ; 82(3): 441-443, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31566335

RESUMO

We present a case about a 53-year-old man who complained of abdominal pain and constipation. Computed tomography showed a well-described nodular structure of 6cm in size with a central dense core of 0.5cm with compression against the rectosigmoid. The presence of a foreign body was suggested and a diagnostic laparoscopy was performed. Surgery revealed a giant peritoneal loose body measuring 5.5cm in diameter. After the removal, the patient was relieved of his symptoms. Peritoneal loose bodies are usually small and asymptomatic. They are mostly found incidentally during laparotomy. Giant peritoneal loose bodies are a rare entity and diagnosis is difficult. A review of the literature is presented.


Assuntos
Dor Abdominal/etiologia , Calcinose/cirurgia , Constipação Intestinal/etiologia , Laparoscopia , Doenças Peritoneais/cirurgia , Peritônio/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Doenças Peritoneais/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
5.
Muscle Nerve ; 60(6): 732-738, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31520483

RESUMO

INTRODUCTION: Myotonic dystrophy type 1 (DM1) is caused by a CTG (cytosine-thymine-guanine) trinucleotide repeat expansion. Congenital DM (CDM) presents in the first month of life, whereas individuals with infantile and juvenile DM1 have later onset of symptoms. METHODS: We performed a retrospective chart review of patients with childhood-onset DM1 seen at one of three locations in Dallas, Texas between 1990 and 2018. Symptoms, disease course, cognitive features, and family history were reviewed. RESULTS: Seventy-four patients were included; CDM was diagnosed in 52 patients. There was maternal inheritance in 74% of patients. CTG repeat number ranged from 143 to 2300. Neuropsychiatric and cognitive deficits were common. Over half of the patients had GI disturbances, and orthopedic complications were common. DISCUSSION: Myotonic dystrophy type 1 in children requires a multidisciplinary approach to management. Presenting symptoms vary, and repeat expansion size does not necessarily directly relate to severity of symptoms. A consensus for outcome measures is required.


Assuntos
Distrofia Miotônica/fisiopatologia , Asma/etiologia , Asma/fisiopatologia , Transtorno do Deficit de Atenção com Hiperatividade/etiologia , Transtorno do Deficit de Atenção com Hiperatividade/fisiopatologia , Doença do Sistema de Condução Cardíaco/etiologia , Doença do Sistema de Condução Cardíaco/fisiopatologia , Criança , Pré-Escolar , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Deficiências do Desenvolvimento/etiologia , Deficiências do Desenvolvimento/fisiopatologia , Feminino , Refluxo Gastroesofágico/etiologia , Refluxo Gastroesofágico/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Herança Materna , Insuficiência da Valva Mitral/etiologia , Insuficiência da Valva Mitral/fisiopatologia , Transtornos do Humor/etiologia , Transtornos do Humor/fisiopatologia , Distrofia Miotônica/complicações , Distrofia Miotônica/genética , Miotonina Proteína Quinase/genética , Estudos Retrospectivos , Expansão das Repetições de Trinucleotídeos
6.
Urology ; 134: 228-231, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31560912

RESUMO

Pudendal nerve decompression surgery has not been studied or reported for the treatment of penile numbness in the absence of pain. Herein, we report a case of a male patient with chronic numbness of the penis and erectile dysfunction in the absence of pelvic pain who was found to have pudendal nerve entrapment. This patient was treated with surgical decompression of the pudendal nerves that resulted in the return of genital sensation and erections. Thus, we propose that pudendal nerve entrapment may be considered as a cause of penile numbness and that pudendal nerve decompression surgery in these patients may be effective.


Assuntos
Disfunção Erétil/etiologia , Hipestesia/etiologia , Pênis/inervação , Neuralgia do Pudendo/diagnóstico , Adulto , Constipação Intestinal/etiologia , Descompressão Cirúrgica , Incontinência Fecal/etiologia , Humanos , Masculino , Exame Neurológico , Neuralgia do Pudendo/complicações , Neuralgia do Pudendo/cirurgia , Incontinência Urinária/etiologia
7.
Cochrane Database Syst Rev ; 9: CD009710, 2019 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-31483486

RESUMO

BACKGROUND: Irritable bowel syndrome (IBS) is a common, chronic disorder that leads to decreased health-related quality of life and work productivity. A previous version of this review was not able to draw firm conclusions about the effectiveness of homeopathic treatment for IBS and recommended that further high quality RCTs were conducted to explore the clinical and cost effectiveness of homeopathic treatment for IBS. Two types of homeopathic treatment were evaluated in this systematic review: 1. Clinical homeopathy where a specific remedy is prescribed for a specific condition; 2. Individualised homeopathic treatment, where a homeopathic remedy based on a person's individual symptoms is prescribed after a detailed consultation. OBJECTIVES: To assess the effectiveness and safety of homeopathic treatment for IBS. SEARCH METHODS: For this update we searched MEDLINE, CENTRAL, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED), the Cochrane IBD Group Specialised Register and trials registers from inception to 31 August 2018. SELECTION CRITERIA: Randomised controlled trials (RCTs), cohort and case-control studies that compared homeopathic treatment with placebo, other control treatments, or usual care, in adults with IBS were considered for inclusion. DATA COLLECTION AND ANALYSIS: Two authors independently assessed the risk of bias and extracted data. The primary outcome was global improvement in IBS as measured by an IBS symptom severity score. Secondary outcomes included quality of life, abdominal pain, stool frequency, stool consistency, and adverse events. The overall certainty of the evidence supporting the primary and secondary outcomes was assessed using the GRADE criteria. We used the Cochrane risk of bias tool to assess risk of bias. We calculated the mean difference (MD) and 95% confidence interval (CI) for continuous outcomes and the risk ratio (RR) and 95% CI for dichotomous outcomes. MAIN RESULTS: Four RCTs (307 participants) were included. Two studies compared clinical homeopathy (homeopathic remedy, asafoetida or asafoetida plus nux vomica) to placebo for IBS with constipation (IBS-C). One study compared individualised homeopathic treatment (consultation plus remedy) to usual care for the treatment of IBS in female patients. One study was a three armed RCT comparing individualised homeopathic treatment to supportive listening or usual care. The risk of bias in three studies (the two studies assessing clinical homeopathy and the study comparing individualised homeopathic treatment to usual care) was unclear on most criteria and high for selective reporting in one of the clinical homeopathy studies. The three armed study comparing individualised homeopathic treatment to usual care and supportive listening was at low risk of bias in four of the domains and high risk of bias in two (performance bias and detection bias).A meta-analysis of the studies assessing clinical homeopathy, (171 participants with IBS-C) was conducted. At short-term follow-up of two weeks, global improvement in symptoms was experienced by 73% (46/63) of asafoetida participants compared to 45% (30/66) of placebo participants (RR 1.61, 95% CI 1.18 to 2.18; 2 studies, very low certainty evidence). In the other clinical homeopathy study at two weeks, 68% (13/19) of those in the asafoetida plus nux vomica arm and 52% (12/23) of those in the placebo arm experienced a global improvement in symptoms (RR 1.31, 95% CI 0.80 to 2.15; very low certainty evidence). In the study comparing individualised homeopathic treatment to usual care (N = 20), the mean global improvement score (feeling unwell) at 12 weeks was 1.44 + 4.55 (n = 9) in the individualised homeopathic treatment arm compared to 1.41 + 1.97 (n=11) in the usual care arm (MD 0.03; 95% CI -3.16 to 3.22; very low certainty evidence).In the study comparing individualised homeopathic treatment to usual care, the mean IBS symptom severity score at 6 months was 210.44 + 112.4 (n = 16) in the individualised homeopathic treatment arm compared to 237.3 + 110.22 (n = 60) in the usual care arm (MD -26.86, 95% CI -88.59 to 34.87; low certainty evidence). The mean quality of life score (EQ-5D) at 6 months in homeopathy participants was 69.07 (SD 17.35) compared to 63.41 (SD 23.31) in usual care participants (MD 5.66, 95% CI -4.69 to 16.01; low certainty evidence).For In the study comparing individualised homeopathic treatment to supportive listening, the mean IBS symptom severity score at 6 months was 210.44 + 112.4 (n = 16) in the individualised homeopathic treatment arm compared to 262 + 120.72 (n = 18) in the supportive listening arm (MD -51.56, 95% CI -129.94 to 26.82; very low certainty evidence). The mean quality of life score at 6 months in homeopathy participants was 69.07 (SD 17.35) compared to 63.09 (SD 24.38) in supportive listening participants (MD 5.98, 95% CI -8.13 to 20.09; very low certainty evidence).None of the included studies reported on abdominal pain, stool frequency, stool consistency, or adverse events. AUTHORS' CONCLUSIONS: The results for the outcomes assessed in this review are uncertain. Thus no firm conclusions regarding the effectiveness and safety of homeopathy for the treatment of IBS can be drawn. Further high quality, adequately powered RCTs are required to assess the efficacy and safety of clinical and individualised homeopathy for IBS compared to placebo or usual care.


Assuntos
Homeopatia/métodos , Síndrome do Intestino Irritável/terapia , Fitoterapia/métodos , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Fibras na Dieta/uso terapêutico , Feminino , Humanos , Masculino , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
8.
BMJ Case Rep ; 12(8)2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31434676

RESUMO

Ectopic adrenocorticotropic hormone (ACTH) syndrome (EAS) is rarely caused by a phaeochromocytoma. We report a case of a 51-year-old woman with an 8-year history of severe constipation who underwent extensive investigations including gastroscopy, colonoscopy, ultrasonography, colonic transit studies and isotope defeacography, which did not reveal any pathology other than slow colonic transit time. The unifying diagnosis of ectopic ACTH and phaeochromocytoma was made after the case was initially investigated for an adrenal incidentaloma. Multiple challenges had to be overcome prior to surgery for the functioning adrenal adenoma including management of refractory hypokalaemia, poor nutritional status, persistent hyperglycaemia, labile blood pressure and florid hypercortisolaemia driving the metabolic derangements. She underwent an uneventful left-sided adrenalectomy and required no medication thereafter with normal blood pressure, blood glucose and serum potassium and resolution of constipation and abdominal symptoms. In conclusion, patients with EAS related to phaeochromocytoma are rare and present with distinctive diagnostic and management challenges but if diagnosed successfully and managed intensively, they are curable.


Assuntos
Síndrome de ACTH Ectópico/diagnóstico , Constipação Intestinal/etiologia , Feocromocitoma/diagnóstico , Síndrome de ACTH Ectópico/complicações , Síndrome de ACTH Ectópico/cirurgia , Adrenalectomia , Doença Crônica , Constipação Intestinal/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Feocromocitoma/complicações , Feocromocitoma/cirurgia , Resultado do Tratamento
9.
World J Gastroenterol ; 25(25): 3268-3280, 2019 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-31333317

RESUMO

BACKGROUND: A large proportion of patients with Hirschsprung disease experience persistent obstructive symptoms after corrective surgery. Persistent obstructive symptoms may result in faecal stasis that can develop into Hirschsprung-associated enterocolitis, a potential life-threatening condition. Important treatment to improve faecal passage is internal anal sphincter relaxation using botulinum toxin injections. AIM: To give an overview of all empirical evidence on the effectiveness of botulinum toxin injections in patients with Hirschsprung disease. METHODS: A systematic review and meta-analysis was done by searching PubMed, EMBASE and the Cochrane Library, using entry terms related to: (1) Hirschsprung disease; and (2) Botulinum toxin injections. 14 studies representing 278 patients met eligibility criteria. Data that were extracted were proportion of patients with improvement of obstructive symptoms or less enterocolitis after injection, proportion of patients with adverse effects and data on type botulinum toxin, mean dose, average age at first injection and patients with associated syndromes. Random-effects meta-analysis was used to aggregate effects and random-effects meta-regression was used to test for possible confounding factors. RESULTS: Botulinum toxin injections are effective in treating obstructive symptoms in on average 66% of patients [event rate (ER) = 0.66, P = 0.004, I 2 = 49.5, n = 278 patients]. Type of botulinum toxin, average dose, average age at first injections and proportion of patients with associated syndromes were not predictive for this effect. Mean 7 duration of improvement after one botulinum toxin injections was 6.4 mo and patients needed on average 2.6 procedures. There was a significant higher response rate within one month after botulinum toxin injections compared to more than one month after Botulinum toxin injections (ER = 0.79, vs ER = 0.46, Q = 19.37, P < 0.001). Botulinum toxin injections were not effective in treating enterocolitis (ER 0.58, P = 0.65, I 2 = 71.0, n = 52 patients). There were adverse effects in on average 17% of patients (ER = 0.17, P < 0.001, I 2 = 52.1, n = 187 patients), varying from temporary incontinence to mild anal pain. CONCLUSION: Findings from this systematic review and meta-analysis indicate that botulinum toxin injections are effective in treating obstructive symptoms and that adverse effects were present, but mild and temporary.


Assuntos
Canal Anal/efeitos dos fármacos , Toxinas Botulínicas Tipo A/administração & dosagem , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Doença de Hirschsprung/cirurgia , Complicações Pós-Operatórias/terapia , Canal Anal/fisiopatologia , Toxinas Botulínicas Tipo A/efeitos adversos , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Constipação Intestinal/terapia , Enterocolite/etiologia , Enterocolite/fisiopatologia , Enterocolite/terapia , Doença de Hirschsprung/complicações , Humanos , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Fatores de Tempo , Resultado do Tratamento
11.
BMC Palliat Care ; 18(1): 57, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307441

RESUMO

BACKGROUND: Constipation is a common symptom for patients receiving palliative care. Whilst international clinical guidelines are available on the clinical management of constipation for people with advanced cancer receiving specialist palliative care (SPC), the extent to which the guidelines are implemented in practice is unclear. This study aimed to examine clinical practices for the assessment and management of constipation for patients with advanced cancer within inpatient SPC settings. METHODS: A multi-site retrospective case-note review was conducted, consisting of 150 patient case-notes from three inpatient SPC units across the United Kingdom between August 2016 and May 2017. The variables selected for review were determined by the recommendations within the clinical guidelines. Descriptive statistics, cross tabulation, chi square, and bivariate correlations were used to examine clinical practices compared to policy guidelines for the assessment and management of constipation. Reporting was structured by the STROBE checklist for observational research (Additional File 2). RESULTS: A comprehensive assessment, including a full history and performing a physical exam, was recorded for 109 patients (73%), however, no standardised documentation was utilised. Assessment was nurse led, with variable involvement across sites of other members of the multidisciplinary team (MDT). Education on prevention was documented in 30 (20%) case-notes, and 53% recorded evidence of non-pharmacological intervention. Age, gender, and reason for admission did not impact on the likelihood of receiving a comprehensive assessment, education, or non-pharmacological intervention, however, significant differences were evident between sites. Pharmacological management was well developed and aligned to the guidelines however, 33% of patient case-notes recorded no information on the titration of laxatives. Twelve percent of patients experienced partial or complete bowel obstruction, and management strategies were variable. CONCLUSIONS: Constipation management is driven by a pharmacological approach, with little evidence of the implementation of preventative and non-pharmacological strategies. The nurse plays a key coordinating role in assessment; however, involvement and roles of the wider MDT varies. Accurate recording of care is essential when examining clinical practice and identifying areas for improvement. Further education is needed to equip HCPs with the knowledge and skills to ensure consistency in assessment and implementation of appropriate non-pharmacological/ preventative strategies.


Assuntos
Constipação Intestinal/etiologia , Neoplasias/complicações , Cuidados Paliativos/métodos , Exame Físico/normas , Idoso , Idoso de 80 Anos ou mais , Constipação Intestinal/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/psicologia , Exame Físico/métodos , Exame Físico/tendências , Estudos Retrospectivos , Reino Unido
12.
Pediatr Surg Int ; 35(9): 1009-1012, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31256299

RESUMO

BACKGROUND: Sacral nerve stimulation (SNS) is frequently used for constipation and fecal incontinence in the adult literature. The purpose of this study is to perform a systemic review of the literature for SNS for constipation and fecal incontinence in children with emphasis in anorectal malformations. METHODS: Systematic literature review was conducted to include all SNS studies in patients < 19 years of age. Studies were separated into those for (1) constipation, (2) bowel and bladder dysfunction, and (3) anorectal malformations. RESULTS: 28 articles were included in the review: (1) 12 constipation (269 patients) and (2) 16 bowel and bladder dysfunction (441 patients). Some studies overlapped groups, as they included some patients with anorectal malformations (4 articles and 29 patients). Constipation studies included slow transit and retention constipation and showed varying degrees of improvement. For bowel and bladder dysfunction, studies also reported varying degrees of improvement using different measures (number of bowel movements per day, transit times, and soiling improvement). There was no specific description of the results in anorectal malformation (ARM) cases and also information regarding specific ARM type, sacral ratio, or presence of tethered cord. CONCLUSIONS: SNS for constipation and urinary problems seems to be promising. Data are limited and heterogeneous, and SNS cannot be definitively encouraged or discouraged in patients with ARM, based on current studies. Future studies should include more objective measurements of bowel outcomes and specify outcomes related to patients with anorectal malformations including information regarding their specific malformation, sacral ratio, and presence of tethered cord. Complications' rate is considerable high.


Assuntos
Malformações Anorretais/complicações , Constipação Intestinal/terapia , Terapia por Estimulação Elétrica/métodos , Incontinência Fecal/terapia , Sacro/inervação , Criança , Pré-Escolar , Constipação Intestinal/etiologia , Incontinência Fecal/etiologia , Feminino , Humanos , Masculino
14.
Curr Urol Rep ; 20(8): 41, 2019 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-31183573

RESUMO

PURPOSE OF REVIEW: No gold standard exists for managing neurogenic bowel dysfunction, specifically in individuals with spina bifida. Since the International Children's Continence Society published its consensus document on neurogenic bowel treatment in 2012, an increased focus on why we must manage bowels and how to improve our management has occurred. This review provides updated information for clinicians. RECENT FINDINGS: A surge in research, mostly retrospective, has been conducted on the success and satisfaction of three types of management for neurogenic bowel. All three management techniques have relatively high success rates for fecal continence and satisfaction rates. Selection of which treatment to carry out still is debated among clinicians. Transanal irrigation is a safe and effective management option for neurogenic bowel that does not require surgery. Antegrade enemas can be carried out via cecostomy tube or Malone antegrade continence enema with similar fecal continence outcomes.


Assuntos
Cecostomia , Enema/métodos , Intestino Neurogênico/terapia , Disrafismo Espinal/complicações , Irrigação Terapêutica , Canal Anal , Criança , Constipação Intestinal/etiologia , Constipação Intestinal/terapia , Incontinência Fecal/etiologia , Incontinência Fecal/terapia , Humanos , Intestino Neurogênico/etiologia , Intestino Neurogênico/cirurgia
15.
BMJ Case Rep ; 12(6)2019 Jun 08.
Artigo em Inglês | MEDLINE | ID: mdl-31177195

RESUMO

Incarcerated diaphragmatic hernias are often challenging to diagnose. 1 Patients often present with non-specific abdominal symptoms, and barring an imaging modality that confirms herniation of intra-abdominal contents, there is no investigation sensitive or specific enough to identify it. It is a rare cause of mechanical bowel obstruction that clinicians should be aware of. This report describes a case of an 81-year-old man who presented to the emergency department with ongoing dyspnoea and constipation secondary to a partial large bowel obstruction due to an incarcerated Morgagni hernia. This case highlights the non-specific symptoms of this condition that often leads to a delayed diagnosis and aims to increase the awareness among clinicians.


Assuntos
Constipação Intestinal/etiologia , Dispneia/etiologia , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas/cirurgia , Idoso de 80 Anos ou mais , Diagnóstico Tardio , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Hérnias Diafragmáticas Congênitas/complicações , Humanos , Laparoscopia , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento
16.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(4): 370-376, 2019 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-31054552

RESUMO

Objective: To investigate the clinical efficacy of laparoscopic subtotal colonic bypass plus colostomy with antiperistaltic cecoproctostomy (SCBCAC) in the treatment of senile slow transit constipation. Methods: A retrospective cohort study was performed. Clinical data of 30 colonic slow transit constipation patients aged ≥70 years old undergoing laparoscopic SCBCAC from July 2012 to October 2016 (bypass plus colostomy group), and 28 patients undergoing laparoscopic subtotal colonic bypass with antiperistaltic cecoproctostomy (SCBAC) from February 2009 to June 2012 (bypass group) at our institute were collected. Efficacy was compared between the two procedures. Inclusion criteria: (1) meeting the Rome III diagnosis criteria for constipation; (2) confirmed diagnosis of slow transit constipation; (3) age ≥ 70 years old; (4) receiving non-surgical treatment for more than 5 years, and Wexner constipation score > 15; (5) follow-up for more than 2 years. Those with psychiatric symptoms or previous psychiatric history, obvious signs of outlet obstructive constipation, organic diseases of the colon and life-threatening cardiovascular diseases or cancer were excluded. In the bypass plus colostomy group, laparoscopy was performed via five trocars. The ileocecal junction and the ascending colon were mobilized and the ileocecal junction was pulled down to the pelvic inlet. The ascending colon was transected and the appendix was excised. The lateral peritoneum of the sigmoid colon and the rectal mesentery were dissected and the upper rectum was transected. The avil of a circular stapler was placed in the bottom of the cecum. The shaft of the stapler was placed in the rectum via the anal canal to complete end-to-side anastomosis (end rectum to lateral cecum). The end of the rectal-sigmoid colon was used for colostomy via an extraperitoneal approach to complete the operation. The following efficacy indexes were collected before surgery and 3, 6, 12, and 24 months after surgery: the number of daily bowel movements, the Wexner incontinence scale (WIS, 0-20, the lower the better), the Wexner constipation scale (WCS, 0-30, the lower the better), the gastrointestinal quality of life index (GIQLI, 0-144, the higher score, the better), abdominal pain intensity indicated by the numerical rating scale (NRS, 0-10, the lower score, the better), and the abdominal bloating score (ABS, 0-4, the lower score, the better). The complications defined as Clavien-Dindo class II or above were observed and recorded. Results: No significant differences in preoperative WCS, WIS, GIQLI, NRS, and ABS were observed between bypass plus colostomy group and bypass group (all P>0.05). All the patients successfully underwent laparoscopic surgery and no patient in either group experienced postoperative fecal incontinence. WCS and GIQLI were significantly improved (all P<0.001) at 3, 6, 12, and 24 months after surgery in both groups. At 12 months after surgery, the number of bowel movements was significantly less in bypass plus colostomy group than that in bypass group [(2.4±0.7) times vs. (3.4±1.2) times, t=4.048, P<0.001]. At 3, 6, 12 and 24 months after surgery, the improvement of GIQLI in bypass plus colostomy group was significantly better than that in bypass group (all P<0.001). At 24 months after surgery, GIQLI in bypass plus colostomy group and bypass group was 122.3±5.3 and 92.8±16.6, respectively, with a significant difference (t=9.276, P<0.001). At 12 and 24 months after surgery, NRS in bypass plus colostomy group was significantly better than that in bypass group (both P<0.001). At 24 months after surgery, NRS in bypass plus colostomy group was 0.9±0.7, while that in bypass group was 3.7±2.7. There was a significant difference between two groups (t=5.585, P<0.001). At 6, 12 and 24 months after surgery, the improvement of ABS in bypass plus colostomy group was also significantly better than that in bypass group. At 24 months after surgery, ABS in bypass plus colostomy group was 0.6±0.6, while that in bypass group was 2.5±1.0, with a significant difference between two groups (t=8.797, P<0.001). At 1 year after surgery, barium enema examination was performed in all the patients of both groups. The barium emptying time was (21.2±3.8) hours and (95.8±86.2) hours in bypass plus colostomy group and bypass group respectively. The former group was significantly better than the latter group (t=4.740, P<0.001). Conclusions: Laparoscopic SCBCAC is an effective and safe procedure for the treatment of senile slow transit constipation and can significantly improve prognosis. Its clinical efficacy is better than laparoscopic SCBAC.


Assuntos
Colectomia , Colo/fisiopatologia , Colostomia , Constipação Intestinal/fisiopatologia , Constipação Intestinal/cirurgia , Trânsito Gastrointestinal , Idoso , Anastomose Cirúrgica/métodos , Antidiarreicos , Ceco/cirurgia , Colo/cirurgia , Constipação Intestinal/etiologia , Humanos , Laparoscopia , Qualidade de Vida , Reto/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
17.
Cir Pediatr ; 32(2): 81-85, 2019 Apr 22.
Artigo em Espanhol | MEDLINE | ID: mdl-31056868

RESUMO

AIM OF THE STUDY: To present our results with transanal irrigation (TAI) for management of fecal incontinence and fecal constipation without response to other treatments. METHODS: Retrospective study of patients with fecal constipation and/or fecal incontinence treated with TAI between 2013 and 2017. A Rintala questionnaire(1) was carried out comparing pre and post-treatment results. This study was approved by the ethical committee. MAIN RESULTS: Twenty-five patients were included with a median age of 13 years old (range 6-44 years). Nineteen patients had spinal pathology (76%), four colorectal surgery (16%) and two functional constipation (8%). They presented fecal incontinence in 20% of cases, 12% of fecal constipation and 68% both conditions. After a mean follow-up of 1.5 years (1 month-4 years), 52% of the patients abandoned the treatment. The mean Rintala score was 6.8±4 before treatment, and after, resulted to 11.42±2.75 (p=0.001). The main complications throughout the treatment were pain (68%) and balloon leaks (28%). The patients declared as cause of treatment cessation: reduced mobility (15%), fear or misinformation (32%) and pain (76%). All patients with reduced mobility (n=3) left treatment, versus 45% (n=12) of the patients that had full mobility (p=0.17, OR 8.3 [IC95% 0.3-38]). Complementary treatments such as laxatives, enemas or digital extraction were abandoned in 55% of the patients. CONCLUSIONS: Using TAI seems to improve quality of life in patients with fecal constipation and fecal incontinence refractory compared to other treatments. Our abandonment rate was higher than expected, so we believe it is necessary to create a support group to improve follow-ups.


Assuntos
Constipação Intestinal/terapia , Incontinência Fecal/terapia , Adolescente , Adulto , Criança , Constipação Intestinal/etiologia , Enema/efeitos adversos , Enema/métodos , Medo , Feminino , Seguimentos , Humanos , Laxantes/uso terapêutico , Masculino , Limitação da Mobilidade , Dor Processual/etiologia , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Prognóstico , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários , Irrigação Terapêutica/efeitos adversos , Irrigação Terapêutica/métodos , Irrigação Terapêutica/psicologia , Resultado do Tratamento , Adulto Jovem
19.
Gastroenterology ; 157(2): 507-521.e4, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31071306

RESUMO

BACKGROUND & AIMS: Mood disorders and constipation are often comorbid, yet their shared etiologies have rarely been explored. The neurotransmitter serotonin (5-HT) regulates central nervous system and enteric nervous system (ENS) development and long-term functions, including gastrointestinal (GI) motility and mood. Therefore, defects in neuron production of 5-HT might result in brain and intestinal dysfunction. Tryptophan hydroxylase 2 (TPH2) is the rate-limiting enzyme in 5-HT biosynthesis. A variant of TPH2 that encodes the R441H substitution (TPH2-R441H) was identified in individuals with severe depression. We studied mice with an analogous mutation (TPH2-R439H), which results in a 60%-80% decrease in levels of 5-HT in the central nervous system and behaviors associated with depression in humans. Feeding chow that contains 5-HTP slow release (5-HTP SR) to TPH2-R439H mice restores levels of 5-HT in the central nervous system and reduces depressive-like behaviors. METHODS: We compared the effects of feeding chow, with or without 5-HTP SR, to mice with the TPH2-R439H mutation and without this mutation (control mice). Myenteric and submucosal plexuses were isolated from all 4 groups of mice, and immunocytochemistry was used to quantify total enteric neurons, serotonergic neurons, and 5-HT-dependent subsets of neurons. We performed calcium imaging experiments to evaluate responses of enteric neurons to tryptamine-evoked release of endogenous 5-HT. In live mice, we measured total GI transit, gastric emptying, small intestinal transit, and propulsive colorectal motility. To measure colonic migrating motor complexes (CMMCs), we isolated colons and constructed spatiotemporal maps along the proximodistal length to quantify the frequency, velocity, and length of CMMCs. We measured villus height, crypt perimeter, and relative densities of enterochromaffin and enteroendocrine cells in small intestinal tissue. RESULTS: Levels of 5-HT were significantly lower in enteric neurons from TPH2-R439H mice than from control mice. TPH2-R439H mice had abnormalities in ENS development and ENS-mediated GI functions, including reduced motility and intestinal epithelial growth. Total GI transit and propulsive colorectal motility were slower in TPH2-R439H mice than controls, and CMMCs were slower and less frequent. Villus height and crypt perimeter were significantly decreased in colon tissues from TPH2-R439H mice compared with controls. Administration of 5-HTP SR to adult TPH2-R439H mice restored 5-HT to enteric neurons and reversed these abnormalities. Adult TPH2-R439H mice given oral 5-HTP SR had normalized numbers of enteric neurons, total GI transit, and colonic motility. Intestinal tissue from these mice had normal measures of CMMCs and enteric epithelial growth CONCLUSIONS: In studies of TPH2-R439H mice, we found evidence for reduced release of 5-HT from enteric neurons that results in defects in ENS development and GI motility. Our findings indicate that neuron production of 5-HT links constipation with mood dysfunction. Administration of 5-HTP SR to mice restored 5-HT to the ENS and normalized GI motility and growth of the enteric epithelium. 5-HTP SR might be used to treat patients with intestinal dysfunction associated with low levels of 5-HT.


Assuntos
5-Hidroxitriptofano/administração & dosagem , Constipação Intestinal/tratamento farmacológico , Depressão/tratamento farmacológico , Trato Gastrointestinal/fisiopatologia , Serotonina/metabolismo , Animais , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Preparações de Ação Retardada/administração & dosagem , Depressão/complicações , Depressão/genética , Depressão/fisiopatologia , Modelos Animais de Doenças , Sistema Nervoso Entérico/efeitos dos fármacos , Sistema Nervoso Entérico/fisiopatologia , Feminino , Motilidade Gastrointestinal/efeitos dos fármacos , Motilidade Gastrointestinal/fisiologia , Trato Gastrointestinal/efeitos dos fármacos , Trato Gastrointestinal/inervação , Humanos , Masculino , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Transgênicos , Mutação , Neurônios/efeitos dos fármacos , Neurônios/metabolismo , Resultado do Tratamento , Triptofano Hidroxilase/genética , Triptofano Hidroxilase/metabolismo
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