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1.
Medicine (Baltimore) ; 99(18): e19836, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358354

RESUMO

INTRODUCTION: Acute hemorrhagic rectal ulcer (AHRU) is a rare entity which has most frequently been described in Japan and Taiwan literature. This study characterizes 11 AHRUs identified and managed at an urban acute care hospital in the United States of America (USA). METHODS: A total of 2253 inpatients underwent colonoscopy. In 1172 patients (52%), colonoscopy was performed for evaluation of lower gastrointestinal (LGI) bleeding. Eleven (0.9%) of the 1172 patients with LGI bleeding had AHRU. RESULTS: AHRU is characterized by a sudden onset of painless and massive lower rectal bleeding in elderly, bedridden patients (pts) with major underlying diseases. The endoscopic findings were classified into 4 types. All 11 ulcers were located in the distal rectum within 10 cm of the dentate line. All 11 patients required blood transfusion (mean = 3.7 units; range 2-9 units). Seven patients responded to blood, plasma, and platelet transfusions. The other 4 patients required endoscopic hemostasis.Three patients died within a month of colonoscopy from comorbidities. None had bleeding as a cause of death. Eight surviving patients did not have recurrent bleeding. CONCLUSION: AHRU does exist in the USA and should be considered as an important cause of acute lower GI bleeding in elderly, critically ill, and bedridden patients. AHRU should be recognized and managed correctly.


Assuntos
Colonoscopia/estatística & dados numéricos , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/métodos , Doenças Retais/cirurgia , Úlcera/cirurgia , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hospitais Urbanos , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Retais/diagnóstico , Reto/irrigação sanguínea , Reto/cirurgia , Úlcera/diagnóstico , Estados Unidos
2.
Hautarzt ; 71(4): 275-283, 2020 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-32025745

RESUMO

BACKGROUND: Sexually transmitted infections (STIs) in the anorectal region are disproportionally detected in risk populations such as men who have sex with men (MSM). However, due to changes in sexual behaviour they are increasingly diagnosed in heterosexual individuals. Due to the recent implementation of oral HIV pre-exposure prophylaxis together with lack of condom use, a further rise in STIs is expected. OBJECTIVES: This review addresses epidemiology, clinical picture, diagnostic pitfalls and current therapy guidelines of "classical" bacterial STIs involving the anorectum. CONCLUSIONS: STI manifestations in the anal region are frequently nonspecific or asymptomatic so that the diagnosis may be missed. In an endoscopic examination of the rectum, they can even mimic inflammatory bowel disease or malignancy. Therefore, knowledge of possible symptoms of bacterial STIs in this area is helpful for early diagnosis. Coinfections with other STIs are common and should prompt a search of other pathogens including HIV and hepatitis B/C.


Assuntos
Doenças do Ânus/diagnóstico , Coinfecção/diagnóstico , Doenças Retais/diagnóstico , Comportamento Sexual , Doenças Sexualmente Transmissíveis , Sexo sem Proteção , Doenças do Ânus/epidemiologia , Doenças do Ânus/terapia , Infecções por Chlamydia/diagnóstico , Infecções por Chlamydia/epidemiologia , Infecções por Chlamydia/terapia , Coinfecção/epidemiologia , Feminino , Gonorreia/diagnóstico , Gonorreia/epidemiologia , Gonorreia/terapia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Heterossexualidade , Homossexualidade Masculina , Humanos , Linfogranuloma Venéreo/diagnóstico , Linfogranuloma Venéreo/epidemiologia , Linfogranuloma Venéreo/terapia , Masculino , Doenças Retais/epidemiologia , Doenças Retais/terapia , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/terapia , Sífilis/diagnóstico , Sífilis/epidemiologia , Sífilis/terapia
4.
BMC Surg ; 19(1): 180, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775691

RESUMO

BACKGROUND: Tailgut cysts arise from the remnants of the tailgut during the embryonic period. Although malignant transition of tailgut cysts is very rarely observed in the clinic, this congenital condition should be carefully monitored for early diagnosis and appropriate treatment, especially when the tailgut cysts are malignant. CASE PRESENTATION: Here, we report the case of a 33-year-old man with retrorectal adenocarcinoma originating from the tailgut cysts. Magnetic resonance imaging (MRI) showed many cystic masses in the posterior rectal space, the largest of which was approximately 100 mm × 59 mm × 53 mm in size and compressed the rectum. The patient underwent surgical resection of the masses located in the retrorectal and anterior sacral spaces. Histological and immunohistological examinations confirmed adenocarcinoma transition of the tailgut cysts. The patient recovered well and was discharged 10 days after surgery. CONCLUSIONS: We have reported a rare case of retrorectal adenocarcinoma originating from tailgut cysts. MRI, histological, and immunohistological examinations are vital for the diagnosis of tailgut cysts. Complete surgical resection of the tumor should be better performed.


Assuntos
Adenocarcinoma/patologia , Cistos/diagnóstico , Hamartoma/diagnóstico , Doenças Retais/diagnóstico , Adulto , Instituições de Assistência Ambulatorial , Cistos/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Sacro
6.
Lakartidningen ; 1162019 Nov 26.
Artigo em Sueco | MEDLINE | ID: mdl-31769859

RESUMO

Solitary rectal ulcer syndrome (SRUS) is a rare disorder likely to be caused by a traumatic and ischemic mucosal injury related to latent or overt rectal prolapse. Mucosal damage can vary between erythema and up to intractable ulceration. The typical symptoms of SRUS may resemble those of inflammatory bowel disease (IBD)-related proctitis or rectal malignancy with mucus- and blood-mixed defecation with urgency and sometimes transient incontinence. The purpose of this paper is to raise awareness of this rare, quality-of-life impacting and difficult-to-treat disease and the not so well-known argon plasma coagulation (APC) treatment that can provide very good and long lasting symptom relief.


Assuntos
Coagulação com Plasma de Argônio , Doenças Retais/cirurgia , Úlcera/cirurgia , Adulto , Procedimentos Clínicos , Endoscopia , Feminino , Humanos , Doenças Retais/diagnóstico , Doenças Retais/etiologia , Doenças Retais/patologia , Síndrome , Úlcera/diagnóstico , Úlcera/etiologia , Úlcera/patologia
7.
BMC Gastroenterol ; 19(1): 195, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752704

RESUMO

BACKGROUND: Hyperlipidaemia may be a potential risk factor for the occurrence of intestinal polyps. This study aimed to evaluate correlation between lipidaemia and the formation of colorectal polyps. METHODS: One hundred and fourteen patients with colorectal polyps and forty-eight healthy controls were included in this study. Colonoscopies were performed for all patients and controls within 1 week before blood samples were taken. The concentrations of serum lipids and lipoproteins were measured simultaneously using an automatic biochemical analyser. The colorectal lesions were classified based on pathological characteristics, and four types were identified in the study: hyperplastic polyp (HP), tubular adenoma (TA), tubulovillous adenoma (TVA) and adenoma with high-grade dysplasia (A-HGD). Advanced adenoma was classified according to the number, size and histological type of polyps. RESULTS: The value of low-density lipoprotein cholesterol (LDL-C) was significantly higher in the group with advanced adenoma than in the controls (p < 0.05). Moreover, the LDL-C values in the HP and TA groups were higher when compared to that of controls (p < 0.05). Obesity, age, and increased TG and LDL-C were independent risk factors for the formation of colorectal polyps. The cut-off values of triglyceride (TG) and LDL-C to distinguish polyp patients from healthy controls were 0.96 mmol/L (AUC = 0.604, p = 0.036) and 3.05 mmol/L (AUC = 0.654, p = 0.002). The combined use of increased LDL-C and TG levels to distinguish polyp patients was effective, with a sensitivity of 50.0% and a specificity of 89.6% (AUC = 0.733, p < 0.01). CONCLUSIONS: Colorectal polyps are more often found in obese and older patients. Increased LDL-C and TG were correlated with the occurrence of polyps. Combination of the two serum indicators was useful to assess risk of colorectal lesions, maybe more effective in screening hyperplastic polyp, tubular adenoma and advanced adenoma.


Assuntos
LDL-Colesterol/sangue , Pólipos do Colo/sangue , Pólipos Intestinais/sangue , Doenças Retais/sangue , Triglicerídeos/sangue , Adulto , Fatores Etários , Biomarcadores/sangue , Pólipos do Colo/diagnóstico , Colonoscopia , Humanos , Hiperlipidemias/complicações , Pólipos Intestinais/diagnóstico , Pessoa de Meia-Idade , Obesidade/complicações , Estudos Prospectivos , Doenças Retais/diagnóstico , Fatores de Risco
8.
Surg Clin North Am ; 99(6): 1151-1162, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676054

RESUMO

Medical treatment remains the mainstay of perianal disease management for CD; however, aggressive surgical management should be considered for severe or recurrent disease. In all cases of perianal CD, medical and surgical treatments should be used in tandem by a multidisciplinary team. Significant development has been made in the treatment of Crohn's-related fistulas, particularly minimally invasive options with recent clinical trials showing success with mesenchymal stem cell applications. Inevitably, some patients with severe refractory disease may require fecal diversion or proctectomy. When considering reversal of a diverting or end ileostomy, cessation of proctitis is the most important factor.


Assuntos
Doença de Crohn/terapia , Fístula Intestinal/cirurgia , Doenças Retais/terapia , Terapia Combinada , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Feminino , Humanos , Fístula Intestinal/etiologia , Fístula Intestinal/fisiopatologia , Masculino , Protectomia/efeitos adversos , Protectomia/métodos , Prognóstico , Doenças Retais/diagnóstico , Doenças Retais/etiologia , Medição de Risco , Índice de Gravidade de Doença , Resultado do Tratamento
10.
Am J Gastroenterol ; 114(11): 1772-1777, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31592781

RESUMO

OBJECTIVES: The impact of opioids on anorectal function is poorly understood but potentially relevant to the pathogenesis of opioid-induced constipation (OIC). To evaluate anorectal function testing (AFT) characteristics, symptom burden, and quality of life in chronically constipated patients prescribed an opioid (OIC) in comparison with constipated patients who are not on an opioid (NOIC). METHODS: Retrospective analysis of prospectively collected data on 3,452 (OIC = 588 and NOIC = 2,864) chronically constipated patients (Rome 3) who completed AFT. AFT variables included anal sphincter pressure and response during simulated defecation, balloon expulsion test (BET), and rectal sensation. Dyssynergic defecation (DD) was defined as an inability to relax the anal sphincter during simulated defecation and an abnormal BET. Patients completed Patient Assessment of Constipation Symptoms (PAC-SYM) and Patient Assessment of Constipation Quality of Life (PAC-QOL) questionnaires. RESULTS: The mean age of the study cohort was 49 years. Most patients were women (82%) and whites (83%). Patients with OIC were older than NOIC patients (50.7 vs 48.3, P = 0.001). OIC patients were significantly more likely to have DD (28.6% vs 21.4%, P < 0.001), an abnormal simulated defecation response on anorectal manometry (59% vs 43.8%, P < 0.001), and an abnormal BET (48% vs 42.5%, P = 0.02) than NOIC patients. OIC patients reported more severe constipation symptoms (P < 0.02) and worse quality of life (P < 0.05) than NOIC patients. DISCUSSION: Chronically constipated patients who use opioids are more likely to have DD and more severe constipation symptoms than NOIC.


Assuntos
Analgésicos Opioides/efeitos adversos , Ataxia , Doenças Funcionais do Colo , Constipação Intestinal , Qualidade de Vida , Doenças Retais , Ataxia/induzido quimicamente , Ataxia/diagnóstico , Ataxia/fisiopatologia , Doença Crônica , Doenças Funcionais do Colo/induzido quimicamente , Doenças Funcionais do Colo/diagnóstico , Doenças Funcionais do Colo/fisiopatologia , Constipação Intestinal/diagnóstico , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Constipação Intestinal/psicologia , Efeitos Psicossociais da Doença , Defecação , Feminino , Humanos , Masculino , Manometria/métodos , Pessoa de Meia-Idade , Doenças Retais/induzido quimicamente , Doenças Retais/diagnóstico , Doenças Retais/fisiopatologia , Índice de Gravidade de Doença
11.
Zentralbl Chir ; 144(4): 340, 2019 08.
Artigo em Alemão | MEDLINE | ID: mdl-31412414
12.
Pediatr Surg Int ; 35(10): 1137-1141, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31420742

RESUMO

PURPOSE: The aim of this study was to investigate risk factors for recurrence in the perineal canal (PC). METHODS: Patients with PC who underwent operations were enrolled in this study and were divided into recurrence and non-recurrence groups. Preoperative infection, the age at the operation, the presence of colostomy and the treatment procedure for fistula were retrospectively investigated. Regarding the treatment procedure for fistula, either closure of the rectal wall with stitches or ligation of fistula in the rectum was performed. These factors were compared between the two groups. RESULTS: Six of 17 patients with PC who underwent surgical treatment had recurrence. There were no significant differences in the incidence of preoperative infection, age at operation or presence of colostomy (p = 0.60, 0.38, 1.00, respectively). In the recurrence group, all patients were treated by closure of the rectal wall. In the non-recurrence group, five were treated by the closure of the rectal wall with stitches and six by ligation of the fistula. There was a significant association between recurrence and the treatment procedure for fistula (p = 0.04). CONCLUSION: Closure of the rectal wall with stitches is a risk factor for the recurrence of PC.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Fístula/cirurgia , Períneo/anormalidades , Doenças Retais/cirurgia , Reto/anormalidades , Feminino , Fístula/diagnóstico , Humanos , Lactente , Masculino , Períneo/cirurgia , Doenças Retais/diagnóstico , Reto/cirurgia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
13.
Rev Gastroenterol Peru ; 39(2): 136-140, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31333230

RESUMO

OBJECTIVE: To describe the anorectal manometry results in the pediatric population with chronic constipation and acquired anorectal disease. MATERIALS AND METHODS: We reviewed the records of children who were referred to the Motility and Pelvic Floor Laboratory of the Hospital San Jose Tecnologico de Monterrey between 2004-2016 for further evaluation with anorectal manometry and who presented acquired anorectal disease. RESULTS: We reviewed 170 records. The mean age was 7.18 ± 4.51 years old. The prevalence of anorectal disease was 73%. The symptoms more frequently presented were difficult evacuation (78%), painful defecation (67%), large and hard stool (50%) and fecal soiling (49%). 44% of patients with hypotonic external anal sphincter (EAS) presented with soiling and 74% of those had diminished critical volume. Significant manometric values (p<0.05) were EAS resting pressure, maximal squeeze pressure, and critical volume. 97.7% of those who underwent abdomino pelvic coordination evaluation had pelvic floor dyssynergia (anismus). CONCLUSIONS: Contrary to adult population, the manometric values in children with acquire anorectal pathology were within normal values except for the EAS resting pressure and critical volume that were diminished. This could suggest a different mechanism in the pediatric population. Pelvic floor dyssynergia could explain chronic constipation in these patients.


Assuntos
Canal Anal/fisiopatologia , Constipação Intestinal/fisiopatologia , Doenças Retais/fisiopatologia , Reto/fisiopatologia , Criança , Pré-Escolar , Doença Crônica , Constipação Intestinal/complicações , Estudos Transversais , Feminino , Humanos , Masculino , Manometria , Doenças Retais/complicações , Doenças Retais/diagnóstico , Doenças Retais/epidemiologia
14.
Curr Gastroenterol Rep ; 21(7): 33, 2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31281951

RESUMO

PURPOSE OF REVIEW: Systemic sclerosis is a chronic autoimmune disorder commonly involving the gastrointestinal tract, including the colon and anorectum. In this review, we summarize major clinical manifestations and highlight recent developments in physiology, diagnostics, and treatment. RECENT FINDINGS: The exact pathophysiology of systemic sclerosis is unclear and likely multifactorial. The role of the microbiome on gastrointestinal manifestations has led to a better understanding of potential pathogenic gut flora. Carbohydrate malabsorption is common. Evaluation using fecal calprotectin and high-resolution anorectal manometry may broaden our understanding of the etiologies of diarrhea and fecal incontinence and help with early recognition of pathology. Prucalopride, a high-affinity 5HT4 agonist, and pyridostigmine, an acetylcholinesterase inhibitor, may help improve colonic transit in patients with constipation. Intravenous immunoglobulins have been used to target muscarinic receptor antibodies that are believed to contribute to gastrointestinal dysmotility. Colonic and anorectal manifestations of systemic sclerosis include constipation, diarrhea, and fecal incontinence, and can diminish quality of life for these patients. Recent studies regarding pathophysiology as well as diagnostic and treatment options are promising. Further targeted studies to facilitate early intervention and better management of refractory symptoms are still needed.


Assuntos
Doenças do Colo/etiologia , Doenças Retais/etiologia , Escleroderma Sistêmico/complicações , Doenças do Colo/diagnóstico , Doenças do Colo/terapia , Humanos , Doenças Retais/diagnóstico , Doenças Retais/terapia
15.
J Laparoendosc Adv Surg Tech A ; 29(9): 1122-1127, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31343375

RESUMO

Background: Since introduced in 2010, the transanal minimally invasive surgery (TAMIS) has been gaining popularity worldwide for local excision of benign and early-stage malignant rectal lesions of the proximal and mid-rectum. The aim of this study was to review our experience with the procedure, including mid-term oncological outcomes. Materials and Methods: This is a retrospective descriptive study. The data collected include all patients who underwent TAMIS procedure in a single tertiary institute. Results: Forty TAMIS procedures were performed on 38 patients, 78% men and 22% women, with a median age of 67 years. The indications were 24 benign lesions, 14 adenocarcinoma, and 1 neuroendocrine tumor. The average lesion size was 43.2 mm and the average distance from the anal verge was 8 cm (range 5-12). We had no intraoperative complications and overall the 30-day morbidity rate was 20%, of which only one was major complication. No perioperative mortality was encountered. After a mean follow-up time of 26 months we had 3 cases of local recurrence (21.4%) of which 2 cases had high-risk features on the primary TAMIS pathology and refused our advice for completion proctectomy. Hence, they were both treated eventually with adjuvant radiotherapy. The distant recurrence rate was 14.2%. Conclusions: The TAMIS procedure is an acceptable option for local excision of rectal lesions for carefully selected patients. It has overt benefits of lower morbidity and easier recovery compared with radical surgery. When it is utilized for early-stage rectal cancers, high-risk pathological features should prompt a completion proctectomy.


Assuntos
Canal Anal/cirurgia , Doenças Retais/cirurgia , Cirurgia Endoscópica Transanal/métodos , Idoso , Canal Anal/diagnóstico por imagem , Feminino , Seguimentos , Humanos , Incidência , Israel/epidemiologia , Masculino , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Recidiva Local de Neoplasia/epidemiologia , Estadiamento de Neoplasias , Doenças Retais/diagnóstico , Neoplasias Retais/diagnóstico , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
17.
Chirurgia (Bucur) ; 114(2): 268-277, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31060660

RESUMO

Background: Mobilization of the colonic splenic flexure (SFM) is an essential surgical step of the restorative rectal resections. However, the surgical procedures are technically complex thereby overcoming the learning curve may not be an easy process. Looking for improved expertise and better outcomes, in 2016, we have decided to routinely perform SFM as a first step of all the laparoscopic or robotic sigmoid and rectal resections. The aim of this paper is to describe the technique of laparoscopic splenic flexure mobilization and to discuss the advantages of using it as the first surgical step in colorectal rectal resection analyzing our last 12 months experience (2018). Method: A detailed description of the laparoscopic surgical technique for SFM is performed. There are four routes for SFM: two from medial to lateral, one starting from the splenic vein the other one from the promontory, a superior to inferior approach and a lateral to medial approach. However, the combination of different maneuvers for an easier, safer approach decreases the morbidity and is saving surgical time. Results: Between January and December 2018, 47 patients had SPM as a first step of the performed colorectal procedure in our institution. There were 30 patients with rectal cancer, 10 with sigmoidal tumors, five with sigmoidal resection for diverticulitis and Hartmann reversal was indicated in two. The robotic approach has been used in 40% (16 patients). No intraoperative incidents were associated with the SFM. No colorectal fistula was encountered. No early cancer recurrence, deaths or major complication were encountered. The mean follow-up for these patients is 7 months (range, 4-12 months). Conclusions: In our perspective, the routine mobilization of the splenic flexure as a first step of the colorectal restorative resections associate many advantages and these strategies should be largely used. There is a learning curve involved in such procedure and it can easily be overcome in high volume centers.


Assuntos
Colectomia/métodos , Doenças do Colo/cirurgia , Laparoscopia/métodos , Protectomia/métodos , Doenças Retais/cirurgia , Anastomose Cirúrgica , Colo Sigmoide/cirurgia , Doenças do Colo/diagnóstico , Humanos , Curva de Aprendizado , Mesentério/cirurgia , Peritônio/cirurgia , Doenças Retais/diagnóstico , Reto/cirurgia , Procedimentos Cirúrgicos Robóticos , Resultado do Tratamento
18.
Korean J Gastroenterol ; 73(5): 299-302, 2019 May 25.
Artigo em Coreano | MEDLINE | ID: mdl-31132828

RESUMO

Rectal involvement by systemic lupus erythematosus (SLE) is quite rare. Approximately 14 cases have been reported worldwide, but only one with ischemic colitis has been reported in Korea. A 17-year-old female patient was hospitalized with abdominal pain and hematochezia. Sigmoidoscopy revealed only a simple rectal ulcer without ischemic colitis. cytomegalovirus and bacterial infections were excluded. A sigmoidoscopic rectal biopsy indicated a rectal invasion by SLE, but the patient showed an acute worsening conditions that did not respond to treatment. This paper reports a case of rectal ulcer that developed in SLE without ischemic colitis with a review of the relevant literature.


Assuntos
Lúpus Eritematoso Sistêmico/diagnóstico , Doenças Retais/diagnóstico , Abscesso/etiologia , Adolescente , Feminino , Humanos , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Doenças Retais/complicações , Doenças Retais/patologia , Sigmoidoscopia , Esteroides/uso terapêutico , Tomografia Computadorizada por Raios X , Úlcera/complicações , Úlcera/diagnóstico
20.
ANZ J Surg ; 89(4): E113-E116, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30887672

RESUMO

BACKGROUND: Haematochezia or per rectal (PR) bleeding is the most common presentation of lower gastrointestinal bleeding. This study analyses the hospital resources used in the management of patients with PR bleeding. METHODS: A retrospective analysis was performed on patients who presented with PR bleeding from June 2012 to December 2013 to a single tertiary centre in Sydney, Australia. Age, gender, comorbidities, use of antiplatelet or anticoagulant medications, vital signs, and haematological data were recorded. The objective factors available on initial patient assessment were analysed for their relationship with the following outcomes: use of computed tomography mesenteric angiogram, formal angiography and embolization, transfusion of blood products, endoscopy, operative management and length of stay. RESULTS: There were 523 confirmed presentations of PR bleeding. Four hundred and fifty-two of these presented directly to emergency department, while 71 were referred from another hospital. One in five patients had blood transfusion (19%), 13% had computed tomography mesenteric angiogram, 4% had embolization and 13% underwent diagnostic and/or therapeutic colonoscopy. Patients referred from other facilities were more comorbid (55% versus 30%), more likely to be on antiplatelet or anticoagulant (69% versus 33%) with a higher rate of embolization (28% versus 4%), more packed cell transfusions (2.1 versus 0.7 units) and longer length of stay (7.9 versus 5.7 days) but mortality was the same (1%). CONCLUSIONS: The management of patients with PR bleeding is resource intensive. Better identification and allocation of resources in patients who present with PR bleeding may lead to better efficiency in managing this growing clinical problem.


Assuntos
Transfusão de Sangue/métodos , Gerenciamento Clínico , Embolização Terapêutica/métodos , Hemorragia Gastrointestinal/terapia , Recursos em Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Doenças Retais/terapia , Idoso , Colonoscopia , Angiografia por Tomografia Computadorizada/métodos , Feminino , Seguimentos , Hemorragia Gastrointestinal/diagnóstico , Humanos , Tempo de Internação , Masculino , Artérias Mesentéricas/diagnóstico por imagem , Pessoa de Meia-Idade , New South Wales , Doenças Retais/diagnóstico , Estudos Retrospectivos
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