Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 143
Filtrar
1.
Gastrointest Endosc ; 90(2): 269-275, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30738034

RESUMO

BACKGROUND AND AIMS: It is standard of care to perform ileocolonoscopy within a year of ileocolonic resection for Crohn's disease (CD) and to guide management decisions based on the Rutgeert score (RS). The modified RS subdivides i2 into lesions confined to the anastomosis (i2a) or >5 aphthous lesions in the neoterminal ileum (i2b). There is uncertainty, however, if i2a lesions incur an increased risk of disease recurrence. The primary aim of this study was to compare the rates of endoscopic progression between i2a and i2b when compared with i0-i1. METHODS: This was a retrospective, single-center study including patients with CD who had an ileocolonoscopy ≤12 months after ileocolonic resection with primary anastomosis and who had >1 year of documented clinical follow-up after the index endoscopic evaluation. All consecutive eligible patients between 2004 and 2014 were included in the study. Demographic, disease, and treatment data were collected. Patients with i3 or i4 at index colonoscopy were excluded from further analyses. Outcomes included endoscopic progression and recurrent surgery. For patients with RS of i0 to i2, endoscopic progression was predefined as progression of the RS in subsequent colonoscopies to i3 or i4. Recurrent surgical interventions were defined as re-resection or stricturoplasty of the previous ileocolonic anastomosis. RESULTS: Two hundred seven CD patients (median age, 36 years [interquartile range, 26-48]) had an ileocolonoscopy ≤12 months after ileocolonic resection. At index colonoscopy, 95 patients (45.9%) had an RS of i0, 31 (14.9%) i1, 40 (19.3%) i2a, 25 (12.1%) i2b, 10 (4.8%) i3, and 6 (2.9%) i4. One hundred ninety-one patients had an RS of i0 to i2 and were included in the analyses for recurrent surgery. One hundred forty-nine patients had a second endoscopic evaluation and were included in the analysis for the primary outcome of endoscopic disease progression. Kaplan-Meier analyses were performed and found the hazard ratio (HR) of endoscopic progression to be significantly higher with i2b lesions when compared with i0 or i1 (HR, 6.22; 95% confidence interval [CI], 2.38-16.2; P = .0008). Patients with i2a did not have significantly higher rates of endoscopic progression when compared with i0 or i1 (HR, 2.30; 95% CI, .80-6.66; P = .12). Likewise, patients with i2b lesions had higher risk of needing recurrent surgery when compared with i0 or i1 (HR, 3.64; 95% CI, 1.10-12.1; P = .034), whereas patients with i2a lesions were not found to have a significantly elevated risk of recurrent surgery (HR, 1.43; 95% CI, .35-5.77; P = .62). CONCLUSION: Endoscopic lesions limited to the ileocolonic anastomosis (RS i2a) in patients with CD undergoing colonoscopy within 1 year of their resection were not associated with a significantly higher rate of progression to more severe disease, whereas those in the neoileum (RS i2b) were. Prospective studies are needed to confirm these findings.


Assuntos
Colo/cirurgia , Doença de Crohn/cirurgia , Doenças do Íleo/epidemiologia , Íleo/cirurgia , Complicações Pós-Operatórias/epidemiologia , Úlcera/epidemiologia , Adulto , Anastomose Cirúrgica , Colonoscopia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença
2.
Dis Colon Rectum ; 61(5): 586-592, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29630003

RESUMO

BACKGROUND: Previous studies suggest that urgent colectomy and primary anastomosis with diversion is safe for perforated diverticulitis. Current guidelines support this approach. OBJECTIVE: The purpose of this study was to describe the use of urgent or emergent primary anastomosis with diversion in diverticulitis before the 2014 American Society of Colon and Rectal Surgeons guidelines and compare national outcomes of primary anastomosis with diversion to the Hartmann procedure. DESIGN: This was a national retrospective cohort study. SETTINGS: The study was conducted with a national all-payer US sample from 1998 to 2011. PATIENTS: Patients included those admitted and treated with urgent or emergent colectomy for diverticulitis. Exclusion criteria were age <18 years, concurrent diagnosis of colorectal cancer or IBD, no fecal diversion performed, and operations >24 hours after admission. MAIN OUTCOME MEASURES: In-hospital mortality was measured. RESULTS: A total of 124,198 patients underwent emergent or urgent colectomy for acute diverticulitis; 67,721 underwent concurrent fecal diversion, including 65,084 (96.1%) who underwent end colostomy and 2637 (3.9%) who underwent anastomosis with ileostomy. The rate of primary anastomosis with diverting ileostomy increased from 30 to 60 diverting ileostomy cases per 1000 operative diverticulitis cases in 1998 versus 2011 (incidence rate ratio = 2.04 (95% CI, 1.70-2.50). However, overall use remained low, with >90% of patients undergoing end colostomy. Complication rates were higher (32.1% vs 23.3%; p < 0.001) and in-hospital mortality rates were higher (16.0% vs 6.4%; p < 0.001) for primary anastomosis with diversion patients compared with end colostomy. These findings were consistent on multivariable logistic regression. Other factors that contributed to in-hospital mortality included increasing age, increasing comorbid disease burden, and socioeconomic status. LIMITATIONS: Billing data can be inaccurate or biased because of nonmedically trained professional data entry. Selection bias could have affected the results of this retrospective study. CONCLUSIONS: The use of primary anastomosis with proximal diversion for urgent colectomy in diverticulitis increased over our study period; however, overall use remained low. Poor national outcomes after primary anastomosis with proximal diversion might affect compliance with new guidelines. See Video Abstract at http://links.lww.com/DCR/A600.


Assuntos
Colectomia/métodos , Colo/cirurgia , Diverticulite/cirurgia , Emergências , Doenças do Íleo/cirurgia , Ileostomia/métodos , Íleo/cirurgia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Colostomia/métodos , Diverticulite/mortalidade , Feminino , Seguimentos , Mortalidade Hospitalar/tendências , Humanos , Doenças do Íleo/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Resultado do Tratamento , Estados Unidos/epidemiologia , Adulto Jovem
3.
Dig Dis Sci ; 63(6): 1592-1599, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29611078

RESUMO

BACKGROUND: The literature on disease characteristics of colonic Crohn's disease (CD) is sparse, especially from Asia, where the burden of inflammatory bowel disease is on the rise. The present study aims to describe the disease characteristics of colonic CD, and compare it with that of ileal/ileocolonic disease. METHODS: This retrospective study included adult patients of CD (diagnosed by standard criteria, follow-up duration > 6 months) on follow-up between August 2004 and January 2016. The disease location was classified by Montreal classification. The data were recorded on demographic characteristics, smoking status, disease phenotype, disease course, treatment received, hospitalization and surgeries. RESULTS: Of 406 CD patients, 123 had colonic [mean age (at onset) 30.4 ± 13.2 years, 59.3% males] and 265 had ileal/ileocolonic disease [mean age (at onset) 32.9 ± 13.8 years, 61.5% males] while 18 patients had isolated upper GI disease. The frequency of inflammatory behavior (B1 phenotype; 61.8 vs. 46.4%, p = 0.003), perianal disease (23.6 vs. 4.5%, p < 0.001), and extra-intestinal manifestation (42.3 vs. 30.2%, p = 0.019) was higher in colonic than ileal/ileocolonic CD. Though not statistically significant, requirement of atleast one course of steroid was lower in colonic CD (72.7 vs. 84.2%, p = 0.098). Although there was no difference in the frequency of hospitalization (30.1 vs. 27.1%, p = 0.45), the overall requirement for surgery was significantly lower in colonic CD (17.1 vs. 26.1%, p = 0.032) and patients with colonic disease had a lower cumulative probability of first surgery in the first 10 years of follow-up [Hazard ratio 0.556 (95% CI 0.313-0.985), p = 0.045]. CONCLUSION: Colonic CD was associated with less aggressive disease behavior and lower requirement of surgery as compared to ileal/ileocolonic CD.


Assuntos
Doenças do Colo , Doença de Crohn , Doenças do Íleo , Adolescente , Adulto , Doenças do Colo/diagnóstico , Doenças do Colo/epidemiologia , Doenças do Colo/terapia , Doença de Crohn/diagnóstico , Doença de Crohn/epidemiologia , Doença de Crohn/terapia , Procedimentos Cirúrgicos do Sistema Digestório , Feminino , Hospitalização , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/epidemiologia , Doenças do Íleo/terapia , Índia/epidemiologia , Masculino , Fenótipo , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/epidemiologia , Adulto Jovem
4.
Vaccine ; 36(51): 7775-7779, 2018 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-28709556

RESUMO

BACKGROUND: Rotavirus vaccination introduction in routine immunization is under consideration in Pakistan. Data on the baseline epidemiology of intussusception will inform surveillance strategies for intussusception after rotavirus vaccine introduction in Pakistan. We describe the epidemiology of intussusception-associated hospitalizations among children <2years of age in Karachi, Pakistan. METHODS: We conducted a retrospective chart review for July 01, 2012 through June 30, 2015 at the National Institute of Child Health (NICH) and Aga Khan University Hospital (AKUH) Karachi. At AKUH, the International Classification of Disease, ninth revision, code 560.0 for intussusception was used to retrieve intussusception case records. At NICH, daily Operation Theater, Emergency Room, and surgical daycare log sheets and surgical ward census sheets were used to identify cases. Records of children who fulfilled eligibility criteria and the Brighton Collaboration level one case definition of intussusception were selected for data analysis. We used structured case report forms to extract data for the descriptive analysis. RESULTS: We identified 158 cases of confirmed intussusception; 30 cases (19%) were from AKUH. More than half (53%) of the cases occurred in children aged 6-12months, followed by 35% among those aged <6months. Two-thirds (106/158) of the cases were male. The most common presenting complaints were vomiting and bloody stool. At NICH, almost all (93%) were managed surgically, while at AKUH, ∼57% of the cases were managed with enemas. Three deaths occurred, all from NICH. Cases occurred without any seasonality. At NICH, 4% (128/3618) of surgical admissions among children aged <2years were attributed to intussusception, while that for AKUH was 2% (30/1702). CONCLUSION: In this chart review, intussusception predominantly affected children 0-6months of age and occurred more commonly in males. This information on the baseline epidemiology of intussusception will inform post-vaccine introduction adverse event monitoring related to intussusception in Pakistan.


Assuntos
Monitoramento Epidemiológico , Hospitalização/estatística & dados numéricos , Doenças do Íleo/epidemiologia , Intussuscepção/epidemiologia , Vacinas contra Rotavirus/efeitos adversos , Feminino , Humanos , Lactente , Recém-Nascido , Intussuscepção/diagnóstico , Masculino , Paquistão/epidemiologia , Estudos Retrospectivos , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Centros de Atenção Terciária , Vacinação/efeitos adversos
5.
J Neonatal Perinatal Med ; 10(3): 281-289, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28854518

RESUMO

OBJECTIVE: To compare demographic data, prenatal and postnatal characteristics, laboratory data, and outcomes in a cohort of premature infants with spontaneous ileal perforation (SIP), surgical necrotizing enterocolitis (sNEC) and matched controls. METHODS: A retrospective case-control study of infants with intestinal perforation with a birth weight (BW) less than 2,000 grams and gestational age (GA) less than 34 weeks and infants without perforation matched for BW (±150 grams) and GA (±1week). RESULTS: 130 premature infants were included, 30 infants with SIP, 35 infants with sNEC and 65 control infants. The median age of onset was 5 days postnatal age in SIP versus 25 days in sNEC (p < 0.001) and the peak onset was at 26 weeks corrected GA for SIP and 30 weeks corrected GA for sNEC. Infants with perforation had significantly higher rates of mortality (p < 0.001) and common morbidities associated with prematurity. Administration of corticosteroids and indomethacin did not differ among groups. SIP was more common among infants born to young mothers (p = 0.04) and less common in infants receiving caffeine (p = 0.02). sNEC was less common among infants receiving early red cell transfusion (p = 0.01). Perforation and sNEC trended towards less common in infants receiving inhaled nitric oxide. CONCLUSION: SIP and sNEC are distinct clinical entities. Potential protective effects of caffeine, inhaled nitric oxide, and early transfusion should be further studied.


Assuntos
Enterocolite Necrosante/epidemiologia , Doenças do Íleo/epidemiologia , Perfuração Intestinal/epidemiologia , Administração por Inalação , Adulto , Idade de Início , Estudos de Casos e Controles , Estudos de Coortes , Fatores Relaxantes Dependentes do Endotélio/uso terapêutico , Enterocolite Necrosante/cirurgia , Enterostomia , Feminino , Humanos , Hipertensão/epidemiologia , Doenças do Íleo/cirurgia , Lactente Extremamente Prematuro , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Perfuração Intestinal/cirurgia , Masculino , Idade Materna , Óxido Nítrico/uso terapêutico , Gravidez , Complicações na Gravidez/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Ruptura Espontânea , Adulto Jovem
6.
Korean J Intern Med ; 32(5): 916-922, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28797160

RESUMO

BACKGROUND/AIMS: In some Western countries, up to 50% of patients with ankylosing spondylitis (AS) have subclinical gut inflammation. This study was conducted to evaluate the prevalence and severity of gut inflammation and to determine clinical factors associated with colonic inflammation in Korean AS patients who performed ileocolonoscopy without evidence of established inf lammatory bowel diseases before. METHODS: One hundred and eight AS patients who underwent ileocolonoscopy were included in this study. Patients were divided into two groups based on gross ileocolonoscopic findings; patients with inflammatory lesions, and patients without inflammatory lesions. RESULTS: Inf lammatory lesions in ileocolonoscopic findings were found in 40 patients. The Ankylosing Spondylitis Disease Activity Score C-reactive protein was higher in the group with inflammatory lesions and gut lesions were found often in the terminal ileum. The risk of inflammatory lesions was higher for AS patients whose symptoms required ileocolonoscopy than for AS patients who underwent routine ileocolonoscopy screening (odds ratio, 3.96). However, abnormal lesions were detected also in 17.6% of the patients who underwent ileocolonoscopy for routine screening and most of them were erosion and ulcer. Among patients with inflammatory lesions (n = 40), 23 showed subclinical gut inflammation associated with AS and 17 were diagnosed finally as Crohn's disease (n = 12), intestinal tuberculosis (n = 4), and ulcerative colitis (n = 1). CONCLUSIONS: Our findings suggest that ileocolonoscopy might be recommended regularly in AS patients even without gastrointestinal symptoms, especially in the patients with high AS activity.


Assuntos
Colite Ulcerativa/patologia , Colonoscopia , Doença de Crohn/patologia , Doenças do Íleo/patologia , Espondilite Anquilosante/epidemiologia , Tuberculose Gastrointestinal/diagnóstico , Adulto , Distribuição de Qui-Quadrado , Colite Ulcerativa/epidemiologia , Doença de Crohn/epidemiologia , Feminino , Humanos , Doenças do Íleo/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Razão de Chances , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Fatores de Risco , Seul/epidemiologia , Índice de Gravidade de Doença , Espondilite Anquilosante/diagnóstico , Tuberculose Gastrointestinal/epidemiologia
7.
Dig Dis Sci ; 62(6): 1607-1614, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28315037

RESUMO

BACKGROUND: Incidence of and risk factors for intestinal free perforation (FP) in patients with Crohn's disease (CD) are not established. AIM: To establish rate of and risk factors for FP in a large cohort of CD patients. METHODS: Medical records of CD patients who visited Asan Medical Center from June 1989 to December 2012 were reviewed. After matching the FP patients to controls (1:4) by gender, year, and age at CD diagnosis, and disease location, their clinical characteristics were compared using conditional logistic regression analysis. RESULTS: Among 2043 patients who were included in our study cohort, 44 patients (2.15%) developed FP over a median follow-up period of 79.8 months (interquartile range 37.3-124.6), with an incidence of 3.18 per 1000 person-years [95% confidence interval (CI) 2.37-4.28]. All 44 patients underwent emergency surgery, and eight patients underwent reoperation within 12 months (8/44, 18.2%). Multivariable-adjusted analysis revealed that anti-TNF therapy [odds ratio (OR), 3.73; 95% CI 1.19-11.69; p = 0.024] was associated with an increased risk of FP. CONCLUSIONS: The incidence of FP in a large cohort of Korean CD patients was 2.15%, which was similar to that in Western reports. Anti-TNF therapy could be risk factors for FP.


Assuntos
Doenças do Colo/epidemiologia , Doença de Crohn/tratamento farmacológico , Doenças do Íleo/epidemiologia , Perfuração Intestinal/epidemiologia , Doenças do Jejuno/epidemiologia , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adulto , Estudos de Casos e Controles , Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Feminino , Seguimentos , Fármacos Gastrointestinais/uso terapêutico , Humanos , Doenças do Íleo/etiologia , Doenças do Íleo/cirurgia , Incidência , Infliximab/uso terapêutico , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Doenças do Jejuno/etiologia , Doenças do Jejuno/cirurgia , Masculino , Reoperação , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
9.
Pan Afr Med J ; 23: 198, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27347287

RESUMO

INTRODUCTION: Ileo-sigmoid knotting (ISK) is a rare cause of bowel obstruction in which the ileum twists around the sigmoid colon. It is associated with rapid bowel gangrene and a high mortality rate. Little has been published about this condition in Kenya. The objective was to determine the presentation, management, and outcome of patients with ISK. METHODS: A seven year (January 2008-December 2014) retrospective chart review of patients managed for ISK at Tenwek Hospital in Bomet, Kenya. RESULTS: A total of 61 cases were identified, with a mean age of 35.8 years (range 2-68), and mean symptom duration of 1.6 days (range 3 hours-7 days). Gangrene was noted to involve both the ileum and colon in 45 patients, the ileum only in 9 patients, and the sigmoid colon only in one. Resection and primary anastomosis was carried out in most cases of gangrenous ileum (48/54, 89%) and gangrenous sigmoid colon (34/46, 74%), while resection and stoma was performed in 8 patients with gangrenous colon. Death occurred in 7 (11.5%) patients due to severe sepsis and multisystem organ failure. Morbidities were noted in 15 (24.6%) patients, including surgical site infection (8, 13.1%), respiratory insufficiency (4, 6.6%), fascial dehiscence (3, 4.9%) and anastomotic leak (2, 3.2%). The mean duration of hospitalization was 8.3 days (range 1-26). CONCLUSION: In this review, though retrospective in nature, ISK was noted to have high rates of bowel gangrene. In the appropriate setting, resection and primary anastomosis can be safely carried out in most cases of gangrenous colon.


Assuntos
Gangrena/epidemiologia , Doenças do Íleo/epidemiologia , Volvo Intestinal/epidemiologia , Doenças do Colo Sigmoide/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Doenças do Colo/complicações , Doenças do Colo/epidemiologia , Doenças do Colo/cirurgia , Feminino , Gangrena/patologia , Gangrena/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/cirurgia , Obstrução Intestinal/etiologia , Volvo Intestinal/complicações , Volvo Intestinal/cirurgia , Quênia/epidemiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/cirurgia , Adulto Jovem
10.
Ulus Travma Acil Cerrahi Derg ; 22(2): 139-44, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27193980

RESUMO

BACKGROUND: Intussusception is the second most common cause of acute abdomen in children, following appendicitis. The aim of the present study was to evaluate the experience of the authors, in an effort to promote intussusception management, especially that of small bowel intussusception. METHODS: Records of intussusception diagnosed between July 2002 and September 2014 were evaluated in terms of patient age, sex, clinical findings, admission time, ultrasonographic findings, treatment methods, and outcomes. RESULTS: Eighty-one patients, 52 males and 29 females, were included (mean age: 10.6 months). Intussusceptions were ileocolic (IC) in 52 cases, ileoileal (IL) in 26, and jejunojejunal (JJ) in 3. Nineteen (23.5%) patients underwent surgery. Hydrostatic reduction was performed in 45 (55.5%) IC cases. Seventeen (21%) patients with small bowel intussusceptions (SBIs), measuring 1.8-2.3 cm in length, spontaneously reduced. All patients who underwent surgery had intussusceptums ≥4 cm. Three of the 4 intestinal resection cases had history of abdominal surgery. CONCLUSION: If peritoneal irritation is present, patients with intussusception must undergo surgery. Otherwise, in patients with IC intussusception and no sign of peritoneal irritation, hydrostatic or pneumatic reduction is indicated. When this fails, surgery is the next step. SBIs free of peritoneal irritation and shorter than 2.3 cm tend to spontaneously reduce. For those longer than 4 cm, particularly in patients with history of abdominal surgery, spontaneous reduction is unlikely.


Assuntos
Doenças do Íleo/epidemiologia , Intussuscepção/epidemiologia , Doenças do Jejuno/epidemiologia , Abdome Agudo/etiologia , Criança , Serviços de Saúde da Criança , Pré-Escolar , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Lactente , Recém-Nascido , Intussuscepção/complicações , Intussuscepção/diagnóstico por imagem , Intussuscepção/cirurgia , Doenças do Jejuno/complicações , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/cirurgia , Masculino , Estudos Retrospectivos , Turquia/epidemiologia
11.
Ethiop Med J ; 54(1): 9-15, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27191025

RESUMO

BACKGROUND: Intussusception is one of the frequent causes of bowel obstruction in infants and toddlers (1). It involves invagination of a portion of intestine into another(2-4). The peak age of occurrence is between the age of 4 and 8 months. The aim of this study is to review the pattern of clinical presentation and seasonal variation of intussusception in our hospital, and to analyze the mode and outcomes of treatment. PATIENTS AND METHODS: This is a four-year retrospective study of children aged 13 years and below who were admitted and treated for intussusception between January 2011 and December 2014 at the pediatric surgery unit of Tikur Anbesa Specialized Hospital (TAH) in Ethiopia. Information on the patients' demographic characteristics, clinical presentation, and month of occurrence as well as the operative findings and outcome were obtained from the pediatric surgery unit record book, patient charts, and the operating theatre registry. RESULTS: One hundred and thirty six cases of intussusception were admitted to TAH, Addis Ababa over a four year period, of which 130 charts were retrieved and analyzed. Males dominated in the series. Age distribution showed that 59.2% of the cases were ≤ one year old, and 77.7 % were ≤ two years old. Abdominal pain, vomiting, bloody mucoid diarrhea and a mass palpated abdominally and/or rectally were the most common modes of presentations, with the classic triad of abdominal pain, vomiting and bloody mucoid diarrhea occurring in nearly two third of cases. The highest peak of presentation was in the month of June with 18 (13.9%) cases. The mean duration of symptoms before presentation to our hospital was 5.2 days with a range of 1-21 days. Intraoperatively, it was found that ileocolic intussusception was the most common type. Simple reduction without bowel resection was possible in 70.8% of cases. There were 44 (33.9 %) complications, wound site infection being the most common occurring in 20 (15.4%) cases and there were 6 deaths. CONCLUSION: Intussusception was more common in the wet season. There was delayed presentation with a higher rate of operative management and bowel resection. The mortality rate has decreased significantly compared with a previous study from this institution.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Doenças do Íleo , Intussuscepção , Dor Abdominal/fisiopatologia , Fatores Etários , Pré-Escolar , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Etiópia/epidemiologia , Feminino , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/epidemiologia , Doenças do Íleo/fisiopatologia , Doenças do Íleo/cirurgia , Lactente , Intussuscepção/diagnóstico , Intussuscepção/epidemiologia , Intussuscepção/fisiopatologia , Intussuscepção/cirurgia , Masculino , Mortalidade , Estudos Retrospectivos , Estações do Ano , Centros de Atenção Terciária/estatística & dados numéricos , Tempo para o Tratamento , Vômito/fisiopatologia
12.
Afr J Paediatr Surg ; 13(4): 166-169, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28051044

RESUMO

BACKGROUND: The classical cases of intussusception are readily diagnosed clinically, and despite recent improvements in radiological techniques, the diagnosis of intussusception and success in its nonoperative reduction has been suboptimal, thus making operative management a veritable backup. This study examined the impact of delays in presentation on the rate of bowel resection, length of hospital stay, and appraised the outcome of operative treatment. PATIENTS AND METHODS: This was a retrospective study of consecutive children admitted and treated surgically for intussusception between January 2002 and December 2011 at the University College Hospital, Ibadan, Nigeria. RESULTS: The mean age at presentation was 13.4 months with a male: female ratio of 1.8:1. Fourteen patients (25.5%) presented within the first 24 h of onset of symptoms with majority (36.4%) presenting between 2 and 3 days of onset of symptoms. The primary surgical intervention was performed on 47 patients (85.5%), and the secondary operative intervention was performed on eight patients (14.5%) who had failed initial nonoperative management of intussusception. Manual reduction of intussusception was performed on 27 patients (49.1%), 26 patients had resection of gangrenous bowel with end-to-end anastomosis while two patients (3.6%) had spontaneous reduction of intussusception which was discovered at laparotomy. The mean duration of hospital stay was 12.1 days (range 3-60 days). The overall mortality was 5.5% (three patients), and three patients (5.5%) had recurrence of intussusception. CONCLUSION: Although mortality is reducing, a high rate of bowel resection is a consequence of delayed presentation and effort should be made to make an early diagnosis of intussusception and make prompt referral to improve outcome.


Assuntos
Diagnóstico Tardio , Países em Desenvolvimento , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Doenças do Íleo/diagnóstico , Intussuscepção/diagnóstico , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Doenças do Íleo/epidemiologia , Doenças do Íleo/cirurgia , Incidência , Lactente , Intussuscepção/epidemiologia , Intussuscepção/cirurgia , Masculino , Nigéria/epidemiologia , Prognóstico , Radiografia Abdominal , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências , Fatores de Tempo , Ultrassonografia
13.
Afr J Paediatr Surg ; 13(4): 175-180, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28051046

RESUMO

BACKGROUND: Typhoid perforation ileitis is a serious complication of typhoid fever, a common and unfortunate health problem in a resource-poor country like Nigeria. Following bowel perforation, treatment is usually by simple closure or bowel resection and anastomosis after adequate aggressive fluid resuscitation and electrolyte correction. Postoperatively, some of these patients do require management in Intensive Care Unit (ICU) on account of sepsis or septic shock and to improve survival. PATIENTS AND METHODS: This is a prospective observational study in which 67 consecutive patients who had exploratory laparotomy for typhoid perforation between August 2009 and October 2012 in the main operating theatre of the University College Hospital, Ibadan, were studied. The attending anaesthetists had the freedom of choosing the appropriate anaesthetic drugs depending on the patients' clinical condition. The reason for admission into the ICU, the types of organ support required and outcomes were recorded. RESULTS: Twenty-five patients (37.3%) out of 67 required critical care. Reasons for admission among others included poor respiratory effort, hypotension, septic shock and delayed recovery from anaesthesia. Twenty-one patients (84%) required mechanical ventilation with a mean duration of 2.14 days (range 1-5 days). Fourteen patients required ionotropic support and the length of ICU stay ranged from 1 to 15 days (mean 4.32 days). Nineteen patients (76%) were successfully managed and discharged to the ward while 24% (6 patients) mortality rate was recorded. CONCLUSION: This study showed high rate of post-operative ICU admission in patients with typhoid perforation with a high demand for critical care involving mechanical ventilation and ionotropic support. In centres that manage patients presenting with typhoid ileitis and perforation, post-operative critical care should be available.


Assuntos
Doenças do Íleo/cirurgia , Unidades de Terapia Intensiva , Perfuração Intestinal/cirurgia , Laparotomia/métodos , Cuidados Pós-Operatórios/métodos , Febre Tifoide/complicações , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Mortalidade Hospitalar/tendências , Humanos , Doenças do Íleo/epidemiologia , Doenças do Íleo/etiologia , Incidência , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Estudos Prospectivos , Ruptura Espontânea , Febre Tifoide/epidemiologia , Adulto Jovem
14.
Afr J Paediatr Surg ; 12(4): 217-20, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26712283

RESUMO

BACKGROUND: The management of intussusception has evolved universally from the use of hydrostatic reduction through operative reduction to the use of pneumatic reduction for the acute and uncomplicated cases and surgical reduction for the complicated cases. However, the process of evolution has been very slow in the developing countries, especially sub-Saharan Africa, due to lack of requisite facilities and expertise to manage these patients nonoperatively. This study examined the trends in the management of childhood intussusception in a developing country, compared operative and nonoperative modalities of treatment, and assessed the impact of delayed presentation on the outcome of management. PATIENTS AND METHODS: This was a prospective study of the management of children with intussusception at the University College Hospital, Ibadan, Nigeria. RESULTS: Fifty-five consecutive cases of intussusception that presented to the Children Emergency Unit of the University College Hospital between January 2005 and December 2011 were prospectively studied. Details of sex, age of the patients, clinical presentation, duration of symptoms, mode of treatment, and incidence of recurrence were recorded and analyzed. The median age was 7 months. Moreover, the duration of symptoms varied from 1 to 21 days with a mean of 4 days. Twenty-two patients (40%) had attempted hydrostatic reduction; this was successful in 14 patients (63.6%), whereas 8 patients (36.4%) had failed reduction. In all, 41 patients (74.6%) had operative management of intussusceptions; primary operative intervention was carried out in 33 patients (60%) and secondary surgical management in 8 patients (14.5%) with failed hydrostatic reduction. At surgery, manual reduction of intussusception was carried out on 17 patients (30.9%) and resection of devitalized bowel with end to end anastomosis was carried out on the remaining 24 patients (43.6%). The incidence of surgical intervention for intussusception was 74.6%, mortality was 3.6%, and recurrence rate was 3.6%. CONCLUSIONS: Nonoperative management of intussusception should be adopted in carefully selected cases of intussusception in this subregion as it will help to reduce the financial burden on the parents while surgical management should be reserved for the complicated cases.


Assuntos
Países em Desenvolvimento , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Gerenciamento Clínico , Doenças do Íleo/epidemiologia , Intussuscepção/epidemiologia , Feminino , Seguimentos , Humanos , Doenças do Íleo/cirurgia , Incidência , Lactente , Intussuscepção/cirurgia , Masculino , Nigéria/epidemiologia , Estudos Prospectivos
15.
Rev Med Chir Soc Med Nat Iasi ; 119(1): 141-6, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25970957

RESUMO

Intussusception is one of the most common causes of acute abdominal conditions requiring surgical therapy in infants and babies. Due to the breakthroughs of pediatric intensive care and imaging methods, which may sometimes replace therapeutic methods, this condition, which used to be associated with high morbidity and mortality rates, is now more easily detected and treated immediately, even by non-surgical means. Nevertheless, there still is a high percent of cases in whom the diagnosis is set relatively late and who require laborious surgical procedures and extensive intestinal resections. These cases have high morbidity rates, the condition sometimes has a negative course and the patients die. We conducted an analytical retrospective study on a group of 49 patients diagnosed with intussusceptions, hospitalized and treated in the Pediatric Surgery Ward of the Children's Hospital of Iasi City during 5 years. Although the demographics and clinical presentation of our patients is largely in agreement with literature data, we note that 69.4% of the patients came to the hospital 24 hours after the onset of their symptoms, which delayed diagnosis setting, ruled out non-surgical therapy and thus led to a high rate of postoperative complications (24.5%) and also to a high mortality rate (6.6%).


Assuntos
Doenças do Íleo/epidemiologia , Doenças do Íleo/cirurgia , Valva Ileocecal , Intussuscepção/epidemiologia , Intussuscepção/cirurgia , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/mortalidade , Incidência , Lactente , Intussuscepção/diagnóstico , Intussuscepção/mortalidade , Masculino , Metáfora , Estudos Retrospectivos , Romênia/epidemiologia , Taxa de Sobrevida , Resultado do Tratamento
16.
Gut Liver ; 9(6): 756-60, 2015 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-25963086

RESUMO

BACKGROUND/AIMS: Pediatric inflammatory bowel disease (IBD) has been increasing worldwide. The characteristics of pediatric-onset IBD have mainly been reported in Western countries. We investigated the clinical characteristics of pediatric IBD in Korea and compared these with the data from the 5-year European multicenter study of children with new-onset IBD (EUROKIDS registry). METHODS: Children who were diagnosed with IBD between July 1987 and January 2012 were investigated at five Korean university hospitals. Their clinical characteristics were retrospectively evaluated by medical record review. The results were compared with the EUROKIDS data. RESULTS: A total of 30 children with Crohn's disease (CD) and 33 children with ulcerative colitis (UC) were enrolled. In comparison with the EUROKIDS group, Korean pediatric IBD patients showed a male predominance (86.7% vs 59.2%, p=0.002 in CD; 75.8% vs 50%, p=0.003 in UC). Korean pediatric CD patients had a higher prevalence of terminal ileal disease (36.7% vs 16.3%, p=0.004) and perianal disease (33.3% vs 8.2%, p<0.001) than patients in the EUROKIDS group. Korean pediatric UC patients had a higher prevalence of proctitis than patients in the EUROKIDS group. CONCLUSIONS: Our results suggest that the characteristics of Korean pediatric IBD patients and European pediatric IBD patients may be different.


Assuntos
Colite Ulcerativa/patologia , Doença de Crohn/patologia , Adolescente , Doenças do Ânus/complicações , Doenças do Ânus/epidemiologia , Doenças do Ânus/patologia , Criança , Colite Ulcerativa/complicações , Colite Ulcerativa/epidemiologia , Doença de Crohn/complicações , Doença de Crohn/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/epidemiologia , Doenças do Íleo/patologia , Masculino , Prevalência , Proctite/epidemiologia , Proctite/etiologia , Sistema de Registros , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores Sexuais
17.
BMC Gastroenterol ; 15: 31, 2015 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-25887913

RESUMO

BACKGROUND: Free perforation is the most severe and debilitating complication associated with Crohn's disease (CD), and it usually requires emergency surgery. The aim of this study was to evaluate the incidence of free perforation among Korean patients with CD. METHODS: The CrOhn's disease cliNical NEtwork and CohorT (CONNECT) study was conducted nationwide in Korea, and patients who were diagnosed with CD between 1982 and 2008 were included in this retrospective study. We investigated the incidence of free perforation among these patients and their clinical characteristics. RESULTS: A total of 1346 patients were analyzed and 88 patients (6.5%) were identified with free perforation in CD. The mean age of the free perforation group was 31.8 ± 13.0 years, which was significantly higher than that of the non-perforated group (27.5 ± 12.1 years) (p = 0.004). Free perforation was the presenting sign of CD in 46 patients (52%). Of the 94 perforations that were present in 88 patients, 81 involved the ileum. Multivariate logistic regression analysis determined that free perforation was significantly associated with being aged ≥ 30 years at diagnosis (OR 2.082, p = 0.002) and bowel strictures (OR 1.982, p = 0.004). The mortality rate in the free perforation group was significantly higher (4.5%) than that in the non-perforated group (0.6%) (p < 0.001). CONCLUSION: The incidence of free perforation in Korean patients with CD was 6.5%. Being aged ≥ 30 years at CD diagnosis and bowel strictures were significant risk factors associated with free perforation.


Assuntos
Doença de Crohn/complicações , Doenças do Íleo/epidemiologia , Perfuração Intestinal/epidemiologia , Doenças do Jejuno/epidemiologia , Adolescente , Adulto , Fatores Etários , Constrição Patológica/epidemiologia , Doença de Crohn/diagnóstico , Doença de Crohn/mortalidade , Diagnóstico Tardio , Feminino , Humanos , Doenças do Íleo/etiologia , Doenças do Íleo/cirurgia , Incidência , Perfuração Intestinal/etiologia , Perfuração Intestinal/mortalidade , Perfuração Intestinal/cirurgia , Intestinos/patologia , Doenças do Jejuno/etiologia , Doenças do Jejuno/cirurgia , Masculino , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
18.
BMC Res Notes ; 7: 762, 2014 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-25346193

RESUMO

BACKGROUND: Relatively common in adults, intestinal tuberculosis is considered rare in children and adolescents. The protean manifestations of intestinal tuberculosis mean that the diagnosis is often delayed (sometimes even for years), thus leading to increased mortality and unnecessary surgery. The main diagnostic dilemma is to differentiate intestinal tuberculosis and Crohn's disease because a misdiagnosis can have dramatic consequences. CASE PRESENTATION: A 13-year-old Caucasian, Italian female adolescent attended the Emergency Department complaining of abdominal pain, a fever of up to 38 °C, night sweats, diarrhea with blood in stool, and a weight loss of about three kilograms over the previous two months. Physical examination revealed a marked skin pallor and considerable abdominal distension with relevant discomfort in all the abdominal quadrant. Laboratory tests revealed a decreased white blood cell count with anemia and increased C-reactive protein levels. The Mantoux tuberculin skin test was negative. A chest X-ray and an abdominal ultrasonography did not reveal any significant findings. The patient underwent colonoscopy that showed diffuse mucosal congestion and significant blood loss, and laparatomy showed small bowel and colon loops with a whitish appearance. A biopsy of the ileal mucosa revealed inflammation with noncaseating granulomas possibly due to bacterial infection. Given the suspicion of an opportunistic bacterial infection in a child with chronic inflammatory bowel disease (possibly Crohn's disease), treatment with a third-generation cephalosporin was started. However, the abdominal pain, fever and poor general condition persisted and so, after 11 days, the patient underwent total body computed tomography and magnetic resonance imaging of the brain. On the basis of the radiological findings, miliary tuberculosis was suspected and bronchoscopy was performed and resulted positive for Mycobacterium tuberculosis. Miliary tuberculosis was confirmed and an effective treatment with four drugs was started. CONCLUSION: This case shows that the manifestations of intestinal tuberculosis can be very difficult to diagnose and mimic those of Chron's disease. Total body computed tomography and laparotomy with an intestinal biopsy for the detection of Mycobacterium tuberculosis are the means of avoid the risks of a misdiagnosis in children with unexplained chronic abdominal problems.


Assuntos
Doenças do Íleo/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Tuberculose Miliar/diagnóstico , Adolescente , Antituberculosos/uso terapêutico , Biópsia , Doença de Crohn/diagnóstico , Diagnóstico Diferencial , Erros de Diagnóstico , Quimioterapia Combinada , Feminino , Humanos , Doenças do Íleo/tratamento farmacológico , Doenças do Íleo/epidemiologia , Doenças do Íleo/microbiologia , Incidência , Itália/epidemiologia , Mycobacterium tuberculosis/isolamento & purificação , Valor Preditivo dos Testes , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Gastrointestinal/tratamento farmacológico , Tuberculose Gastrointestinal/epidemiologia , Tuberculose Gastrointestinal/microbiologia , Tuberculose Miliar/tratamento farmacológico , Tuberculose Miliar/epidemiologia , Tuberculose Miliar/microbiologia , Imagem Corporal Total/métodos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA