Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.411
Filtrar
1.
Medicine (Baltimore) ; 99(34): e21106, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846752

RESUMO

RATIONALE: Colonic telangiectasia, also known as colonic angiodysplasia, refers to arteriovenous malformations that occur in the colon, which are common vascular lesions in the GI tract. PATIENT CONCERNS: We report a patient, who was admitted to our hospital for colonoscopy. DIAGNOSES: Under a microscope, all the segments of the whole colon and the varicose veins showed multiple flaky spider-like telangiectasia changes. The blood vessels were radially distributed and converged in the center. The largest blood vessel was about 10 mm in diameter and had a smooth surface with no ulcers, erosion, or bleeding. INTERVENTIONS: It was recommended that the patient undergo a capsule endoscopy to examine small intestine. OUTCOMES: The patient did not agree to endoscopy for personal reasons. During the follow-up half a year later, the patient had no melena with normal range of hemoglobin and red blood cell counts. The fecal occult blood test came out negative. LESSONS: While the etiology of colonic telangiectasia remains unclear, it is common in the elderly, and is more associated with geriatric conditions and diseases, especially atherosclerotic diseases. Patients who are diagnosed with colonic telangiectasia but are asymptomatic, do not need further treatment. It is usually recommended to monitor the color of stool and check the hemoglobin and fecal occult blood regularly. Colonoscopy is the main method of diagnosis of colonic telangiectasia, and the positive rate is greater than 90%. This procedure should be performed when there is no bleeding or a small amount of bleeding.


Assuntos
Doenças do Colo/diagnóstico , Telangiectasia/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade
5.
Am J Emerg Med ; 38(8): 1697.e1-1697.e3, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32546319

RESUMO

Adult intussusception is an uncommon cause of abdominal pain and poses diagnostic challenges for emergency physicians due to its varied presenting symptoms and time course. We report a case of chronic colocolic intussusception secondary to a lead point submucosal lipoma. Dedifferentiating intussusception with or without a lead point is important in determining appropriate management.


Assuntos
Doenças do Colo/etiologia , Neoplasias do Colo/complicações , Intussuscepção/etiologia , Lipoma/complicações , Dor Abdominal/etiologia , Adulto , Doenças do Colo/diagnóstico , Doenças do Colo/diagnóstico por imagem , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/diagnóstico por imagem , Humanos , Intussuscepção/diagnóstico , Intussuscepção/diagnóstico por imagem , Lipoma/diagnóstico , Lipoma/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X
6.
BMC Gastroenterol ; 19(1): 210, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31805875

RESUMO

BACKGROUND: Fecal calprotectin (FCP), magnetic resonance enterography (MRE), and colonoscopy are complementary biometric tests that are used to assess patients with Crohn's Disease (CD). While prior studies have evaluated the association between combinations of these tests, no study has established a correlation between all three: FCP, MRE, and colonoscopy. We prospectively investigated if there is correlation between these three tests, which may result in improved clinical outcomes that can then be used to streamline patient monitoring and treatment modification. METHODS: One hundred fifty-six patients with colonic CD were prospectively examined between March 2017 and December 2018. FCP levels, MRE, and colonoscopy were assessed in parallel on all 156 patients. Clinical CD activity was measured with the Crohn's Disease Activity Index (CDAI). CD activity with FCP was measured with a quantitative immunoassay. CD activity on MRE was measured with the Magnetic Resonance Index of Activity (MaRIA). CD activity on colonoscopy was measured with the Crohn's Disease Endoscopic Index of Severity (CDEIS). RESULTS: One hundred twelve patients (72%) had active disease (Crohn's Disease Activity Index > 150) and 44 patients (28%) were in clinical remission disease (Crohn's Disease Activity Index < 150). FCP levels, MaRIA, and CDEIS are highly correlated with positive and significant Pearson and Spearman coefficients, respectively (P < 0.0001), in univariate analyses. Regression analysis (multivariate analyses) demonstrates significant, positive correlation between FCP and MaRIA (r = 1.07, P < 0.0001) and between FCP and CDEIS (r = 0.71, P = 0.03), and between. MaRIA and CDEIS (r = 0.63, P = 0.01). CONCLUSIONS: FCP levels significantly correlate with the degree of active inflammation in patients with colonic Crohn's Disease. Improved clinical results may be achieved by using a biometric strategy that incorporates FCP, colonoscopy, and MRE together. This strategy may in-turn be used in the future to streamline monitoring disease activity and adjustment of therapy to improve long term patient outcomes.


Assuntos
Doenças do Colo/diagnóstico , Colonoscopia , Doença de Crohn/diagnóstico , Fezes/química , Complexo Antígeno L1 Leucocitário/análise , Imagem por Ressonância Magnética/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Doenças do Colo/epidemiologia , Doença de Crohn/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Probabilidade , Estudos Prospectivos , Análise de Regressão , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Adulto Jovem
7.
Dis Colon Rectum ; 62(12): 1528-1532, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31725583

RESUMO

BACKGROUND: Performing colonoscopies is an integral component of colorectal surgery residency training. There exists a paucity of literature regarding colonoscopy quality metrics with colorectal trainee involvement. OBJECTIVE: This study aimed to investigate the effect of colorectal surgery resident participation on quality metrics in screening colonoscopy. DESIGN: Screening colonoscopies performed between August 1, 2016, and July 31, 2018, were queried from a prospectively maintained institutional database. Data were cross-checked with resident case logs to verify colonoscopies with resident participation. SETTING: This study was conducted by the colorectal surgery department at a tertiary level hospital in the United States. PATIENTS: Consecutive, asymptomatic patients aged ≥45 years, undergoing screening colonoscopy, were selected. MAIN OUTCOME MEASURES: The quality parameters measured included overall, male, and female adenoma detection rates; total examination time; withdrawal time; cecal intubation rate; quality of bowel preparation; complications; and medication dosage. RESULTS: A total of 4594 patients were included in the study with a mean age of 60.5 ± 8.4 years (range, 45-91); 51.7% were women. Overall, 4186 of the colonoscopies were performed without resident participation, and 408 were performed with resident participation. Scope insertion, withdrawal, and total examination times were longer in the resident group. Cecal intubation rate, polypectomy rate, sex-specific and overall adenoma detection rates, and complication rates were similar between the groups. In the multivariate model, trainee involvement had no significant impact on adenoma detection rate. In addition, the trainee group utilized a higher mean dose of fentanyl. LIMITATIONS: The retrospective nature of the data with possible coding errors of the database and the inability to quantify the amount of resident participation and to clarify the degree of attending surgeon assistance and oversight were limitations of the study. CONCLUSIONS: Colorectal surgery resident participation in screening colonoscopy takes longer and appears safe, while achieving all national quality metrics without compromising adenoma detection rates. Changes in colonoscopy scheduling in regard to length of time may prove beneficial when there is resident participation. See Video Abstract at http://links.lww.com/DCR/B43. PARTICIPACIÓN DE LOS RESIDENTES DE CIRUGÍA COLORRECTAL EN COLONOSCOPIAS DE CRIBADO: ¿CÓMO AFECTA LA CALIDAD?: La realización de colonoscopias es un componente integral del entrenamiento de residencia en cirugía colorrectal. Existe una escasez de literatura con respecto a las medidas de calidad de la colonoscopia con la participación de los aprendices colorrectales.Investigar el efecto de la participación de residentes de cirugía colorrectal en las medidas de calidad en la colonoscopia de cribado.Las colonoscopias de cribado realizadas entre el 1 de agosto de 2016 y el 31 de julio de 2018 se consultaron desde una base de datos institucional mantenida prospectivamente. Los datos se cotejaron con registros de casos de residentes para verificar las colonoscopias con participación de residentes.Departamento de cirugía colorrectal en un hospital de tercer nivel de los Estados Unidos.Pacientes consecutivos, asintomáticos, edad ≥45 años, sometidos a colonoscopia de detección.Parámetros de calidad que incluyen tasas generales de detección de adenoma en hombres y mujeres, tiempo total de examen, tiempo de retiro, tasa de intubación cecal, calidad de la preparación intestinal, complicaciones y dosis de medicamentos.Se incluyeron un total de 4.594 pacientes en el estudio con una edad media de 60,5 ± 8,4 años (rango, 45-91) y 51,7% mujeres. En total 4,186 de las colonoscopias se realizaron sin participación de los residentes y 408 se realizaron con la participación de los residentes. Los tiempos de inserción, retiro y examen total del alcance fueron más largos en el grupo residentes. La tasa de intubación cecal, la tasa de polipectomía, las tasas de detección de adenoma específicos de género y generales, y las tasas de complicaciones fueron similares entre los grupos. En el modelo multivariado, la participación de los aprendices no tuvo un impacto significativo en la tasa de detección de adenoma. Además, el grupo de aprendices utilizó una dosis media más alta de fentanilo.Carácter retrospectivo de los datos con posibles errores de codificación de la base de datos. Incapacidad para cuantificar la cantidad de participación de los residentes y para aclarar el grado de asistencia y supervisión del cirujano.La participación de los residentes de cirugía colorrectal en la colonoscopia de cribado lleva más tiempo y parece segura, mientras se logran todas las medidas de calidad nacionales sin comprometer las tasas de detección de adenoma. Los cambios en la programación de la colonoscopia con respecto al período de tiempo pueden ser beneficiosos cuando hay participación de residentes. Vea el resumen del video en http://links.lww.com/DCR/B43.


Assuntos
Doenças do Colo/diagnóstico , Colonoscopia/métodos , Colonoscopia/normas , Cirurgia Colorretal/educação , Fentanila/administração & dosagem , Idoso , Competência Clínica , Feminino , Humanos , Internato e Residência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sensibilidade e Especificidade , Centros de Atenção Terciária , Fatores de Tempo , Estados Unidos
8.
Rev Gastroenterol Peru ; 39(3): 284-287, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31688855

RESUMO

Balantidiasis is a zoonosis produced by Balantidium coli, which inhabits the large intestine of the pig and man. Infection is uncommon in humans and mainly affects the colon. It occurs more frequently in developing countries, tropical and subtropical regions. Colonic balantidiasis can occur in most cases asymptomatically and reach in the most severe cases such as dysenteric diarrhea that can be complicated by low digestive bleeding and even perforation. We present the case of a 72-year-old man, from the Peruvian highlands, who was a farmer and breeder of swine and sheep, who came for 3 months of illness, initially characterized by liquid stools with bloodless mucus, abdominal pain, nausea, vomiting and in the last month of illness he presents dysenteric diarrhea. Colonoscopy was performed due to suspicion of infectious colitis, Balantidium coli trophozoites were found in the fresh sample and colonic tissue biopsy. Patient receives treatment with amebicide and antibacterial without clinical improvement, presenting as a complication multiple perforation in the sigmoid colon, treated with resection and terminal colostomy. Finally, the patient died despite receiving medical and surgical treatment.


Assuntos
Balantidíase , Doenças do Colo/parasitologia , Idoso , Balantidíase/diagnóstico , Balantidíase/terapia , Doenças do Colo/diagnóstico , Doenças do Colo/terapia , Evolução Fatal , Humanos , Masculino
9.
Cir Pediatr ; 32(3): 150-153, 2019 Jul 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31486308

RESUMO

INTRODUCTION: Colopericardial fistula is a rare complication of colonic replacement surgery whose incidence is unknown. Therefore, we present the following case and perform a literature review. CLINICAL CASE: 17-year-old female patient of age consults for respiratory distress and precordial pain of 5 days of evolution. Background: Long gap esophageal atresia (esophagostoma and feeding gastrostomy, subsequent colonic graft). Bilateral pneumonia is initially diagnosed. It rapidly evolves to a state of sepsis. On chest x-ray, pneumopericardium is observed. Water-soluble contrasted study confirms diagnosis of colopericardial fistula. Surgical treatment is established, despite this the patient dies due to respiratory distress. COMMENT: Colopericardial fistula is a very serious entity with a high mortality rate. The clinical presentation and the complementary methods of diagnostic confirmation must be known in order to carry out the appropriate treatment.


Assuntos
Doenças do Colo/diagnóstico , Esôfago/cirurgia , Fístula/diagnóstico , Adolescente , Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Atresia Esofágica/cirurgia , Evolução Fatal , Feminino , Fístula/etiologia , Fístula/cirurgia , Gastrostomia/métodos , Humanos , Pneumopericárdio/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico
10.
Acta Med Port ; 32(9): 614-617, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31493366

RESUMO

Intramural hematoma of the colon is very rare, particularly when associated with the development of autoantibodies against factor VIII.We report a case of a 66-year-old man with abdominal pain, hematochezia and clots in the left colon, without any radiologic signs of active bleeding or bowel occlusion or analytical changes in routine coagulation screening, but with positive autoantibodies against factor VIII. The clinical instability prompted surgical exploration. An intramural hematoma of the left colon was found, and a left colectomy was performed. The patient was treated with hemoderivatives and corticosteroids with clinical improvement. The diagnosis of spontaneous intramural hematoma might be a challenge, particularly in the absence of clinical suspicion. An early recognition is essential for a positive outcome. This case highlights a rare cause of bleeding and intestinal obstruction, but also the difficulty and relevance of establishing a clinical diagnosis when diagnostic tests are not completely informative.


Assuntos
Dor Abdominal/etiologia , Autoanticorpos/análise , Doenças do Colo/etiologia , Fator VIII/imunologia , Hematoma/etiologia , Hemofilia A/complicações , Idoso , Doenças do Colo/diagnóstico , Doenças do Colo/cirurgia , Colonoscopia , Fator VIII/análise , Hemorragia Gastrointestinal/etiologia , Hematoma/diagnóstico , Hematoma/cirurgia , Hemofilia A/diagnóstico , Humanos , Obstrução Intestinal/etiologia , Masculino
11.
Dis Colon Rectum ; 62(9): 1028-1030, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31397752

RESUMO

CASE SUMMARY: An otherwise healthy 59-year-old man presented to the emergency department with 2 weeks of narrowed stools, 5 days of obstipation, and 1 day of abdominal pain, nausea, and vomiting. Computed tomography revealed an obstructing sigmoid mass without evidence of metastatic disease, and the CEA was 1.2 ng/mL. Flexible sigmoidoscopy confirmed a circumferentially obstructing distal sigmoid neoplasm. Endoscopic stent placement was immediately followed by a firm distended abdomen. An upright radiograph obtained following the procedure demonstrated free intraperitoneal air. An emergent Hartmann procedure was performed for iatrogenic colon perforation in a patient with malignant obstruction and chronic dilation of the proximal colon.


Assuntos
Doenças do Colo/cirurgia , Ileostomia/métodos , Obstrução Intestinal/cirurgia , Laparoscopia/métodos , Neoplasias do Colo Sigmoide/complicações , Sigmoidoscopia/métodos , Tomografia Computadorizada por Raios X/métodos , Doenças do Colo/diagnóstico , Doenças do Colo/etiologia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Neoplasias do Colo Sigmoide/diagnóstico , Neoplasias do Colo Sigmoide/cirurgia
12.
BMJ Case Rep ; 12(7)2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31337625

RESUMO

We present the case of a 34-year-old woman who was diagnosed to have adenocarcinoma of the caecum based on the clinical, radiological, histopathological and intraoperative findings. However, postoperative histopathology showed only features of xanthogranulomatous inflammation without any evidence of malignancy. This benign chronic inflammatory condition could present as a histological surprise. It is important for both surgeons and pathologists alike to be aware of this.


Assuntos
Adenocarcinoma/patologia , Colo Ascendente/patologia , Doenças do Colo/patologia , Neoplasias do Colo/patologia , Erros de Diagnóstico , Granuloma/patologia , Inflamação/patologia , Xantomatose/patologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/cirurgia , Adulto , Biópsia , Colectomia , Doenças do Colo/diagnóstico , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/cirurgia , Feminino , Granuloma/diagnóstico , Humanos , Inflamação/diagnóstico , Xantomatose/diagnóstico
13.
Nat Rev Gastroenterol Hepatol ; 16(9): 559-579, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31296967

RESUMO

Alterations in colonic motility are implicated in the pathophysiology of bowel disorders, but high-resolution manometry of human colonic motor function has revealed that our knowledge of normal motor patterns is limited. Furthermore, various terminologies and definitions have been used to describe colonic motor patterns in children, adults and animals. An example is the distinction between the high-amplitude propagating contractions in humans and giant contractions in animals. Harmonized terminology and definitions are required that are applicable to the study of colonic motility performed by basic scientists and clinicians, as well as adult and paediatric gastroenterologists. As clinical studies increasingly require adequate animal models to develop and test new therapies, there is a need for rational use of terminology to describe those motor patterns that are equivalent between animals and humans. This Consensus Statement provides the first harmonized interpretation of commonly used terminology to describe colonic motor function and delineates possible similarities between motor patterns observed in animal models and humans in vitro (ex vivo) and in vivo. The consolidated terminology can be an impetus for new research that will considerably improve our understanding of colonic motor function and will facilitate the development and testing of new therapies for colonic motility disorders.


Assuntos
Colo/fisiopatologia , Doenças do Colo/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Animais , Doenças do Colo/diagnóstico , Doenças do Colo/terapia , Consenso , Humanos , Manometria
14.
Turk J Gastroenterol ; 30(7): 630-635, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31290751

RESUMO

BACKGROUND/AIMS: Preforming total colonoscopy (TCS) is sometimes difficult due to adhesions or long colons. The PCF-PQ260L (PQL) was developed to overcome TCS-related difficulties. The aim of this study was to investigate the performance and usefulness of PQL for difficult colon cases. MATERIALS AND METHODS: This was a retrospective single center observational cohort study investigating differences in patient characteristics and examination performance between patients examined with PQL, versus standard (SD), scopes. Secondly, we directly compared PQL and SD scopes in patients treated with both types of scope. RESULTS: The PQL was used with 105 patients and SD scopes were used with 1119 patients. Patients in the PQL group were significantly shorter (157cm vs 163cm, p< 0.01) and lighter, compared to the SD group (52 kg vs 58 kg, p< 0.01). There were no significant statistical differences with regard to cecal intubation rate, cecal intubation time, and adenoma detection. Direct comparison of use of PQL and SD scopes on the same patients revealed shorter average cecal intubation time (7 min vs 10 min, p< 0.01), and significantly increased numbers of patients reporting no pain (66 % vs 20 %, p< 0.01) and needing no sedative drugs (48% vs 25 %, p< 0.01) associated with PQL use. CONCLUSION: The examination performance of the PQL scope was similar to the SD scope. The PQL may be a good option for patients who with difficult colons.


Assuntos
Colo/anatomia & histologia , Doenças do Colo/diagnóstico , Colonoscópios , Desenho de Equipamento , Idoso , Constrição Patológica , Feminino , Humanos , Masculino , Medição da Dor , Estudos Retrospectivos , Aderências Teciduais/complicações
15.
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
17.
Am J Case Rep ; 20: 1057-1062, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31324749

RESUMO

BACKGROUND Ehlers-Danlos Syndrome (EDS) is a group of connective tissue disorders with heterogeneous clinical features associated with varying genetic mutations. EDS type IV, also known as vascular EDS (vEDS), is the rarest type but has fatal complications, including rupture of major vasculature and intestinal and uterine perforation. Intestinal perforation can be spontaneous or a consequence of long-standing constipation, a common symptom among patients with EDS. CASE REPORT We present a case of a 6-year-old boy with the previous diagnosis of vEDS who presented with colonic perforation from a stercoral ulcer. He underwent diagnostic laparoscopy and loop colostomy, with an uneventful postoperative course. Unfortunately, he developed a second colonic perforation 14 months after the initial episode and underwent total abdominal colectomy with end ileostomy. CONCLUSIONS Intestinal perforation is a well-documented and devastating complication of vEDS. However, spontaneous intestinal perforation is extremely rare in a young child. Therefore, the diagnosis of vEDS should be included in the differential diagnosis if a child presents with intestinal perforation. There is no clear guideline available for surgical management of colonic perforation in patients with vEDS, but total abdominal colectomy appears to provide the best chance of preventing recurrent perforation.


Assuntos
Doenças do Colo/diagnóstico , Doenças do Colo/etiologia , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/diagnóstico , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Criança , Doenças do Colo/cirurgia , Diagnóstico Diferencial , Humanos , Perfuração Intestinal/cirurgia , Masculino
19.
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
20.
World J Gastroenterol ; 25(15): 1899-1906, 2019 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-31057303

RESUMO

BACKGROUND: Cytomegalovirus (CMV) remains a critical complication after solid-organ transplantation. The CMV antigenemia (AG) test is useful for monitoring CMV infection. Although the AG-positivity rate in CMV gastroenteritis is known to be low at onset, almost all cases become positive during the disease course. We treated a patient with transverse colon perforation due to AG-negative CMV gastroenteritis, following a living donor liver transplantation (LDLT). CASE SUMMARY: The patient was a 52-year-old woman with decompensated liver cirrhosis as a result of autoimmune hepatitis who underwent a blood-type compatible LDLT with her second son as the donor. On day 20 after surgery, upper and lower gastrointestinal endoscopy (GE) revealed multiple gastric ulcers and transverse colon ulcers. The biopsy tissue immunostaining confirmed a diagnosis of CMV gastroenteritis. On day 28 after surgery, an abdominal computed tomography revealed transverse colon perforation, and simple lavage and drainage were performed along with an urgent ileostomy. Although the repeated remission and aggravation of CMV gastroenteritis and acute cellular rejection made the control of immunosuppression difficult, the upper GE eventually revealed an improvement in the gastric ulcers, and the biopsy samples were negative for CMV. The CMV-AG test remained negative, therefore, we had to evaluate the status of the CMV infection on the basis of the clinical symptoms and GE. CONCLUSION: This case report suggests a monitoring method that could be useful for AG-negative CMV gastroenteritis after a solid-organ transplantation.


Assuntos
Doenças do Colo/diagnóstico , Infecções por Citomegalovirus/complicações , Gastroenterite/complicações , Perfuração Intestinal/diagnóstico , Transplante de Fígado/efeitos adversos , Antígenos Virais/sangue , Antígenos Virais/imunologia , Colo/diagnóstico por imagem , Colo/virologia , Doenças do Colo/etiologia , Citomegalovirus/imunologia , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/sangue , Infecções por Citomegalovirus/imunologia , Infecções por Citomegalovirus/virologia , Doença Hepática Terminal/imunologia , Doença Hepática Terminal/patologia , Doença Hepática Terminal/cirurgia , Endoscopia Gastrointestinal , Feminino , Gastroenterite/sangue , Gastroenterite/imunologia , Gastroenterite/virologia , Hepatite Autoimune/imunologia , Hepatite Autoimune/patologia , Hepatite Autoimune/cirurgia , Humanos , Perfuração Intestinal/etiologia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA