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1.
Ann R Coll Surg Engl ; 103(4): 235-244, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682486

RESUMO

INTRODUCTION: The debate on the best surgical management strategy for acute malignant left-sided colonic obstruction is ongoing. Decompressing colostomy (DC) and stenting as a bridge to surgery (SBTS) are the currently proposed alternative approaches to emergency colectomy (EC). However, the results of a traditional meta-analysis were inconclusive. Therefore, a network meta-analysis (NMA) was conducted to compare the three approaches for acute left-sided colonic obstruction. METHODS: A systematic literature search of Embase, PubMed, Google Scholar and the Cochrane library was performed. A traditional meta-analysis and subsequent NMA were conducted. FINDINGS: A significantly greater number of primary anastomoses were performed in the DC cohort than in the EC and SBTS cohorts. The 90-day mortality rate was significantly lower in the DC cohort than in the EC and SBTS cohorts. Higher costs were associated with the SBTS cohort (by US$2,000) than with the EC cohort. The locoregional recurrence rate was higher for the SBTS cohort than for the EC cohort. CONCLUSIONS: Evidence from the first NMA suggests there may be some clinical advantages associated with DC as an alternative approach to the EC and SBTS approaches for adequately selected patients with malignant large bowel obstruction.


Assuntos
Colectomia , Doenças do Colo/cirurgia , Neoplasias do Colo/complicações , Colostomia , Obstrução Intestinal/cirurgia , Stents , Doença Aguda , Doenças do Colo/etiologia , Humanos , Obstrução Intestinal/etiologia , Metanálise em Rede
2.
Arq Bras Cir Dig ; 33(4): e1570, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33759960

RESUMO

BACKGROUND: Ki-67 in ascending colon: A) experiment and B) control. Intestinal diversions have revolutionized the treatment of morbid obesity due to its viability and sustained response. However, experimental studies suggest, after these derivations, a higher risk of colon cancer. AIM: To analyze the histological and immunohistological changes that the jejunojejunal shunt can produce in the jejunum, ileum and ascending colon. METHOD: Twenty-four male Wistar rats were randomly divided into two groups, control (n=12) and experiment (n=12) and subdivided into groups of four. Nine weeks after the jejunojejunal shunt, segmental resection of the excluded jejunum, terminal ileum and ascending colon was performed. Histological analysis focused on the thickness of the mucosa, height of the villi, depth of the crypts and immunohistochemistry in the expression of Ki-67 and p53. RESULTS: Significant differences were found between the experiment and control groups in relation to the thickness of the mucosa in the jejunum (p=0.011), in the ileum (p<0.001) and in the colon (p=0.027). There was also a significant difference in relation to the height of the villus in the ileum (p<0.001) and the depth of the crypts in the jejunum (p0.001). The results indicated that there is a significant difference between the groups regarding the expression of Ki-67 in the colon (p<0.001). No significant differences were found between the groups regarding the expression of Ki-67 in the jejunum and ileum. In the P53 evaluation, negative nuclear staining was found in all cases. CONCLUSION: The jejunojejunal deviation performed in the Roux-in-Y gastrojejunal bypass, predispose epithelial proliferative effects, causing an increase in the thickness of the mucosa, height of the villi and depth of the crypts of the jejunum, ileum and ascending colon.


Assuntos
Doenças do Colo , Derivação Gástrica , Animais , Doenças do Colo/etiologia , Derivação Gástrica/efeitos adversos , Humanos , Íleo , Mucosa Intestinal , Intestino Delgado , Intestinos , Jejuno/cirurgia , Antígeno Ki-67/metabolismo , Masculino , Ratos , Ratos Wistar
4.
Medicine (Baltimore) ; 99(31): e21525, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756196

RESUMO

RATIONALE: Adult intussusception is rarely observed, accounting for about 5% of all cases of intussusception. Most ileal lipomas are asymptomatic and do not need any special treatment. Herein, we describe a case with ileocolic intussusception caused by ileal lipoma. PATIENT CONCERNS: A 27-year-old woman complaints of intermittent abdominal pain for 10 days. DIAGNOSIS: Abdominal computed tomography demonstrated ileocolic intussusception. Colonoscopy revealed a spherical polypoid lesion with surface capillary rising from the lateral wall of the ileum. A diagnosis of ileocolic intussusception was made. INTERVENTIONS: The patient underwent primary resection of the intussuscepted intestine after which an end-to-end anastomosis was performed. OUTCOMES: Histopathology report confirmed a 4.5 cm × 3.5 cm lipoma in the terminal ileum. The patient was discharged on a postoperative day 9 without complications. LESSONS: We describe the difficulties in diagnosis and treatment of this rare cause of intussusception and review the literature on adult intussusceptions. The ileal lipoma is a very rare cause of ileocolic intussusception. Abdominal CT and colonoscopy are important for the diagnosis of intussusception and abdominal lipomas. Surgical resection remains the treatment of choice.


Assuntos
Doenças do Colo/etiologia , Doenças do Íleo/complicações , Intussuscepção/etiologia , Lipoma/complicações , Adulto , Feminino , Humanos , Doenças do Íleo/cirurgia , Lipoma/cirurgia
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
7.
Ann Palliat Med ; 9(2): 488-492, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32156124

RESUMO

Post-polypectomy syndrome (PPS) results from electrocoagulation injury to the bowel wall that induces a transmural burn and localized peritonitis. It has a good prognosis; however, there are exceptions when complications are observed. We here report a case of a 50-year-old man who developed lumbosacral pain and high fever with chills four days after colonoscopy, during which polypectomy was performed by endoscopic mucosal resection (EMR) and argon plasma coagulation (APC). Both the plain abdominal film and abdominal CT scan showed no free air, and lumbar CT showed no apparent lesions, which satisfied the diagnosis of PPS. However, the patient was in a critical condition as he developed septic shock caused by bacteremia. Following active treatment, the patient's condition rapidly improved. Therefore, we suggest that clinicians should consider the severity of PPS with sepsis and colon transmural burn. Patients with a diagnosis of PPS should be admitted to the hospital for observation and treatment to avoid adverse consequences.


Assuntos
Colo/lesões , Doenças do Colo/etiologia , Colonoscopia/efeitos adversos , Sepse/etiologia , Humanos , Perfuração Intestinal/diagnóstico , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Sepse/terapia , Síndrome
9.
Medicine (Baltimore) ; 99(10): e19404, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150089

RESUMO

INTRODUCTION: Colonic intramural hematomas are rarely encountered clinical entity. Colonic intramural hematomas are frequently associated with blunt trauma, and they could occur spontaneously in patients under anticoagulant therapy or with bleeding diathesis. There were few reports on synchronous colon cancer and intramural hematoma. Intramural hematomas of gastrointestinal tract in those patients undergoing anticoagulation treatment often occurred at the esophagus, duodenum, and small intestine, while colon was rarely affected site. Clinical symptoms of colonic intramural hematomas may include abdominal pain, lower gastrointestinal bleeding, and occasionally bowel obstruction. PATIENT CONCERNS: We herein report 2 cases of colonic intramural hematomas. Case 1 presented with abdominal pain and decreased defecation. Colonoscopy and contrast-enhanced computed tomography (CT) revealed intramural hematoma proximal to the neoplasm at ascending colon. Case 2 was a patient under regular anticoagulation therapy after coronary arterial stent implantation. His chief complaints were intermittent abdominal pain and distension. Colonoscopy and contrast-enhanced CT demonstrated intramural hematoma at sigmoid colon. DIAGNOSIS: Case 1 was diagnosed synchronous colonic intramural hematoma and colon cancer at ascending colon via surgery. Case 2 was diagnosed intramural hematoma of sigmoid colon through colonoscopy and follow-up CT. INTERVENTIONS: Case 1 underwent right hemicolectomy. Case 2 received conservative treatment including anticoagulation discontinuation, total parenteral nutrition, and intravenous hydration. OUTCOMES: They both had a good recovery. CONCLUSION: Colonoscopy and CT are useful in diagnosing colonic intramural hematoma. The optimal treatment should be individualized according to different etiologies causing hematoma.


Assuntos
Doenças do Colo/diagnóstico por imagem , Doenças do Colo/terapia , Hematoma/diagnóstico por imagem , Hematoma/terapia , Dor Abdominal/etiologia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso , Anticoagulantes/efeitos adversos , Colectomia , Doenças do Colo/etiologia , Neoplasias do Colo/complicações , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/cirurgia , Colonoscopia , Constipação Intestinal/etiologia , Hidratação , Hematoma/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nutrição Parenteral , Tomografia Computadorizada por Raios X
10.
JAMA Surg ; 155(3): 206-215, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31913422

RESUMO

Importance: Bridge to elective surgery using self-expandable metal stent (SEMS) placement is a debated alternative to emergency resection for patients with left-sided obstructive colon cancer because of oncologic concerns. A decompressing stoma (DS) might be a valid alternative, but relevant studies are scarce. Objective: To compare DS with SEMS as a bridge to surgery for nonlocally advanced left-sided obstructive colon cancer using propensity score matching. Design, Setting, and Participants: This national, population-based cohort study was performed at 75 of 77 hospitals in the Netherlands. A total of 4216 patients with left-sided obstructive colon cancer treated from January 1, 2009, to December 31, 2016, were identified from the Dutch Colorectal Audit and 3153 patients were studied. Additional procedural and intermediate-term outcome data were retrospectively collected from individual patient files, resulting in a median follow-up of 32 months (interquartile range, 15-57 months). Data were analyzed from April 7 to October 28, 2019. Exposures: Decompressing stoma vs SEMS as a bridge to surgery. Main Outcomes and Measures: Primary anastomosis rate, postresection presence of a stoma, complications, additional interventions, permanent stoma, locoregional recurrence, disease-free survival, and overall survival. Propensity score matching was performed according to age, sex, body mass index, American Society of Anesthesiologists score, prior abdominal surgery, tumor location, pN stage, cM stage, length of stenosis, and year of resection. Results: A total of 3153 of the eligible 4216 patients were included in the study (mean [SD] age, 69.7 [11.8] years; 1741 [55.2%] male); after exclusions, 443 patients underwent bridge to surgery (240 undergoing DS and 203 undergoing SEMS). Propensity score matching led to 2 groups of 121 patients each. Patients undergoing DS had more primary anastomoses (104 of 121 [86.0%] vs 90 of 120 [75.0%], P = .02), more postresection stomas (81 of 121 [66.9%] vs 34 of 117 [29.1%], P < .001), fewer major complications (7 of 121 [5.8%] vs 18 of 118 [15.3%], P = .02), and more subsequent interventions, including stoma reversal (65 of 113 [57.5%] vs 33 of 117 [28.2%], P < .001). After DS and SEMS, the 3-year locoregional recurrence rates were 11.7% for DS and 18.8% for SEMS (hazard ratio [HR], 0.62; 95% CI, 0.30-1.28; P = .20), the 3-year disease-free survival rates were 64.0% for DS and 56.9% for SEMS (HR, 0.90; 95% CI, 0.61-1.33; P = .60), and the 3-year overall survival rates were 78.0% for DS and 71.8% for SEMS (HR, 0.77; 95% CI, 0.48-1.22; P = .26). Conclusions and Relevance: The findings suggest that DS as bridge to resection of left-sided obstructive colon cancer is associated with advantages and disadvantages compared with SEMS, with similar intermediate-term oncologic outcomes. The existing equipoise indicates the need for a randomized clinical trial that compares the 2 bridging techniques.


Assuntos
Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Neoplasias do Colo/complicações , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Stents Metálicos Autoexpansíveis , Estomas Cirúrgicos , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/mortalidade , Feminino , Humanos , Obstrução Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida
13.
Digestion ; 101(2): 208-216, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30840962

RESUMO

BACKGROUND/AIMS: Recently, endoscopic detachable snare ligation (EDSL) has become increasingly common as treatment for colonic diverticular hemorrhage. This study aimed to evaluate the efficacy and safety of EDSL in comparison with endoscopic clipping (EC) as treatment for colonic diverticular hemorrhage. METHODS: From April 2013 to September 2017, 131 patients were treated with EDSL or EC at the Tokyo Metropolitan Bokutoh Hospital. We retrospectively evaluated patient characteristics and clinical outcomes, including early rebleeding rates (rebleeding within 30 days after initial hemostasis) and complications for each procedure. RESULTS: Of 131 patients, 44 and 87 were treated with EDSL and EC respectively. We initially achieved endoscopic hemostasis in all patients. The early rebleeding rate was significantly lower for EDSL (6.8%, 3 patients) than for EC (23.0%, 20 patients). There were no differences in the total procedure time (43 vs. 45 min, p = 0.84) or time to hemostasis after identification of bleeding site (12 vs. 10 min, p = 0.23). There were no severe complications following EDSL. CONCLUSION: The results of this study suggest that EDSL is superior to EC as treatment for colonic diverticular hemorrhage. EDSL may provide improvements in the clinical course of patients with colonic diverticular hemorrhage.


Assuntos
Doenças do Colo/cirurgia , Colonoscopia/métodos , Divertículo do Colo/complicações , Hemorragia Gastrointestinal/cirurgia , Hemostase Endoscópica/instrumentação , Ligadura/instrumentação , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/etiologia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemostase Endoscópica/métodos , Humanos , Ligadura/métodos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Instrumentos Cirúrgicos , Resultado do Tratamento
14.
J Crohns Colitis ; 14(2): 205-215, 2020 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-31282946

RESUMO

BACKGROUND AND AIMS: Based on genetics and natural history, Crohn's disease can be separated into two entities, an ileal and a colonic disease. Protein-based approaches are needed to elucidate whether such subphenotypes are related to distinct pathophysiological processes. METHODS: The proteome of ulcer edges was compared with that of paired control tissue samples [n = 32 biopsies] by differential proteomics in the ileum and the colon of Crohn's disease patients [n = 16]. The results were analysed using a hypothesis-driven approach [based on the literature] and a hypothesis-free approach [pathway enrichment analyses] to determine common and segment-specific pathophysiological processes associated with ileal and colonic CD ulcer edges. To confirm the involvement of a key pathway highlighted by proteomics, two proteins were also studied by immunochemistry. RESULTS: In the ileum and the colon, 4428 and 5204 proteins, respectively, were identified and quantified. Ileal and colonic ulcer edges differed in having a distinct distribution of proteins associated with epithelial-mesenchymal transition, neutrophil degranulation, and ribosomes. Ileal and colonic ulcer edges were similarly characterized by an increase in the proteins implicated in the endoplasmic reticulum protein-processing pathway and a decrease in mitochondrial proteins. Immunochemistry confirmed the presence of endoplasmic reticulum stress in the mucosa of ileal and colonic ulcer edges. CONCLUSION: This study provides protein-based evidence for partially distinct pathophysiological processes being associated with ileal and colonic ulcer edges in Crohn's disease patients. This could constitute a first step toward the development of gut segment-specific diagnostic markers and therapeutics.


Assuntos
Doenças do Colo/etiologia , Doença de Crohn/complicações , Doenças do Íleo/etiologia , Úlcera/etiologia , Adulto , Idoso , Colo/metabolismo , Colo/fisiopatologia , Doenças do Colo/metabolismo , Doenças do Colo/fisiopatologia , Doença de Crohn/metabolismo , Doença de Crohn/fisiopatologia , Feminino , Humanos , Doenças do Íleo/metabolismo , Doenças do Íleo/fisiopatologia , Íleo/metabolismo , Íleo/fisiopatologia , Masculino , Pessoa de Meia-Idade , Proteômica/métodos , Úlcera/metabolismo , Úlcera/fisiopatologia
15.
Asian J Surg ; 43(5): 577-584, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31400954

RESUMO

BACKGROUND/OBJECTIVE: Colonoscopy-induced colonic perforation often requires surgical management. The aim of this study was to analyze the outcomes after surgery for colonoscopic perforations (CPs). METHODS: This was a retrospective chart review study of 48 patients who underwent surgery for CPs between January 2002 and May 2017. The patients were divided into two groups: Group I (n = 25) had diagnostic CPs, and Group II (n = 23) had therapeutic CPs. RESULTS: The most common perforation sites in Group I were the sigmoid colon (n = 19; 76.0%), whereas in Group II were the transverse colon (n = 10, 43.5%) and sigmoid colon (n = 10, 43.5%; p = 0.013). The surgeries performed were primary closure (n = 16, [64.0%] Group I; n = 11 [47.8%] Group II) and bowel resection (n = 9 [36.0%] Group I; n = 11 [47.8%] Group II). The rate of temporary stomas was higher in Group II (n = 9, 26.1%) than Group I (n = 2, 8.0%; p = 0.030). The re-perforation rate after surgery was 8.0% (n = 2) in Group I and 8.7% (n = 2) in Group II (p = 0.568). These re-perforation patients all those who had a simple closure without a wedge resection. The conversion rate after laparoscopic surgery was 20.0% (n = 2 of 10) in Group I and 33.3% (n = 1 of 3) in Group II. CONCLUSIONS: Surgical management is one of the important therapies in the treatment of CP. Simple primary closure without a wedge resection should be used cautiously. Therapeutic CPs was associated with more temporary stoma formation. The type of surgery should be carefully selected, depending on the type of CP.


Assuntos
Colo Sigmoide/cirurgia , Doenças do Colo/etiologia , Doenças do Colo/cirurgia , Colonoscopia/efeitos adversos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Técnicas de Fechamento de Ferimentos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estomas Cirúrgicos , Resultado do Tratamento
16.
BMC Pediatr ; 19(1): 492, 2019 12 12.
Artigo em Inglês | MEDLINE | ID: mdl-31830939

RESUMO

BACKGROUND: Colon stenosis and acute appendicitis are rare diseases among premature babies. To the best of our knowledge, no study has identified both the conditions in preterm babies. CASE PRESENTATION: Here we report a case of a preterm Japanese male baby who developed ascending colon stenosis and appendicitis. During his neonatal intensive care unit stay, he developed increasing apnea and vomiting with rapidly worsening abdominal distention. Contrast radiographs indicated colon stenosis. Emergent exploratory laparotomy revealed ascending colon stenosis with appendix adhesion; both the lesions were surgically resected. The pathological findings suggested that he had appendicitis several weeks prior to the surgery; the onset of colon lesion seemed later than that of appendix. The perforated appendix was covered by the ascending colon, and inflammatory reactions led to the narrowing of the intestinal lumen. CONCLUSIONS: Neonatal appendicitis and colon stenosis are both challenging for the diagnosis, and early laparotomy is necessary when these conditions are suspected.


Assuntos
Apendicite/complicações , Colo/patologia , Doenças do Colo/etiologia , Doença Aguda , Constrição Patológica/etiologia , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino
17.
BMC Gastroenterol ; 19(1): 208, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801483

RESUMO

BACKGROUND: Despite pancreatic extracorporeal shock wave lithotripsy (P-ESWL) is a minimally invasive treatment for pancreatic stones, complications exist. CASE PRESENTATION: A 37-year-old male was diagnosed with chronic pancreatitis and admitted to our hospital for recurrent acute pancreatitis. After the first P-ESWL session, the patient complained of a new type of pain different from the previous pain pattern. Computerized tomography and colonoscopy were arranged and colonic hematoma was found. Since the patient had stable vital signs, no special treatment was given focusing on the colonic hematoma. Five days later, P-ESWL treatment was repeatedly performed for four consecutive days. Two days after the last P-ESWL session, the patient underwent endoscopic retrograde cholangiopancreatography. At the three-month follow up visit, the colonic hematoma disappeared and pancreatic stones decreased significantly. CONCLUSIONS: To the best of our knowledge, colonic hematoma after P-ESWL for pancreatic stones has never been reported. Here, we present the only case of colonic hematoma after P-ESWL, which was coincidentally found in more than 6000 P-ESWL sessions in our hospital. As the symptoms of colonic hematoma are mild, we believe the incidence of colonic hematoma has been underestimated. Many people with colonic hematoma after P-ESWL may be undiagnosed or misdiagnosed. Treatment for colonic hematoma depends on whether there is severe clinical state. Exploration of more precise location method for pancreatic stones may reduce the probability of P-ESWL complication.


Assuntos
Cálculos/terapia , Doenças do Colo/etiologia , Hematoma/etiologia , Litotripsia/efeitos adversos , Pancreatopatias/terapia , Adulto , Doenças do Colo/diagnóstico por imagem , Colonoscopia , Hematoma/diagnóstico por imagem , Humanos , Masculino , Pancreatite Crônica/diagnóstico
18.
Am J Gastroenterol ; 114(12): 1847-1856, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31805016

RESUMO

OBJECTIVES: Although systemic sclerosis (SSc) is known to affect the gastrointestinal (GI) tract, most of the literature focuses on esophageal, small intestinal, or anorectal manifestations. There have been no reviews focused on large bowel SSc complications in over 30 years. The aim of this study is to perform a systematic review of colonic manifestations and complications of SSc. METHODS: An experienced librarian conducted a search of databases, including English and Spanish articles. The search used keywords including "systemic sclerosis," "scleroderma," and "colon." A systematic review was performed using Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Case reports/series were screened for validity by adapting from criteria published elsewhere. RESULTS: Of 1,890 articles, 74 met selection criteria. Fifty-nine of the 77 articles were case reports/series. The most common article topics on colonic SSc complications were constipation/dysmotility (15), colonic volvulus (8), inflammatory bowel disease (7), microscopic colitis (6), megacolon (6), and telangiectasia (6). Colonic manifestations constituted 24% of articles on GI complications of SSc. There were a total of 85 cases (84% women, with a median age of onset of colon complication of 52 years). Limited cutaneous SSc phenotype (65.6%) was more common than diffuse (26.2%). Patients frequently had poor outcomes with high mortality related to colonic complications (27%). Recent studies explore contemporary topics such as the microbiome in SSc and prucalopride for chronic constipation in SSc. DISCUSSION: Colonic complications comprise a large proportion of the published reports on GI symptoms afflicting patients with SSc and require raised diagnostic suspicion and deliberate action to avoid potentially serious complications including death.


Assuntos
Doenças do Colo/fisiopatologia , Escleroderma Sistêmico/fisiopatologia , Colite Microscópica/etiologia , Colite Microscópica/fisiopatologia , Doenças do Colo/etiologia , Constipação Intestinal/etiologia , Constipação Intestinal/fisiopatologia , Humanos , Doenças Inflamatórias Intestinais/etiologia , Doenças Inflamatórias Intestinais/fisiopatologia , Volvo Intestinal/etiologia , Volvo Intestinal/fisiopatologia , Megacolo/etiologia , Megacolo/fisiopatologia , Esclerodermia Difusa/complicações , Esclerodermia Difusa/fisiopatologia , Esclerodermia Limitada/complicações , Esclerodermia Limitada/fisiopatologia , Escleroderma Sistêmico/complicações , Telangiectasia/etiologia , Telangiectasia/fisiopatologia
19.
Zhonghua Wai Ke Za Zhi ; 57(12): 917-920, 2019 Dec 01.
Artigo em Chinês | MEDLINE | ID: mdl-31826596

RESUMO

Objective: To examine the effectiveness of non-operative of colonic fistula following acute pancreatitis. Methods: Retrospective analysis of 354 patients with acute pancreatitis who were admitted to Department of Hepatobiliary Surgery of Chinese People's Liberation Army General Hospital from January 2013 to December 2018. Age of the patients was (46±14) years (range: 14-85 years); 249 cases (70.3%) were males. There were 41 cases of acute edematous pancreatitis and 313 cases of acute necrotising pancreatitis. Two hundred and fifteen cases were diagnosed as moderate severe acute pancreatitis and 139 were diagnosed as severe acute pancreatitis. Among 313 cases of acute necrotising pancreatitis, 62 cases underwent non-surgical treatment, 251 cases underwent surgical treatment in which 218 of minimal access retroperitoneal pancreatic necrosectomy underwent percutaneous nephroliguectomy with peripancreatic necrotic tissue removal technique. Results: There were 15 cases of colon fistula following acute necrotising pancreatitis, and the incidence rate was 4.2%(15/354). There were 7 males and 8 females, with age of (39±8) years (range: 27 to 50 years). The median interval between acute pancreatitis onset and diagnosis of colonic fistula was 71 days(27-134) days. Two cases occurred at the hepatic flexure of the colon, 4 cases at transverse colon, and 9 cases at splenic flexure of colon. Of the 354 patients, 39 cases died and the mortality was 11.0%. Two patients underwent laparotomy, and one of them died. The remaining 13 patients underwent non-surgical treatment and were discharged. Conclusion: Acute pancreatitis with colonic fistula can be treated with non-surgical treatment and can achieve good prognosis.


Assuntos
Doenças do Colo/terapia , Fístula Intestinal/terapia , Pancreatite/terapia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/etiologia , Feminino , Humanos , Fístula Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Pancreatite/complicações , Pancreatite Necrosante Aguda/complicações , Pancreatite Necrosante Aguda/terapia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
20.
Eur J Radiol ; 121: 108717, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31739271

RESUMO

OBJECTIVE: To identify magnetic resonance imaging (MRI) features associated with colorectal surgical bowel resection for treatment of deep infiltrating endometriosis (DIE). MATERIALS AND METHODS: 122 preoperative pelvic MRIs in women with laparoscopically-proven DIE and subsequent surgery (2006-2015) were identified, and retrospective cohort analysis performed. MRIs were reviewed independently by two radiologists blinded to surgical/histopathological outcomes. Associations between MRI characteristics of middle/posterior compartment endometriosis and surgical outcomes were investigated to identify MRI features associated with colorectal surgical bowel resection. RESULTS: MRI features associated with colorectal surgical intervention were: presence of an MRI bowel lesion (sensitivity 95.3%, specificity 63.3%, ROC-AUC 0.79); MRI bowel lesions ≥20 mm in length (sensitivity 91%, specificity 77%, ROC-AUC 0.84); MRI bowel lesions invading the muscularis or submucosa/mucosa layers (sensitivity 95.3%, specificity 63.3%, ROC-AUC 0.90). CONCLUSION: This study identifies MRI features that have potential diagnostic utility in identifying the need for colorectal surgical intervention in patients with DIE.


Assuntos
Doenças do Colo/diagnóstico por imagem , Doenças do Colo/cirurgia , Endometriose/complicações , Endometriose/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Doenças Retais/diagnóstico por imagem , Doenças Retais/cirurgia , Adulto , Doenças do Colo/etiologia , Endometriose/patologia , Feminino , Humanos , Valor Preditivo dos Testes , Doenças Retais/etiologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade
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