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1.
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
2.
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
3.
Cir. pediátr ; 32(4): 190-194, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184108

RESUMO

Objetivos. El gold standard para el tratamiento de la invaginación ileocólica en el paciente estable sin complicación radiológica es el enema hidrostático. No hay unanimidad sobre si la sintomatología prolongada de invaginación influye en los resultados de dicho tratamiento. El objetivo de este estudio es determinar si el enema hidrostático es efectivo y seguro en pacientes con clínica de invaginación ileocólica mayor de 24 horas. Material y métodos. Estudio retrospectivo de los pacientes diagnosticados de invaginación ileocólica en nuestro hospital entre 2014 y 2017. Hemos dividido en 2 grupos a los pacientes a los que se realizó enema en función del tiempo de clínica, mayor o menor de 24 horas. El análisis estadístico se realizó mediante el test exacto de Fisher. Resultados. En este periodo se atendieron 59 niños con invaginación ileocólica con duración variable de los síntomas (2 horas a 7 días). Del total de pacientes, en 49 se realizó enema hidrostático inicial con una efectividad del 91,8% (45 pacientes). En el grupo de clínica <24 horas (33 pacientes, 67,3%) se objetivó una efectividad del 93,9% y en el grupo de clínica >24 horas (16 pacientes, 32,7%) se objetivó una efectividad del 87,5%. No hubo diferencias significativas al comparar la efectividad entre ambos grupos (p=0,588). En ningún paciente hubo complicaciones tras el enema. Conclusiones. El empleo del enema hidrostático en pacientes con clínica prolongada de invaginación es efectivo y seguro. Consideramos que debería ser la primera herramienta terapéutica en el paciente estable sin complicación radiológica, independientemente del tiempo de evolución


Purpose. Hydrostatic enema is the gold standard treatment for ileocolic intussusception in stable patients without radiologic complication. There is no consensus about the influence of long history of symptoms in the outcome of this treatment. The aim of this study is to determine whether hydrostatic enema is effective and safe in patients with history of ileocolic intussusception of over 24 hours. Materials and methods. Retrospective review of all patients with ileocolic intussusception admitted to our hospital between 2014 and 2017. We divided the patients in whom enema was attempted on into two groups according to the length of history: over or under 24 hours. Statistical analysis was done by using the Fisher's exact test. Results. In this study period 59 children presented with ileocolic intussusception. Duration of symptoms was variable (range 2 hours-7 days). Of the total of patients, initial hydrostatic enema was attempted on 49, with a success rate of 91.8% (45 patients). In the group of his-tory <24 hours (33 patients, 67.3%) we observed a 93.9% effectiveness and in the group >24 hours (16 patients, 32.7%) effectiveness was 87.5%. Success rate showed no significant difference when compar-ing both groups (p=0.588). No complications were seen after enema reduction. Conclusions. The use of hydrostatic enema in patients with long history of intussusception is successful and safe. We consider it to be the first-line treatment in stable patients with no radiologic complication, regardless the duration of symptoms


Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Enema/métodos , Intussuscepção/diagnóstico , Doenças do Íleo/complicações , Hidrostática/métodos , Estudos de Coortes , Doenças do Íleo/terapia , Doenças do Colo/complicações , Doenças do Colo/terapia , Estudos Retrospectivos , Dor Abdominal/etiologia
4.
Medicine (Baltimore) ; 98(33): e16846, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415410

RESUMO

RATIONALE: Primary epiploic appendagitis (PEA) is a rare cause of acute abdomen caused by spontaneous torsion or venous thrombosis of epiploic appendices, it commonly manifests with acute lower quadrant pain, thus may mimic acute diverticulitis, appendicitis, or mesenteric infarction. PATIENT CONCERNS: In this case report, we report a 44 years old man who presented with persistent sharp pain in the left lower quadrant abdomen, Laboratory tests were mostly normal, contrast enhanced computed tomography (CECT) revealed a slightly high density shadow with fat foci in the middle was presented around the local descending colon, accompanied by the adjacent peritoneal thickening. DIAGNOSES: He was diagnosed with PEA as confirmed by an abdominal contrast enhanced computed tomography (CECT) scan. INTERVENTIONS: He was followed up in the clinic without any dietary restrictions, antibiotic or analgesic drugs use. OUTCOMES: The abdominal pain gradually subsided a week later, and there were no recurrence of the symptoms during follow-up. LESSONS: In our case, the diagnosis of PEA using CECT allows the patient to avoid surgery and other invasive treatment.


Assuntos
Abdome Agudo/diagnóstico , Colo Descendente/diagnóstico por imagem , Doenças do Colo/diagnóstico por imagem , Abdome Agudo/terapia , Adulto , Apendicite/diagnóstico , Colo Descendente/patologia , Doenças do Colo/patologia , Doenças do Colo/terapia , Tratamento Conservador , Diagnóstico Diferencial , Diverticulite/diagnóstico , Humanos , Masculino , Ultrassonografia Doppler em Cores
6.
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
7.
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
8.
Dig Liver Dis ; 51(6): 769-773, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31122823

RESUMO

Eosinophilic colitis is a rare entity characterized by the presence of a high eosinophilic infiltrate into the colonic wall in symptomatic patients, more often presenting with abdominal pain or diarrhea. These characteristics distinguish eosinophilic colitis from primary colonic eosinophilia, in which patients are asymptomatic. Primary colonic eosinophilia does not need any therapy, while eosinophilic colitis requires a strict treatment, similar to that of the more codified chronic intestinal inflammatory diseases. To date the lack of codified guidelines regarding the diagnostic criteria and the eosinophil threshold values for each colonic segment are the main diagnostic challenge for eosinophilic colitis. In addition, eosinophilic colitis is a diagnosis of exclusion, once all other causes of colonic eosinophilia (food allergens, infections, drugs, etc.) have been excluded. Several treatment options are available for eosinophilic colitis, although the evidence for most of them is limited to case reports and small case series. We examine the epidemiology, etiology, pathophysiology, diagnostic criteria and therapeutic options of eosinophilic colitis reporting recent evidence from the current literature.


Assuntos
Colite/terapia , Doenças do Colo/terapia , Eosinofilia/terapia , Colite/diagnóstico , Colite/epidemiologia , Doenças do Colo/diagnóstico , Doenças do Colo/epidemiologia , Diagnóstico Diferencial , Diarreia/diagnóstico , Diarreia/etiologia , Eosinofilia/diagnóstico , Eosinofilia/epidemiologia , Humanos , Mucosa Intestinal/patologia
9.
BMC Gastroenterol ; 19(1): 55, 2019 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-30991964

RESUMO

BACKGROUND: Severe haemorrhage is an uncommon but life-threatening complication of ulcerative colitis (UC). Superselective transcatheter embolization has shown to be an effective and safe therapeutic modality in patients with lower gastrointestinal bleeding of various aetiologies; nevertheless, its role in UC-related acute bleeding is unknown. CASES PRESENTATION: Efficacy and safety of selective transcatheter arterial embolization in three consecutive UC patients diagnosed with massive haemorrhage admitted in a tertiary institution are reported. In all patients computed tomography scan showed active arterial haemorrhage from ascendant or sigmoid colon; subsequent arteriography demonstrated active arterial bleeding from colic branches of the superior or inferior mesenteric arteries, and selective transcatheter embolization was performed with immediate technical success in all three cases. Nevertheless, rebleeding requiring subtotal colectomy occurred between 5 h and 6 days after the procedure. CONCLUSIONS: Transcatheter arterial embolization is not an effective therapeutic approach in UC patients with severe, acute colonic haemorrhage. Colectomy should not be delayed in this setting.


Assuntos
Colite Ulcerativa/complicações , Doenças do Colo/terapia , Embolização Terapêutica , Hemorragia Gastrointestinal/terapia , Adulto , Colectomia , Colo Ascendente/diagnóstico por imagem , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/etiologia , Embolização Terapêutica/efeitos adversos , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Humanos , Ileostomia , Recidiva , Doenças do Colo Sigmoide/diagnóstico por imagem , Doenças do Colo Sigmoide/etiologia , Doenças do Colo Sigmoide/terapia
10.
Rev Gastroenterol Mex ; 84(2): 220-240, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31014749

RESUMO

Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.


Assuntos
Doenças do Colo/terapia , Doenças Diverticulares/terapia , Consenso , Técnica Delfos , Diverticulite/terapia , Guias como Assunto , Humanos , México
12.
Gastrointest Endosc ; 89(4): 865-871, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30612959

RESUMO

BACKGROUND AND AIMS: Acute lower GI bleeding is a frequent cause of hospital admission. The objective of this study was to evaluate the safety and performance of a hemostatic powder (TC-325/Hemospray) in the treatment of nonvariceal lower GI bleeding. METHODS: Patients were enrolled into this prospective, multicenter, single-arm study at 4 tertiary care centers in Canada. Fifty patients with active lower GI bleeding of multiple different causes (52 bleeding sites) underwent topical endoscopic application of hemostatic powder. The primary endpoint was powder-related adverse events within 30 days of the index procedure. Secondary endpoints were initial hemostasis as well as recurrent bleeding and mortality within 30 days of the index procedure. RESULTS: Most patients (96%) had a single bleeding site, and most bleeding (73%) was due to polypectomy. Overall, the powder was applied as monotherapy in 13 bleeding sites (25%), as combination therapy in 22 bleeding sites (42.3%), and as rescue therapy in 17 bleeding sites (32.7%). Hemostasis was achieved in 98% of patients. No patient experienced a powder-related adverse event. Five patients (10%) developed recurrent bleeding within 30 days. One patient (2%) died within 30 days of powder application, but the death was not directly related to hemostatic powder use. CONCLUSIONS: The hemostatic powder is a safe and effective option for patients with lower GI bleeding of varying causes, and in particular, postpolypectomy hemorrhage. The hemostatic powder is effective as monotherapy, part of a combination approach, or as a rescue therapeutic option for the treatment of nonvariceal lower GI bleeding. (Clinical trial registration number: NCT02099435.).


Assuntos
Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/métodos , Hemostáticos/uso terapêutico , Enteropatias/terapia , Minerais/uso terapêutico , Hemorragia Pós-Operatória/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canadá , Doenças do Ceco/terapia , Doenças do Colo/terapia , Pólipos do Colo/cirurgia , Colonoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Estudos Prospectivos , Doenças Retais/terapia , Recidiva , Resultado do Tratamento
14.
Surg Laparosc Endosc Percutan Tech ; 29(3): 173-177, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30608917

RESUMO

PURPOSE: The purpose of our study was to investigate the clinical outcomes of colonoscopic perforations in patients. MATERIALS AND METHODS: We retrospectively studied patients with perforations secondary to diagnostic/therapeutic colonoscopy between 2009 and 2015 at the Pontevedra Hospital Complex. We analyzed age, closure method, length of hospitalization, and long-term progress. RESULTS: Of the 34 perforations detected, 67.6% occurred in patients aged below 75 years. Most perforations occurred in the descending colon (55%). Perforations occurred in 55.9% of outpatients and 45% of inpatients. Diagnostic and therapeutic colonoscopies caused perforations in 20.6% and 79.4% of patients, respectively. Conservative treatment alone was performed in 5.9%, complete or partial endoscopic closure in 14.7%, and surgery in 79.4% of patients. Patients treated only conservatively or with concomitant endoscopic closure showed no mortality. The mortality rate was 14.8% in those treated surgically, and 55% of these patients required a subsequent ostomy. CONCLUSIONS: Conservative management with antibiotics and parenteral nutrition concomitant with complete/partial endoscopic closure effectively treats perforations, provided intraprocedural diagnosis is possible with immediate administration of antibiotics after the procedure. Nevertheless, studies with larger number of patients and statistical analysis are necessary in the near future.


Assuntos
Doenças do Colo/etiologia , Colonoscopia , Perfuração Intestinal/etiologia , Adulto , Idoso , Colo/cirurgia , Doenças do Colo/terapia , Tratamento Conservador/métodos , Jejum/fisiologia , Feminino , Humanos , Doença Iatrogênica , Perfuração Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos , Adulto Jovem
15.
Curr Opin Gastroenterol ; 35(1): 42-50, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30480590

RESUMO

PURPOSE OF REVIEW: Eosinophilic colitis is a rare condition, with a prevalence rate in the USA of 2-3/100 000 persons (0.003%), but diagnosed in 0.1% of biopsies in those colonoscoped for diarrhoea. Secondary colonic eosinophilia is more common and associated with systemic, colonic and infectious diseases. In this review, the latest advances in diagnosis, treatment and prognosis are summarized and discussed. RECENT FINDINGS: What constitutes a 'normal' count of eosinophils is poorly documented but there are recent studies that establish normal colonic eosinophil ranges as well as distinguishing histological and clinical findings in primary eosinophilic colitis and secondary colonic eosinophilia in children and adults. Primary eosinophilic colitis is rare, relatively straightforward to diagnose, but may be difficult to treat. Colonic eosinophilia may be overt in parasite infection and connective tissue disease. More subtle, secondary colonic eosinophilia is a useful biomarker for gastrointestinal diseases, such as inflammatory bowel disease, colonic spirochaetosis and collagenous colitis, but the eosinophilia may more often be overlooked. A limited number of drugs are also known to cause left sided colonic eosinophilia such as clopidogrel, ibuprofen and oestroprogestinic agents. SUMMARY: Advances in our understanding of primary eosinophilic colitis and secondary colonic eosinophilia is progressing and if present, colonic eosinophilia should point the clinician and pathologist to a list of differential diagnoses worth considering to direct optimal management.


Assuntos
Colite , Doenças do Colo , Eosinofilia , Colite/diagnóstico , Colite/patologia , Colite/terapia , Doenças do Colo/diagnóstico , Doenças do Colo/patologia , Doenças do Colo/terapia , Diagnóstico Diferencial , Diarreia/diagnóstico , Diarreia/etiologia , Eosinofilia/diagnóstico , Eosinofilia/patologia , Eosinofilia/terapia , Humanos , Mucosa Intestinal/patologia
16.
Pediatr Radiol ; 49(1): 76-81, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30232533

RESUMO

BACKGROUND: Ileocolic intussusception occurs when the terminal ileum "telescopes" into the colon. We observed that ileocolic intussusception lengths are similar regardless of location in the colon. OBJECTIVE: To examine the uniformity of ileocolic intussusception length and its relationship to colon location, symptom duration and reducibility. MATERIALS AND METHODS: We retrospectively reviewed ultrasound-diagnosed pediatric ileocolic intussusceptions initially treated with pneumatic reduction at the Mayo Clinic or Texas Children's Hospital. We recorded demographic, imaging and surgical findings including age, gender, symptom duration, location of the ileocolic intussusception, reducibility with air enema and, if fluoroscopically irreducible, surgical findings. RESULTS: We identified 119 ileocolic intussusceptions (64% boys), with 81% in the right colon. There was no significant relationship between ileocolic intussusception length and colon location (P=0.15), nor ileocolic intussusception length and symptom duration (P=0.36). Ileocolic intussusceptions were more distal with increasing symptom duration (P=0.016). Successful reductions were unrelated to symptom duration (P=0.84) but were more likely with proximal versus distal locations (P=0.02). CONCLUSION: Ileocolic intussusception lengths are relatively uniform regardless of location along the course of the colon where they present. Our findings suggest that most of the apparent distal propagation of ileocolic intussusceptions is not caused by increasing telescoping of small bowel across the ileocecal valve but rather by foreshortening of the right colon. This implies poor cecal fixation and confirms fluoroscopic and surgical observations of cecal displacement from the right lower quadrant with ileocolic intussusceptions. The movement of the leading edge of the ileocolic intussusception during reduction is first due to "relocating" the cecum into the right lower quadrant after which the reduction of small bowel back across the ileocecal valve then occurs.


Assuntos
Doenças do Colo/diagnóstico por imagem , Doenças do Íleo/diagnóstico por imagem , Intussuscepção/diagnóstico por imagem , Ultrassonografia/métodos , Doenças do Colo/terapia , Feminino , Humanos , Doenças do Íleo/terapia , Lactente , Intussuscepção/terapia , Masculino , Estudos Retrospectivos , Resultado do Tratamento
17.
Gastroenterol Hepatol ; 42(3): 157-163, 2019 Mar.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30314765

RESUMO

OBJECTIVES: (1) To evaluate the short- and long-term clinical outcomes of patients after colorectal stent placement and (2) to assess the safety and efficacy of the stents for the resolution of colorectal obstruction according to the insertion technique. METHODS: Retrospective cohort study which included 177 patients with colonic obstruction who underwent insertion of a stent. RESULTS: A total of 196 stents were implanted in 177 patients. Overall, the most common cause of obstruction was colorectal cancer (89.3%). Ninety-two stents (47%) were placed by radiologic technique and 104 (53%) by endoscopy under fluoroscopic guidance. Technical success rates were 95% in both groups. Clinical success rates were 77% in the radiological group and 81% in the endoscopic group (p>0.05). The rate of complications was higher in the radiologic group compared with the endoscopic group (38% vs 20%, respectively; p=0.006). Among patients with colorectal cancer (158), 65 stents were placed for palliation but 30% eventually required surgery. The multivariate analysis identified three factors associated with poorer long-term survival: tumor stage IV, comorbidity and onset of complications. CONCLUSIONS: Stents may be an alternative to emergency surgery in colorectal obstruction, but the clinical outcome depends on the tumor stage, comorbidity and stent complications. The rate of definitive palliative stent placement was high; although surgery was eventually required in 30%. Our study suggests that the endoscopic method of stent placement is safer than the radiologic method.


Assuntos
Doenças do Colo/terapia , Obstrução Intestinal/terapia , Implantação de Prótese/métodos , Doenças Retais/terapia , Stents Metálicos Autoexpansíveis , Idoso , Doenças do Colo/etiologia , Doenças do Colo/mortalidade , Colonoscopia , Neoplasias Colorretais/complicações , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/patologia , Constrição Patológica/complicações , Diverticulite/complicações , Feminino , Fluoroscopia , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/estatística & dados numéricos , Implantação de Prótese/estatística & dados numéricos , Radiografia Intervencionista , Doenças Retais/etiologia , Doenças Retais/mortalidade , Estudos Retrospectivos , Stents Metálicos Autoexpansíveis/estatística & dados numéricos , Resultado do Tratamento
19.
Int J Colorectal Dis ; 34(1): 169-175, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30406317

RESUMO

PURPOSE: In case reports or small studies, percutaneous endoscopic caecostomy (PEC) has been proposed as an alternative to the Malone intervention to perform antegrade colonic enemas. Our goal was to assess the feasibility, efficacy, and tolerance of PEC in a large group of patients with refractory colorectal functional disorders. METHODS: From September 2006 to April 2014, all patients undergoing PEC for constipation, fecal incontinence, and incontinence after rectal resection in two expert centers were studied. The PEC procedure consisted in anchoring the caecum to the abdominal wall (caecopexy) and placing a specifically designed tube in the colonic lumen to perform antegrade enemas. The quality of life (GIQLI), constipation (Kess), and incontinence (Cleveland) scores were assessed before PEC and at 3, 6, 12, and 24 months. RESULTS: A total of 69 patients were included. GIQLI scores were significantly improved in constipation group (n = 43), incontinence group (n = 19), and rectal resection group (n = 10). In the constipation group, Kess score decreased from 25.9 before PEC to 20.6 at 2 years (p = 0.01). In the incontinence and post-rectal resection groups, Cleveland scores decreased from 14.3 before PEC to 2.7 at 6 months (p = 0.01) and to 10.4 at 2 years (p = 0.04). Overall, PEC was considered successful by patients in 58%, 74%, and 90% of cases, in constipation, incontinence, and rectal resection groups, respectively. Chronic pain (52%) at the catheter site was the most frequent complication. CONCLUSIONS: Percutaneous endoscopic caecostomy for antegrade colonic enemas improves significantly the quality of life of patients with colorectal disorder refractory to medical treatment.


Assuntos
Cecostomia , Colo/patologia , Doenças do Colo/fisiopatologia , Doenças do Colo/terapia , Endoscopia , Doenças Retais/fisiopatologia , Doenças Retais/terapia , Cateteres , Cecostomia/efeitos adversos , Remoção de Dispositivo , Endoscopia/efeitos adversos , Determinação de Ponto Final , Humanos , Pessoa de Meia-Idade , Irrigação Terapêutica , Resultado do Tratamento
20.
Ann Ital Chir ; 89: 212-216, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30588924

RESUMO

The authors present a series of 15 patients with lower gastrointestinal bleeding. 11 (73%) out of 15 patients, were directly subjected to surgery, and 4 (37%) attempted to stop hemorrhage with angiography. In the group of patients undergoing surgery we had a mortality of 1 out of 12 (8%). In the group of patients undergoing embolization, two of four died with 50% of mortality. All patients undergoing surgery had received from a minimum of two to a maximum of four blood bags before surgery. 8 out of 12 patients (67%) received more than two bags. In 10 (67%) out of 15 patients TC scan preoperatively identified the site of bleeding. 10 cases out of 15 patients was evident Anticoagulant or antiplatelet use. In the group of patients undergoing surgical treatment with haemorrhage stopping 60% (6 out of 10) did not take these drugs. No patient had significant alterations to the INR value. Patients undergoing Surgical treatment without haemorrhage stopping had an average age significantly higher than the group with haemorrhage stopping (84 aa vs 54.2). In this group CT scan had identified the source of bleeding in one patient on two (50%) and all patients In the group of deceased patients, the average age was 78 aa, the tac had never identified the site of bleeding, and all had antiaggregates. In the group of deceased patients, the average age was 78 aa, CT scan had never identified the site of bleeding, and all In the group of deceased patients, the average age was 78 aa, the tac had never identified the site of bleeding, and all had antiaggregates KEY WORDS: Lower gastrointestinal bleeding, Prognostic factors, Surgical management.


Assuntos
Doenças do Colo/cirurgia , Hemorragia Gastrointestinal/cirurgia , Técnicas Hemostáticas , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Anticoagulantes/efeitos adversos , Transfusão de Sangue , Doenças do Colo/induzido quimicamente , Doenças do Colo/diagnóstico por imagem , Doenças do Colo/terapia , Terapia Combinada , Embolização Terapêutica , Feminino , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Hemostasia Cirúrgica , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/efeitos adversos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
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