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1.
Surg Infect (Larchmt) ; 20(6): 499-503, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31066632

RESUMO

Background: Jejunal diverticulitis is rare and usually an incidental diagnosis found on imaging. Its symptoms are non-specific. Hence, the diagnosis often is delayed, and a high mortality rate has been reported. The aim of this study was to review our experience in the management of jejunal diverticulitis and to propose a management algorithm. Methods: A retrospective review of all cases of jejunal diverticulitis seen from November 2015 to November 2018 was performed. Data collected included demographics, history of diverticulitis, risk factors, clinical presentation, biochemistry and imaging results, and management outcome. Results: Eight patients were identified during the study period, five females and three males with a median age of 71 years (range 61-85 years). One patient was on steroid treatment, and one patient had a history of jejunal diverticulitis. Abdominal pain was present in all patients, but other symptoms were variable. Two patients were initially believed to have constipation and were discharged home. All patients underwent a computed tomography (CT) scan for the diagnosis, showing that three had uncomplicated jejunal diverticulitis and five had localized perforation. Five patients were managed conservatively initially; two failed this treatment because of small bowel obstruction and persistent abdominal pain with rising inflammatory markers. Three underwent emergency laparotomy (two because of sepsis; one was thought to have a foreign body). There were no deaths. A proposed management algorithm is discussed. Conclusions: A CT scan is the mainstay for the accurate diagnosis of jejunal diverticulitis. The proposed algorithm can aid in selection of patients suitable for conservative management.


Assuntos
Algoritmos , Gerenciamento Clínico , Diverticulite/diagnóstico , Diverticulite/terapia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X
2.
Am J Gastroenterol ; 114(8): 1238-1247, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30865014

RESUMO

Involvement of the gastrointestinal (GI) tract is an infrequent extrathoracic presentation of sarcoidosis. We reviewed 305 cases of GI involvement reported in 238 patients, in whom GI sarcoidosis was the first sign of the disease in half the cases. The disease does not affect the GI tract uniformly, with a clear oral-anal gradient (80% of reported cases involved the esophagus, stomach, and duodenum). Clinicopathological mechanisms of damage may include diffuse mucosal infiltration, endoluminal exophytic lesions, involvement of the myenteric plexus, and extrinsic compressions. Ten percent of patients presented with asymptomatic or subclinical disease found on endoscopy. The diagnosis is relevant clinically because 22% of cases reviewed presented as life threatening. In addition, initial clinical/endoscopic findings may be highly suggestive of GI cancer. The therapeutic approach is heterogeneous and included wait-and-see or symptomatic approaches, glucocorticoid/immunosuppressive therapy, and surgery. Sarcoidosis of the gut is a heterogeneous, potentially life-threatening condition that requires a multidisciplinary approach and early clinical suspicion to institute personalized therapeutic management and follow-up.


Assuntos
Gastroenteropatias/diagnóstico , Sarcoidose/diagnóstico , Transtornos de Deglutição/etiologia , Duodenopatias/diagnóstico , Duodenopatias/patologia , Duodenopatias/terapia , Endoscopia Gastrointestinal , Acalasia Esofágica/diagnóstico , Acalasia Esofágica/etiologia , Acalasia Esofágica/patologia , Acalasia Esofágica/terapia , Doenças do Esôfago/complicações , Doenças do Esôfago/diagnóstico , Doenças do Esôfago/patologia , Doenças do Esôfago/terapia , Mucosa Esofágica/patologia , Gastroenteropatias/complicações , Gastroenteropatias/patologia , Gastroenteropatias/terapia , Glucocorticoides/uso terapêutico , Humanos , Doenças do Íleo/diagnóstico , Doenças do Íleo/patologia , Doenças do Íleo/terapia , Imunossupressores/uso terapêutico , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/patologia , Doenças do Jejuno/terapia , Linfadenopatia/complicações , Mediastino , Plexo Mientérico , Miotomia , Pólipos/diagnóstico , Pólipos/patologia , Pólipos/terapia , Inibidores da Bomba de Prótons/uso terapêutico , Sarcoidose/complicações , Sarcoidose/patologia , Sarcoidose/terapia , Gastropatias/diagnóstico , Gastropatias/patologia , Gastropatias/terapia
3.
Minerva Chir ; 74(2): 137-145, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29795067

RESUMO

INTRODUCTION: Small bowel non-Meckelian diverticulitis (SBNMD) is not so an uncommon cause of admission in departments of emergency surgery. Our aim is to highlight signs and symptoms for early diagnosis and report proper surgical treatments. EVIDENCE ACQUISITION: The systematic review protocol was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P). EVIDENCE SYNTHESIS: Twelve studies met our inclusion criteria. A total of 527 patients diagnosed with SBNMD were analyzed: there were 159 (30%) cases of diverticular bleeding, 125 (23%) cases of perforated SBNMD, 91 (17.26%) cases of intestinal obstruction, 79 (14.9%) cases of non-complicated diverticulitis, and 36 (6.8%) cases of ileal diverticulosis. Among bleeding patients, endoscopy procedures were performed in 51 (32%) cases. Surgery was necessary in 77/159 (48.4%) cases. Medical treatment was sufficient in 15/159 (9.4%) cases. In case of perforation, 93/125 (74.4%) patients were submitted to surgery, with open technique in 78/93 (83.8%) patients, by laparoscopy in 2/93 (2.1%) with conversion rate of 1.07%. Eight of 125 (6.4%) cases received medical treatment. In case of obstruction, non-operative management was effective in 3/91 (3.2%) cases. Surgery was performed in 74/91 (78%) cases, with open technique in 64/91 (86.4%) cases, by laparoscopy in 3/74 (4%), with one patient converted in laparotomy. CONCLUSIONS: Diagnosis of SBNMD is often made at emergency surgical exploration with high morbidity and mortality rate. SBNMD must be considered in elderly patients presenting with abdominal pain. A multidisciplinary approach to the patient (involving a radiologist, a surgeon, and a gastroenterologist) is necessary to make an early diagnosis. In case of complicated SBNMD, the emergency surgeon must choose the right surgical treatment.


Assuntos
Diverticulite/diagnóstico , Doenças do Íleo/diagnóstico , Intestino Delgado , Doenças do Jejuno/diagnóstico , Abdome Agudo/etiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Diverticulite/complicações , Diverticulite/terapia , Doença Diverticular do Colo , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/epidemiologia , Humanos , Doenças do Íleo/complicações , Doenças do Íleo/terapia , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/epidemiologia , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/epidemiologia , Doenças do Jejuno/complicações , Doenças do Jejuno/terapia , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Avaliação de Sintomas , Adulto Jovem
4.
Eur J Gastroenterol Hepatol ; 31(1): 135-139, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30211720

RESUMO

OBJECTIVES: Perforated jejunal diverticulitis (PJD) is rare, but it has high mortality rates. The role of nonsurgical management is debated. The aim of this study is to assess the outcomes of medical and surgical management of PJD. PATIENTS AND METHODS: A single-centre study on a series of emergency patients diagnosed with PJD between 2010 and 2016 was conducted. RESULTS: Eleven patients with PJD were treated (seven women). Nine out of 11 were diagnosed by a computed tomography scan, and two were diagnosed at laparotomy. The initial approach was medical treatment in five patients, based on clinical and imaging findings. Four (80%) of these five patients were discharged without the need for surgical intervention. The median hospital stay was 7.5 days. Seven patients required surgery overall with a median length of hospital stay of 10.8 days. Surgical procedures consisted of segmental bowel resection and primary anastomosis in six patients and simple closure in one. There was no perioperative deaths. One patient required percutaneous drainage because of anastomotic leak, and one required reoperation owing to evisceration. DISCUSSION: Selected patients with PJD can be successfully managed with conservative approach, based on clinical and computed tomography findings.


Assuntos
Tratamento Conservador , Procedimentos Cirúrgicos do Sistema Digestório , Diverticulite/terapia , Perfuração Intestinal/terapia , Doenças do Jejuno/terapia , Idoso , Tratamento Conservador/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Diverticulite/diagnóstico por imagem , Diverticulite/cirurgia , Drenagem , Emergências , Feminino , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/cirurgia , Tempo de Internação , Masculino , Complicações Pós-Operatórias/terapia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
BMJ Case Rep ; 20182018 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-29848538

RESUMO

A 91-year-old African American man was admitted with sudden onset diffuse abdominal pain which radiated to the right flank. CT of the abdomen with contrast showed diverticula in the jejunum with adjacent inflammation and microperforation that was contained. Conservative therapy similar to colonic diverticulitis was effective. Although rare, our case highlights the importance of having an early and high suspicion for jejunal diverticulitis when patients present with non-specific abdominal symptoms in order to avoid perforation.


Assuntos
Tratamento Conservador/métodos , Diverticulite/terapia , Doenças do Jejuno/terapia , Dor Abdominal/etiologia , Idoso de 80 Anos ou mais , Diverticulite/diagnóstico por imagem , Diagnóstico Precoce , Humanos , Doenças do Jejuno/diagnóstico por imagem , Masculino , Tomografia Computadorizada por Raios X , Resultado do Tratamento
8.
Pediatr Ann ; 47(5): e220-e225, 2018 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-29750290

RESUMO

Neonatal intestinal obstruction is caused by an anatomical abnormality that produces bowel movement failure. Intestinal obstruction presents with three classic clinical signs: vomiting, abdominal distention, and failure to pass meconium. Intestinal obstruction is one of the most common causes for admitting a pediatric patient to the pediatric surgery unit in his or her first weeks of postnatal life. Congenital obstruction of the digestive tract in neonates is a common problem, with the most frequent cause being anorectal malformations (41%), followed by esophageal obstruction (24%), and duodenal obstruction (20%). [Pediatr Ann. 2018;47(5):e220-e225.].


Assuntos
Doenças do Colo/diagnóstico , Duodenopatias/diagnóstico , Doenças do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Doenças do Jejuno/diagnóstico , Doenças do Colo/etiologia , Doenças do Colo/terapia , Diagnóstico Diferencial , Duodenopatias/etiologia , Duodenopatias/terapia , Humanos , Doenças do Íleo/etiologia , Doenças do Íleo/terapia , Recém-Nascido , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Doenças do Jejuno/etiologia , Doenças do Jejuno/terapia , Síndrome
9.
Cir Cir ; 86(2): 148-151, 2018.
Artigo em Espanhol | MEDLINE | ID: mdl-29809182

RESUMO

Jejunal diverticular disease is a very uncommon pathology often asymptomatic. Associated complications appear in less than 30% of patients and they can present as diverticulitis, refractary inflammation, obstruction, hemorrhage, perforation or intraabdominal abscess formation. Clinical manifestations are usually unspecific and high suspicion index is required to reach the diagnosis. Treatment of complications includes volume replacement, transfusions, antibiotic therapy, percutaneous drainage or surgical intervention. We present a retrospective observational study of the cases treated in our hospital between 2007 and 2016.


Assuntos
Diverticulite/diagnóstico , Diverticulite/terapia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Retrospectivos
10.
AJR Am J Roentgenol ; 210(6): 1245-1251, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29629799

RESUMO

OBJECTIVE: Acute jejunoileal diverticulitis is a very rare and potentially serious disease affecting mostly elderly patients. The diagnosis is based on imaging but remains underrecognized. The purpose of this study is to describe the clinical and CT features and the outcomes of patients with acute jejunoileal diverticulitis. MATERIALS AND METHODS: Cases of acute jejunoileal diverticulitis managed at three French hospitals November 2005 through January 2015 were identified retrospectively. The final diagnosis relied either on a clinical and radiologic data review by a panel of experts or on surgical findings. Demographic, clinical, laboratory, and 18-month outcome data were collected. CT scans were reviewed by two radiologists who reached a consensus about the presence of an inflammatory diverticulum, evidence of complications, and presence of other bowel diverticula. RESULTS: We identified 33 cases of acute jejunoileal diverticulitis in 33 patients with a median age of 78 years, including 30 (91%) patients in whom an inflammatory diverticulum was identified at the jejunum (n = 26, 87%) or ileum (n = 4, 13%). Extraintestinal gas was seen in 10 (30%) patients and extraintestinal fluid in 11 (33%) patients. Other small-bowel diverticula were visible in all 33 patients. The diverticulitis was mild and resolved with nonoperative treatment in 22 (67%) patients and was severe in the remaining 11 (33%) patients, eight of whom required emergent surgery. CONCLUSION: Acute jejunoileal diverticulitis is a rare and usually nonserious condition that chiefly involves the jejunum. A detailed CT assessment may allow nonoperative treatment.


Assuntos
Diverticulite/diagnóstico por imagem , Doenças do Íleo/diagnóstico por imagem , Doenças do Jejuno/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Doença Aguda , Idoso , Idoso de 80 Anos ou mais , Meios de Contraste , Diagnóstico Diferencial , Diverticulite/classificação , Diverticulite/terapia , Feminino , França , Humanos , Doenças do Íleo/classificação , Doenças do Íleo/terapia , Doenças do Jejuno/classificação , Doenças do Jejuno/terapia , Masculino , Interpretação de Imagem Radiográfica Assistida por Computador , Estudos Retrospectivos
11.
J Pediatr Surg ; 53(9): 1669-1674, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29241965

RESUMO

PURPOSE: The purpose of this study is to review published reports and contribute new cases of umbilical cord ulceration (UCU) with perinatal hemorrhage into the amniotic cavity in the setting of duodenal or jejunal obstruction because knowledge of this sequence is poorly disseminated and could be lifesaving. METHODS: Published reports of UCU with hemorrhage associated with congenital duodenal or jejunal obstruction were reviewed. Chart review was conducted for the cases encountered at our institutions between January 2008 and March 2017. We noted perinatal complications, method of delivery, gestational age, birth weight, gender, number, location, and pathologic description of umbilical cord ulcers, and outcome. RESULTS: Thirty-one reports and 7 new cases were studied. Perinatal complications included: preterm labor or preterm premature rupture of membranes: 63%; fetal distress: 95%; mean gestational age: 33weeks; premature gestation: 95%; bloody amniotic fluid: 90%. Pathological analysis of UCUs revealed solitary, multifocal, helical and punched-out lesions. There were 12 neonatal deaths (32%), and 12 intrauterine deaths (32%). Survival rate was 37%. CONCLUSIONS: UCU with perinatal hemorrhage is associated with duodenal and jejunal obstruction. Knowing the typical clinical signs of this potential catastrophic complication could prompt lifesaving delivery. TYPE OF STUDY: Prognostic LEVEL OF EVIDENCE: IV.


Assuntos
Duodenopatias/complicações , Hemorragia/etiologia , Obstrução Intestinal/complicações , Doenças do Jejuno/complicações , Complicações na Gravidez/etiologia , Úlcera/complicações , Cordão Umbilical , Duodenopatias/congênito , Duodenopatias/diagnóstico , Duodenopatias/terapia , Feminino , Hemorragia/diagnóstico , Hemorragia/terapia , Humanos , Recém-Nascido , Obstrução Intestinal/congênito , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/terapia , Doenças do Jejuno/congênito , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/terapia , Masculino , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Diagnóstico Pré-Natal , Prognóstico , Estudos Retrospectivos , Úlcera/congênito , Úlcera/diagnóstico
12.
Clin J Gastroenterol ; 11(1): 19-22, 2018 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29067636

RESUMO

Rapunzel syndrome is a rare form of gastric trichobezoar (hair ball) involving extension of a tail of the hair into the small bowel. A 13-year-old girl was admitted with a 4-day history of epigastric pain and nausea which worsened after meals. Abdominal ultrasound showed duodenal wall thickening and lymphadenopathy. Esophagogastroduodenoscopy identified a gastric trichobezoar with a tail extending into the duodenum. In addition, multiple longitudinal duodenal and jejunal ulcers were noted. The ulcers appeared to be a result of direct pressure by the tail itself against the intestinal mucosa. The trichobezoar was successfully retrieved endoscopically under general anesthesia. Her symptoms resolved completely after retrieval. Psychiatric follow-up was carried out to help reduce the risk of recurrence. Here, we describe a novel complication of Rapunzel syndrome, i.e., multiple longitudinal ulcers of the small intestine. This novel finding suggests that the mucosal damage caused by the trichobezoar of Rapunzel syndrome can occur in an earlier stage than previously thought. In addition, we also strongly recommend using general anesthesia with intubation when removing a gastric trichobezoar to ensure protection of the airway.


Assuntos
Bezoares/complicações , Duodenopatias/etiologia , Doenças do Jejuno/etiologia , Estômago , Úlcera/etiologia , Dor Abdominal/etiologia , Adolescente , Duodenopatias/terapia , Endoscopia do Sistema Digestório , Feminino , Humanos , Doenças do Jejuno/terapia , Síndrome , Úlcera/terapia
14.
Presse Med ; 46(12 Pt 1): 1139-1143, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29133083

RESUMO

Diverticulitis is much less common in the jejunum than in colonic diverticula probably because of diverticulum larger size, better intra-luminal flow and relatively sterile jejunal content. Complications of jejunal diverticulitis are acute intestinal obstruction, diverticular bleeding and mainly perforation with mesenteric abscess, localized or generalized peritonitis. The Multi-detector row computed tomography is now the best diagnostic imaging for small bowel diverticulitis as well as its complications. Magnetic resonance enterography is also quite useful but it is still impractical to resort to such an imaging in an abdominal emergency. Non-surgical treatment is usually sufficient for jejunal diverticulitis without peritonitis but it does not prevent recurrence of diverticulitis. Surgery is mandatory in case of generalized peritonitis or voluminous local abscess complicating small bowel diverticulitis. In case of extensive small bowel diverticulosis, resection should be limited to the intestinal loop with complicated diverticulum (local abscess, peritonitis or bleeding) to avoid short bowel syndrome. Poor prognostic factors are advanced age, associated comorbidities, delayed diagnosis and mainly the time interval between perforation and surgery.


Assuntos
Algoritmos , Diverticulite/terapia , Doenças do Jejuno/terapia , Diverticulite/diagnóstico , Humanos , Doenças do Jejuno/diagnóstico
15.
BMJ Case Rep ; 20172017 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-28438753

RESUMO

Small bowel diverticulosis of the jejunum and ileum is an uncommon finding with a prevalence rate of 0.2% to 1.3% at autopsy and 0.3% to 1.9% on small bowel studies. Diagnosis can be difficult because there are no pathognomonic features or clinical symptoms that are specific for small bowel diverticulosis. Though rare, it is critical to keep the possibility of small bowel diverticulosis in mind when evaluating cases of malabsorption, chronic abdominal pain, haemorrhage, perforation and intestinal obstruction, especially in patients with connective tissue disorders, a family history of diverticula and a personal history of colonic diverticulosis. Guidelines for the treatment of complicated small bowel diverticulosis are not clearly defined. However, the consensus in treatment is to do a small bowel resection with primary anastomosis. We report three interesting cases of jejunoileal diverticula that presented in an occult manner and later progressed to more emergent manifestations.


Assuntos
Doenças Diverticulares/diagnóstico , Doenças do Íleo/diagnóstico , Intestino Delgado , Doenças do Jejuno/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Diagnóstico por Imagem , Progressão da Doença , Doenças Diverticulares/patologia , Doenças Diverticulares/terapia , Feminino , Humanos , Doenças do Íleo/patologia , Doenças do Íleo/terapia , Doenças do Jejuno/patologia , Doenças do Jejuno/terapia , Masculino
16.
Medicine (Baltimore) ; 96(16): e6360, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-28422828

RESUMO

RATIONALE: Gastrointestinal Mucormycosis (GIM) is a kind of opportunistic fungal infection with poor prognosis. It usually occurs in patients with immune deficiency. We reported a case of immunocompetent male patient. PATIENT CONCERNS: This patient was presented as abdominal distension and gastrointestinal bleeding. DIAGNOSES: A variety of hemostatic methods was ineffective to stop the bleeding. The patient finally received laparotomy, and the jejunum lesions were found. INTERVENTIONS: Pathological examination confirmed it to be gastrointestinal mucormycosis in jejunum. OUTCOMES: However, after systemic anti-fungi therapy, the patient died of septic shock. LESSONS: The diagnosis mainly relies on pathological examination. Early diagnosis and early application of systemic amphotericin B liposome were fundamental for improving the prognosis.


Assuntos
Doenças do Jejuno/diagnóstico , Mucormicose/diagnóstico , Idoso , Diagnóstico Diferencial , Evolução Fatal , Humanos , Doenças do Jejuno/complicações , Doenças do Jejuno/patologia , Doenças do Jejuno/terapia , Jejuno/patologia , Laparotomia , Masculino , Mucormicose/complicações , Mucormicose/patologia , Mucormicose/terapia , Choque Séptico/etiologia
17.
Korean J Gastroenterol ; 69(1): 74-78, 2017 Jan 25.
Artigo em Coreano | MEDLINE | ID: mdl-28135795

RESUMO

Jejunal variceal bleeding is less common compared with esophagogastric varices in patients with portal hypertension. However, jejunal variceal bleeding can be fatal without treatment. Treatments include surgery, transjugular intrahepatic porto-systemic shunt (TIPS), endoscopic sclerotherapy, percutaneous coil embolization, and balloon-occluded retrograde transvenous obliteration (BRTO). Percutaneous coil embolization can be considered as an alternative treatment option for those where endoscopic sclerotherapy, surgery, TIPS or BRTO are not possible. Complications of percutaneous coil embolization have been reported, including coil migration. Herein, we report a case of migration of the coil into the jejunal lumen after percutaneous coil embolization for jejunal variceal bleeding. The migrated coil was successfully removed using surgery.


Assuntos
Embolização Terapêutica , Hemorragia Gastrointestinal/etiologia , Doenças do Jejuno/terapia , Equipamentos Cirúrgicos/efeitos adversos , Angiografia , Oclusão com Balão , Embucrilato/química , Hemorragia Gastrointestinal/cirurgia , Humanos , Hipertensão Portal/patologia , Doenças do Jejuno/diagnóstico , Neoplasias Hepáticas/terapia , Masculino , Pessoa de Meia-Idade , Escleroterapia , Tomografia Computadorizada por Raios X
18.
Gan To Kagaku Ryoho ; 44(12): 1644-1646, 2017 Nov.
Artigo em Japonês | MEDLINE | ID: mdl-29394729

RESUMO

Case is a 66-year-old male. He was inserted covered self expandable metallic stent(SEMS)for jejunal stenosis due to gastric cancer recurrence. Migration was occurred after 4 days from stent replacement. We had removed SEMS by endoscopy, and re-inserted non-covered SEMS. Two months later, stent stenosis was occurred by tumor ingrowth. We tried to insert another stent in the stenotic stent. The patient was able to maintain oral intake without complication for 3 months. SEMS placement would improve a quality of life for selected patients with recurrent jejunal stenosis.


Assuntos
Obstrução Intestinal/terapia , Doenças do Jejuno/terapia , Stents Metálicos Autoexpansíveis , Neoplasias Gástricas/patologia , Idoso , Gastrectomia , Humanos , Obstrução Intestinal/etiologia , Doenças do Jejuno/etiologia , Masculino , Recidiva , Neoplasias Gástricas/cirurgia , Resultado do Tratamento
20.
Langenbecks Arch Surg ; 402(7): 1071-1078, 2017 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27534867

RESUMO

PURPOSE: The jejunum is a relatively uncommon localization of Crohn's disease (CD) compared to the terminal ileum or the large bowel. The type of surgery and the short and long-term results after surgery have not been extensively investigated. A review of patients who underwent surgery for jejunal CD in our center was examined. METHODS: Between 1986 and 2011, 110 patients underwent surgery for jejunal CD. Thirty patients (27.3 %) were surgically treated with resection, 29 patients (26.4 %) with one or more strictureplasties, and 51 patients (46.3 %) with both a resection and one or more strictureplasties. RESULTS: There was no statistical difference in terms of short-term postoperative complications between patients operated with three different options (p = 0.72). Patients were followed up for a period ranging from 2 to 18 years (mean 11 years). During this period, 42 patients had no CD recurrence, 11 patients had medical recurrences only, while 57 patients had surgical recurrences, too. There was no statistical difference in terms of medical and surgical recurrence between the three types of surgical procedures employed (p = 0.24) and between smokers and non-smokers. The recurrent CD was prevalently treated with strictureplasty. CONCLUSIONS: The most frequently employed surgery for the treatment of jejunal CD is a combined type of treatment, i.e., resection of the most affected tract and strictureplasty of the residual strictures. This approach does not imply an increased risk of postoperative complications and recurrence and can reduce the risk of the short bowel syndrome.


Assuntos
Doença de Crohn/terapia , Doenças do Jejuno/terapia , Complicações Pós-Operatórias/etiologia , Adolescente , Adulto , Idoso , Terapia Combinada , Doença de Crohn/patologia , Feminino , Humanos , Doenças do Jejuno/patologia , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Recidiva , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
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