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1.
J Surg Res ; 246: 73-77, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31562988

RESUMO

BACKGROUND: Biliary dyskinesia (BD) is a common indication for cholecystectomy in children. Current literature demonstrates an improvement in symptoms after cholecystectomy in most pediatric patients with an EF <35%; however, data supporting the efficacy of cholecystectomy for hyperkinetic BD (EF >65%) is sparse. We sought to determine whether children with hyperkinetic BD (HBD) had resolution of their symptoms after laparoscopic cholecystectomy at our institution. MATERIALS AND METHODS: We conducted a retrospective chart review of children who had undergone laparoscopic cholecystectomy for HBD at our institution between September 2010 and July 2015. Patients completed a phone survey about symptom resolution, whether they were happy to have undergone cholecystectomy, overall satisfaction on a 1-10 scale, and additional workup for those with ongoing pain. Analysis was performed using STATA statistical software with a P-value < 0.05 as statistically significant. RESULTS: Thirteen patients met inclusion criteria. Median gallbladder ejection fraction was 93% [IQR: 90, 97]. Median postoperative follow-up was 59 d [IQR: 25, 151] at which time 50% reported resolution of symptoms. Eight patients participated in the survey at a median follow-up of 45 mo [IQR: 40, 66]. Fifty percent reported ongoing abdominal pain. Frequency of pain varied among patients with pain, occurring from <1 time per week to a few times per day. Five patients (63%), including one patient with ongoing pain, were happy that their gallbladder had been removed and overall satisfaction rating was 5 on a scale of 1-10. CONCLUSIONS: Only half of children with HBD were asymptomatic at long-term follow-up. Cholecystectomy for HBD may or may not improve symptoms.


Assuntos
Dor Abdominal/cirurgia , Discinesia Biliar/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Dor Pós-Operatória/diagnóstico , Medidas de Resultados Relatados pelo Paciente , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adolescente , Discinesia Biliar/complicações , Discinesia Biliar/fisiopatologia , Feminino , Seguimentos , Vesícula Biliar/fisiopatologia , Vesícula Biliar/cirurgia , Humanos , Masculino , Medição da Dor , Dor Pós-Operatória/etiologia , Satisfação do Paciente , Estudos Retrospectivos , Autorrelato/estatística & dados numéricos , Fatores de Tempo , Resultado do Tratamento
2.
BMJ Case Rep ; 12(12)2019 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-31852688

RESUMO

Unindicated hysterectomy is a disturbing problem in India. Women are counselled into the procedure by the fear of cancer, and by reinforcing their notion that unrelated somatic problems are solved by the removal of the uterus. This is a case of a woman from the state of Bihar, India, who was referred to us after an unindicated hysterectomy at the age of 24, performed as a first-line treatment for lower abdominal pain. This highlights the problem of rising hysterectomy in India and the lack of integrated treatment for women with the debilitating condition of chronic pelvic pain. Pelvic pain and vaginal discharge are often not indicative of pelvic inflammatory disease, and need a more considerate and broad-minded approach. Public health initiatives should take more account of women's lack of knowledge of reproductive health and make efforts to disseminate such information by the use of television, radio and newspapers in local languages.


Assuntos
Dor Abdominal/cirurgia , Depressão/psicologia , Histerectomia/efeitos adversos , Procedimentos Desnecessários/efeitos adversos , Adulto , Terapia de Casal , Depressão/etiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Terapia de Reposição Hormonal , Humanos , Histerectomia/psicologia , Hérnia Incisional/tratamento farmacológico , Hérnia Incisional/etiologia , Índia
3.
Surg Clin North Am ; 99(6): 1163-1176, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676055

RESUMO

Patients with inflammatory bowel disease (IBD) will often require abdominal surgical intervention for indications not directly related to their IBD. Because these patients often have a history of multiple previous abdominal operations and/or ostomies, they are at increased risk for incisional and parastomal hernias. They may also have develop symptomatic cholelithiasis, chronic pain, or desmoid disease. All of these potentially surgical issues may require special consideration in the IBD population.


Assuntos
Colecistectomia Laparoscópica/métodos , Neoplasias do Sistema Digestório/cirurgia , Hérnia Ventral/cirurgia , Doenças Inflamatórias Intestinais/cirurgia , Reoperação/métodos , Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Colecistectomia Laparoscópica/efeitos adversos , Neoplasias do Sistema Digestório/diagnóstico , Feminino , Fibromatose Agressiva/diagnóstico , Fibromatose Agressiva/cirurgia , Hérnia Ventral/diagnóstico , Herniorrafia/efeitos adversos , Herniorrafia/métodos , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Masculino , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Medição de Risco , Telas Cirúrgicas , Resultado do Tratamento
4.
BMC Surg ; 19(1): 168, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711462

RESUMO

BACKGROUND: Appendiceal inversion with neoplasia in adults is an extremely rare event with a reported incidence of < 0.01%. Preoperative diagnosis is very important for surgical treatment; however, it is very difficult to be exact. CASE PRESENTATION: The patient was a 60-year-old woman with complaints of intermittent abdominal pain. Computed tomography and colonoscopy revealed a cecal mass, which was diagnosed as a tubulovillous adenoma in the preoperative colonoscopic biopsy. At surgery, the appendix was found to be completely inverted into the cecum. The cecum was partially resected, and surgical pathology examination confirmed a tubulovillous adenoma of the appendix with local high-grade intraepithelial neoplasia. CONCLUSIONS: Although preoperative diagnosis of appendiceal inversion with neoplasia may be often difficult due to its non-specific symptoms, clinicians should consider this disease entity when they encounter an intraluminal protruding cecal mass without visualization of the normal appendix on CT and colonoscopy.


Assuntos
Dor Abdominal/etiologia , Apêndice/diagnóstico por imagem , Doenças do Ceco/diagnóstico , Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Apendicectomia/métodos , Apêndice/cirurgia , Doenças do Ceco/complicações , Doenças do Ceco/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Laparoscopia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X/métodos
5.
Khirurgiia (Mosk) ; (11): 42-51, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31714529

RESUMO

OBJECTIVE: To evaluate quality of life in long-term postoperative period in patients with chronic pancreatitis. MATERIAL AND METHODS: There were 31 (21 males and 10 females) patients with complicated forms of chronic pancreatitis who underwent surgery in 2015-2017. Mean age was 49 (44; 53) years, body mass index - 22.4 (20.4; 24) kg/m2. HR-QOL was determined using the questionnaires SF-36, QLQ EORTS C30, VAS. Postoperative control was made no earlier than 6 months after surgery. Median follow-up 11.5 months. The data were analyzed using non-parametric methods. Quantitative data are shown as median with interquartile range. Differences between quantitative values were determined using the Mann-Whitney test. RESULTS: Physical status value (SF-36) before surgery was 30.5 (24.8; 37.5), after surgery - 50.8 (46.7; 56.5). Mental status value was 30.2 (26.7; 36.4) prior to surgery and 53.8 (48.7; 57.3) after operation. Improvement of QoL (QLQ C30) from 29.17 (0; 50.0) before surgery to 75.0 (54.2; 83.3) after operation was observed. VAS-score of pain severity was 8 (8; 10) prior to surgery and 3 (2; 5) after surgery. Differences were significant (p<0.05). CONCLUSION: Surgical treatment of complicated chronic pancreatitis significantly reduces pain and improves HR-QoL. However, recurrent symptoms of chronic pancreatitis in long-term period cannot be excluded due to short follow-up period (median less than one year). The further investigation is needed.


Assuntos
Pancreatite Crônica/cirurgia , Qualidade de Vida , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Adulto , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pancreatectomia , Pancreatite Crônica/complicações , Resultado do Tratamento
6.
BMJ ; 367: l5462, 2019 10 09.
Artigo em Inglês | MEDLINE | ID: mdl-31597637

RESUMO

The studyPeden CJ, Stephens T, Martin G et al. Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial. Lancet 2019;393:2213-21.This project was funded by the NIHR Health Services and Delivery Research Programme (project number 12/5005/10).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000789/national-quality-improvement-programmes-need-time-and-resources-to-have-impact.


Assuntos
Dor Abdominal/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório , Tratamento de Emergência , Melhoria de Qualidade/organização & administração , Doença Aguda , Análise por Conglomerados , Procedimentos Clínicos , Procedimentos Cirúrgicos do Sistema Digestório/normas , Tratamento de Emergência/normas , Humanos , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade/normas
7.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570352

RESUMO

Streptococcus pyogenes is a common cause of infection. Since 2010, the Centers for Disease Control has noted a 24% rise in invasive S. pyogenes infections with a mortality rate of 10%. We present a case series and review of the English literature. Two patients presented with findings concerning for appendicitis, each underwent laparoscopic appendectomies. Both had diffuse peritoneal inflammation without appendicitis, cultures grew S. pyogenes and both recovered with appropriate antibiotics. Thirty cases were identified in a review of the English literature. The average age was 27 years, 75% were in women, 9% were immunocompromised, 15% had rashes and 88% underwent surgical intervention. Previous work identified female gender, immunosuppression and preceding varicella infection as risk factors for invasive S. pyogenes. Given the similarities to appendicitis, early suspicion can influence antibiotic therapy and possibly improve outcomes.


Assuntos
Dor Abdominal/microbiologia , Antibacterianos/uso terapêutico , Apendicectomia , Apendicite/microbiologia , Laparoscopia , Peritonite/microbiologia , Infecções Estreptocócicas/diagnóstico , Dor Abdominal/cirurgia , Adolescente , Apendicite/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Peritonite/cirurgia , Tomografia Computadorizada por Raios X
8.
Am Surg ; 85(10): 1104-1107, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657303

RESUMO

Chronic abdominal pain of unknown origin is a challenging diagnosis encountered by clinicians. Patients often undergo an extensive workup and long periods of uncertainty without the establishment of a definitive diagnosis. Diagnostic laparoscopy is a relatively safe procedure that can be used as an effective diagnostic and therapeutic tool in treating this disease. This was a retrospective, single-institution study exploring the efficacy of diagnostic laparoscopy in treating chronic abdominal pain of unknown origin. More than 90 per cent of laparoscopies resulted in a positive finding, with adhesions being the most common. A total of 50 per cent of patients experienced resolution of symptoms on follow-up. Patients were overwhelmingly satisfied with their postoperative outcomes and willing to undergo the procedure again with their outcomes in mind.


Assuntos
Dor Abdominal/diagnóstico , Dor Abdominal/cirurgia , Dor Crônica/diagnóstico , Dor Crônica/cirurgia , Laparoscopia , Dor Abdominal/epidemiologia , Dor Abdominal/etiologia , Dor Crônica/epidemiologia , Dor Crônica/etiologia , Feminino , Humanos , Laparoscopia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Retrospectivos , Fatores de Tempo , Aderências Teciduais/complicações , Aderências Teciduais/diagnóstico , Aderências Teciduais/cirurgia , Resultado do Tratamento
9.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 37(3): 318-324, July-Sept. 2019. tab
Artigo em Inglês | LILACS | ID: biblio-1041334

RESUMO

ABSTRACT Objective: To investigate the influence of patient age on the diagnosis and management of appendicitis, as well as to evaluate the rate of complications according to the age group. Methods: We undertook a retrospective analysis of 1,736 children who underwent laparoscopic appendectomy in our center between January 2000 and December 2013. Patients were divided in groups taken into account their age: group A were infants, group B were preschoolers, group C were those ones older than five years old, and group D were those ones younger than five years old. A p value of 0.05 was considered statistically significant. Results: We found higher incidence of misdiagnosis and atypical symptoms in the youngest patients. The rate of perforation was similar between group A and B (p=0.17). However, it was higher in group D than in group C (p<0.0001). The incidence of postoperative complications was higher in the youngest patients too (p=0.0002). Conclusions: The age does make a difference in acute appendicitis. Because of its unusual presentation in children younger than five years old, it is often misdiagnosed, which leads to an increased morbidity. Although clinical presentation varies between infants and preschoolers, no statistically significant differences were observed in the rate of perforated appendix or postoperative complications.


RESUMO Objetivo: Investigar a influência da idade do paciente no diagnóstico e tratamento de apendicite, bem como avaliar a frequência de complicações dependendo da faixa etária. Métodos: Análise retrospectiva dos 1.736 pacientes pediátricos que foram submetidos à apendicectomia laparoscópica em nosso hospital de janeiro de 2000 a dezembro de 2013. Os pacientes foram divididos em grupos de acordo com sua idade: grupo A eram crianças, grupo B eram pré-escolares, grupo C eram maiores de cinco anos de idade e grupo D eram menores de cinco anos de idade. Considerou-se estatisticamente significante p-valor <0,05. Resultados: Encontramos maior incidência de diagnóstico incorreto e sintomas atípicos em pacientes mais novos. A taxa de perfuração foi semelhante entre os grupos A e B (p=0.17); foi maior, porém, no grupo D que no grupo C (p<0.0001). A incidência de complicações no pós-operatório também foi maior em pacientes mais novos (p=0.0002). Conclusões: A idade faz diferença em casos de apendicite aguda. Por causa da sua apresentação rara em crianças menores de cinco anos, é frequentemente diagnosticada incorretamente, o que aumenta a morbidade. Apesar de sua apresentação clínica variar entre lactentes e pré-escolares, não foram observadas diferenças estatisticamente significativas na proporção de apêndices perfurados nem na de complicações pós-operatórias.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Apendicectomia/estatística & dados numéricos , Apendicite/diagnóstico , Dor Abdominal/diagnóstico , Apendicite/cirurgia , Biomarcadores/sangue , Dor Abdominal/cirurgia , Estudos Retrospectivos , Erros de Diagnóstico/estatística & dados numéricos , Contagem de Leucócitos
10.
J Nepal Health Res Counc ; 17(2): 264-266, 2019 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-31455947

RESUMO

Abdominal cocoon syndrome is rare cause of intestinal obstruction characterized by small bowel encapsulation by a fibro-collagenous membrane or "cocoon".A 30 yearman presented in emergency department with abdominal pain. Preoperatively contrast enhanced computed tomography of abdomen revealed encapsulated cluster of mildly dilated and edematous small bowel loops with multiple air fluid levels with thin membrane and crowding of mesenteric vessels in left upper quadrant.Intra-operatively, the entire small bowel was found to be encapsulated in a dense fibrous sac. The peritoneal sac was excised, followed by lysis of the inter-loop adhesionswith smooth postoperative recovery.High index of suspicion is required in patient presenting with features of recurrent acute or chronic small bowel obstruction for diagnosis of abdominal cocoon syndrome. Contrast enhanced Computed Tomography of abdomen is a useful radiological to aid in preoperative diagnosis of syndrome. Keywords: Abdomen; abdominal cocoon; CECT; encapsulated cluster.


Assuntos
Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/cirurgia , Adulto , Meios de Contraste , Diagnóstico Diferencial , Humanos , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Masculino , Síndrome
12.
Internist (Berl) ; 60(9): 982-986, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31317221

RESUMO

Spontaneous splenic rupture is an uncommon complication of acute pancreatitis. This report describes the case of a 60-year-old man with acute pancreatitis complicated by splenic rupture. The patient was admitted to the emergency department with pain in the upper abdomen that had been present for 2 days. He was diagnosed with acute pancreatitis of alcoholic etiology. The patient was admitted to the hospital for two recurrent episodes in the last 4 months of acute pancreatitis of alcoholic etiology. Magnetic resonance imaging of the abdomen revealed a suspicious area of necrosis. Seventy-two hours after admission, the patient had significant improvement in symptoms and the inflammation markers rapidly decreased. However, he showed clinical worsening on the seventh day of hospitalization, with increasing abdominal distension and reduced hemoglobin levels. A CT angiography showed a large amount of free fluid in the abdominal cavity, along with a large splenic hematoma. The patient subsequently underwent laparotomy, which showed hemoperitoneum due to rupture of the splenic parenchyma. A splenectomy was performed with resection of the pancreatic tail.


Assuntos
Dor Abdominal/etiologia , Pancreatite/complicações , Ruptura Esplênica/diagnóstico , Ruptura Esplênica/etiologia , Dor Abdominal/cirurgia , Doença Aguda , Doença Crônica , Humanos , Laparotomia , Masculino , Pessoa de Meia-Idade , Pancreatite/diagnóstico , Pancreatite/cirurgia , Ruptura Espontânea , Esplenectomia , Ruptura Esplênica/cirurgia , Resultado do Tratamento
14.
Adv Emerg Nurs J ; 41(3): 215-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31356246

RESUMO

Abdominal pain in the pediatric patient presents a unique diagnostic challenge for emergency department (ED) providers due to the wide range of possible etiologies and sequelae. The list of differential diagnoses is extensive and includes the spectrum of conditions that range from benign and self-limiting to those that are potentially life-threatening. This article describes a case of a young toddler with an acute appendicitis complicated by perforation and abscess formation. Although acute appendicitis is uncommon in infants and younger children, it does occur and, as this case illustrates, is often misdiagnosed, which leads to delayed treatment and a higher incidence of complications. This article includes a discussion of the challenges faced by ED providers in the clinical-decision making process when caring for a pediatric patient with abdominal pain due to an acute appendicitis. This discussion includes the age-associated epidemiology, pathophysiology, clinical presentation, and evidence-based recommendations for diagnosis and treatment.


Assuntos
Dor Abdominal/diagnóstico , Apendicite/diagnóstico , Dor Abdominal/cirurgia , Apendicectomia , Apendicite/cirurgia , Diagnóstico Diferencial , Serviço Hospitalar de Emergência , Humanos , Lactente , Masculino
15.
BMJ Case Rep ; 12(6)2019 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-31217212

RESUMO

Uterine torsion is an uncommon entity that is defined as a rotation of greater than 45° around the longitudinal axis of the uterus. Although cases of uterine torsion among pregnant patients have been mentioned in the literature, torsion of a non-gravid uterus is a rare occurrence. A 73-year-old nulliparous woman with a known fibroid uterus underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy with frozen section of a 17-18 cm pelvic mass seen on CT imaging. The source of the pelvic mass was unclear on imaging, and benign and malignant possibilities were discussed. During the procedure, necrosis of the uterine fundus and bilateral adnexa were seen due to the fundus being torsed with the uterine fibroid being the pivot point. Uterine torsion, though rare, can be the cause of acute pelvic pain in a postmenopausal woman.


Assuntos
Dor Abdominal/diagnóstico por imagem , Doenças dos Anexos/diagnóstico por imagem , Leiomioma/patologia , Necrose/diagnóstico por imagem , Anormalidade Torcional/diagnóstico por imagem , Ultrassonografia , Doenças Uterinas/diagnóstico por imagem , Dor Abdominal/cirurgia , Doenças dos Anexos/patologia , Doenças dos Anexos/cirurgia , Idoso , Feminino , Secções Congeladas , Humanos , Histerectomia , Necrose/patologia , Necrose/cirurgia , Pós-Menopausa , Salpingo-Ooforectomia , Anormalidade Torcional/patologia , Anormalidade Torcional/cirurgia , Resultado do Tratamento , Doenças Uterinas/patologia , Doenças Uterinas/cirurgia
16.
Updates Surg ; 71(2): 305-312, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31254233

RESUMO

Percutaneous ultrasonography (perc-US) and magnetic resonance enterography (e-MR) are the present standards for staging patients with Crohn's disease (CD). However, intraoperative data still have some discrepancies with preoperative ones. The contribution of intraoperative ultrasonography (IOUS) has never been evaluated. Sixty-five consecutive patients scheduled for ileal/colonic resection for CD between 2010 and 2014 were prospectively enrolled. All patients had perc-US, e-MR and IOUS. Data from different imaging modalities were compared. The reference standard was the final pathology. Surgery was scheduled because of intestinal obstruction (n = 31 patients), inflammatory mass (n = 21), fistula (n = 10), or abdominal pain/sepsis (n = 3). Fourteen (21.5%) patients had a major discrepancy between preoperative and intraoperative data that required a modification of the surgical planning (five additional ileal lesions, three unknown ileo-sigmoid fistulas, and six not confirmed CD sites). IOUS correctly staged CD in all but one patients (missed ileo-colonic fistula). Pathology data differed from Perc-US data in 13 (20%) patients, from e-MR data in 14 (21.5%), and from IOUS data in one (1.5%). The sensitivity of Perc-US, e-MR and IOUS was: for the identification of CD sites 84.2%, 86.1%, and 100%; for the identification of stenoses 86.8%, 86.8%, and 100%; for the identification of fistulas 75.0%, 81.3%, and 93.8%, respectively. IOUS contributed to the surgical planning in 8 (12.3%) patients. IOUS is a safe, feasible and easy-to-perform procedure that optimizes staging of CD and, in some patients, helps to better define the treatment strategy. It could be helpful to face complex disease presentations on the basis of objective and reproducible data.


Assuntos
Doença de Crohn/diagnóstico por imagem , Doença de Crohn/cirurgia , Ultrassonografia/métodos , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Adolescente , Adulto , Idoso , Doença de Crohn/complicações , Feminino , Humanos , Doenças Inflamatórias Intestinais/diagnóstico por imagem , Doenças Inflamatórias Intestinais/etiologia , Doenças Inflamatórias Intestinais/cirurgia , Fístula Intestinal/diagnóstico por imagem , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Período Intraoperatório , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
BMJ Case Rep ; 12(6)2019 Jun 21.
Artigo em Inglês | MEDLINE | ID: mdl-31229972

RESUMO

Trichobezoars are relatively uncommon problems with a known female predominance. We report two female children with gastric bezoars. Main presenting symptoms were abdominal distension, weight loss and anaemia. Upper abdominal mass was palpable in both. Diagnosis was suspected on initial abdominal radiograph and ultrasound scan then confirmed by upper endoscopy. No bowel extension was recorded in either case. We report here a modification of the surgical technique in which the gastrostomy cut edges were anchored to the laparotomy skin. This modification aided easy and complete delivery of hair balls avoiding any spillage or wound contamination.


Assuntos
Dor Abdominal/cirurgia , Bezoares/cirurgia , Gastrostomia , Laparotomia , Radiografia Abdominal , Tricotilomania/patologia , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Bezoares/diagnóstico por imagem , Bezoares/patologia , Criança , Pré-Escolar , Feminino , Gastrostomia/métodos , Humanos , Laparotomia/métodos , Tricotilomania/complicações , Tricotilomania/diagnóstico por imagem , Infecção dos Ferimentos/prevenção & controle
18.
J Laparoendosc Adv Surg Tech A ; 29(8): 1081-1084, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237499

RESUMO

Introduction: Cholecysto-choledocolithiasis is a rare entity in children and its management is still challenging and controversial. The laparoendoscopic rendezvous (LERV) procedure, consisting of laparoscopic cholecystectomy and simultaneous endoscopic retrograde cholangiopancreatography for the management of symptomatic choledocholithiasis is well described in adult patients. However, in the literature, few reports about its application in the pediatric population have been recorded. Aim of the Study: The aim of the present study is to report our first successful cases of symptomatic cholecysto-choledocholithiasis LERV treatment. Methods: Two girls suffering of hemolytic disease presented to our third referral center with acute abdominal pain due to cholecysto-choledocholithiasis. Preoperative, perioperative, and postoperative data were retrospectively reviewed. Results: Surgery was performed without complications. The girls were dismissed once re-alimentation and re-canalization were achieved and had no other episodes of biliary cholic. Reported advantages of LERV include: a shorter in-hospital stay, a reduction in the number of procedures and anesthesia, and a reduced overall risk of complications. Conclusions: The promising result with our 2 cases suggest that, when performed in highly specialized centers, LERV is a safe procedure, which leads to considerable benefits, despite logistic and organizational difficulties.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia Laparoscópica/métodos , Coledocolitíase/cirurgia , Tempo de Internação , Esfinterotomia Endoscópica/métodos , Dor Abdominal/cirurgia , Anestesia , Criança , Feminino , Humanos , Duração da Cirurgia , Período Pós-Operatório , Procedimentos Cirúrgicos Reconstrutivos , Estudos Retrospectivos , Risco
19.
Isr Med Assoc J ; 21(4): 251-254, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31032566

RESUMO

BACKGROUND: When a woman with an endometrioma presents with acute abdominal pain, it is unclear whether ovarian torsion should be suspected. OBJECTIVES: To compare patient characteristics, imaging results, and surgical management of endometriomas in elective versus emergent surgeries. METHODS: This retrospective cohort study included women treated at our institution during the period 1990-2015 who presented with histologically verified endometrioma and who underwent either planned surgery or emergent surgery due to suspected adnexal torsion. RESULTS: Of 225 surgeries performed, 174 were elective and 51 emergent. Patients in the emergent group were significantly younger (33.9 ± 11.1 vs. 39.01 ± 10.9 years, P = 0.004). Abdominal pain was the main complaint of all the emergent surgery patients and the leading complaint in 21% of the elective surgery patients (P < 0.001), with right-sided predominance in both groups. Sonographic parameters were similar in both groups. Bilateral ovarian cysts were noted in 11.7% and 11.0% of emergent and elective patients, respectively (P = 0.87). Laboratory evaluation was notable for a higher white blood cell count and CA125 levels among emergent patients. All patients in the emergent group and 93% of patients in the elective group were managed laparoscopically. No cases of torsion were noted. The rate of intra-pelvic adhesions was similar in both groups (56.8% vs. 66.6%, P = 0.19). CONCLUSIONS: Endometrioma may present with acute abdominal pain. However, adnexal torsion in these patients is rare. These cases can be managed using a minimally invasive approach, assuming an optimal surgical setting.


Assuntos
Doenças dos Anexos/complicações , Doenças dos Anexos/diagnóstico por imagem , Endometriose/complicações , Endometriose/cirurgia , Anormalidade Torcional/complicações , Anormalidade Torcional/diagnóstico por imagem , Dor Abdominal/etiologia , Dor Abdominal/cirurgia , Dor Aguda/etiologia , Dor Aguda/cirurgia , Doenças dos Anexos/cirurgia , Adulto , Estudos de Coortes , Procedimentos Cirúrgicos Eletivos/métodos , Endometriose/diagnóstico por imagem , Feminino , Humanos , Estudos Retrospectivos , Anormalidade Torcional/cirurgia , Resultado do Tratamento , Ultrassonografia/métodos
20.
BMJ Case Rep ; 12(4)2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30954954

RESUMO

Gastrointestinal duplications are extremely rare congenital abnormalities having definite difficulties to be diagnosed preoperatively. Most of them are presented at the oesophagus and ileum and only involve colon from 4% to 18%. We illustrate a case report of an 18-year-old female patient with transverse colon duplication. There were symptom manifestations such as chronic constipation with flatulence accompanied with abdominal pain. We demonstrate this case report due to non-specific clinical presentation and some difficulties to form preoperative diagnosis. The patient underwent surgery. Tubular transverse colon duplication communicated with normal bowel in the proximal part was revealed. We performed transverse colon resection with duplication. The postoperative period was uneventful.


Assuntos
Dor Abdominal/etiologia , Colectomia/métodos , Colo Transverso/anormalidades , Constipação Intestinal/etiologia , Dor Abdominal/cirurgia , Adolescente , Doença Crônica , Colo Transverso/fisiopatologia , Colo Transverso/cirurgia , Constipação Intestinal/diagnóstico , Constipação Intestinal/fisiopatologia , Constipação Intestinal/cirurgia , Feminino , Flatulência/etiologia , Humanos , Resultado do Tratamento
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