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1.
Medicine (Baltimore) ; 99(8): e19343, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32080155

RESUMO

RATIONALE: Foreign body (FB) ingestion is a relatively common clinical situation in the emergency department. However, multiple sharply pointed foreign bodies located in different organs are rare conditions and no definite treatment guidelines has been established. PATIENT CONCERNS: A 31-year-old amateur magician visited the outpatient clinic with a chief complaint of epigastric discomfort. He might have accidentally swallowed some needles while practicing a magic trick 2 days before. DIAGNOSIS: Imaging tests revealed 1 needle was stuck in the left liver lobe through the stomach wall, 1 was in the third portion of the duodenum, 3 were in the ascending colon, and 2 were in the transverse colon. INTERVENTIONS: A needle in the duodenum and 5 in the colon were removed by endoscopy. The needle stuck in the liver from the stomach was not visible inside the stomach and was successfully removed by laparoscopy a few days later. OUTCOMES: The patient was able to tolerate an oral diet and was discharged on postoperative day 4 without any complications. LESSONS: Developing a treatment plan in cases of multiple sharp FB may be difficult. A multidisciplinary team of endoscopists and surgeons is needed to determine the best possible treatment plan. This experience illustrates the importance of the planning of the sequence and method of removal of multiple foreign bodies from the gastrointestinal tract.


Assuntos
Endoscopia do Sistema Digestório , Corpos Estranhos/cirurgia , Laparoscopia , Agulhas , Acidentes , Adulto , Colo/diagnóstico por imagem , Colo/cirurgia , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Magia , Masculino , Radiografia , Estômago/diagnóstico por imagem , Estômago/cirurgia
2.
Gut ; 69(2): 295-303, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31331994

RESUMO

BACKGROUND: The duodenum has become a metabolic treatment target through bariatric surgery learnings and the specific observation that bypassing, excluding or altering duodenal nutrient exposure elicits favourable metabolic changes. Duodenal mucosal resurfacing (DMR) is a novel endoscopic procedure that has been shown to improve glycaemic control in people with type 2 diabetes mellitus (T2D) irrespective of body mass index (BMI) changes. DMR involves catheter-based circumferential mucosal lifting followed by hydrothermal ablation of duodenal mucosa. This multicentre study evaluates safety and feasibility of DMR and its effect on glycaemia at 24 weeks and 12 months. METHODS: International multicentre, open-label study. Patients (BMI 24-40) with T2D (HbA1c 59-86 mmol/mol (7.5%-10.0%)) on stable oral glucose-lowering medication underwent DMR. Glucose-lowering medication was kept stable for at least 24 weeks post DMR. During follow-up, HbA1c, fasting plasma glucose (FPG), weight, hepatic transaminases, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), adverse events (AEs) and treatment satisfaction were determined and analysed using repeated measures analysis of variance with Bonferroni correction. RESULTS: Forty-six patients were included of whom 37 (80%) underwent complete DMR and 36 were finally analysed; in remaining patients, mainly technical issues were observed. Twenty-four patients had at least one AE (52%) related to DMR. Of these, 81% were mild. One SAE and no unanticipated AEs were reported. Twenty-four weeks post DMR (n=36), HbA1c (-10±2 mmol/mol (-0.9%±0.2%), p<0.001), FPG (-1.7±0.5 mmol/L, p<0.001) and HOMA-IR improved (-2.9±1.1, p<0.001), weight was modestly reduced (-2.5±0.6 kg, p<0.001) and hepatic transaminase levels decreased. Effects were sustained at 12 months. Change in HbA1c did not correlate with modest weight loss. Diabetes treatment satisfaction scores improved significantly. CONCLUSIONS: In this multicentre study, DMR was found to be a feasible and safe endoscopic procedure that elicited durable glycaemic improvement in suboptimally controlled T2D patients using oral glucose-lowering medication irrespective of weight loss. Effects on the liver are examined further. TRIAL REGISTRATION NUMBER: NCT02413567.


Assuntos
Diabetes Mellitus Tipo 2/cirurgia , Duodenoscopia/métodos , Duodeno/cirurgia , Ressecção Endoscópica de Mucosa/métodos , Mucosa Intestinal/cirurgia , Adulto , Idoso , Glicemia/metabolismo , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/tratamento farmacológico , Ressecção Endoscópica de Mucosa/efeitos adversos , Estudos de Viabilidade , Feminino , Hemoglobina A Glicada/metabolismo , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos
3.
Khirurgiia (Mosk) ; (12): 37-46, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31825341

RESUMO

OBJECTIVE: To formulate the concept of physiological reconstruction of the digestive tract during redo gastric surgery. MATERIAL AND METHODS: There were 52 patients who underwent redo gastric surgery after previous resections, drainage and antireflux procedures in 2011-2017 at the Vishnevsky National Research Surgical Center. Redo resection of the stomach with Billroth-1 and Hofmeister reconstructions were performed in 5 (9.6%) and 1 patient (1.9%), respectively. Roux-en-Y reconstruction was performed in 4 (7.7%) patients after gastric remnant extirpation. Jejunogastroplasty was used in 30 (57.7%) patients. A segment of the transverse colon as the reconstructive material was used in 2 (3.8%) patients, left colon - in 8 (15.4%) after esophagectomy. One (1.9%) patient underwent extirpation of 'small' stomach and thoracic esophagus after previous gastric bypass. Gastric remnant was used as an isoperistaltic tube for subtotal esophagoplasty. Reconstruction was not possible in only 1 (1.9%) patient after advanced visceral resection for recurrent cancer within esophagojejunostomy due to deficit of visceral material. RESULTS: Postoperative complications were observed in 5 (9.6%) patients. Partial failure of esophagojejunostomy and duodenojejunostomy occurred in 2 (3.8%) and 1 patient (1.9%), respectively. Colon transplant necrosis was noted in 1 (1.9%) patient that required resection followed by colo- and esophagostomy nutrition. One patient died on the 1st postoperative day from progressive multiple organ failure. At the end of the study, 44 (86.2%) out of 51 patients were under follow-up. Good results were revealed in 26 (59.9%) patients, satisfactory outcomes - in 12 (27.4%) patients. Redo surgery was not effective in only 6 (13.7%) patients. CONCLUSION: Evaluation of our results demonstrates complete alleviation of pathological postoperative syndromes after gastric surgery in the majority of patients. Therefore, redo surgery with gastroplasty and restoration of duodenal passage are advisable.


Assuntos
Trato Gastrointestinal/cirurgia , Neoplasias Gástricas/cirurgia , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Duodeno/cirurgia , Gastrectomia/efeitos adversos , Gastroenterostomia/efeitos adversos , Gastroplastia , Humanos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação , Estudos Retrospectivos
4.
Rev Col Bras Cir ; 46(5): e20192264, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31859724

RESUMO

OBJECTIVE: biliopancreatic diversion with duodenal switch is a complex, malabsorptive procedure, associated with improved weight loss and metabolic control. Staged surgery with sleeve gastrectomy as the first stage is an option for reducing complications in superobese patients. However, some problems persist: large livers can hamper the surgical approach and complications such as leaks can be severe. Intestinal transit bipartition is a modified and simplified model of biliopancreatic diversion that complements sleeve gastrectomy. It is similar to the duodenal switch, but with less complexity and fewer nutritional consequences. This study assessed the feasibility and safety of isolated transit bipartition as the initial procedure in a two-step surgery to treat superobesity. METHODS: this prospective study included 41 superobese patients, with mean BMI 54.5±3.5kg/m2. We performed a laparoscopic isolated transit bipartition as the first procedure in a new staged approach. We analyzed weight loss and complications during one year of follow-up. RESULTS: we completed all the procedures by laparoscopy. After six months, the mean percent excess weight loss was 28%, remaining stable until the end of the study. There were no intraoperative difficulties. Half of the patients experienced early diarrhea, and three had marginal ulcers. There were no major surgical complications or deaths. CONCLUSION: isolated laparoscopic transit bipartition is a new option for a staged approach in superobesity, which can provide a safer second procedure after effective weight loss over six months. It may be useful particularly in the management of patients with severe obesity.


Assuntos
Desvio Biliopancreático/métodos , Duodeno/cirurgia , Gastrectomia/métodos , Obesidade Mórbida/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Perda de Peso , Adulto Jovem
5.
Pan Afr Med J ; 33: 303, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692774

RESUMO

Duodenal duplication is an extremely rare congenital abnormality that occurs mostly in children. It represents only 2% to 12% of all gastrointestinal tract duplication. Its clinical presentation is highly variable and non-specific making the positive diagnosis very difficult. Imaging modalities can help to detect the lesions making the diagnosis more accurate before surgery. Here, we report a case of duodenal duplication revealed by chronic abdominal pain and treated by surgical resection in a 26-year-old man. Even in adults, it is necessary to evoke the diagnosis of duodenal duplication in patients with unexplained abdominal pain. Surgical resection remains the treatment of choice and endoscopic treatment is reserved for selected patients in whom surgery is difficult.


Assuntos
Dor Abdominal/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Duodeno/anormalidades , Adulto , Dor Crônica/etiologia , Duodeno/cirurgia , Humanos , Masculino
6.
Medicine (Baltimore) ; 98(47): e17835, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31764778

RESUMO

INTRODUCTION: An Inferior vena cava (IVC) filter is an intravascular filter that is implanted into the IVC to prevent pulmonary embolism in medical, surgical, and trauma patients. The insertion of an IVC filter is a relatively safe procedure, but rarely may be associated with symptomatic perforation of the IVC wall, particularly in the long term. PATIENT CONCERNS AND DIAGNOSIS: A 74-year-old-woman with a medical history of IVC filter insertion visited the emergency department complaining of abdominal pain. A computed tomography scan showed perforation of the IVC wall and penetration into the duodenum by one of the filter's struts. INTERVENTIONS: We performed a laparotomy to remove the IVC filter. OUTCOMES: Postoperatively, the patient was admitted to the general ward. On hospital day 12, she was discharged without any complications. We followed her up and computed tomography did not show any abnormal findings six months after discharge. LESSONS: There is currently no evidence testifying to the benefits of IVC filter removal. Detailed, evidence-based guidelines on the indications, timing and procedure for IVC filter removal are needed. Documenting cases of long-term complications of IVC filter s such as in this patient serve to accelerate the publication of updated guidelines and are aimed at improving outcomes of similar cases in the future.


Assuntos
Duodeno/lesões , Perfuração Intestinal/etiologia , Complicações Pós-Operatórias/etiologia , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/lesões , Idoso , Remoção de Dispositivo , Duodeno/cirurgia , Feminino , Humanos , Perfuração Intestinal/cirurgia , Complicações Pós-Operatórias/cirurgia , Veia Cava Inferior/cirurgia
8.
Cir Cir ; 87(S1): 53-57, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501625

RESUMO

There are few reported cases of small bowel injury due to blunt abdominal trauma. We describe the clinical presentation and surgical management of these lesions. This is the clinical case of a polytraumatized male with a duodenal injury IIID3 according to AAST, who underwent resection of the intestinal segment with duodeno-duodenum anastomosis with favorable results. The infrequent presentation of injuries to the small intestine due to blunt trauma may lead the clinician to overlook the need for intentional interrogation about the kinematics of the trauma, while at the same time neglecting the taking of complementary diagnostic imaging studies, this because of a lack of clinical suspicion. It is important to analyze the patient's context, which will allow us to assess the need to delve into diagnostic studies in order to optimize their treatment.


Assuntos
Traumatismos Abdominais/cirurgia , Duodeno/lesões , Ferimentos não Penetrantes/cirurgia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Acidentes de Trânsito , Adulto , Colectomia , Duodeno/irrigação sanguínea , Duodeno/cirurgia , Gastrostomia , Hematoma/classificação , Hemoperitônio/etiologia , Humanos , Íleo/irrigação sanguínea , Isquemia/etiologia , Isquemia/cirurgia , Jejunostomia , Lacerações/classificação , Fígado/lesões , Masculino , Mesentério/lesões , Nutrição Parenteral , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Ferimentos não Penetrantes/etiologia
9.
Cir Cir ; 87(S1): 22-27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501628

RESUMO

Introduction: Wilkie's syndrome is a rare entity that presents as a chronic intestinal obstruction secondary to mechanical compression of the third portion of the duodenum due to a decreased aorto-mesenteric angle. This entity has a reported incidence of 0.012 to 2.4% and can lead to high morbidity and mortality; In addition, there are major controversies regarding its diagnosis and treatment, which is why the authors present a case report of a patient with a diagnosis of Wilkie's syndrome and its surgical management via laparoscopy. Methods: A case of a patient with clinical and imaging manifestations of superior mesenteric artery syndrome is presented, along with acritical review of the literature, taking into account articles published in the PubMed and ScienceDirect databases during the past 8 years. Clinical case: A 27-year-old patient with 20 years of abdominal pain that exacerbated one week before admission, with a clinical and imaging manifestations of Wilkie's syndrome. Patient presents refractoriness to medical management, which led to a surgical approach with laparoscopic duodenum-jejunostomy that was carried out without perioperative complications and satisfactory results. Discussion and conclusions: The superior mesenteric artery syndrome is a rare entity that in some scenarios requires surgical management. The laparoscopic duodeno-jejunostomy is the procedure of choice to manage this entity as evidenced in our case, which is also consistent with what is reported in the world medical literature.


Assuntos
Duodeno/cirurgia , Jejuno/cirurgia , Laparoscopia/métodos , Síndrome da Artéria Mesentérica Superior/cirurgia , Adulto , Anastomose Cirúrgica , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Síndrome da Artéria Mesentérica Superior/complicações , Síndrome da Artéria Mesentérica Superior/diagnóstico por imagem
10.
Chirurgia (Bucur) ; 114(4): 494-505, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511136

RESUMO

Background: Duodenal polyposis (DP) is often associated in patients with in patients with familial adenomatous polyposis (FAP) and the risk of malignancy is endoscopically assessed using the Spigelman score. Endoscopic therapy is the first option for PD while surgery is indicated for the advanced stages of the disease (Spiegelman III-IV). Pancreas-sparing duodenectomy (PSD) was proposed as a less aggressive alternative to pancreatoduodenectomy (PD), leaving the entire pancreas in situ while the number of anastomoses is reduced. Open PSD with Billroth or pillorus preserving reconstruction is the general used. The use of a Roux limb is very limited in literature, as it increases the procedure complexity, the number of anastomosis and it may reduce the endoscopic access for the postoperative surveillance after total duodenectomy. We aim to describe the technique for Laparoscopic Pancreas Sparing Total Duodenectomy (LPSTD) with Roux-en-Y reconstruction and to present the procedure's outcomes in a patient presenting Spigelman IV duodenal polyposis associated with FAP after open total colectomy. Method: Laparoscopic Pancreas Sparing Total Duodenectomy (LPSTD) with antrectomy cholecystectomy and Roux en Y reconstruction was performed in a 39-year-old man with a history of FAP, open colectomy with ileorectal anastomosis and duodenal polyps. The preoperative investigations and the surgical steps of the laparoscopic approach are described in details. Results: The operative time was 280 minutes. Two postoperative complications were encountered, a self-limited pancreatico-jejunal anastomosis hemorrhage occurred in POD 1 and necrosis of the cystic duct stump with bile peritonitis (POD7). Both of them required laparoscopic exploration. Oral feeding was introduced in the POD 2. The patient has been discharged in the POD 14. No other complications like delayed gastric emptying, pancreatic or biliary fistula at the site of PJA or ulcer were encountered. The 6 months postoperative evaluation, including the CT scan and the endos-copic retrograde inspection of the neo-papilla revealed no recurrence on the jejunum. Conclusions: Although it is a complex technique, LPSTD represents a good alternative to PD for patients with FAP and large, periampullary villous adenoma especially those with high grade dysplasia. The use of laparoscopy and of Roux en Y reconstruction may reduce the postoperative morbidity rate in PSD.


Assuntos
Pólipos Adenomatosos/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Neoplasias Duodenais/cirurgia , Duodeno/cirurgia , Adulto , Anastomose em-Y de Roux , Humanos , Laparoscopia , Masculino , Pâncreas/cirurgia , Resultado do Tratamento
11.
Chirurgia (Bucur) ; 114(4): 518-521, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511138

RESUMO

Duodenal injury is an unusual complication of laparoscopic cholecystectomy, mostly caused by direct injury of the duodenum by laparoscopic instruments, either mechanical or thermal. The management is usually surgical, with satisfactory results, as long as the complication is detected early. We report two cases of duodenal perforations during laparoscopic cholecystectomy. One was treated with primary closure of the defect, while the other was managed conservatively with abdominal drainage and food deprivation. Both techniques proved successful in the management of that complication.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Duodeno/lesões , Perfuração Intestinal/terapia , Tratamento Conservador , Drenagem , Duodeno/cirurgia , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Resultado do Tratamento
12.
World J Gastroenterol ; 25(32): 4673-4681, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31528093

RESUMO

Zollinger-Ellison syndrome (ZES) is characterized by gastric acid hypersecretion causing severe recurrent acid-related peptic disease. Excessive secretion of gastrin can now be effectively controlled with powerful proton pump inhibitors, but surgical management to control gastrinoma itself remains controversial. Based on a thorough literature review, we design a surgical algorithm for ZES and list some significant consensus findings and recommendations: (1) For sporadic ZES, surgery should be routinely undertaken as early as possible not only for patients with a precisely localized diagnosis but also for those with negative imaging findings. The surgical approach for sporadic ZES depends on the lesion location (including the duodenum, pancreas, lymph nodes, hepatobiliary tract, stomach, and some extremely rare sites such as the ovaries, heart, omentum, and jejunum). Intraoperative liver exploration and lymphadenectomy should be routinely performed; (2) For multiple endocrine neoplasia type 1-related ZES (MEN1/ZES), surgery should not be performed routinely except for lesions > 2 cm. An attempt to perform radical resection (pancreaticoduodenectomy followed by lymphadenectomy) can be made. The ameliorating effect of parathyroid surgery should be considered, and parathyroidectomy should be performed first before any abdominal surgery for ZES; and (3) For hepatic metastatic disease, hepatic resection should be routinely performed. Currently, liver transplantation is still considered an investigational therapeutic approach for ZES. Well-designed prospective studies are desperately needed to further verify and modify the current considerations.


Assuntos
Gastroenterologia/normas , Oncologia/normas , Guias de Prática Clínica como Assunto , Síndrome de Zollinger-Ellison/cirurgia , Duodeno/citologia , Duodeno/patologia , Duodeno/cirurgia , Células Secretoras de Gastrina/patologia , Gastrinas/metabolismo , Gastroenterologia/métodos , Hepatectomia , Humanos , Fígado/citologia , Fígado/patologia , Fígado/cirurgia , Excisão de Linfonodo , Oncologia/métodos , Pâncreas/citologia , Pâncreas/patologia , Pâncreas/cirurgia , Pancreaticoduodenectomia , Paratireoidectomia , Estômago/citologia , Estômago/patologia , Estômago/cirurgia , Fatores de Tempo , Síndrome de Zollinger-Ellison/patologia
13.
BMJ Case Rep ; 12(9)2019 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-31488444

RESUMO

Endoscopic biliary stenting is a well-recognised method of palliation of malignant biliary obstruction. Distal stent migration causing duodenal perforation is an uncommon complication of this procedure and is usually delayed. Early stent migration resulting in duodenal perforation is extremely rare and can be easily overlooked. We present a case of stent migration and resultant intraperitoneal duodenal perforation that occurred 24 hours following plastic stent insertion for a malignant biliary stricture in a 63-year-old woman. The patient required emergent abdominal laparoscopy with the placement of intraperitoneal drain, followed by endoscopic extraction of the stent and closure of the defect using a through-the-scope clip. This case report addresses intraperitoneal duodenal perforation secondary to early migration of biliary stents. Special emphasis is placed on the importance of prompt diagnosis and the use of endoclips in the management of this serious complication of endoprosthesis.


Assuntos
Procedimentos Cirúrgicos do Sistema Biliar/efeitos adversos , Duodeno/lesões , Migração de Corpo Estranho/diagnóstico por imagem , Stents/efeitos adversos , Duodeno/cirurgia , Feminino , Migração de Corpo Estranho/cirurgia , Humanos , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
14.
World J Gastroenterol ; 25(28): 3787-3797, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391773

RESUMO

BACKGROUND: Congenital duodenal obstruction (CDO) can be complete (CCDO) or incomplete (ICDO). To date there is no outcome analysis available that compares both subtypes. AIM: To quantify and compare the association between CCDO and ICDO with outcome parameters. METHODS: We retrospectively reviewed all patients who underwent operative repair of CCDO or ICDO in our tertiary care institution between January 2004 and January 2017. The demographics, clinical presentation, preoperative diagnostics and postoperative outcomes of 50 patients were compared between CCDO (n = 27; atresia type 1-3, annular pancreas) and ICDO (n = 23; annular pancreas, web, Ladd´s bands). RESULTS: In total, 50 patients who underwent CDO repair were enrolled and followed for a median of 5.2 and 3.9 years (CCDO and ICDO, resp.). CCDO was associated with a significantly higher prenatal ultrasonographic detection rate (88% versus 4%; CCDO vs ICDO, P < 0.01), lower gestational age at birth, lower age and weight at operation, higher rate of associated congenital heart disease (CHD), more extensive preoperative radiologic diagnostics, higher morbidity according to Clavien-Dindo classification and comprehensive complication index (all P ≤ 0.01). The subgroup analysis of patients without CHD and prematurity showed a longer time from operation to the initiation of enteral feeds in the CCDO group (P < 0.01). CONCLUSION: CCDO and ICDO differ with regard to prenatal detection rate, gestational age, age and weight at operation, rate of associated CHD, preoperative diagnostics and morbidity. The degree of CDO in mature patients without CHD influences the postoperative initiation of enteral feeding.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Duodenal/cirurgia , Duodeno/anormalidades , Nutrição Enteral/estatística & dados numéricos , Laparoscopia/métodos , Fatores Etários , Criança , Pré-Escolar , Obstrução Duodenal/congênito , Obstrução Duodenal/diagnóstico , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
15.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451461

RESUMO

This is a case report of a neonate who was antenatally diagnosed with jejunal atresia which turned out to be duodenal atresia with apple peel syndrome. A previous sibling, who also had apple peel but with jejunal atresia, succumbed to sepsis after surgery. The first sibling had jejunal stenosis and had died of sepsis following surgery. Combination of duodenal atresia with apple peel is extremely rare. This coupled with a familial condition is rarer still. This case was challenging due to the short length of the gut and prolonged need for total parenteral nutrition and sepsis in postoperative period.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Duodenal , Atresia Intestinal , Jejunostomia/métodos , Sepse Neonatal , Adulto , Diagnóstico Diferencial , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/etiologia , Obstrução Duodenal/fisiopatologia , Obstrução Duodenal/cirurgia , Duodeno/anormalidades , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/diagnóstico , Atresia Intestinal/genética , Atresia Intestinal/fisiopatologia , Atresia Intestinal/cirurgia , Jejuno/anormalidades , Jejuno/diagnóstico por imagem , Jejuno/cirurgia , Anamnese , Sepse Neonatal/diagnóstico , Sepse Neonatal/etiologia , Sepse Neonatal/terapia , Nutrição Parenteral Total/métodos , Gravidez , Diagnóstico Pré-Natal/métodos , Doenças Raras/diagnóstico , Irmãos , Resultado do Tratamento
16.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(8): 762-766, 2019 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-31422615

RESUMO

Objective: To evaluate the efficacy of reinforcement on duodenal stump using single purse-string suture during laparoscopic radical gastrectomy for gastric cancer in preventing duodenal stump leakage. Methods: A descriptive cohort study was conducted to retrospectively collect clinical data of 211 patients with gastric adenocarcinoma who underwent laparoscopic radical gastrectomy with Roux-en-Y or Billroth Ⅱ reconstruction and reinforcement on duodenal stump using laparoscopic single purse-string suture in Zhongshan Hospital of Fudan University between January 2013 and December 2016. Of 211 patients, 136 were male and 75 were female with mean age of (57.5±11.1)(24 to 87) years. Tumors locating at gastric upper 1/3, middle 1/3 and low 1/3 were found in 62, 68 and 81 patients respectively. Eighty-three cases underwent total gastrectomy, 128 underwent distal subtotal gastrectomy, 107 underwent Roux-en-Y reconstruction and 104 underwent Billroth II reconstruction. The procedure of reinforcement on duodenal stump using single purse-string suture during laparoscopic radical gastrectomy was as follows: (1) after cutting the duodenal stump to about 2.0 cm in length, use a 3-0 single-strand absorbable suture to make a muscle layer purse at a distance of 1.0 to 1.5 cm from the duodenal stump; (2) use the purse line to make a slipknot; (3) push the duodenum stump into the purse with a needle holder or grasper; (4) tighten the knot of the purse string, and then make 4 to 5 knots for reinforcement. Postoperative complications were defined and graded according to the Clavien-Dindo grading criteria, and the incidence of early complications was recorded. Clinicopathologic features and postoperative outcomes were analyzed. Results: All patients completed operations successfully. The mean time of laparoscopic single purse-string suture was (5.1±1.6) (3.6 to 10.2) minutes. Postoperative early complication occurred in 31 cases (14.7%), of whom 27 cases developed surgery-related complications (12.8%), including 7 cases (3.3%) of peritoneal infection, 6 (2.8%) of pancreatic leakage, 4 (1.9%) of wound infection, 4 (1.9%) of gastroplegia, 2 (0.9%) of peritoneal hemorrhage, 2 (0.9%) of intestinal obstruction, 2 (0.9%) of lymphatic leakage, and no duodenal stump leakage; while 4 cases (1.9%) developed internal non-surgical complication, including 3 cases (1.4%) of pulmonary infection and 1 (0.5%) of cardiovascular event. The patient with peritoneal hemorrhage was healed after re-operation and all other patients were discharged uneventfully after conservative treatment. Four cases (1.9%) developed complications beyond grade III a of Clavien-Dindo criteria. Conclusion: Reinforcement on duodenal stump using laparoscopic single purse-string suture during laparoscopic radical gastrectomy with Roux-en-Y or Billroth II reconstruction is simple and effective, and can prevent the risk of development of duodenal stump leakage.


Assuntos
Adenocarcinoma/cirurgia , Anastomose Cirúrgica/efeitos adversos , Fístula Anastomótica/prevenção & controle , Duodeno/cirurgia , Gastrectomia/métodos , Neoplasias Gástricas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica/métodos , Fístula Anastomótica/etiologia , Feminino , Gastrectomia/efeitos adversos , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Técnicas de Sutura , Adulto Jovem
17.
BMC Surg ; 19(1): 121, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31455328

RESUMO

BACKGROUND: By comparing the long-term prognostic outcomes after pancreaticoduodenectomy (PD) and limited resection (LR), this study aimed to investigate the optimal surgical modality for duodenal gastrointestinal stromal tumors (GISTs). METHODS: Two authors independently searched PubMed, Web of Science, Embase, and the Cochrane Library for published articles comparing the long-term prognostic and clinicopathological factors of duodenal GIST patients undergoing PD versus LR. Relevant information was extracted and analyzed. RESULTS: After screening, 10 items comprising 623 cases were eventually included. This meta-analysis explicitly indicated that PD treatment was associated with worse long-term prognosis (hazard ratio = 1.93; 95% confidence interval [CI], 1.39-2.69; p < 0.001; I2 = 0) and more complications (odds ratio [OR] = 2.90; 95% CI, 1.90-4.42; p < 0.001; I2 = 10%) than LR treatment. Nevertheless, for duodenal GISTs, PD was related to the following clinicopathological features: invasion of the second part of the duodenum (OR = 3.39; 95% CI, 1.69-6.79; p < 0.001; I2 = 50%), high-degree tumor mitosis (> 5/50 high-power fields; OR = 2.24; 95% CI, 1.42-3.52; p < 0.001; I2 = 0), and high-risk classification (OR = 3.17; 95% CI; 2.13-4.71; p < 0.001; I2 = 0). CONCLUSIONS: Since PD is associated with worse long-term prognosis and more complications, its safety and efficacy should be ascertained. Our findings recommend the use of LR to obtain negative incision margins when conditions permit it.


Assuntos
Neoplasias Duodenais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Pancreaticoduodenectomia/métodos , Duodeno/cirurgia , Tumores do Estroma Gastrointestinal/patologia , Humanos , Margens de Excisão , Pessoa de Meia-Idade , Prognóstico
18.
Updates Surg ; 71(3): 451-456, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31270684

RESUMO

Duodenal resections are sometimes necessary for radical surgery. We analyzed technical aspects and post-operative outcomes in patients with RPS and GIST involving duodenum. We identified patients who underwent duodenal resection for RPS and GIST at our Institute between 2000 and 2016. Clinical, pathological and treatment variables were analyzed. Thirty patients were treated: 15 for GIST, 15 for RPS. Sixteen duodenal wedge resections (WR) and 14 segmental resections (SR) were performed. Multi-organ resection was frequently performed (63.4%). Median time to flatus was 3 days (range 1-6), to oral refeeding 4.5 (range 2-15). Overall postoperative morbidity rate was 53% (16/30): Clavien Dindo grade ≤ II: 10; duodenum-related complication rate was 33% (10/30), Clavien Dindo grade ≤ II: 9. Morbidity rates were higher in SR than WR. Duodenal resections for RPS and GIST have significant morbidity rate and whenever it is possible, WR is preferable to SR because of the lower morbidity rate.


Assuntos
Duodeno/cirurgia , Neoplasias Gastrointestinais/cirurgia , Tumores do Estroma Gastrointestinal/cirurgia , Neoplasias Retroperitoneais/cirurgia , Sarcoma/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Atenção Terciária/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
19.
Am J Case Rep ; 20: 896-901, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31231118

RESUMO

BACKGROUND The effective and safe treatment of chronic frequently relapsing pancreatitis is challenging. CASE REPORT We present the case of a 63-year-old male patient with severe complications of this variant of the disease: parapancreatitis with the formation of an inflammatory mass, fermentative ascites-peritonitis, 2-sided pleural effusions, sepsis, and cachexia. Conservative treatment was ineffective, and emergency surgery was chosen. A novel surgical procedure - open internal stenting of the main pancreatic duct via pancreatowirsungotomy and duodenotomy - was used successfully in this difficult case. The elimination of pancreatic ductal hypertension and maintenance of maximum physiological pancreatic juice outflow, achieved via surgery, led to rapid improvement in the patient's condition. He was discharged on the 26th day after surgery. The clinical outcome was good at the 2-year follow-up. CONCLUSIONS Open stenting of the main pancreatic duct can be recommended for treating patients similar to the patient described in this paper - having severe complications of CP against the background of a relapse, exhaustion, and being in a severely or critically ill general condition. This surgical procedure is especially important when minimally invasive methods of eliminating pancreatic hypertension are technically unsuccessful or impossible due to the lack of necessary equipment and staff.


Assuntos
Hipertensão/cirurgia , Ductos Pancreáticos/cirurgia , Pancreatite Crônica/cirurgia , Stents , Estado Terminal , Duodeno/cirurgia , Humanos , Hipertensão/diagnóstico , Hipertensão/etiologia , Masculino , Pessoa de Meia-Idade , Pancreatite Crônica/diagnóstico , Pancreatite Crônica/etiologia , Recidiva
20.
Khirurgiia (Mosk) ; (5): 77-81, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31169824

RESUMO

Treatment of complicated giant duodenal ulcers is one of the most difficult problems in abdominal surgery. Simultaneous course of diabetes mellitus and giant duodenal ulcer has clinical features and requires correction of the treatment. It is presented case report that may be useful regarding accumulation of knowledge about comorbid course of these pathologies. The patient 58-year old was urgently delivered with signs of gastrointestinal bleeding, ulcerative anamnesis for 15 years, diabetes mellitus type 2 for 8 years. Gastroduodenoscopy revealed chronic giant (2.5×3.5 cm) duodenal ulcer complicated by bleeding and subcompensated pyloric stenosis. Endoscopic hemostasis included drug injection and argon-plasma coagulation. Recurrent bleeding occurred after 22 hours. It was performed Billroth II procedure with resection of 2/3 of the stomach and manual formation of 'difficult' duodenal stump. Cicatricial ring was used as a frame for the stump. Postoperative period was uneventful, patient was discharged after 14 days. This clinical case demonstrates the need for more active surgical strategy in patients with diabetes mellitus and reliability of the proposed method of 'difficult' stump forming.


Assuntos
Diabetes Mellitus Tipo 2/complicações , Úlcera Duodenal/cirurgia , Úlcera Péptica Hemorrágica/cirurgia , Estenose Pilórica/cirurgia , Cicatriz/etiologia , Cicatriz/cirurgia , Úlcera Duodenal/complicações , Úlcera Duodenal/diagnóstico , Duodeno/patologia , Duodeno/cirurgia , Gastroenterostomia , Humanos , Pessoa de Meia-Idade , Úlcera Péptica Hemorrágica/diagnóstico , Úlcera Péptica Hemorrágica/etiologia , Estenose Pilórica/diagnóstico , Estenose Pilórica/etiologia , Reprodutibilidade dos Testes
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