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1.
Medicine (Baltimore) ; 99(15): e19630, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282712

RESUMO

To investigate computed tomography and angiography findings and clinical outcomes after transcatheter arterial embolization for acute upper gastrointestinal bleeding from advanced gastric cancers.From January 2005 to December 2014, 58 patients with pathologically proven gastric cancer were treated at our institution with transcatheter arterial embolization due to acute upper gastrointestinal bleeding recalcitrant to endoscopic treatment. The electronic medical records for each patient were reviewed for clinical presentation, endoscopy history, computed tomography and angiographic findings, blood transfusion requirements, and follow-up results.Angiography findings were positive in 13 patients (22.4%): contrast extravasation was found in 9 patients and pseudoaneurysm in 4 patients. All patients with positive angiograms underwent selective embolization treatment. Those with negative angiography findings underwent empirical embolization. Gelfoam, n-butyl cyanoacrylate, coils, or a combination of these were used as embolic agents. The overall clinical success rate was 72.4% (42/58), and the success rate for patients with positive angiography was 53.8% (7/13). The median survival was 97.5 days (range, 7-1415 days), and the 1-month survival rate was 89.6% (52/58). The 1-month survival rate of the clinical success group was 95.2% (40/42), which was significantly higher than that of the clinical failure group (P = .04). The clinical success group also required significantly fewer transfusions (2.43 units, range 0-24 units) (P = .02).Transcatheter arterial embolization is a highly effective treatment for advanced gastric cancer with active bleeding. It should be considered as an additional treatment, especially when endoscopic or surgical treatment fails or when these approaches are difficult.


Assuntos
Embolização Terapêutica/métodos , Hemorragia Gastrointestinal/terapia , Neoplasias Gástricas/complicações , Tomografia Computadorizada por Raios X/métodos , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/epidemiologia , Angiografia/instrumentação , Embolização Terapêutica/tendências , Embucrilato/uso terapêutico , Extravasamento de Materiais Terapêuticos e Diagnósticos/diagnóstico por imagem , Extravasamento de Materiais Terapêuticos e Diagnósticos/epidemiologia , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/epidemiologia , Esponja de Gelatina Absorvível/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estômago/irrigação sanguínea , Estômago/patologia , Neoplasias Gástricas/patologia , Taxa de Sobrevida , Resultado do Tratamento
2.
Rev. esp. enferm. dig ; 112(4): 290-293, abr. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-187508

RESUMO

INTRODUCCIÓN Y OBJETIVO: estudios han evaluado la concordancia entre la cápsula endoscópica y la enteroscopia doble-balón con resultados diversos. El objetivo de este estudio es identificar factores que predicen la visualización de las lesiones en el intestino delgado por enteroscopia doble-balón después de una cápsula endoscópica positiva. MÉTODOS: estudio retrospectivo, observacional y comparativo que evaluó a pacientes con enteroscopia doble balón después de un cápsula endoscópica positiva entre enero de 2017 y agosto de 2019. Los datos estudiados fueron demográficos, indicaciones, comorbilidades y resultados de cápsula endoscópica y enteroscopia doble-balón. Se evaluaron mediante una regresión logística múltiple. RESULTADOS: se incluyeron 91 pacientes (edad 58 ± 16,5 años, 53 mujeres). Sesenta y dos enteroscopia doble-balón (68,1 %) encontraron las mismas lesiones que la cápsula endoscópica. Los factores predictivos para enteroscopia doble-balón positiva fueron lesiones múltiples (OR 8,10, 1,50-43,78; p = 0,015) y < 15 días ambos estudios (OR 5,31, 1,19-23,66; p = 0,029). En el subgrupo de pacientes con hemorragia de intestino delgado (70 pacientes), 46 enteroscopia doble-balón (65,7 %) coincidieron con la cápsula endoscópica. Los factores predictivos en este grupo fueron lesiones múltiples (OR 10,42, 1,37-79,30; p = 0,024), < 15 días entre ambos estudios (OR 13,51, 1,78-102,22; p = 0,012), > 60 años (OR 7,45, 1,51-36,75; p = 0,014) y úlceras (OR 4,67, 1,08-20,22; p = 0,039). CONCLUSIONES: los factores predictivos para enteroscopia doble-balón positiva después de cápsula endoscópica positiva son lesiones múltiples y < 15 días entre ambos procedimientos. En pacientes con hemorragia de intestino delgado, edad mayor a 60 años y presencia de úlceras también son


No disponible


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/lesões , Hemorragia Gastrointestinal/diagnóstico por imagem , Valor Preditivo dos Testes , Sensibilidade e Especificidade , Endoscopia por Cápsula , Enteroscopia de Duplo Balão , Estudos Retrospectivos
5.
Rev. esp. enferm. dig ; 112(4): 262-268, abr. 2020. tab, graf
Artigo em Inglês | IBECS | ID: ibc-187504

RESUMO

BACKGROUND: data on the long-term outcome of patients with obscure gastrointestinal bleeding (OGIB) with positive small bowel findings in capsule endoscopy but negative small bowel findings in device-assisted enteroscopy are scarce. OBJECTIVE: this study aimed to evaluate the rebleeding rate and time to rebleed in patients with no small bowel findings in enteroscopy, after a positive capsule endoscopy in the setting of OGIB. Baseline predictors for rebleeding were assessed. METHODS: a retrospective double-center study was performed, including patients with OGIB with positive findings by capsule endoscopy and negative small bowel findings by enteroscopy. RESULTS: thirty-five patients were included. Rebleeding occurred in 40 % of patients during a median follow-up of 27 months. Further evaluation in patients with a rebleed was performed in 85.7 %, leading to a final diagnosis in 78.6 %. The rebleeding rate increased progressively over time, from 17.2 % at one month to 54.4 % at four years. Overt bleeding at the time of the first episode was a predictor of rebleeding (p = 0.03) according to the multivariate analysis. This was 50 % at one year compared with 21.8 % in patients with occult bleeding on admission. CONCLUSIONS: in obscure gastrointestinal bleeding, long-term follow-up and further evaluation may be considered after a positive capsule endoscopy. Even if there are no small bowel findings by device-assisted enteroscopy. The rebleeding rate in our study was 40 %, mainly in the presence of an overt bleeding on admission


No disponible


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/cirurgia , Enteroscopia de Balão , Recidiva , Endoscopia por Cápsula , Estudos Retrospectivos , Fatores de Risco
6.
Medicine (Baltimore) ; 99(5): e18923, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000404

RESUMO

To evaluate the risk of first upper gastrointestinal bleeding by computerized tomoscanning (CT) for esophageal varices patients with cirrhotic portal hypertension.One hundred thirty two esophageal varices patients with cirrhotic portal hypertension who are also complicated with gastrointestinal bleeding were recruited as bleeding group, while another 132 patients without bleeding as non-bleeding group. The diameter of esophageal varices, number of vascular sections, and total area of blood vessels were measured by CT scanning. The sensitivity and specificity of these indicators were calculated, and Youden index was adjusted with the critical point.The diameter of esophageal varices was 7.83 ±â€Š2.76 mm in bleeding group, and 6.57 ±â€Š3.42 mm in non-bleeding group. The Youden index was 0.32 with the critical point 5.55 mm. The area under the receiver operating characteristics (AUROC) was 0.72. The number of venous vessels was 4.5 ±â€Š2 in bleeding group, whereas being 4 ±â€Š2 in non-bleeding group. The Youden index was 0.35 with a critical point 4, and the area under the curve (AUC) was 0.68. The blood vessel area was 1.73 ±â€Š1.15 cm in bleeding group, and 1.12 ±â€Š0.89 cm in non-bleeding group. The Youden index was 0.48 with the critical point being 1.03 cm, and corresponding AUC was 0.82.Among all 3 indicators of the total area, diameter, and number of sections of the esophageal varices, the total area of esophageal varices showed more accuracy as a potential and novel indicator for bleeding prediction.


Assuntos
Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Hipertensão Portal/complicações , Cirrose Hepática/complicações , Tomografia Computadorizada por Raios X , Adulto , Idoso , Varizes Esofágicas e Gástricas/epidemiologia , Esôfago/diagnóstico por imagem , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Hipertensão Portal/diagnóstico por imagem , Hipertensão Portal/epidemiologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Sensibilidade e Especificidade
7.
Can Assoc Radiol J ; 71(2): 149-153, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32063019

RESUMO

Meckel diverticulum is the most common and well-known congenital anomaly of the digestive system. Although most cases are asymptomatic, Meckel diverticulum can have a variety of complications, including gastrointestinal bleeding as a result of peptic ulceration, diverticulitis, and small bowel obstruction. Although the radiologic findings of these complications have been reported, they are difficult to diagnose preoperatively because Meckel diverticulum is a small entity. Computed tomography and scintigraphy play an important role in the diagnosis of Meckel diverticulum and its complications. It is important to be familiar with the radiologic features of acute abdomen due to complications of Meckel diverticulum to be able to manage the condition appropriately.


Assuntos
Abdome Agudo/diagnóstico por imagem , Hemorragia Gastrointestinal/diagnóstico por imagem , Obstrução Intestinal/diagnóstico por imagem , Divertículo Ileal/diagnóstico por imagem , Abdome Agudo/etiologia , Diverticulite/diagnóstico por imagem , Diverticulite/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Obstrução Intestinal/etiologia , Divertículo Ileal/complicações , Cintilografia , Tomografia Computadorizada por Raios X
8.
Am J Gastroenterol ; 115(3): 376-380, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32022723

RESUMO

INTRODUCTION: Patients hospitalized with myocardial infarction (MI) are at risk of gastrointestinal bleeding because of the need for antiplatelet agents and/or anticoagulation. The data regarding the safety of endoscopy after MI are limited. This study sought to assess mortality rates of patients hospitalized with acute MI who require esophagogastroduodenoscopy or colonoscopy using the National Inpatient Sample (NIS) database. METHODS: A retrospective cohort analysis of all adult inpatients in the NIS from 2016 admitted for ST-elevation infarction myocardial infarction (STEMI), non-STEMI, or type II non-STEMI was conducted. Data were collected including patient demographics and indication for endoscopy per ICD-10 coding. HCUPnet was used to query NIS to obtain all inpatient mortality. The primary methods included adjusted χ for categorical outcomes, adjusted linear regression for continuous outcomes, and adjusted logistic regression for multivariable analysis. RESULTS: A total of 1,281,749 patients were admitted for acute coronary syndrome in 2016, and 55,035 of these patients underwent endoscopy In the multivariable regression analysis, those who underwent a GI procedure (odds ratio [OR] 0.80, P value < 0.002) and angiogram (OR 0.48, P value < 0.001) had lower in-hospital mortality, after adjusting for age, Elixhauser index, need for angiogram, sex, race, and hospital type. Endoscopy postcatheterization was not associated with a difference in mortality compared with preangiogram (OR = 0.84, 95% confidence interval 0.60-1.19). DISCUSSION: Patients who underwent endoscopy are sicker and have higher mortality rates than those who do not undergo endoscopy, but after adjusting for comorbidities, mortality is actually lower. This suggests that endoscopy is safe and should be performed when clinically indicated despite recent cardiac ischemia.


Assuntos
Endoscopia do Sistema Digestório , Hemorragia Gastrointestinal/diagnóstico por imagem , Mortalidade Hospitalar , Infarto do Miocárdio/complicações , Idoso , Bases de Dados Factuais , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Hospitalização , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/mortalidade , Infarto do Miocárdio/terapia , Segurança do Paciente , Prognóstico , Estudos Retrospectivos
9.
Einstein (Sao Paulo) ; 18: eRC4934, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31994612

RESUMO

Varicose gastrointestinal bleeding is one of the major causes of morbidity and mortality in patients with chronic liver disease. Endoscopic treatment is the first therapeutic line for these patients, however, for those whom this therapeutic modality fail, a broad knowledge of alternative treatment options may improve the prognosis. We describe a case of a patient who were successfully embolized from gastroesophageal varices via transsplenic access.


Assuntos
Embolização Terapêutica/métodos , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Veia Esplênica/cirurgia , Adulto , Angiografia/métodos , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Humanos , Veia Porta/cirurgia , Veia Esplênica/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Ultrassonografia Doppler/métodos , Trombose Venosa/cirurgia
10.
J Comput Assist Tomogr ; 44(1): 145-152, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31939896

RESUMO

OBJECTIVES: We investigated the computed tomographic characteristics of gastrointestinal air motion artifact (GIAMA), which can be misinterpreted as active gastrointestinal bleeding. METHODS: We simulated GIAMA using 3 types of air-ball phantoms (air-ball in water, air-ball in oil, air-water-ball in oil) and a bovine intestine in oil phantom. We also performed a retrospective clinical review of precontrast abdominal computed tomography images of 76 patients to investigate the frequency, location, shape, and maximum density of hyperdense GIAMA. RESULTS: In phantom studies, air motion artifacts appeared as dark and bright streak artifacts at the borders of a moving air-ball and water or oil. In the clinical study, hyperdense GIAMA was visualized in 60 (79.0%) of 76 patients. The small intestine was most commonly affected (46.4%), and the intramural type had the highest frequency (58.0%). CONCLUSION: Knowing the radiologic features of GIAMA can assists radiologists in identifying active gastrointestinal bleeding sites accurately.


Assuntos
Hemorragia Gastrointestinal/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Interpretação de Imagem Radiográfica Assistida por Computador/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Animais , Bovinos , Reações Falso-Positivas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Imagens de Fantasmas , Estudos Retrospectivos , Sensibilidade e Especificidade , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-31785729

RESUMO

Colonoscopy is an integral diagnostic and therapeutic tool in the management of patients with lower gastrointestinal bleeding (LGIB). After resuscitation, reversal of coagulopathy, and exclusion of a proximal source of bleeding, colonoscopy should be performed in most patients with LGIB. Bowel preparation, typically with polyethylene glycol based solutions, is needed to closely inspect the colonic mucosa for bleeding sources. Colonoscopy within 24 h is recommended for high-risk patients with ongoing bleeding, although there is limited evidence that this strategy improves clinical outcomes. When active or stigmata of bleeding is detected, endoscopic intervention is indicated and can reduce future rebleeding. The most common options for endoscopic intervention include clipping, endoscopic band ligation, and coagulation, however rigorous head-to-head comparisons of different endoscopic tools are unavailable. Future research is needed to determine the optimal timing of colonoscopy, appropriate reversal strategies for patients on antithrombotics, and the most effective endoscopic hemostatic therapy.


Assuntos
Colonoscopia/métodos , Endoscopia/métodos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Hemorragia Gastrointestinal/patologia , Humanos , Resultado do Tratamento
12.
Artigo em Inglês | MEDLINE | ID: mdl-31785731

RESUMO

Endoscopy is the gold standard for evaluating and treating acute upper gastrointestinal bleeding (UGIB). The optimal timing of endoscopy is a very important consideration in the overall management of UGIB, but there is on going uncertainty regarding timing of the procedure, particularly in those with more severe bleeding. This is reflected by inconsistencies between current guidelines. Although evidence suggests endoscopy should be undertaken within 24 h for all admitted patients with UGIB, a small group of patients with severe bleeding or high-risk features may require more urgent endoscopy. The exact timing of the procedure in this high-risk group remains unclear, with recent data suggesting that performing endoscopy too early may be associated with worse outcome. In this article we examine the evidence for optimal timing of endoscopy in patients presenting with UGIB and suggest a clinical approach to this important aspect of patient management.


Assuntos
Endoscopia Gastrointestinal/métodos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Humanos
13.
Am Surg ; 85(11): 1246-1252, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775966

RESUMO

When endoscopy is performed for acute GI bleeding, therapeutic endoscopic procedures are infrequently required (only 6% of cases). We sought to determine the natural history of GI hemorrhage in patients who have undergone therapeutic endoscopy. We queried our hospital database for inpatients with acute GI bleeding who underwent therapeutic endoscopy between 2015 and 2017. The primary endpoints were recurrence of bleeding and the subsequent need for repeated endoscopic interventions, angioembolization, or surgery. Demographic information was collected. We reviewed 205 hospitalized patients: mean age was 70 years, 58 per cent were male, and mean hemoglobin was 9 g/dL. Patients had medical conditions predisposing them to bleeding in 59 per cent and history of previous GI bleeding in 37 per cent of cases. Sixty per cent were on antiplatelet/anticoagulation medications, and 10 per cent were receiving nonsteroidal anti-inflammatory medications. Blood transfusions were given to 78 per cent of patients, with an average of 2.3 units of packed red blood cells transfused per patient before intervention. Recurrence of hemorrhage after therapeutic endoscopy was seen in 9 per cent of patients. Only 2 per cent underwent a second therapeutic endoscopic procedure, and 5 per cent had surgery or angioembolization (half of these patients then had a further recurrence of bleeding). In total, seven patients died (3%). Recurrence of GI bleeding after therapeutic endoscopies is uncommon (9%). Surgery and angioembolization are not commonly necessary, but when used are only successful in 50 per cent of cases.


Assuntos
Hemorragia Gastrointestinal/terapia , Hemostase Endoscópica/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Anticoagulantes/uso terapêutico , Transfusão de Eritrócitos/estatística & dados numéricos , Feminino , Hemorragia Gastrointestinal/sangue , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/etiologia , Hemoglobina A/análise , Humanos , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação de Plaquetas/uso terapêutico , Recidiva , Retratamento , Estudos Retrospectivos , Adulto Jovem
14.
Eur J Radiol ; 120: 108691, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31589996

RESUMO

PURPOSE: To determine radiological or clinical criteria guiding treatment decisions in active lower gastrointestinal bleeding (LGIB). MATERIALS AND METHODS: We consecutively and retrospectively included all patients admitted to our emergency department for acute LGIB proven by CT angiography (CTA) from 2004 to 2017. Patients were divided into two groups depending on whether they first underwent interventional radiological (IR) or surgical treatment. Two radiologists reviewed CTA and angiographic images. Patients' hemodynamic and clinical parameters, delay between imaging and treatment, procedure characteristics, and outcomes were investigated to detect differences between the two groups. RESULTS: Initial management consisted of IR in 62 cases (70.5%) and surgery in 26 (29.5%). IR cases were older than surgical cases (74.3 vs 64.3y, p = 0.014). Baseline hemodynamic parameters were similar between the two groups. For colonic bleeding sources, the delay between CTA and IR was shorter than between CTA and surgery (p = 0.027), while there was a trend towards a shorter delay for all LGIB taken together (p = 0.061). In cases with hematochezia or melena, IR was more frequently performed than surgery (p = 0.001). Surgical cases showed higher base excesses (p = 0.039) and lactate levels (p = 0.042) after treatment compared with IR cases. Length of hospital stay was similar between the two groups (p = 0.728). During angiography, 41 (66%) cases were embolized. Complications occurred in three cases after IR (7%) and in five after surgery (19%). CONCLUSION: Initial management of active LGIB revealed by CTA (i.e. IR versus surgery), may depend on age and clinical signs, rather than hemodynamic parameters.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Embolização Terapêutica/métodos , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/terapia , Doença Aguda , Idoso , Feminino , Hemorragia Gastrointestinal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiologia Intervencionista/métodos , Estudos Retrospectivos , Resultado do Tratamento
15.
J Vet Intern Med ; 33(5): 1964-1969, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31381197

RESUMO

BACKGROUND: Video capsule endoscopy (VCE) is a noninvasive imaging modality that can identify mucosal lesions not detected with traditional endoscopy or abdominal sonography. In people, VCE is used in diagnostic and management protocols of various gastrointestinal (GI) disorders, particularly in GI bleeding of obscure origin or unexplained iron deficiency anemia (IDA). OBJECTIVE: To evaluate the utility of VCE in the identification of mucosal lesions in dogs with evidence of GI hemorrhage. ANIMALS: Sixteen client-owned dogs that underwent VCE. METHODS: Retrospective case-control study. Medical records were reviewed to include dogs with microcytosis, low normal mean corpuscular volume, or clinical GI bleeding that received VCE. RESULTS: Median age of dogs was 8.7 years (range, 8 months to 15 years) with a median weight of 21.7 kg (range, 6.9-62.5 kg). Abdominal ultrasound (16), abdominal radiography (4), and abdominal CT (1) did not identify a cause for GI blood loss. Gastric mucosal lesions were identified by VCE in 15 of 16 dogs and small intestinal lesions in 12 of 14 dogs, with 2 capsules remaining in the stomach. Endoscopy was performed in 2 dogs before VCE; 1 dog had additional small intestinal lesions identified through the use of VCE. CONCLUSIONS AND CLINICAL IMPORTANCE: Video capsule endoscopy is a minimally invasive diagnostic tool that can identify GI lesions in dogs presenting with microcytosis with or without GI hemorrhage when ultrasonography is inconclusive; however, the majority of lesions identified would have been apparent with conventional endoscopy.


Assuntos
Endoscopia por Cápsula/veterinária , Doenças do Cão/diagnóstico por imagem , Índices de Eritrócitos/veterinária , Hemorragia Gastrointestinal/veterinária , Anemia Ferropriva/etiologia , Animais , Endoscopia por Cápsula/métodos , Estudos de Casos e Controles , Cães , Feminino , Hemorragia Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Masculino , Estudos Retrospectivos
16.
BMJ Case Rep ; 12(8)2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31434664

RESUMO

Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder presenting with asymmetric limb hypertrophy, cutaneous capillary malformations and lower extremity varicosities. We discuss a 27-year-old man born with varicosities on both lower extremities, which progressively enlarged. Physical examination showed a grossly enlarged right hand. There were multiple compressible varicosities, diffuse port-wine stains on the right leg and limb-length discrepancy on the left leg. CT angiogram and Doppler ultrasound revealed several venous varicosities. Ectatic veins in the right leg converge into the lateral marginal vein of Servelle, an embryonic vein, typically seen in KTS patients. KTS is diagnosed clinically and imaging plays a role in differentiating this from other disease entities that present similarly. Doppler ultrasound is the initial imaging of choice to characterise varicosities and to identify thrombosis and reflux. Plain radiographs confirm limb hypertrophy. MRI and CT angiograms are useful to evaluate vascular anomalies and its accompanying soft tissue changes.


Assuntos
Endoscopia do Sistema Digestório/instrumentação , Hemorragia Gastrointestinal/diagnóstico por imagem , Síndrome de Klippel-Trenaunay-Weber/diagnóstico por imagem , Imagem Multimodal , Radiografia/instrumentação , Adulto , Anti-Inflamatórios não Esteroides/uso terapêutico , Antifibrinolíticos/uso terapêutico , Hemorragia Gastrointestinal/tratamento farmacológico , Hemorragia Gastrointestinal/etiologia , Humanos , Síndrome de Klippel-Trenaunay-Weber/complicações , Síndrome de Klippel-Trenaunay-Weber/patologia , Síndrome de Klippel-Trenaunay-Weber/fisiopatologia , Masculino , Ácido Tranexâmico/uso terapêutico , Resultado do Tratamento
17.
Radiología (Madr., Ed. impr.) ; 61(4): 297-305, jul.-ago. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-185307

RESUMO

Objetivo: Revisar la embriología, los hallazgos clínicos y la apariencia en la tomografía computarizada multidetector (TCMD) del divertículo de Meckel (DM) complicado en adultos. Conclusión: La presencia de un DM en una TCMD debe sospecharse cuando se observa una estructura tubular ciega conectada al íleon terminal por un cuello de tamaño variable. Las reconstrucciones multiplanares y la enterografía por TC pueden ayudar al diagnóstico. En pacientes con síntomas de obstrucción o inflamación intestinal, se debe considerar la posibilidad de un DM complicado; especialmente cuando el íleon terminal y el apéndice vermiforme son normales. La angiografía por TCMD, en casos de hemorragia digestiva aguda, puede identificar extravasación de contraste y acumulación de sangre en el DM. La observación de la arteria onfalomesentérica es diagnóstica de DM. Otros hallazgos en la TCMD, como la presencia de enterolitos o cambios inflamatorios en torno al DM, pueden facilitar el diagnóstico


Objective: To review the embryology, the clinical findings and the appearance in multidetector computed tomography (MDCT) of complicated Meckel's diverticulum (DM) in adults. Conclusion: The presence of an MD in a MDCT should be suspected when a blind tubular structure connected to the terminal ileum by a neck of variable size is observed. Multiplanar 2D reconstructions images and CT enterography can help in the diagnosis. In patients with symptoms of obstruction or intestinal inflammation, the possibility of a complication secondary to a MD should be considered, especially when the terminal ileum and the vermiform appendix are normal. MDCT angiography, in cases of acute gastrointestinal bleeding, can identify contrast extravasation and accumulation of blood in the MD, and could demonstrate the persistent omphalomesenteric artery, which is diagnostic of MD. Other MDCT findings such as the presence of enteroliths or associated inflammatory changes around the MD can facilitate the preoperative diagnosis of MD complications


Assuntos
Humanos , Divertículo Ileal/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Divertículo Ileal/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Divertículo Ileal/embriologia , Hemorragia Gastrointestinal/diagnóstico por imagem
18.
BMJ Case Rep ; 12(7)2019 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-31296619

RESUMO

Acute upper gastrointestinal (UGI) bleeding in cirrhosis has been classically linked to variceal rupture, although peptic ulcer and portal hypertensive gastropathy-related bleed are not uncommon. Gastrointestinal stromal tumour (GIST) is the most common mesenchymal tumour and may also present as UGI bleed; however, there are no reports of GIST presenting as UGI bleed in patients with cirrhosis. Here, we report three cases of GIST who had presented with UGI bleed and were successfully managed with surgical excision and are tolerating imatinib without recurrence.


Assuntos
Hemorragia Gastrointestinal/etiologia , Neoplasias Gastrointestinais/complicações , Tumores do Estroma Gastrointestinal/complicações , Cirrose Hepática/complicações , Idoso , Antineoplásicos/uso terapêutico , Hemorragia Gastrointestinal/diagnóstico por imagem , Neoplasias Gastrointestinais/diagnóstico por imagem , Neoplasias Gastrointestinais/terapia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/terapia , Trato Gastrointestinal/diagnóstico por imagem , Trato Gastrointestinal/cirurgia , Humanos , Mesilato de Imatinib/uso terapêutico , Cirrose Hepática/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
19.
Am J Forensic Med Pathol ; 40(4): 376-380, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31306168

RESUMO

Barotrauma-associated perforation of the colon is not common and usually occurs due to the passage of compressed air through the anus. Most of the cases are accidental and done for fun often at the victim's workplace. Therefore, it is necessary that the workers should be made aware of the dangers of the equipment they regularly use at their workplace. Here, we describe one such case where a rice mill worker died when compressed air through an air pump pipe entered his rectum. His chief complaint was abdominal pain and breathing difficulty. Computed tomography scan of the abdomen and thorax showed pneumoperitoneum, pneumomediastinum, and soft tissue emphysema. There was a complete tear in the rectosigmoid junction of the colon. The mucosa was deeply hemorrhagic and congested. Histopathology of this segment showed hemorrhagic necrosis of the mucosa.


Assuntos
Colo/lesões , Ar Comprimido/efeitos adversos , Perfuração Intestinal/etiologia , Exposição Ocupacional/efeitos adversos , Colo/diagnóstico por imagem , Colo/patologia , Evolução Fatal , Hemorragia Gastrointestinal/diagnóstico por imagem , Hemorragia Gastrointestinal/patologia , Humanos , Mucosa Intestinal/patologia , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/patologia , Masculino , Enfisema Mediastínico/diagnóstico por imagem , Necrose , Peritonite/etiologia , Pneumoperitônio/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Pediatr Surg Int ; 35(11): 1197-1210, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31300851

RESUMO

PURPOSE: This exclusively surgical series on pediatric non-variceal gastrointestinal bleed (NVGIB) defines three levels of bleed site and describes etiology, bleed severity, diagnostic algorithm, and surgical management for each bleed site. Management challenges are detailed. METHODS: Patients aged ≤ 18 years treated surgically for NVGIB were analysed. RESULTS: Bleed site (n = 87) was classified as: upper gastrointestinal bleed (UGIB; n = 11); small bowel bleed (SBB: n = 52); and lower GIB (n = 24). Four etiology-based groups were identified: lesions with ectopic gastric mucosa (EGM; n = 33), tumours (n = 23), ulcers (n = 21), and vascular pathology (n = 8). Bleed severity spectrum was: acute severe bleed (n = 12); subacute overt bleed (n = 59); and occult GIB (n = 16). Preoperative diagnosis was obtained in all UGIB and LGIB lesions. Eighty-two percent of surgical SB lesions were diagnosed preoperatively on Tc99m pertechnetate scan, computed tomography enterography-angiography, and capsule endoscopy; remaining 18% were diagnosed at laparotomy with intra-operative enteroscopy (IOE). Surgical management was tailored to bleed site, severity, and etiology. Indications of IOE and approach to management challenges are detailed. CONCLUSIONS: The commonest site-specific bleed etiologies were duodenal ulcers for UGIB, EGM lesions for SBB, and tumours for LGIB. SBB presented diagnostic challenge. Diagnostic algorithm was tailored to bleed site, age-specific etiology, bleed severity, and associated abdominal/systemic symptoms. Management challenges were acute severe bleed, occult GIB, SBB, obscure GIB, and rare etiologies. IOE has a useful role in SBB management.


Assuntos
Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/cirurgia , Adolescente , Algoritmos , Falso Aneurisma/complicações , Endoscopia por Cápsula , Criança , Pré-Escolar , Coristoma/complicações , Doença de Crohn/complicações , Úlcera Duodenal/complicações , Feminino , Mucosa Gástrica , Hemorragia Gastrointestinal/diagnóstico por imagem , Neoplasias Gastrointestinais/complicações , Artéria Hepática , Humanos , Lactente , Masculino , Divertículo Ileal/complicações , Compostos Radiofarmacêuticos , Pertecnetato Tc 99m de Sódio , Tomografia Computadorizada por Raios X , Malformações Vasculares/complicações
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