Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 20.476
Filtrar
1.
Surg Clin North Am ; 99(6): 1141-1150, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31676053

RESUMO

Although improved medical therapies have been associated with decreased rates of emergent intestinal resection for inflammatory bowel disease, prompt diagnosis and management remain of utmost importance to ensure appropriate patient care with reduced morbidity and mortality. Emergent indications for surgery include toxic colitis, acute obstruction, perforation, acute abscess, or massive hemorrhage. Given this broad spectrum of emergent presentations, a multidisciplinary team including surgeons, gastroenterologists, radiologists, nutritional support services, and enterostomal therapists are required for optimal patient care and decision making. Management of each emergency should be individualized based on patient age, disease type and duration, and patient goals of care.


Assuntos
Colectomia/métodos , Hemorragia Gastrointestinal/cirurgia , Doenças Inflamatórias Intestinais/complicações , Obstrução Intestinal/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Anastomose Cirúrgica , Colite Ulcerativa/complicações , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/terapia , Doença de Crohn/complicações , Doença de Crohn/diagnóstico , Doença de Crohn/terapia , Emergências , Feminino , Hemorragia Gastrointestinal/etiologia , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Perfuração Intestinal/fisiopatologia , Masculino , Equipe de Assistência ao Paciente/organização & administração , Prognóstico , Medição de Risco , Resultado do Tratamento
2.
Medicine (Baltimore) ; 98(41): e17455, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593102

RESUMO

INTRODUCTION: Behçet disease (BD) is an autoimmune disorder characterized by oral aphthosis, genital aphthosis, ocular lesions, and arthritis. However, other fatal complications are often misdiagnosed, which implies that the early diagnosis of the disease is important for a good prognosis. PATIENT CONCERNS: A 51-year-old man complained of hematemesis for 5 hours and syncope once. DIAGNOSIS: BD as demonstrated by esophageal ulcer and aortic aneurysm rupture. INTERVENTIONS: Surgeries were conducted to repair the thoracic aortic aneurysm, proton-pump inhibitor was used to reduce acid secretion, antibiotics were applied for anti-infective therapy, and immunosuppressor was administered to control the injuries of BD. OUTCOMES: The patient was discharged and his medication dosage was reduced gradually until the minimum maintenance dose. In the follow-ups, the gastric ulcer and vascular aneurysm were not found. CONCLUSION: We presented a rare case of BD with the concurrence of huge esophageal ulcer and thoracic aortic aneurysms rupture, which helped us to diagnose BD at the early stage, while confronting atypical manifestations.


Assuntos
Aneurisma da Aorta Torácica/etiologia , Ruptura Aórtica/etiologia , Síndrome de Behçet/complicações , Doenças do Esôfago/etiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade
3.
Medicine (Baltimore) ; 98(41): e17511, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593121

RESUMO

Acute esophageal necrosis (AEN) is a serious disease which can causes gastrointestinal bleeding and death. Although black color change is not essential factor of organ necrosis, AEN is also known as "black esophagus." Because of its rarity, there are limited studies regarding risk factors of mortality and recurrence. Thus, we conducted a multicenter retrospective study in order to evaluate the clinical characteristics of AEN. Method Clinical datum of AEN patients from 7 tertiary hospitals located in Daejeon-Choongcheong province were evaluated based on medical records. Our primary endpoint was risk factors for mortality and the secondary endpoint was risk factors for recurrence and clarifying whether "black esophagus" is a right terminology.Fourty one patients were enrolled. Thirty six patients were male, mean age was 69.5 years. Nine patients had died, and 4 patients showed recurrence. Sepsis and white color change in endoscopy were related to high mortality (Chi-Squared test, P < .05). Old age, high pulse rate, low hemoglobin, and low albumin were also related to high mortality. Unexpectedly, heavy drinking showed favorable a mortality. Septic condition and high pulse rate showed poor mortality in logistic regression test (P < .05). Coexisting duodenal ulcer was related to recurrence (Chi-Squared test, P < .05). There was no difference in the underlying condition except patients with a coexisting cancer and white-form displayed lower hemoglobin level. Conclusion: Our results imply that white color change, septic condition, high pulse rate, and low hemoglobin & albumin are poor prognostic factors in AEN. Further evaluation may help clarify the findings of our study.


Assuntos
Doenças do Esôfago/mortalidade , Hemorragia Gastrointestinal/mortalidade , Necrose/diagnóstico por imagem , Necrose/mortalidade , Doença Aguda , Idoso , Albuminas/análise , Úlcera Duodenal/epidemiologia , Endoscopia do Sistema Digestório/métodos , Doenças do Esôfago/diagnóstico por imagem , Doenças do Esôfago/patologia , Esôfago/irrigação sanguínea , Esôfago/patologia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemoglobinas/análise , Humanos , Masculino , Pessoa de Meia-Idade , Necrose/complicações , Necrose/patologia , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Sepse/epidemiologia , Sepse/etiologia , Sepse/mortalidade
5.
Pan Afr Med J ; 33: 113, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31489091

RESUMO

Meckel's diverticulum (MD) is a remnant of omphalomesenteric channel. It is often asymptomatic but it can be responsible for various clinical complications and variable clinical status especially in children. We conducted a retrospective study on complications of MD among children hospitalized in the division of Paediatric Surgery at the University Hospital Hassan II, Fez, Morocco. The study aimed to describe the clinical, radiological and therapeutic features of MD. The study was conducted over a period of 10 years (January 2009 - December 2018) and involved 18 children (15 boys and 3 girls) aged 1 day - 15 years (with an average age of 5 years) who had undergone surgery for complications of MD. Acute intussusception and intestinal occlusion were the most frequent complications. Other complications included: infection of the MD (1 case) and digestive hemorrhage (2 cases). Two rare types of neonatal Meckel's diverticulum were described (neonatal occlusion and fistula associated with omphalocele). In no case, abdominal X-ray without treatment, ultrasound and CT scan showed MD. Scintigraphy was performed in 2 patients with hematochezia and it helped to make the diagnosis of MD in one case. Three patients underwent laparoscopic surgery with resection of the MD and intestinal anastomosis with laparoscopy. The other patients underwent laparotomy. Ileostomy was performed in one case, followed by secondary recovery. Patient's outcome was good, except for one case of anastomotic leakage. Anatomopathological examination showed two cases of heterotopia.


Assuntos
Anastomose Cirúrgica/métodos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia/métodos , Divertículo Ileal/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Hemorragia Gastrointestinal/epidemiologia , Hemorragia Gastrointestinal/etiologia , Humanos , Lactente , Recém-Nascido , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intussuscepção/epidemiologia , Intussuscepção/etiologia , Intussuscepção/cirurgia , Laparotomia/métodos , Masculino , Divertículo Ileal/diagnóstico , Divertículo Ileal/cirurgia , Marrocos , Estudos Retrospectivos
6.
Medicine (Baltimore) ; 98(36): e16981, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490379

RESUMO

RATIONALE: Henoch-Schönlein purpura (HSP) is a common disease in children. However, HSP with intussusception and intestinal obstruction has a low morbidity in children and is occasionally seen in adults. Herein, a rare adult case of HSP complicated with intussusception and hemafecia that was successfully treated with surgery is described. PATIENT CONCERNS: A 19-year-old Chinese man suffered from HSP combined with intussusception and intestinal obstruction and presented with vomiting, diarrhea, abdominal pain, and rash. DIAGNOSIS: Henoch-Schönlein purpura with intussusception and intestinal obstruction. INTERVENTIONS: The patient underwent an emergency laparotomy and manual reset. OUTCOME: The patient was discharged 7 days after surgery in stable condition. We followed the patient to the sixth month after surgery. This patient has no long-term complications after surgery. LESSONS: HSP with intussusception and intestinal obstruction is rarely seen in adults. Patients with HSP often present with abdominal pain as the first symptom, which is easily confused with other diseases. Once the HSP is diagnosed, surgery should be performed as soon as possible, provided there is no absolute contraindication.


Assuntos
Hemorragia Gastrointestinal/etiologia , Enteropatias/etiologia , Intussuscepção/etiologia , Púrpura de Schoenlein-Henoch/complicações , Humanos , Enteropatias/cirurgia , Intussuscepção/cirurgia , Masculino , Adulto Jovem
7.
Cochrane Database Syst Rev ; 9: CD010546, 2019 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-31550050

RESUMO

BACKGROUND: Portal hypertension commonly accompanies advanced liver disease and often gives rise to life-threatening complications, including haemorrhage from oesophageal and gastrointestinal varices. Variceal haemorrhage commonly occurs in children with chronic liver disease or portal vein obstruction. Prevention is therefore important. Following numerous randomised clinical trials demonstrating efficacy of non-selective beta-blockers and endoscopic variceal ligation in decreasing the incidence of variceal haemorrhage, primary prophylaxis of variceal haemorrhage in adults has become the established standard of care. Hence, band ligation and beta-blockers have been proposed to be used as primary prophylaxis of oesophageal variceal bleeding in children. OBJECTIVES: To determine the benefits and harms of band ligation compared with any type of beta-blocker for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. SEARCH METHODS: We searched The Cochrane Hepato-Biliary Group Controlled Trials Register (February 2019), CENTRAL (December 2018), PubMed (December 2018), Embase Ovid (December 2018), LILACS (Bireme; January 2019), and Science Citation Index Expanded (Web of Science; December 2018). We scrutinised the reference lists of the retrieved publications and performed a manual search from the main paediatric gastroenterology and hepatology conferences (NASPGHAN and ESPGHAN) abstract books from 2009 to 2018. We searched ClinicalTrials.gov for ongoing clinical trials. There were no language or document type restrictions. SELECTION CRITERIA: We planned to include randomised clinical trials irrespective of blinding, language, or publication status for assessment of benefits and harms. We planned to also include quasi-randomised and other observational studies retrieved with the searches for randomised clinical trials for report of harm. DATA COLLECTION AND ANALYSIS: We planned to summarise data from randomised clinical trials using standard Cochrane methodologies. MAIN RESULTS: We found no randomised clinical trials assessing band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. AUTHORS' CONCLUSIONS: Randomised clinical trials assessing the benefits or harms of band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis are lacking. There is a need for well-designed, adequately powered randomised clinical trials to assess the benefits and harms of band ligation versus beta-blockers for primary prophylaxis of oesophageal variceal bleeding in children with chronic liver disease or portal vein thrombosis. Those randomised clinical trials should include patient-relevant clinical outcomes such as mortality, failure to control bleeding, and adverse events.


Assuntos
Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/prevenção & controle , Hemorragia Gastrointestinal/cirurgia , Ligadura/métodos , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Antifibrinolíticos/uso terapêutico , Doença Hepática Terminal/complicações , Varizes Esofágicas e Gástricas/tratamento farmacológico , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Veia Porta , Prevenção Primária , Ensaios Clínicos Controlados Aleatórios como Assunto , Trombose Venosa/complicações
8.
S D Med ; 72(6): 250-252, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31461229

RESUMO

Gastrointestinal (GI) histoplasmosis is a rare disease with variable manifestations. We report a case of a male patient who developed disseminated histoplasmosis with prominent manifestations of GI bleeding, and esophagogastroduodenoscopy and colonoscopy revealed atypical ulcers. With the treatment of itraconazole, patient's GI bleeding stopped, and follow up endoscopies revealed resolution of the ulcers.


Assuntos
Hemorragia Gastrointestinal , Histoplasmose , Colonoscopia , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/etiologia , Histoplasmose/complicações , Humanos , Itraconazol/uso terapêutico , Masculino
10.
Ann Hematol ; 98(10): 2311-2318, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31432214

RESUMO

The role of adjunctive corticosteroid in septic shock remains debatable, and its role has not been assessed in neutropenic patients. We evaluated whether hydrocortisone reduces 28-day mortality in neutropenic patients with septic shock. We conducted a retrospective cohort study between January 2012 and May 2017 at a tertiary care center in South Korea. Patients who developed septic shock treated with at least one vasopressor and whose absolute neutrophil count was < 1000 cells/µL were included. Patients were classified into a steroid and a no-steroid group. The primary outcome of the study was 28-day mortality. Propensity score matching was used to adjust baseline characteristics and disease severity between the groups. Of the 287 patients analyzed, 189 were classified in the no-steroid group and 98 in the steroid group. Fifty propensity score-matched pairs were compared for the study outcomes. We found no significant difference in 28-day mortality between patients treated with and without steroid after propensity score matching (38.0% and 42.0%, respectively; p = 0.838). Incidences of pneumonia and gastrointestinal bleeding were more frequent in the steroid group, but it was not statistically significant after matching. In conclusion, adjunctive hydrocortisone was not associated with reduced 28-day mortality in neutropenic patients with septic shock.


Assuntos
Hidrocortisona/administração & dosagem , Neutropenia , Choque Séptico , Adulto , Idoso , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Humanos , Hidrocortisona/efeitos adversos , Incidência , Masculino , Pessoa de Meia-Idade , Mortalidade , Neutropenia/complicações , Neutropenia/tratamento farmacológico , Neutropenia/mortalidade , Pneumonia/etiologia , Pneumonia/mortalidade , Estudos Retrospectivos , Choque Séptico/complicações , Choque Séptico/tratamento farmacológico , Choque Séptico/mortalidade , Fatores de Tempo
11.
Niger J Clin Pract ; 22(8): 1099-1108, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31417053

RESUMO

Background: Upper gastrointestinal system (GIS) bleeding is one of the most common causes of mortality and morbidity. The predictive values of pre-endoscopic Rockall score (PERS), full Rockall score (FRS), Glasgow-Blatchford score (GBS), pre-endoscopic Baylor score (PEBS), and full Baylor score (FBS) to predict bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death are investigated in our study. Methods: This study was retrospectively conducted in patients admitted to emergency department with upper GIS bleeding. Demographic and clinical characteristics of the patients were recorded. The relationships of the aforementioned scores with in-hospital termination, bleeding at follow-up, endoscopic therapy, blood transfusion requirement, and death were explored. Results: The study included a total of 420 subjects, of which 269 (64%) were men. All scoring systems were able to predict transfusion need and GBS was superior to other scores (P < 0.0001). In terms of endoscopic treatment, it was determined that only PERS, FRS, and FBS were statistically significant in predicting ability and PERS >3, FRS >5 and FBS >10 patients needed endoscopic treatment. All scoring systems were able to predict rebleeding. In comparison of two groups for rebleeding, it was found that PEBS was better able to predict bleeding during follow-up than both FRS and FBS, and PERS was better able to predict bleeding during follow-up than both FRS and FBS. All scoring systems were able to predict mortality. FRS and PERS scores had a greater discriminatory power for predicting death than the rest of the scores (P < 0.001). Conclusion: All scoring systems were effective for predicting need for blood transfusion, rebleeding, and death. GBS had more predictive power for transfusion need, PERS and PEBS for rebleeding, and FRS for mortality. PERS, FRS, and FBS were found to be effective in predicting endoscopic treatment.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Hospitalização/estatística & dados numéricos , Medição de Risco/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Serviço Hospitalar de Emergência , Endoscopia do Sistema Digestório , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/mortalidade , Hemorragia Gastrointestinal/terapia , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Curva ROC , Estudos Retrospectivos , Índice de Gravidade de Doença , Turquia/epidemiologia
12.
Medicine (Baltimore) ; 98(31): e16521, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31374013

RESUMO

RATIONALE: Massive intestinal bleeding as a complication of typhoid fever has rarely been reported due to the advent of antibiotics. In addition, although several literatures have been issued on the use and success of endoscopic modalities in cases of massive typhoid ulcer bleeding, few have described hemostasis by endoscopic hemoclipping. PATIENT CONCERNS: We describe a case of a 61-year-old Korean female who presented acute episodes of massive lower gastrointestinal bleeding during admission to local hospital with a provisional diagnosis of acute gastroenteritis. She had returned from a trip to Southeast Asia 3 weeks prior to admission DIAGNOSES:: After the result of blood culture was identified as Salmonella typhi, we could make a diagnosis of typhoid fever complicated by massive intestinal bleeding and acute pancreatitis based on elevated serum lipase and computerized tomography (CT) findings. INTERVENTIONS: The patient was treated successfully by two repeat colonoscopic hemostasis procedures involving the deployment of hemoclips on ulcers in the terminal ileum and 10-day course of intravenous ciprofloxacin OUTCOMES:: The patient was stable and reported no further episodes of intestinal bleeding or fever during the follow-up time. In addition, acute pancreatitis, which is a rare complication of typhoid fever, resolved without complication on follow-up CT and a laboratory study. LESSONS: Considering the risk of procedure-related complications such as perforation of the small intestine wall, which become thin and friable due to ulceration, mechanical hemostasis methods, such as hemoclipping, might be safer than coagulation, when the bleeding spot can be identified and is not multiple, as in our case. In addition, our case demonstrates that S. typhi should be considered in the differential diagnosis of massive lower gastrointestinal hemorrhage, especially in the setting of recent travel in South or Southeast Asia.


Assuntos
Hemorragia Gastrointestinal/etiologia , Pancreatite/etiologia , Febre Tifoide/complicações , Febre Tifoide/cirurgia , Tratamento Conservador , Endoscopia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Salmonella typhi/patogenicidade
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(7): 673-677, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31302967

RESUMO

Objective: To use the meta-analysis in evaluating the hemorrhage-prevention value of second-look endoscopy after endoscopic submucosal dissection (ESD) for early gastric cancer. Methods: A literature search was conducted to identify all relevant studies comparing second-look endoscopy and non-second-look endoscopy after gastric ESD. The Medline/PubMed, Ovid, Elsevier ScienceDirect, EBSCO, CNKI and VIP databases were searched systematically. Literature inclusion criteria: (1) all the patients were diagnosed as early gastric cancer receiving ESD; (2) end point of the study included postoperative bleeding rate of ESD. Exclusion criteria: (1) papers of repeated research, review, comment, guideline, etc; (2) non-control study. Meta-analysis method was used to calculate a pooled odds ratio (OR) for developing post-ESD bleeding. Results: The meta-analysis showed that post-ESD bleeding was observed in 40 of 1287 patients (3.1%) without second-look endoscopy and in 40 of 968 patients (4.1%) with second- look endoscopy (OR=1.25, 95% CI: 0.79-1.98), with no significant difference between these two groups. Subgroup analysis on research method still indicated no significant difference of post-ESD bleeding between RCT group (OR=1.45,95%CI: 0.79-2.65) and non-RCT group (OR=1.02, 95%CI: 0.50-2.08) (all P>0.05). Conclusion: Based on meta analysis, second-look endoscopy can not reduce the rate of postoperative bleeding of ESD. Therefore, routine second-look endoscopy after gastric ESD may not be necessary to prevent delayed postoperative bleeding of ESD.


Assuntos
Ressecção Endoscópica de Mucosa/efeitos adversos , Hemorragia Gastrointestinal/prevenção & controle , Cirurgia de Second-Look , Neoplasias Gástricas/cirurgia , Mucosa Gástrica/cirurgia , Hemorragia Gastrointestinal/etiologia , Gastroscopia , Humanos
14.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(7): 694-696, 2019 Jul 25.
Artigo em Chinês | MEDLINE | ID: mdl-31302972

RESUMO

Special diseases with hemorrhoid hemorrhage are intractable cases in clinical practice. Surgery may result in serious trauma and high risk, such as higher morbidity of postoperative complication, delayed hospital stay, and even death. These patients usually underwent conservative therapy or injection therapy. In 2017, our Professional Committee standardized the procedure of Shaobei injection and established the clinical guideline, but still lacked guidance for special diseases with hemorrhoid hemorrhage. In view of this, based on current medical conditions, combined with years of clinical practice, after repeated discussions, comprehensive multidisciplinary perspectives on patients with special diseases such as coagulopathy, hypertension, diabetes, portal hypertension, renal dysfunction, immunodeficiency, and antithrombotic therapy, the experts of this guideline-writing committee formulate the corresponding clinical management strategies, mainly emphasizing on preoperative management of underlying disease, choice of anesthesia methods, and precautions during surgery.


Assuntos
Hemorragia Gastrointestinal/terapia , Hemorroidas/terapia , Injeções/efeitos adversos , Tratamento Conservador , Hemorragia Gastrointestinal/etiologia , Hemorroidas/complicações , Humanos , Injeções/métodos , Guias de Prática Clínica como Assunto
15.
Medicine (Baltimore) ; 98(29): e16505, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335721

RESUMO

Prior studies have demonstrated positive impacts of antibiotic use on reducing mortality, rebleeding events, and length of hospitalization in adult cirrhotic patients with acute upper gastrointestinal bleeding (UGIB). We aimed to investigate the use of antibiotics in cirrhotic children with acute UGIB and its impact on patient outcomes.This was a retrospective study using the Pediatric Health Information System database. Cirrhotic patients aged 0 to 18 years with acute UGIB, admitted between October 2005 and September 2015, were identified based on ICD-9 codes. Patients with no documented endoscopy during admission were excluded.Forty-four (23 females) cirrhotic children were eligible for data analysis. The median patient age was 6 years. Etiology of acute UGIB included esophageal varices (n = 37), non-variceal bleeding (n = 4), and both (n = 3). A significant proportion of cirrhotic children with acute UGIB (n = 30, 68%) were given intravenous antibiotics within 48 hours of admission. Among children who did not develop bacteremia, 68% received antibiotics vs. 32% who did not (P = .6). The rate of readmission within 30 days of discharge was 7% in patients with antibiotics vs. 21% in those without antibiotics (P = .3).This study suggested that antibiotic use within 48 hours of admission in cirrhotic children with acute UGIB might have a positive impact on the percentage of children free of bacteremia and the readmission rate. A prospective study should investigate whether prophylactic antibiotics should be targeted only to a subgroup of cirrhotic children with acute UGIB who are particularly at high risk for bacterial infection.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/prevenção & controle , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/terapia , Cirrose Hepática/complicações , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/etiologia , Técnicas Hemostáticas , Humanos , Lactente , Kansas , Tempo de Internação , Masculino , Readmissão do Paciente , Estudos Retrospectivos , Prevenção Secundária
17.
Zhonghua Er Ke Za Zhi ; 57(7): 526-531, 2019 Jul 02.
Artigo em Chinês | MEDLINE | ID: mdl-31269552

RESUMO

Objective: To investigate the effect of the endoscopic selective varices devascularization (ESVD) for the esophageal gastric varices bleeding (EGVB) in children. Methods: The clinical data of the patients diagnosed with EGVB and treated with ESVD from January 2018 to March 2018 were retrospectively analyzed. The effects, safety and complications of ESVD were evaluated. Results: There were five patients (including 2 males and 3 females, age ranged from 4 to 7 years) in the study. No rebleeding was found at the first follow-up on one week post operation. Three patients were treated with the endo-therapy at the twice follow-up (3 months after surgery): 2 patients had ESVD again and 1 patient had resection under endoscopy due to stenosis caused by surgical scar. After the second procedure, there was no rebleeding but one patient had abdominal pain caused by mesenteric thrombosis, cured with low molecular weight heparin. Conclusion: The ESVD for EGVB is safe and effective, but the long-term curative effect should be further studied.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Esôfago/cirurgia , Hemorragia Gastrointestinal/cirurgia , Veias/cirurgia , Criança , Pré-Escolar , Endoscopia , Varizes Esofágicas e Gástricas/complicações , Varizes Esofágicas e Gástricas/diagnóstico por imagem , Varizes Esofágicas e Gástricas/cirurgia , Esôfago/irrigação sanguínea , Feminino , Seguimentos , Hemorragia Gastrointestinal/etiologia , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Resultado do Tratamento
18.
Chirurgia (Bucur) ; 114(3): 409-413, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31264580

RESUMO

Pica is a serious condition that is characterized by ingesting inedible things which can prove to be fatal (glass, pebbles, etc.) We present the case of a 64-year-old male patient who is admitted to the emergency room with the following complaints: upper GI tract bleeding manifested through hematemesis and melena, epigastric pain, lack of bowel movements. A contrast computed tomograohy is performed showing the presence of a hyper-dense stomach content, gastric wall thickening, abdominal fluid but with no signs of intestinal occlusion. A laparotomy is performed and ollowing an anterior gastrotomy a large quantity of pebbles is found along with a hemorrhagic and stenotic tumor of the lesser curvature. Taking into account the intraoperative aspect the decision was made to perform an end-to-side stapled esophago-jejunal anastomosis on an omega loop with a Braun entero-entero anastomosis following total gastric resection and D1 lymphadenectomy. Postoperative course is uneventful. A barium swallow carried out on the 10th day following surgery shows a functional anastomosis without leakage. On day 11, the patient is discharged. Pica is usually discovered by accident, most frequently on the operating table which is why thorough preoperative examination and investigations are required.


Assuntos
Esôfago/cirurgia , Hemorragia Gastrointestinal/etiologia , Jejuno/cirurgia , Pica/complicações , Anastomose Cirúrgica , Gastrectomia , Hemorragia Gastrointestinal/cirurgia , Hematemese/etiologia , Hematemese/cirurgia , Humanos , Masculino , Melena/etiologia , Melena/cirurgia , Pessoa de Meia-Idade , Pica/diagnóstico por imagem , Pica/cirurgia , Estômago/diagnóstico por imagem , Estômago/cirurgia
19.
Medicine (Baltimore) ; 98(28): e16363, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305432

RESUMO

RATIONALE: Diffuse large B-cell lymphoma (DLBCL) is the most frequent human immunodeficiency virus (HIV)-related Non-Hodgkin's Lymphoma of the stomach. Although gastrointestinal (GI) bleeding due to primary gastric lymphoma has been previously reported in the literature, there have been no reports of stomach wall involvement of intra-abdominal lymphoma presenting as GI bleeding. PATIENT CONCERNS: We present a rare case of direct invasion of DLBCL to the stomach wall that presented as upper GI bleeding in a patient with HIV. DIAGNOSIS: Upper endoscopy showed a large ulcerofungating mass in the lesser curvature of upper stomach body. The computed tomography scan showed an about 22 × 12 cm sized huge mass that invades into the stomach wall in the abdominal cavity. A diagnosis of DLBCL was established after histological examination. INTERVENTION: The patient was treated with 6 courses of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP). OUTCOMES: The patient achieved a complete response with 6 courses of R-CHOP treatment. No recurrence was observed during the 4-month follow-up period. LESSONS: Because of the high incidence of lymphoma in patients with HIV, if such patients complain of dyspepsia, epigastric soreness, or melena, malignant tumors, such as lymphomas or stomach cancers, should be suspected. As in this patient, doctors should be aware that intra-abdominal lymphoma can invade into the stomach wall and cause bleeding.


Assuntos
Hemorragia Gastrointestinal/etiologia , Infecções por HIV/complicações , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/patologia , Neoplasias Gástricas/complicações , Neoplasias Gástricas/secundário , Diagnóstico Diferencial , Feminino , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/terapia , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Pessoa de Meia-Idade , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/tratamento farmacológico , Trato Gastrointestinal Superior
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA