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1.
BMC Surg ; 21(1): 73, 2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541322

RESUMO

BACKGROUND: Intestinal failure (IF) is a rare but severe form of organ failure. The condition is defined as body's inability to absorb adequate fluids, macronutrients and minerals for growth and development, so that intravenous supplementation is necessary. A broad spectrum of diseases, trauma and complications of surgery might eventually end up with intestinal failure. Nowadays, intestinal failure patients are preferably cared for in intestinal rehabilitation units (IRU). Autologous gastrointestinal reconstruction (AGIR) refers to non-transplant operative management of IF patients designed to improve enteral tolerance and gut absorptive capacity. CASE PRESENTATION: Herein we present five cases with complications of surgeries due to peptic ulcer bleeding, blunt abdominal trauma, obesity and gastric tumor. The surgeries were complicated by anastomotic leak, peritonitis and fistula formation. By adopting multidisciplinary decisions and special care for each complication, all the five patients were successfully managed and discharged. DISCUSSION AND CONCLUSIONS: As presented, re-anastomosis in presence of abdominal contamination will probably fail. In patients with intestinal failure, PN should start as soon as possible to increase the success rate of future surgeries and prevent potential need for intestinal transplantation. We suggest referring patients with complicated outcomes of gastrointestinal surgeries to the IRUs to reduce morbidity and mortality.


Assuntos
Gastrectomia , Derivação Gástrica , Enteropatias/cirurgia , Fístula Intestinal/cirurgia , Intestino Delgado/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Adulto , Fístula Anastomótica , Humanos , Enteropatias/complicações , Masculino , Pessoa de Meia-Idade , Falha de Tratamento
2.
Zhonghua Wai Ke Za Zhi ; 59(1): 40-45, 2021 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-33412632

RESUMO

Objective: To examine the clinical characteristics, the potential relative factors for postoperative abdominal septic complications, and prognosis factors of surgical recurrence of Crohn disease (CD) patients after the first surgery. Methods: All the CD patients from Department of General Surgery, Jinling Hospital, Medical School of Nanjing University who had undergone at least one abdominal surgery from January 2007 to December 2017 were included for retrospective analysis. Hospital records were reviewed for information on clinical characteristics. Relative factors of postoperative abdominal septic complications were accessed by Logistic regression models, and prognosis factors of surgical recurrence were accessed by Cox proportional hazards regression models. Results: There were 1 048 patients included (733 males and 315 females), accounting for 1 513 operations. The age was 31(17) years and the length of resected small bowel was 30.0(40.0) cm at the first resection, 20.0(35.0) cm at the second resection, and 20.0(23.5) cm at the third resection. The length of resected small bowel was 25.0(40.0) cm at any resection. At the first abdominal surgery, 70.99%(744/1 048) patients were aged between 17 and 40 years, 66.98%(702/1 048) patients had ileocolonic disease, and 60.40%(633/1 048) patients had penetrating behavior. Penetrating behavior (OR=8.594, 95%CI: 3.397 to 21.740, P<0.01) and current smoking status (OR=2.671, 95%CI: 1.044 to 6.832, P=0.040) were significantly associated with an increased risk of postoperative septic complications, whereas staged operation (OR=0.360, 95%CI: 0.184 to 0.707, P=0.003) was associated with a decreased risk. Male gender (HR=1.500, 95%CI: 1.128 to 1.995, P=0.005), upper gastrointestinal disease (HR=1.526, 95%CI: 1.033 to 2.255, P=0.034), penetrating behavior (HR=1.506, 95%CI: 1.132 to 2.003, P=0.005) and emergency surgery (HR=1.812, 95%CI: 1.375 to 2.387, P<0.01) were significantly associated with an increased risk of postoperative surgical recurrence, whereas staged operation (HR=0.361, 95%CI: 0.227 to 0.574, P<0.01) was significantly associated with a decreased risk. Conclusions: In this cohort of CD patients receiving abdominal surgery from an inflammatory bowel disease center, the median age was 31 years and the median length of resected small bowel was 30 cm, at first resection. Patients who have risk factors of adverse postoperative outcome may be benefited from staged surgical approach.


Assuntos
Doença de Crohn , Procedimentos Cirúrgicos do Sistema Digestório , Intestino Delgado/cirurgia , Adolescente , Adulto , Anastomose Cirúrgica , Doença de Crohn/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Infecções/etiologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Recidiva , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
3.
BMC Surg ; 21(1): 63, 2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509187

RESUMO

BACKGROUND: Small bowel obstruction (SBO) is observed in around 10% of patients with prior open abdominal surgery. Rectal resection causes the highest readmission rates. The aim of this study was to investigate risk factors for readmission for SBO and causes for SBO in patients who needed surgery following rectal cancer surgery. METHODS: A population-based registry with prospectively gathered data on 752 consecutive patients with rectal cancer who underwent open pelvic surgery between January 1996 and January 2017 was used. Univariable and multivariable regression analysis was performed, and the risk of SBO was assessed. RESULTS: In total, 84 patients (11%) developed SBO after a median follow-up time of 48 months. Of these patients, 57% developed SBO during the 1st year after rectal cancer surgery. Surgery for SBO was performed in 32 patients (4.3%), and the cause of SBO was stoma-related in one-fourth of these patients. In the univariable analysis previous RT and re-laparotomy were found as risk factors for readmission for SBO. Re-laparotomy was an independent risk factor for readmission for SBO (OR 2.824, CI 1.129-7.065, P = 0.026) in the multivariable analysis, but not for surgery for SBO. Rectal resection without anastomoses, splenic flexors mobilization, intraoperative bleeding, operative time were not found as risk factors for SBO. CONCLUSIONS: One-tenth of rectal cancer patients who had open surgery developed SBO, most commonly within the 1st postoperative year. The risk of SBO is greatest in patients with complications after rectal cancer resection that result in a re-laparotomy.


Assuntos
Obstrução Intestinal , Protectomia/efeitos adversos , Neoplasias Retais , Idoso , Feminino , Humanos , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Laparotomia/efeitos adversos , Laparotomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Protectomia/métodos , Protectomia/estatística & dados numéricos , Neoplasias Retais/epidemiologia , Neoplasias Retais/cirurgia , Sistema de Registros/estatística & dados numéricos , Reoperação/efeitos adversos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco
4.
BMJ Case Rep ; 13(12)2020 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-33372018

RESUMO

An 85-year-old malnourished woman presented with symptoms of small bowel obstruction of uncertain aetiology. She had presented numerous times over the previous 2 years with symptoms of left groin and thigh pain, vomiting and abdominal distension. A CT of her abdomen and pelvis ultimately revealed a left-sided pelvic hernia, between the obturator internus and pectineal muscles. This was consistent with an obturator hernia. Diagnostic laparoscopy confirmed an obturator hernia of Richter type, incarcerated within the left obturator canal. Reduction revealed a hernia sac containing viable small bowel. A primary repair was performed using a double-layer suture technique to both close and plug the hernia defect. The patient rapidly recovered following hernia repair, with resolution of all previous long-standing symptoms. This case exemplifies the typical presentation of an obturator hernia and the diagnostic challenge it poses to clinicians.


Assuntos
Hérnia do Obturador/diagnóstico , Obstrução Intestinal/etiologia , Idoso de 80 Anos ou mais , Feminino , Virilha , Hérnia do Obturador/complicações , Hérnia do Obturador/diagnóstico por imagem , Hérnia do Obturador/cirurgia , Herniorrafia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Laparoscopia , Desnutrição/complicações , Dor/etiologia , Telas Cirúrgicas , Coxa da Perna , Tomografia Computadorizada por Raios X , Vômito/etiologia
5.
J Med Life ; 13(3): 371-377, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33072210

RESUMO

The study of the incidence of cryoglobulinemia is relevant in patients with an intestinal anastomotic leak. This study aims to determine a laboratory marker of the risk of small intestine anastomotic leak. The study was based on 96 patients who were subjected to resections of segments of the small intestine with the formation of intestinal anastomoses at the State Institution "Zaytsev V.T. Institute of General and Urgent Surgery of National Academy of Medical Sciences of Ukraine". Of all the operated patients, there were 55.2% women and 44.8% men. Of the 96 patients examined, cryoglobulinemia was detected in the majority - 62.5% of patients, of which 4 were later proved to have inactive hepatitis C; the remaining 38.5% had no cryoglobulinemia. According to the existing theory of the autoimmune mechanism of postoperative surgical complications formation, the revealed decrease in the level of cryoglobulins on the second day could be related to their fixation in the microcirculatory bed and the development of immunocomplex inflammation. While the increase in the content of cryoglobulins in serum on the third day can be caused by their entry into the circulatory bed from deposition or fixation sites and the development of a secondary immune response. In patients with intestinal anastomosis failure after resection of intestinal segments, cryoglobulinemia rates increased more than 80 mg/l; this indicator could be used as a marker of postoperative complications.


Assuntos
Crioglobulinas/análise , Procedimentos Cirúrgicos do Sistema Digestório , Intestino Delgado/cirurgia , Anastomose Cirúrgica/efeitos adversos , Crioglobulinemia/sangue , Crioglobulinemia/imunologia , Feminino , Humanos , Imunoglobulinas/sangue , Linfócitos/metabolismo , Masculino , Pessoa de Meia-Idade , Fagocitose , Ucrânia
6.
Medicine (Baltimore) ; 99(44): e22741, 2020 Oct 30.
Artigo em Inglês | MEDLINE | ID: mdl-33126311

RESUMO

Percutaneous balloon dilatation for benign biliary-enteric anastomosis stricture has been the most widely used alternative to endoscopic treatment. However, patency results from the precedent literature are inconsistent.The objective of this study was to evaluate the safety and feasibility of repeated balloon dilatation with long-term biliary drainage for the treatment of benign biliary-enteric anastomosis strictures.Data from patients with benign biliary-enteric anastomosis strictures who underwent percutaneous transhepatic cholangiography (PTC), repeated balloon dilatation with long-term biliary drainage (repeated-dilatation group; n = 23), or PTC and single balloon dilatation with long-term biliary drainage (single-dilatation group; n = 26) were reviewed. Postoperative complications, jaundice remission, and sustained anastomosis patency were compared between the groups.All procedures were successful. No severe intraoperative complications, such as biliary bleeding and perforation, were observed. The jaundice remission rate in the first week was similar in the 2 groups. During the 26-month follow-up period, 3 patients in the repeated-dilatation group had recurrences (mean time to recurrence: 22.84 ±â€Š0.67 months, range: 18-26 months). In the single-dilatation group, 15 patients had recurrences (mean time to recurrence = 15.28 ±â€Š1.63 months, range: 3-18 months). The duration of patency after dilatation was significantly better in the repeated-dilatation group (P = .01). All patients with recurrence underwent repeat PTC followed by balloon dilatation and biliary drainage.Repeated balloon dilatation and biliary drainage is an effective, minimally invasive, and safe procedure for treating benign biliary-enteric anastomosis strictures, and provides significantly higher patency rates than single dilatation.


Assuntos
Cateterismo/métodos , Dilatação/métodos , Drenagem/métodos , Complicações Pós-Operatórias/cirurgia , Estomas Cirúrgicos/efeitos adversos , Adulto , Idoso , Anastomose Cirúrgica/efeitos adversos , Ductos Biliares/patologia , Ductos Biliares/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estomas Cirúrgicos/patologia , Resultado do Tratamento
7.
S D Med ; 73(7): 308-310, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32805780

RESUMO

Intrauterine devices (IUDs) are one of the most widely utilized contraceptive methods. A rare but potentially serious complication of IUD use is perforation of the uterus and translocation into the abdominal cavity. The present case of an IUD embedding into the small bowel demonstrates this complication.


Assuntos
Corpos Estranhos , Intestino Delgado , Dispositivos Intrauterinos , Feminino , Corpos Estranhos/cirurgia , Humanos , Intestino Delgado/cirurgia , Dispositivos Intrauterinos/efeitos adversos
8.
Surgery ; 168(4): 695-700, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32713755

RESUMO

BACKGROUND: The utility of adjuvant systemic therapy in small bowel gastrointestinal stromal tumor remains unclear. METHODS: We queried the National Cancer Data Base for individuals having enterectomy to negative margins for small bowel gastrointestinal stromal tumor between 2010 and 2015. Subjects were categorized by tumor size (2.1-5 cm, 5.1-10 cm, >10 cm) and histologic grade (≤5 mitoses/50 high-power field and >5 mitoses/50 high-power field). Cox proportional hazard analysis was performed to evaluate the association between adjuvant therapy and overall survival. RESULTS: One thousand five hundred fifty-nine patients met the inclusion criteria. On univariate comparison to resection alone, adjuvant therapy was associated with improved overall survival for individuals with high-grade tumors of intermediate and large size (85% vs 48%, P = .010; 75% vs 47%, P = .003) but not for those with high-grade tumors of small size or low-grade tumors of any size. On multivariable analysis adjusted for age, comorbid disease state, and tumor size, adjuvant therapy was independently associated with reduced risk of mortality for high-grade (hazard ratio 0.37, 95% confidence interval: 0.21-0.64) but not low-grade tumors. CONCLUSION: Adjuvant therapy after R0 resection for small bowel gastrointestinal stromal tumor should be administered after careful consideration of the size and grade of a patient's tumor.


Assuntos
Antineoplásicos/uso terapêutico , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/cirurgia , Mesilato de Imatinib/uso terapêutico , Neoplasias Intestinais/tratamento farmacológico , Neoplasias Intestinais/cirurgia , Intestino Delgado/cirurgia , Idoso , Quimioterapia Adjuvante , Feminino , Tumores do Estroma Gastrointestinal/patologia , Humanos , Neoplasias Intestinais/patologia , Intestino Delgado/patologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Modelos de Riscos Proporcionais , Estudos Retrospectivos
10.
BMC Surg ; 20(1): 168, 2020 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-32711489

RESUMO

BACKGROUND: Adhesive small bowel obstruction (ASBO) is one of the most common causes of postoperative morbidity. According to Boyle's law, decreased barometric pressure expands the volume of intestinal gas. We aimed to elucidate the relationship between barometric pressure and ASBO. METHODS: We divided 215 admissions of 120 patients with ASBO into three groups: the fasting group, which responded to fasting (n = 51); the decompression group, which was successfully treated with gastrointestinal decompression (n = 104); and the surgery group which required emergency or elective surgery to treat ASBO (n = 60). We compared and examined clinical backgrounds, findings on admission, and barometric pressure during the peri-onset period (29 days: from 14 days before to 14 days after the onset of ASBO). RESULTS: There were significant differences among the three groups regarding gender, history of ASBO, hospital length of stay, and barometric pressure on the onset day of ASBO. Barometric pressure on the onset day was significantly higher in the fasting group than in the decompression group (p = 0.005). During pre-onset day 5 to post-onset day 2, fluctuations in the barometric pressure in the fasting and decompression groups showed reciprocal changes with a symmetrical axis overlapping the median barometric pressure in Matsumoto City; the fluctuations tapered over time after onset. In the fasting group, the barometric pressure on the onset day was significantly higher than that on pre-onset days 14, 11, 7, 4, 3, and 2; post-onset days 3 and 10; and the median pressure in Matsumoto City. Conversely, in the decompression group, the barometric pressure on the onset day was lower than that on pre-onset days 14, 5-2; post-onset days 1, 2, 7, 8, 11, 13, and 14; and the median pressure in Matsumoto City. In the surgery group, the barometric pressure on the onset day was equivalent to those on the other days. CONCLUSIONS: ASBO with response to conservative treatment is vulnerable to barometric pressure. Additionally, ASBO that is successfully treated with fasting and decompression is associated with a different barometric pressure on the onset day and reciprocal fluctuations in the barometric pressure during the peri-onset period.


Assuntos
Pressão Atmosférica , Obstrução Intestinal , Intestino Delgado/fisiopatologia , Aderências Teciduais/complicações , Idoso , Idoso de 80 Anos ou mais , Jejum/fisiologia , Feminino , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/fisiopatologia , Obstrução Intestinal/cirurgia , Obstrução Intestinal/terapia , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Intubação Gastrointestinal , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Aderências Teciduais/cirurgia , Resultado do Tratamento
11.
BMC Surg ; 20(1): 124, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517682

RESUMO

BACKGROUND: Cocoon abdomen is a relatively rare abdominal disease characterized by the total or partial encasement of the small intestinal by a dense fibro-collagenous membrane. CASE PRESENTATION: We reported an unusual case of idiopathic cocoon abdomen with congenital colon malrotation. Laparotomy and sac release were performed on the patient. The patient was no recurrence 6 months after operation. A literature review was also performed. CONCLUSION: Preoperative diagnosis of abdominal cocoon is difficult. A careful history, physical examination and appropriate radiology may be helpful in making a definitive diagnosis. If conservative treatment can't relieve symptoms effectively, surgery is currently considered to be important in the management of this disease.


Assuntos
Abdome/anormalidades , Colo/anormalidades , Anormalidades do Sistema Digestório/diagnóstico , Volvo Intestinal/diagnóstico , Abdome/cirurgia , Colo/cirurgia , Humanos , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Radiografia
12.
Ulus Travma Acil Cerrahi Derg ; 26(4): 593-599, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32589236

RESUMO

BACKGROUND: An incarcerated hernia is a part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia. An increase in morbidity and mortality occurs after intestinal resections from strangulated hernias. This study aims to examine the markers that may be effective in determining the risk of small bowel resection due to incarcerated hernias. In particular, we aimed to investigate the effect s of blood lactate levels in determining this risk. METHODS: A cross-sectional retrospective study was designed. Patients, whose preoperative diagnosis were reported as incarcerated hernia and had essential information, were included in this study. They were divided into two groups according to whether they had resection or not. Age, gender, hernia type, hernia side, resection material, blood lactate level (BLL), white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY), neutrophil/lymphocyte ratio (NLR), platelet count (PLT), lactate dehydrogenase (LDH), radiologic bowel obstruction sign and comorbidities were evaluated. RESULTS: Sixty-seven patients were included in this study. It was observed that 16 (23.9%) of these patients underwent small intestinal resection, 16 (23.9%) had an omentum resection, while no resection was performed on 35 (52.2%) patients. There was a statistically significant difference regarding radiologically intestinal obstruction (p=0.001), hernia type (p=0.005), BLL (p<0.001), WBC, NLR and LDH values (p<0.05). In incarcerated hernia patients with a lactate value ≥1.46 mg/dL, sensitivity was observed to be 84.0% and specificity 86.0% (p<0.001). CONCLUSION: In patients with a preliminary diagnosis of an incarcerated hernia, the risk of possible small bowel resection is the most important point in deciding for an operation. The presence of an intestinal obstruction in radiological examinations, and particularly the high levels of WBC, NLR, LDH and BLL, may indicate a necessity for possible small bowel resection. Concerning the risk associated with small bowel resection, blood lactate levels ≥1.46 mg/dL may be alerting.


Assuntos
Hérnia Abdominal , Obstrução Intestinal , Intestino Delgado/cirurgia , Ácido Láctico/sangue , Estudos Transversais , Hérnia Abdominal/sangue , Hérnia Abdominal/complicações , Hérnia Abdominal/epidemiologia , Humanos , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Estudos Retrospectivos , Fatores de Risco
14.
Ann R Coll Surg Engl ; 102(8): 571-576, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32538120

RESUMO

INTRODUCTION: Intertwining of bowel loops to form a knot is very rare cause of intestinal obstruction. Among intestinal knots, ileoileal knotting is the most rare, with only a handful of cases reported in literature. We present a rare case of ileoileal knotting and review of small bowel knots. The aim of this review was to summarise the existing evidence on small bowel knots and to postulate the possible mechanisms for knotting. METHODS: A systematic search was conducted for literature published up to December 2019 using MEDLINE, PubMed and Google Scholar databases, together with the references of the full-text articles retrieved. Papers with case reports of small bowel knots were considered to be eligible for inclusion in the review. FINDINGS: A total of 14 case reports were evaluated. There was no clear predilection for age or sex. Mostly cases were from Asia and Africa with no cases from the West. The presenting complaints were abdominal pain (93%), vomiting (64%), abdominal distention (57 %) and obstipation (43%). The bowel was gangrenous in 78% of cases. All underwent exploration, with the majority requiring resection and anastomosis of the involved segment. CONCLUSION: Ileoileal knotting is a very rare cause of intestinal obstruction. Possible mechanisms include loaded bowel with longer mesentery, vigorous peristalsis, single bulky meal, pregnancy and intussusception. The condition is extremely difficult to diagnose preoperatively and it is usually diagnosed intraoperatively. The standard of treatment is resection of gangrenous part and anastomosis.


Assuntos
Obstrução Intestinal , Intestino Delgado , Dor Abdominal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gangrena , Humanos , Lactente , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/patologia , Obstrução Intestinal/fisiopatologia , Obstrução Intestinal/cirurgia , Volvo Intestinal , Intestino Delgado/patologia , Intestino Delgado/fisiopatologia , Intestino Delgado/cirurgia , Intussuscepção , Masculino , Pessoa de Meia-Idade , Vômito , Adulto Jovem
15.
Medicentro (Villa Clara) ; 24(2): 360-372, abr.-jun. 2020. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1124997

RESUMO

RESUMEN Las hernias internas son una causa poco frecuente de obstrucción del intestino delgado (representan menos del 5 %). La hernia pericecal ocupa alrededor de la décima parte de las hernias internas; mientras que, la hernia paracecal constituye una de sus cuatro variantes, las que a su vez, pueden ser congénitas o adquiridas. Se presentó un paciente masculino de 98 años de edad, operado por obstrucción intestinal debido a hernia paracecal, que requirió resección de intestino y anastomosis, con evolución favorable. En la búsqueda realizada en Cochrane no se encontró ningún otro caso publicado por autores cubanos. Se revisó la literatura al respecto y se insistió en la necesidad de tener presente dicho diagnóstico en el actuar diario del cirujano, ya que se comporta con una alta mortalidad sino se sospecha, debido a que cursa generalmente con compromiso vascular.


ABSTRACT Internal hernias are an uncommon cause of small bowel obstruction (they represent less than 5%). The pericaecal hernia occupies about a tenth of the internal hernias while the paracaecal hernia is one of its four variants, which in turn can be congenital or acquired. We present a 98-year-old male patient operated on bowel obstruction due to paracaecal hernia, which required bowel resection and anastomosis, with favourable evolution. No other case published by Cuban authors was found when searching in Cochrane Library. Literature on this subject was also reviewed, insisting on the need for surgeons to bear this diagnosis in mind in their daily work, since it is manifested with a high mortality if it is not suspected, because it generally involves vascular compromise.


Assuntos
Hérnia/complicações , Obstrução Intestinal/etiologia , Intestino Delgado/cirurgia
16.
Surg Clin North Am ; 100(3): 635-648, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32402306
17.
J Surg Res ; 254: 7-15, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32402834

RESUMO

BACKGROUND: Acute mesenteric ischemia is a life-threatening acute condition, which requires an interdisciplinary approach, including vascular recanalization and surgical treatment. Visual evaluation of intestinal perfusion might be misleading, and therefore, additional tools are necessary to reliably be able to resect the ischemic intestine. Hyperspectral imaging (HSI) has been shown to be feasible and safe for real-time assessment of tissue perfusion in visceral surgery but has never been used in cases of acute mesenteric ischemia. Therefore, we applied HSI in acute mesenteric ischemia to evaluate it for potential aid in the objectively discriminating ischemic and well-perfused intestine during explorative laparotomy. METHODS: We recorded HSI measurements in 11 cases of acute mesenteric ischemia during explorative laparotomy. We evaluated the recorded images for macroscopic visual perfusion quality and divided it into three groups. Of those three groups, we calculated and compared the HSI indexes of tissue saturation, near-infrared perfusion index, organ hemoglobin index, and tissue water index, as well as the reflectance spectra. RESULTS: We found significant differences in tissue saturation (0.7% versus 0.45%; P = 0.002) and near-infrared perfusion index (0.58 versus 0.23; P < 0.001) in poorly perfused intestinal segments compared with the viable intestine. Furthermore, we could detect an increasing peak at 630 nm of the reflectance spectra in less viable tissues, indicating a maximum in necrotic tissues. We attributed this peak to an increase in met-hemoglobin content in necrotic tissues, which is supported by the increase in the HSI organ hemoglobin index. CONCLUSIONS: HSI is able to discriminate tissue perfusion in acute mesenteric ischemia reliably and therefore might be helpful for resection. In addition, HSI gives information on tissue viability via reflectance spectra.


Assuntos
Diagnóstico por Imagem/métodos , Intestinos/irrigação sanguínea , Isquemia Mesentérica/diagnóstico por imagem , Isquemia Mesentérica/cirurgia , Idoso , Idoso de 80 Anos ou mais , Colectomia , Corantes , Feminino , Humanos , Verde de Indocianina , Intestino Delgado/cirurgia , Masculino , Isquemia Mesentérica/mortalidade , Pessoa de Meia-Idade , Imagem Óptica , Complicações Pós-Operatórias , Estudos Prospectivos , Síndrome do Intestino Curto/etiologia
18.
Niger J Clin Pract ; 23(5): 741-743, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32367885

RESUMO

Obturator hernia (OH) is a relatively rare pelvic hernia. OH is usually seen in elderly, multiparous females and patients with a low body weight. Obturator hernia accounts for 0.07-0.4% of all intraabdominal hernias and 0.2-5.8% of small bowel hernias. The diagnosis of obturator hernia can be difficult and often delayed. Any therapeutic delay is associated with serious complications and higher mortality rates. The correct preoperative diagnosis of obturator hernia is facilitated by computed tomography (CT). Our case was admitted to our emergency unit with intolerance to oral intake for one week. Abdominal ultrasonography was not helpful. The CT of the abdomen revealed the incarcerated intestinal segment. Diagnostic laparoscopy confirmed the CT findings. The intestine was gangrenous and perforated. Segmental resection and anastomosis was performed. Early diagnosis and surgical intervention are essential. This demonstrates that emergency CT scan is useful for the diagnosis of obturator hernia in patients presenting with mechanical intestinal obstruction of unknown origin.


Assuntos
Hérnia do Obturador , Obstrução Intestinal , Intestino Delgado , Idoso , Feminino , Hérnia do Obturador/complicações , Hérnia do Obturador/diagnóstico , Hérnia do Obturador/cirurgia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Laparoscopia , Tomografia Computadorizada por Raios X
20.
Ann R Coll Surg Engl ; 102(7): e155-e157, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32326724

RESUMO

Small bowel obstruction from internal hernias is a familiar pathology for the surgeon, with an incidence of 0.5-5.8%. However, pericaecal hernia is a very uncommon type of internal hernia. Diagnosis and early treatment are essential to avoid strangulation and necrosis of the incarcerated small bowel. We report a case of an 84-year-old woman with no previous history of abdominal surgery who came to our hospital having endured 6 hours of abdominal pain and vomiting. Following physical examination and computed tomography, a diagnosis of small bowel obstruction caused by pericaecal hernia was made and emergency surgery was performed. The hernia was successfully reduced with a laparoscopic approach. Although pericaecal hernia is a rare disease, surgeons should bear it in mind as a differential diagnosis in small bowel obstruction.


Assuntos
Hérnia Abdominal/complicações , Herniorrafia/métodos , Obstrução Intestinal/etiologia , Intestino Delgado/cirurgia , Laparoscopia/métodos , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Feminino , Hérnia Abdominal/diagnóstico , Hérnia Abdominal/cirurgia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Tomografia Computadorizada por Raios X
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