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1.
Gac. méd. espirit ; 22(2): 120-130, mayo.-ago. 2020. graf
Artigo em Espanhol | LILACS | ID: biblio-1124841

RESUMO

RESUMEN Fundamento: La invaginación intestinal como causa de dolor abdominal es un motivo infrecuente de consulta en la edad adulta. Una lesión orgánica es la causante en el 90 % de los casos. Pueden ser lesiones malignas o benignas, y entre estas últimas se mencionan los lipomas de intestino delgado. Objetivo: Presentar el caso de una paciente con invaginación intestinal secundaria a pólipo mesenquimatoso. Presentación del caso: Paciente femenina de 47 años de edad, con antecedentes de dolor abdominal recurrente hacia fosa ilíaca derecha y cambios intermitentes en el hábito intestinal. En los estudios de imagen realizados se le diagnosticó una invaginación de intestino delgado, la cual se corroboró en el acto quirúrgico y mediante anatomía patológica que informó un pólipo mesenquimatoso (fibrolipoma) como causante. Conclusiones: La invaginación intestinal, aunque infrecuente, puede ser la forma de presentación de dolor abdominal recurrente en el adulto.


ABSTRACT Background: Intestinal invagination as a cause of abdominal pain is an infrequent reason for consultation in adulthood. An organic injury is the cause in 90 % of cases. They can be malignant or benign lesions, and among the latter, lipomas of the small intestine are mentioned. Objective: To present the case of a patient with intestinal invagination secondary to a mesenchymal polyp. Case presentation: A 47-year-old female patient with a history of recurrent abdominal pain towards the right iliac fossa and intermittent changes in bowel habit. In the imaging studies, an invagination of the small intestine was diagnosed which was corroborated in the surgical act and by pathological anatomy that reported a mesenchymal polyp (fibrolipoma) as the cause. Conclusion: Intestinal invagination, although infrequent, may be the form of presentation of recurrent abdominal pain in adults.


Assuntos
Dor Abdominal , Pólipos Intestinais/patologia , Intussuscepção/cirurgia , Adulto , Neoplasias do Íleo/cirurgia
2.
Chirurgia (Bucur) ; 115(3): 404-409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614297

RESUMO

Introduction: The GIST tumors are very rare entities ( 1% of all tumors). They originate in the Cajal interstitial cells, which are part of the autonomic nervous system of the intestine. Their most common location is the stomach, followed by the small intestine. The aim of this paper is to present a very rare case of perforated ileal GIST, associated with Meckel diverticulum. Case report: A 71 years old patient with comorbidities is admitted in emergency for symptoms and signs of acute surgical abdomen. The exploratory laparotomy reveals generalized acute peritonitis due to perforated ileal tumor and Meckel's diverticulum. A segmental enterectomy is performed, with favorable postoperative evolution. The histological examination of the resection piece shows the appearance of GIST, confirmed immunohistochemically. Conclusions: The GIST tumors of the small intestine are unusual tumors and the spontaneous perforation and life-threatening hemorrhage are a rarity. The main treatment for this form of GIST is the resection, with a favorable clinical outcome.


Assuntos
Abdome Agudo , Tumores do Estroma Gastrointestinal , Neoplasias do Íleo/complicações , Perfuração Intestinal , Divertículo Ileal , Idoso , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias do Íleo/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Resultado do Tratamento
3.
Rev Mal Respir ; 37(6): 497-501, 2020 Jun.
Artigo em Francês | MEDLINE | ID: mdl-32482379

RESUMO

INTRODUCTION: Thymomas are epithelial neoplasms of thymic origin, preferentially localized in the anterior mediastinum. Recurrences after surgery are uncommon and usually occur in the intrathoracic area. The occurrence of extra-thoracic metastases is an unusual phenomenon. CASE REPORT: Here we report the case of a 61-year-old man with no special medical history. He smoked about 40 pack years but stopped in 1999. Initially he presented with a mediastinal thymoma and underwent surgical resection. One year later the development of abdominal pain and bowel disorders lead to the discovery of an ileal ulcero-necrotic tumour. After surgical resection, histological examination revealed secondary thymoma. A few months later he underwent cerebral MRI because of neurological symptoms. This revealed a second metastasis located in the brain. Stereotactic radiotherapy led to an improvement. After more than one year of follow-up the patient developed a papillary thyroid carcinoma but there were no signs of recurrence of the thymoma. CONCLUSIONS: Extra-thoracic metastases of thymoma are exceptional but their existence should not be overlooked. Their management is not standardised because of lack of data in the literature. Though surgical excision in oligo-metastatic subjects is a frequently reported therapeutic option, a radiotherapeutic approach, particularly in cerebral situations, could be a credible alternative.


Assuntos
Neoplasias Encefálicas/secundário , Neoplasias do Íleo/secundário , Timoma/patologia , Neoplasias do Timo/patologia , Encéfalo/diagnóstico por imagem , Encéfalo/patologia , Neoplasias Encefálicas/radioterapia , Neoplasias Encefálicas/cirurgia , Terapia Combinada , Humanos , Neoplasias do Íleo/radioterapia , Neoplasias do Íleo/cirurgia , Íleo/diagnóstico por imagem , Íleo/patologia , Masculino , Pessoa de Meia-Idade , Timoma/diagnóstico , Timoma/radioterapia , Timoma/cirurgia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/radioterapia , Neoplasias do Timo/cirurgia
4.
J Surg Oncol ; 122(2): 204-211, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32291778

RESUMO

BACKGROUND AND OBJECTIVES: We classified the extent of mesenteric mass (MM) involvement that predicts challenging mesenteric lymph node dissection (mLND) by minimally invasive surgery (MIS) for ileal neuroendocrine tumors (i-NETs). METHODS: Patients who underwent surgery for i-NETs were retrospectively reviewed. MM involvement was classified as region-0: no MM; region-1: >2 cm from the origins of the ileocolic artery/vein; region-2: ≤2 cm from the origins; and region-3: more proximal superior mesenteric artery/vein. Logistic regression analysis was used to evaluate the predictive value of MM regions for gross positive mesenteric margin (mR2) and/or conversion among the MIS cohort. The open surgery cohort was used as a reference for mR2 rates. RESULTS: Of 108 patients, 83 patients (77%) underwent MIS. MMs in region-2 and region-3 were independent risk factors for mR2 and/or conversion (odds ratio [95% confidence interval]: 4.25 [1.17-16.4] and 8.51 × 107 [11.0-], respectively, against regions-0 and 1]. mR2 rates of MIS and open surgery cohorts per region did not differ significantly (4% and 7% for regions-0 and 1; 17% and 25% for region-2; and 100% and 83% for region-3). CONCLUSIONS: The novel stratification of MM regions was predictive of challenging mLND by MIS. Surgeons should have a low threshold for conversion for MMs in proximal regions.


Assuntos
Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Linfonodos/patologia , Linfonodos/cirurgia , Mesentério/patologia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Estudos de Coortes , Humanos , Excisão de Linfonodo , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Valor Preditivo dos Testes , Estudos Retrospectivos
5.
BMC Med Genet ; 21(1): 76, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32272879

RESUMO

BACKGROUND: Despite recent findings that epithelial cell adhesion molecule (EPCAM) deletions can cause Lynch syndrome (LS), its clinical characteristics are still unknown. We present the first case of ileum cancer in a patient with germline EPCAM gene deletion, which was discovered during ovarian tumor surgery. CASE PRESENTATION: A 59-year-old woman presented with a history of colon cancer occurring at 38 and 55 years old. Five of her siblings had a history of colon cancer, and an elder sister had confirmed LS. As imaging examination revealed an ovarian tumor, and we performed hysterectomy and bilateral salpingo-oophorectomy. Careful observation during surgery revealed a cherry-sized tumor in the ileum, prompting partial ileal resection. Pathological examination showed the ovarian tumor to be a metastasis of ileum cancer. Genetic testing with blood-relative information using multiplex ligation-dependent probe amplification showed EPCAM exons 8 and 9 deletions, confirming LS. The patient received adjuvant chemotherapy with CAPOX (capecitabine and oxaliplatin) and has remained disease-free for 24 months. CONCLUSIONS: We were fortunate to identify ileum cancer that would have been difficult to find preoperatively through careful observation during ovarian tumor surgery and successfully treated the patient by using surgical resection and CAPOX chemotherapy. When treating patients with hereditary cancer syndromes including LS, we should keep all associated cancers in mind.


Assuntos
Adenocarcinoma , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Molécula de Adesão da Célula Epitelial/genética , Neoplasias do Íleo , Neoplasias Ovarianas , Ovariectomia , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/genética , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Capecitabina/administração & dosagem , Neoplasias Colorretais Hereditárias sem Polipose/tratamento farmacológico , Neoplasias Colorretais Hereditárias sem Polipose/genética , Neoplasias Colorretais Hereditárias sem Polipose/cirurgia , Terapia Combinada , Feminino , Mutação em Linhagem Germinativa , Humanos , Neoplasias do Íleo/tratamento farmacológico , Neoplasias do Íleo/genética , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Pessoa de Meia-Idade , Neoplasias Ovarianas/tratamento farmacológico , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/secundário , Neoplasias Ovarianas/cirurgia , Oxaliplatina/administração & dosagem , Linhagem , Deleção de Sequência , Resultado do Tratamento
6.
BMJ Case Rep ; 13(4)2020 Apr 16.
Artigo em Inglês | MEDLINE | ID: mdl-32303529

RESUMO

Adenocarcinoma of the bowel is a dreadful sequelae of inflammatory bowel disease that can be difficult to diagnose and has been shown to have poor prognosis. The diagnosis is often made on histopathological examination of the resected specimen for what is suspected to be an exacerbation of the underlying intestinal Crohn's. A 39-year-old woman who was being treated for small bowel Crohn's disease for 4 years presented with features of intermittent intestinal obstruction that was refractory to medical therapy. A contrast CT of the abdomen was suggestive of ileocaecal Crohn's disease, and colonoscopy revealed a stricture at proximal transverse colon with multiple superficial ulcers. She underwent a mesentery sparing right hemicolectomy and had an uneventful recovery. The biopsy, however, was reported to be moderately differentiated adenocarcinoma stage T3N0 with a harvest of four pericolic nodes. Adjuvant chemotherapy was advised, which she deferred. Ten months later, she presented to the emergency room with features of intestinal obstruction. Contrast CT of the abdomen showed thickening at the anastomotic site with intestinal obstruction. On exploratory laparotomy, tumour recurrence was noted at the site of the anastomosis and diffuse peritoneal metastasis. A palliative diversion ileostomy was done due to inoperable obstructing disease. She was then given palliative therapy and subsequently succumbed to the illness. The inclusion of mesentery with the resected specimen in Crohn's disease has been a debate over many years. Since the preoperative diagnosis of carcinoma of the bowel in Crohn's disease is challenging, all ileocolic resections should be radical as done in oncological resections. This would yield better oncological safety and may improve survival rates.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias do Ceco/cirurgia , Doença de Crohn/complicações , Neoplasias do Íleo/cirurgia , Adenocarcinoma/etiologia , Adulto , Neoplasias do Ceco/etiologia , Feminino , Humanos , Neoplasias do Íleo/etiologia
7.
Intern Med ; 59(14): 1727-1730, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32238724

RESUMO

Small-bowel hemangiomas are a possible source of gastrointestinal bleeding for which there is no established treatment approach. In this report, we describe the case of a 58-year-old woman who presented with hematochezia and who was diagnosed with small bowel hemangioma. She was successfully treated using endoscopic sclerotherapy. Initial capsule endoscopy revealed bleeding in the ileum. Subsequent double-balloon enteroscopy showed a 2-cm, bluish-purple, ileal submucosal tumor with an overlying protrusion. The lesion was responsible for the hematochezia and was treated with intralesional injection of polidocanol. The hematochezia completely resolved and at 4 months after sclerotherapy, the size of the lesion was significantly reduced.


Assuntos
Enteroscopia de Duplo Balão/métodos , Hemangioma/tratamento farmacológico , Hemangioma/cirurgia , Neoplasias do Íleo/tratamento farmacológico , Neoplasias do Íleo/cirurgia , Polidocanol/uso terapêutico , Soluções Esclerosantes/uso terapêutico , Escleroterapia/métodos , Feminino , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(49): e18103, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804320

RESUMO

INTRODUCTION: Benign prostatic hyperplasia, bladder outlet obstruction, and overactive bladder are major causes of lower urinary tract symptoms (LUTS). Tumor compression of the urinary bladder resulting in LUTS was clinically observed. Gastrointestinal stromal tumors (GISTs) presenting with LUTS have not been reported before. Herein, we report a patient with extraluminal GIST of the ileum who had LUTS without gastrointestinal symptoms during the clinical course. PATIENT CONCERNS: A 68-year-old man visited the genitourinary outpatient department because of frequent urination with mild dysuria. He also complained of poor appetite, fatigue, and body weight loss of 10 kg over 6 months. A large presacral solid mass lesion compressing the bladder and surrounded by the bowel with gas content was identified through abdominal computed tomography. DIAGNOSIS: GIST of the ileum with mesenteric invasion was revealed by pathological examination. INTERVENTIONS: Exploratory laparotomy with removal of the pelvic tumor and segmental resection of the ileum was performed. OUTCOMES: Now, he received adjuvant imatinib target therapy for 1 year with stable condition. CONCLUSION: Extravesical compression or invasion of the urinary bladder by a pelvic mass lesion is common but is rarely accompanied by GISTs of the ileum. Specific findings identified through imaging should alert the surgeon to this specific entity and prepare thoroughly before surgical intervention.


Assuntos
Tumores do Estroma Gastrointestinal/patologia , Neoplasias do Íleo/patologia , Idoso , Quimioterapia Adjuvante , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/cirurgia , Masculino , Incontinência Urinária/etiologia
11.
Anticancer Res ; 39(11): 6413-6416, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31704875

RESUMO

BACKGROUND/AIM: The aim of this study was to present the clinical characteristics, natural history and survival outcomes of primary gastrointestinal non-Hodgkin lymphomas (PGINHL) in the pediatric population. PATIENTS AND METHODS: Surveillance, Epidemiology, and End Results (SEER) database was queried for patients aged 0 to 19 years with PGINHL between 1973 and 2014. RESULTS: A total of 452 cases were identified [mean age 11.0 (±5.1)] years, whites 84.1%, males (76.5%). The majority of tumors were noted in the small bowel (SB) (47.6%), followed by large bowel (LB) (28.5%) and the stomach (10.0%). Overall, the most common histological subtype was Burkitt lymphoma (51.8%), followed by diffuse large B-cell lymphoma (DLBCL) (26.1%). Mean overall survival (OS) of the entire cohort was 33,33 years with a 5-yr, 10-yr and 30-yr survival rate of 86%, 86% and 79%, respectively. Large bowel tumors had the best long-term survival rates whereas; gastric tumors had the worst with 30-yr survival rate 84% and 74%, respectively. Overall, 328 (72.6%) patients received surgery. No significant survival difference was noted between patients who underwent surgery and those who did not. CONCLUSION: This study presents the largest dataset of pediatric PGINHL and describes the clinical features and outcomes of these patients in addition to summarizing the literature.


Assuntos
Neoplasias Gastrointestinais , Linfoma não Hodgkin , Adolescente , Linfoma de Burkitt/mortalidade , Linfoma de Burkitt/patologia , Linfoma de Burkitt/cirurgia , Neoplasias do Ceco/mortalidade , Neoplasias do Ceco/patologia , Neoplasias do Ceco/cirurgia , Criança , Pré-Escolar , Feminino , Neoplasias Gastrointestinais/mortalidade , Neoplasias Gastrointestinais/patologia , Neoplasias Gastrointestinais/cirurgia , Humanos , Neoplasias do Íleo/mortalidade , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Lactente , Recém-Nascido , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/cirurgia , Linfoma não Hodgkin/mortalidade , Linfoma não Hodgkin/patologia , Linfoma não Hodgkin/cirurgia , Masculino , Programa de SEER , Neoplasias Gástricas/mortalidade , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , Taxa de Sobrevida , Adulto Jovem
12.
Am Surg ; 85(10): 1125-1128, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657307

RESUMO

Neuroendocrine tumors (NETs) are the most common malignancy arising in Meckel's diverticula (MDs). To date, there are no large series characterizing these tumors. The National Cancer Database was queried for patients with MD NETs (n = 162) from 2004 to 2014. Patient and tumor characteristics as well as outcomes were analyzed. MD NETs were more common in men (72.8%) at a median age of 62 years; 95.1 per cent of patients were white. All patients underwent surgery. Clinical M0 disease was present in 97.4 per cent of patients, and 88.2 per cent of tumors were well differentiated. Lymphovascular invasion was present in 13.2 per cent. Most (60.4%) tumors were less than 10 mm. Lymphadenectomy was performed in 32.9 per cent of patients, with 52.1 per cent of these found to have metastatic lymph node disease. Although most MD NETs are well differentiated, smaller than 10 mm, and do not have lymphovascular invasion, lymph node metastases are commonly found, suggesting that mesenteric lymphadenectomy with adequate resection of the small bowel may be necessary for adequate staging and disease clearance.


Assuntos
Neoplasias do Íleo/etiologia , Divertículo Ileal/complicações , Tumores Neuroendócrinos/etiologia , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias do Íleo/epidemiologia , Neoplasias do Íleo/patologia , Neoplasias do Íleo/cirurgia , Estimativa de Kaplan-Meier , Excisão de Linfonodo/estatística & dados numéricos , Metástase Linfática , Masculino , Divertículo Ileal/epidemiologia , Pessoa de Meia-Idade , Tumores Neuroendócrinos/epidemiologia , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Programa de SEER/estatística & dados numéricos , Distribuição por Sexo , Carga Tumoral
13.
J Surg Oncol ; 120(8): 1311-1317, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31613999

RESUMO

BACKGROUND AND OBJECTIVES: Ileal neuroendocrine tumors (i-NETs) frequently metastasize to mesenteric lymph nodes and the liver. Regional lymphadenopathy is associated with desmoplasia of the mesentery forming a large mesenteric mass (LMM). Although the latest American Joint Committee on Cancer TNM staging (8th edition) defined LMM >2 cm as N2, the prognostic impact of LMM is ill-defined. We evaluated whether LMM is prognostic for patients with i-NETs. METHODS: This single-institution, retrospective cohort study included 106 patients who underwent resection of i-NETs between 2007 and 2018. Overall survival (OS) and liver progression-free survival (LPFS) were compared between patients with and without LMM. RESULTS: LMM was present in 66 patients (62%) and was not associated with the presence or absence of liver metastasis (P = .969) or the extent of liver involvement (P = .938). OS and LPFS differed significantly between patients with and without LMM (5-year OS rates of 64.8% and 92.9%, respectively, P = .011; 3-year LPFS rates of 45.3% and 67.5%, respectively, P = .025). In multivariate analysis, LMM was an independent prognostic factor for both OS (hazard ratio: 4.69, 95% confidence interval: 1.63-17.6) and LPFS (1.99, 1.08-3.88). CONCLUSION: LMM >2 cm is prognostic for OS and LPFS and represents aggressive tumor biology.


Assuntos
Neoplasias do Íleo/mortalidade , Neoplasias do Íleo/patologia , Linfonodos/patologia , Mesentério/patologia , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/patologia , Idoso , Estudos de Coortes , Feminino , Humanos , Neoplasias do Íleo/cirurgia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/cirurgia , Prognóstico , Intervalo Livre de Progressão , Estudos Retrospectivos
14.
Cir Cir ; 87(S1): 17-21, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31501629

RESUMO

Introduction: Patients with inflammatory bowel disease (IBD) have a higher risk of developing gastrointestinal tumors, the adenocarcinoma is the most frequently associated, and neuroendocrine tumor (NET) the most rare. Clinical cases: We present two patients, one with Crohn's disease and the other with ulcerative colitis, who present nonspecific symptoms, and after resection of an intestinal lesion, a gastrointestinal NET (GINET) is diagnosed. Discussion and conclusion: The GINET have an insidious clinic and these can be confused with those of the IBD. There could be an association between both pathologies; an important role of the chronic intestinal inflammatory process is suggested. The best treatment for GINET is the resection.


Assuntos
Colite Ulcerativa/complicações , Doença de Crohn/complicações , Neoplasias do Íleo/diagnóstico , Tumores Neuroendócrinos/diagnóstico , Neoplasias Retais/diagnóstico , Idoso , Carcinoma de Células Renais , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/cirurgia , Pólipos do Colo/complicações , Pólipos do Colo/tratamento farmacológico , Colonoscopia , Doença de Crohn/tratamento farmacológico , Doença de Crohn/cirurgia , Diagnóstico Tardio , Diagnóstico Diferencial , Suscetibilidade a Doenças , Humanos , Neoplasias do Íleo/complicações , Neoplasias do Íleo/cirurgia , Imunossupressores/efeitos adversos , Imunossupressores/uso terapêutico , Achados Incidentais , Inflamação , Neoplasias Renais , Masculino , Pessoa de Meia-Idade , Segunda Neoplasia Primária/complicações , Segunda Neoplasia Primária/diagnóstico , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/cirurgia , Neoplasias Retais/complicações , Neoplasias Retais/cirurgia
15.
Medicine (Baltimore) ; 98(27): e16305, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277169

RESUMO

RATIONALE: Intestinal ganglioneuromatosis (IGNM) is a rare disease, defined by an abnormal proliferation of ganglion cells, nerve fibers and Schwann cells in the enteric nerve system. PATIENT CONCERNS: A 54-year-old woman presented with a one-year history of recurrent episodes of hypogastric pain, with vomiting, nausea, melena, and weight loss of 10 kg in recent 5 months. DIAGNOSES: The patient was diagnosed as a diffuse IGNM by pathological examination. INTERVENTIONS: A complete excision of the tumor was performed. OUTCOMES: On follow-up after 26 months, the patient was asymptomatic without complications. LESSONS: This report showed a rare case of diffuse IGNM not associated with NF1 or MEN2b. Preoperative radiological examination suggested an intestinal GIST, yet the final diagnosis of diffuse IGNM was made according to the pathological examination of the resected specimen. Although the prevalence of ganglioneuromatosis is low, this condition should be considered in the differential diagnosis of intestinal mass in adults.


Assuntos
Ganglioneuroma/diagnóstico , Tumores do Estroma Gastrointestinal/diagnóstico , Neoplasias do Íleo/diagnóstico , Diagnóstico Diferencial , Feminino , Ganglioneuroma/cirurgia , Humanos , Neoplasias do Íleo/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
17.
Pediatr Surg Int ; 35(8): 879-885, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31139892

RESUMO

BACKGROUND: Most cases of intussusception in children are idiopathic. Rarely, a malignant disease such as intestinal lymphoma may cause intussusception. Due to dramatic changes of expected outcome with chemotherapy regime alone, the surgical management of patients with intestinal lymphoma presenting with intussusception has to be reevaluated. METHODS: Retrospective chart review from May 2011 to February 2017. We included all patients with intestinal lymphoma presenting with intussusception. RESULTS: We found five patients with a mean age of 6.4 years (range 3-16). The most common presenting symptom was abdominal pain for several weeks which had acutely worsened. In all but one patient an ultrasound before pneumatic or hydrostatic reduction showed a finding suspicious of a pathological lead-point. Pneumatic or hydrostatic reduction was attempted in all patients, no complications were noted. In one patient reduction was not successful. Recurrence after reduction occurred in two patients. Two patients needed surgery, three had a percutaneous ultrasound-guided biopsy for diagnostic purposes. All patients had aggressive mature B cell non-Hodgkin lymphoma. CONCLUSION: A high index of suspicion for the presence of a pathological lead-point in children older than 4 years and children with recurrent intussusception is necessary in patients presenting with intussusception. Malignant, highly aggressive B cell non-Hodgkin lymphoma, although rare, must actively be searched for. Pneumatic or hydrostatic reduction should remain the first line treatment in most cases.


Assuntos
Neoplasias do Íleo/complicações , Intussuscepção/etiologia , Laparotomia/métodos , Linfoma/complicações , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Pressão Hidrostática , Neoplasias do Íleo/diagnóstico , Neoplasias do Íleo/cirurgia , Biópsia Guiada por Imagem , Intussuscepção/diagnóstico , Intussuscepção/terapia , Linfoma/diagnóstico , Linfoma/cirurgia , Masculino , Estudos Retrospectivos , Ultrassonografia
18.
Ann Ital Chir ; 82019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31112522

RESUMO

INTRODUCTION: Adult intussusception is a rare cause of bowel obstruction with atypical presentation. It can be associated with primary or secondary intestinal tumors and, rarely, with lipomatous masses. CASE REPORT: We report the case of a 69-year old man presenting with a history of gastrointestinal bleeding and anemia. Upper and lower endoscopies were negative for bleeding. On abdominal contrast enhanced computerized tomography (CT) scan, a trans-omental hernia in the right lower abdominal quadrant was diagnosed with no active bleeding or evidence of tumor. On exploratory laparoscopy we detected an ileo-ileal intussusception caused by a submucosal mass in the distal ileum, which was reduced and we then performed a segmental resection of the involved small bowel tract. The patient fully recovered by postoperative day 3 when he was discharged home. Final pathology confirmed an ileal lipoma. CONCLUSION: Ileal intussusception caused by lipoma is a rare condition, which can be diagnosed with endoscopy, barium enema, and abdominal ultrasound or CT scanning, but preoperative diagnosis may be difficult. The treatment of choice is the reduction of the intussusception and the resection (laparoscopic or open) of the involved tract. KEY WORDS: Intussusception, Lipoma, Ileum, Laparoscopy, Bleeding.


Assuntos
Doenças do Íleo/cirurgia , Neoplasias do Íleo/cirurgia , Intussuscepção/cirurgia , Laparoscopia , Lipoma/cirurgia , Idoso , Hemorragia Gastrointestinal/etiologia , Humanos , Doenças do Íleo/etiologia , Neoplasias do Íleo/complicações , Intussuscepção/etiologia , Lipoma/complicações , Masculino
19.
BMJ Case Rep ; 12(5)2019 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-31126929

RESUMO

Intramesosigmoid hernias are a rare cause of small bowel obstruction. Here, we present such a case with learning points derived from diagnostic dilemma, shared decision making in consent and the management of a rare cause of a common surgical emergency.


Assuntos
Adenocarcinoma/diagnóstico , Neoplasias do Íleo/diagnóstico , Obstrução Intestinal/diagnóstico , Neoplasias Gástricas/diagnóstico , Adenocarcinoma/secundário , Adenocarcinoma/cirurgia , Idoso , Diagnóstico Diferencial , Humanos , Neoplasias do Íleo/secundário , Neoplasias do Íleo/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Metástase Neoplásica , Neoplasias Gástricas/patologia
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