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1.
World J Gastroenterol ; 25(28): 3787-3797, 2019 Jul 28.
Artigo em Inglês | MEDLINE | ID: mdl-31391773

RESUMO

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


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Duodenal/cirurgia , Duodeno/anormalidades , Nutrição Enteral/estatística & dados numéricos , Laparoscopia/métodos , Fatores Etários , Criança , Pré-Escolar , Obstrução Duodenal/congênito , Obstrução Duodenal/diagnóstico , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
2.
BMJ Case Rep ; 12(8)2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31451461

RESUMO

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


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Duodenal , Atresia Intestinal , Jejunostomia/métodos , Sepse Neonatal , Adulto , Diagnóstico Diferencial , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/etiologia , Obstrução Duodenal/fisiopatologia , Obstrução Duodenal/cirurgia , Duodeno/anormalidades , Duodeno/diagnóstico por imagem , Duodeno/cirurgia , Feminino , Humanos , Recém-Nascido , Atresia Intestinal/diagnóstico , Atresia Intestinal/genética , Atresia Intestinal/fisiopatologia , Atresia Intestinal/cirurgia , Jejuno/anormalidades , Jejuno/diagnóstico por imagem , Jejuno/cirurgia , Anamnese , Sepse Neonatal/diagnóstico , Sepse Neonatal/etiologia , Sepse Neonatal/terapia , Nutrição Parenteral Total/métodos , Gravidez , Diagnóstico Pré-Natal/métodos , Doenças Raras/diagnóstico , Irmãos , Resultado do Tratamento
3.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466956

RESUMO

A 55-day-old boy was transferred to our unit with intestinal obstruction and obstructive jaundice after two neonatal operations for duodenal atresia and intestinal malrotation. Abdominal ultrasound showed dilated intrahepatic and extrahepatic ducts with cut-off at the distal common bile duct (CBD). He underwent emergency laparotomy for adhesive intestinal obstruction with a contained abscess from mid-jejunal perforation. Biliary dissection was not attempted due to poor preoperative nutritional status. Tube cholecystostomy was created for biliary decompression. Postoperative magnetic resonance cholangiopancreatography showed dilated CBD with cut-off at the ampulla but did not demonstrate pancreaticobiliary maljunction (PBMJ). The diagnostic dilemma was whether our patient had congenital PBMJ or had developed biliary stricture from perioperative ischaemic scarring. He underwent definitive surgery at 7 months: excision of dilated CBD with Roux-en-Y hepaticojejeunal reconstruction, excisional tapering duodenoplasty and jejunostomy creation. Intraoperative finding was type I choledochal cyst and subsequently confirmed on histology. Postoperative recovery was uneventful and bilirubin levels normalised.


Assuntos
Ducto Colédoco/diagnóstico por imagem , Obstrução Duodenal/cirurgia , Atresia Intestinal/cirurgia , Obstrução Intestinal/cirurgia , Icterícia Obstrutiva/cirurgia , Colangiopancreatografia por Ressonância Magnética , Ducto Colédoco/cirurgia , Diagnóstico Diferencial , Humanos , Lactente , Obstrução Intestinal/diagnóstico por imagem , Icterícia Obstrutiva/diagnóstico por imagem , Laparotomia , Masculino , /cirurgia , Reoperação/efeitos adversos , Resultado do Tratamento , Ultrassonografia
4.
Medicine (Baltimore) ; 98(27): e15856, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277088

RESUMO

RATIONALE: Duodenal obstruction (DO) sometimes induces the groove pancreatitis. However, the case of DO due to chronic pancreatitis in pancreas tail (CPPT) is extremely rare. Therefore, the managements of DO caused by CPPT have not been established yet. PATIENT CONCERNS: A 68-year-old man, who was under the treatment of chronic pancreatitis, presented to our hospital with nausea and abdominal pain. He was diagnosed as DO caused by CPPT. The Conservative treatment, including the nasogastric aspiration and intravenous infusion under the absence of food, was performed. The drainage fluid from naso-gastric tube had been more than 2000 ml per a day although continuing treatment for 14 days. Hence, we decided that the conservative therapy was failed and the surgical intervention was required. DIAGNOSIS: Computed tomography showed gastroduodenal expansion due to stenosis at the horizontal portion of the duodenum with increasing pancreatic pseudocyst. The contrast radiography of the duodenum showed severe stenosis around Treitz ligament. His pre-surgical diagnosis was DO due to CPPT through exclusion of other etiologies for DO such as annular pancreas, SMA syndrome, duodenal diaphragm and Crohn disease. INTERVENTION: Spleen preserving distal pancreatectomy (Warshaw operation) was performed with gastrojejunostomy. During surgery, marked redness and thickness of the mesenteric serosa around Treiz ligament were observed. His surgical findings were supported our preoperative prediction. OUTCOMES: The patient was successfully treated and discharged uneventfully after postoperative day 14. At the 9 months follow-up visit, the patient is still doing well without any symptoms. CONCLUSION: Combination of gastrojejunostomy and Warshaw operation is one of the ideal surgical procedures for patients of DO due to CPPT.


Assuntos
Obstrução Duodenal/cirurgia , Derivação Gástrica/métodos , Pancreatectomia/métodos , Pseudocisto Pancreático/cirurgia , Pancreatite Crônica/complicações , Idoso , Obstrução Duodenal/etiologia , Humanos , Masculino , Tratamentos com Preservação do Órgão , Pseudocisto Pancreático/diagnóstico por imagem , Pseudocisto Pancreático/etiologia , Tomografia Computadorizada por Raios X
5.
Am J Case Rep ; 20: 1108-1113, 2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31350383

RESUMO

BACKGROUND Duodenal compression between the superior mesenteric vessels and aorta or its branches is a rare disease in which the angle between the superior mesenteric vessels and aorta becomes acute, resulting in duodenal obstruction. Reduction in retroperitoneal fat due to several debilitating conditions is considered to be the cause of the decreased angle between the 2 vessels. Nutcracker phenomenon is the asymptomatic compression of the left renal vein (LRV) between the aorta and the superior mesenteric artery. CASE REPORT We report the case of a 33-year-old man who presented with postprandial abdominal pain, mainly at the epigastric region, colicky in nature, without radiation, accompanied by nausea, postprandial vomiting, and loss of weight. Computed tomography (CT) of the abdomen showed duodenal compression between the SMV and the right common iliac artery, which has never been reported before. Laparoscopic duodenojejunostomy was performed. CONCLUSIONS Vascular compression of the duodenum presents with manifestations of proximal small bowel obstruction, which may have chronic, intermittent, or acute symptoms. Diagnosis is difficult due to the lack of knowledge of this rare disorder. Most of these symptoms can be present in other diseases, and symptoms sometimes do not correspond with imaging findings. Therefore, for a better outcome, the clinician should have a high index of suspicion and should be able to exclude other causes with similar manifestations.


Assuntos
Obstrução Duodenal/cirurgia , Duodenostomia , Jejunostomia , Laparoscopia , Veias Mesentéricas/cirurgia , Síndrome do Quebra-Nozes/diagnóstico por imagem , Adulto , Obstrução Duodenal/diagnóstico por imagem , Obstrução Duodenal/etiologia , Humanos , Masculino , Veias Mesentéricas/diagnóstico por imagem , Síndrome do Quebra-Nozes/complicações , Tomografia Computadorizada por Raios X
7.
BMJ Case Rep ; 12(6)2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31227569

RESUMO

Annular pancreas (AP) is a rare diagnosis in the adult population but can cause significant morbidity if not correctly identified. In adults, the most common symptoms are abdominal pain, nausea and vomiting. While these are not specific to AP, they are important clues to this diagnosis in the right clinical context. We present the case of a 24-year-old woman presenting with a 6-year history of progressive abdominal pain and dyspepsia in the context of an extensive negative workup. Upper gastrointestinal (GI) series and MRI revealed partial duodenal obstruction, concerning for AP. While patients with chronic abdominal pain and vague GI complaints may be diagnosed with functional bowel disorders, it is important to appropriately address the possibility of an underlying structural lesion such as AP. This strategy is not only cost-effective but also saves the patient discomfort associated with unnecessary procedures and allows a timely intervention.


Assuntos
Dor Abdominal/etiologia , Obstrução Duodenal/diagnóstico por imagem , Pâncreas/anormalidades , Pancreatopatias/diagnóstico , Obstrução Duodenal/cirurgia , Feminino , Humanos , Laparoscopia , Pâncreas/cirurgia , Pancreatopatias/cirurgia , Resultado do Tratamento , Trato Gastrointestinal Superior/diagnóstico por imagem , Adulto Jovem
8.
J Laparoendosc Adv Surg Tech A ; 29(10): 1216-1222, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31150305

RESUMO

Background: Laparoscopic duodenal atresia (DA) repair is a demanding procedure that requires performing a watertight anastomosis in a small working space. Drawbacks of the approach have been high leakage rates and long operative times. In this article, we evaluate our initial experience with DA repair using a laparoscopic miniature stapler (LA-MS) and compared outcomes with a historic cohort of laparoscopic hand-sewn (LA-HS) and open repairs (ORs). Materials and Methods: A retrospective analysis of all patients who underwent surgery for DA at our two centers between January 2010 and April 2018 was performed. Demographics, comorbidities, intra- and postoperative data, and outcome parameters were evaluated and statistically analyzed. Results: DA repair was performed in 44 patients. Ten patients underwent laparoscopic DA repair using an MS, 21 patients laparoscopic repair with HS anastomosis, and 13 patients underwent OR. Median age and weight at surgery was 13.5 days (range: 2-173) and 3300 g (range: 1630-5600) in the LA-MS group, 4 days (range: 2-269) and 2750 g (range: 1700-4095) in the LA-HS group and 4 days (range: 1-17) and 2222 g (range: 1520-3590) in the OR group, respectively. Mean operative time was significantly shorter in the laparoscopic stapled group compared with LA-HS group (145 ± 37 minutes (range: 97-217) versus 201 ± 47 minutes (range: 119-275), P < .004). Duodenojejunostomy was performed more frequently in the laparoscopic stapled group compared with the open procedure (P = .008). Overall complication rate was similar between groups. Time to initiation of feeds and time to full feeds were significantly shorter in the laparoscopic stapled group compared with the open approach (5 versus 11.9 days, P = .041 and 14.5 versus 24.4 days, P = .020). Conclusion: Laparoscopic DA repair using an MS is a novel, safe, and feasible technique that was associated with significantly shorter operating times than HS laparoscopic DA repair. Owing to its simplicity, this technique has the potential to become the new standard of care.


Assuntos
Obstrução Duodenal/cirurgia , Atresia Intestinal/cirurgia , Laparoscopia/instrumentação , Grampeadores Cirúrgicos , Grampeamento Cirúrgico/instrumentação , Anastomose Cirúrgica/instrumentação , Anastomose Cirúrgica/métodos , Feminino , Humanos , Lactente , Recém-Nascido , Laparoscopia/métodos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Grampeamento Cirúrgico/métodos , Resultado do Tratamento
9.
Tokai J Exp Clin Med ; 44(2): 31-33, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31250423

RESUMO

Duodenal atresia concomitant with type-A esophageal atresia (DA + TA-EA) is rare. A pronounced enlargement of a closed loop of the upper gastrointestinal tract serves as an early clue for its prenatal detection. We describe an atypical case of DA + TA-EA in which the dilatation of the upper gastrointestinal tract remained mild. Ultrasonographic examination at 28 weeks of gestation showed mild polyhydramnios. Subsequent detailed sonographic and magnetic resonance imaging studies revealed a mildly enlarged stomach and duodenum that resembled a "double bubble," mild ascites, and polydactyly of the right thumb. Fetal abdominal circumference measurements were within normal range. A female neonate born at 36 weeks gestation did not show abdominal distension. DA + TA-EA was diagnosed based on clinical characteristics and X-ray studies of the neonate; the diagnosis was confirmed by surgery. Duodenoduodenostomy and gastrostomy in the first week of life and esophagoesophagostomy at six months of age were performed with satisfactory results, and the infant developed well. Prominent and/or increasing C-shaped fluid collection in the upper abdomen is a highly useful diagnostic sign for DA + TA-EA, but it is not applicable for all fetuses with this disease. Physicians should bear this caveat in mind to avoid diagnostic delays and initiate prompt postnatal therapy.


Assuntos
Obstrução Duodenal/diagnóstico por imagem , Atresia Esofágica/diagnóstico por imagem , Doenças Fetais/diagnóstico por imagem , Atresia Intestinal/diagnóstico por imagem , Diagnóstico Pré-Natal , Adulto , Obstrução Duodenal/cirurgia , Duodenostomia , Atresia Esofágica/cirurgia , Esofagostomia , Feminino , Doenças Fetais/cirurgia , Gastrostomia , Humanos , Recém-Nascido , Atresia Intestinal/cirurgia , Imagem por Ressonância Magnética , Gravidez , Radiografia , Resultado do Tratamento , Ultrassonografia Pré-Natal
13.
J Surg Res ; 241: 128-134, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31022678

RESUMO

BACKGROUND: The combination of esophageal atresia, congenital duodenal obstruction, and anorectal malformation has seldom been reported. We describe the largest series of patients with such association, which we summed up with the mnemonic acronym DATE [D-duodenal obstruction, A-anorectal malformation (ARM), and TE-tracheoesophageal fistula with esophageal atresia]. METHODS: This was a multicenter retrospective review of 13 patients recruited from 8 institutions over a nearly 5-decade period (1968-2017). Information gathered included type of DATE malformations, other associated anomalies, type and timing of surgery, and clinical outcomes. RESULTS: The DATE association consisted of type C esophageal atresia (13), complete (9) or incomplete (4) congenital duodenal obstruction (CDO), and high or intermediate (8) or low (5) ARM. Eight patients had at least one additional component feature of VACTERL association. A total of 6 patients died. Overall, 9 patients achieved complete restoration of gastrointestinal continuity, 7 of whom are alive at a median follow-up of 4 y (range, 1 to 9). Survivors received a median of 6 major operations (range, 4 to 14) to overcome their anomalies and surgical complications. Two incomplete duodenal obstructions were initially overlooked. All survivors with high or intermediate ARM defects required some form of bowel management to keep them clean. CONCLUSIONS: The DATE association is a low-frequency entity, often occurring among the wider spectrum of VACTERL association. Functional outcomes largely depend on the severity of ARM or other major associated malformations. Awareness of the DATE association may avoid untoward diagnostic delays of subtler component features of the spectrum, such as an incomplete CDO.


Assuntos
Anormalidades Múltiplas/epidemiologia , Malformações Anorretais/epidemiologia , Obstrução Duodenal/epidemiologia , Atresia Esofágica/epidemiologia , Fístula Traqueoesofágica/epidemiologia , Anormalidades Múltiplas/diagnóstico , Anormalidades Múltiplas/cirurgia , Canal Anal/anormalidades , Malformações Anorretais/diagnóstico , Malformações Anorretais/cirurgia , Criança , Pré-Escolar , Diagnóstico Diferencial , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/cirurgia , Atresia Esofágica/diagnóstico , Atresia Esofágica/cirurgia , Esôfago/anormalidades , Feminino , Cardiopatias Congênitas/diagnóstico , Humanos , Lactente , Recém-Nascido , Itália/epidemiologia , Rim/anormalidades , Deformidades Congênitas dos Membros/diagnóstico , Masculino , Diagnóstico Pré-Natal/estatística & dados numéricos , Prevalência , Estudos Retrospectivos , Coluna Vertebral/anormalidades , Análise de Sobrevida , Traqueia/anormalidades , Fístula Traqueoesofágica/diagnóstico , Fístula Traqueoesofágica/cirurgia , Resultado do Tratamento
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