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1.
BMJ Case Rep ; 14(4)2021 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-33811094

RESUMO

A young male in his early 30s presented to us with increasing swelling at the umbilicus, and an umbilical hernia was diagnosed. At laparoscopic intraperitoneal onlay mesh (IPOM) repair, an unexpected finding of a thin innocuous-looking fibrous film over the small bowel was noted. This finding presented a dilemma as to the probable pathology of this material, and a decision had to be made on whether laparoscopic IPOM could be continued. It was prudently decided to abandon the plan of placing a mesh intraperitoneally and an open repair of the umbilical hernia was done. In retrospect this was a wise decision, as, after 7 months he had to have a laparotomy for intestinal obstruction, when the classic thick fibrous encapsulating abdominal cocoon was seen. Hence here we have followed the evolution of the abdominal cocoon from its original asymptomatic phase to the classic encapsulating sclerosing peritonitis with probably laparoscopic gas insufflation being the precipitating factor.


Assuntos
Hérnia Ventral , Insuflação , Obstrução Intestinal , Laparoscopia , Hérnia Ventral/cirurgia , Humanos , Insuflação/efeitos adversos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Peritônio/cirurgia , Telas Cirúrgicas
2.
Am J Case Rep ; 22: e929150, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33872294

RESUMO

BACKGROUND Abnormal communicating channels or fistulas between the gallbladder or common bile duct and the intestine are rare, but have potential to result in serious complications. Further complications can arise with migration of gallstones from the gallbladder to the intestines, causing distal obstruction in the ileum, intestinal hemorrhage, or intestinal perforation. High clinical suspicion is warranted for the diagnosis of Bouveret's syndrome, with anticipation of surgery to prevent distal gallstone migration that would otherwise result in unfavorable patient outcomes. CASE REPORT A 51-year-old woman presented with biliary colic and a computed tomography scan showed that a gallstone measuring approximately 3 cm was lodged in the first portion of the duodenum. The patient was diagnosed with cholecystoduodenal fistula with Bouveret's syndrome. Because of the acute presentation of symptoms, she underwent an exploratory laparotomy with disconnection of the cholecystoduodenal fistula, cholecystectomy with debridement of the duodenum, transduodenal gallstone removal, and primary duodenoplasty closure of D1. CONCLUSIONS As the present case illustrates, distal migration of a gallstone through a cholecystoduodenal fistula can occur rapidly and without obvious symptoms. It also can occur spontaneously and not just secondary to fragmentation by laser lithotripsy. To prevent morbidity and mortality, a high degree of clinical suspicion is warranted when diagnosing patients in whom a gallstone ileus is seen on imaging.


Assuntos
Cálculos Biliares/diagnóstico por imagem , Fístula Intestinal/diagnóstico , Obstrução Intestinal , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Obstrução da Saída Gástrica , Humanos , Fístula Intestinal/etiologia , Fístula Intestinal/cirurgia , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
3.
BMC Gastroenterol ; 21(1): 176, 2021 Apr 17.
Artigo em Inglês | MEDLINE | ID: mdl-33865311

RESUMO

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) is a relatively safe and convenient mode of treatment for ureteral and renal stones, despite its relative safety; ESWL is not without its complications. We present a case of a patient we managed for small bowel obstruction and strangulation due to an adhesive internal hernia after ESWL was done because of right ureteral calculi. CASE PRESENTATION: We report a case of a 59-year-old patient who presented with severe abdominal pain a few hours after ESWL because of a right upper ureteric calculus. The abdominal pain increased in severity in time and became more generalized. The patient had one episode of gross hematochezia as she was being prepped for emergency laparotomy. Intra-op, she had a strangulated internal hernia because of an omental-mesenteric adhesion. CONCLUSION: This case report hopes to highlight the potential of complications like acquired IH due to adhesions in patients with a history of ureteral calculi, and also the complications that may come about post-ESWL. Patients who present with signs of persistent abdominal pain post-ESWL should be vigilantly observed. If symptoms persist, increase in intensity or there is a general deterioration of the patients' hemodynamic status, even in light of negative MDCT findings, prompt surgical intervention is crucial for definitive diagnosis as well as management.


Assuntos
Tratamento por Ondas de Choque Extracorpóreas/efeitos adversos , Obstrução Intestinal/terapia , Cálculos Ureterais/terapia , Feminino , Humanos , Obstrução Intestinal/etiologia , Litotripsia/efeitos adversos , Litotripsia/métodos , Pessoa de Meia-Idade , Cálculos Ureterais/complicações
4.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(4): 335-343, 2021 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-33878823

RESUMO

Objective: To compare the effects of 3 treatment strategies (emergent surgery, self-expanding metallic stents, self-expanding metallic stents plus neoadjuvant chemotherapy) on postoperative anal function and quality of life in patients with complete obstructive left hemicolon cancer. Methods: A retrospective cohort study was conducted. Clinical data of patients with complete obstructive left hemicolon cancer admitted to General Surgery Department of Beijing Chaoyang Hospital between January 2017 and October 2019 were retrospectively collected. Patient inclusion criteria: (1) complete obstructive left hemicolon cancer was confirmed through clinical manifestation and abdominal computed tomography; (2) adenocarcinoma was confirmed by postoperative pathology; (3) emergent radical resection of primary tumor was performed with temporary stoma, or radical resection of primary tumor and primary anastomosis was performed without stoma, 7 to 14 days after completion of insertion of self-expanding metallic stents. Patients who did not receive stoma reversion after emergent operation were excluded. According to different therapies, patients were divided into three groups: emergent surgery (ES) group, self-expanding metallic stents (SEMS) group and self-expanding metallic stents plus neoadjuvant chemotherapy (SEMS+NAC) group. Wexner score for incotinence (higher score indicates the worse anal function), Vaizey score (>10 indicates fecal incontinence) and low anterior resection syndrome (LARS) scale (higher score indicates the worse anal function) were applied to evaluate anal function of patients among groups at postoperative 1-, 6- and 12-month. EORTC QLQ-C30 questionnaire was used to assess the quality of life. Risk factors of decreased anal function were identified by logistic regression analysis. Results: A total of 72 patients were enrolled, including 27 (37.5%) patients in ES group, 23 (31.9%) in SEMS group and 22 (30.6%) in SEME+NAC group. The baseline characteristics including age, gender, tumor location, comorbidities, total blood loss, operation time and postoperative complications, were comparable among groups, except that the proportion of laparoscopic surgery was significantly lower in ES group (4/27, 14.9%) than that in SEMS (15/23, 65.2%) and SEMS+NAC group (16/22, 72.7%) with significant difference (P<0.001). The follow-up ended up to October 2020, and the overall follow-up rate was 79.2% (57/72). No significant differences existed in the Wexner score of patients among groups at postoperative 1-, 6- and 12-month (all P>0.05). The Vaizey scores at postoperative 1-month in ES, SEMS and SEMS+NAC group were 7 (0-17), 3 (0-7) and 4 (0-8) respectively with significant difference (H=18.415, P=0.001), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). Vaizey scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The LARS scores at postoperative 1-month in ES, SEMS and SEMS+NAC groups were 20 (0-37), 15 (0-24) and 16 (0-28) respectively with significant difference (H=3.660, P=0.036), and the scores in SEMS and SEMS+NAC groups were significantly lower than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC groups (P>0.05). LARS scores at postoperative 6- and 12-month among 3 groups were not significantly different (both P>0.05). The QLQ-C30 score revealed that the social function of patients in SEMS group and SEMS+NAC group was significantly better than that in ES group (both P<0.05), while no significant difference existed between SEMS and SEMS+NAC group (P>0.05). The logistic regression analysis revealed that only ES was an independent risk factor of decreased anal function (OR=2.264, 95% CI: 1.098-4.667, P=0.027). Conclusion: Compared to ES, SEMS may improve quality of life and short-term anal function of patients with complete obstructive left hemicolon cancer.


Assuntos
Obstrução Intestinal , Neoplasias Retais , Humanos , Complicações Pós-Operatórias , Qualidade de Vida , Estudos Retrospectivos , Síndrome , Resultado do Tratamento
5.
Pan Afr Med J ; 38: 64, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33889230

RESUMO

Anorectal malformations (ARM) are developmental anomalies of the genitor anal elements, they represent a wide range of anomalies. An early diagnosis allows a better management as it reduces mortality associated with ARM, especially in developing countries. A prospective cross-sectional study has been carried, including patients from 0 to one year, admitted in our service for ARM. Twenty-four (24) patients have been considered. The median age was 2 days, the sex ratio 1/3 for female. Intestinal occlusions were the most frequent circumstances of diagnosis (50%), low ARMs were the most frequent, diagnosed in 11 patients (45.7%) of which 10 did not have any fistula. The most common associated malformation was intestinal atresia (3 patients). Anoplasty was done using abdominoperineal pull-through associated to anal dilatations in 13 patients (54.1%). Six patients died from unknown etiology and 6 were lost from the follow-up. Concerning the functional outcome, 12 of the 24 patients concerned by the study attended review and 3 of them presented signs of fecal incontinence, 9 of them were continents among whom 8 were diagnosed low ARM and one with high ARM. ARMs are encountered in our environment, nonetheless, the diagnosis is still made most of the time, during an intestinal occlusion. The mortality rate is still high and measures should be taken to allow long-term reviews, which will surely reduce the number of lost patients.


Assuntos
Malformações Anorretais/diagnóstico , Incontinência Fecal/etiologia , Atresia Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Malformações Anorretais/complicações , Malformações Anorretais/cirurgia , Estudos Transversais , República Democrática do Congo , Incontinência Fecal/epidemiologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Atresia Intestinal/epidemiologia , Obstrução Intestinal/epidemiologia , Masculino , Estudos Prospectivos
6.
Gan To Kagaku Ryoho ; 48(3): 413-415, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33790172

RESUMO

A 50s-year-old man was admitted to our hospital because of abdominal pain and vomitting. CT showed a thickened wall of the sigmoid colon, marked enlargement of the oral side, and a 30 mm tumor on the left lateral section of the liver. We diagnosed colonic obstruction due to sigmoid colon cancer with liver metastasis. We failed to place a colonic stent for decompression, so we performed a colostomy using the cecum. An exploratory laparoscopy was performed instead of curative surgery due to peritoneal disseminations, followed by chemotherapy and molecular targeted therapy. Although primary lesion, liver metastatic lesion and disseminated lesions were reduced by pharmacotherapy the patient developed a grade 2 skin disorder around the colostomy. Therefore, it was determined that molecular targeted therapy could not be continued. The resection of the primary lesion and closure of the colostomy were performed to continue pharmacotherapy. Pharmacotherapy was resumed after operation. The patient is currently getting complete remission, undergoing maintenance therapy with no skin disorders. In this case, surgery was performed as part of the multidisciplinary treatment. It suggested that palliative surgery might be an effective option in multidisciplinary treatment.


Assuntos
Obstrução Intestinal , Neoplasias do Colo Sigmoide , Colo Sigmoide , Colostomia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos
7.
Gan To Kagaku Ryoho ; 48(3): 449-451, 2021 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-33790184

RESUMO

Although radiation therapy for pelvic cancer leads to improved outcomes, it may cause radiation enteritis. Radiation enteritis is classified as early and late reaction. Late reaction indicate progressive and irreversible changes caused by ischemic changes of the intestinal mucosa. Severe cases require a surgical treatment, which is challenging because of severe adhesions and a high risk of suture failure. In addition, the postoperative course may be unfavorable in some cases. We performed surgery for 4 radiation enteritis cases; however, the postoperative course was unfavorable in 2 cases because of impaired absorption and ileus of the remaining short bowel. These patients could not eat adequately after discharge; therefore, we needed to explain and make them understand the benefits and disadvantages of radiation therapy.


Assuntos
Enterite , Obstrução Intestinal , Neoplasias Pélvicas , Lesões por Radiação , Enterite/etiologia , Humanos , Mucosa Intestinal , Lesões por Radiação/etiologia
9.
Lakartidningen ; 1182021 04 12.
Artigo em Sueco | MEDLINE | ID: mdl-33847368

RESUMO

Mechanical intestinal obstruction is an important diagnosis and a common cause of acute abdominal pain. Adhesions and scar tissue in the abdomen after previ-ous surgery is a frequent source. Small bowel obstruction caused by adhesions can be treated conservatively, but surgery may be needed. Laparotomy is usually the approach for adhesiolysis, but laparoscopy is an option. This case rapport describes a man in his 50s being admitted with severe abdominal pain and vomiting. Further investigation showed a small bowel obstruction caused by adhesions. After two days expectation, surgery be-came necessary. During laparoscopy, the surgeon's finger was introduced intraabdominally and used to release the adhesion.  We here present a possible approach to a situation encountered during laparoscopic adhesiolysis and encourage creativity and laparoscopy in selected patients with mechanical small bowel obstruction.


Assuntos
Obstrução Intestinal , Laparoscopia , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Masculino , Complicações Pós-Operatórias , Aderências Teciduais/complicações , Aderências Teciduais/cirurgia , Resultado do Tratamento
10.
Anticancer Res ; 41(4): 1945-1950, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813400

RESUMO

BACKGROUND/AIM: Endoluminal self-expanding metallic stents (SEMS) may overcome the risk of mortality and morbidity of acute intestinal obstruction because of stage IV colon (CC) or rectal (RC) cancer. We evaluated the QoL in these groups of patients. PATIENTS AND METHODS: Forty-eight patients were enrolled in a prospective longitudinal cohort single-center trial to undergo SEMS positioning. Twenty-five patients had a CC and 23 RC. Karnofsky performance scale, Visual Analogue Scale and the EQ-5D- 5L™ questionnaire were administered before treatment and at 1, 3 and 6 months. RESULTS: Harmonized to the Italian population, the index values showed a statistically significant deterioration of the QoL in patients with RC when compared to those with CC at 1-, 3- and 6-months (1 month: p=0.001; 3- month: p=0.001; 6-month: p=0.045). Similarly, Visual Analogue Scale showed variations at 1- (p=0.008), 3- (p=0.001) and 6-months (p=0.020). Rectal stent deployment was the only independent predictor for a worse QoL in all domains (p<0.017; OR=0.196; 95%CI=0.51-0.749). CONCLUSION: Patients affected with stage IV CC had a better QoL after SEMS placement when compared to those affected with RC. The persistency of the primary tumor at the rectal level, even if irradiated, might negatively affect QoL.


Assuntos
Adenocarcinoma/cirurgia , Neoplasias do Colo/cirurgia , Qualidade de Vida , Neoplasias Retais/cirurgia , Stents Metálicos Autoexpansíveis , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/patologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/instrumentação , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Progressão da Doença , Feminino , Seguimentos , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/etiologia , Neoplasias Retais/patologia , Stents Metálicos Autoexpansíveis/efeitos adversos , Resultado do Tratamento
11.
Anticancer Res ; 41(4): 1959-1970, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813402

RESUMO

BACKGROUND/AIM: The diagnosis of acute small bowel obstruction (ASBO) may be difficult and the decision to operate is based on clinical findings. So far, the diagnostic scores (DSs) for ASBO detection have been rarely evaluated. PATIENTS AND METHODS: A cohort of 1,333 acute abdominal pain (AAP) patients with 54 ASBO patients, were included in the study. The most significant diagnostic findings (in multivariate logistic regression analysis) were used to construct DS formulas for ASBO diagnosis with location of pain at diagnosis (LP+) and without location of pain at diagnosis (LP-). Meta-analytical techniques were used to calculate the summary sensitivity (Se) and specificity (Sp) estimates for each data sets (history-taking, findings, and DS formulas). RESULTS: In SROC analysis, the AUC values for i) clinical history-taking, ii) diagnostic findings and tests, iii) DSLP- and iv) DSLP+ were as follows: i) AUC=0.638 (95%CI=0.600-0.676); ii) AUC=0.694 (95%CI=0.630-0.724), iii) AUC=0.962 (95%CI=0.940-0.986), and for iv) AUC=0.971 (95%CI=0.952-0.988). In roccomp analysis for the AUC values, the differences are significant as follows: between i) and ii) p=0.312; between i) and iii) p<0.0001; between i) and iv) p<0.0001; between ii) and iii) p<0.0001; between ii) and iv) p<0.0001; and between iii) and iv) p=0.317. CONCLUSION: The present study is the first to provide data that the DS could be used for clinical diagnosis of ASBO without radiological or laboratory analyses, to reach a high diagnostic accuracy in AAP patients.


Assuntos
Abdome Agudo/diagnóstico , Técnicas de Diagnóstico do Sistema Digestório , Obstrução Intestinal/diagnóstico , Intestino Delgado/patologia , Abdome Agudo/etiologia , Abdome Agudo/patologia , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Dor Abdominal/patologia , Doença Aguda , Área Sob a Curva , Estudos de Coortes , Conjuntos de Dados como Assunto , Diagnóstico Diferencial , Humanos , Obstrução Intestinal/complicações , Obstrução Intestinal/patologia , Anamnese , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Projetos de Pesquisa , Sensibilidade e Especificidade
12.
Arch. argent. pediatr ; 119(2): e158-e162, abril 2021. ilus
Artigo em Espanhol | LILACS, BINACIS | ID: biblio-1152049

RESUMO

La dilatación segmentaria intestinal es una entidad congénita extremadamente rara, caracterizada por la dilatación local del intestino que no se debe a la obstrucción distal ni a la ausencia de células ganglionares. Se presenta el caso clínico de una paciente en el período neonatal con la presentación típicamente descrita en esta enfermedad en ausencia de comorbilidades, forma clínica poco descrita en la bibliografía. Se desarrolla también la resolución quirúrgica con resección segmentaria y los hallazgos anatomopatológicos.


Segmental dilatation of the intestine is an extremely rare congenital entity characterized by a local dilation of the intestine without distal obstruction or the absence of ganglion cells. We present the case of a patient in the neonatal period with typical clinical features in absence of other comorbidities, shortly published in the bibliography. We also describe the surgical resolution and the pathological results.


Assuntos
Humanos , Feminino , Recém-Nascido , Obstrução Intestinal/diagnóstico por imagem , Colectomia , Dilatação
13.
Medicine (Baltimore) ; 100(9): e25035, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33655978

RESUMO

BACKGROUND: Adhesive small bowel obstruction (ASBO) is one of the most common complications and is a major cause of re-admission after intra-abdominal surgery. The initial management of patients with ASBO is nonoperative treatment such as nil per os and decompression using a nasogastric tube. However, the ideal management of ASBO remains controversial. METHODS: This study will be a prospective, single-center, double-blind randomized controlled trial. Ninety two participants diagnosed with ASBO will be randomly assigned to either the verum or the sham laser acupuncture (SLA) group in a 1:1 ratio. All participants will undergo laser acupuncture (LA) or SLA once a day on 6 acupoints (LI4, PC6, ST25, ST36, CV4 and CV12) for 6 consecutive days after enrollment. The primary outcome measure will be the success rate of conservative treatment for ASBO. Secondary outcomes will be time to oral intake and length of hospital stay. The serum levels of lipase, amylase, cortisol, motilin, ghrelin, and intestinal fatty acid binding protein (I-FABP) will also be measured before intervention, on day 4, and on the day of discharge, respectively. Data will be analyzed by Chi-Squared test or t test between 2 groups. OBJECTIVES: The aim of this protocol is to investigate the clinical efficacy of LA on ASBO. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04318821. Registered on 24 March 2020.


Assuntos
Terapia por Acupuntura/métodos , Obstrução Intestinal/terapia , Intestino Delgado , Lasers , Aderências Teciduais/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Feminino , Humanos , Obstrução Intestinal/etiologia , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
14.
BMC Surg ; 21(1): 148, 2021 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-33743658

RESUMO

BACKGROUND: Bridge to elective surgery (BTS) using self-expanding metal stents (SEMSs) is a common alternative to emergency surgery (ES) for acute malignant left-sided colonic obstruction (AMLCO). However, studies regarding the long-term impact of BTS are limited and have reported unclear results. METHODS: A multicenter observational study was performed at three hospitals from April 2012 to December 2019. Propensity score matching (PSM) was introduced to minimize selection bias. The primary endpoint was overall survival. The secondary endpoints included surgical approaches, primary resection types, total stent-related adverse effects (AEs), surgical AEs, length of hospital stay, 30-day mortality and tumor recurrence. RESULTS: Forty-nine patients in both the BTS and ES groups were matched. Patients in the BTS group more often underwent laparoscopic resection [31 (63.3%) vs. 8 (16.3%), p < 0.001], were less likely to have a primary stoma [13 (26.5%) vs. 26 (53.1%), p = 0.007] and more often had perineural invasion [25 (51.0 %) vs. 13 (26.5 %), p = 0.013]. The median overall survival was significantly lower in patients with stent insertion (41 vs. 65 months, p = 0.041). The 3-year overall survival (53.0 vs. 77.2%, p = 0.039) and 5-year overall survival (30.6 vs. 55.0%, p = 0.025) were significantly less favorable in the BTS group. In multivariate Cox regression analysis, stenting (hazard ratio(HR) = 2.309(1.052-5.066), p = 0.037), surgical AEs (HR = 1.394 (1.053-1.845), p = 0.020) and pTNM stage (HR = 1.706 (1.116-2.607), p = 0.014) were positively correlated with overall survival in matched patients. CONCLUSIONS: Self-expanding metal stents as "a bridge to surgery" are associated with more perineural invasion, a higher recurrence rate and worse overall survival in patients with acute malignant left-sided colonic obstruction compared with emergency surgery.


Assuntos
Doenças do Colo , Tratamento de Emergência , Obstrução Intestinal , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças do Colo/cirurgia , Doenças do Colo/terapia , Feminino , Humanos , Obstrução Intestinal/cirurgia , Obstrução Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Resultado do Tratamento
15.
J Med Life ; 14(1): 32-36, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33767782

RESUMO

Acute small bowel obstruction remains one of the most challenging nosologies in emergency surgery, leading to a pronounced imbalance between lipid peroxidation and the antioxidant defense system. We aimed to study changes in the anti- and prooxidant status of serum and small intestine wall in an experiment modeling acute small bowel obstruction. The control group included 11 rats, and the main group included 42 rats (simulation of mechanical bowel obstruction on day 1 was conducted in 14 rats, on day 2 - in 12 rats, on day 3 - in 16 rats). Acute small bowel obstruction was modeled by ligation. Serum analysis and removal of the small intestinal wall were performed on days 1, 2, and 3. Indicators of lipid peroxidation and antioxidant protection were determined by the spectrophotometric method, and the imbalance between lipid peroxidation and antioxidant protection gradually increased from 1 to 3 days of observation. On day 3, the low level of aldehyde increased 1.3 times, and the level of superoxide dismutase decreased 1.2 times compared to the control group. Pathophysiological changes in the wall of the small intestine are caused by the activation of lipid peroxidation and the exhaustion antioxidant protection, whereby the degree of their severity increases depending on the increase in time from the moment of modeling of acute obstruction of the small intestine.


Assuntos
Antioxidantes/metabolismo , Obstrução Intestinal/metabolismo , Intestino Delgado/patologia , Doença Aguda , Animais , Intestino Delgado/cirurgia , Peroxidação de Lipídeos , Masculino , Ratos , Superóxido Dismutase/metabolismo
16.
Ann R Coll Surg Engl ; 103(4): 255-262, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682461

RESUMO

INTRODUCTION: Laparoscopic adhesiolysis is increasingly being used to treat adhesional small bowel obstruction (ASBO) as it has been associated with reduced postoperative length of stay (LOS) and faster recovery. However, concerns regarding limited working space, iatrogenic bowel injury and failure to relieve the obstruction have limited its uptake. This study reports our centre's experience of adopting laparoscopy as the standard operative approach. METHODS: A single-centre prospective cohort study was performed incorporating local data from the National Emergency Laparotomy Audit Database; January 2015 to December 2019. All patients undergoing surgery for ASBO were included. Patient demographic, operative and inhospital outcomes data were compared between different surgical approaches. Linear regression analysis was performed for LOS. RESULTS: A total of 299 cases were identified. Overall, 76.3% of cases were started laparoscopically and 52.2% were completed successfully. Patients treated laparoscopically had lower Portsmouth - Physiological and Operative Severity Score for the enuMeration of Mortality and morbidity (P-POSSUM) predicted mortality (median 2.1 (interquartile range (IQR) 1.3-5.0) vs 5.7 (IQR 2.0-12.4), p=<0.001) and shorter postoperative LOS compared with open (median 4.2 days (IQR 2.5-8.2) vs 11.3 days (IQR 7.3-16.6), p=0.000). Inhospital mortality was lower in the laparoscopic group (2 vs 7 deaths, p=<0.001). In regression analysis, laparoscopic surgery was found to have the strongest association with postoperative LOS (ß -8.51 (-13.87 to -3.16) p=0.002) compared with open surgery. CONCLUSIONS: Laparoscopy is a safe and feasible approach for adhesiolysis in the majority of patients with ASBO. It is associated with reduced LOS with no impact on complications or mortality.


Assuntos
Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Laparoscopia , Aderências Teciduais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Emergências , Feminino , Mortalidade Hospitalar , Humanos , Obstrução Intestinal/etiologia , Tempo de Internação/estatística & dados numéricos , Modelos Lineares , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Aderências Teciduais/complicações , Resultado do Tratamento
17.
Ann R Coll Surg Engl ; 103(4): e127-e130, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682463

RESUMO

A wandering spleen is a very rare event characterised by the absence of the spleen in its anatomical position due to the hyperlaxity of its ligaments. We present a case of wandering spleen complicated by splenic vascular pedicle torsion, thrombosis and subsequent splenic infarction. Compression of the infarcted spleen on the rectosigmoid junction led to the development of a sigmoid volvulus, which presented as an acute large bowel obstruction. The patient underwent emergency laparotomy, splenectomy, sigmoid decompression and sigmoidopexy. After a follow-up period of two years, the volvulus had not recurred.


Assuntos
Obstrução Intestinal/etiologia , Volvo Intestinal/etiologia , Doenças do Colo Sigmoide/etiologia , Infarto do Baço/diagnóstico , Baço Flutuante/diagnóstico , Doença Aguda , Feminino , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/cirurgia , Volvo Intestinal/diagnóstico , Volvo Intestinal/cirurgia , Pessoa de Meia-Idade , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/cirurgia , Esplenectomia , Infarto do Baço/complicações , Infarto do Baço/cirurgia , Baço Flutuante/complicações , Baço Flutuante/cirurgia
18.
Ann R Coll Surg Engl ; 103(4): 235-244, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682486

RESUMO

INTRODUCTION: The debate on the best surgical management strategy for acute malignant left-sided colonic obstruction is ongoing. Decompressing colostomy (DC) and stenting as a bridge to surgery (SBTS) are the currently proposed alternative approaches to emergency colectomy (EC). However, the results of a traditional meta-analysis were inconclusive. Therefore, a network meta-analysis (NMA) was conducted to compare the three approaches for acute left-sided colonic obstruction. METHODS: A systematic literature search of Embase, PubMed, Google Scholar and the Cochrane library was performed. A traditional meta-analysis and subsequent NMA were conducted. FINDINGS: A significantly greater number of primary anastomoses were performed in the DC cohort than in the EC and SBTS cohorts. The 90-day mortality rate was significantly lower in the DC cohort than in the EC and SBTS cohorts. Higher costs were associated with the SBTS cohort (by US$2,000) than with the EC cohort. The locoregional recurrence rate was higher for the SBTS cohort than for the EC cohort. CONCLUSIONS: Evidence from the first NMA suggests there may be some clinical advantages associated with DC as an alternative approach to the EC and SBTS approaches for adequately selected patients with malignant large bowel obstruction.


Assuntos
Colectomia , Doenças do Colo/cirurgia , Neoplasias do Colo/complicações , Colostomia , Obstrução Intestinal/cirurgia , Stents , Doença Aguda , Doenças do Colo/etiologia , Humanos , Obstrução Intestinal/etiologia , Metanálise em Rede
19.
Khirurgiia (Mosk) ; (3): 26-35, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33710823

RESUMO

OBJECTIVE: To analyze the factors of mortality in patients with acute adhesive small bowel obstruction (AASBO). MATERIAL AND METHODS: A retrospective multiple-center study included 143 (85.6%) patients with AASBO out of 167 consecutive patients with small bowel obstruction for the period 2017-2019. All patients were divided into 3 groups: early surgery group (within 12 hours after admission), late surgery (after 12 hours), non-surgical management group. The outcomes and Kaplan-Meier survival were compared in all groups. RESULTS: AASBO was resolved without surgery in 77 (53.8%) patients 19.6±17.4 (M=14) hours. In the Early Surgery Group (n=36), 24 patients had strangulation, 12 ones had non-strangulated bowel obstruction. In the Late Surgery Group (n=30), 15 patients had strangulation and 15 ones had no strangulation. Mortality was similar in early and late surgery (p=0.287), early and late surgery in patients with strangulation (p=0.940), early and late surgery in patients without strangulation (p=0.76). Patients died (n=10) after surgery only. Thus, postoperative mortality was 15.2%, overall mortality - 7.0%. All patients who underwent surgery after 24 hours (n=14) survived. Surgery increased the mortality risk compared to non-surgical management (95% CI 0 - 15.9, p=0.001). There was no effect of surgery time (more or less than 12 hours) on mortality for strangulation (95% CI 13.0-16.7, p 0.788) and non-strangulated obstruction (95% CI 29.4-5.4, p=0.061), bowel resection (95% CI 33.3-14.0, p=0.187), presence of bowel ischemia (95% CI 14.3-17.9, p 0.613). CONCLUSION: Delayed surgery may be advisable in patients with AASBO and no obvious signs of strangulation due to less mortality.


Assuntos
Obstrução Intestinal , Intestino Delgado/cirurgia , Isquemia/cirurgia , Aderências Teciduais/cirurgia , Doença Aguda , Tratamento Conservador , Humanos , Obstrução Intestinal/mortalidade , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Obstrução Intestinal/terapia , Intestino Delgado/irrigação sanguínea , Intestino Delgado/patologia , Isquemia/etiologia , Isquemia/mortalidade , Isquemia/terapia , Estimativa de Kaplan-Meier , Estudos Retrospectivos , Fatores de Risco , Tempo para o Tratamento , Aderências Teciduais/complicações , Aderências Teciduais/terapia , Resultado do Tratamento
20.
Ann R Coll Surg Engl ; 103(5): e177-e179, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33682464

RESUMO

Caecal volvulus is an uncommon cause of intestinal obstruction. Diagnosis may be challenging due to lack of clinical familiarity, variable clinical presentation and misinterpretation of diagnostic imaging and procedures. This case report describes a 29-year-old male with acute intestinal obstruction secondary to caecal volvulus, on a background of recurrent caecocolic torsion. Diagnosis required repeat axial imaging and endoscopy when initial imaging studies were misinterpreted.


Assuntos
Doenças do Ceco , Volvo Intestinal , Abdome/diagnóstico por imagem , Abdome/cirurgia , Dor Abdominal/etiologia , Adulto , Doenças do Ceco/diagnóstico , Doenças do Ceco/cirurgia , Colectomia , Humanos , Ileostomia , Obstrução Intestinal/etiologia , Volvo Intestinal/diagnóstico , Volvo Intestinal/cirurgia , Masculino , Recidiva
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