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1.
N Z Med J ; 133(1521): 102-105, 2020 09 04.
Artigo em Inglês | MEDLINE | ID: mdl-32994641

RESUMO

Foreign body ingestion is not uncommon in patients with mental disorders, alcohol intoxication and for purposes of drug trafficking. Small objects pass spontaneously; however, larger ones may get stuck in the oesophagus, stomach or at narrow areas of the bowel. 'Body packers' is a term used to describe persons who swallow or insert drug-filled packets into a body cavity. They are also called 'swallowers', 'internal carriers', 'couriers' or 'mules'. We report a 37-year-old previous drug abuser who presented with dysphagia. Upper GI endoscopy showed an oblong foreign body covered in plastic in the lower oesophagus. This could not be extracted and hence was pushed into the stomach. Three weeks later, he presented with bowel obstruction that was shown on abdominal radiograph and confirmed by CT indicating multiple dilated small bowel loops with a transition point in the terminal ileum where the ingested package was identified. The package was then removed through a longitudinal enterotomy. Ingested foreign bodies causing dysphagia should ideally be extracted endoscopically. If not possible, then a watch-and-wait policy may be justified. While most ingested objects pass spontaneously, unusual and larger ones may require surgical extraction. The contents, nature and reason for ingesting this strange object remain a mystery. With history of drug abuse and the consistent denial of knowingly swallowing that object, we can only conclude that the patient was trying to transport an illicit drug in the packet.


Assuntos
Corpos Estranhos , Obstrução Intestinal , Adulto , Transtornos de Deglutição/etiologia , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Íleo/diagnóstico por imagem , Íleo/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Laparotomia , Masculino , Tomografia Computadorizada por Raios X
2.
Medicine (Baltimore) ; 99(36): e22071, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899075

RESUMO

BACKGROUND: Whether prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) offers long-term survival benefit to patients with low-grade appendiceal mucinous neoplasms (LAMNs) after resection surgery is still under heated debate. The aim of the present meta-analysis is to investigate the comparative effectiveness and safety of prophylactic HIPEC regimens in LAMNs METHODS:: A systematic search of MEDLINE, EMBASE, PubMed, Web of Science, the Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform (ICTRP), clinicaltrials.gov and controlledtrials.com will be performed. All published RCTs and quasi-RCTs through July 20, 2020 with language restricted in English will be included in this review study. Two reviewers will independently conduct the procedures of study identification, data collection, and methodological quality assessment. The primary outcomes are overall survival (OS) and disease-free survival (DFS). The secondary outcomes consist of peritonitis and sepsis, colonic fistula, chemotherapy-associated adverse events, and adhesive intestinal obstruction. The pooled odds ratios (ORs) or hazard ratios (HRs) and relative 95% confident intervals (CIs) of each outcome measurement will be calculated. EndNote X9 software will be applied to manage all citations. The Stata software version 14.0 and R x64 software version 3.5.1 will be employed for main statistical analyses. DISCUSSION: This study will employ a network meta-analysis to summarize direct and indirect evidence in the specific area to provide detailed individualized guidance on surgical management for LAMNs. REGISTRATION: This protocol was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 25 July 2020 (registration number INPLASY202070112).


Assuntos
Adenocarcinoma Mucinoso/terapia , Neoplasias do Apêndice/patologia , Hipertermia Induzida/métodos , Metanálise em Rede , Adenocarcinoma Mucinoso/mortalidade , Neoplasias do Apêndice/cirurgia , Ensaios Clínicos como Assunto , Intervalo Livre de Doença , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Humanos , Hipertermia Induzida/efeitos adversos , Fístula Intestinal/epidemiologia , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Peritonite/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Segurança , Sepse/epidemiologia , Aderências Teciduais/complicações , Aderências Teciduais/epidemiologia , Resultado do Tratamento
3.
BMC Gastroenterol ; 20(1): 269, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32799796

RESUMO

BACKGROUND: Cancer patients are at increased risk of novel coronavirus disease 2019 (COVID-19). Currently, surgeries for cancer patients with COVID-19 are generally suggested to be properly delayed. CASE PRESENTATION: We presented a 69-year-old Chinese female colon cancer patient with COVID-19, the first case accepted the surgical treatment during the pandemic in China. The patient developed a fever on January 28, 2020. After treatments with Ceftriaxone and Abidol, her fever was not moderated yet. A repeat chest computed tomography (CT) scan showed significantly exacerbated infectious lesions with a positive result for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) nucleic acid. An abdomen CT scan indicated the tumor of ascending colon with local wrapped changes. She was diagnosed with 'Severe novel coronavirus pneumonia' and 'Incomplete bowel obstruction: Colon cancer?'. After actively anti-inflammatory and anti-viral therapies, a right colectomy with lymph node dissection was performed on March 11, followed by a pathological examination. The patient successfully recovered from COVID-19 pneumonia and incomplete bowel obstruction after surgery without any postoperative related complications and was discharged on the 9th day after operation. Significant degeneration, necrosis and slough of focal intestinal and colonic mucosal epithelial cells were observed under microscope. No surgeons, nurses or anesthetists in our team were infected with SARS-CoV-2. CONCLUSIONS: It is meaningful and imperative to share our experience of protecting health care personnels from SARS-CoV-2 infection and providing references for optimizing treatment of cancer patients, at least for the operative intervention with absolute necessity or surgical emergency, during the outbreak of COVID-19.


Assuntos
Betacoronavirus/isolamento & purificação , Colectomia/métodos , Neoplasias do Colo , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Idoso , Colo Ascendente/diagnóstico por imagem , Colo Ascendente/patologia , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/patologia , Neoplasias do Colo/fisiopatologia , Neoplasias do Colo/cirurgia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Feminino , Humanos , Controle de Infecções/métodos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Pandemias/prevenção & controle , Pneumonia Viral/diagnóstico , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Pneumonia Viral/virologia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
4.
Orv Hetil ; 161(32): 1331-1338, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32750021

RESUMO

Intussusception is one of the most common abdominal emergencies in children. The understanding of its aetiology and management has changed significantly over the last decades. Earlier, the hypertrophic Peyer's patches and polyps were considered responsible, but with the knowledge obtained from the lipopolysaccharide-induced animal model of intussusception, the rotavirus vaccination, the seasonality and the postnatal changes of the enteric nervous system it became clear that the intestinal motility plays a key role in the aetiology. The efficacy of non-operative management is continuously improving. The radiologists initially moved from the hydrostatic X-ray-controlled reduction towards the air enema (pneumatic reduction), however, nowadays, there is a shift back to hydrostatic procedures but under ultrasound guidance to reduce radiation exposure. In many institutions, intussusception is managed as day-case rather than as an inpatient case. The role of medications like glucagon and cyclo-oxygenase inhibitors used during reduction manoeuvres and prevention of recurrence is still controversial. Surgical management is shifting towards laparoscopy. The authors herein reviewed the current literature to present recent insights into understanding the pathogenesis and management updates. Orv Hetil. 2020; 161(32): 1331-1338.


Assuntos
Enema/métodos , Glucagon/uso terapêutico , Glucocorticoides/uso terapêutico , Obstrução Intestinal/diagnóstico por imagem , Intussuscepção/terapia , Laparoscopia , Ultrassonografia , Criança , Enema/efeitos adversos , Humanos , Lactente , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Intussuscepção/diagnóstico por imagem , Intussuscepção/cirurgia , Radiografia , Recidiva , Prevenção Secundária
5.
Radiologe ; 60(9): 781-790, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32776239

RESUMO

Cystic fibrosis (CF) is the most common fatal autosomal recessive disease in the Caucasian population. A mutation in the cystic fibrosis transmembrane regulator protein (CFTR) gene leads to the production of abnormally viscous mucus and secretions in the lungs of these patients. A similar pathology also occurs in other organs. In the abdomen, among others the gastrointestinal tract, the pancreas, and the hepatobiliary system are affected. The involvement of the pancreas leads to its exocrine and endocrine insufficiency. Hepatic manifestations include hepatic steatosis, focal biliary and multilobular cirrhosis, and portal hypertension. Biliary complications include cholelithiasis, microgallbladder, and sclerosing cholangitis. In the gastrointestinal tract, complications such as the distal intestinal obstruction syndrome, invaginations, chronic constipation, wall thickening, and fibrosis in the colon may occur. An important renal manifestation is nephrolithiasis. With currently rapidly increasing life expectancy of patients with cystic fibrosis, complications of extrapulmonary cystic fibrosis manifestations including hepatic and gastrointestinal malignancy could be an increasing cause of morbidity and mortality of these patients. It is therefore important for radiologists to know and recognize these clinical patterns and to monitor these manifestations in follow-up exams. Previous therapy of extrapulmonary manifestations has been largely symptomatic. Fortunately, the new CFTR modulators seem to represent an effective causal therapeutic approach here.


Assuntos
Fibrose Cística , Obstrução Intestinal , Abdome/patologia , Fibrose Cística/complicações , Humanos , Obstrução Intestinal/etiologia , Pulmão , Pâncreas
6.
Medicine (Baltimore) ; 99(34): e21701, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846788

RESUMO

Obturator hernia is a relatively rare type of abdominal hernia, in which abdominal contents protrude through the obturator canal, a condition that can lead to small bowel obstruction. Its rarity and nonspecific signs and symptoms make a preoperative diagnosis difficult. The present study analyzed the clinical manifestations, diagnostic methods and operative treatment outcomes in patients with obturator hernia.Between January 2012 and October 2019, 1028 adults underwent surgical repair of abdominal wall hernia at the Department of Surgery, Kyungpook National University Hospital. The medical records of eleven patients who were treated for small bowel obstruction due to obturator hernia were retrospectively evaluated. Patient characteristics, clinical presentation, preoperative radiological diagnosis, operative findings, treatment, complications, and outcomes were recorded.All 11 patients were elderly women, with a mean age of 80.2 years (range, 71-87 years). Their mean body mass index was 17.9 kg/m (range, 11.9-22.2 kg/m). Symptoms at presentation were abdominal pain and vomiting, with a mean duration of symptoms prior to admission of 5.6 days (range, 1-15 days). Based on abdominopelvic computed tomography (CT) scans, all 11 patients were preoperatively diagnosed with obturator hernia, followed by laparoscopic exploration or laparotomy as soon as possible. Of the 11 patients, 6 (54.5%) had left-sided, four (36.4%) had right-sided, and one (9.1%) had bilateral obturator hernias. Three patients (27.3%) required resection of the ileum due to perforation or strangulation. All underwent simple closure of the hernia defect with interrupted or purse-string sutures. Ten patients recovered uneventfully, whereas one had wound seroma and ileus. Recurrence has not been observed in the 8 surviving patients.Obturator hernia should be included in the differential diagnosis of intestinal obstruction of unknown origin, especially in emaciated elderly women with chronic disease. Early surgical intervention without delay is imperative to avoid postoperative morbidity and mortality associated with intestinal strangulation due to obturator hernia. Obturator hernia can be sufficiently repaired with simple suture closure without mesh.


Assuntos
Hérnia do Obturador/patologia , Hérnia do Obturador/cirurgia , Idoso , Idoso de 80 Anos ou mais , Índice de Massa Corporal , Feminino , Hérnia do Obturador/complicações , Hérnia do Obturador/diagnóstico por imagem , Humanos , Obstrução Intestinal/etiologia , Laparoscopia/métodos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
9.
Am Surg ; 86(6): 675-684, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32683979

RESUMO

Gallstone ileus is an unusual complication of cholelithiasis. Classically, a stone is impacted at the terminal ileum originating from a cholecystoduodenal fistula. Exceptions to this pathophysiology have been noted at each step. In this systematic review, we document a comprehensive review of postcholecystectomy gallstone ileus inclusive of 49 separate cases and report 8 different mechanisms leading to this unusual complication. The most common mechanism is a lost stone during cholecystectomy that then erodes through the intestinal wall leading to bowel obstruction. Our review showed an older, female predominance (64.0%) at an average age of 68.0 years, patients typically had a burden of comorbidities. Delay in diagnosis was common (64% of cases) with the correct diagnosis made in 37.5% of patients during admission. Pneumobilia was commonly reported (29.0%). There was a wide range in the amount of time between cholecystectomy and gallstone ileus, from 10 days to 50 years (mean 12.4 years). Postcholecystectomy gallstone ileus is an unusual complication of cholelithiasis, which mandates surgery. Retrieval of stones should be undertaken if they are spilled during cholecystectomy. Owing to the increasing age of the American patient population, it is likely that a higher number of patients with this condition will be encountered.


Assuntos
Colecistectomia/efeitos adversos , Colelitíase/complicações , Cálculos Biliares/complicações , Doenças do Íleo/etiologia , Fatores Etários , Humanos , Obstrução Intestinal/etiologia , Fatores de Risco , Fatores Sexuais
10.
PLoS One ; 15(7): e0236421, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716958

RESUMO

BACKGROUND: NOD2 variants are the strongest genetic predictors for susceptibility to Crohn's disease (CD). However, the clinical value of NOD2 on an individual patient level remains controversial. We aimed to define the predictive power of the major NOD2 mutations regarding complicated CD in a large single center cohort. METHODS: 1076 CD patients were prospectively genotyped for the three common CD-associated NOD2 mutations rs2066844, rs2066845, and rs2066847, followed by detailed genotype-phenotype analyses. RESULTS: Overall, 434 CD patients (40.3%) carried at least one of the three main NOD2 mutations. A significantly higher minor allele frequency (15.6%) of the NOD2 frameshift mutation p.Leu1007fsX1008 (rs2066847) was seen in patients with aggressive disease compared to 8.2% in patients with mild disease (p = 2.6 x 10-5). Moreover, a total of 54 CD patients (5.0%) were homozygous for this NOD2 frameshift mutation. 100% of these patients had ileal disease compared to 82% of NOD2 wild-type carriers (p<0.0001). In homozygous carriers of the NOD2 frameshift mutation, 87% presented with ileal stenosis, 68.5% had fistulas, and 72.2% required CD-related surgery despite immunosuppressive therapy in 87% of these patients. All homozygous carriers of the 1007fs mutation who were active smokers had ileal stenosis and required CD-related surgery. CONCLUSION: Homozygosity for Leu1007fsX1008 is an excellent biomarker for predicting complicated CD on an individual patient level. Active smoking and homozygosity for this mutation is associated with a 100% risk for developing ileal stenosis requiring CD-related surgery. In these patients, smoking cessation and early initiation of immunosuppressive strategies may be beneficial.


Assuntos
Doença de Crohn/genética , Doença de Crohn/patologia , Doenças do Íleo/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Mutação/genética , Proteína Adaptadora de Sinalização NOD2/genética , Fumar/efeitos adversos , Adolescente , Adulto , Estudos de Coortes , Doença de Crohn/complicações , Feminino , Dosagem de Genes , Frequência do Gene/genética , Marcadores Genéticos , Predisposição Genética para Doença , Heterozigoto , Homozigoto , Humanos , Doenças do Íleo/etiologia , Modelos Logísticos , Masculino , Fenótipo , Fatores de Risco , Índice de Gravidade de Doença , Adulto Jovem
11.
Medicine (Baltimore) ; 99(23): e20629, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32502042

RESUMO

BACKGROUND: Incarcerated groin hernia (IGH) is a common surgical emergency. However, there are few accurate and applicable predictors for differentiating patients with strangulated groin hernia from those with IGH. In this study, we aimed to identify the independent risk factors for bowel resection in patients with IGH. METHODS: We retrospectively collected 323 patients who underwent emergency hernia repair surgery for IGH between January 2010 and October 2019. The patients were categorized into those who received bowel resection and those who did not require bowel resection. The receiver-operating characteristic curve was used to identify the best cutoff values for continuous variables. Following this, univariate and multivariate analyses were performed to identify potential risk factors for bowel resection in these patients. RESULTS: Univariate analysis identified 6 variables that were significantly associated with bowel resection among patients with IGH. On multivariate analysis, neutrophil-to-lymphocyte ratio (NLR) (odds ratio [OR] = 3.362, 95% confidence interval [CI] 1.705-6.628, P = .000) and bowel obstruction (OR = 3.191, 95% CI 1.873-5.437, P = 0.000) were identified as independent risk factors for bowel resection among patients with IGH. CONCLUSION: In this study, an elevated NLR and those with bowel obstruction are associated with an increased risk of bowel resection among patients with IGH. Based on our findings, surgeons should prioritize prompt emergency surgical repair for patients who present with elevated NLR and bowel obstruction concurrent with IGH.


Assuntos
Hérnia Inguinal/cirurgia , Herniorrafia/efeitos adversos , Obstrução Intestinal/cirurgia , Estudos de Casos e Controles , Emergências , Feminino , Hérnia Inguinal/complicações , Herniorrafia/métodos , Humanos , Obstrução Intestinal/etiologia , Linfócitos/metabolismo , Masculino , Neutrófilos/metabolismo , Estudos Retrospectivos , Fatores de Risco
12.
Khirurgiia (Mosk) ; (6): 24-30, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32573528

RESUMO

OBJECTIVE: To study and systematize clinical symptoms of tuberculous perivisceritis, to clarify diagnostic value of laboratory and instrumental survey in these patients and to identify the features of surgical treatment. MATERIAL AND METHODS: There were 8 patients with tuberculous perivisceritis. Examination included computed tomography of the abdominal cavity and chest, ultrasound, laparoscopy. All patients underwent surgical treatment with histological, cytological, microbiological and molecular genetic analysis of peritoneal exudate and biopsy of peritoneal specimens. RESULTS: Clinical picture of tuberculous perivisceritis is variable and non-specific. Periods of exacerbation are replaced by periods of prolonged remission. The complex of radiological survey used in verification of perivisceritis does not allow accurate determining the nature of disease. However, peritoneal tuberculosis may be suspected as a rule considering signs of thickening of the peritoneum. Objective confirmation of perivisceritis is possible only during surgical intervention. In this case, etiological factor can be established only after a thorough histological examination of resected fibrous capsule. CONCLUSION: Clinical picture of tuberculous perivisceritis does not have specific symptoms. The disease is characterized by prolonged and undulating course. Acute peritonitis and acute intestinal obstruction may be suspected during exacerbation of the pathological process. Laparotomy followed by complete excision of fibrous capsule and adhesiolysis is preferred.


Assuntos
Peritônio/cirurgia , Peritonite Tuberculosa/diagnóstico , Peritonite Tuberculosa/cirurgia , Aderências Teciduais/cirurgia , Doença Aguda , Fibrose/microbiologia , Fibrose/cirurgia , Humanos , Obstrução Intestinal/etiologia , Peritônio/microbiologia , Peritônio/patologia , Aderências Teciduais/microbiologia
13.
Radiologe ; 60(9): 831-838, 2020 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-32495009

RESUMO

CLINICAL ISSUE: Abdominal complications are often the first indications for cystic fibrosis (CF), a multiorgan disease. A broad range of abdominal manifestations are associated with the disease, including gastrointestinal abnormalities (such as meconium ileus in newborns and distal intestinal obstruction syndrome in older children) and hepatobiliary alterations (e.g., cholelithiasis, microgallbladder, hepatosteatosis, biliary cirrhosis). A characteristic finding is pancreatic involvement, which leads to exocrine and over the course of time to endocrine insufficiency. STANDARD RADIOLOGICAL METHODS: Ultrasonography is the preferred and often sole modality for a precise diagnosis of abdominal CF manifestations. However, all imaging modalities can be used, depending on the pathology: X­ray, fluoroscopic examinations, computed tomography, magnetic resonance imaging (also with application of magnetic resonance cholangiopancreatography). METHODICAL INNOVATIONS/PERFORMANCE: Scoring systems are useful for standardized diagnostics. Sonographic findings, described using a scoring system, correlate with clinical symptoms, such as pancreatic lipomatosis with abdominal pain (p = 0.018), flatulence (p = 0.006), and gastroesophageal reflux (p = 0.006). EVALUATION/PRACTICAL RECOMMENDATIONS: A standardized approach with structured reporting is important due to the numerous abdominal CF manifestations. To enable precise follow-up analyses, scoring systems based on sonographic findings are excellent.


Assuntos
Abdome , Fibrose Cística , Obstrução Intestinal , Abdome/diagnóstico por imagem , Adolescente , Idoso , Criança , Fibrose Cística/complicações , Fibrose Cística/diagnóstico por imagem , Humanos , Recém-Nascido , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Pâncreas/diagnóstico por imagem , Tomografia Computadorizada por Raios X
14.
Gan To Kagaku Ryoho ; 47(4): 718-721, 2020 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-32389995

RESUMO

In December 20XX-1, abdominal enhanced CT of a 73-year-old female patient showed a 28mm-in-diameter pancreatic tail cancer with splenic venous invasion. She underwent neoadjuvant GEM/TS-1 combination chemotherapy but abandoned this chemotherapy due to melena and exanthema. She underwent a distal pancreatectomy with lymph node dissemination. In these pathological findings, the tumor was diagnosed as a pancreatic tail cancer with splenic venous invasion(T3, N0, M0, Stage ⅡA). She underwent adjuvant GEM chemotherapy, but she abandoned this chemotherapy due to exanthema and was managed with observation. In September 20XX, she had a postoperative bowel obstruction and was treated with natural light. However, she had a postoperative bowel obstruction again in July, 20XX+1. Fluoroscopic images revealed stenosis in the intestine located 170 cm from the nasal cavity. She underwent open surgery to manage the bowel obstruction. There was a peritoneal tumor with adhesion to each intestine serosa in 3 areas located 80 cm, 100 cm, and 150 cm from the Treitz ligament. Therefore, she underwent a small intestine resection and anastomosis 70 cm to 110 cm from the Treitz ligament. Pathological findings showed that there was a 3mm-in-diameter adenocarcinoma in this peritoneal tumor. In these findings, this final diagnosis was an adhesive intestinal obstruction caused by peritoneal metastasis. Curative resection for single peritoneal recurrent metastasis might be useful for prognosis prolongation.


Assuntos
Obstrução Intestinal , Neoplasias Pancreáticas , Neoplasias Peritoneais , Idoso , Feminino , Humanos , Obstrução Intestinal/etiologia , Pancreatectomia , Neoplasias Pancreáticas/cirurgia , Neoplasias Peritoneais/secundário , Peritônio
16.
Clin Imaging ; 65: 37-46, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32353717

RESUMO

Upper gastrointestinal obstruction (UGIO), obstruction occurring at the level of the stomach or duodenum, represents only about 5% of bowel obstructions. As with other bowel obstructions, timely diagnosis is necessary to prevent complications including ischemia and death. Because the presenting symptoms of UGIO can be vague and nonspecific, the diagnosis may not be suspected clinically. The radiologist therefore provides immense value as the diagnosis and often the etiology of the obstruction can be ascertained through imaging. Here we present a simple classification scheme of etiologies of UGIO into congenital, malignant, infectious/inflammatory, and mechanical categories, and provide examples of the most common and some uncommon causes for each category. We highlight that several of the congenital etiologies of UGIO can present at any age, including adulthood, and therefore it is important for the radiologist to keep these diagnoses in mind when reviewing cases of UGIO. For each etiology, we provide typical imaging strategies that are used for diagnosis as well as key points regarding the diagnosis.


Assuntos
Obstrução Duodenal/diagnóstico por imagem , Obstrução da Saída Gástrica/diagnóstico por imagem , Obstrução Intestinal/etiologia , Adulto , Duodeno , Feminino , Obstrução da Saída Gástrica/complicações , Humanos , Masculino
17.
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
18.
Medicine (Baltimore) ; 99(18): e19944, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358366

RESUMO

INTRODUCTION: Slow transit constipation is a major cause of chronic constipation. During pregnancy, changes in hormone levels and the physical effects of an enlarged uterus could cause new onset slow transit constipation or aggravate a pre-existing constipation. The management of slow transit constipation-induced ileus during pregnancy is a medical dilemma. PATIENT CONCERNS: A 28-year-old pregnant woman presented to the emergency department with a 7-day history of worsening bloating and abdominal colic. The patient was in her third trimester (27 weeks). She had a 5-year history of constipation which had worsened with her pregnancy, and neither flatus nor stool could be passed. DIAGNOSIS: Based on the constipation history and computed tomography, a slow transit constipation-induced ileus was confirmed. INTERVENTIONS: As medications for the management of constipation and endoscopic efforts to remove the blockage were ineffective and the patient's symptoms worsened, Cesarean section and colectomy with ileorectal anastomosis were performed. OUTCOMES: After the procedure, the patient recovered and defecated well. At the 6-month follow-up, the patient reported that she defecated two to three times per day without difficulty. CONCLUSION: Pregnancy can worsen pre-existing constipation and cause ileus. In cases where drug treatment is unsuccessful, colectomy, and ileorectal anastomosis may be necessary.


Assuntos
Constipação Intestinal/complicações , Íleus/etiologia , Íleus/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Adulto , Cesárea , Colectomia/métodos , Feminino , Humanos , Gravidez
19.
J Laparoendosc Adv Surg Tech A ; 30(5): 485-487, 2020 May.
Artigo em Inglês | MEDLINE | ID: covidwho-96783

RESUMO

Introduction: The recent COVID-19 pandemic outbreak has made surgeons change and take on newer strategies and safe exercises. All elective cases have been put off, but oncology cases need to be done to prevent progression of the disease. There is concern about minimally invasive surgery due to aerosol formation. Here we discuss how we have dealt with this in our colorectal surgery department taking into account current evidence about the danger of viral transmission during laparoscopic surgery. Discussion: We report a case of 28 years old female patient with carcinoma rectum. The patient had near total intestinal obstruction. She was operated on utilizing laparoscopic anterior resection. The air seal (CONMED, Utica, NY) and high-efficiency particulate air (HEPA) filter was utilized for safe gas evacuation. There is no evidence against laparoscopic surgery, which suggest viral transmission. One should take utmost precautions using N95 masks and personal protective equipment (PPE). Air filtration products like aerosol, HEPA filters will be of great aid in safe evacuation of gases. Conclusion: At present, there is no solid evidence to suggest viral transmission through surgical smoke. We believe due to effective smoke containment, less blood loss, and less postoperative stay, laparoscopy will be a non-inferior option than open surgical procedure. We advise taking all precautions for operating room staff to lessen the danger of transmission.


Assuntos
Colectomia/métodos , Infecções por Coronavirus , Controle de Infecções/normas , Obstrução Intestinal/cirurgia , Laparoscopia/métodos , Pandemias , Pneumonia Viral , Neoplasias Retais/cirurgia , Adulto , Feminino , Humanos , Controle de Infecções/métodos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Obstrução Intestinal/etiologia , Laparoscopia/normas , Neoplasias Retais/complicações
20.
Khirurgiia (Mosk) ; (3): 67-73, 2020.
Artigo em Russo | MEDLINE | ID: mdl-32271740

RESUMO

OBJECTIVE: To analyze acute complications of stromal gastrointestinal tumors and determine diagnosis and optimal treatment of these patients. MATERIAL AND METHODS: There were 33 patients with acute complications of GIST aged 40-74 years. RESULTS: Acute complications were presented by gastrointestinal and (or) intratumoral (interstitial) bleeding (n=31). Hemorrhage was combined with stomach perforation in 1 case, intussusception and obstruction of the duodenum in 1 patient, small bowel obstruction in 2 patients. All findings were confirmed by the marker CD 117 (+). One patient died in long-term period after R0-resection and chemotherapy. Targeted therapy was used in 2 patients. CONCLUSION: Clinical examples indicate the progress in diagnosis and treatment of GIST due to development of instrumental imaging techniques, histological and histochemical verification of the process.


Assuntos
Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/terapia , Adulto , Idoso , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Tumores do Estroma Gastrointestinal/diagnóstico , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Intestino Delgado , Intussuscepção/etiologia , Intussuscepção/terapia , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas c-kit/análise
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