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1.
Rev Med Chil ; 149(3): 464-468, 2021 Mar.
Artigo em Espanhol | MEDLINE | ID: mdl-34479326

RESUMO

Small intestine neuroendocrine tumors (NET-SI) are relatively rare neoplasms. If encountered, the most common location is the ileum. Symptoms are usually non-specific, delaying the tumors diagnosis. NET-SI are often small in size and can be challenging to recognize on imaging studies. However, they have a tendency to induce a pronounced fibrotic reaction in the mesentery, often accompanied by large calcified mesenteric adenopathies. In some cases, the fibrotic reaction can produce rare complications, such as intestinal obstruction or vascular congestion with occasional secondary ischemia. This case report presents a 79-year-old male with a partial small bowel obstruction caused by a fibrotic reaction and mesenteric adenopathies of a well-differentiated neuroendocrine tumor of the ileum. The patient also presented multiple peritoneal metastases at diagnosis. Characteristic imaging findings of the tumor, allowed an accurate and early diagnosis. Once the acute episode was resolved, the diagnosis was confirmed with an image guided biopsy.


Assuntos
Neoplasias Intestinais , Obstrução Intestinal , Tumores Neuroendócrinos , Idoso , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Intestino Delgado/diagnóstico por imagem , Linfonodos , Masculino , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico por imagem
2.
Am J Case Rep ; 22: e932280, 2021 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-34482359

RESUMO

BACKGROUND Intussusception is the most common cause of intestinal obstruction in children, with a peak incidence usually before the second year of age, while in neonates it is a rare entity. We describe a delayed and incidental diagnosis of neonatal intussusception secondary to Meckel's diverticulum in a neonate with shaken baby syndrome (SBS). This is, to the best of our knowledge, the first reported case of a neonatal intussusception with a Meckel's diverticulum as a lead point in a neurologically impaired child. CASE REPORT A term baby presented at 22 days of age at our Emergency Department in severe conditions due to a suspected SBS. Eight days following hospitalization in the Intensive Care Unit, an isolated episode of rectal bleeding occurred, without any worsening of general conditions or abdominal distension. The ultrasonography showed a "doughnut sign" with high suspicion of ileocecal intussusception. A rectal barium contrast enema was performed but was not resolutive. At exploratory laparotomy an ileocecal intussusception with Meckel's diverticulum acting as a lead point was identified and an intestinal resection was needed due to the ischemic condition of the ileum. The post-operative course was uneventful and the baby recovered well; the residual neurological impairment needed long-term follow-up. CONCLUSIONS Intussusception is a rare entity in neonates and, when severe neurological impairment is present, the diagnosis can be missed because of the compromised condition of the baby and the paucity of gastrointestinal manifestations. In addition, due to the high incidence of lead point in neonatal cases, we recommend reserving non-operative treatment only for selected cases.


Assuntos
Obstrução Intestinal , Intussuscepção , Divertículo Ileal , Criança , Humanos , Íleo , Lactente , Recém-Nascido , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intussuscepção/diagnóstico por imagem , Intussuscepção/etiologia , Divertículo Ileal/complicações , Divertículo Ileal/diagnóstico por imagem , Ultrassonografia
3.
Pan Afr Med J ; 39: 86, 2021.
Artigo em Francês | MEDLINE | ID: mdl-34466188

RESUMO

Meckel´s diverticulum is the most common congenital anomaly affecting the gastrointestinal tract resulting from failure of involution of the omphalomesenteric duct. This anomaly is most often asymptomatic and may be revealed by a complication, such as intussusception. This study reports the diagnostic pathway and the management of an 18-year-old female patient admitted to the Emergency Department with ileoileal invagination due to Meckel´s diverticulum complicated by occlusion. This study is interesting because it provides an overview of this rare disease whose diagnosis, based on abdominal scanner, must be made early in order to prevent small bowel perforation or necrosis. Bowel resection without desinvagination is the gold standard treatment.


Assuntos
Obstrução Intestinal/etiologia , Intussuscepção/etiologia , Divertículo Ileal/diagnóstico , Adolescente , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Obstrução Intestinal/cirurgia , Intussuscepção/cirurgia , Divertículo Ileal/complicações , Divertículo Ileal/cirurgia
4.
BMJ Case Rep ; 14(8)2021 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433526

RESUMO

A 50-year-old woman was admitted to our emergency surgery department with 1-week history of abdominal pain, distension, vomiting and constipation. On examination, she has a distended abdomen with sluggish bowel sounds, but no clinical signs of peritonitis. Blood tests were normal except for the increased white cell count and erythrocyte sedimentation rate (ESR). CT scan with oral as well as intravenous contrast demonstrated the small bowel obstruction without any insight into the aetiology of the disease. Intraoperatively, the right fallopian tube was found to encircle the terminal ileum. A right salpingo-oophorectomy was performed to release the bowel. This case report describes a rare cause of the small bowel obstruction in female patients.


Assuntos
Tubas Uterinas , Obstrução Intestinal , Dor Abdominal/etiologia , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
5.
BMJ Case Rep ; 14(8)2021 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404648

RESUMO

Blunt abdominal trauma can affect mesenteric circulation which may lead to bowel strictures. Indocyanine green (ICG) angiography can be used to assess mesenteric blood flow and bowel perfusion as a guide to resect length intraoperatively. But this concept has not been applied to ischaemic bowel strictures. We present a case of ischaemic ileal stricture induced by blunt abdominal trauma which was managed by resection and anastomosis. Intraoperative near-infrared (NIR) ICG angiography was used as a guide to resect the bowel length. This case emphasises that ischaemic bowel strictures should be suspected in patients presenting with intestinal obstruction following trauma. Resection and anastomosis of the affected segment remains the primary treatment modality with excellent outcomes. NIR ICG angiography is a real-time objective and useful resource for assessing bowel perfusion and could be used to determine the length of the segment to be resected in patients with ischaemic bowel stricture.


Assuntos
Verde de Indocianina , Obstrução Intestinal , Anastomose Cirúrgica , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Fluorescência , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia
6.
Am J Case Rep ; 22: e931398, 2021 Aug 04.
Artigo em Inglês | MEDLINE | ID: mdl-34344857

RESUMO

BACKGROUND Obturator hernia is an uncommon (0.07-1% incidence rate) subtype of hernia of the abdominal wall, with its incarceration being a rare cause of bowel obstruction. Obturator hernia has a higher incidence in elderly women and in malnourished people. This type of hernia has the highest morbidity and mortality rates of all abdominal wall hernias. This article reports a case of an emaciated 93-year-old woman who presented with small bowel obstruction due to incarcerated obturator hernia, successfully managed surgically with a modified mesh-plug hernioplasty. CASE REPORT An emaciated 93-year-old woman presented with diffuse abdominal pain, more intense on the right iliac fossa, radiating to the right thigh, with 8-h evolution and associated with dark-colored vomiting but normal bowel transit. This patient had a surgical history of right Richter´s femoral hernia, strangulated, with previous intestinal resection and a right femoral hernioplasty. A computed tomography (CT) scan revealed an incarcerated obturator hernia on the right side containing a short segment of small intestine. The patient underwent an exploratory laparotomy and a mesh-plug hernioplasty. During follow-up, there was no evidence of recurrence or complications. CONCLUSIONS Obturator hernia diagnosis is challenging due to its rarity and its signs and symptoms being often unspecific. CT scan has the highest sensitivity and is the best diagnostic tool. Surgical management is the only possible treatment for obturator hernia. Awareness of this condition is essential to allow an earlier approach and attempt to mitigate the associated high morbidity and mortality rates.


Assuntos
Parede Abdominal , Hérnia do Obturador , Obstrução Intestinal , Dor Abdominal , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia do Obturador/complicações , Hérnia do Obturador/diagnóstico por imagem , Hérnia do Obturador/cirurgia , Herniorrafia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Telas Cirúrgicas
7.
J Med Case Rep ; 15(1): 397, 2021 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-34289914

RESUMO

BACKGROUND: Ileoileal knotting is one of the rarest causes of intestinal obstruction. The pathology involves knotting of the ileum around itself, leading to mechanical intestinal obstruction that can rapidly evolve to gangrene. CASE PRESENTATION: Here we will discuss the case of an 18-year-old Oromo girl who presented with sudden onset of severe abdominal pain and signs of generalized peritonitis.Ultrasound examination showed massive peritoneal and cul-de-sac fluid. Explorative laparotomy was done, with a tentative diagnosis of ruptured ovarian cyst. Intraoperative finding was a gangrenous ileoileal knot. The gangrenous segment was resected and ileotransverse anastomosis done. Postoperative course was uneventful, and the patient was discharged improved on the sixth postoperative day. CONCLUSION: We present this case to highlight the diagnostic difficulty that one can face in females of child-bearing age and to create awareness of this rare cause of intestinal obstruction, as morbidity and mortality are very high because of rapid progression to gangrene.


Assuntos
Obstrução Intestinal , Dor Abdominal , Adolescente , Feminino , Gangrena/etiologia , Gangrena/cirurgia , Humanos , Íleo/diagnóstico por imagem , Íleo/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado
8.
Am J Case Rep ; 22: e932419, 2021 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-34301913

RESUMO

BACKGROUND Capsule endoscopy has played a significant role in small bowel investigation, providing the opportunity of detecting neoplastic lesions to a greater degree and at an earlier stage than other diagnostic procedures. Failure to excrete the capsule with the feces within 48 h can lead to capsule retention with increased risk of further complications such as bowel obstruction and perforation. Capsule retention can remain undetected in case of incomplete follow-up and poor patient compliance. Acute small bowel obstruction as late as many months following capsule endoscopy investigation is very rare, with only a few cases reported in the published literature. We herein report a rare case of prolonged capsule retention which remained undiagnosed, resulting in small bowel obstruction 6 months after the initial investigation. CASE REPORT An 82-year-old woman presented with abdominal pain and symptoms suggestive of intestinal obstruction. The patient history included a capsule endoscopy investigation because of episodes of abdominal pain 6 months prior to admission. Both the outcome of the investigation and the excretion of the capsule remained undetermined due to her history of dementia and follow-up failure. Radiologic investigations identified the capsule causing small bowel obstruction. Upon surgery, the capsule was found to be impacted in a stenotic small bowel lesion, and a segmental small bowel resection was performed. Histologic examination revealed the presence of a stenotic small bowel neuroendocrine tumor. CONCLUSIONS Appropriate follow-up is necessary to diagnose the complication of capsule retention which, if it remains unrecognized, can cause life-threatening complications as late as many months after capsule endoscopy.


Assuntos
Endoscopia por Cápsula , Neoplasias Intestinais , Obstrução Intestinal , Tumores Neuroendócrinos , Idoso de 80 Anos ou mais , Feminino , Humanos , Neoplasias Intestinais/complicações , Neoplasias Intestinais/diagnóstico , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Intestino Delgado/diagnóstico por imagem
9.
J Med Case Rep ; 15(1): 356, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34238340

RESUMO

BACKGROUND: Uterine artery embolization in the treatment of uterine leiomyoma has been rarely associated with dislodgement and expulsion of infarcted uterine fibroids through the vagina, peritoneum, or bowel wall, predominantly occurring within 6 months of uterine artery embolization. CASE PRESENTATION: We present the case of a 54-year-old African American woman who underwent uterine artery embolization 11 years prior and developed mechanical small bowel obstruction from the migration of fibroid through a uteroenteric fistula with ultimate impaction within the distal small bowel lumen. Small bowel resection and hysterectomy were curative. CONCLUSIONS: Uteroenteric fistula with small bowel obstruction due to fibroid expulsion may present as a delayed finding after uterine artery embolization and requires heightened awareness.


Assuntos
Embolização Terapêutica , Obstrução Intestinal , Leiomioma , Embolização da Artéria Uterina , Doenças Uterinas , Neoplasias Uterinas , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Leiomioma/complicações , Leiomioma/cirurgia , Pessoa de Meia-Idade , Resultado do Tratamento , Neoplasias Uterinas/complicações , Neoplasias Uterinas/cirurgia
10.
Ann Ital Chir ; 102021 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-34230436

RESUMO

Mirizzi Syndrome (MS) is a rare gallbladder disease described by Argentine surgeon, Pablo Luis Mirizzi in 1948. It concerns a wide range of clinical manifestations, including gallstone obstruction of the intestine. The modified classification by Csendes distinguishes five types of MS. The case described by the authors of this paper could be classified as type Vb, which means MS with a complication of obstruction. A 74-year-old woman with nonspecific, permanent, diffuse abdominal pain and bile vomiting was admitted to the emergency department where conservative treatment was administered. Based on the preoperative diagnosis of ileus, the patient was qualified for a laparotomy. The patient had a cholecystoduodenal fistula which was responsible for the displacement of the stone into the intestinal lumen and consequently for the mechanical obstruction of the intestine. It must be taken into account that the clinical manifestation of MS may be biliary obstruction, as occurred in the case presented below. Biliary symptoms may occur, but this is not a common situation, whereas half of patients with an obstruction have a history of biliary disease. The case presented here can be a valuable lesson in being mindful of the possibility of elderly and female patients developing biliary obstruction, even without having a history of chronic gallstone disease. Therefore, a meticulous intraoperative inspection should be performed in such cases in order to search for possible fistulas. KEY WORDS: Cholecystoduedenal fistula, Gallstone disease, Mirizzi syndrome.


Assuntos
Cálculos Biliares , Íleus , Fístula Intestinal/cirurgia , Obstrução Intestinal , Síndrome de Mirizzi , Idoso , Feminino , Cálculos Biliares/complicações , Cálculos Biliares/cirurgia , Humanos , Íleus/etiologia , Íleus/cirurgia , Fístula Intestinal/complicações , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Síndrome de Mirizzi/etiologia , Síndrome de Mirizzi/cirurgia , Reoperação
11.
J Laparoendosc Adv Surg Tech A ; 31(8): 881-889, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34265212

RESUMO

Crohn's disease (CD) is a pan-intestinal disease of the gastrointestinal tract characterized by inflammatory, penetrating, and fibrostenotic phenotypes. Fibrostenotic stricture formation, without inflammatory or penetrating disease, is a common complication in CD, primarily affecting the small intestine and leading to small bowel obstruction. Because there is no medical therapy that prevents or reverses stricturing disease, endoscopic and surgical treatments are the mainstays of treatment, indicated to palliate symptoms and treat the complications. Endoscopic approaches include dilation, stricturotomy, and endoscopic stenting. Surgical options include resection, intestinal bypass, and various strictureplasty techniques. In this article, we will focus on the treatment of stricturing CD: specifically, the considerations important in choosing between different treatment options and technical tips to deal with complicated disease.


Assuntos
Doença de Crohn , Obstrução Intestinal , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Doença de Crohn/complicações , Doença de Crohn/cirurgia , Dilatação , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado , Resultado do Tratamento
13.
Pediatr Emerg Care ; 37(8): e488-e490, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34267160

RESUMO

ABSTRACT: Superior mesenteric artery syndrome (SMAS) is an uncommon condition that can lead to upper gastrointestinal obstruction. Although SMAS is a rare diagnosis, our patient, a 13-year-old adolescent boy with no relevant medical or surgical history, had a classical presentation of the disorder. In this article, we discuss the risk factors, common presentation, and treatment options of SMAS, and why it is important to consider in the differential diagnosis of a pediatric patient presenting with bilious emesis and no other risk factors for intestinal obstruction.


Assuntos
Obstrução Intestinal , Síndrome da Artéria Mesentérica Superior , Adolescente , Criança , Diagnóstico Diferencial , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Fatores de Risco , Síndrome da Artéria Mesentérica Superior/diagnóstico , Síndrome da Artéria Mesentérica Superior/diagnóstico por imagem , Vômito/etiologia
14.
Medicine (Baltimore) ; 100(27): e26616, 2021 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-34232219

RESUMO

ABSTRACT: There has been increased use of self-expandable metal stents (SEMS) in treating malignant colorectal obstruction (MCO). The aim of this study was to investigate factors that are associated with the outcomes of SEMS placement for MCO.Clinical data from patients who underwent SEMS placement for MCO at 6 hospitals in Honam province of South Korea between 2009 and 2018 were reviewed retrospectively. Eight hundred two patients were identified and their data were analyzed. Technical success, clinical success, complications, and predictors of outcome were included as main outcome measures.Technical and clinical success rates were 98.8% (792/802) and 90.1% (723/802), respectively. Complications including stent migration, stent occlusion due to tumor ingrowth and outgrowth, perforation, bacteremia/fever, and bleeding occurred in 123 (15.3%) patients. In multivariate regression analyses, procedure time was significantly associated with the technical success of SEMS placement (P = .001). Longer length of obstruction, the use of covered stent, and longer procedure time were significant independent predictive factors for the clinical success of SEMS placement (odds ratio [OR] 0.974 (95% confidence interval [CI] 0.950-0.990); P = .043, OR 0.255 (95% CI 0.138-0.471); P < .001, and OR 0.957 (95% CI 0.931-0.984); P = .002, respectively). Stage IV colorectal cancer and the use of covered stent were significant independent predictive factors for the development of complications after SEMS placement (OR 2.428 (95% CI 1.407-4.188); P = .001 and OR 3.329 (95% CI 2.060-5.378); P < .001, respectively).Longer length of obstruction, the use of covered stent, and longer procedure time were associated with lower clinical success rates. Having stage IV colorectal cancer and the use of covered stents were associated with an increased risk of complications.


Assuntos
Neoplasias Colorretais/complicações , Obstrução Intestinal/cirurgia , Cuidados Paliativos/métodos , Stents Metálicos Autoexpansíveis , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
Am J Case Rep ; 22: e932132, 2021 Jul 13.
Artigo em Inglês | MEDLINE | ID: mdl-34255765

RESUMO

BACKGROUND Internal hernias involve protrusion of the small bowel through a peritoneal or mesenteric space in the abdominal or pelvic cavity. Congenital internal small bowel hernias are rare and patients with them usually present with small bowel obstruction (SBO) at a young age, whereas in older patients, internal small bowel hernias usually are acquired secondary to previous surgery. The present report is of a rare case of SBO due to dual congenital internal small bowel hernias in a 51-year-old man with no history of abdominal surgery. CASE REPORT We report a case of dual congenital internal hernias of the small bowel in a patient who presented with symptoms and signs of SBO. He had no history of abdominal trauma, surgery, or comorbid conditions. His abdomen was mildly distended with minimal tenderness in the upper left quadrant but there was no guarding or rebound tenderness. Abdominal X-rays confirmed the SBO. A contrast-enhanced computed tomography scan of the patient's abdomen revealed SBO with transition at 2 points, suggestive of a closed-loop obstruction. However, the exact cause of the SBO was confirmed at laparotomy, which revealed dual internal hernias (intramesosigmoid and paraduodenal). The hernias were managed individually and the patient had a successful outcome after surgery. CONCLUSIONS Although the present report is of a rare presentation of internal small bowel hernia, the case underscores that patients with this condition may present with SBO. Successful surgical management requires knowledge of the intra-abdominal peritoneal spaces and management of the hernia sac.


Assuntos
Hérnia Abdominal , Obstrução Intestinal , Dor Abdominal , Hérnia Abdominal/complicações , Hérnia Abdominal/diagnóstico por imagem , Hérnia Abdominal/cirurgia , Humanos , Hérnia Interna , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Masculino , Pessoa de Meia-Idade
16.
Ann Palliat Med ; 10(7): 7378-7387, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34263636

RESUMO

BACKGROUND: Preoperative intestinal decompression, such as self-expandable metallic stents (SEMS) and transanal decompression tubes (TDT), has been widely used for patients with malignant large-bowel obstruction (MLBO). The aim of this study is to evaluate the clinical outcomes of SEMS for MLBO as a bridge to surgery compared to TDT. METHODS: We searched three databases, including PubMed, Embase, and Web of Science from inception until June 12, 2019. Risk ratio (RR) or weight mean difference (WMD) with 95% CIs was used to calculate the data extracted from included studies. RESULTS: Five studies with 226 participants were included in this review. SEMS insertion showed significantly higher clinical success rate (RR =1.30, 95% CI: 1.06, 1.60; P=0.012) and technical success rate (RR =1.33, 95% CI: 1.07, 1.65; P=0.011), as well as higher rates of solid food intake (RR =27.15, 95% CI: 8.73, 84.45; P<0.001) and temporal discharge (RR =64.47, 95% CI: 9.10, 456.57; P<0.001), as compared with TDT insertion. Moreover, SEMS insertion significantly reduced the blood loss (WMD =-69.73 mL, 95% CI: -81.61, -57.85; P<0.001), and prolonged the operative time (WMD =93.49 minutes, 95% CI: 14.24, 172.75; P=0.021) in the treatment of MLBO. Duration of hospital stay, complication rate and mortality rate were comparable between the two treatments. DISCUSSION: Preoperative SEMS insertion offered better effects for MLBO, including higher success rate, and higher rates of solid food intake and temporary discharge, compared with TDT.


Assuntos
Neoplasias Colorretais , Obstrução Intestinal , Descompressão , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Estudos Retrospectivos , Stents , Resultado do Tratamento
17.
BMC Surg ; 21(1): 309, 2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34253214

RESUMO

BACKGROUND: Small bowel obstruction (SBO) is common and usually requires surgical intervention. Intestinal plication is a traditional but critical strategy for SBO in certain scenarios. This study is to compare the short-term and long-term outcome between internal and external plications in the management of SBO. METHODS: All patients receiving intestinal plication in our hospital were retrospectively collected. Short-term outcome including postoperative complications, reoperation, postoperative ICU stay, starting day of liquid diet and postoperative hospitalization, as well as long-term outcome including recurrence of obstruction, readmission, reoperation and death were compared between groups. Gut function at annual follow-up visits was evaluated as well. RESULTS: Nine internal and 11 external candidates were recruited into each group. The major causes of plication were adhesive obstruction, abdominal cocoon, volvulus and intussusception. Lower incidence of postoperative complication (p = 0.043) and shorter postoperative hospitalization (p = 0.049) was observed in internal group. One patient receiving external plication died from anastomosis leakage. During the 5-year follow-up period, the readmission rate was low in both groups (22.2 % vs. 9.1 %), and none of patients required reoperation or deceased. None of patients exhibited gut dysfunction, and all patients restored normal gut function after 4 years. Patients in external group demonstrated accelerated recovery of gut function after surgery. CONCLUSIONS: This study compares short-term and long-term outcome of patients receiving internal or external intestinal plication. We suggest a conservative attitude toward external plication strategy. Surgical indication for intestinal plication is critical and awaits future investigations.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Obstrução Intestinal , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/cirurgia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Reoperação , Estudos Retrospectivos
18.
ANZ J Surg ; 91(7-8): 1596-1603, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34125472

RESUMO

BACKGROUND: Obturator hernia is a rare pelvic hernia associated with a high morbidity and mortality. It most commonly occurs in elderly, multiparous females with symptoms and signs of small bowel obstruction. We present an Australian hospital network experience on emergency presentations of obturator hernias highlighting differences between clinical profile and surgical management. METHODS: A retrospective review of adult patients diagnosed with acute obturator hernia during a 10 year period (2010-2020) was conducted across 10 major Sydney hospitals in New South Wales, Australia. RESULTS: Obturator hernia was diagnosed in 18 patients (mean 82.7 years, range: 60-96 years old), all confirmed on pre-operative computed tomography imaging. The most common presentations were elderly women demonstrating clinical features of a small bowel obstruction. The mean onset of symptoms from home to hospital admission was 49.4 h. Non-survivors had a significantly elevated urea level (15.6 vs. 7.8 mmol/L, p = 0.036) at presentation and a longer delay from onset of presenting symptoms to diagnosis (84.0 vs. 36.2 h, p = 0.028). Eleven patients underwent urgent laparotomy and six laparoscopic repairs. The mean operative time was 101.0 min. The average hospital length of stay was 16.2 days with a mortality rate of 27.8%. CONCLUSION: Timely diagnosis and operative intervention for obturator hernia is the cornerstone of management.


Assuntos
Hérnia do Obturador , Obstrução Intestinal , Idoso , Austrália/epidemiologia , Feminino , Hérnia do Obturador/diagnóstico por imagem , Hérnia do Obturador/epidemiologia , Hérnia do Obturador/cirurgia , Herniorrafia , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Estudos Retrospectivos
19.
Ann Ital Chir ; 922021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34085987

RESUMO

AIM: Presenting an extraordinary cause of intestinal obtuction, leading to incarcerated obturator hernia. CASE REPORT: We present a rare case of obturator hernia in a 90-year-old female, who presented with a three-day history of inability to defecate and abdominal pain, distension, and vomiting on the day of presentation. Hours later, a computed tomography scan revealed a bowel obstruction secondary to a right-sided obturator hernia. She underwent an emergency exploratory laparotomy and the incarcerated bowel was reduced with a repairment of the hernial defect. The patient demonstrated an uneventful postoperative period and was discharged on hospital day four. DISCUSSION: Obturator hernia, a rare anterior abdominal wall hernia, in which abdominal contents protrude through the obturator canal, is an unusual cause of intestinal obstruction. It has one of the highest mortality rates of all abdominal wall hernias with a challenging diagnosis that can still be misleading even to the most experienced surgeons. CONCLUSION: Providers should be aware of inability to defecate, abdominal pain, distension, and vomiting that may be due to an existence of incarcerated/strangulated obturator hernia, thus the further evaluation should be considered as the elements of the clinical picture are incongruent. KEY WORDS: Emergencies, Hernia, Intestines, Intestinal obstruction, Obturator.


Assuntos
Hérnia do Obturador , Obstrução Intestinal , Dor Abdominal/etiologia , Idoso de 80 Anos ou mais , Feminino , Hérnia do Obturador/complicações , Hérnia do Obturador/diagnóstico por imagem , Hérnia do Obturador/cirurgia , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Laparotomia , Tomografia Computadorizada por Raios X
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