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1.
Braz J Med Biol Res ; 52(10): e8343, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31618295

RESUMO

The objective was to study the effect of mechanical intestinal obstruction in rats on the phenotype of interstitial cells of Cajal (ICC). Healthy Wistar rats were randomly divided into sham-operation group (C), one day obstruction group (M1), two days obstruction group (M2), and three days obstruction group (M3), with 10 rats in each group. The expression of SCF mRNA and c-Kit protein in intestinal tissue was investigated by RT-PCR and immunohistochemistry. Compared with the sham-operation group, the relative expression of SCF mRNA and the expression of c-Kit protein in intestinal tissue were significantly decreased in both obstruction groups. Levels decreased gradually with the prolongation of obstruction time, and significantly decreased on the 3rd day after obstruction (P<0.05). Immunohistochemical staining of the small intestine showed that the number of ICC in the sham-operation group was the highest, and they were gradually decreased with the extension of obstruction time in the M1 to M3 groups. There was a significant difference between groups (P<0.05). Intestinal obstruction caused a decrease in the concentrations of SCF mRNA and c-Kit protein in ICC. With the prolongation of intestinal obstruction, the number of ICCs gradually decreased.


Assuntos
Células Intersticiais de Cajal/metabolismo , Obstrução Intestinal/metabolismo , Proteínas Proto-Oncogênicas c-kit/metabolismo , RNA Mensageiro/metabolismo , Fator de Células-Tronco/metabolismo , Animais , Modelos Animais de Doenças , Imuno-Histoquímica , Células Intersticiais de Cajal/patologia , Obstrução Intestinal/patologia , Masculino , Fenótipo , Ratos , Ratos Wistar
2.
Medicina (Kaunas) ; 55(9)2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31480453

RESUMO

Background and Objectives: The morphopathogenesis of adhesions is a complex process, characterized by the accumulation of an extracellular matrix, inflammation and hypoxia. The regulatory role between morphopathogenic factors in adhesions has not yet been defined. The aim was to investigate the appearance of transforming growth factor beta (TGFß), hepatocyte growth factor (HGF), basic fibroblast growth factor (FGF-2), fibroblast growth factor receptor 1 (FGFR1), vascular endothelial growth factor (VEGF), protein gene product 9.5 (PGP 9.5), chromogranin A (CgA), interleukin-1 alpha (IL-1α), interleukin-4 (IL-4), interleukin-6 (IL-6), interleukin-7 (IL-7), interleukin-8 (IL-8), interleukin-10 (IL-10), tumor necrosis factor alpha (TNFα), human beta defensine-2 (HBD-2), matrix metaloproteinase-2 (MMP-2) and matrix metaloproteinase-2 tissue inhibitor (TIMP-2) in intraabdominal adhesions. Materials and Methods: The study material was obtained from 49 patients under one year of age with total or partial bowel obstruction. All factors were detected using immunohistochemistry methods and their relative distribution was evaluated by means of the semiquantitative counting method. Results: Intraabdominal adhesions are characterized by increased TGFß, FGFR1, VEGF and decreased FGF-2, HGF, PGP 9.5, IL-1, IL-4, IL-8, TIMP-2 findings. The most significant changes observed were the remodulation of the extracellular matrix, promotion of neoangiogenesis and the maintenance of a prolonged inflammation. Conclusions: The increase in TGFß, relative to the decrease of HGF, as well as the disbalance between MMP-2 and TIMP-2 proves an increased fibrosis in intraabdominal adhesions. Less detected FGF-2 and more prominent FGR1 findings points out a compensatory receptor stimulation in response to the lacking same factor. The decrease in PGP 9.5 and the increase in VEGF-positive macrophages indicate hypoxic injury and proves the stimulation of neoangiogenesis. An unpronounced IL-1 and marked IL-10 finding indicate the local tissue protection reaction, the decrease in IL-4 could be the direct cause of giant cells, but the decrease of IL-8 could confirm a delayed chemotaxis of inflammatory cells.


Assuntos
Peptídeos e Proteínas de Sinalização Intercelular/fisiologia , Obstrução Intestinal/patologia , Aderências Teciduais/patologia , Humanos , Lactente , Peptídeos e Proteínas de Sinalização Intercelular/análise , Obstrução Intestinal/etiologia , Intestinos/química , Intestinos/patologia , Aderências Teciduais/etiologia
3.
J Surg Oncol ; 120(6): 1038-1043, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31392725

RESUMO

BACKGROUND: Seprafilm did not decrease small bowel obstruction (SBO), but significantly decreased reoperation in patients with inflammatory bowel disease. However, the preventive effect in colon cancer remains unclear. METHODS: We conducted a randomized controlled trial in patients with colon cancer. The study group comprised 345 patients with colon cancer. In the seprafilm group (n = 166), two sheets of seprafilm were inserted under a midline incision. Patients who were admitted and required decompression were considered to have SBO. RESULTS: The median follow-up was 61.9 months. Patient characteristics were well balanced. There was no significant difference in the incidence of SBO between the seprafilm group (7.8%) and the control group (10.6%) (P = .46). In patients who underwent reoperation, SBO occurred in a midline incision in one patient and at other sites in four patients in the seprafilm group as compared with two patients and five patients, respectively, in the control group. Multivariate analysis showed that only a history of laparotomy was an independent risk factor for SBO. CONCLUSIONS: Seprafilm did not decrease SBO or reoperation in colon cancer. The incidence of SBO caused by adhesion to the midline incision was relatively low as compared with that caused by adhesion to other sites.


Assuntos
Colectomia/efeitos adversos , Neoplasias do Colo/cirurgia , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Ácido Hialurônico/uso terapêutico , Obstrução Intestinal/prevenção & controle , Intestino Delgado/patologia , Complicações Pós-Operatórias , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Neoplasias do Colo/patologia , Feminino , Seguimentos , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Aderências Teciduais
4.
Eur J Radiol ; 118: 264-270, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31439253

RESUMO

PURPOSE: A multiphasic cine sequence performed during magnetic resonance enterography (MRE) has been shown to increase diagnostic accuracy of MRE demonstrating limited movement in inflamed intestine in patients with Crohn's disease (CD). Our aim was to confirm in our study population that intestinal inflammation was associated with decreased motility and determine if factors suggestive of complicated disease such as the presence of a stricture or fistula were associated with decreased motility on the MRE cine sequence. METHODS: This was a retrospective study of 59 patients (mean age 40.8 ±â€¯16.1) with Crohn's disease who had a small bowel lesion on MRE. Two gastrointestinal radiologists independently scored MRE findings using a qualitative, subjective scoring system. Univariate and multivariable ordered logistic regression models were used to evaluate the associations between cine sequence score, radiologic image findings, and clinical data. RESULTS: On univariate analysis, radiologic findings reflecting active inflammation, the presence of a stricture, and penetrating disease were associated with decreased motility. On multivariable analysis, hyper-enhancement, the presence of a comb sign, and global evidence of active inflammation remained associated with decreased motility. Of the factors suggesting complicated disease, the presence of stricture (Odds Ratio 0.40, 95% Confidence Interval 0.17-0.95, p-value 0.038) was associated with decreased motility. CONCLUSIONS: As previously shown, well-established radiologic findings of bowel inflammation were associated with decreased small bowel motility. In this study, we have added that the radiologic finding of a fixed stricture is also associated with decreased motility.


Assuntos
Doença de Crohn/fisiopatologia , Motilidade Gastrointestinal/fisiologia , Intestino Delgado , Adulto , Idoso , Constrição Patológica/patologia , Constrição Patológica/fisiopatologia , Doença de Crohn/patologia , Fístula Cutânea/etiologia , Fístula Cutânea/patologia , Fístula Cutânea/fisiopatologia , Feminino , Humanos , Inflamação/patologia , Fístula Intestinal/etiologia , Fístula Intestinal/patologia , Fístula Intestinal/fisiopatologia , Obstrução Intestinal/patologia , Intestinos/patologia , Modelos Logísticos , Imagem por Ressonância Magnética/métodos , Imagem Cinética por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
5.
Ethiop J Health Sci ; 29(4): 529-532, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31447527

RESUMO

Background: A lipoma of the small bowel mesentery is a rare clinical entity. It rarely causes intestinal obstruction mainly due to volvulus. Case: We report a case of a 25 years old male who presented with acute exacerbation of abdominal pain, nausea and vomiting. Plain abdominal x-ray showed complete small bowel obstruction. At laparotomy, there was small bowel volvulus with a big yellow mass as an axis. Enbloc resection and end-to-end ileal anastomosis was done. Conclusion: Mesenteric lipoma are rare. They should be considered in cases of long standing abdominal pain.


Assuntos
Volvo Intestinal/etiologia , Lipoma/complicações , Mesentério , Neoplasias Peritoneais/complicações , Dor Abdominal/etiologia , Adulto , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Volvo Intestinal/diagnóstico , Volvo Intestinal/patologia , Volvo Intestinal/cirurgia , Lipoma/diagnóstico , Lipoma/patologia , Lipoma/cirurgia , Masculino , Mesentério/patologia , Mesentério/cirurgia , Neoplasias Peritoneais/diagnóstico , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/cirurgia
6.
BMJ Case Rep ; 12(7)2019 Jul 08.
Artigo em Inglês | MEDLINE | ID: mdl-31289166

RESUMO

Myxoid liposarcoma (MLS) represents one of the three main morphological subgroups of liposarcomas. Extrapulmonary recurrence to the retroperitoneum and abdomen is common in MLS. A pregnant patient was referred to our hospital due to abdominal pain and obstipation. In the past, she had received a multimodal treatment of an MLS of the left dorsal thigh. Now, MRI revealed a 14.6×10.1×12.4 cm-sized tumour adjacent to the uterus with a known twin pregnancy (26th week). We performed surgery under tocolytic therapy. The tumour has been completely removed. The histopathological examination revealed a nodular manifestation of a moderately differentiated MLS arising from the mesentery. Eleven weeks later, our patient delivered healthy twins. This is the first report of surgical resection of MLS during a twin pregnancy. With a multidisciplinary approach and a concerted treatment by surgeons and obstetricians, surgical resection resolved malignant intestinal obstruction and enabled an uncomplicated continuation of pregnancy.


Assuntos
Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Lipossarcoma Mixoide/complicações , Lipossarcoma Mixoide/patologia , Adulto , Anastomose Cirúrgica/métodos , Terapia Combinada , Parto Obstétrico , Feminino , Humanos , Obstrução Intestinal/cirurgia , Lipossarcoma Mixoide/diagnóstico por imagem , Lipossarcoma Mixoide/cirurgia , Imagem por Ressonância Magnética/métodos , Recidiva Local de Neoplasia , Gravidez , Gravidez de Gêmeos , Tocólise/métodos , Resultado do Tratamento
7.
Trop Doct ; 49(4): 318-320, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31324130

RESUMO

Mucormycosis is generally considered to be an acute, rapidly progressing, opportunistic fungal infection. Chronic manifestations are extremely rare. Mucormycosis affecting the jejunum is very rare and few cases have been reported. We report a case of mucormycosis causing jejunal stricture in an infant aged six months.


Assuntos
Obstrução Intestinal/etiologia , Doenças do Jejuno/etiologia , Mucormicose/complicações , Humanos , Lactente , Obstrução Intestinal/microbiologia , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Doenças do Jejuno/microbiologia , Doenças do Jejuno/patologia , Masculino , Mucormicose/microbiologia , Mucormicose/patologia , Resultado do Tratamento
8.
BMJ Case Rep ; 12(7)2019 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-31352380

RESUMO

A 20-year-old woman with no medical or surgical history presented with acute onset crampy abdominal pain on a background of uninvestigated similar chronic abdominal pain. She became obstructed during her admission and a contrast swallow showed a complete obstruction at the level of the proximal jejunum. A diagnostic laparoscopy revealed a congenital band adhesion from the greater omentum to the proximal jejunum to be the cause, and dissection of the band relieved her obstruction. This case presents a rare cause of mechanical obstruction, and highlights the seriousness of investigating obstructive symptoms even in atypical patient populations.


Assuntos
Dor Abdominal/patologia , Anormalidades do Sistema Digestório/complicações , Obstrução Intestinal/etiologia , Laparoscopia , Aderências Teciduais/complicações , Tomografia Computadorizada por Raios X , Dor Abdominal/diagnóstico por imagem , Dor Abdominal/etiologia , Anormalidades do Sistema Digestório/diagnóstico por imagem , Anormalidades do Sistema Digestório/fisiopatologia , Feminino , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/patologia , Jejuno/anormalidades , Omento/anormalidades , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/patologia , Resultado do Tratamento , Adulto Jovem
9.
Surg Oncol ; 29: 134-139, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31196477

RESUMO

AIM: The palliative surgical outcome score (PSOS) was proposed for evaluation of the effect of palliative surgical interventions. As a surrogate measure for successful symptom control, it is defined as the proportion of days outside the hospital of the remaining life time up to six months after a palliative intervention. In this study we evaluate the PSOS in patients treated palliatively with self-expanding metal stents (SEMSs) for incurable malignant colorectal obstruction. METHODS: All eligible patients endoscopically treated with palliative intent with SEMSs were identified. Demographics and clinical characteristics, including complete follow-up, were recorded, and the PSOS was calculated. Non-parametric tests were used for comparisons, and survival was evaluated by univariable and multivariable analyses. RESULTS: Between 2005 and 2013, 116 patients (median age 71.5 years; 53.4% women) were identified. Most obstructions were caused by primary colorectal cancers. Technical- and clinical success rates were 94.0% and 87.1%, respectively. Procedure-related complications occurred in 17 (14.7%) of the patients, and most were minor. A PSOS>70 (regarded as excellent palliation) was achieved in 79 (68.1%) patients. This goal was significantly more often achieved in patients who survived at least 6 months than in those with shorter survival (p < 0.001). No clinical variables at the time of the endoscopic palliative procedure could predict a PSOS>70. However, in patients who survived at least 6 months (n = 69), a PSOS>70 was independently associated with better survival in the multivariable Cox analysis. CONCLUSIONS: PSOS could be used as a practical proxy or a pragmatic tool for the effectiveness of palliative interventions, when such interventions are compared. Clinical factors that could significantly add to the clinical decision-making and predict a PSOS>70 in an individual patient were not identified for this specific group of patients.


Assuntos
Neoplasias Colorretais/complicações , Obstrução Intestinal/terapia , Metais , Cuidados Paliativos , Pontuação de Propensão , Stents , Adulto , Idoso , Idoso de 80 Anos ou mais , Endoscopia , Feminino , Seguimentos , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
10.
J Med Case Rep ; 13(1): 148, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31097019

RESUMO

BACKGROUND: Multiple myeloma is a hematological malignancy that classically results in an abnormal clonal proliferation of plasma cells in the bone marrow. Extramedullary disease in the setting of multiple myeloma, referred to as secondary extramedullary plasmacytoma, is found in 7-17% of cases of multiple myeloma at the time of diagnosis and can involve any organ system. Small bowel obstruction is a rare but important gastrointestinal manifestation of multiple myeloma that should be considered in patients with multiple myeloma who present with concerning abdominal symptoms. CASE PRESENTATION: We present the case of a 52-year-old African-American man with a history of deep venous thrombosis (he is on anticoagulation) and pathologic fracture secondary to multiple myeloma diagnosed 4 months prior to our encounter. He presented with abdominal pain, constipation, nausea, and vomiting. An abdominal X-ray showed distended bowel loops concerning for bowel obstruction and a contrast-enhanced computed tomography scan of his abdomen and pelvis showed a 5.4 cm soft tissue mass involving a loop of distal ileum. He underwent laparoscopic exploration of his abdomen with small bowel resection and primary anastomosis for a small intussusception. He had an uneventful postoperative course and was discharged on postoperative day 6. CONCLUSIONS: Multiple myeloma has myriad presentations. Gastrointestinal involvement, although rare, can manifest as small bowel obstruction for which early recognition and appropriate surgical management are key to improving outcome. Intussusception is the most common mechanism of obstruction from extramedullary plasmacytoma causing small bowel obstruction and this has been seen in five of six case reports, including this case. It is important to recognize and consider the risks of immunosuppression, venous thromboembolism, and malnutrition in the surgical management of gastrointestinal complications of multiple myeloma.


Assuntos
Obstrução Intestinal/patologia , Intestino Delgado/patologia , Mieloma Múltiplo/patologia , Plasmocitoma/diagnóstico por imagem , Dor Abdominal , Anastomose Cirúrgica , Constipação Intestinal , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Laparoscopia , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/complicações , Mieloma Múltiplo/diagnóstico por imagem , Plasmocitoma/complicações , Plasmocitoma/cirurgia , Radiografia Abdominal , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Gynecol Oncol ; 154(1): 177-182, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31056111

RESUMO

OBJECTIVES: To describe and compare treatments and outcomes of patients with malignant bowel obstructions (MBO) due to uterine or ovarian cancer. METHODS: Retrospective chart review from two institutions of women admitted 1/1/2005-12/31/2016 with a MBO from recurrent/progressive uterine or ovarian cancer. Data collected includes patient characteristics, cancer-directed treatments before and after MBO, MBO management strategies, and survival after MBO. RESULTS: Women with MBO from uterine cancer (n = 46) and ovarian cancer (n = 130) underwent similar inpatient interventions such as inpatient chemotherapy and surgery. Median overall survival (OS) after admission for MBO for all patients was 105 days and was shorter for uterine cancer patients (57 vs 131 days, p = 0.0013). Uterine and ovarian cancer patients who had surgery had similar survival (182 vs 210 days, p = 0.6), as did those discharged on hospice from their first admission for MBO (26 vs 38 days, p = 0.1). Uterine and ovarian cancer patients had similar rates of post-discharge chemotherapy (37% vs 50%, p = 0.12), but uterine cancer patients who had chemotherapy still had shorter survival (151 vs 225 days, p = 0.03). CONCLUSIONS: MBO has a relatively poor prognosis. Ovarian and uterine cancer patients whose interventions included surgery or hospice had similar outcomes. Among patients managed medically without hospice, uterine cancer patients experienced worse survival, even when candidates for subsequent chemotherapy. Patient counseling regarding goals of care at this difficult juncture can be informed by these findings and will be enhanced by patient-reported and qualitative data on the patient experience with MBO.


Assuntos
Obstrução Intestinal/etiologia , Neoplasias Ovarianas/complicações , Neoplasias Uterinas/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Obstrução Intestinal/patologia , Obstrução Intestinal/terapia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/complicações , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/terapia , Estudos Retrospectivos , Resultado do Tratamento , Neoplasias Uterinas/patologia , Neoplasias Uterinas/terapia
12.
Vet Radiol Ultrasound ; 60(4): 423-431, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31050093

RESUMO

Benign stricture is an uncommon cause of chronic small intestinal obstruction in the cat. The purpose of this retrospective case series was to describe the ultrasonographic features, histopathological findings, and clinical presentation in a group of cats with benign small intestinal stricture. Inclusion criteria were cats presenting during the period 2010-2017, and that had ultrasonography and small intestinal stricture confirmed at surgery. For each cat, clinical data and ultrasonographic findings were retrieved from the medical record, and histopathology, where available, was reviewed. Eight cats met the inclusion criteria. The location of strictures was duodenum (1/8), mid- to distal jejunum (4/8), and ileum (3/8). Ultrasonographic findings included gastric distension (8/8) and generalized (3/8) or segmental (5/8) intestinal dilation consistent with mechanical obstruction. Ingesta did not propagate beyond the strictured segment. Wall thickening was mild to moderate (3-6 mm). Normal wall layering was disrupted in all cats. Strictures were predominantly hypoechoic (7/8) and associated with hyperechoic peri-intestinal mesentery (6/8). Annular strictures (5/8) were less than 15 mm in length whereas long-segment strictures (3/8) were greater than 15 mm in length. Histopathology showed transmural disease with fibrosis and inflammation (8/8), often (6/8) extending into the bordering mesentery. The mucosa was the most severely affected layer and epithelial injury accompanied the mucosal fibrosis/inflammation. Clinical presentation reflected delayed diagnosis of chronic bowel obstruction with debilitation (8/8), marked weight loss (8/8), and prerenal azotemia (5/8). Benign fibrostenotic stricture should be considered a differential diagnosis in debilitated young cats presenting with chronic bowel disease and ultrasonographic features of intestinal obstruction.


Assuntos
Doenças do Gato/diagnóstico por imagem , Doenças do Gato/patologia , Fibrose/veterinária , Obstrução Intestinal/veterinária , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Ultrassonografia/veterinária , Animais , Gatos , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/patologia , Constrição Patológica/veterinária , Feminino , Fibrose/diagnóstico por imagem , Fibrose/patologia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/patologia , Masculino , Estudos Retrospectivos
13.
Gut ; 68(6): 1115-1126, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30944110

RESUMO

Patients with Crohn's disease commonly develop ileal and less commonly colonic strictures, containing various degrees of inflammation and fibrosis. While predominantly inflammatory strictures may benefit from a medical anti-inflammatory treatment, predominantly fibrotic strictures currently require endoscopic balloon dilation or surgery. Therefore, differentiation of the main components of a stricturing lesion is key for defining the therapeutic management. The role of endoscopy to diagnose the nature of strictures is limited by the superficial inspection of the intestinal mucosa, the lack of depth of mucosal biopsies and by the risk of sampling error due to a heterogeneous distribution of inflammation and fibrosis within a stricturing lesion. These limitations may be in part overcome by cross-sectional imaging techniques such as ultrasound, CT and MRI, allowing for a full thickness evaluation of the bowel wall and associated abnormalities. This systematic literature review provides a comprehensive summary of currently used radiologic definitions of strictures. It discusses, by assessing only manuscripts with histopathology as a gold standard, the accuracy for diagnosis of the respective modalities as well as their capability to characterise strictures in terms of inflammation and fibrosis. Definitions for strictures on cross-sectional imaging are heterogeneous; however, accuracy for stricture diagnosis is very high. Although conventional cross-sectional imaging techniques have been reported to distinguish inflammation from fibrosis and grade their severity, they are not sufficiently accurate for use in routine clinical practice. Finally, we present recent consensus recommendations and highlight experimental techniques that may overcome the limitations of current technologies.


Assuntos
Doença de Crohn/epidemiologia , Obstrução Intestinal/epidemiologia , Intestino Delgado/patologia , Imagem Multimodal/métodos , Comorbidade , Constrição Patológica/diagnóstico por imagem , Constrição Patológica/epidemiologia , Constrição Patológica/patologia , Doença de Crohn/diagnóstico por imagem , Doença de Crohn/patologia , Estudos Transversais , Técnicas de Imagem por Elasticidade/métodos , Feminino , Fibrose/diagnóstico por imagem , Fibrose/epidemiologia , Humanos , Incidência , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/patologia , Intestino Delgado/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Masculino , Prognóstico , Medição de Risco , Tomografia Computadorizada por Raios X/métodos , Ultrassonografia Doppler/métodos
14.
Ann Surg Oncol ; 26(9): 2787-2796, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30989498

RESUMO

BACKGROUND: Although self-expandable metal stents (SEMS) are widely used as a bridge to surgery (BTS) in patients with malignant colorectal cancer obstruction, there has been some debate about their effect on long-term oncological outcomes. Furthermore, data on the safety and feasibility of minimally invasive surgery (MIS) combined with stent placement are scarce. We aimed to determine the long-term oncological outcomes of SEMS as a BTS, and the short-term outcomes of SEMS used with minimally invasive colorectal surgery. METHODS: Data from patients who were admitted with malignant obstructing colon cancer between January 2006 and December 2015 were retrospectively reviewed; 71 patients underwent direct surgery and 182 patients underwent SEMS placement as a BTS. Long-term and short-term outcomes of the groups were compared. In a subgroup analysis of the BTS group, the short-term outcomes of conventional open surgery and MIS were compared. RESULTS: There were no differences in long-term oncologic outcomes between groups. The primary anastomosis rate was higher in the stent group than in the direct surgery group. In the stent group, postoperative complication rates were lower in the minimally invasive group than in the open surgery group. Time to flatus and time to soft diet resumption were shorter in the minimally invasive group, as was length of hospital stay. CONCLUSIONS: Elective surgery after stent insertion does not adversely affect long-term oncologic outcomes. Furthermore, MIS combined with stent insertion for malignant colonic obstruction is safe and feasible.


Assuntos
Neoplasias do Colo/mortalidade , Obstrução Intestinal/mortalidade , Procedimentos Cirúrgicos Minimamente Invasivos/mortalidade , Complicações Pós-Operatórias , Stents Metálicos Autoexpansíveis/estatística & dados numéricos , Idoso , Neoplasias do Colo/complicações , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Estudos de Viabilidade , Feminino , Seguimentos , Humanos , Obstrução Intestinal/complicações , Obstrução Intestinal/patologia , Obstrução Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida
15.
World J Surg Oncol ; 17(1): 63, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30961608

RESUMO

INTRODUCTION: Lung cancer is the most common cause of cancer-related deaths globally. Metastatic disease is often found at the time of initial diagnosis in the majority of lung cancer patients. However, colonic metastases are rare. This report describes an uncommon case of colonic metastasis from lung adenocarcinoma. CASE PRESENTATION: A 64-year-old female presented to her gastroenterologist for progressively worsening abdominal pain and constipation. Exploratory colonoscopy revealed a large rectosigmoid mass resulting in near total rectal occlusion. Her specialist recommended she immediately go to her regional hospital for further workup. On admission, she complained of continued abdominal pain and constipation. Notably, she had a past medical history of non-small cell lung cancer (T1bN3M0 stage IIIB), diagnosed 1 year prior. She was thought to be in remission following radiation and immunotherapy with pembrolizumab. Upon hospital admission, she underwent an urgent colostomy, ileocecectomy and anastomosis, and rectosigmoid mass resection with tissue sampling. Pathology confirmed the diagnosis of colonic metastasis from primary lung adenocarcinoma. Treatment was with systemic chemotherapy followed by localized radiation to the pelvic region was started. She did not respond well to these therapies. Subsequent imaging showed refractory tumor growth in the pelvic region. Treatment could not be completed due to the patient experiencing a debilitating stroke, and she was transitioned to hospice care. CONCLUSIONS: Clinicians should have a low threshold for intestinal investigation and considerations for colonic metastasis when patients with a history of primary lung cancer have abdominal symptoms.


Assuntos
Adenocarcinoma/complicações , Neoplasias do Colo/complicações , Obstrução Intestinal/etiologia , Neoplasias Pulmonares/complicações , Adenocarcinoma/patologia , Neoplasias do Colo/secundário , Feminino , Humanos , Obstrução Intestinal/patologia , Neoplasias Pulmonares/patologia , Pessoa de Meia-Idade , Prognóstico
16.
J Cancer Res Ther ; 15(2): 375-379, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30964114

RESUMO

Context: Endoscopic self-expandable metal stents (SEMSs) are the bridge of obstructive colorectal cancer surgery. The debate is still open on whether the procedure and effects can be the same between the SEMS combined obstructive colon cancer resection and nonobstructive colon cancer resection, both of which were under laparoscopic. Aims: This retrospective study was designed to compare whether the same effects could be achieved in both resections. Settings and Design: The retrospective analysis was from September 2016 to November 2017. In the observation group (OG), 20 patients hospitalized for obstruction of the left colon cancer were included, who received obstructive colon cancer laparoscopic resection (LR) combined with SEMS insertion. In control group (CG), 20 patients were randomly selected, who underwent nonobstructive colon cancer LR during this period. Subjects and Methods: The differences between the two groups were compared, including operation time, intraoperative blood loss, the number of removed lymph nodes, postoperative anal exhaust time, and hospital stay. Results: Both groups were comparable in the age, gender, weight, the distribution of tumor, lymph node metastasis, tumor, node, and metastasis staging, operation time, intraoperative blood loss, the number of removed lymph nodes, and postoperative anal exhaust time. The hospital stay was 15.2 ± 1.3 days and 14.2 ± 1.5 days in OG and CG, respectively, and it was longer in OG than that of in CG (P = 0.032). Conclusions: Obstructive colon cancer LR combined with SEMS insertion was a safe and feasible radical treatment strategy. The same level of procedure and effects could be achieved, compared to that of nonobstructive colon cancer LR.


Assuntos
Neoplasias do Colo/diagnóstico , Neoplasias do Colo/terapia , Obstrução Intestinal/patologia , Obstrução Intestinal/terapia , Laparoscopia , Stents , Idoso , Idoso de 80 Anos ou mais , Terapia Combinada , Feminino , Humanos , Laparoscopia/métodos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Resultado do Tratamento
17.
J Pediatr Surg ; 54(6): 1164-1167, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30879740

RESUMO

BACKGROUND: Meconium plug syndrome (MPS) is associated with Hirschsprung disease (HD) in 13-38% of cases. This study sought to assess institutional variation in utilization of rectal biopsy in children with MPS and the likelihood of diagnosing HD in this population. METHODS: Patients with MPS on contrast enema in the first 30 days of life from the Pediatric Health Information System database in 2016-2017 were included. Institutional rates of rectal biopsies performed during the initial admission were calculated and then used to predict institutional rates of early HD diagnoses using Poisson regression. RESULTS: Of 373 newborns with MPS, 106 (28.4%) underwent early rectal biopsy, of whom 43 (40.5%) had HD. Fifty-seven (15.3%) were ultimately diagnosed with HD. Eight (14%) of these patients had a delayed diagnosis. HD rates between institutions did not differ significantly (range 0-50%, p=0.52), but usage of early rectal biopsy did (range 0-80%, p=0.03). Each additional early biopsy increased the early HD diagnosis rate by 35% (ß=0.30, 95% CI 0.15-0.45, p<0.0001). CONCLUSION: The incidence of HD is increased in children with MPS. There is significant hospital variability in the utilization of early rectal biopsy, and opportunity exists to standardize practice. TYPE OF STUDY: Study of Diagnostic test Level of Evidence: Level III.


Assuntos
Doenças Fetais , Doença de Hirschsprung , Obstrução Intestinal , Mecônio/fisiologia , Biópsia , Doenças Fetais/diagnóstico , Doenças Fetais/epidemiologia , Doenças Fetais/patologia , Doença de Hirschsprung/complicações , Doença de Hirschsprung/diagnóstico , Doença de Hirschsprung/epidemiologia , Doença de Hirschsprung/patologia , Humanos , Recém-Nascido , Obstrução Intestinal/complicações , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/epidemiologia , Obstrução Intestinal/patologia , Estudos Retrospectivos
18.
Leg Med (Tokyo) ; 38: 32-35, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30927624

RESUMO

Internal abdominal hernia, defined as protrusion of viscera through a defect of the mesentery, has been considered a rare clinical entity. Recent clinical reviews reported a wide range of onset age (from newborns to the elderly) and symptoms (from minimal abdominal symptoms to severe acute abdomen). Sudden and unexpected death due to internal abdominal hernia is rare in infants or toddlers, and only 4 autopsy cases had been reported previously. We report the case of a 3-month-old Japanese boy who unexpectedly died 4 h after first vomiting. Autopsy showed a wide bowel obstruction with necrosis through a congenital mesenteric defect. The larynx was filled with gastric content (milky white viscous muddy material). In the cross section of both lungs, the same material was found to be expressed from the bronchioles. We diagnosed the cause of death as asphyxiation by viscous milk/vomitus aspiration caused by bowel obstruction due to an internal abdominal hernia. In case of sudden and unexpected death of an infant, autopsy is crucial to determine the cause of death. During autopsy, it is helpful to determine the character and distribution of gastric and airway contents to confirm milk or vomitus aspiration.


Assuntos
Asfixia/etiologia , Asfixia/patologia , Patologia Legal , Hérnia Abdominal/complicações , Hérnia Abdominal/patologia , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Intestinos/patologia , Autopsia , Conteúdo Gastrointestinal , Humanos , Lactente , Laringe/patologia , Pulmão/patologia , Masculino , Mesentério/anormalidades , Mesentério/patologia , Necrose
19.
J Obstet Gynaecol ; 39(5): 587-593, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30822180

RESUMO

A small bowel prolapse through the vaginal introitus after a transvaginal instrumental gravid uterus perforation is a surgical emergency. To define the mechanisms of an irreversible, small bowel ischaemia due to small bowel prolapse through a vaginal introitus, ClinicalTrials.gov, PubMed, PubMed Central, and Google Scholar were searched. Out of the 81 articles screened, 28 cases of a small bowel evisceration through vaginal introitus were included. A small bowel obstruction severity grading was defined with risk factors; potential mechanisms of different severity grades after a transvaginal instrumental gravid uterine perforation with a vaginal evisceration. The duration of symptoms or a delay in the diagnosis did not change the incidence of the two most severe grades-mesenteric stripping and a small bowel degloving. Both obstruction types develop immediately during an instrumental abortion. The severity of obstruction does not influence the maternal outcome.


Assuntos
Enteropatias/etiologia , Intestino Delgado , Instrumentos Cirúrgicos/efeitos adversos , Perfuração Uterina/complicações , Vagina , Feminino , Humanos , Enteropatias/patologia , Enteropatias/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/patologia , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Mesentério/patologia , Gravidez , Prolapso , Fatores de Risco , Perfuração Uterina/cirurgia
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