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1.
BMJ Case Rep ; 14(2)2021 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-33563666

RESUMO

Tuberculosis (TB), a significant cause of morbidity and mortality worldwide, is particularly relevant in low/middle-income countries like India, where the disease is endemic. The female reproductive system is very vulnerable to this infection with, the clinical presentation being utterly silent in most patients. Symptoms of TB in pregnancy may initially be attributed to the gravidity itself besides temporary concealment of associated weight loss by the normally occurring weight gain during the pregnancy. Untreated TB may cause pregnancy loss by either placental damage or direct harm to both the mother and child. We report a case of latent disseminated TB in a young immunocompetent female that was revealed in the postpartum state (after full-term stillbirth delivery at home) as 20 ileal perforations secondary to intestinal TB. Due to ongoing sepsis and delayed presentation to the hospital, the patient could not be salvaged despite the best possible efforts.


Assuntos
Doenças do Íleo/microbiologia , Perfuração Intestinal/microbiologia , Complicações Infecciosas na Gravidez/microbiologia , Natimorto , Tuberculose Gastrointestinal/complicações , Adulto , Evolução Fatal , Feminino , Humanos , Gravidez
2.
BMJ Case Rep ; 14(2)2021 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-33568413

RESUMO

Cocaine, an alkaloid, is an addictive drug and its abuse as a recreational drug is on the increasing side with its associated complications. Gastrointestinal complications, after cocaine abuse, are less known and need to be addressed since the abuse is on the rise and the existing evidence is scarce. We report a case of a 22-year-old male patient who presented with abdominal pain following a cocaine injection. On examination, signs of peritonitis were noted and laparotomy revealed a 2×1 cm perforation in the distal ileum. The unhealthy intestinal segment was resected and taken out as a double-barrel ileostomy. The patient had an episode of severe lower gastrointestinal bleeding on postoperative day 6. CT and colonoscopy revealed signs of ischaemic bowel and tissue biopsy showed oedematous, inflamed and haemorrhagic bowel mucosa. The patient was managed conservatively and is doing well under follow-up in a de-addiction centre.


Assuntos
Transtornos Relacionados ao Uso de Cocaína/complicações , Hemorragia Gastrointestinal/induzido quimicamente , Hemorragia Gastrointestinal/cirurgia , Perfuração Intestinal/induzido quimicamente , Perfuração Intestinal/cirurgia , Doenças Raras/diagnóstico , Doenças Raras/cirurgia , Adulto , Humanos , Masculino , Resultado do Tratamento , Adulto Jovem
3.
Gan To Kagaku Ryoho ; 48(2): 285-287, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33597383

RESUMO

An 80s male, with a medical history of hypertension, hyperuricemia, and atrial fibrillation, visited our emergency outpatient department with vomiting and diarrhea as the chief complaint in August 2017. The blood examination revealed a high level of inflammatory reaction. The plain abdominal CT revealed fluid retention contacting the small intestine and intraabdominal free gas. We diagnosed the case as a small intestinal perforation, following which we performed emergency surgery. The small intestine was perforated, and an abscess cavity was formed between the transverse mesocolon and mesentery proper. Thus, the abscess was removed, and about 30 cm of the small intestine, including the perforated site, was resected, followed by the reconstruction. The resected specimens revealed squamous cell carcinoma at the small intestinal perforated site. Lung squamous cell carcinoma was diagnosed by subsequent chest CT and immunostaining. We administered 3 courses of chemotherapy combined with carboplatin and albumin-bound paclitaxel. Although the effect was partially observed, interstitial pneumonia occurred, which was inferred to be drug-induced. The patient died in 195 days following the surgery. Herein, we reported a case of lung cancer, which was diagnosed on the detection of gastrointestinal perforation caused by a small intestinal metastasis.


Assuntos
Carcinoma de Células Escamosas , Perfuração Intestinal , Neoplasias Pulmonares , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Pulmão , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/tratamento farmacológico , Masculino
4.
BMJ Case Rep ; 14(1)2021 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-33436359

RESUMO

A 29-year-old male paratrooper presented to multiple emergency departments (EDs) and his primary provider multiple times over sequential days. Each time, the patient received the same diagnosis of acute on chronic back pain. The patient was treated conservatively and routine MRI of the lumbar spine was performed 5 days after the last visit. It revealed a lesion occupying nearly all the visualised portion of the spinal canal. The patient was immediately called back for further imaging. The patient was then diagnosed with a foreign body perforating the rectosigmoid colon, an epidural abscess and pelvic osteomyelitis. The patient was immediately taken to the ED where he was found to be septic. The foreign body was surgically removed and determined to be a swallowed toothpick. Urgent surgical decompression of epidural space was also performed. The patient then underwent a prolonged but near complete recovery.


Assuntos
Abscesso Epidural/etiologia , Corpos Estranhos/complicações , Perfuração Intestinal/etiologia , Osteomielite/etiologia , Sepse/etiologia , Adulto , Dor nas Costas/diagnóstico , Erros de Diagnóstico , Humanos , Masculino
7.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431529

RESUMO

Abdominoperineal excision of rectum (APER) is one of the widely used surgical procedures to treat low rectal cancer, benign conditions like Crohn's proctitis with anal involvement and as a salvage procedure for anal cancer. Perineal wound infection is a well-recognised complication following such major surgery. Occurrence of appendicitis in a few weeks' time following such a major surgery is uncommon. However, here we present a rare case report of perforated appendicitis presenting as persistent perineal discharge in an elderly man, following laparoscopic APER for a low rectal tumour. To our knowledge, this is the first time such a rare clinical presentation of appendicitis is reported in the history of medical literature. Through this case report, we aim to highlight the importance of considering such an uncommon presentation in patients with perineal discharge, following APER.


Assuntos
Abscesso/diagnóstico , Apendicite/complicações , Infecções por Escherichia coli/diagnóstico , Perfuração Intestinal/diagnóstico , Infecção Pélvica/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Protectomia/efeitos adversos , Abscesso/etiologia , Abscesso/cirurgia , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Idoso , Apendicectomia , Apendicite/diagnóstico , Apendicite/cirurgia , Diagnóstico Diferencial , Escherichia coli/isolamento & purificação , Infecções por Escherichia coli/etiologia , Infecções por Escherichia coli/cirurgia , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Masculino , Infecção Pélvica/etiologia , Infecção Pélvica/cirurgia , Períneo/microbiologia , Períneo/patologia , Períneo/cirurgia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Neoplasias Retais/diagnóstico , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/patologia , Reto/cirurgia
8.
Arq Bras Cir Dig ; 33(3): e1546, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33470376

RESUMO

BACKGROUND: Mortality after emergency surgery in randomized controlled trials. The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity. AIM: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment. METHOD: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion. RESULTS: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion. CONCLUSION: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.


Assuntos
Colo Sigmoide/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Diverticulite/complicações , Diverticulite/cirurgia , Perfuração Intestinal/cirurgia , Peritonite/etiologia , Anastomose Cirúrgica/métodos , Colostomia/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Diverticulite/patologia , Humanos , Ileostomia/efeitos adversos , Perfuração Intestinal/patologia , Peritonite/cirurgia , Complicações Pós-Operatórias , Resultado do Tratamento
9.
BMC Surg ; 21(1): 50, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33478454

RESUMO

BACKGROUND: Gastrointestinal lymphomas like diffuse large B-cell lymphoma (DLBCL) are rare complications of ulcerative colitis (UC), and only a few studies have reported intestinal ulcers caused by DLBCL, which got perforated during the treatment of UC. CASE PRESENTATION: A 43-year-old man with severe lower abdominal pain and an 8-year history of UC was admitted in our hospital. He was diagnosed UC since 8 years and received a maintenance oral dose of 5-aminosalicylic acid, and no other immunosuppressive drugs. A deep rectal ulcer was endoscopically diagnosed 10 months before admission, no malignancy or cytomegalovirus infection was detected on biopsy. After 7 months a further endoscopy with biopsies confirmed the finding and the absence of malignancy. Three months later the patient developed sudden abdominal pain and was admitted in our hospital. Rectal perforation was suspected on X-ray and computed tomography imaging, and an emergency surgery was performed. Surgical exploration revealed a perforation on the anterior wall of the rectum. A subtotal colectomy with temporary ileostomy was performed. Pathology examinations showed lymphocyte infiltration of all of the layers of the perforated site and an immunohistochemical evaluation revealed DLBCL. Clinical staging was stage IV, and the patient received a 6-months regimen of R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisolone) chemotherapy. Positron emission tomography restaging revealed disappearance of distant uptake and a slight uptake in the residual rectum, and completion proctectomy with ileal pouch-anal anastomosis was performed. No residual tumor in the specimen was found, and the patient was disease-free at 2 years follow-up. CONCLUSIONS: DLBCL may increase the frequency of perforation and is a poor prognostic risk factor for patients with UC. This case study emphasizes the importance of careful medical surveillance and repeated endoscopic biopsies during the treatment of UC.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Colite Ulcerativa , Perfuração Intestinal/cirurgia , Linfoma Difuso de Grandes Células B , Neoplasias Retais , Adulto , Colectomia , Colite Ulcerativa/complicações , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/cirurgia , Ciclofosfamida/uso terapêutico , Doxorrubicina/uso terapêutico , Humanos , Ileostomia , Perfuração Intestinal/etiologia , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Linfoma Difuso de Grandes Células B/etiologia , Linfoma Difuso de Grandes Células B/cirurgia , Masculino , Prednisona/uso terapêutico , Prognóstico , Neoplasias Retais/diagnóstico , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/etiologia , Neoplasias Retais/cirurgia , Reto/lesões , Reto/patologia , Reto/cirurgia , Rituximab/uso terapêutico , Vincristina/uso terapêutico
10.
J Formos Med Assoc ; 120(1 Pt 2): 293-302, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33289640

RESUMO

BACKGROUND: Primary intestinal lymphomas (PILs) are rare, and this study compared the clinical outcomes of aggressive primary intestinal B-cell lymphomas (aB-PILs) and T/natural killer-cell lymphomas (T/NK-PILs). METHODS: The clinical information of patients diagnosed with aggressive PILs at our institution between 1995 and 2015 were retrospectively investigated. Pathological subtypes were confirmed according to the 2016 revision of the World Health Organization classification. The correlation between clinicopathological features and overall survival (OS) was determined using univariate and multivariate analyses. RESULTS: Cases of T/NK-PILs had higher initial bowel perforation incidence (67% vs. 7%, P < 0.001) and lower complete response rate to first-line chemotherapy regimens (22% vs. 69%, P = 0.009) than aB-PILs. Patients with aB-PILs had a better 5-year event-free survival rate (55.8% vs. 13.9%, P = 0.026) and a 5-year OS rate (74.3% vs. 29.6%, P = 0.036) than those with T/NK-cell lymphomas. Multivariate analysis identified that female gender and stage III/IV were unfavorable prognostic factors. Among the 54 patients with diffuse large B-cell lymphoma (DLBCL), those with International Prognostic Index (IPI) scores of 0-2 had a better 5-year OS rate than those with scores of 3-5 (84.2% vs. 46.8%, P = 0.002). IPI scores of 3-5 (P = 0.026) and tumors located in the large intestine (P = 0.015) were poor prognostic factors based on the multivariate analysis. CONCLUSION: The prognosis of T/NK-PILs was less favorable than that of aB-PILs. Female gender, stage III/IV disease, DLBCL with IPI scores of 3-5, or tumors in the large intestine were poor prognostic factors.


Assuntos
Perfuração Intestinal/etiologia , Linfoma Difuso de Grandes Células B/patologia , Linfoma de Células T Periférico/patologia , Adulto , Idoso , Feminino , Humanos , Imunofenotipagem , Perfuração Intestinal/epidemiologia , Linfoma Difuso de Grandes Células B/mortalidade , Linfoma de Células T Periférico/mortalidade , Linfoma de Células T Periférico/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Adulto Jovem
11.
Arch. argent. pediatr ; 118(6): 405-415, dic 2020. tab, ilus
Artigo em Inglês, Espanhol | LILACS, BINACIS | ID: biblio-1146069

RESUMO

Objetivo. Investigar la frecuencia de la enterocolitis necrosante (ECN) en prematuros y evaluar los factores de riesgo asociados con su aparición y progresión a perforación intestinal.Métodos. Cohorte retrospectiva de prematuros hospitalizados entre 2015 y 2018. Las características perinatales, clínicas, nutricionales y de laboratorio se analizaron con SPSS-23, y los factores de riesgo mediante una regresión logística.Resultados. En 1428 neonatos, la tasa de ECN fue del 18,28 %. La concepción por reproducción asistida, la cesárea y los corticoesteroides posnatales se asociaron con ECN (OR: 4,056; IC del 95 %: 2,810-5,854; OR: 1,961; IC del 95 %: 1,321-2,910; OR: 6,422; IC del 95 %: 4,327-9,530). El momento de la primera alimentación enteral se asoció con ECN, pero no con perforación intestinal (p < 0,001; p = 0,604). De 261 pacientes con ECN, 47 (18 %) tuvieron perforación intestinal. El momento de la primera alimentación enteral y el ductus persistente con repercusión hemodinámica fueron factores predisponentes para ECN, y el puntaje de Apgar bajo al minuto 5 para perforación intestinal. (OR: 6,515; IC del 95 %: 5,011-8,470; OR: 4,715; IC del 95 %: 2,717-8,183; OR: 2,748; IC del 95 %: 1,100-6,866). La mortalidad fue del 9 %. La ECN aumentó el riesgo de mortalidad 2,192 veces (IC del 95 %: 1,469-3,271); en perforación intestinal, el riesgo aumentó 11,527 veces (IC del 95 %: 6,293-21,115).Conclusión. El conducto arterial persistente y el retraso en la primera nutrición enteral fueron factores predisponentes para ECN, y el puntaje de Apgar bajo al minuto 5 para perforación intestinal.


Aim. To investigate NEC frequency in premature infants and assess risk factors associated with disease-onset and progression to intestinal perforation.Methods. Retrospective cohort in preterm neonates hospitalized between 2015 and 2018. Perinatal characteristics, clinical features, nutritional data and laboratory outcome were analyzed using SPSS-23 statistical package. Logistic regression was performed to analyze associated risk factors.Results. In 1428 neonates, the rate of developing NEC was 18.28 %. Conception with assisted reproductive technology, cesearean section and postnatal-steroids were associated with NEC (OR: 4.056, 95 % CI: 2.810-5.854, OR: 1.961, 95 % CI: 1.321-2.910, OR: 6.422; 95 % CI: 4.327-9.530).Timing of first enteral feeding was associated to developing NEC, but not to intestinal perforation (p < 0.001, p = 0.604). Forty-seven of 261 NEC patients (18 %) have developed intestinal perforation. Antenatal steroids showed to reduce severe consequences (p = 0.001). Timing of first enteral feeding and hemodynamically significant PDA were predisposing factors for NEC and low 5-minutes Apgar score for intestinal perforation. (OR: 6.515; 95 % CI: 5.011-8.470; OR: 4.715; 95 % CI: 2.717-8.183; OR: 2.748; 95 % CI: 1.100-6.866).Mortality was 9 %. Developing NEC increased risk of mortality by 2.192 times (95 % CI: 1.469-3.271); in intestinal perforation, mortality risk increased to 11.527 (95 % CI: 6.293-21.115).Conclusion. NEC frequency was 18.28 %. Intestinal perforation occurred in 18 % of NEC patients. PDA and delay in first enteral nutrition were predisposing factors for acquiring NEC and low 5-minutes Apgar scores for intestinal perforation


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Enterocolite Necrosante , Perfuração Intestinal/diagnóstico por imagem , Índice de Apgar , Turquia , Recém-Nascido Prematuro , Terapia Intensiva Neonatal , Estudos Retrospectivos , Fatores de Risco , Idade Gestacional , Nutrição Enteral
12.
Acta Gastroenterol Belg ; 83(4): 663-665, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33321027

RESUMO

Covered oesophageal stents are often used to treat dysphagia in patients with inoperable oesophageal cancer. Stent migration is a well-known but usually benign complication. We report the case of a patient whose esophageal stent migrated into the distal ileum with perforation hereof. A laparoscopic stent extraction and intestinal repair was necessary to treat the perforation.


Assuntos
Transtornos de Deglutição , Neoplasias Esofágicas , Estenose Esofágica , Migração de Corpo Estranho , Perfuração Intestinal , Migração de Corpo Estranho/complicações , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Stents/efeitos adversos
13.
Rev Med Liege ; 75(12): 809-815, 2020 Dec.
Artigo em Francês | MEDLINE | ID: mdl-33331706

RESUMO

OBJECTIVE: The aim of our retrospective study is to analyse the results of endoscopic macro-clips used for closing intestinal breaches in the real life. Post-endoscopic, spontaneous perforations and surgical fistulas are included. Our results are compared with principal published series. METHODS: Between 2010 and 2015, 25 consecutive patients underwent an endoscopic suture with macro-clips to seal a breach resulting from endoscopic perforation, surgical fistula, invasive medical procedure or spontaneous perforation. RESULTS: The endoscopic efficacy was immediate for all patients whose perforation was of endoscopic aetiology. None of them required surgery. Secondary complementary endoscopic treatment was only used in 6/25 patients. All of them had non-endoscopic aetiology for their perforation. The survival at 1 month was 84 % and at 3 months of 76 %. CONCLUSION: Our results confirm the high efficiency of macro-clips in the treatment of endoscopic breaches in a regional hospital center. The use of macro-clips seems less convincing for the closure of some postoperative fistula. The suture with macro-clips associated with endoscopic and medical treatments allowed to avoid surgical redo in some cases.


Assuntos
Fístula , Perfuração Intestinal , Endoscopia , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Estudos Retrospectivos , Instrumentos Cirúrgicos , Resultado do Tratamento
14.
Gastroenterol. hepatol. (Ed. impr.) ; 43(8): 431-438, oct. 2020. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-196894

RESUMO

OBJETIVO: Evaluar la eficacia y seguridad de la terapia de vacío endoscópica (TVE) en perforaciones y dehiscencias del tracto digestivo superior. PACIENTES Y MÉTODOS: Estudio retrospectivo observacional donde se incluyeron todos los pacientes que presentaron algún defecto del tracto gastrointestinal superior y que fueron sometidos a TVE en el período comprendido entre abril de 2017 y febrero de 2019 en 3 centros españoles. Para ello se utilizó el único sistema de terapia de vacío aprobado para uso endoscópico hasta la fecha (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Alemania). RESULTADOS: Un total de 11 pacientes fueron sometidos a TVE como tratamiento de una dehiscencia de sutura anastomótica tras esofaguectomía (n=7), gastrectomía (n=2), como tratamiento de una perforación esofágica tras septomiotomía endoscópica de Zenker (n=1) y tras una perforación esofágica espontánea o síndrome de Boerhaave (n=1). La mediana del tamaño de la cavidad fue de 8×3cm. De mediana, la TVE se inició a los 7días de la cirugía inicial. La mediana de duración de la TVE fue de 28días. La mediana de esponjas colocadas fue de 7 y el intervalo de recambio de las esponjas, de 3,7días. En 10 casos (91%) se consiguió el cierre del defecto y en 9 casos (82%) la resolución clínica del cuadro infeccioso asociado. Cinco pacientes presentaron algún evento adverso: 3 estenosis anastomóticas, un episodio de dolor retrofaríngeo y un caso de neumonía de nueva aparición. La mediana de estancia hospitalaria desde el inicio de la TVE fue de 45días. Un paciente falleció debido a complicaciones sépticas secundarias a la dehiscencia de sutura. CONCLUSIÓN: La TVE tiene una eficacia superior al 90% en las perforaciones y fugas anastomóticas del tracto digestivo superior. Adicionalmente es una terapia segura, siendo los eventos adversos leves


AIM: To evaluate the efficacy and safety of endoscopic vacuum therapy (EVT) in the management of perforations and anastomotic leaks of the upper gastrointestinal tract. PATIENTS AND METHODS: This is a retrospective observational study which included patients who underwent EVT due to any upper gastrointestinal defect between April 2017 and February 2019 in three Spanish Hospitals. To this end, we used the only medical device approved to date for endoscopic use (Eso-SPONGEr; B. Braun Melsungen AG, Melsungen, Germany). RESULTS: 11 patients were referred for EVT of an anastomotic leak after esophagectomy (n=7), gastrectomy (n=2), esophageal perforation secondary to endoscopic Zenker's septomiotomy (n=1) and Boerhaave syndrome (n=1). The median size of the cavity was 8×3cm. The median delay between surgery and EVT was 7 days. The median of EVT duration was 28 days. The median number of sponges used was 7 and the mean period replacement was 3.7 days. In 10 cases (91%), the defect was successfully closed. In 9 cases (82%) clinical resolution of the septic condition was achieved. 5 patients presented some adverse event: 3 anastomotic strictures, 1 retropharyngeal pain and 1 case of new-onset pneumonia. The median hospital stay from the start of EVT was 45 days. 1 patient died owing to septic complications secondary to the anastomotic leak. CONCLUSION: EVT was successful in over 90% of perforations and anastomotic leaks of the upper gastrointestinal tract. Moreover, this is a safe therapy with only mild adverse events associated


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Deiscência da Ferida Operatória/terapia , Endoscopia do Sistema Digestório/métodos , Resultado do Tratamento , Perfuração Intestinal/cirurgia , Estudos Retrospectivos , Perfuração Intestinal/diagnóstico , Fístula do Sistema Digestório/cirurgia , Fístula Anastomótica
15.
Am J Trop Med Hyg ; 103(4): 1600-1603, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32876011

RESUMO

The COVID-19 pandemic has recently spread worldwide, presenting primarily in the form of pneumonia or other respiratory disease. In addition, gastrointestinal manifestations have increasingly been reported as one of the extrapulmonary features of the virus. We report two cases of SARS-CoV-2 infection complicated by paralytic ileus. The first patient was a 33-year-old man who was hospitalized with severe COVID-19 pneumonia requiring ventilator support and intensive care. He developed large bowel dilatation and perforation of the mid-transverse colon, and underwent laparotomy and colonic resection. Histopathology of the resected bowel specimen showed acute inflammation, necrosis, and hemorrhage, supporting a role for COVID-19-induced micro-thrombosis leading to perforation. The second patient was a 33-year-old man who had severe COVID-19 pneumonia, renal failure, and acute pancreatitis. His hospital course was complicated with paralytic ileus, and he improved with conservative management. Both cases were observed to have elevated liver transaminases, which is consistent with other studies. Several authors have postulated that the angiotensin-converting enzyme 2 receptors, the host receptors for COVID-19, that are present on enterocytes in both the small and large bowel might mediate viral entry and resultant inflammation. This is a potential mechanism of paralytic ileus in cases of severe COVID-19 infection. Recognizing paralytic ileus as a possible complication necessitates timely diagnosis and management.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/virologia , Perfuração Intestinal/virologia , Pseudo-Obstrução Intestinal/virologia , Pancreatite/virologia , Pneumonia Viral/virologia , Insuficiência Renal/virologia , Adulto , Biomarcadores/metabolismo , Infecções por Coronavirus/diagnóstico por imagem , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/fisiopatologia , Perfuração Intestinal/terapia , Pseudo-Obstrução Intestinal/diagnóstico por imagem , Pseudo-Obstrução Intestinal/fisiopatologia , Pseudo-Obstrução Intestinal/terapia , Fígado/enzimologia , Fígado/patologia , Fígado/virologia , Masculino , Pancreatite/diagnóstico por imagem , Pancreatite/fisiopatologia , Pancreatite/terapia , Pandemias , Pneumonia Viral/diagnóstico por imagem , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Respiração com Pressão Positiva/métodos , Diálise Renal , Insuficiência Renal/diagnóstico por imagem , Insuficiência Renal/fisiopatologia , Insuficiência Renal/terapia , Tomografia Computadorizada por Raios X , Transaminases/metabolismo
16.
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue ; 32(8): 943-946, 2020 Aug.
Artigo em Chinês | MEDLINE | ID: mdl-32912407

RESUMO

OBJECTIVE: To analyze the clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation. METHODS: Clinical data of patients with septic shock due to gastrointestinal perforation admitted to the department of critical care medicine of the Affiliated Hospital of Guizhou Medical University from January 2018 to December 2019 were analyzed retrospectively. The general information; procalcitonin (PCT), acute physiology and chronic health evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores during the first 24 hours in intensive care unit (ICU); results of ascites culture during the first 72 hours in ICU; the maximum dosage and total time of norepinephrine (NE) in ICU; mechanical ventilation time, the length of ICU stay, occurrence of acute kidney injury (AKI), continuous renal replacement therapy (CRRT) and 28-day mortality were collected. The patients were divided into upper gastrointestinal tract group (stomach and duodenum) and lower gastrointestinal tract group (jejunum, ileum, appendix, colon and rectum), with a boundary of Treitz. The clinical features between the two groups were compared. RESULTS: There were 33 patients in the upper gastrointestinal tract group and 30 patients in the lower gastrointestinal tract group. There was no significant difference in gender and age between the two groups. The main pathogens in the ascites cultures in the upper gastrointestinal tract group were Candida albicans (45.5%), Enterococcus faecalis (18.2%) and Escherichia coli (18.2%). Escherichia coli (46.2%) and Enterococcus faecalis (30.8%) were the main pathogens in the lower gastrointestinal tract group. There were significant differences in PCT, the length of ICU stay, mechanical ventilation time, the maximum dosage and total time of NE between the upper gastrointestinal tract group and lower gastrointestinal tract group [PCT (µg/L): 17.69 (3.83, 26.62) vs. 32.82 (4.21, 100.00), the length of ICU stay (hours): 149.0 (102.5, 302.0) vs. 115.5 (30.8, 214.5), mechanical ventilation time (hours): 106.0 (41.5, 183.0) vs. 57.5 (25.0, 122.3), the maximum dosage of NE (µg×kg-1×min-1): 1.2 (0.5, 2.0) vs. 0.7 (0.5, 1.2), the total time of NE (hours): 72.0 (21.0, 145.0) vs. 26.5 (18.0, 80.5), all P < 0.05], while there was no statistically differences in APACHE II or SOFA scores [APACHE II: 30.0 (24.5, 35.0) vs. 28.0 (25.0, 33.5), SOFA: 10.67±4.14 vs. 9.50±3.33, both P > 0.05]. Compared with the lower gastrointestinal tract group, patients in the upper gastrointestinal tract group were more likely to have AKI (78.8% vs. 53.3%, P < 0.05) and require CRRT (39.4% vs. 16.7%, P < 0.05), but there was no significant difference in the 28-day mortality (39.4% vs. 43.3%, P > 0.05). CONCLUSIONS: The clinical characteristics of septic shock caused by upper and lower gastrointestinal perforation are not the same. Patients with septic shock caused by upper gastrointestinal perforation are more likely to suffer from fungal infection, with more severe shock, more likely to have AKI and require CRRT, and significantly longer mechanical ventilation and the length of ICU stay. While patients with septic shock caused by lower gastrointestinal perforation showed higher PCT.


Assuntos
Perfuração Intestinal , Choque Séptico , APACHE , Humanos , Unidades de Terapia Intensiva , Escores de Disfunção Orgânica , Estudos Retrospectivos
17.
Ann Ital Chir ; 91: 235-238, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32877383

RESUMO

The present pandemic caused by the SARS COV-2 coronavirus is still ongoing, although it is registered a slowdown in the spread for new cases. The main environmental route of transmission of SARS-CoV-2 is through droplets and fomites or surfaces, but there is a potential risk of virus spread also in smaller aerosols during various medical procedures causing airborne transmission. To date, no information is available on the risk of contagion from the peritoneal fluid with which surgeons can come into contact during the abdominal surgery on COVID-19 patients. We have investigated the presence of SARS-CoV-2 RNA in the peritoneal cavity of patients affected by COVID-19, intraoperatively and postoperatively. KEY WORDS: Covid-19, Laparotomy, Surgery.


Assuntos
Líquido Ascítico/virologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/transmissão , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Perfuração Intestinal/cirurgia , Laparotomia , Pandemias , Pneumonia Viral/transmissão , Doenças do Colo Sigmoide/cirurgia , Viremia/transmissão , Aerossóis , Idoso de 80 Anos ou mais , Infecções por Coronavirus/sangue , Infecções por Coronavirus/complicações , Infecções por Coronavirus/prevenção & controle , Estudos Transversais , Divertículo/complicações , Evolução Fatal , Feminino , Humanos , Perfuração Intestinal/sangue , Perfuração Intestinal/complicações , Perfuração Intestinal/virologia , Período Intraoperatório , Nasofaringe/virologia , Pandemias/prevenção & controle , Pneumonia Viral/sangue , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Período Pós-Operatório , Estudos Prospectivos , RNA Viral/isolamento & purificação , Risco , Soro/virologia , Doenças do Colo Sigmoide/sangue , Doenças do Colo Sigmoide/complicações , Doenças do Colo Sigmoide/virologia , Viremia/virologia
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