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1.
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
3.
Chirurgia (Bucur) ; 115(3): 404-409, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614297

RESUMO

Introduction: The GIST tumors are very rare entities ( 1% of all tumors). They originate in the Cajal interstitial cells, which are part of the autonomic nervous system of the intestine. Their most common location is the stomach, followed by the small intestine. The aim of this paper is to present a very rare case of perforated ileal GIST, associated with Meckel diverticulum. Case report: A 71 years old patient with comorbidities is admitted in emergency for symptoms and signs of acute surgical abdomen. The exploratory laparotomy reveals generalized acute peritonitis due to perforated ileal tumor and Meckel's diverticulum. A segmental enterectomy is performed, with favorable postoperative evolution. The histological examination of the resection piece shows the appearance of GIST, confirmed immunohistochemically. Conclusions: The GIST tumors of the small intestine are unusual tumors and the spontaneous perforation and life-threatening hemorrhage are a rarity. The main treatment for this form of GIST is the resection, with a favorable clinical outcome.


Assuntos
Abdome Agudo , Tumores do Estroma Gastrointestinal , Neoplasias do Íleo/complicações , Perfuração Intestinal , Divertículo Ileal , Idoso , Tumores do Estroma Gastrointestinal/complicações , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias do Íleo/cirurgia , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Resultado do Tratamento
5.
Surg Obes Relat Dis ; 16(9): 1372-1375, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32723601

RESUMO

Tocilizumab, a monoclonal antiinterluekin-6 receptor antibody, has been empirically used in the treatment of cytokine release syndrome associated with severe coronavirus disease 2019 infections. The efficacy and safety of these medications for these patients is unknown. The purpose of this report was to present a case of acute large bowel perforation in a morbidly obese patient with coronavirus disease 2019 pneumonia who received empiric Tocilizumab. This case report analyzes the risks of acute large bowel perforation after using this medication empirically and discusses the appropriate management of this adverse event.


Assuntos
Anticorpos Monoclonais Humanizados/efeitos adversos , Betacoronavirus , Doenças do Ceco/etiologia , Infecções por Coronavirus/tratamento farmacológico , Perfuração Intestinal/etiologia , Obesidade Mórbida/complicações , Pneumonia Viral/tratamento farmacológico , Doenças do Ceco/diagnóstico , Doenças do Ceco/cirurgia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Síndrome da Liberação de Citocina/etiologia , Síndrome da Liberação de Citocina/prevenção & controle , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico
6.
Medicine (Baltimore) ; 99(23): e20050, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32501967

RESUMO

INTRODUCTION: Enteropathy-associated T-cell lymphoma (EATL) is a very rare form of lymphoma in the gastrointestinal tract. The proximal jejunum and ileum are the most common sites of EATL, whereas EATL rarely arises in the duodenum, and EATL involving metastasis of the bilateral ovaries is even rarer. PATIENT CONCERNS: A 43-year-old female suffered from upper abdominal pain and weight loss for 3 months. DIAGNOSIS: Type II EATL. INTERVENTIONS: The patient was initially treated with chemotherapies, including 4 cycles of the CHOP-E and 2 cycles of the DHAP+ chidamide chemotherapy regimens. However, the patient did not respond well to chemotherapy. Surgical treatment of the duodenal obstruction, with perforation of small intestine and the duodenum, was performed successively. OUTCOMES: The patient died of septic shock only 1 day after the surgery for the second perforation. Her overall survival was 11 months from the time of initial diagnosis. CONCLUSION: This case suggests that EALT is highly invasive and its clinical course is very aggressive. Intestinal perforation, intestinal obstruction, or involvement of extraintestinal organs may occur in EALT patients. Additionally, EALT patients respond poorly to chemotherapy and have an extremely unfavorable prognosis.


Assuntos
Duodenopatias/patologia , Linfoma de Células T Associado a Enteropatia/patologia , Adulto , Feminino , Humanos , Obstrução Intestinal/complicações , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Neoplasias Ovarianas/secundário
7.
BMC Surg ; 20(1): 121, 2020 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-32503493

RESUMO

BACKGROUND: Liver abscess due to gastrointestinal perforation by foreign bodies is rare. Furthermore, there are few case reports of liver abscess via the portal vein caused by perforation of the lower gastrointestinal tract by a foreign body. CASE PRESENTATION: A 54-year-old man visited our hospital because of a fever that had lasted for 1 month. There were no physical findings except for the fever. Laboratory tests showed only elevated inflammatory markers. Abdominal contrast-enhanced computed tomography revealed an abscess in the right lobe of the liver and a high-density object in the small intestine. We diagnosed him with liver abscess secondary to intestinal perforation by a foreign body. The patient underwent drainage of the liver abscess and laparoscopic surgery for perforation of the small intestine. A fish bone had perforated the top of Meckel's diverticulum, which had been covered by the ileal mesentery. We successfully performed diverticulectomy and removed the fish bone. The patient was discharged without complications on the 13th postoperative day. CONCLUSIONS: Liver abscess caused by foreign bodies requires multidisciplinary treatment, so we must detect and remove the cause of the abscess earlier. Liver abscess can form via the portal vein secondary to lower gastrointestinal perforation, as in this case. When exploring the cause of liver abscess, we should investigate the whole body, including the lower gastrointestinal tract.


Assuntos
Corpos Estranhos/complicações , Perfuração Intestinal/cirurgia , Divertículo Ileal/complicações , Animais , Humanos , Laparoscopia/efeitos adversos , Abscesso Hepático/etiologia , Masculino , Pessoa de Meia-Idade , Veia Porta , Tomografia Computadorizada por Raios X
13.
Int J Colorectal Dis ; 35(9): 1797-1800, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32458395

RESUMO

INTRODUCTION: Since the outbreak of novel coronavirus (2019-nCoV), it became evident that a proportion of patients may present with gastrointestinal symptoms. CASE: We report the case of a Covid-19-infected patient who, during recovery from the pulmonary pneumonia, had gastrointestinal symptoms followed by a diastasic right colon perforation due to acute over distension of the bowel. CONCLUSION: This case highlights the importance of paying attention to initial gastrointestinal symptoms in order to prevent possible complications.


Assuntos
Colectomia/métodos , Infecções por Coronavirus/complicações , Perfuração Intestinal/complicações , Perfuração Intestinal/diagnóstico por imagem , Pneumonia Viral/complicações , Síndrome Respiratória Aguda Grave/complicações , Anastomose Cirúrgica/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Emergências , Seguimentos , Humanos , Perfuração Intestinal/cirurgia , Laparotomia/métodos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Cuidados Pós-Operatórios/métodos , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
BMC Surg ; 20(1): 99, 2020 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-32398146

RESUMO

BACKGROUND: Ingested toothpick may cause severe complications if there is no intervention timely. Toothpicks that required surgical intervention often retrieved through exploratory laparotomy or laparoscopic exploration surgery under general anesthesia, while, those through lumbar approach have been rarely reported. Herein, authors report a case of ingested toothpick which removed through the lumbar surgical approach under local anesthesia and the patient has gained a considerable recovery. CASE PRESENTATION: A 57-year-old man was admitted to our hospital with distending pain in the right flank for more than 20 days. He had a history of accidental toothpick ingestion. Abdominal computed tomography (CT) scan and Color Doppler Ultrasound of the superficial tissue (right flank pain area) consistently revealed a linear lesion -corresponding to the toothpick- was located at the right flank next to the body surface. Surgery via lumbar approach was then successfully performed to retrieve the toothpick under local anesthesia. The post-procedural course was uneventful, and the patient was discharged on the third day after surgery, no complications were noted at the 18-month follow-up. CONCLUSION: When a foreign body that causes perforation of the digestive tract remains for a relative long time (non-acute stage) and the perforation is close to the body surface, a local anesthesia surgery through the corresponding body surface may be a considerable choice.


Assuntos
Corpos Estranhos/complicações , Região Lombossacral/cirurgia , Humanos , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios X
15.
Ir Med J ; 113(1): 12, 2020 01 16.
Artigo em Inglês | MEDLINE | ID: mdl-32298562

RESUMO

Presentation We describe an unusual presentation of sigmoid colon perforation secondary to an ingested chicken bone. Diagnosis The patient presented with a 4 day history of abdominal pain and distension. On examination there were signs of peritonism. Inflammatory markers were raised. Computed tomography revealed a linear density projecting through the wall of the colon. Treatment The patient underwent emergency laparotomy and a Hartmann's procedure. A chicken bone was found to be the causative foreign object. Conclusion Foreign body ingestion is an uncommon cause of sigmoid perforation which may mimic more common surgical presentations such as diverticulitis.


Assuntos
Colo Sigmoide , Corpos Estranhos/complicações , Perfuração Intestinal/etiologia , Idoso de 80 Anos ou mais , Colo Sigmoide/diagnóstico por imagem , Colo Sigmoide/cirurgia , Emergências , Feminino , Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Humanos , Perfuração Intestinal/cirurgia , Laparotomia , Tomografia Computadorizada por Raios X
16.
Medicine (Baltimore) ; 99(15): e19508, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282701

RESUMO

INTRODUCTION: Gastrointestinal perforation due to foreign body intake is rare and often secondary to unintentional intake; hence, a misdiagnosis is likely. Herein, we report a case of perforation of the ileum due to fish bone. CASE PRESENTATION: A 57-year-old woman presented with right lower abdominal pain. She did not provide any information about having a history of swallowing foreign bodies. Surgery for uterine fibroids and subtotal gastrectomy was performed 6 years ago. DIAGNOSIS: Laboratory tests and imaging examination showed normal results. During laparotomy, a fish bone was found at the end of the ileum. Two senior radiologists re-evaluated the computed tomography scan, and confirmed the presence of the suspected foreign body. INTERVENTIONS: Partial intestinal resection and manual ileum end anastomosis were performed. OUTCOMES: The patient recovered well after surgery and recalled that she had eaten fish the night before experiencing abdominal pain. CONCLUSION: An accurate diagnosis of complications due to fish bone intake, often secondary to the unintentional intake, is quite challenging. Detailed history-taking about the patient's diet and eating habits is therefore important. Clinical manifestations are mainly determined by the location of perforation, which typically occurs at the junction of the ileum and rectal sigmoid colon. Imaging examination and surgery are often used for definite diagnosis.


Assuntos
Perfuração Intestinal/etiologia , Alimentos Marinhos/efeitos adversos , Osso e Ossos , Feminino , Humanos , Perfuração Intestinal/cirurgia , Pessoa de Meia-Idade
19.
Cardiovasc Pathol ; 47: 107193, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32151788

RESUMO

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly called Churg-Strauss syndrome, is an uncommon disease with pathological features consisting of systemic necrotizing vasculitis, eosinophilic infiltration, and granulomatous or nongranulomatous extravascular eosinophilic inflammation. EGPA preferentially affects certain organ systems, including the airways, peripheral nerves, heart, kidney, and gastrointestinal tract. Although gastrointestinal involvement, such as ulcerations, is common in EGPA, gastrointestinal perforation is relatively uncommon and is associated with a poor prognosis. Ulceration, perforation, and stenosis of the gastrointestinal tract are assumed to be the result of ischemia caused by vasculitis. The histological finding in the biopsy specimens of EGPA is generally only eosinophil infiltration, and vasculitis is not often seen. Therefore, in biopsy specimens, it is difficult to distinguish eosinophilic gastroenteritis from the gastrointestinal involvement of EGPA. In addition, in general, steroid therapy is the first-choice treatment for EGPA, but some reports have described the frequent occurrence of acute ulcer or perforation of the gastrointestinal tract in association with steroid treatment. We herein report an EGPA patient who was treated with steroid therapy and subsequently developed perforation of the small intestine.


Assuntos
Síndrome de Churg-Strauss/tratamento farmacológico , Glucocorticoides/efeitos adversos , Perfuração Intestinal/induzido quimicamente , Intestino Delgado/efeitos dos fármacos , Úlcera/induzido quimicamente , Idoso , Síndrome de Churg-Strauss/patologia , Progressão da Doença , Evolução Fatal , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/patologia , Perfuração Intestinal/cirurgia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Intestino Delgado/cirurgia , Masculino , Metilprednisolona , Recidiva , Fatores de Risco , Resultado do Tratamento , Úlcera/diagnóstico por imagem , Úlcera/patologia , Úlcera/cirurgia
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