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1.
Medicine (Baltimore) ; 99(30): e21120, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791686

RESUMO

INTRODUCTION: Pancreaticoduodenectomy (PD) has been widely applied as a standard surgical procedure to treat periampullary diseases. The placement of a pancreaticojejunal anastomotic stent is considered an effective and safe method for preventing pancreatic fistula after PD. Recently, the role of pancreaticojejunal anastomotic stents has been challenged, as gradually increasing complications have been observed. Stent-related small bowel perforation has only occurred in 2 cases as long-term complications but has not been reported to occur within 1 week after surgery. PATIENT CONCERNS: Here, we report the case of a 71-year-old female patient complaining of painless jaundice who underwent PD with a pancreaticojejunal anastomotic stent for a duodenal papillary adenocarcinoma (T4N1M0). Four days after surgery, she had a sudden rise in temperature, high white blood cell count, significantly elevated C-reactive protein and 400 ml green-brown drainage fluid. Enhanced computed tomography showed hydrops abdominis. DIAGNOSIS: Small bowel perforation caused by stent migration was considered first. INTERVENTIONS: An emergency exploratory laparotomy was performed. We located the pancreaticojejunal anastomotic stent, which extended 2 cm from the small bowel, and sutured the jejunum hole after cutting away the protruding part of the stent. OUTCOMES: The patient recovered smoothly and was discharged on the 7th day after the second surgery. After more than 12 months of follow-up, the patient is doing well and is free of any symptoms related to the procedure. CONCLUSION: We caution that stent-related complications can occur when perioperative patients suffer from unexplained or sudden changes in vital signs after PD. In addition, the function of the pancreaticojejunal anastomotic stent needs to be reevaluated by future studies.


Assuntos
Perfuração Intestinal/etiologia , Doenças do Jejuno/etiologia , Falha de Prótese/efeitos adversos , Stents/efeitos adversos , Idoso , Feminino , Humanos , Pancreaticoduodenectomia/efeitos adversos , Pancreaticojejunostomia/efeitos adversos , Complicações Pós-Operatórias/etiologia
3.
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
4.
Am Surg ; 86(5): 546-548, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32684041

RESUMO

Calciphylaxis or calcific uremic arteriolopathy is a rare entity associated with the end-stage renal disease that presents with necrotic cutaneous lesions that may require surgical management. Extracutaneous manifestations of calciphylaxis including visceral ischemia have been reported; however, surgical intervention for colonic ischemia has only been reported twice. We report a 49-year-old male with calciphylaxis who subsequently developed Ogilvie's syndrome complicated by perforation requiring total abdominal colectomy with end ileostomy. Surgeons treating this disease should have a heightened awareness of the extracutaneous sequelae of calciphylaxis.


Assuntos
Calciofilaxia/complicações , Pseudo-Obstrução do Colo/etiologia , Perfuração Intestinal/etiologia , Humanos , Masculino , Pessoa de Meia-Idade
5.
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
6.
Rev Chilena Infectol ; 37(2): 186-189, 2020 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-32730488

RESUMO

Gastrointestinal tuberculosis is a rare extrapulmonary manifestation, it represents 3% of cases and mainly involves the ileocecal region; appendiceal involvement is rare. Tuberculous appendicitis can present as an acute condition indistinguishable from other causes of appendicitis and the diagnosis is generally made by histopathological finding, which delays treatment and can lead to complications. The postpartum period is at risk of a reactivation of tuberculosis, due to changes in the immune system that manifests as an immune reconstitution syndrome. We present the case of a postpartum patient admitted for septic shock secondary to perforated appendicitis, the pathology reported chronic granulomatous inflammation and subsequent confirmation by molecular technique of pulmonary tuberculosis.


Assuntos
Apendicite , Apêndice , Perfuração Intestinal/etiologia , Tuberculose Gastrointestinal , Apendicectomia , Apendicite/complicações , Feminino , Humanos , Período Pós-Parto , Tuberculose Gastrointestinal/complicações
7.
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
8.
BMC Surg ; 20(1): 131, 2020 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-32532257

RESUMO

BACKGROUND: We examined the validity and applicability of the Kugel repair approach for obturator hernias, whereby we placed a Kugel patch through the preperitoneal space after placing a short 5-cm skin incision just medial to the anterior iliac spine and 2 cm cranial to the expected origin of the internal inguinal ring. METHODS: We studied patients who underwent surgical Kugel repair for obturator hernias at the Department of General Surgery, Saitama Medical University between 2007 and 2017. We examined the operating time, length of hospital stay, postoperative complications, and mortality rate. RESULTS: Fifty-eight patients with obturator hernias presented with symptoms of small bowel obstruction. A Kugel approach was used in 53 patients and a midline approach was used in 5 patients with preoperative peritonitis. Of the 53 patients managed using the Kugel approach, 39 did not require intestinal resection; a mesh was used in all these patients. In the remaining 14 patients, intestinal resection was required and performed using the same approach; subsequently, a mesh was used successfully in 6 of these 14 patients. The overall median operating time was 47 min; the corresponding values for procedures with and without intestinal resection were 39 and 68 min, respectively. In terms of postoperative complications, operative mortality was not noted among patients without intestinal perforation; however, superficial surgical site infection developed in 2 patients. Among the 5 patients with preoperative peritonitis who underwent exploratory laparotomy via a midline incision, intestinal perforation was detected during surgery, and all patients required intestinal resection; none of the patients had received a mesh, and 2 patients died after surgery. CONCLUSIONS: The Kugel repair approach was possible even in patients with obturator hernia requiring intestinal resection. However, for patients with perforations, open surgery should be performed after securing the surgical field through a midline incision.


Assuntos
Hérnia do Obturador/cirurgia , Complicações Pós-Operatórias/epidemiologia , Telas Cirúrgicas , Idoso , Idoso de 80 Anos ou mais , Feminino , Hérnia do Obturador/complicações , Humanos , Obstrução Intestinal/cirurgia , Perfuração Intestinal/etiologia , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Estudos Retrospectivos , Resultado do Tratamento
9.
Gan To Kagaku Ryoho ; 47(4): 706-708, 2020 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-32389991

RESUMO

Previous studies have reported that perforations of the small intestine caused by metastatic tumors prior to the diagnosis of primary lung cancer are very rare. A 79-year-old man was admitted to our hospital with acute lower abdominal pain. Abdominal computed tomography revealed intraperitoneal free air around the bowel wall thickening in the small intestine. The patient was diagnosed with acute peritonitis caused by perforation of the small intestine, and an emergency operation was performed. Laparotomy revealed perforation in the jejunum without any palpable tumor in the abdomen. Partial resection of the jejunum revealed an ulcerating lesion at the perforation site. Histological examination indicated small intestinal metastasis secondary to lung adenocarcinoma. Positron emission tomography performed after discharge showed a small reticular opacity with intense accumulation of FDG in the left lung. The patient was diagnosed with perforation of the small intestine metastasis secondary to lung adenocarcinoma. The postoperative course was uneventful; the patient received chemotherapy, and is alive 6months after the operation.


Assuntos
Adenocarcinoma de Pulmão/secundário , Perfuração Intestinal/etiologia , Neoplasias Pulmonares , Peritonite , Idoso , Humanos , Intestino Delgado , Masculino , Peritonite/etiologia
10.
Updates Surg ; 72(3): 901-905, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32430719

RESUMO

Gastrostomy tubes, placed either endoscopically or laparoscopically, are the most widely used method to deliver enteral feeding to patients unable to be fed by mouth. Tube gastrostomy is quick and low cost and allows the health care professionals for a convenient route to deliver enteral nutrition to their patients. Nevertheless, bearing an indwelling gastric tube could not be as convenient for patients. Complications, such as bowel perforation, tube dislodgement, peristomal infection or bleeding occur in up to 17% of patients, and some other drawbacks of gastric tubes, such as peristomal pain, are often understated. We present our technique for laparoscopic creation of a tubularized continent gastrostomy, originally conceived for the emergency treatment of patients with a dislodged percutaneous endoscopic gastrostomy, to provide them with a reliable new route for gastric feeding. After healing, this gastrostomy does not need an indwelling tube to stay patent, requires only a light gauze dressing and can be used by intermittent catheterization at conventional feeding times during the day. Laparoscopic tubularized continent gastrostomy can be offered to patients as a reliable alternative to tube gastrostomy.


Assuntos
Gastrostomia/métodos , Laparoscopia/métodos , Nutrição Enteral/métodos , Gastrostomia/efeitos adversos , Hemorragia/etiologia , Humanos , Infecções/etiologia , Perfuração Intestinal/etiologia
11.
JAMA Netw Open ; 3(5): e205741, 2020 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-32453385

RESUMO

Importance: Up to 30% of patients with a diagnosis of colorectal cancer (CRC) present as an emergency (an intestinal obstruction, perforation, or emergency hospital admission) (OPE). There are limited data about the association of organized, population-based colorectal cancer screening with the rate of emergency presentations. Objective: To examine the association of CRC screening with OPE at cancer diagnosis and time trends in the rate of OPE after the start of organized CRC screening using a highly sensitive fecal occult blood test. Design, Setting, and Participants: A historical cohort study was conducted among 1861 individuals 52 to 74 years of age with a diagnosis of CRC from January 1, 2007, to December 31, 2015, who lived in Winnipeg, Manitoba, a province with universal health care and an organized CRC screening program. Statistical analysis was performed from January 22, 2019, to February 26, 2020. Exposures: Variables included prior CRC screening, era of diagnosis, cancer stage at diagnosis, tumor site in the colon, area level mean household income, primary care continuity of care, and comorbidity. Main Outcomes and Measures: The primary outcomes were defined as an OPE. Logistic regression was used to evaluate factors associated with OPE at CRC diagnosis. Trends over time were calculated using Joinpoint Regression. Results: From 2007 to 2015, 1861 individuals 52 to 74 years of age (1133 men; median age, 65.1 years [interquartile range, 60.0-70.3 years]) received a diagnosis of CRC in Winnipeg. Most individuals had good continuity of care and moderate comorbidities. Overall, 345 individuals (18.5%) had an OPE. The rate of emergency hospital admissions decreased significantly from 2007 (the start of the organized, province-wide CRC screening program) to 2015 (annual change, -7.1%; 95% CI, -11.3% to -2.8%; P = .01). There was no change in the rate of obstructions or perforations or stage IV CRCs. Individuals who were up to date for CRC screening were significantly less likely to receive a diagnosis of an OPE (odds ratio, 0.38; 95% CI, 0.28-0.50; P < .001). The results were similar after adding emergency department visits and stage IV CRC at diagnosis to the outcome. Conclusions and Relevance: This study suggests that the rate of emergency hospital admissions decreased over time for individuals who underwent CRC screening, but there was no change in the rate of obstructions and perforations. Individuals who were up to date for CRC screening were less likely to have a CRC diagnosis with an OPE.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Obstrução Intestinal/epidemiologia , Perfuração Intestinal/epidemiologia , Idoso , Colonoscopia/estatística & dados numéricos , Emergências , Feminino , Humanos , Obstrução Intestinal/etiologia , Perfuração Intestinal/etiologia , Masculino , Manitoba/epidemiologia , Pessoa de Meia-Idade
13.
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
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
17.
J Surg Res ; 249: 42-49, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-31918329

RESUMO

BACKGROUND: The impact of social, racial, and economic inequities on health and surgical outcomes for children is poorly described. METHODS: A systematic review using search terms related to disparities in care of pediatric appendicitis identified 20 titles and narrowed to 11 full texts. Nine retrospective studies were analyzed, representing 350,408 cases treated across the United States from 1983 to 2010. Outcomes included length of stay (LOS), appendiceal perforation rate (AP), laparoscopic versus open approach, and rate of misdiagnosis. RESULTS: The most frequently reported outcomes were LOS (six of nine studies) and AP (six of nine studies). AP was higher for young children (48% for <6 versus 25% for >10), those in rural settings (42% versus 26% in urban settings), and patients receiving care at children's hospitals (35% versus 22% at nonchildren's hospitals). Longer LOS was associated with young age in three studies (2-5 d for age <10 y versus 1-3 d for age >11 y), race in four studies (1.5-3 d for African American children versus 1-2 d for other races), and lower family income in two studies (2-4 d versus 1-3 d for highest income). Inequitable use of laparoscopy, time to surgery, and rates of misdiagnosis were also reported to be associated with age and race. CONCLUSIONS: Although limited, the existing literature suggests that social, racial, and economic inequalities impact management and outcomes in pediatric appendicitis. More studies are needed to better describe and mitigate disparities in the surgical care of children.


Assuntos
Apendicectomia/estatística & dados numéricos , Apendicite/cirurgia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Perfuração Intestinal/epidemiologia , Laparoscopia/estatística & dados numéricos , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Apendicite/complicações , Apendicite/diagnóstico , Criança , Erros de Diagnóstico/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Perfuração Intestinal/etiologia , Tempo de Internação/estatística & dados numéricos , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Tempo para o Tratamento/estatística & dados numéricos
18.
BMC Gastroenterol ; 20(1): 5, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914931

RESUMO

BACKGROUND: The duodenum is a common site for diverticulum formation. Most of the duodenal diverticula are asymptomatic, incidental findings. Perforation is a rare but potentially lethal complication of duodenal diverticular disease. Surgery remains the mainstay of treatment for perforated duodenal diverticula. In recent years, a few cases were successfully managed either conservatively or with endoscopy. CASE PRESENTATION: We present two cases of female patients treated in our department for duodenal diverticulum perforation. The first case was treated surgically with a diverticulectomy. The second case was managed conservatively with bowel rest and intravenous antibiotics. Both patients had an uncomplicated postoperative course and were discharged home. CONCLUSIONS: Both surgical and conservative treatments are viable options for a perforated duodenal diverticulum in selected patients. Patients with a contained duodenal diverticular perforation can be managed conservatively at the outset. Possibly, the introduction of a classification system for duodenal diverticulum perforation may help clinicians in making essential therapeutic decisions.


Assuntos
Divertículo/diagnóstico , Duodenopatias/diagnóstico , Duodeno/cirurgia , Perfuração Intestinal/diagnóstico , Antibacterianos/uso terapêutico , Tratamento Conservador/métodos , Diagnóstico Diferencial , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Divertículo/complicações , Divertículo/terapia , Duodenopatias/etiologia , Duodenopatias/terapia , Feminino , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/terapia , Pessoa de Meia-Idade , Resultado do Tratamento
19.
BMJ Case Rep ; 13(1)2020 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-31907219

RESUMO

Here we present a rare case of spontaneous colonic perforation in a middle-aged woman affected by systemic sclerosis (SSc). In spite of maximal medical support and prompt emergency laparotomy for source control the patient died due to multiorgan failure within 48 hours of admission. This case emphasises that although rarely, patients with scleroderma can present with colonic perforation which unfortunately due to their decreased physiological reserve, can lead to rapid and irreversible deterioration and subsequent death. It is therefore essential that clinicians faced with abdominal symptoms and signs in patients affected by SSc are able to quickly differentiate acute visceral perforation from benign causes.


Assuntos
Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Escleroderma Sistêmico/complicações , Perfuração Espontânea/etiologia , Perfuração Espontânea/cirurgia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade
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