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1.
Chirurgia (Bucur) ; 114(4): 518-521, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31511138

RESUMO

Duodenal injury is an unusual complication of laparoscopic cholecystectomy, mostly caused by direct injury of the duodenum by laparoscopic instruments, either mechanical or thermal. The management is usually surgical, with satisfactory results, as long as the complication is detected early. We report two cases of duodenal perforations during laparoscopic cholecystectomy. One was treated with primary closure of the defect, while the other was managed conservatively with abdominal drainage and food deprivation. Both techniques proved successful in the management of that complication.


Assuntos
Colecistectomia Laparoscópica/efeitos adversos , Duodeno/lesões , Perfuração Intestinal/terapia , Tratamento Conservador , Drenagem , Duodeno/cirurgia , Humanos , Perfuração Intestinal/etiologia , Perfuração Intestinal/cirurgia , Resultado do Tratamento
2.
Early Hum Dev ; 137: 104836, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31437732

RESUMO

BACKGROUND: Iatrogenic gastrointestinal perforations are rare, but life-threatening events in preterm infants. AIM: Aim of the study was to report on incidence, management, morbidity, and mortality. STUDY DESIGN: This was a retrospective analysis performed at a tertiary neonatal intensive care unit in Vienna, Austria. SUBJECTS: Extremely low birth weight infants (ELBW, birth weight < 1000 g) with perforations of the upper gastrointestinal tract (GIT) caused by gastric tubes were included. OUTCOME MEASURES: All ELBW infants born within the 6-year study period were identified and their discharge summaries or notes were screened for esophageal and gastric perforations. Data on incidence, management of GIT perforations, morbidity, and mortality were obtained. RESULTS: During a 6-year study period 646 ELBW infants were analyzed. Incidence of perforations was 1.1% (n = 7/646). Median gestational age was 23 + 3 (range: 23 + 0-24 + 5). Perforations occurred on the third day of life (=median, range: day 2-14) and were primarily managed conservatively. Enteral feeding was stopped for 6 days (range: 4-13 days), antibiotic therapy administered for 16 days (range: 8-22 days). In one infant, gastrorrhaphy was performed. CONCLUSIONS: Conservative treatment of upper GIT perforations led to spontaneous recovery without major complications in 85.7%.


Assuntos
Nutrição Enteral/efeitos adversos , Perfuração Esofágica/terapia , Doença Iatrogênica/epidemiologia , Recém-Nascido de muito Baixo Peso , Perfuração Intestinal/terapia , Áustria , Tratamento Conservador/métodos , Tratamento Conservador/estatística & dados numéricos , Perfuração Esofágica/epidemiologia , Perfuração Esofágica/etiologia , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/etiologia , Masculino , Morbidade
3.
Medicine (Baltimore) ; 98(32): e16750, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393390

RESUMO

RATIONALE: Crohn disease includes 3 phenotypes, inflammatory, stricturing, and penetrating. In cases where corticosteroids and immunosuppressive agents are not suitable treatment options, enteral nutrition (EN) can be used to reduce disease severity and enhance barrier defense with fewer potential adverse effects. PATIENT CONCERNS: A 23-year-old man with abdominal pain and diarrhea presented at our hospital in 2014. The frequency of defecation was 3 or 4 times a day without mucus or blood in the stool. His body mass index was 15.8, and in laboratory tests the erythrocyte sedimentation rate was 42.4 mm/h, serum C reactive protein was 65.2 mg/L, the leukocyte count was 11.64 × 109/L, and hemoglobin was 111 g/L. DIAGNOSIS: In computed tomography (CT) enterography the ascending colon was thickened, and there was effusion and enlarged lymph nodes around the colon. Colonoscopy revealed ulcer, polypoid proliferation, and bowel stenosis in many segments. Chronic inflammation was evident in multiple biopsies. Crohn disease was diagnosed based on the above observations. INTERVENTIONS: Mesalazine was administered at a dose of 4 g daily for 2 years. The patient was hospitalized again due to severe abdominal pain and ongoing fever. Intestinal perforation was detected via CT. Percutaneous drainage was performed followed by administration of intravenous metronidazole (0.5 g) and ciprofloxacin (0.2 g) twice a day. Peptison liquid was used as exclusive EN. After 2 weeks the antibiotics regimen was changed to metronidazole 0.4 g twice a day and ciprofloxacin 0.25 g 3 times a day, both administered orally. OUTCOMES: CT revealed that the infection was eliminated and the fistula was healed after 10 weeks, at which point antibiotics and exclusive EN was discontinued. Azathioprine was prescribed at a dose of 2 mg/kg daily to maintain clinical remission. The patient did not report any pain or diarrhea at a 1-year follow-up visit. LESSONS: The present case suggests that exclusive EN combined with antibiotics is useful in inducing remission in Crohn disease patients with active disease and penetrating complications.


Assuntos
Doença de Crohn/complicações , Doença de Crohn/terapia , Nutrição Enteral/métodos , Perfuração Intestinal/etiologia , Perfuração Intestinal/terapia , Adulto , Antibacterianos/uso terapêutico , Doença de Crohn/tratamento farmacológico , Humanos , Perfuração Intestinal/tratamento farmacológico , Masculino , Indução de Remissão , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X
4.
BMJ Case Rep ; 12(8)2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31444261

RESUMO

We report a case of juvenile dermatomyositis (JDM) with cytomegalovirus (CMV) colitis which was further complicated with perforation. The patient, a 6-year-old girl, was diagnosed with JDM 1 month prior to the current presentation. After 2 weeks of optimising her treatment with steroid, intravenous Ig and methotrexate, she was readmitted with diffuse abdominal pain. Erect abdominal X-ray revealed gas under diaphragm. An exploratory laparotomy showed perforation of the large intestine. A biopsy showed inclusion bodies of CMV with immunohistochemistry for CMV positive. Strong positive CMV DNA PCR from tissue specimen, positive IgG CMV and negative IgM CMV in blood suggested a reactivation of CMV. The treatment followed included surgery and strategic use of antiviral agents as well as immunomodulators. CMV enteritis with complications should also be suspected in optimally treated autoimmune disease patients, including JDM, when they present with abdominal symptoms.


Assuntos
Colite/diagnóstico , Infecções por Citomegalovirus/diagnóstico , Citomegalovirus/isolamento & purificação , Dermatomiosite , Perfuração Intestinal/diagnóstico , Dor Abdominal/etiologia , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Criança , Colite/complicações , Colite/terapia , Colostomia , Terapia Combinada , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/terapia , Feminino , Humanos , Fatores Imunológicos/administração & dosagem , Fatores Imunológicos/uso terapêutico , Perfuração Intestinal/complicações , Perfuração Intestinal/terapia
7.
J Pediatr Surg ; 54(10): 2084-2091, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31084913

RESUMO

BACKGROUND: Spontaneous intestinal perforation (SIP) is an intestinal complication that occurs in very ill preterms. We investigated whether SIP survivors have worse neurodevelopmental and gastrointestinal outcomes and a poorer quality of life than controls. METHODS: A retrospective case-matched cohort study was performed involving infants treated for SIP in a NICU between August 1994 and April 2014. Controls and SIP patients were matched to gestational age, gender, and birth period. Medical records were reviewed. Telephone surveys were conducted to evaluate the medical condition, quality of life (PedsQL™ 4.0), neuropsychiatric and gastrointestinal outcome. McNemar's and Wilcoxon tests were performed, and generalized linear models were computed. RESULTS: Forty-nine SIP patients were included. The percentages of children with multiple disabilities (40% vs. 17%, OR = 3.3) and requiring physiotherapy (86% vs. 60%, OR = 4.77) were higher in the SIP group than in the control group. Intraventricular hemorrhage (IVH) led to a worse neurodevelopmental outcome regardless of SIP (OR = 8.79 for disability), and female gender was a protective factor against disability (OR = 0.06). Reported quality of life and gastrointestinal comorbidities did not differ between the two groups. CONCLUSION: SIP survivors tend to be at risk of multiple disabilities. IVH and female gender influence the neurodevelopmental outcome regardless of SIP. LEVELS OF EVIDENCE: Level III: case-control study.


Assuntos
Doenças do Recém-Nascido , Recém-Nascido de muito Baixo Peso , Perfuração Intestinal , Estudos de Casos e Controles , Deficiências do Desenvolvimento , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/fisiopatologia , Doenças do Recém-Nascido/terapia , Perfuração Intestinal/epidemiologia , Perfuração Intestinal/fisiopatologia , Perfuração Intestinal/terapia , Masculino , Qualidade de Vida , Estudos Retrospectivos , Resultado do Tratamento
8.
Surg Clin North Am ; 99(3): 555-569, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31047042

RESUMO

In patients with advanced esophageal or gastric cancer, it is highly likely that palliation of symptoms will become a focus of treatment. Dysphagia and obstruction are the most common complaints, and many of these patients can be treated with endoscopic interventions to alleviate symptoms. Bleeding, perforation, and nutritional issues are common problems. Attempts at palliation should be guided by thoughtful discussions regarding patients' goals of care. Owing to the high morbidity and mortality in patients with limited life expectancy, a strategy of working from the least invasive to the most invasive interventions should be guided by the patient's goals.


Assuntos
Neoplasias Esofágicas/terapia , Cuidados Paliativos/métodos , Neoplasias Gástricas/terapia , Coagulação com Plasma de Argônio/métodos , Braquiterapia/métodos , Quimiorradioterapia/métodos , Criocirurgia/métodos , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/terapia , Dilatação/métodos , Endoscopia Gastrointestinal/métodos , Etanol/administração & dosagem , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/terapia , Perfuração Intestinal/etiologia , Perfuração Intestinal/terapia , Terapia a Laser/métodos , Estadiamento de Neoplasias/métodos , Apoio Nutricional , Fotoquimioterapia/métodos , Soluções Esclerosantes/administração & dosagem , Escleroterapia/métodos , Stents Metálicos Autoexpansíveis
9.
J Surg Res ; 240: 70-79, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30909067

RESUMO

BACKGROUND: Management of perforated appendicitis in children remains controversial. Nonoperative (NO) and immediate operative (IO) strategies are used with varying outcomes. We hypothesized that IO intervention for patients with perforated appendicitis would be more cost-effective than NO management. METHODS: A retrospective chart review of all patients with appendicitis from 2012 to 2015 was performed. Patients with perforated appendicitis were defined by evidence of perforation on imaging. We excluded patients who presented with sepsis, organ failure, and ventriculoperitoneal shunts. NO management was determined by surgeon preference. Univariate and multivariate analyses were performed. RESULTS: IO was performed on 145 patients with perforated appendicitis, whereas 83 were treated with NO management. Compared to IO patients, NO patients incurred higher overall costs, greater length of stay, more readmissions, complications, peripherally inserted central venous catheter lines, interventional radiology drains, and unplanned clinic and emergency department visits (P < 0.0001 for all). Multivariate analysis adjusting for age, days of symptoms, admission C-reactive protein and white blood cell count revealed that NO management was independently associated with increased costs (OR 1.35, 1.12-1.62, 95% CI). Cost curves demonstrated that total cost for IO surpasses that of NO management when patients present with greater than 6.3 d of symptoms (P = 0.01). CONCLUSIONS: Our data suggest that IO is more cost-effective than NO management for patients with perforated appendicitis who present with less than 6.3 d of symptoms, after which point, NO management is more cost-effective. LEVEL OF EVIDENCE: IV.


Assuntos
Antibacterianos/uso terapêutico , Apendicectomia/métodos , Apendicite/terapia , Análise Custo-Benefício , Perfuração Intestinal/terapia , Adolescente , Antibacterianos/economia , Apendicectomia/economia , Apendicectomia/estatística & dados numéricos , Apendicite/complicações , Apendicite/economia , Criança , Pré-Escolar , Drenagem/economia , Drenagem/estatística & dados numéricos , Feminino , Humanos , Lactente , Perfuração Intestinal/economia , Perfuração Intestinal/etiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Estudos Retrospectivos , Fatores de Tempo , Tempo para o Tratamento
10.
Medicine (Baltimore) ; 98(9): e14624, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30817580

RESUMO

RATIONALE: Behçet's disease (BD) is a chronic immune-mediated inflammatory disorder involving multiple organ systems. In BD, intestinal ulcers can present as a refractory lesion capable of perforation, which makes the choice of treatment difficult. PATIENT CONCERNS: A 34-year-old male who was diagnosed with intestinal BD and suffered with an ileocecal perforation. He underwent surgery for an ileostomy and was given corticosteroids as treatment. However, the ulcerative lesion remained resistant to the therapy that was provided which delayed the closure operation. DIAGNOSIS: Intestinal BD with severe post-operative complication. INTERVENTIONS: A course of adalimumab (ADa) therapy was started. Subsequently surgery was performed. And ADa and thalidomide were used as a maintenance therapy. OUTCOMES: In this case, a course of ADa therapy was given which healed the intestinal ulcers and allowed us to successfully perform the closure operation. LESSONS: This case indicates that ADa may be an effective treatment option in future cases, minimizing complications and allowing the closure operation to be performed successfully.


Assuntos
Adalimumab/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Síndrome de Behçet/terapia , Ileostomia/efeitos adversos , Perfuração Intestinal/terapia , Complicações Pós-Operatórias/terapia , Adulto , Ceco/lesões , Humanos , Ileostomia/métodos , Íleo/lesões , Enteropatias/etiologia , Enteropatias/terapia , Perfuração Intestinal/etiologia , Masculino , Complicações Pós-Operatórias/etiologia , Reoperação , Resultado do Tratamento , Úlcera/etiologia , Úlcera/terapia
11.
Surg Laparosc Endosc Percutan Tech ; 29(3): 173-177, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30608917

RESUMO

PURPOSE: The purpose of our study was to investigate the clinical outcomes of colonoscopic perforations in patients. MATERIALS AND METHODS: We retrospectively studied patients with perforations secondary to diagnostic/therapeutic colonoscopy between 2009 and 2015 at the Pontevedra Hospital Complex. We analyzed age, closure method, length of hospitalization, and long-term progress. RESULTS: Of the 34 perforations detected, 67.6% occurred in patients aged below 75 years. Most perforations occurred in the descending colon (55%). Perforations occurred in 55.9% of outpatients and 45% of inpatients. Diagnostic and therapeutic colonoscopies caused perforations in 20.6% and 79.4% of patients, respectively. Conservative treatment alone was performed in 5.9%, complete or partial endoscopic closure in 14.7%, and surgery in 79.4% of patients. Patients treated only conservatively or with concomitant endoscopic closure showed no mortality. The mortality rate was 14.8% in those treated surgically, and 55% of these patients required a subsequent ostomy. CONCLUSIONS: Conservative management with antibiotics and parenteral nutrition concomitant with complete/partial endoscopic closure effectively treats perforations, provided intraprocedural diagnosis is possible with immediate administration of antibiotics after the procedure. Nevertheless, studies with larger number of patients and statistical analysis are necessary in the near future.


Assuntos
Doenças do Colo/etiologia , Colonoscopia , Perfuração Intestinal/etiologia , Adulto , Idoso , Colo/cirurgia , Doenças do Colo/terapia , Tratamento Conservador/métodos , Jejum/fisiologia , Feminino , Humanos , Doença Iatrogênica , Perfuração Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Técnicas de Fechamento de Ferimentos , Adulto Jovem
12.
Eur J Gastroenterol Hepatol ; 31(1): 135-139, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30211720

RESUMO

OBJECTIVES: Perforated jejunal diverticulitis (PJD) is rare, but it has high mortality rates. The role of nonsurgical management is debated. The aim of this study is to assess the outcomes of medical and surgical management of PJD. PATIENTS AND METHODS: A single-centre study on a series of emergency patients diagnosed with PJD between 2010 and 2016 was conducted. RESULTS: Eleven patients with PJD were treated (seven women). Nine out of 11 were diagnosed by a computed tomography scan, and two were diagnosed at laparotomy. The initial approach was medical treatment in five patients, based on clinical and imaging findings. Four (80%) of these five patients were discharged without the need for surgical intervention. The median hospital stay was 7.5 days. Seven patients required surgery overall with a median length of hospital stay of 10.8 days. Surgical procedures consisted of segmental bowel resection and primary anastomosis in six patients and simple closure in one. There was no perioperative deaths. One patient required percutaneous drainage because of anastomotic leak, and one required reoperation owing to evisceration. DISCUSSION: Selected patients with PJD can be successfully managed with conservative approach, based on clinical and computed tomography findings.


Assuntos
Tratamento Conservador , Procedimentos Cirúrgicos do Sistema Digestório , Diverticulite/terapia , Perfuração Intestinal/terapia , Doenças do Jejuno/terapia , Idoso , Tratamento Conservador/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Diverticulite/diagnóstico por imagem , Diverticulite/cirurgia , Drenagem , Emergências , Feminino , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/cirurgia , Tempo de Internação , Masculino , Complicações Pós-Operatórias/terapia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
14.
J Gastroenterol Hepatol ; 34(1): 22-30, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30069935

RESUMO

Rescue therapy for gastrointestinal (GI) refractory bleeding, perforation, and fistula has traditionally required surgical interventions owing to the limited performance of conventional endoscopic instruments and techniques. An innovative clipping system, the over-the-scope clip (OTSC), may play an important role in rescue therapy. This innovative device is proposed as the final option in endoscopic treatment. The device presents several advantages including having a powerful sewing force for closure of GI defects using a simple mechanism and also having an innovative feature, whereby a large defect and fistula can be sealed using accessory forceps. Consequently, it is able to provide outstanding clinical effects for rescue therapy. This review clarifies the current status and limitations of OTSC according to different indications of GI refractory disease, including refractory bleeding, perforation, fistula, and anastomotic dehiscence. An extensive literature search identified studies reported 10 or more cases in which the OTSC system was applied. A total of 1517 cases described in 30 articles between 2010 and 2018 were retrieved. The clinical success rates and complications were calculated overall and for each indication. The average clinical success rate was 78% (n = 1517) overall, 85% for bleeding (n = 559), 85% (n = 351) for perforation, 52% (n = 388) for fistula, 66% (n = 97) for anastomotic dehiscence, and 95% (n = 122) for other conditions, respectively. The overall and severe OTSC-associated complications were 1.7% (n = 23) and 0.59% (n = 9), respectively. This review concludes that the OTSC system may serve as a safe and productive device for GI refractory diseases, albeit with limited success for fistula.


Assuntos
Fístula do Sistema Digestório/terapia , Endoscopia Gastrointestinal/instrumentação , Hemorragia Gastrointestinal/terapia , Perfuração Intestinal/terapia , Fístula Anastomótica/terapia , Endoscopia Gastrointestinal/efeitos adversos , Perfuração Esofágica/terapia , Humanos , Terapia de Salvação
15.
Scand J Gastroenterol ; 53(10-11): 1298-1303, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30353758

RESUMO

OBJECTIVES: The aim of this study was to describe patient characteristics and results of non-operative management for patients presenting with computed tomography (CT) verified perforated diverticulitis with extraluminal or free air. METHODS: All patients treated for diverticulitis (ICD-10: K-57) during 2010-2014 were identified and medical records were reviewed. Re-evaluations of CT examinations for all patients with complicated disease according to medical records were performed. All patients diagnosed with perforated diverticulitis and extraluminal or free air on re-evaluation were included and characteristics of patients having immediate surgery and those whom non-operative management was attempted are described. RESULTS: Of 141 patients with perforated diverticulitis according to medical records, 136 were confirmed on CT re-evaluation. Emergency surgical intervention within 24 h of admission was performed in 29 (21%) patients. Non-operative management with iv antibiotics was attempted for 107 patients and was successful in 101 (94%). The 30-day mortality rate was 2%. The presence of a simultaneous abscess was higher for patients with failure of non-operative management compared with those that were successfully managed non-operatively (67% compared to 17%, p = .013). Eleven out of thirty-two patients (34%) with free air were successfully managed conservatively. Patients that were operated within 24 h from admission were more commonly on immunosuppressive therapy, had more commonly free intraperitoneal air and free fluid in the peritoneal cavity. CONCLUSIONS: Non-operative management is successful in the majority of patients with CT-verified perforated diverticulitis with extraluminal air, and also in one-third of those with free air in the peritoneal cavity.


Assuntos
Antibacterianos/administração & dosagem , Doença Diverticular do Colo/terapia , Drenagem , Perfuração Intestinal/terapia , Abscesso/complicações , Administração Intravenosa , Adulto , Idoso , Idoso de 80 Anos ou mais , Ar , Terapia Combinada , Doença Diverticular do Colo/complicações , Doença Diverticular do Colo/diagnóstico por imagem , Doença Diverticular do Colo/mortalidade , Feminino , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/etiologia , Perfuração Intestinal/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Suécia/epidemiologia , Tomografia Computadorizada por Raios X , Adulto Jovem
16.
Fukushima J Med Sci ; 64(3): 157-162, 2018 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-30197398

RESUMO

A 66-year-old man was diagnosed from colonoscopy as having a 40-mm elevated tumor in the cecum. With a preoperative diagnosis of intramucosal carcinoma, endoscopic submucosal dissection (ESD) was performed. The tumor was resected en bloc, yielding a specimen with a 66-mm diameter. No perforation was detected during the operation.Although neither abdominal pain nor fever was observed immediately after ESD, abdominal pain developed on the following day. Two days after ESD, the abdominal pain ceased. The patient was managed conservatively with fasting and intravenous antibiotic treatment. Four days after ESD, abdominal X-ray revealed marked gas retention. Computed tomography revealed pneumoperitoneum and a pelvic abscess, leading to a diagnosis of delayed perforation after colonic ESD and paralytic intestinal obstruction. A decompression tube was then inserted transnasally into the small intestine. Because a gradual decrease occurred in intestinal gas, the decompression tube was removed. Oral ingestion was resumed 13 days post-ESD.Delayed perforation after colonic ESD often requires emergency surgery. The present case was managed conservatively, despite paralytic intestinal obstruction. This approach is rarely employed for this condition and is therefore worth reporting.


Assuntos
Neoplasias do Colo/cirurgia , Ressecção Endoscópica de Mucosa/efeitos adversos , Perfuração Intestinal/etiologia , Idoso , Neoplasias do Ceco/diagnóstico , Neoplasias do Ceco/cirurgia , Neoplasias do Colo/diagnóstico , Tratamento Conservador , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/terapia , Masculino , Fatores de Tempo
19.
World J Emerg Surg ; 13: 36, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30123315

RESUMO

ᅟ: Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC). Methods: The literature was extensively queried for focused publication until December 2017. Precise analysis and grading of the literature has been performed by a working group formed by a pool of experts: the statements and literature review were presented, discussed and voted at the Consensus Conference of the 4th Congress of the World Society of Emergency Surgery (WSES) held in Campinas in May 2017. Results: CT scan is the best imaging technique to evaluate large bowel obstruction and perforation. For OLCC, self-expandable metallic stent (SEMS), when available, offers interesting advantages as compared to emergency surgery; however, the positioning of SEMS for surgically treatable causes carries some long-term oncologic disadvantages, which are still under analysis. In the context of emergency surgery, resection and primary anastomosis (RPA) is preferable to Hartmann's procedure, whenever the characteristics of the patient and the surgeon are permissive. Right-sided loop colostomy is preferable in rectal cancer, when preoperative therapies are predicted.With regards to the treatment of ORCC, right colectomy represents the procedure of choice; alternatives, such as internal bypass and loop ileostomy, are of limited value.Clinical scenarios in the case of perforation might be dramatic, especially in case of free faecal peritonitis. The importance of an appropriate balance between life-saving surgical procedures and respect of oncologic caveats must be stressed. In selected cases, a damage control approach may be required.Medical treatments including appropriate fluid resuscitation, early antibiotic treatment and management of co-existing medical conditions according to international guidelines must be delivered to all patients at presentation. Conclusions: The current guidelines offer an extensive overview of available evidence and a qualitative consensus regarding management of large bowel obstruction and perforation due to colorectal cancer.


Assuntos
Neoplasias Colorretais/terapia , Guias como Assunto/normas , Obstrução Intestinal/terapia , Perfuração Intestinal/terapia , Colectomia/métodos , Colostomia/métodos , Humanos , Obstrução Intestinal/diagnóstico , Perfuração Intestinal/diagnóstico , Stents Metálicos Autoexpansíveis , Tomografia Computadorizada por Raios X/métodos
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 21(6): 660-665, 2018 Jun 25.
Artigo em Chinês | MEDLINE | ID: mdl-29968241

RESUMO

OBJECTIVE: To summarize the diagnosis and treatment of iatrogenic colonoscopic perforation (ICP). METHODS: Clinical data, treatment course and outcome of 17 patients who developed ICP following colonoscopic examination or operation at Department of Colorectal Surgery, Changhai Hospital from January 2000 to December 2013 were retrospectively analyzed. RESULTS: During above 13 years, a total of 127 106 patients underwent colonoscopic examination or operation, of whom 17 cases (0.013%) had ICP. There were 8 males and 9 females with an average age of 65.2 (32-85) years. The interval between the onset of ICP and clinically diagnosed ICP was 0 to 6 days after performance. ICP occurred in 8 patients following colonoscopy operations, including simple colonic polyp excision, endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD), while in 9 patients following simple colonoscopy examination. Except for one patient who was immediately diagnosed with ICP through the finding of "yellow adipose tissue visible in the vision field" during operation,7 early cases (41.2%) were diagnosed by abdominal X-ray examination, and 9 later cases were confirmed by abdominal CT examination. The perforation sites included sigmoid colon in 5 cases, caecum in 3 cases, descending colon in 3 cases, descending and sigmoid junction in 2 cases, ileum in 1 case, splenic flexure in 1 case, sigmoid and rectum junction in 1 case, retum in 1 case. One case with ICP following ESD after resection of polyp in caecum was cured successfully with conservative treatment, including fasting, gastrointestinal decompression, fluid infusion, anti-infection and nutritional support. One case with ICP, which was found during colonoscopic operation and the perforation was immediately closed with titanium clip, received conservative treatment, including anti-infection and then was cured. Fifteen patients underwent surgery, including 8 patients with primary intention intestinal perforation repair, 4 patients with primary intention resection of associated intestine and anastomosis, 2 patients with primary intention resection of associated intestine and ostomy, 1 patient with primary intention intestinal perforation repair and ostomy. Postoperative abdominal incision infection occurred in 4 cases, pulmonary infection in 1 case, incision infection with cardiovascular event or urinary tract infection in 1 case each. All the patients were cured and discharged. Average hospital stay was 18.6(3-45) days. CONCLUSIONS: ICP should be diagnosed by physical examination and imaging examination as soon as possible. For perforation during colonoscopic performance, colonoscopic titanium clip can be used for closure. Perforation repair is still the main procedure for ICP. If necessary, partial intestinal resection and anastomosis or ostomy can be selected.


Assuntos
Colonoscopia/efeitos adversos , Doença Iatrogênica , Perfuração Intestinal , Adulto , Idoso , Idoso de 80 Anos ou mais , Pólipos do Colo , Feminino , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/etiologia , Perfuração Intestinal/terapia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
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