RESUMEN
Results of diagnosis and surgical treatment of 852 patients, suffering an acute appendicitis (AA) with atypical course, were analyzed. Retrocecal localization of appendix was noted in 61.2% of observations, a pelvic one in 24.3%, medial in 11.2%, and subhepatic in 3.4%. Destructive forms of atypical AA were diagnosed in 92.5% patients, and various kinds of peritonitis in 77.7%. Some diagnostic (rectal thermometry, test with ethanol) and operative methods (including laparoscopic) in destructive forms of AA, complicated by typhlitis, were improved and tested. Diagnostictreatment algorithm, permitting to optimize tactic of treatment and to reduce the early postoperative complications rate from 9.9 tо 3.5% (Ñ<0.001), was proposed.
Asunto(s)
Apendicectomía/métodos , Apendicitis/cirugía , Laparoscopía/métodos , Peritonitis/cirugía , Tiflitis/cirugía , Enfermedad Aguda , Adulto , Anciano , Anciano de 80 o más Años , Algoritmos , Apendicitis/diagnóstico , Apendicitis/patología , Apéndice , Toma de Decisiones Clínicas , Femenino , Humanos , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Obstrucción Intestinal/patología , Masculino , Persona de Mediana Edad , Peritonitis/diagnóstico , Peritonitis/patología , Complicaciones Posoperatorias , Periodo Posoperatorio , Supuración/diagnóstico , Supuración/etiología , Supuración/patología , Tiflitis/diagnóstico , Tiflitis/patologíaRESUMEN
Abdominal pain is common during chemotherapy for childhood leukemia. Clinically differentiating typhlitis from appendicitis can be difficult. We present an 8-year-old boy with abdominal pain in the setting of acute lymphoblastic leukemia and neutropenia. Following appendectomy for presumed appendicitis, pathology revealed appendiceal typhlitis. Diagnostic and treatment considerations are discussed.
Asunto(s)
Apendicitis/diagnóstico , Apendicitis/cirugía , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Tiflitis/diagnóstico , Tiflitis/cirugía , Apendicectomía/métodos , Apendicitis/complicaciones , Niño , Diagnóstico Diferencial , Humanos , Masculino , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Tiflitis/complicacionesRESUMEN
BACKGROUND: Ileocolic resection for Crohn's disease can be performed entirely laparoscopically. However, an incision is needed for specimen extraction. This prospective observational study assessed the feasibility of endoscopic transcolonic specimen removal. METHODS: Endoscopic specimen removal was attempted in a consecutive series of ten patients scheduled for laparoscopic ileocolic resection. Primary outcomes were feasibility, operating time, reoperation rate, pain scores, morphine requirement and hospital stay. To assess applicability, outcomes were compared with previous data from patients who had laparoscopically assisted operations. RESULTS: Transcolonic removal was successful in eight of ten patients; it was considered not feasible in two patients because the inflammatory mass was too large (7-8 cm). Median operating time was 208 min and median postoperative hospital stay was 5 days. After surgery two patients developed an intra-abdominal abscess, drained laparoscopically or percutaneously, and one patient had another site-specific infection. The operation took longer than conventional laparoscopy, with no benefits perceived by patients in terms of cosmesis or body image. CONCLUSION: Transcolonic removal of the specimen in ileocolic Crohn's disease is feasible in the absence of a large inflammatory mass but infection may be a problem. It is unclear whether the technique offers benefit compared with conventional laparoscopic surgery.
Asunto(s)
Ciego/cirugía , Enfermedad de Crohn/cirugía , Ileítis/cirugía , Íleon/cirugía , Laparoscopía , Tiflitis/cirugía , Adulto , Analgésicos Opioides/uso terapéutico , Anastomosis Quirúrgica , Imagen Corporal , Estudios de Factibilidad , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Morfina/uso terapéutico , Dolor Postoperatorio/etiología , Dolor Postoperatorio/prevención & control , Estudios Prospectivos , Calidad de Vida , Manejo de Especímenes , Grapado Quirúrgico , Técnicas de Sutura , Adulto JovenRESUMEN
A rare case of acute typhlitis is reported. The patient had undergone chemotherapy for a breast cancer. Clinical and diagnostic tools as well as general and topical care are examined.
Asunto(s)
Antineoplásicos/efectos adversos , Hidrocarburos Aromáticos con Puentes/efectos adversos , Taxoides/efectos adversos , Tiflitis/inducido químicamente , Adulto , Antineoplásicos/administración & dosificación , Neoplasias de la Mama/tratamiento farmacológico , Hidrocarburos Aromáticos con Puentes/administración & dosificación , Carcinoma Ductal/tratamiento farmacológico , Femenino , Humanos , Reoperación , Taxoides/administración & dosificación , Resultado del Tratamiento , Tiflitis/diagnóstico , Tiflitis/cirugíaAsunto(s)
Ileítis/patología , Ileítis/cirugía , Tiflitis/cirugía , Anciano de 80 o más Años , Femenino , Humanos , Laparoscopía/métodosRESUMEN
Crohn's disease may involve any part of the alimentary tract, including the stomach and duodenum. We report herein the case of a 22 year-old male in whom Crohn disease was diagnosed due to weight loss in relation with a stenosis of the first and second parts of the duodenum. A gastrojejunostomy was performed with a good subsequent result. The initial management of a Crohn's disease with involvement of the duodenum is medical. When there is an indication for surgery, a gastroenterostomy is preferred, albeit with a high incidence of outlet obstruction and marginal ulceration.
Asunto(s)
Enfermedad de Crohn/cirugía , Enfermedades Duodenales/cirugía , Adulto , Constricción Patológica/cirugía , Duodenitis/cirugía , Derivación Gástrica/métodos , Humanos , Ileítis/cirugía , Masculino , Tiflitis/cirugíaRESUMEN
Isolated acute typhlitis caused by a caecal faecolith is extremely rare. Hereby we report such a case. A 30-year-old man presented clinically as acute appendicitis. During open surgery, an inflamed caecal mass was found. A limited colectomy including the mass and grossly health margins was performed. Histopathological examination confirmed that acute typhlitis was caused by an impacted caecal faecolith. The appendix was normal. Faecolith is an extremely rare cause of acute inflammation of the caecum presenting as a mass which is usually treated by limited right hemicolectomy.