ABSTRACT
Abstract Coronary subclavian steal syndrome is an uncommon cause of angina in patients with a previous coronary artery bypass graft procedure. The patient had chest pain with the exertion of the left upper limb, difference in blood pressure between the left and right arm, occlusion at the ostium of the left subclavian artery. He underwent carotid subclavian bypass surgery that was successful in relieving symptoms. On the other hand, the patient had an embolic stroke related to the procedure and further assessment may be necessary.
ABSTRACT
A intussuscepção intestinal em adultos é rara. Ao contrário do que ocorre na faixa pediátrica, é, na maioria das vezes, secundária a uma lesão definida com potencial significativo de malignidade. O objetivo deste estudo é avaliar retrospectivamente os aspectos diagnósticos e terapêuticos da intussuscepção intestinal em adultos. Foram estudados, retrospectivamente, os dados relativos às causas, à apresentação clínica, ao diagnóstico e ao manejo da doença em 16 pacientes, sendo 10 do sexo feminino (62 percent) e com média de idade de 49 anos (variação de 19-76 anos). Os principais achados clínicos foram: dor abdominal (100 percent), náuseas e vômitos (62,5 percent), massa palpável (62,5 percent), distensão abdominal (37,5 percent) e hemorragia digestiva baixa (31,25 percent). Sete pacientes (43,75 percent) apresentaram quadro agudo, sendo seis por obstrução intestinal (37,5 percent). O diagnóstico pré-operatório foi firmado em 8 pacientes (50 percent), através de exame clínico associado a ultra-sonografia, tomografia computadorizada, trânsito intestinal ou colonoscopia. Todos os pacientes foram submetidos a tratamento cirúrgico. Em cinco pacientes (31,25 percent) o segmento acometido foi o intestino delgado; em seis (37,5 percent) o íleo terminal e a valva ileocecal e em cinco (31,25 percent) havia acometimento colônico. Causa anatômica patológica foi identificada em 14 pacientes (87,5 percent), sendo que oito (50 percent) eram portadores de neoplasias malignas. Os procedimentos de ressecção realizados foram enterectomia (18,75 percent), hemicolectomia direita com anastomose primária (31,25 percent) ou ileostomia e fístula mucosa (12,5 percent), retossigmoidectomia a Hartmann (12,5 percent), retossigmoidectomia com anastomose primária (6,25 percent) e colectomia total com anastomose íleo-retal (6,25 percent). Dois pacientes (12,5 percent) foram tratados com redução sem ressecção. Complicações pós-operatórias ocorreram em 3 pacientes (seroma,...
Intestinal intussusception in adult patients is a rare entity. Differently from pediatric patients, this condition is often secondary to a defined lesion. A significant percentage of these lesions are malignant. Therefore, an optimal treatment is necessary to this condition. The aim of this study is to determine causes and management of adult intussusception. We carried out a retrospective review of adults patients with diagnosis of intussusception from 1997 to 2007 in our institution. Details concerning presentation, diagnosis, management, and pathology were analyzed. Sixteen patients with intestinal intussusception underwent laparotomy. There were 10 women with median age of 49 years (range, 19-76). Abdominal pain was the most common clinical finding. Seven patients (46.6 percent) presented with acute symptoms, six caused by intestinal obstruction. Diagnosis of gastrointestinal intussusception was correctly done preoperatively in 8 patients (50 percent). Five patients (31.25 percent) had the lead point of the intussusception in the small bowel, two in the jejunum and three in the ileum. Six patients (37.5 percent) had the lead point in the ileocecal valve resulting in ileocolic intussusception and five patients (31.25 percent) had colonic leading points. An anatomic or pathologic cause of the intussusception was identified in 14 patients (87.5 percent). In two patients (12.5 percent) the intussusception occurred in the postoperative period without associated lesions. Malignant neoplasms accounted for eight of sixteen patients (50 percent). All patients underwent operative management. The two patients who have postoperative intussusception of the small bowel underwent reduction with no resection. The others three patients with small bowel intussusception underwent to enterectomy. Right hemicolectomy was performed in five of the six patients with ileo-colonic intussusception. Retossigmidectomy was performed in one of the two patients...