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1.
Pediátr. Panamá ; 53(1): 36-38, 30 de abril de 2024.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1553028

ABSTRACT

Durante décadas el estudio de las enfermedades cardiacas ha sido una de las principales preocupaciones de los profesionales del área de la salud, más aún aquellos casos donde la patología es de tipo congénita, debido a las múltiples complicaciones que se pueden generar en la calidad de vida de los pacientes diagnosticados, por falta de un manejo adecuado. Tal es el caso de la fistula coronaria, que es una anomalía de este tipo de arterias, los síntomas más frecuentes son la dificultad respiratoria, ángor, taponamiento cardiaco y muerte súbita, por ello, entre más precoz sea el diagnostico existirán mayores posibilidades de la reducción de los riesgos agravados de la enfermedad. Se presenta el caso de un paciente pediátrico cuyos estudios demostraron la presencia de una fistula coronaria proveniente de la arteria coronaria izquierda hacia la aurícula derecha, cuya frecuencia no es muy alta y por lo cual puede ser considerada como una enfermedad rara, así que también se describe el tratamiento recibido para dicha malformación congénita y los resultados obtenidos luego del manejo dado. Objetivo: Describir el caso de un paciente pediátrico con falla cardiaca secundario a una fistula coronaria. Conclusiones: La fistula coronaria es una cardiopatía congénita poco frecuente, sin embargo, la presencia de esta anomalía pone en riesgo la vida de los pacientes que tienen esta afectación en cuanto al funcionamiento o estructura de su corazón, la descripción de este caso clínico aporta información relevante para el conocimiento científico del área de la salud, en lo que respecta al diagnóstico y manejo temprano de esta afectación en la función cardiaca de los pacientes pediátricos, ya que, se logró tener un estatus exitoso post cierre endovascular de la fistula coronaria identificada, que favorecerá al comportamiento normal de las funciones del corazón y por consiguiente la calidad y el pronóstico de vida del paciente tratado. (provisto por Infomedic International)


For decades, the study of heart disease has been one of the main concerns of health professionals, especially in cases where the pathology is congenital, due to the multiple complications that can be generated in the quality of life of diagnosed patients, for lack of proper management. Such is the case of coronary fistula, which is an anomaly of this type of arteries, the most frequent symptoms are respiratory distress, angina, cardiac tamponade and sudden death, therefore, the earlier the diagnosis, the greater the possibilities of reducing the aggravated risks of the disease. We present the case of a pediatric patient whose studies showed the presence of a coronary fistula from the left coronary artery to the right atrium, whose frequency is not very high and therefore can be considered a rare disease, and we also describe the treatment received for this congenital malformation and the results obtained after the management given. Objective: To describe the case of a pediatric patient with heart failure secondary to a coronary fistula. Conclusions: Coronary fistula is a rare congenital heart disease, however, the presence of this anomaly puts at risk the life of patients who have this affectation in terms of the function or structure of their heart, the description of this clinical case provides relevant information for the scientific knowledge of the health area, regarding the diagnosis and early management of this affectation in the cardiac function of pediatric patients, since a successful status was achieved after endovascular closure of the identified coronary fistula, which will favor the normal behavior of the heart functions and consequently the quality and prognosis of life of the treated patient. (provided by Infomedic International)

2.
Rev. colomb. cir ; 39(2): 260-267, 20240220. tab
Article in Spanish | LILACS | ID: biblio-1532615

ABSTRACT

Introducción. La fístula pancreática postoperatoria es una de las complicaciones más importantes en la cirugía hepatobiliopancreática. Su diagnóstico se hace mediante la presencia de un nivel de amilasa en el líquido de drenaje al menos tres veces por encima del valor de la amilasa en suero a partir del tercer día postoperatorio. El objetivo de este estudio fue caracterizar los pacientes con fístula pancreática postoperatoria en nuestra institución, evaluando la importancia de la detección temprana y el establecimiento de un manejo oportuno. Métodos. Estudio descriptivo, retrospectivo, que incluyó los pacientes sometidos a pancreatoduodenectomía, con diagnóstico de fístula pancreática postoperatoria como complicación de cirugía hepatobiliopancreática, en el Hospital Internacional de Colombia, en Piedecuesta, entre enero del 2017 y diciembre de 2020. Se excluyeron los pacientes con otro tipo procedimiento quirúrgico y aquellos que decidieron no participar en el estudio. Resultados. Se evaluaron 69 pacientes, con un predominio del sexo femenino (n=38; 55,1 %) y mediana de la edad de 57 años. El 33,3 % (n=24) de los pacientes intervenidos desarrollaron fístula pancreática postoperatoria, siendo el 23,2 % fuga bioquímica, grado B 8,7 % y grado C 2,9 %, para quienes se indicaron manejo expectante, control ecográfico y reintervención, respectivamente. Fallecieron 5 pacientes (7,2 %). Conclusiones. La fístula pancreáticapostoperatoria es una complicación para tener en cuenta en todos los pacientes sometidos a pancreatoduodenectomía. Existen estrategias que pueden permitir disminuir la incidencia de esta complicación, con el fin de mejorar el desenlace, el pronóstico y la morbilidad posquirúrgica.


Introduction. Postoperative pancreatic fistula is one of the most important complications in hepatobiliopancreatic surgery. Its diagnosis is made by the presence of an amylase level in the drainage fluid at least three times above the serum amylase value from the third postoperative day. The objective of this study was to characterize patients with postoperative pancreatic fistula at our institution, evaluating the importance of early detection and to establish a timely management. Methods. Descriptive, retrospective study that included patients who underwent pancreatoduodenectomy with a diagnosis of postoperative pancreatic fistula as a complication of hepatobiliopancreatic surgery at the Hospital Internacional Colombia, between January 2017 and December 2020. Patients with another type of procedure performed by this specialty and those who did not decide to participate in the study were excluded. Results. A total of 69 patients were included, the median age was 57 years with a predominance of females (n=38; 55.1%). 33.3% (n=24) of the operated patients developed postoperative pancreatic fistula, with 23.2% having a biochemical leak, grade B in 8.7% and grade C in 2.9%, for whom expectant management, ultrasound control and reintervention were indicated, respectively. Five patients died (7.2%). Conclusions. Pancreatic fistula is a complication to take into account in all patients undergoing pancreatoduodenectomy. There are strategies that can reduce the incidence of this complication and thus improve not only the outcome but also the prognosis and postoperative morbidity.


Subject(s)
Humans , Pancreas , Pancreatic Fistula , Pancreatic Neoplasms , Postoperative Complications , Pancreaticoduodenectomy
3.
Rev. colomb. cir ; 39(2): 291-298, 20240220. fig
Article in Spanish | LILACS | ID: biblio-1532631

ABSTRACT

Introducción. Una fístula es una conexión anormal entre dos superficies epitelizadas. Cerca del 80 % de las fístulas entero-cutáneas son de origen iatrogénico secundarias a cirugía, y un menor porcentaje se relacionan con traumatismos, malignidad, enfermedad inflamatoria intestinal o isquemia. La morbilidad y las complicaciones asociadas pueden ser significativas, como la desnutrición, en la que intervienen múltiples factores. Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Google Scholar y SciELO, utilizando las palabras claves descritas y se seleccionaron los artículos más relevantes de los últimos años. Resultados. La clasificación de las fístulas se basa en su anatomía, su gasto o secreción diaria y su localización. Existe una tríada clásica de las complicaciones: sepsis, desnutrición y anomalías electrolíticas. El control del gasto de la fístula, el drenaje adecuado de las colecciones y la terapia antibiótica son claves en el manejo precoz de estos pacientes. Los estudios recientes hacen hincapié en que la sepsis asociada con la desnutrición son las principales causas de mortalidad. Conclusiones. Esta condición representa una de las complicaciones de más difícil y prolongado tratamiento en cirugía abdominal y colorrectal, y se relaciona con importantes tasas de morbilidad, mortalidad y altos costos para el sistema de salud. Es necesario un tratamiento multidisciplinario basado en la reanimación con líquidos, el control de la sepsis, el soporte nutricional y el cuidado de la herida, entre otros factores.


Introduction. A fistula is an abnormal connection between two epithelialized surfaces. About 80% of enterocutaneous fistulas are of iatrogenic origin secondary to surgery, and a smaller percentage are related to trauma, malignancy, inflammatory bowel disease or ischemia. The associated morbidity and complications can be significant, such as malnutrition, in which multiple factors intervene. Methods. A literature search was carried out in the PubMed, Google Scholar and SciELO databases using the keywords described and the most relevant articles from recent years were selected. Results. The classification of fistulas is based on their anatomy, their daily secretion output, and their location. There is a classic triad of complications: sepsis, malnutrition and electrolyte abnormalities. Control of fistula output, adequate drainage of the collections and antibiotic therapy are key to the early management of these patients. Recent studies emphasize that sepsis associated with malnutrition are the main causes of mortality. Conclusions. This condition represents one of the most difficult and prolonged complications to treat in abdominal and colorectal surgery, and is related to significant rates of morbidity, mortality and high costs for the health system. Multidisciplinary treatment based on fluid resuscitation, sepsis control, nutritional support, and wound care, among other factors, is necessary.


Subject(s)
Humans , Surgical Procedures, Operative , Cutaneous Fistula , Nutritional Status , Morbidity , Intestinal Fistula , Rectal Fistula
5.
Braz. dent. sci ; 27(1): 1-6, 2024. ilus
Article in English | LILACS, BBO | ID: biblio-1532548

ABSTRACT

Background: Odontogenic maxillary sinusitis caused by a foreign body presents diagnostic and therapeutic challenges due to its infrequent occurrence and unique characteristics compared to sinusitis originating from other sources. CaseReport:Illustrating such fact, this report presents the clinical case of a 37-year-old woman referred complaining of pain in the same region where she had extracted her upper right first molar five days before. The intraoral examination revealed the presence of an orifice in the region, suggesting oroantral communication. Imaging exams revealed opacification of the right maxillary sinus and the unexpected presence of a highly radiodense object. With the diagnosis of maxillary sinusitis due to a foreign body established, the surgical approach initially consisted of administering preoperative medication, preceded by access to the maxillary antrum using the Caldwell-Luc technique. The object was found and removed, consisting of a surgical drill. At follow-up there was complete absence of symptoms and complete closure of communication. Conclusion: Cases of odontogenic maxillary sinusitis caused by drill detachment after tooth extraction are fairly uncommon. A thorough clinical evaluation proved to be essential and the Caldwell-Luc access was effective, safe and with good postoperative results, even with the absence of standardized diagnostic and management methods(AU)


Contexto: A sinusite maxilar odontogênica causada por corpo estranho apresenta desafios diagnósticos e terapêuticos devido à sua ocorrência infrequente e características únicas em comparação com sinusites originadas de outras fontes. Relato do Caso: Ilustrando tal fato, este relato apresenta o caso clínico de uma mulher de 37 anos de idade encaminhada com queixa de dor em mesma região que havia extraído o primeiro molar superior direito cinco dias antes. Ao exame intraoral verificou-se a presença de um orifício na região, sugerindo comunicação oroantral. Os exames de imagem revelaram opacificação do SM direito e a inesperada presença de um objeto altamente radiodenso. Com o diagnóstico de sinusite maxilar por corpo estranho estabelecido, a abordagem cirúrgica consistiu inicialmente na administração de medicação pré-operatória, precedida pelo acesso ao antro maxilar através da técnica de Caldwell-Luc. O objeto foi encontrado e removido, consistindo em uma broca cirúrgica. Ao acompanhamento houve ausência completa dos sintomas e total fechamento da comunicação. Conclusão: Casos de sinusite maxilar odontogênica causada por descolamento da broca após extração dentária são bastante incomuns. Uma avaliação clínica minuciosa mostrou-se primordial e o acesso de Caldwell-Luc eficaz, seguro e com bons resultados pós-operatórios, mesmo com as ausências de métodos de diagnóstico e manejo padronizados.(AU)


Subject(s)
Humans , Female , Adult , Surgery, Oral , Maxillary Sinusitis , Oroantral Fistula
6.
Acta Paul. Enferm. (Online) ; 37: eAPE001762, 2024. tab, graf
Article in Portuguese | LILACS-Express | LILACS, BDENF | ID: biblio-1533312

ABSTRACT

Resumo Objetivo Avaliar a presença de isquemia na porção distal das mãos dos membros superiores com Fistula Arteriovenosa (FAV) de pacientes em Terapia Renal Substitutiva (TRS) através da termografia por infravermelho. Método Amostra composta por 15 pacientes em TRS por hemodiálise por meio de FAV que responderam um questionário elaborado pelos próprios autores com as seguintes variáveis: dados sociodemográficos, diagnóstico, sinais vitais e dados sobre a FAV. Para obtenção dos termogramas das mãos com e sem FAV foi utilizado uma câmera termográfica por infravermelho C5, FLIR Systems, fixada a 50 cm das mãos dos participantes, privilegiando o enquadramento bilateral enquadrando ambas as mãos. Os dados obtidos foram organizados em planilha de Excel 2011® e comparados estatisticamente utilizando o programa Microcal Origin 6.0, para avaliar se existia diferença entre as médias de temperatura. Resultados Com relação as variáveis sociodemográficas, o gênero masculino foi o predominante, faixa etária com média de 45 anos, ensino fundamental (incompleto/completo), casados e provenientes de outros municípios. A termografia demonstrou que há diferença de temperatura entre as mãos com FAV e sem FAV, com variação na temperatura de 1,78°C (± DP 1,99°C), menor para as mãos com FAV. Conclusão A análise da distribuição do sangue das mãos por meio da termografia pode fornecer evidências sobre a microcirculação periférica e orientar o diagnóstico precoce e o tratamento da isquemia induzida por FAV em indivíduos em TRS, como ferramenta inovadora de diagnóstico auxiliar das complicações dos acessos venosos de pacientes em hemodiálise.


Resumen Objetivo Evaluar la presencia de isquemia en la parte distal de las manos de los miembros superiores con fístula arteriovenosa (FAV) de pacientes en terapia de reemplazo renal (TRR) a través de la termografía infrarroja. Métodos Muestra compuesta por 15 pacientes en TRR por hemodiálisis mediante FAV que respondieron un cuestionario elaborado por los propios autores con las siguientes variables: datos sociodemográficos, diagnóstico, signos vitales y datos sobre la FAV. Para obtener los termogramas de las manos con y sin FAV, se utilizó una cámara termográfica infrarroja C5, FLIR Systems, ubicada a 50 cm de las manos de los participantes, favoreciendo el encuadramiento bilateral y encuadrando ambas manos. Los datos obtenidos se organizaron en una planilla de Excel 2011® y se compararon estadísticamente con el programa Microcal Origin 6.0, para evaluar si había diferencia entre los promedios de temperatura. Resultados Con relación a las variables sociodemográficas, el género masculino fue predominante, grupo de edad promedio de 45 años, educación primaria (incompleta/completa), casados y provenientes de otros municipios. La termografía demostró que hay diferencia de temperatura entre las manos con FAV y sin FAV, con una variación de temperatura de 1,78°C (± DP 1,99°C), menor en las manos con FAV. Conclusión El análisis de la distribución de la sangre de las manos por medio de termografía puede ofrecer evidencias sobre la microcirculación periférica y guiar el diagnóstico temprano y el tratamiento de la isquemia inducida por FAV en individuos en TRR, como una herramienta innovadora de diagnóstico auxiliar de las complicaciones de los accesos vasculares de pacientes en hemodiálisis.


Abstract Objective To assess the presence of ischemia in the distal portion of the hands of the upper limbs with arteriovenous fistula (AVF) in patients undergoing renal replacement therapy (RRT) using infrared thermography. Method The sample consisted of 15 patients on RRT via hemodialysis using an AVF who answered a questionnaire prepared by the authors themselves with sociodemographic data, diagnosis, vital signs and data on AVF. To obtain thermograms of hands with and without AVF, a C5 infrared thermographic camera, FLIR Systems, was used, fixed 50 cm from participants' hands, favoring bilateral framing of both hands. The data obtained were organized in an Excel 2011® spreadsheet and statistically compared using the Microcal Origin 6.0 program to assess whether there was a difference between temperature averages. Results Regarding sociodemographic variables, males were predominant, with a mean age of 45 years, (incomplete/complete) elementary school, married and from other municipalities. Thermography demonstrated that there is a difference in temperature between hands with AVF and without AVF, with a temperature variation of 1.78°C (± SD 1.99°C), lower for hands with AVF. Conclusion The analysis of hand blood distribution using thermography can provide evidence on peripheral microcirculation and guide the early diagnosis and treatment of AVF-induced ischemia in individuals undergoing RRT as an innovative auxiliary diagnostic tool for complications of venous access in hemodialysis patients.

7.
Journal of Clinical Hepatology ; (12): 773-781, 2024.
Article in Chinese | WPRIM | ID: wpr-1016523

ABSTRACT

ObjectiveTo investigate the differences in the risk factors for postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy (PD) between the 2005 and 2016 editions of the definition and classification standards for pancreatic fistula, and to establish a risk prediction model for pancreatic fistula based on the 2016 edition. MethodsA retrospective analysis was performed for the clinical data of 303 patients who were admitted to Tianjin Third Central Hospital and underwent PD from January 2016 to May 2022, and the patients with POPF were identified based on the new and old editions. The independent-samples t test or the non-parametric Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. The univariate and multivariate logistic regression analyses were used to investigate the differences in the risk factors for pancreatic fistula after PD between the two editions; a risk prediction model was established for POPF based on the 2016 edition, and the receiver operating characteristic curve was used to invesitgate the accuracy of this model in predicting POPF and perform model validation. ResultsAccording to the 2005 edition, the univariate analysis showed that the diameter of the main pancreatic duct (χ2=31.641, P<0.001), main pancreatic duct index (χ2=52.777, P<0.001), portal vein invasion (χ2=6.259, P=0.012), intra-abdominal fat thickness (χ2=7.665, P=0.006), preoperative biliary drainage (χ2=5.999, P=0.014), pancreatic cancer (χ2=5.544, P=0.019), marginal pancreatic thickness (t=2.055, P=0.032), pancreatic CT value (t=-3.224, P=0.002), and preoperative blood amylase level (Z=-2.099, P=0.036) were closely associated with POPF, and the multivariate logistic regression analysis showed that main pancreatic duct index (odds ratio [OR]=0.000, 95% confidence interval [CI]: 0.000‍ ‍—‍ ‍0.011, P<0.05), pancreatic cancer (OR=4.843, 95%CI: 1.285‍ ‍—‍ ‍18.254, P<0.05), and pancreatic CT value (OR=0.869, 95%CI: 0.806‍ ‍—‍ ‍0.937, P<0.05) were independent risk factors; based on the 2016 edition, the univariate analysis showed the diameter of the main pancreatic duct (χ2=5.391, P=0.020), main pancreatic duct index (χ2=11.394, P=0.001), intra-abdominal fat thickness (χ2=8.899, P=0.003), marginal pancreatic thickness (t=2.665, P=0.009), pancreatic CT value (t=-2.835, P=0.004) were closely associated with POPF, and the multivariate logistic regression analysis showed that main pancreatic duct index (OR=0.001, 95%CI: 0.000‍ ‍—‍ ‍0.050, P<0.05) and pancreatic CT value (OR=0.943, 95%CI: 0.894‍ ‍—‍ ‍0.994, P<0.05) were independent risk factors. A risk prediction model was established for POPF after PD, and the ROC curve analysis showed that this model had an area under the ROC curve of 0.788 (95%CI: 0.707‍ ‍—‍ ‍0.870) in the modeling group and 0.804 (95%CI: 0.675‍ ‍—‍ ‍0.932) in the validation group. ConclusionMain pancreatic duct index and pancreatic CT value are closely associated with POPF after PD, and the risk prediction model for pancreatic fistula based on the 2016 edition has a good prediction accuracy.

8.
China Pharmacy ; (12): 695-700, 2024.
Article in Chinese | WPRIM | ID: wpr-1013104

ABSTRACT

OBJECTIVE To investigate the effect and mechanism of Panax notoginseng saponins (PNS) on wound healing after anal fistula surgery in rats by regulating the hypoxia-inducible factor-1α (HIF-1α)/vascular endothelial growth factor (VEGF)/ vascular endothelial growth factor receptor-2 (VEGFR2) signaling pathway. METHODS SD rats were selected to establish a postoperative rat model of anal fistula by infecting wound with Escherichia coli. The model rats were randomly grouped into model group, PNS low-dose and high-dose groups (15, 30 mg/cm2), high-dose of PNS+2-methoxyestradiol (2ME2) group (PNS 30 mg/cm2+HIF-1α inhibitor 2ME2 4 mg/kg), with 10 rats in each group. Another 10 normal rats were selected for back hair removal treatment as the control group. Each drug group was injected with the corresponding drug solution intramuscularly or (and) intraperitoneally, once a day, for 3 weeks. After the last administration, the wound healing rate (excluding the control group), microvascular density (MVD), the expression of collagen Ⅰ and fibronectin (FN) in the wound tissue were detected in each group; the levels of angiogenic factors [VEGF, E-mail:842710813@qq.com angiopoietin-Ⅰ (Ang-Ⅰ), Ang-Ⅱ] in serum, the levels of inflammatory factors [interleukin-6 (IL-6) and IL-2] in serum binggui7183@163.com and wound tissue as well as the expressions of the related proteins of HIF-1α/VEGF/VEGFR2 signaling pathway in the wound tissue of rats were also detected in each group. RESULTS The MVD, the expression of collagen Ⅰ and FN in the wound tissue, and the levels of IL-6 and IL-2 in serum and wound tissue of rats increased significantly in the model group, compared to the control group (P<0.05), while the serum levels of VEGF, Ang- Ⅰ and Ang-Ⅱ decreased significantly (P<0.05). The wound healing rate, the MVD in wound tissue, the serum levels of VEGF, Ang-Ⅰ and Ang-Ⅱ, the expressions of collagen Ⅰ and FN in the wound tissue, and protein expressions of HIF-1α, VEGF and VEGFR2 in the PNS low-dose and high-dose groups increased significantly, compared to the model group (P<0.05), while the levels of IL-6 and IL-2 in serum and wound tissue decreased significantly (P<0.05); the high-dose PNS had a stronger effect (P< 0.05). 2ME2 could weaken the effect of PNS on above indicators of rats after anal fistula surgery (P<0.05). CONCLUSIONS PNS can promote the production of angiogenic factors and inhibit the production of pro-inflammatory factors, thereby promoting wound healing in rats after anal fistula surgery. The above effects are related to the activation of HIF-1α/VEGF/VEGFR2 signaling pathway.

9.
Journal of Clinical Otorhinolaryngology Head and Neck Surgery ; (12): 77-82, 2024.
Article in Chinese | WPRIM | ID: wpr-1011106

ABSTRACT

Objective:To investigate the management of granulation tissue during surgery for infected congenital preauricular fistula and to assess the surgical outcomes. Methods:To summarize the surgical methods and the treatment of granulation methods in 140 cases of congenital preauricular fistula during the period of infection treated in our department from January 2018 to September 2022. The study divided patients into an observation group (79 patients) undergoing fistulectomy without granulation treatment, and a control group (61 patients) where fistulectomy and granulation resection were performed concurrently.. After six months of follow-up, the wound healing, recurrence rates, and the aesthetic assessment of granulation healing were evaluated using the Stony Brook Scar Evaluation Scale(SBSES). Results:The two surgical approaches were applied to a total of 140 patients with infected congenital preauricular fistula. There was no statistical difference in wound healing and recurrence rates between the observation group and the control group. However, the observation group exhibited smaller scars. Conclusion:In cases of infected congenital preauricular fistula, surgical removal without excising granulation tissue is feasible, leading to effective healing and lesser scar formation.


Subject(s)
Humans , Cicatrix , Wound Healing , Craniofacial Abnormalities , Fistula/surgery , Treatment Outcome
10.
J. vasc. bras ; 23: e20230054, 2024. tab, graf
Article in Portuguese | LILACS-Express | LILACS | ID: biblio-1550521

ABSTRACT

Resumo Contexto O acesso vascular preferencial para hemodiálise é a fístula arteriovenosa nativa, pois oferece melhores resultados em curto e longo prazo, proporciona menor morbimortalidade e traz vantagens adicionais em relação aos cateteres venosos centrais ou enxertos arteriovenosos. No entanto, a obesidade pode oferecer um desafio adicional proporcionado pela barreira de tecido celular subcutâneo que recobre a superfície da veia a ser puncionada. Objetivos Demonstrar a experiência do serviço com a lipectomia em acessos autólogos em pacientes obesos. Métodos Foram revisados ​​pacientes consecutivos submetidos à lipectomia por impossibilidade ou dificuldade na punção da FAV, motivada pela acentuada profundidade da veia cefálica no antebraço ou braço. Resultados Vinte e dois pacientes foram revisados (15 homens e 7 mulheres), com índice de massa corporal médio de 34 kg/m2 (variação de 28 a 40 kg/m2). A idade média foi de 58,4 anos. O tempo médio entre a confecção do acesso e a lipectomia foi de 45,1 dias, e o tempo da intervenção até a liberação para uso nas sessões de hemodiálise oscilou de 21 a 42 dias, com média de 30,9 dias. A profundidade média pré-operatória da veia cefálica no membro foi de 7,9 mm (variação de 7,0 a 10,0 mm). Isso foi reduzido para uma profundidade média de 4,7 mm (faixa de 3,0 a 6,0 mm) (P = 0,01). O período médio de seguimento dos pacientes foi de 13,2 meses. Houve perda de seguimento em quatro pacientes e quatro óbitos no período não relacionados ao acesso vascular. Conclusões A obesidade não deve ser um fator limitante para a criação de uma FAV nativa, pois a lipectomia é uma alternativa relativamente simples de superficialização, que permite a funcionalidade de fístulas arteriovenosas nativas e profundas em obesos.


Abstract Background The preferred vascular access for hemodialysis is a native arteriovenous fistula (AVF) because it offers the best results in the short and long terms, lower morbidity and mortality, and has additional advantages in relation to central venous catheters or arteriovenous grafts. However, obesity can present an additional challenge because of the barrier of subcutaneous cellular tissue covering the surface of the vein to be punctured. Objectives The authors review their experience with excision of subcutaneous tissue (lipectomy) overlying upper arm cephalic vein arteriovenous fistulas in obese patients. Methods Consecutive vascular access patients undergoing lipectomy for cannulation with difficult access because of vein depth were reviewed. Cephalic vein depth was measured by ultrasound in all cases. Results Twenty-two patients were reviewed (15 men and 7 women), with a mean body mass index of 34.0 kg/m2 (range: 28-40 kg/m2). Mean age was 58.4 years. The mean preoperative vein depth of 7.9 mm (range: 7.0-10.0 mm) was reduced to 4.7 mm (range: 3.0-6.0 mm) (P 0.01). The mean follow-up period for patients was 13.2 months. Four patients were lost to follow-up and four died during the period due to causes unrelated to vascular access. Conclusions Obesity should not be a limiting factor to creation of a native AVF, since lipectomy is a relatively simple option for superficialization, enabling functioning native and deep arteriovenous fistulas in obese patients.

11.
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1535460

ABSTRACT

Introducción: El Íleo biliar (IB) es una obstrucción intestinal mecánica muy poco frecuente, del 1 al 4 % de todas las obstrucciones intestinales, y es más común en pacientes de edad avanzada. Se produce a través de una fístula bilioentérica en el intestino delgado, sobre todo en el íleon distal. Luego de tener un enfoque diagnóstico mediante imagenología, en su gran mayoría, se opta por el tratamiento quirúrgico para eliminar el o los cálculos impactados. El éxito de esta intervención depende en gran medida del tamaño del cálculo biliar, de la ubicación de la obstrucción intestinal y comorbilidades preexistentes. Caso clínico: Mujer de 78 años con cuadro clínico de obstrucción intestinal, emesis de contenido fecaloide y sintomática respiratoria; se evidenció una masa concéntrica a nivel de íleon distal y proceso neumónico concomitante por tomografía toracoabdominal. Se realizó laparotomía exploratoria con enterolitotomía, extracción de cálculo y anastomosis íleo-ileal y fue trasladada a la UCI en donde presentó falla ventilatoria y requerimiento de ventilación mecánica; se confirmó infección viral por SARS-CoV-2 mediante RT - PCR. Discusión: El IB es una obstrucción intestinal que ocurre con mayor frecuencia en pacientes de edad avanzada. Se habla de la fisiopatología y mecanismo de producción de la fístula entérica y se presentan opciones diagnósticas, terapéuticas y quirúrgicas para dirigir el manejo clínico más apropiado. Conclusión: El IB es difícil de diagnosticar. Debido a su baja incidencia, no existe un consenso que paute el manejo a seguir en los pacientes con diagnóstico de IB. Aunque el tratamiento estándar es la intervención quirúrgica, hay diversas opiniones en cuanto al tipo de cirugía a realizar.


Introduction: Biliary ileus (BI) is a very rare mechanical intestinal obstruction, responsible for 1-4% of all intestinal obstructions and more frequent in elderly patients. It occurs through a bilioenteric fistula in the small bowel, mainly in the distal ileum. After a diagnostic imaging approach, the vast majority opt for surgical treatment to remove the impacted stone or stones. The success of this intervention depends largely on the size of the stone, the location of the bowel obstruction and pre-existing comorbidities. Case report: 78-year-old woman with clinical symptoms of intestinal obstruction, fecaloid emesis, respiratory symptoms, concentric mass at the level of the distal ileum and concomitant pneumonic process in the thoraco-abdominal CT scan. Exploratory laparotomy was performed, with total lithotomy, extraction of the calculus and ileo-ileal anastomosis, and she was transferred to the ICU, where she presented ventilatory failure and required mechanical ventilation. SARS-CoV-2 infection was confirmed with RT-PCR. Discussion: IB is an intestinal obstruction that occurs more frequently in elderly patients. The pathophysiology and the mechanism of production of enteric fistula are discussed and diagnostic, therapeutic and surgical options are presented to guide the most appropriate clinical management. Conclusion: Enteric fistula is difficult to diagnose. Due to its low incidence, there is no consensus on the management of patients diagnosed with IB. Although the standard treatment is surgical intervention, there are divergent opinions as to the type of surgery to be performed.

12.
Arch. argent. pediatr ; 121(6): e202202857, dic. 2023. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1518596

ABSTRACT

Las neoplasias de páncreas son una entidad poco frecuente en pediatría; el tumor pseudopapilar de páncreas (TSP) es el más comúnmente diagnosticado. Habitualmente, se localizan en la cabeza del páncreas. La cirugía de Whipple o pancreatoduodenectomía es la técnica elegida para el tratamiento de los tumores benignos o malignos de páncreas. Si bien la mortalidad conocida ha descendido en los últimos años, debido a la mayor experiencia de los cirujanos y al mejor cuidado pre- y posoperatorio, la morbilidad se ha mantenido elevada secundaria a las complicaciones asociadas. Dentro de estas se destacan retardo en el vaciamiento gástrico, colecciones intraabdominales, fístula pancreática, reestenosis del sitio quirúrgico y hemorragia pospancreatectomía. Se presenta el caso clínico de una niña de 13 años con diagnóstico de TSP que recibió tratamiento quirúrgico efectivo desde el punto de vista oncológico, pero que requirió una internación prolongada secundaria a las complicaciones quirúrgicas.


Pancreatic neoplasms are rare in pediatrics; the pseudopapillary tumor (PPT) of the pancreas is the most common. PPTs of the pancreas are usually located in the head of the pancreas. A pancreaticoduodenectomy or Whipple procedure is the technique of choice for the treatment of benign or malignant pancreatic tumors. Although mortality for this cause has decreased in recent years, due to the greater experience of surgeons and improved pre- and postoperative care, morbidity has remained high secondary to associated complications. These include delayed gastric emptying, intra-abdominal collections, pancreatic fistula, surgical site restenosis, and post-pancreatectomy hemorrhage. Here we describe the clinical case of a 13-year-old girl diagnosed with PPT of the pancreas who underwent an effective surgery in terms of cancer treatment, but who required a prolonged hospitalization secondary to surgical complications.


Subject(s)
Humans , Female , Adolescent , Pancreatic Neoplasms/surgery , Pancreatic Neoplasms/pathology , Pancreaticoduodenectomy/adverse effects , Pancreaticoduodenectomy/methods , Pancreatectomy/adverse effects , Pancreatectomy/methods , Postoperative Complications/diagnosis , Postoperative Complications/etiology
13.
Braz. J. Anesth. (Impr.) ; 73(6): 725-735, Nov.Dec. 2023. tab, graf
Article in English | LILACS | ID: biblio-1520381

ABSTRACT

Abstract Background: Ultra-low-dose Spinal Anesthesia (SA) is the practice of employing minimal doses of intrathecal agents so that only the roots that supply a specific area are anesthetized. The aim of this study was to compare the effectiveness and safety of ultra-low-dose spinal anesthesia with that of Perineal Blocks (PB). Methods: A two-arm, parallel, double-blind randomized controlled trial comparing two anesthetic techniques (SA and PB) for hemorrhoidectomy and anal fistula surgery was performed. The primary outcomes were postoperative pain, complementation and/or conversion of anesthesia, and hemodynamic changes. Results: Fifty-nine patients were included in the final analysis. The mean pain values were similar in the first 48 h in both groups (p > 0.05). The individuals allocated to the SA group did not need anesthetic complementation; however, those in the PB group required it considerably (SA group, 0% vs. PB group, 25%; p = 0.005). Hemodynamic changes were more pronounced after PB: during all surgical times, the PB group showed lower MAP values and higher HR values (p < 0.05). Postoperative urinary retention rates were similar between both groups (SA group 0% vs. PB group 3.1%, p = 0.354). Conclusion: SA and PB are similarly effective in pain control during the first 48 h after hemorrhoidec-tomy and anal fistula surgery. Although surgical time was shorter among patients in the PB group, the SA technique may be preferable as it avoids the need for additional anesthesia. Furthermore, the group that received perineal blocks was under sedation with a considerable dose of propofol.


Subject(s)
Humans , Rectal Fistula/surgery , Anesthesia, Spinal/methods , Anesthetics , Pain, Postoperative/prevention & control , Anesthesia, Local
14.
Braz. J. Anesth. (Impr.) ; 73(6): 744-750, Nov.Dec. 2023. tab, graf
Article in English | LILACS | ID: biblio-1520387

ABSTRACT

Abstract Background and aims: Dexamethasone as adjunct to local anesthetic solution improves the quality of brachial plexus block (BPB). However, evidence for its efficacy at low doses (< 4 mg) is lacking. This study was designed to evaluate the duration of analgesia attained with low dose dexamethasone as adjuvant to local anesthetic for creation of arteriovenous fistula (AVF) under BPB. Methods: Sixty-six patients scheduled for AVF creation were randomly allocated to receive either saline (control) or 2 mg dexamethasone, together with 0.5% ropivacaine and 0.2% lignocaine. The primary outcome was duration of analgesia, defined as time from performing the block to the first analgesic request. The secondary outcomes were time from injection to complete sensory block, time from injection to complete motor block, duration of motor block, postoperative analgesic consumption, and fistula patency at three months. Results: All the blocks were effective. In the group that received dexamethasone, the time to first analgesic request was significantly delayed (432 ± 43.8 minutes vs. 386.4 ± 40.2 minutes; p < 0.01). The onset of sensory and motor blockade occurred faster in dexamethasone group and overall analgesic consumption was also reduced. However, dexamethasone addition did not prolong the duration of motor block. There was no statistically significant difference in the patency of fistulas between the two groups at three months. (p = 0.34). Conclusion: Addition of low-dose perineural dexamethasone to local anesthetic solution significantly prolonged the duration of analgesia. Further trials are warranted to compare the adverse effects between dexamethasone doses of 4 mg and lower.


Subject(s)
Humans , Arteriovenous Fistula , Brachial Plexus Block , Kidney Failure, Chronic , Pain, Postoperative , Dexamethasone , Analgesics , Anesthetics, Local
15.
J. coloproctol. (Rio J., Impr.) ; 43(4): 316-320, Oct.-Dec. 2023. ilus
Article in English | LILACS | ID: biblio-1528934

ABSTRACT

Introduction: Perianal fistula is a common colorectal disease which is caused mainly by cryptoglandular disease. Although most cases are treated successfully by surgery, management of complex perianal fistulas (CPAF) remains a challenge with limited results in recurrence and sometimes associated with fecal incontinence. The CPAF treatment with autologous adipose-derived mesenchymal stem cells (ASCs) had become a research hotspot. The technique started to be used in the treatment of Crohn's disease (CD) fistulas, where the studies showed safe and goods result from the procedure. Cultured ASCs have been used but this approach requires the preceding collection of adipose tissue, time for isolation of ASCs and subsequent in vitro expansion, need for laboratory facilities, and expertise in cell culturing. These factors have been getting over by using the commercially available alternative, allogenic ASCs. Treatment with allogeneic ASCs has shown good results in patients with CD fistulas, however with the disadvantage of being expensive. Objective: To show that the injection with freshly collected adipose tissue is an alternative to treatment with autologous or allogenic ASCs with several advantages. Methods: In this case report, we show our first experience in the treatment of CPAF with the application of collected adipose tissue in a tertiary referral hospital from Belo Horizonte, Brazil. Results The patient had a good postoperative recuperation with a complete fistula healing after 8 months without adverse effects. Conclusion: Injection with freshly collected adipose tissue is a promising and apparently safe sphincter-sparing technique in the treatment of CPAF. (AU)


Subject(s)
Humans , Female , Adult , Rectal Fistula/surgery , Mesenchymal Stem Cells , Crohn Disease
16.
J. coloproctol. (Rio J., Impr.) ; 43(4): 251-255, Oct.-Dec. 2023. tab
Article in English | LILACS | ID: biblio-1528936

ABSTRACT

Introduction: Transanal Endoscopic Microsurgery (TEM) is a minimally invasive method for management of different proctologic conditions. Despite widespread use of this method, it is not used widely in Iran. This report is about to describe the application of TEM in managing different proctologic conditions in a tertiary colorectal referral center in Iran regarding methods and complications. Methods: All of the patients' documents such as procedure, method, early postop complications and further operations were actively reviewed and the data were entered in to the database. Results: Since 2012 till the end of 2020 chart review was done and 150 cases of TEM operation were found. The most frequent procedure that was done was resection procedure. Using different energy devices during surgery or suturing versus not suturing the defect were not associated with complication. There was a case of in hospital mortality and one case delayed perianal fistula following TEM. Measurement of lesion distance from anal verge was not significantly different using TEM or colonoscopy. Villous adenomas detected in colonoscopy were mostly associated with malignancy. In evaluated resected lesions most of cases had free base and distance from anal verge or using different energy devices were not associated with obtaining free base. Conclusion: TEM is a safe minimal invasive procedure with acceptable complications that could be helped in managing different proctologic conditions and the results of reviewing our patients revealed the same results that is reported from other colorectal centers. (AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Transanal Endoscopic Surgery/methods , Postoperative Complications , Colonoscopy
17.
Rev. cuba. cir ; 62(4)dic. 2023.
Article in Spanish | LILACS, CUMED | ID: biblio-1550846

ABSTRACT

Introducción: El síndrome de Mirizzi es una entidad clínica rara y difícil de tratar; sin embargo, los avances tecnológicos recientes han brindado a los cirujanos nuevas opciones para un diagnóstico y tratamiento más efectivos de esta afección. Objetivo: Presentar el caso de síndrome de Mirizzi, complicación inusual de la colelitiasis. Presentación del caso: Se presenta una paciente femenina, de 56 años de edad, que acude a nuestra institución por presentar ictericia intermitente, dolor en el hipocondrio derecho, coluria y acolia. Conclusiones: El síndrome de Mirizzi, complicación de la colelitiasis, es una entidad poco frecuente, de difícil diagnóstico preoperatorio, por lo que en un gran porcentaje de los casos se diagnostica intraoperatoriamente. Su tratamiento es quirúrgico(AU)


Introduction: Mirizzi syndrome is a rare condition, difficult to treat; however, recent technological advances have provided surgeons with new options for diagnosing and treating this condition more effectively. Objective: To present a case of Mirizzi syndrome, an unusual complication of cholelithiasis. Case presentation: The case is presented of a 56-year-old female patient, who comes to our institution with intermittent jaundice, right hypochondrium pain, choluria and acholia. Conclusions: Mirizzi syndrome, a complication of cholelithiasis, is a rare entity, difficult to diagnose preoperatively; therefore, a large percentage of it's cases are diagnosed intraoperatively. Its treatment is surgical(AU)


Subject(s)
Cholelithiasis/complications , Mirizzi Syndrome/epidemiology , Cholelithiasis/diagnostic imaging
18.
Arq. gastroenterol ; 60(4): 490-524, Oct.-Nov. 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1527858

ABSTRACT

ABSTRACT Background: Fistulizing perianal Crohn's disease poses a treatment challenge, and researchers postulate that this phenotype in young male patients could have a worst outcome. Objective: Thus, the aim of this study was to assess whether sex influences the response to treatment for these patients. Methods: This systematic review (PROSPERO CRD42022319629) was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol. We selected articles published in English, Spanish, Portuguese, and Italian between 2010 and 2020 in the PubMed and Science Direct databases. According to the PICO acronym, prospective studies in patients older than 18 years with the objective of treating fistulizing perianal Crohn's disease were selected. Studies in pediatric populations, retrospective, without treatment objectives, and that included only rectovaginal fistulas or a single sex were excluded. Study quality was assessed using the Cochrane risk of bias tool and Newcastle-Ottawa scale. Results: Of the 1887 articles found, 33 were included. Most studies used anti-TNF drugs as treatment (n=11). Ten studies had subgroup analyses; of them, the two studies reporting sex differences used infliximab and adalimumab as treatment and showed that women had a longer fistula closure time than men. Conclusion: This systematic review showed that few data corroborate the difference between sexes in the treatment of fistulizing perianal Crohn's disease, possibly having a greater relationship with the phenotype. However, considering the lack of results, further studies with this objective and with standardization of fistulas and response assessment methods are needed.


RESUMO Contexto: A doença de Crohn perianal fistulizante representa um desafio de tratamento, e postula-se que esse fenótipo em pacientes jovens do sexo masculino poderia ter um pior resultado. Objetivo: O objetivo deste estudo foi avaliar se o sexo influencia a resposta ao tratamento desses pacientes. Métodos: Esta revisão sistemática (PROSPERO CRD42022319629) foi conduzida de acordo com o protocolo Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Foram selecionados artigos publicados em inglês, espanhol, português e italiano entre 2010 e 2020 nas bases de dados PubMed e Science Direct. De acordo com o acrônimo PICO, foram selecionados estudos prospectivos em pacientes maiores de 18 anos com objetivo de tratamento da doença de Crohn perianal fistulizante. Foram excluídos estudos em populações pediátricas, retrospectivos, sem objetivos de tratamento e que incluíssem apenas fístulas retovaginais ou um único sexo. A qualidade dos estudos foi avaliada usando a ferramenta de risco de viés Cochrane e a escala Newcastle-Ottawa. Resultados: Dos 1.887 artigos encontrados, 33 foram incluídos. A maioria dos estudos utilizou medicamentos anti-TNF como tratamento (n=11). Dez estudos tiveram análises de subgrupos; deles, os dois estudos que relataram diferenças entre os sexos usaram infliximabe e adalimumabe como tratamento e mostraram que as mulheres tiveram um tempo de fechamento da fístula maior que os homens. Conclusão: Esta revisão sistemática mostrou que poucos dados corroboram a diferença entre os sexos no tratamento da doença de Crohn perianal fistulizante, possivelmente tendo maior relação com o fenótipo. Porém, dada à falta de resultados, são necessários mais estudos com esse objetivo e com padronização das fístulas e métodos de avaliação da resposta.

19.
J. bras. nefrol ; 45(3): 287-293, Sept. 2023. tab
Article in English | LILACS-Express | LILACS | ID: biblio-1521095

ABSTRACT

ABSTRACT Introduction: The high rate of arteriovenous fistula maturation failure is a concern in a scenario of growing numbers of patients on hemodialysis. Non-vascular factors tied to maturation success have not been fully discussed. Methods: This prospective observational cohort study included patients with CKD on dialysis or pre-dialysis prescribed arteriovenous fistula creation for the first time in an ambulatory surgical center in Joinville, Brazil, from January 2021 to July 2021. Anthropometric aspects, sociodemographic characteristics, comorbidities, and vascular parameters observed in Doppler ultrasound were analyzed. Variables associated with maturation were analyzed in multivariate models by logistic regression. Results: Eighty-eight of 145 participants (60.1%) were males. Included patients had a median age of 59 years. Successful arteriovenous fistula maturation occurred in 113 (77.9%) patients. Factors such as increased BMI, hematocrit, arm circumference, and skinfold thickness were associated with lower chances of arteriovenous fistula maturation in univariate analysis. On the other hand, larger vein and artery diameter and fistulas in the more proximal portion of the arm were associated with higher maturation success. In multivariate analysis, smoking and larger skinfold and arm circumference were associated with lower chances of successful maturation. Increased systolic blood pressure and vein diameter were associated with greater chance of success. Conclusion: In addition to the vascular parameters assessed in Doppler ultrasonography, factors related to obesity and/or nutritional aspects may influence arteriovenous fistula maturation.


Resumo Introdução: A alta taxa de falha na maturação da fístula arteriovenosa é motivo de preocupação para o crescente número de pacientes em hemodiálise. Os fatores não vasculares não foram totalmente estudados em relação ao sucesso da maturação. Métodos: Estudo de coorte prospectivo, observacional de pacientes com DRC diálise ou pré-diálise encaminhados para a primeira criação de fístula arteriovenosa em um centro cirúrgico ambulatorial de Joinville, Brasil, de janeiro de 2021 a julho de 2021. Aspectos antropométricos, características sociodemográficas, comorbidades, além de fatores vasculares verificados pelo ultrassom Doppler. As variáveis associadas à maturação foram analisadas em modelos multivariados por regressão logística. Resultados: Dos 145 pacientes participantes, 88 (60,1%) eram homens, com idade mediana de 59 anos. Houve sucesso na maturação da fístula arteriovenosa em 113 (77,9%) pacientes. Fatores como aumento do IMC, hematócrito, circunferência do braço e valor das dobras cutâneas foram associados a menor chance de maturação da fístula arteriovenosa na análise univariada. Por outro lado, o maior diâmetro da veia e da artéria e fístulas na porção mais proximal do membro superior foram associados a maior sucesso de maturação. Na análise multivariada, tabagismo, maior dobra cutânea e circunferência do braço foram associados a menor chance de sucesso da maturação. O aumento da pressão arterial sistólica e o do diâmetro da veia foram associados a maior chance de sucesso. Conclusão: Além dos aspectos vasculares avaliados pela ultrassonografia Doppler, fatores relacionados à obesidade e/ou a aspectos nutricionais podem influenciar a maturação da fístula arteriovenosa.

20.
Rev. colomb. cir ; 38(4): 753-758, 20230906. fig
Article in Spanish | LILACS | ID: biblio-1511135

ABSTRACT

Introducción. El íleo biliar es una complicación rara de la colelitiasis y su incidencia varía del 1 al 4 %. Consiste en la migración de un cálculo de la vesicular biliar al tracto gastrointestinal, generando obstrucción intestinal. Presenta síntomas inespecíficos dependiendo del nivel de la obstrucción, lo que hace que su diagnóstico no suela ser precoz, repercutiendo en el deterioro clínico del paciente. Es especialmente grave en pacientes de edad avanzada y con comorbilidades. Casos clínicos. Se reportan los casos de dos pacientes con dolor abdominal difuso, en quienes se diagnosticó íleo biliar por tomografía. Se realizó manejo quirúrgico, el primero mediante técnica abierta y estrategia de dos pasos, y el otro mediante técnica laparoscópica. Discusión. El íleo biliar es una etiología rara de obstrucción intestinal. El cálculo migra debido a una fistula colecisto-entérica y el nivel de obstrucción es con mayor frecuencia la válvula ileocecal. Los síntomas son inespecíficos y dependen del nivel de obstrucción: dolor abdominal difuso mal caracterizado, náuseas, vómito, ausencia de flatos. El diagnóstico se hace mediante tomografía abdominal, en la cual se evidencia la tríada de Rigler. El manejo es quirúrgico, con enterotomía para extraer el cálculo y resolver la obstrucción. Conclusión. El íleo biliar es una patología que debe ser considerada en el abordaje de la obstrucción intestinal, aunque sea poco frecuente. El manejo quirúrgico es clave para resolver el cuadro de obstrucción intestinal; aún así genera importante morbimortalidad en especial en pacientes de avanzada edad.


Introduction. Gallstone ileus is a rare complication of cholelithiasis, its incidence varies from 1% to 4%. It consists of the migration of a stone from the gallbladder to the gastrointestinal tract, causing intestinal obstruction. It presents with non-specific symptoms depending on the level of the obstruction, which means that its diagnosis is not usually early, with repercussions on the clinical deterioration of the patient, being serious especially in elderly patients and with comorbidities. Clinical cases. Two patients with diffuse abdominal pain are reported. A tomographic diagnosis was made showing gallstone ileus. Surgeries were performed, in the first case using an open technique and a 2-step strategy, and on the second one using a laparoscopic technique. Discussion. Gallstone ileus is a rare etiology of intestinal obstruction. Symptoms are usually poorly characterized: diffuse abdominal pain, nausea, vomiting, absence of flatus. The diagnosis is made by abdominal tomography in which Rigler's triad is evident. Management is surgical through enterotomy to remove the stone and resolve the obstruction. Conclusion. Gallstone ileus is a rare pathology that should be considered in the approach to intestinal obstruction. Surgical management is key to resolving intestinal obstruction. Even so, it generates significant morbidity and mortality, especially in elderly patients.


Subject(s)
Humans , Gallstones , Intestinal Obstruction , Postoperative Complications , Cholelithiasis , Digestive System Fistula , Biliary Fistula
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