ABSTRACT
Introducción: la obstrucción del intestino delgado (SBO) es una presentación común en cualquier unidad de cirugía general. Sin embargo, su diagnóstico y manejo preoperatorio a menudo pueden ser difíciles debido a sus múltiples causas. La obstrucción intestinal pequeña secundaria a la impactación de bezoar es considerablemente infrecuente, con una frecuencia reportada de aproximadamente 0.4% a 4%. La incidencia de bezoar como causa de obstrucción intestinal es baja. El método complementario con la mayor sensibilidad y especificidad continúa siendo CT del abdomen y la pelvis con contraste oral e intravenoso. El tratamiento debe ser quirúrgico. Modificar la dieta junto con el manejo de los trastornos es la mejor forma de prevención.
Introduction: Small Bowel Obstruction (SBO) is a common presentation in any general surgery unit. However, its diagnosis and preoperative management can often be difficult due to its multiple causes. Small bowel obstruction secondary to bezoar impaction is considerably uncommon, with a reported frequency of about 0.4% to 4%. The incidence of bezoar as a cause of intestinal obstruction is low. The complementary method with the highest sensitivity and specificity continues to be CT of the abdomen and pelvis with oral and intravenous contrast. Treatment must be surgical. Modifying the diet along with managing the disorders is the best form of prevention
Subject(s)
Humans , Female , Aged , Bezoars/surgery , Preoperative Care/methods , Diet , Abdomen, Acute/diagnosis , Intestinal Obstruction/surgeryABSTRACT
Introducción: La apendagitis epiploica es un proceso inflamatorio producido por daño estructural debido a torsión que genera zonas hemorrágicas o isquémicas, o bien por una inflamación circundante que afecta los apéndices y genera infarto o necrosis grasa. Objetivo: Describir las características clínico-imagenológicas de un paciente con diagnóstico de apendangitis epiploica en el curso de su infección por COVID-19. Caso clínico: Paciente blanco, masculino de 48 años, con diagnóstico de COVID-19, que comenzó con cuadro de dolor abdominal difuso de 8 días de evolución, que se intensificó en las últimas 24 horas a nivel de la fosa iliaca derecha, acompañado de fiebre, estado nauseabundo y toma del estado general. Se le realiza rayos X de abdomen simple encontrándose íleo regional y tomografía axial computarizada con doble contraste, se halló el signo del halo hiperdenso compatible con apendangitis epiploica. Se decide tratamiento conservador. Se tiene en cuenta la comorbilidad con la COVID-19. Se le realizó seguimiento clínico-imagenológico con evolución favorable con la terapéutica impuesta. Desarrollo: La apendagitis epiploica es una causa de dolor abdominal infrecuente, que puede simular un cuadro de abdomen agudo. La evolución de esta enfermedad puede ser autolimitada por lo que se recomienda el manejo conservador. Conclusiones: Con la presente investigación se exponen los hallazgos clínicos-imagenológicos de la apendagitis epiploica, entidad poco conocida, que puede imitar un abdomen agudo quirúrgico y conllevar a una innecesaria intervención quirúrgica(AU)
Introduction: Epiploic appendagitis is an inflammatory process caused by structural damage due to torsion that generates hemorrhagic or ischemic areas, or by surrounding inflammation that affects the appendages and generates infarction or fat necrosis. Objective: describe the clinical-imaging characteristics of a patient diagnosed with epiploic appendangitis in the course of his COVID-19 infection. Clinical case report: We report the case of a white, 48-year-old male patient, diagnosed with COVID-19, who began with an 8-day history of diffuse abdominal pain, which intensified in the last 24 hours at the level of the right iliac fossa, accompanied by fever, nauseous state and taking of the general state. Simple abdominal X-rays were performed, finding regional ileus and computed tomography with double contrast, a hyperdense halo sign compatible with epiploic appendangitis was found. Conservative treatment is decided. Comorbidity with COVID-19 is taken into account. Clinical-imaging follow-up was carried out with favorable evolution with the imposed therapy. Development: Epiploic appendagitis is an infrequent cause of abdominal pain, which can simulate an acute abdomen. The evolution of this disease can be self-limited, so conservative management is recommended. Conclusions: This research disclosures the clinical-imaging findings of epiploic appendagitis, a little-known entity that can mimic an acute surgical abdomen and lead to unnecessary surgical intervention(AU)
Subject(s)
Humans , Male , Tomography, X-Ray Computed/methods , Colon/diagnostic imaging , COVID-19/epidemiology , Abdomen, Acute/diagnosisABSTRACT
Intestinal obstruction is the most frequent clinical manifestation of colon tumors, most of which are located in the descending and recto-sigmoid colon. Emergency bowel obstruction surgery is associated with high mortality and morbidity risks and the ideal approach remains controversial. Multi-stage procedures and the use of stents as bridges for surgery are promising options. A case of a 61-year-old patient with an acute obstructive abdomen secondary to colorectal neoplasm is presented, with emphasis on its diagnosis and treatmen (AU)
Obstrução intestinal é a manifestação clínica mais frequente de tumores de cólon sendo esses, em sua maioria, localizados no cólon descendente e reto-sigmoide. A cirurgia de emergência para obstrução intestinal é associada a altos riscos de mortalidade e de morbidade e a abordagem ideal permanece controversa. Procedimentos em vários estágios e o uso de stents como ponte para cirurgia são opções promissoras. É apresentado um caso de paciente de 61 anos, com abdome agudo obstrutivo secundário à neoplasia colorretal, com ênfase em seu diagnóstico e tratamento (AU)
Subject(s)
Humans , Female , Middle Aged , Colorectal Neoplasms/surgery , Colorectal Neoplasms/diagnosis , Colectomy , Abdomen, Acute/diagnosis , Intestinal Obstruction/therapyABSTRACT
Reporte de caso: La literatura manifiesta que el quiste de uraco es raro, por lo cual el diagnóstico es aún más difícil de establecer, debido a que solo se presentan síntomas cuando ya existe una complicación, por tanto se puede suponer que algunas personas sean poseedoras de un quiste de uraco y sin presentar sintomatología, siguen con sus actividades de la vida sin problemas. A continuación, presentamos el caso de una paciente, que ingreso con una clínica sugerente de abdomen agudo por apendicitis, pero los exámenes de imágenes revelaron otro diagnóstico, confirmándose con la intervención quirúrgica y posteriormente anatomía patológica. (AU)
Case report: The literature states that the urachus cyst is rare, so the diagnosis is even more difficult to establish, because symptoms only manifest when a complication already exists, so it can be assumed that many people have a urachus cyst, and without having symptoms, they continue with their life activities without problems. Next, we present the case of a patient, who admitted to a clinic suggestive of an acute abdomen due to appendicitis, but the imaging tests revealed another diagnosis, confirming with the surgical intervention and subsequently pathological anatomy. (AU)
Subject(s)
Humans , Female , Adult , Appendicitis , Urachal Cyst/complications , Diagnosis, Differential , Abdomen, Acute/diagnosisABSTRACT
Diagnostic laparoscopy is a surgical diagnostic procedure used to examine the organs inside the abdomen by mean of an optic fiber. The patient with acute abdominal pain and with a not clearly etiology, can represent a great challenge at the moment to perform a definitive diagnosis at urgency. The paraclinic studies must be required considering the particular characteristics of each patient and its clinical presentation at the moment of the medical attention. Considering the more frequent indications for the laparoscopic approach, the diagnostic laparoscopy, occupies the third place after the acute appendicitis and the acute cholecistitis. The aim of this report was to consider a casuistic of 356 patients with acute abdominal pain of uncertain etiology, studied by the authors. Of these patients, the 88% were females. From the rsults obtained, it becomes evident that the video diagnostic laparoscopy proved to be an effective technique in the emergency department with benefit for the patients, mainly for acute cases
Subject(s)
Humans , Epidemiology, Descriptive , Retrospective Studies , Laparoscopy/rehabilitation , Emergencies , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Abdomen, Acute/therapyABSTRACT
La anisakiasis es una zoonosis cada vez más prevalente especialmente en países europeos, causada por la ingesta del nemátodo del género Anisakis en su tercer estadio larvario tras el consumo de pescado crudo o poco cocido. Puede producir una afectación gastrointestinal y también una reacción de hipersensibilidad a las proteínas del parasito. Presentamos un caso de anisakiasis gástrica acompañada de hipersensibilidad (forma gastroalérgica) tras la ingesta de pescado crudo.
Anisakiasis is a zoonosis with an increasing prevalence, especially in European countries, caused by the ingestion of the nematode of the genre Anisakis in its third larvae stage after consuming undercooked or raw fish. It may produce gastrointestinal symptoms and hypersensitivity reactions to the proteins of the worm. We present a case of gastric anisakiasis accompanied by hypersensitivity symptoms (gastroallergic form) after the ingestion of raw fish.
Subject(s)
Aged , Female , Humans , Anisakiasis/diagnosis , Abdomen, Acute/diagnosis , Diagnosis, Differential , Emergencies , Emergency Service, Hospital , Abdomen, Acute/etiologyABSTRACT
RESUMO Objetivo: estabelecer a correlação entre dados objetivos coletados na avaliação inicial e os desfechos nos casos de dor abdominal aguda. Métodos: estudo retrospectivo, de caso controle, em que foram revisados prontuários de pacientes atendidos em um serviço de urgência e emergência no ano de 2016, diagnosticados com dor abdominal e pélvica. Resultados: de 2.352 prontuários avaliados, 330 foram considerados válidos para o estudo. Destes pacientes, 235 (71,2%) receberam alta e os 95 (28,8%) restantes foram internados, submetidos à cirurgia ou morreram. A análise estatística demonstrou que sexo masculino, idade ≥50 anos, temperatura axilar >37,3ºC, anemia, leucocitose >10.000/mm3, neutrocitose acima de 7.700/mm3, linfopenia <2.000/mm3 e hiperamilasemia são variáveis isoladamente associadas a pior desfecho. Conclusão: a presença de três ou mais das variáveis avaliadas aumenta fortemente a chance de um paciente sofrer os desfechos de cirurgia ou morte, sendo a chance de óbito tanto maior quanto maior o número de variáveis presentes.
ABSTRACT Objective: to establish a correlation between objective data collected at the initial evaluation and the outcomes in cases of acute abdominal pain. Methods: we conducted a retrospective, case-control study in which we reviewed medical records of patients treated at an emergency room in 2016, diagnosed with abdominal and pelvic pain. Results: of the 2,352 medical records evaluated, we considered 330 valid for the study. Of these patients, 235 (71.2%) were discharged and the remaining 95 (28.8%) were hospitalized, submitted to surgery, or died. The statistical analysis demonstrated that male gender, age ≥50, axillary temperature >37.3ºC, anemia, leukocytosis >10,000/mm3, neutrophil count above 7,700/mm3, lymphocyte count less than 2,000/mm3 and hyperamylasemia were variables in independently associated with worse outcome. Conclusion: the presence of three or more of the evaluated variables greatly increases the chances of a patient suffering the outcomes of surgery or death, the chance of death being greater the greater the number of variables present.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Abdominal Pain/diagnosis , Abdomen, Acute/diagnosis , Abdominal Pain/etiology , Abdominal Pain/physiopathology , Case-Control Studies , Sex Factors , Retrospective Studies , Risk Factors , Emergency Service, Hospital , Abdomen, Acute/etiology , Abdomen, Acute/physiopathology , Middle AgedSubject(s)
Humans , Male , Adult , Abdomen, Acute/diagnosis , Peritoneal Cavity/pathology , Peritoneal Neoplasms , Diagnostic Imaging , Infarction , OmentumABSTRACT
Summary Perforated gastric carcinoma is a rare condition that is hard to diagnose preoperatively. It is associated with advanced cancer stages and has a high mortality, particularly in cases presenting preoperative shock. Few studies have investigated the presentation and adequate management of these carcinomas. In addition, there are no reports in the literature on perforations extending to the spleen, as described in this case, making the management of these lesions challenging. Our article reports a case of gastric tumor perforation extending to the spleen, which presented as a perforated acute abdomen. The patient was treated with total gastrectomy and D2 lymph node resection with splenectomy and progressed well with current survival of one year at disease stage IV.
Resumo A neoplasia gástrica perfurada é uma condição incomum e de difícil diagnóstico pré-operatório, estando relacionada a estágios avançados e com alta mortalidade, principalmente na presença de choque pré-operatório. Poucos estudos foram feitos quanto a sua forma de apresentação e ao tratamento adequado. Além disso, não há nenhum relato em literatura quanto à extensão da perfuração para o baço, como é descrito neste caso, tornando mais difícil a conduta. Este artigo relata um caso de perfuração de neoplasia gástrica com extensão para o baço, que se apresentou como abdome agudo perfurativo. Submetido a gastrectomia total e ressecção linfonodal D2 com esplenectomia, apresentou boa evolução e sobrevida atual de 1 ano, em um estadiamento IV da doença.
Subject(s)
Humans , Male , Stomach Neoplasms/diagnosis , Adenocarcinoma/diagnosis , Spontaneous Perforation/diagnosis , Abdomen, Acute/diagnosis , Stomach Neoplasms/surgery , Stomach Neoplasms/complications , Adenocarcinoma/surgery , Adenocarcinoma/complications , Disease-Free Survival , Diagnosis, Differential , Spontaneous Perforation , Spontaneous Perforation/etiology , Gastrectomy , Middle Aged , Neoplasm StagingABSTRACT
Resumo Relatamos o caso de uma menina de 12 anos que deu entrada na unidade de emergência com quadro de abdome agudo hemorrágico, massa abdominal pulsátil e instabilidade hemodinâmica. Confirmado o diagnóstico de aneurisma roto de artéria ilíaca direita, foi realizada correção cirúrgica de emergência por reparo aberto com reconstrução extra-anatômica, utilizando enxerto sintético de fino calibre, compatível com a anatomia. O tratamento foi bem-sucedido e a criança apresentou evolução favorável em curto prazo.
Abstract We describe the case of a 12-year-old girl who presented at the emergency department with hemorrhagic acute abdomen, an abdominal pulsating mass and hemodynamic instability. A diagnosis of ruptured right iliac artery aneurysm was confirmed and an emergency open repair procedure was performed with extra-anatomic reconstruction, using a small-caliber synthetic graft, compatible with her anatomy. The treatment was successful and the child was doing well at short-term follow-up.
Subject(s)
Humans , Female , Child , Aneurysm, Ruptured/surgery , Child , Iliac Aneurysm/surgery , Iliac Artery , Abdomen, Acute/complications , Abdomen, Acute/diagnosis , Blood Vessel ProsthesisABSTRACT
A trombose de veia porta é uma causa rara de abdome agudo vascular e está diretamente relacionada a trombofilias hereditárias ou adquiridas. O caso de um paciente de 60 anos, sexo masculino, com quadro clínico de isquemia mesentérica confirmada por exame de imagem é apresentado. Foi submetido a enterectomia e enteroanastomose e, após esplenoportografia que detectou trombose de veia porta, indicou-se tratamento medicamentoso com infusão contínua de ativador tecidual do plasminogênio recombinante (Alteplase) através de cateterismo seletivo da artéria mesentérica superior. Trata-se de um tratamento inovador. Obteve-se sucesso na recanalização do sistema porta. O paciente evoluiu com quadro de sepse abdominal, necessitando de assistência em terapia intensiva por 25 dias. Evoluiu bem e recebeu alta hospitalar com o uso de anticoagulante. O artigo apresenta uma breve revisão de literatura e discussão do caso clínico
Portal vein thrombosis is a rare vascular cause of acute abdomen and it is directly related to hereditary or acquired thrombophilias. This article presents the case of a 60-year-old male patient, with clinical signs of mesenteric ischemia that was confirmed by imaging examination. He underwent enterectomy and enteroanastomosis and, after detection of portal vein thrombosis by splenoportography, he was prescribed drug-based treatment with continuous infusion of recombinant tissue plasminogen activator (Alteplase) via selective catheterization of the superior mesenteric artery. This is a treatment innovation. The portal system was successfully recanalized. However, the patient developed abdominal sepsis and required intensive care for 25 days. His clinical status improved and he was discharged with a prescription for oral anticoagulant. This article presents a brief review of the literature and a discussion of portal vein thrombosis
Subject(s)
Humans , Male , Middle Aged , Catheterization/methods , Mesenteric Artery, Superior , Portal Vein , Thrombosis/therapy , Abdomen, Acute/diagnosis , Abdomen, Acute/therapy , Anticoagulants/therapeutic use , Mesenteric Ischemia/diagnosis , Mesenteric Ischemia/therapy , Risk Factors , Splenic Vein , Thrombolytic Therapy/methods , Tomography, X-Ray Computed/methodsABSTRACT
A ruptura esplênica é uma complicação possível da malária. É importante pela dificuldade diagnóstica, pois um elevado índice de suspeição é necessário para um diagnóstico atempado. Pode condicionar uma hemorragia intraperitoneal e deve ser considerada no diagnóstico diferencial de quadros de dor abdominal, hipotensão e diminuição do hematócrito. Os autores descrevem o caso de um homem de 59 anos, com ruptura esplênica secundária à malária por Plasmodium falciparum, tendo realizado esplenectomia urgente. Com a apresentação do caso, os autores pretendem chamar a atenção para a necessidade de incluir esta afecção no diagnóstico diferencial dos doentes com malária e hipotensão refractária.
Splenic rupture is a possible complication of malaria. Due to its difficult diagnosis, it is important, because a high level of suspicion is needed for a timely diagnosis. It results in intraperitoneal bleeding and should be considered in the differential diagnosis of abdominal pain, hypotension and low hematocrit. The authors report the case of a 59-year old man with splenic rupture secondary to malarial infection by Plasmodium Falciparum, who was treated with urgent splenectomy. This case is presented to remind the clinicians of include this entity in the differential diagnosis of patients with malaria and refractory hypotension.
Subject(s)
Humans , Male , Middle Aged , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Abdomen, Acute/surgery , Malaria/complications , Plasmodium falciparum , Rupture, Spontaneous/diagnosis , Rupture, Spontaneous/etiology , Rupture, Spontaneous/surgery , Spleen/abnormalities , Spleen/surgery , Splenic Rupture/diagnosis , Splenic Rupture/etiology , Splenic Rupture/surgeryABSTRACT
A etiologia mais comumente relacionada ao quadro de abdome agudo inflamatório na criança é a apendicite aguda. O diagnóstico é essencialmente clínico, mas quando houver dúvida diagnóstica, podem ser empregados métodos de imagem. A conduta varia de acordo com o estágio da doença.
The etiology most commonly related to inflammatory acute abdomen in children is acute appendicitis. The diagnosis is primarily clinical, but imaging methods can be used when there is diagnostic uncertainty. Management varies according to the stage of the disease.
Subject(s)
Abdomen, Acute/diagnosis , Appendicitis/drug therapy , Appendicitis/surgery , Pediatrics , ChildABSTRACT
INTRODUCCIÓN: Se define al término Abdomen Agudo como al dolor abdominal de aparición repentina e intensidad severa que requiere una medida terapéutica inmediata. Debe ser considerado una emergencia médica. El cuadro clínico de apendicitis aguda presenta las características antes mencionadas, por lo que el diagnóstico certero y precoz es de importancia relevante. No siempre puede realizarse a un diagnóstico fiable y preciso con la anamnesis, el examen físico y los resultados de laboratorio de análisis, por lo que el diagnóstico imagenológico juega un rol importante para decidir la conducta a seguir. La ecografía es un examen dinámico, en tiempo real, de bajo costo y repetible debido a que no presenta los efectos adversos de la radiación. Diferentes estudios demostraron que la tasa de apendicectomías negativas disminuyó a aproximadamente el 10% con el uso rutinario de la ecografía. OBJETIVO: Correlacionar los resultados ecográficos con el diagnóstico anatomopatológico de pacientes operados con diagnóstico de apendicitis. Determinar si es un método complementario confiable para establecer diagnóstico y determinar conducta. Evaluar la tasa de apendicectomías negativas. MATERIAL Y MÉTODOS: Éste estudio de cohorte retrospectivo relacionó la ecografía y los resultados de anatomía patológica de 219 pacientes con diagnóstico de apendicitis intervenidos quirúrgicamente, entre el 1º de enero y 30 de Junio de 2014. RESULTADOS: Se realizaron ecografía abdominal a la totalidad de los pacientes operados con diagnóstico de apendicitis. De éstas, el 60,3% fueron informadas positivas para dicho diagnóstico. Todos los apéndices resecados fueron enviados a anatomía patológica, confirmándose el diagnóstico de apendicitis en el 87,7% de las piezas. Ciento cincuenta casos fueron positivos en ecografía y anatomía patológica, lo que representa el 68,49%. Once casos fueron negativos en ecografía y anatomía patológica, lo que representa el 5,02%...
INTRODUCTION: It defines the term acute abdomen as the sudden onset abdominal pain and severe intensity that requires immediate therapeutic measure. Should be considered medical emergency. The clinical picture of acute appendicitis presents the above characteristics, so the accurate and early diagnosis is of significant importance. You cannot always be a reliable and accurate diagnosis with history, physical examination and laboratory results of analysis, so the diagnostic imaging plays an important role in deciding what action to take. Ultrasound testis a dynamic, real-time, low-cost, repeatable because no adverse effects of radiation. Different studies showed that negative appendectomy rate decreased to approximately 10%with routine use of ultrasound. OBJECTIVE: To correlate the sonosoon graphic findings with pathologic diagnosis of patients operated with a diagnosis of appendicitis. Determine if it is a complementary method to establish reliable diagnosis and determine be havior. Assessing the negative appendectomy rate. METHODS: This retrospective cohort study linked the ultrasound and pathology results of 219 patients diagnosed with appendicitis surgery between January 1 and June 30, 2014. RESULTS: Abdominal ultra sound to all operated patients diagnosed with appendicitis were performed. Of these, 60.3% were reported positive for the diagnosis. All resected appendices were sent to pathology, confirming the diagnosis of appendicitis in 87.7% of the parts. One hundred and fifty cases were positive in ultra sound and pathology, representing 68.49%. Eleven cases were negative on ultra sound and pathology, representing 5.02%...
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Abdomen, Acute/diagnosis , Appendicitis/diagnostic imaging , Appendicitis/pathology , Appendicitis/surgery , Ultrasonography , Appendectomy , Early Diagnosis , Retrospective Studies , Sensitivity and SpecificityABSTRACT
Introducción: en Cuba, la expectativa de vida de la población se ha elevado considerablemente lo que hace necesaria la capacitación para un mejor desempeño de los profesionales de la salud. Objetivo: valorar los conocimientos adquiridos para el tratamiento del abdomen agudo quirúrgico en el adulto mayor en la carrera de Medicina. Métodos: se evaluaron grupos representativos con estudiantes de Medicina y docentes de la Facultad General Calixto García, mediante entrevistas de profundidad. Resultados: los estudiantes evaluaron de excelente o bien los conocimientos adquiridos sobre los síndromes abdominales agudos durante su rotación por cirugía, el 69,4 por ciento consideró que el programa de la asignatura incluye contenidos que posibilitan evaluar la urgencia abdominal del adulto mayor, el 18,4 por ciento entendió que el programa no brinda esa posibilidad y un 12,2 por ciento desconocía este hecho, el 90,8 por ciento de los estudiantes consideró que es necesaria una propuesta de modificación de los temas relacionados con el abdomen agudo en la asignatura Cirugía General, el 66,7 por ciento de los docentes opinaron que son insuficientes los contenidos impartidos en la asignatura relacionados con el tratamiento quirúrgico del abdomen agudo del anciano, para lograr las habilidades necesarias en los futuros profesionales, el 33,3 por ciento consideran que los contenidos son suficientes. Conclusión: el envejecimiento poblacional exige un mejor desempeño de los profesionales de la salud para elevar la calidad de vida del adulto mayor. El programa de la asignatura Cirugía General, que se imparte en la carrera de Medicina necesita una revisión curricular de acuerdo al contexto actual.
Introduction: life expectancy of the Cuban population has considerably risen, so the training of the health professionals is necessary to improve their performance. Objective: to assess the knowledge on treatment of acute surgical abdomen in the older adult in the medical studies. Methods: Representative groups of medical students and professors from Calixto Garcia medical school were evaluated through in-depth interviews. Results: the evaluation given by students about the acquired knowledge on the acute abdominal syndromes during their rotation in the surgery service was excellent or good. In the group, 69.4 percent stated that the subject curriculum included the elements that make the evaluation of abdominal emergency possible in the older adult whereas 18.4 percent did not and 12.2 percent ignored this fact; 90.8 percent of students deemed necessary a proposal of changing topics related to acute abdomen treatment in the general surgery subject and 66.7 percent of the professors expressed that in the present surgery curriculum, the contents taught as to the surgical treatment of the acute abdomen in the elderly was not enough for the future medical professionals to attain the necessary skills, but 33.3 percent considered these same contents as adequate. Conclusions: population aging demands better performance of health professionals to raise the quality of life of the older adult. The General Surgery subject curriculum taught in the medical studies needs to be revised in line with the present context.
Subject(s)
Humans , Aged , Abdomen, Acute/surgery , Abdomen, Acute/diagnosis , Curriculum/standards , Education, Medical/methods , Cuba , Interviews as Topic/methodsABSTRACT
La gastritis enfisematosa (GE) es una entidad poco frecuente, descripta por primera vez por Fraenkel en 1889. Se caracteriza por la invasión de la pared gástrica por gérmenes productores de gas, y se asocia a una alta morbimortalidad. Se describen en la bibliografía diferentes factores de riesgo que favorecerían su desarrollo, entre ellos ingesta de cáusticos, diabetes, abuso de alcohol, isquemia gástrica y cirugía de estómago. El cuadro clínico se caracteriza por dolor abdominal agudo y progresivo asociado a repercusión sistémica, sepsis severa, shock séptico, disfunción orgánica múltiple y muerte. Los métodos de diagnóstico por imágenes cumplen un rol fundamental en su abordaje, siendo la tomografía computada multidetector (TCMD) el método de elección, ya que cuenta con la capacidad de mostrar la presencia de gas en el interior de la pared gástrica (neumatosis gástrica) en asociación con el aumento de su espesor, siendo estos dos hallazgos la clave en el diagnóstico. También se encuentra presente un aumento de la densidad del tejido perigástrico compatible con cambios de tipo inflamatorio o infeccioso, y en algunas ocasiones se asocia a neumatosis portal. Se realiza una actualización del tema enfatizando el rol de la TCMD para su diagnóstico.
Emphysematous gastritis (EG) is a rare entity first described in 1889. It is characterized by the invasion of the gastric wall by gas-producing bacteria, and is associated with high morbidity and mortality. The clinical picture is characterized by acute abdominal pain associated with progressive systemic repercussions, severe sepsis, septic shock, multiple organ dysfunction, and death. Imaging methods play a fundamental role in the diagnosis. Multidetector Computed Tomography (MDCT) is the method of choice, since it has the ability to show the presence of gas within the gastric wall (gastric pneumatosis) in association with increased wall thickness. These two features are key findings for diagnosis. Increased density of perigastric tissue is frequently present, due to infectious or inflammatory changes; sometimes portal pneumatosis is present as well. An update on EG is presented, emphasizing the role of MDCT in diagnosis.
Subject(s)
Humans , Male , Adult , Emphysema/pathology , Gastritis/pathology , Pneumatosis Cystoides Intestinalis/pathology , Tomography/methods , Diagnostic Techniques and Procedures , Abdomen, Acute/diagnosis , Melena/diagnosisABSTRACT
O hematoma espontâneo do músculo reto abdominal é uma condição incomum, causado pela concentração de sangue emsua própria bainha muscular, sem associação com traumas, mas pelo rompimento dos vasos epigástricos ou por lesão da própria musculatura. O presente trabalho relata o caso de uma idosa de 75 anos que apresentou, após crises de tosse, intensa dor abdominal e equimose periumbilical e em flancos, simulando abdome agudo, caracterizado como hematoma espontâneo do músculo reto abdominal após exames de imagem. A paciente foi submetida a tratamento conservador, mas, no 20° dia após o quadro agudo, evoluiu com abscesso local, sendo tratada com drenagens e antibióticos. Ressalta-se a importância do reconhecimento do quadro na prática clínica, pois sua semelhança com outras condições abdominais agudas pode levar a intervenções cirúrgicas desnecessárias...
Spontaneous rectus sheath hematoma is a rare situation, caused by the accumulation of blood inside the rectus abdominal muscle sheath, not associated with trauma, because of rupture of epigastric vessels or muscle lesion. This paper reports the case ofa 75-year old woman, who presented severe abdominal pain and ecchymosis, identified as spontaneous rectus sheath hematoma after imaging. She was treated conservatively, but an abscess was drained and used antibiotics on the 20th day after the beginning of pain, finally resolving the case. This report reinforces the need for recognizing this situation in clinical practice, because it is similar to other acute abdominal conditions, and it could lead to an unnecessary surgery...
Subject(s)
Humans , Female , Aged , Abdomen, Acute/diagnosis , Hematoma , Rectus AbdominisABSTRACT
La apendagitis epiploica primaria es una enfermedad relativamente infrecuente dentro de los diagnósticos diferenciales del abdomen agudo. Describimos las características clínicas y evolución de una serie de 73 casos de apendagitis epiploica primaria. Se realizó una búsqueda de imágenes ecográficas y tomográficas con diagnóstico de apendagitis en el sistema de información hospitalario electrónico del Hospital Alemán entre abril del 2007 y julio del 2013 y posteriormente se revisaron sus historias clínicas. Se incluyeron 73 casos; la edad promedio fue de 45 años (± 16), 54 (74%) eran varones. El motivo de consulta fue dolor abdominal: en fosa ilíaca izquierda en 65 (el 89% de los casos); en fosa ilíaca derecha en seis (8%) y en otras localizaciones en dos (3%). Se les realizó ecografía abdominal a 44 (60%), tomografía computarizada a 21 (29%), y ambos estudios a 8 (11%). En el 49% de los casos se solicitó interconsulta con el servicio de cirugía. Recibieron tratamiento con antibióticos 15 (21%) pacientes, de los cuales el 73% fue indicado por un médico clínico. Recibieron tratamiento ambulatorio con antiinflamatorios no esteroides 67 (92%); dos requirieron cirugía laparoscópica, dos internación y dos opiáceos. La apendagitis epiploica es infrecuente dentro de los diagnósticos diferenciales de abdomen agudo, pero es una entidad que no debe ser desconocida por los médicos para prevenir intervenciones innecesarias y el uso excesivo de antibióticos.
Primary epiploic appendagitis is a relatively rare disease in the differential diagnosis of acute abdomen, nonetheless it is an entity that should not be ignored by physicians and surgeons in order to prevent unnecessary interventions and overuse of antibiotics. To substantiate this concept a search was conducted at the Hospital Aleman, Buenos Aires between April 2007 and July 2013. The aim was clinical histories containing sonographic and tomographic images with diagnosis of omental appendagitis; and subsequently their electronic medical records were reviewed. The clinical features and outcome of a case series of 73 primary omental appendagitis were selected; the mean age was 45 years (± 16); 54 (74%) were men. Abdominal pain (left lower quadrant in 89% of cases) was the most common symptom. Abdominal ultrasound was performed on 44 (60%) of patients, computed tomography on 21 (29%), and both studies on 8 (11%) of cases in this series. In 49% of cases surgery consultation was requested. Fifteen patients (21%) were treated with antibiotics, 73% of them were prescribed by a clinician. Sixty seven patients (92%) were treated as outpatients with non steroidal anti-inflammatory drugs (NSAIDs); two required laparoscopic surgery, two required hospitalization and two others were treated with opioids. Epiploic apendagitis is uncommon in the differential diagnosis of acute abdomen, but is an entity that should not be ignored by physicians to prevent unnecessary interventions and overuse of antibiotics.
Subject(s)
Adult , Female , Humans , Male , Middle Aged , Colitis/diagnosis , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Analgesics, Opioid/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Colitis/complications , Colitis/therapy , Diagnosis, Differential , Laparoscopy , Rare Diseases , Retrospective StudiesSubject(s)
Humans , Male , Pancreatitis/pathology , Retroperitoneal Space , Gases , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Pancreatitis/therapyABSTRACT
Objetivo: Relatar o caso vivenciado na prática de enfermagem, no manejo de complicações de pele periestoma,e avaliar as mudanças clínicas obtidas após a utilização de protetores cutâneos. Relato de caso: O estudo foi desenvolvido em uma paciente estomizada de 57 anos, cuja pele periestoma apresentava extensa dermatite periestomal com aspecto brilhante, altamente exsudativa, irritativa e dolorosa, em que o dispositivo para estomia mantinha-se adaptado por menos de 24 horas. Conclusão: Após o manejo dos protetores cutâneos, houve evolução satisfatória em relação à lesão periestomal e no emocional, o que resultou no fechamento da ileostomia.
Objective: To report a case experienced in nursing practice regarding the management of peristomal skin complications, as well as to evaluate the clinical changes obtained after the use of skin protectors. Case report: this study was developed in a patient with stoma 57, whose skin had extensive peristomal dermatitis, glossy, highly exudative, irritating and painful, who had a device installed for ostomy adapted forless than 24 hours. Conclusion: After the management of skin protectors, there was satisfactory progress in relation to peristomal and emotional injury, which resulted in the closure of the ileostomy.