Gastritis enfisematosa. Reporte de un caso en el adulto mayor / Emphysematous gastritis. Report of a case in the elderly

Introducción: la gastritis enfisematosa es una patología poco común pero con alta mortalidad, su presentación clínica es insidiosa, la imagen por tomografía se distingue por un patrón de burbujas lineales con engrosamiento de la pared gástrica. Caso clínico: paciente masculino de 78 años, previamente sano, funcional, que fue ingresado por fractura pertrocantérica de cadera izquierda, quien durante la hospitalización presenta delirium hiperactivo, distención abdominal con disminución de perístalsis además de hipotensión arterial, se realiza tomografía abdominal con evidencia de dilatación gástrica y múltiples burbujas de aire en pared. Es manejado con antibiótico de amplio espectro, fluidoterapia y nutrición parenteral, con respuesta favorable.Conclusiones: la edad avanzada no conlleva por sí misma un peor pronóstico de la enfermedad, la evidencia apoya que un diagnóstico precoz y la intervención terapéutica temprana, son las medidas que han demostrado ser efectivas para la disminución de la mortalidad en pacientes con gastritis enfisematosa

Introduction: Emphysematous gastritis is an uncommon pathology but with high mortality, its clinical presentation is insidious, the tomography image is distinguished by a pattern of linear bubbles with thickening of the gastric wall.Background: This is a 78-year-old male, previously healthy, functional, who was admitted for pertrochanteric fracture of the left hip, who during hospitalization presented hyperactive delirium, abdominal distention with decreased perstalsis in addition to arterial hypotension, an abdominal tomography with evidence of gastric dilation and multiple air bubbles in the wall. He is managed with a broad spectrum antibiotic, fluid therapy and parenteral nutrition, with a favorable response.Conclusions: Advanced age does not in itself lead to a worse disease prognosis, the evidence supports that early diagnosis and early therapeutic intervention are the easures that have proven to be more effective in reducing mortality in patients with emphysematous gastritis.

Type 2 myocardial infarction resulted from the left thoracic stomach

Abstract The universal definition of myocardial infarction (MI) provides five subtypes of acute myocardial infarction (AMI). We present an interesting case of a type 2 myocardial infarction caused by the dilation of the left thoracic stomach.

Epidemiological and pathological aspects of noninfectious diseases of the gastrointestinal tract in 114 horses in Southern Brazil / Aspectos epidemiológicos e patológicos de doenças não infecciosas do trato gastrointestinal de 114 equinos no sul do Brasil

Equine colic is one of the most common cause of death in horses, but few studies have investigated specifically the conditions at the necropsy. This study aimed to describe the epidemiological and pathological features of noninfectious diseases of the gastrointestinal tract in horses. A retrospective study was conducted in search of cases of these diseases affecting horses from 2005 to 2017. During this period, 114 horses died of noninfectious diseases of the gastrointestinal tract, and the main causes were: primary gastric dilation (27/114), volvulus (27/114), enterolithiasis (20/114), rectal (colonic) perforation (15/114), gastric or cecocolonic impaction (10/114), incarcerations (6/114), intussusception (4/114), and others (5/114). Mixed breeds horses (56/114) and males (69/114) were mostly affected. The horses had a median and mean age of 10 and 10.9-years old, respectively. Primary gastric dilation was characterized by distension of the stomach by moderate to large amounts of content, which in 21 cases caused tearing of the stomach wall at the greater curvature (peritonitis), and the main predisposing factor was alimentary overload (17/27). Intestinal volvulus occurred within the small intestine (14 cases) and within the large intestines (13 cases). Grossly, there was intestinal ischemia with reddened to deep-black serosa and diffusely red mucosae. Enterolithiasis caused partial or complete obstruction of the right dorsal colon (9/20), transverse colon (4/20), small colon and right dorsal colon (3/20), rectum and right dorsal colon (2/20), and small colon (2/20). Viscera perforation and peritonitis occurred in 11 cases. Rectal (colonic) perforation involved the rectum (10/15), rectum/small colon (4/15), and the small colon (1/15). It was characterized by a focally extensive transmural tearing, associated with reddened borders, and retroperitoneal to diffuse peritonitis. Palpation related iatrogenic injuries (11/15) were the main cause. Impactions affected the large colon (7/10), the cecum (2/10), and the stomach (1/10). Incarcerations consisted of inguinoscrotal hernias (2/6), small intestine entrapment by a mesenteric failure (2/6), diaphragmatic hernia, and umbilical eventration. Grossly, the organs were constricted by a hernial ring, with intestinal ischemia and reddened to dark-red serosa. Predisposing factors included previous surgeries (2/6) and patent inguinal ring (1/6). Intussusception involved the small intestine (3/4) and ileocecum (1/4). Foals with lack of colostrum intake and concomitant pneumonia was a characteristic presentation (3/4). Grossly, the intussusceptum slipped into intussuscipiens, with diffuse deep black-red discoloration. Other causes included large colon displacement (2/5), extrinsic and intrinsic obstruction of the small intestine (2/5), and an intestinal adenocarcinoma. Noninfectious gastrointestinal diseases are major causes of death in horses. Epidemiological and gross features of the conditions should be accounted to obtain a final diagnosis of the cause of the colic.(AU)

A cólica em equinos é considerada como a principal causa de morte de cavalos, porém poucos estudos têm investigado especificamente as condições envolvidas através da necropsia. O objetivo desse estudo foi descrever os aspectos epidemiológicos e patológicos de doenças não infecciosas do trato gastrointestinal de equinos. Foi conduzido um estudo retrospectivo em busca de casos dessas doenças envolvendo cavalos de 2005 a 2017. Durante esse período, 114 equinos morreram devido a doenças não infecciosas do trato gastrointestinal, e as principais causas foram: dilatação gástrica (27/114), vólvulos (27/114), enterolitíase (20/114), ruptura retal (colônica) (15/114), compactação gástrica ou cecocolônica (10/114), encarceramentos (6/114), intussuscepções (4/114), e outros (5/114). Animais sem raça definida (56/114) e machos (69/114) foram mais afetados. Os equinos apresentavam uma média e mediana de idade de 10 e 10,9 anos, respectivamente. A dilatação gástrica primária era caracterizada por distensão do estômago por moderada a grande quantidade de conteúdo, que em 21 casos provocava ruptura da parede gástrica na curvatura maior (peritonite), e o principal fator predisponente foi sobrecarga alimentar (17/27). Vólvulo intestinal ocorreu no intestino delgado e no intestino grosso (14 e 13 casos, respectivamente). Macroscopicamente, havia isquemia intestinal com serosa avermelhada a enegrecida e mucosa difusamente avermelhada. A enterolitíase causou obstrução parcial ou completa do cólon dorsal direito (9/20), cólon transverso (4/20), cólon menor e cólon dorsal direito (3/20), cólon menor (2/20), e reto e cólon maior direito (2/20). Perfuração de vísceras e peritonite foram observadas em 11 casos. A ruptura retal (colônica) envolveu o reto (10/15), reto/cólon menor (4/15) e cólon menor (1/15). Essa era caracterizada por ruptura transmural focalmente extensa, com bordos avermelhados e peritonite retroperitoneal a difusa. Traumas relacionados à palpação (11/15) foram a principal causa. Compactações afetaram o cólon maior (7/10), ceco (2/10) e estômago (1/10). Encarceramentos consistiram em hérnias inguinoescrotais (2/6), encarceramento de alças intestinais por falha no mesentério (2/6), hérnia diafragmática e eventração umbilical. Macroscopicamente, os órgãos estavam constritos por um anel hernial, com isquemia intestinal e serosa avermelhada a vermelho-escura. Fatores predisponentes incluíram cirurgias prévias (2/6) e anel inguinal patente (1/6). Intussuscepções envolveram o intestino delgado (3/4) e íleoceco (1/4). A apresentação característica foi em potros com falta de colostro e concomitante pneumonia. Macroscopicamente, o intussuscepto deslizava em direção ao intussuscepiente, exibindo coloração vermelho-enegrecida difusa. Outras causas incluíram deslocamento de cólon maior (2/5), obstrução extrínseca e intrínseca do intestino delgado (2/5), e um caso de adenocarcinoma intestinal. Doenças não infecciosas são importantes causas de morte em equinos. Os aspectos epidemiológicos e macroscópicos das condições devem ser considerados para o que o diagnóstico final da causa da cólica seja obtido.(AU)

Acute gastric dilatation and ischemia associated with portal vein gas caused by binge eating

No abstract available.

Repeated gastric dilatations leading to fatal abdominal compartment syndrome in a patient with bulimia nervosa

Cases of repeated acute gastric dilatations after binge eating in one patient are rarely reported. We report here a case of repeated acute gastric dilatations in a 22-year-old woman with bulimia nervosa. Her repeated acute gastric dilatations seem to have been related to superior mesenteric artery syndrome. On her last visit due to acute gastric dilatation, she underwent emergency gastric decompression surgery because of abdominal compartment syndrome; however, she eventually died because of ischemia reperfusion injury. Emergency physicians should be aware of the need to manage acute gastric dilatation in patients with eating disorder and should pay attention to the signs and distinctive clinical features of abdominal compartment syndrome.

Hinchazón/distensión funcional: un enfoque práctico / Functional abdominal bloating/ distension: a practical approach

Although abdominal bloating and distension are frequent symptoms, they are considered a challenge in medical practice. Treatment alternatives with varying efficacy levels, associated to the lack of knowledge about this problem, generate difficulties in the doctor­patient relation, and patient's frustration and anxiety. Advances in understanding their etiopathogenetic factors have lead treatment of these patients towards a personalized approach. The purpose of the article is to provide a brief description about abdominal bloating and distension, and ultimately give a practical approach of this condition.

A pesar de que la hinchazón (bloating) y la distensión abdominal son síntomas altamente frecuentes, son considerados un desafío en el quehacer médico. Alternativas terapéuticas con grados de eficacia variables, asociado a un desconocimiento en el enfrentamiento clínico, generan dificultades en la atención de estos pacientes por parte de los médicos, además de frustración para el paciente. Avances en la comprensión de su etiopatogenia han permitido dirigir el tratamiento de estos pacientes de manera personalizada. Este artículo tiene como objetivo realizar una breve descripción del cuadro, y dar finalmente un enfoque práctico frente a esta condición.

Resistance to rupture of the equine stomach / Resistência à ruptura do estômago equino

Equine colic is an important and common cause of disease and death in horses. Gastric rupture has been extensively described in the literature, and is known to affect expressive numbers of horses. Gastric dilatation, which precedes rupture, may be observed when the animal consumes large amounts of recently harvested grass or drinks water too fast, though diagnosis criteria also include infestation with Gastherophilus and the presence of ileus and distal intestinal obstructions. The objective of the present study was to determine the resistance to rupture of the equine stomach to air (mm Hg) and water (L) injection. Forty stomachs of young horses (20 geldings and 20 mares) with no defined breed were analyzed. Total organ length (cm), weight (g), greater curved length (cm), lesser curved length (cm) and height (cm) were measured, with no statistical difference between males and females (p > .05). However, stomachs of horses were larger than those of mares and therefore presented higher volumetric capacity (p<0.05). No difference between males and females was observed in the pressure assay (93mmg Hg). Rupture occurred along the greater curvature (99%) and on the visceral (80%) and diaphragmatic (20%) surfaces, across all layers of the gastric wall. Although the equine stomach is relatively small, the organ is considerably resistant to rupture, whether by injection of air or liquid. Horses and mares exhibit similar resistance values, although the stomach of females has smaller volumetric capacity.(AU)

A cólica é um dos problemas mais comuns na clínica de equinos sendo responsável por grande número de mortes. A ruptura gástrica tem sido amplamente descrita na literatura e acomete número expressivo de animais. A dilatação gástrica, que antecede a ruptura, pode advir do consumo excessivo de capim recém-cortado, ingestão rápida de água, infestação por Gastherophilus, ocorrência de íleo paralítico e obstruções intestinais distais. A ruptura gástrica tem sido amplamente descrita na literatura e acomete um número expressivo de animais. Este estudo objetivou determinar a resistência à ruptura do estômago equino mediante a insuflação de ar atmosférico (mmHg) e do preenchimento com água (L). Foram utilizados 40 estômagos de equinos adultos jovens (20 machos castrados e 20 fêmeas) sem raça definida. Medidas relativas ao comprimento total do órgão (cm), peso do órgão (g), curvatura maior (cm), curvatura menor (cm) e altura (cm) foram aferidas e não diferiram entre machos e fêmeas (p>0,05). No entanto, os estômagos dos machos apresentaram medidas superiores as das fêmeas e por assim serem, comportaram um maior volume de água (p<0,05). No teste de resistência mediante insuflação de ar atmosférico não houve diferença entre machos e fêmeas (93mmHg). Os rompimentos ocorreram ao longo da curvatura maior (99%) nas faces visceral (80%) e diafragmática (20%) e abrangeram todas as camadas da parede gástrica. Apesar de ser um órgão relativamente pequeno, o estômago dos equinos apresenta considerável resistência à ruptura, seja por líquido ou por ar atmosférico. Machos e fêmeas possuem resistência gástrica semelhante, embora o estômago das fêmeas equinas comporte um menor volume.(AU)

Síndrome de Wilkie / Wilkie Syndrome

El síndrome de Wilkie o síndrome de la arteria mesentérica superior, es una entidad patológica poco frecuente. Descrito inicialmente por Von Rokitansky en 1861 y apoyado luego por Willet, en 1868. Se caracteriza por una compresión extrínseca de la tercera porción del duodeno por la arteria mesentérica superior y la aorta, ante la reducción del ángulo aortomesentérico. Se presenta el caso de un paciente masculino de 36 años de edad, sin patologías médicas previas, con un cuadro crónico de pérdida de peso, vómitos y sensación de plenitud gástrica. Consultó a valoración en el Servicio de Cirugía, tras realizarse gastroscopía que revelaba una estrechez extrínseca distal al píloro gástrico. Se efectuaron estudios complementarios radiográficos, los cuales revelaron la disminución del ángulo entre la arteria aorta y la arteria mesentérica superior. Posteriormente se realizó un abordaje laparoscópico con anastomosis duodeno yeyunal latero-lateral, con corrección del cuadro patológico y evolución favorable del paciente.

Superior mesenteric artery (SMA) syndrome (Wilkie syndrome) is an uncommon condition. It was first described in 1861 by Von Rokitansky and then reviewed by Willet in 1868. The syndrome develops when the third part of the duodenum is obstructed by the angle formed between the Aortic Artery and the Superior Mesenteric Artery. A 36-year-old male, with no previous medical conditions, with chronic weight loss, vomiting and epigastric pain. The patient was assessed by the Surgery Department after a gastric endoscopy revealed an extrinsic obstruction of the duodenum. After several radiological studies, a reduction of the Aortic and Superior Mesenteric Artery angle was found. A laparoscopic duodenum-yeyunum anastomosis was performed, the medical condition was solved and the patient evolved positively.

Volumetría del remanente gástrico poscirugía de manga gástrica / Post-Sleeve Gastric Pouch Volumetry

La cirugía bariátrica, en sus diferentes modalidades, es una técnica empleada cada vez más en el manejo de los pacientes con obesidad. La cirugía de manga gástrica es una técnica restrictiva utilizada ampliamente y que presenta buenos resultados; sin embargo, al igual que cualquier otro procedimiento, no está exento de complicaciones. En este artículo se indica una manera precisa de evaluar el volumen del remanente gástrico, ya que el incremento de este posterior a la cirugía de manga gástrica es una de las principales causas por las cuales no hay pérdida de peso luego este procedimiento.

Bariatric surgery, through its various forms, is a technique which is increasingly used in the management of patients with obesity. The gastric sleeve is a widely used restrictive technique and it has good results, however, like any other procedure is not exempt of complications. This paper discusses an accurate measurement of gastric pouch, since its increased size is a major cause of absence of weight loss after this procedure.

Balloon dilatation in patients with gastric outlet obstruction related to peptic ulcer disease

Background and study aims: Gastric outlet obstruction [GOO] is a rare complication of peptic ulcer disease [PUD]. The endoscopic balloon dilatation [EBD] associated with medical treatment of Helicobacter pylori is a successful method in the management of pyloric stenosis. The aim of this study was to describe epidemiological, clinical, and endoscopic characteristics of GOO related to PUD and to evaluate the effectiveness, safety, and outcome of EBD

Patients and methods: In a retrospective study of patients seen between 1999 and 2009 with symptoms of GOO secondary to PUD, pyloro-bulbar stenosis was confirmed by endoscopic examination. Balloon dilatation was performed when obstruction persisted after treatment with double-dose proton-pump inhibitor [PPI] intravenously for 7-10 days. The H. pylori status was assessed with histology, and eradication therapy was prescribed for infection

Results: A total of 45 consecutive patients [38 males, 7 females median age, 51.9 years; range, 20-58 years] with symptoms of GOO secondary to PUD underwent EBD. Median follow-up time of the 45 patients was 32 months [range, 4-126 months]. The immediate success rate of the procedure was 95.5%. Clinical remission was noted in 84.4% of the patients. Remission without relapse was observed in 55.8%, 30 months after the dilatation. Pyloric stenosis relapsed in 15 patients [39.5%] after a median period of 22.9 months. The dilatation was complicated in three patients [6.7%, two perforations and one bleeding]. A total of 13 patients [29%] underwent surgery. H. pylori was found to be positive in 97.7% of the patients, and was eradicated in 78.4% of them. Smoking and failure of H. pylori eradication were associated with the relapse of the stenosis

Conclusion: EBD is a simple, effective, and safe therapy for the GOO related to PUD, producing short- and long-term remission

Acute gastric dilatation causing fatal outcome in a young female with eating disorder: a case report / 대한마취과학회지

A 21-year-old female with a history of bulimia nervosa came to the emergency room due to severe abdominal pain after excessive eating five hours previously. On arrival at the emergency room, extreme abdominal distension was detected and the patient's legs changed color. Computed tomography suggested severe gastric dilatation, so abdominal compartment syndrome was suspected and an emergent laparotomy was supposed to be conducted. Though anesthesia was induced without event, abrupt hemodynamic collapse developed just after the operation started. In spite of active resuscitation for 29 min, the patient did not recover and expired. As the incidence of eating disorders is increasing, anesthesiologists should keep in mind the possibility of abdominal compartment syndrome in patients with a recent history of binge eating, and prepare optimal anesthetic and resuscitation remedies against sudden deteriorations of a patient's condition.

Delayed Pneumoperitoneum and Acute Pulmonary Edema Secondary to Acute Gastric Dilatation

Pneumoperitoneum caused by acute gastric dilatation (AGD) is a very rare complication. We report a case of pneumoperitoneum and acute pulmonary edema caused by AGD in a patient with Parkinson's disease. A 78-year-old woman presented with pneumonia and AGD. We inserted a nasogastric tube and administered empirical antibiotics. We performed an endoscopy, and perforation or necrosis of the stomach and pyloric stenosis were not observed. Thirty-six hours after admission, the patient suddenly developed dyspnea and shock, and eventually died. We suspected the cause of death was pneumoperitoneum and acute pulmonary edema caused by AGD during the conservative treatment period. Immunocompromised patients with chronic illness require close observation even if they do not show any symptoms suggestive of complications. Even if the initial endoscopic or abdominal radiologic findings do not show gastric necrosis or perforation, follow-up with endoscopy is essential to recognize complications of AGD early.

Fluoroscopic Guided benign Oesophageal Stricture Dilatation in Children: 12 Years' Experience

Background. Benign oesophageal strictures (BOSs) are a debilitating health concern in the paediatric populations of developing countries; which lead to impaired weight gain. Various non-surgical methods may be used to address these strictures.Objectives. To compare the success and complications of fluoroscopically guided Savary-Gilliard bougienage (SGB) with balloon dilatation and the combination of both methods for the treatment of BOSs in children at Universitas Hospital; Bloemfontein; South Africa.Methods. A retrospective review of the patient notes on all children ?12 years who underwent oesophageal dilatation for benign strictures from January 2001 to June 2012 was performed. Interventional radiologists performed the dilatations on children under general anaesthesia either by angioplasty balloon; SGB or a combination of both. Postdilatation contrast swallows were done to confirm the absence of perforation.Results. A total of 432 oesophageal dilatations was performed on 63 children aged ?12 years. Of these; 36 were males (57); and 71 were exclusive balloon dilatation; 19 exclusive SGB and 10 utilised both techniques. Five dilatations failed (1.2) and no complications were documented. Average follow-up dilatations needed per procedure were 8.3 after SGB; 7.2 after balloon dilatation; and 4.2 after a combined method (p0.05). Strictures due to caustic ingestion required; on average; more dilatations (n

Gastric Emphysema Related with Superior Mesenteric Artery Syndrome / 이화의대지

Gastric emphysema is caused by a mucosal disruption of stomach, which is leading to the dissection of air into the wall. A 24-year-old man admitted to our hospital with vomiting, abdominal distension, and pain. Abdominal computed tomography showed severe gastric distension, air within the gastric wall, and a compressed third segment of the duodenum by superior mesenteric artery (SMA). The upper endoscopy revealed multiple geographic ulcers in the gastric body and marked dilatation of the second segment of duodenum and a collapsed third segment. Based on these findings and his symptoms, the patient was diagnosed as having gastric emphysema related with SMA syndrome. He improved after the nasogastric decompression, jejunal feeding and administration of antibiotics. We report a rare case of gastric emphysema related with SMA syndrome. He was managed successfully with medical treatment and nutritional support.

Superior Mesenteric Artery Syndrome with Massive Gastric Dilatation

Superior mesenteric artery (SMA) syndrome is a rare disorder characterized by extrinsic compression of the third portion of the duodenum between the superior mesenteric artery and aorta, resulting in intermittent obstruction, thereby resulting in proximal duodenal and stomach dilatation. Although the most characteristic symptoms are postprandial epigastric pain, fullness, voluminous vomiting, and eructation, severe symptoms including acute massive gastric dilatation to the extent of surgical abdomen was rarely reported. We report a case of SMA syndrome in a 24-year-old patient with an eating disorder. CT and an upper gastointestinal contrast series revealed massive gastric dilatation which induced vascular compressions. Endoscopy showed deep extensive ulcerations of the whole stomach with duodenal necrosis and ischemia, which prompted immediate surgical laparotomy, but no remarkable intra-abdominal peritonitis evidence was noted. We treated the patient conservatively and the patient recovered from all the symptoms.

Hepatic portal venous gas in paralytic ileus / 영남의대학술지

Hepatic portal venous gas (HPVG) is a rare radiographic finding associated with severe intra-abdominal disease and fatal outcome. Most cases of HPVG are historically related to mesenteric ischemia accompanied by bowel necrosis. The current spread of computed tomography scan promotes not only the early detection of related severe diseases but also the identification of other causes of HPVG. It has been reported in many non-fatal conditions, such as inflammatory bowel disease, intra-abdominal abscess, bowel obstruction, paralytic ileus, endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy, and gastric dilatation. Among these, paralytic ileus is a very rare condition, with no case yet reported in South Korea. Reported herein is a case of HPVG in paralytic ileus, which was treated well internally and was promptly resolved.

A Case of Gastric Emphysema Associated with Superior Mesenteric Artery Syndrome

We introduce a rare case of gastric emphysema. A 68-year-old man presented with vomiting and dyspnea. Simple abdominal X-ray and CT showed marked dilatation of the stomach and abnormal intramural gas consistent with gastric emphysema. We performed gastric decompression via nasogastric tube drainage and parenteral nutritional support. Nine days after admission, the abnormal intramural gas had disappeared on follow-up CT. The acute gastric dilatation in this patient may have resulted from gastric hypomotility as a result of diabetic gastroparesis in addition to superior mesenteric artery syndrome resulting from malnutrition.

A Case of Gastric Emphysema in Anorexia Nervosa Presenting as Acute Gastric Distension / 대한소화기학회지

Gas within the gastric wall is an alarming finding and a rare condition. Clinically, this condition is divided into two entities; Gastric emphysema and emphysematous gastritis. These two diseases should be differentiated because they are characterized by different clinical symptoms, possible etiology, treatment and prognosis. While emphysematous gastritis is a severe condition with high mortality, gastric emphysema is asymptomatic and usually has benign course. Rarely, anorexia nervosa and bulimia nervosa have been discribed to be associated with acute gastric distension and duodenal obstruction induced by superior mesentery artery syndrome. So, gastric emphysema could be accompanied by acute gastric distension induced by anorexia nervosa. We report a rare case of gastric emphysema in a patient with anorexia nervosa presenting as superior mesenteric artery syndrome with relevant literatures. In this case, the gastric emphysema was improved without surgical intervention after nasogastric tube for decompression and feeding insertion in the fourth portion of the duodenum.

Dilatación precoz: evolución y complicaciones en esofagitis caústicas grado II y III en niños / Earily dilatation: evaluation and complications in caustic esophagitis grade II and in children

La dilatación precoz en esofagitis caústica no está bien establecida. Objetivo: Evaluar el beneficio de la dilatación precoz, en la evolución y complicaciones de esofagitis caústicas grado II y III. Pacientes y Métodos: Estudio prospectivo de 32 niños, grupo A (dilatación precoz) y B (dilatación tardía). Se utilizo el índice de dilatación periódica para evaluar beneficio de la dilatación precoz. Resultados: edad promedio 2,3 años; 13 (40,62%) hembras y 19 (59,38%) varones; 21/32 (65,62%) desarrollaron estenosis esofágica, 6/15 (40,00%) grupo A, 15/17 (88,23%) grupo B (p=0,0041). Estenosis simples en 12/21 (57,14%), complejas 9/21 (42,85%), recurrentes 2/6 y refractaria 2/6, grupo A; 6/15 recurrente y 5/15 refractarias, 1/15 perforación esofágica, grupo B. El promedio de sesiones de dilatación 17 vs 44,6 (p=0,0297) e índice de dilatación periódica de 3,04 vs 4,11 (p=0.0002) grupo A y B respectivamente. Conclusiones: la dilatación precoz en esofagitis caústica es segura y contribuye a disminuir el número de sesiones de dilatación y complicaciones. Se destaca, la importancia de la prevención de la ingesta accidental de cáusticos.

Early dilatation in caustic esophagitis is not well established. Objective: Evaluate the benefits of early dilatation in the evolution and complications of grade I and II caustic esophagitis in children. Patients and Methods: Prospective study of 32 children, group A (early dilatation) and B (late dilatation). The periodic dilatation index was used to evaluate the benefits of early dilatation. Results: Average age 2,3 years old; 13 (40,62%) female and 19 (59,38%) male; 21/32 (65,62%) developed esophageal stenosis. 6/15 (40,00%) group A, 15/17 (88,23%) group B (p=0,0041). Simple stenosis in 12/21 (57,14%), complex 9/21 (42,85%), recurrent 2/6 and refractory 2/6, group A; 6/15 recurrent and 5/15 refractory, 1/15 esophageal perforation, group B. The average of dilatation sessions was 17 vs. 44,6 (p=0,0297) and periodic dilatation index was 3,04 vs. 4,11 (p=0.0002) group A and B respectively. Conclusions: early dilatation in caustic esophagitis is safe and contributes to decrease the number of dilatation sessions and complications.