Small bowel perforation and death caused by anaplastic thyroid carcinoma metastasis in a patient with concomitant colonic and bilateral breast carcinoma

Undifferentiated or anaplastic thyroid carcinoma (ATC) is rare and one of the most aggressive human malignancies. The tumor is usually voluminous and fast-growing and mostly affects older women. The most common sites of distant metastases are the lungs, brain, and bones. Herein, we describe the case of a 66-year-old woman with a history of bilateral breast carcinoma and ATC, who presented with an acute abdomen and subsequently died. At autopsy, an isolated metastasis of ATC in the small intestine leading to bowel perforation was found. Moreover, there was adenocarcinoma in the descending colon. The review of extra-abdominal malignancies metastasizing to bowel and coincidence of breast and thyroid carcinoma is included.

Evisceración del intestino delgado estrangulado en una anciana con douglascele / Evisceration of the impacted small bowel in an elderly with douglascele

Se presenta el caso clínico de una anciana de 86 años de edad con evisceración del intestino delgado a través del periné. Se efectuó la exploración quirúrgica urgente del abdomen y se observó la perforación del fondo del saco de Douglas y la salida de 50 cm de intestino delgado estrangulado, de manera que se realizó la resección intestinal de todo el segmento afectado y anastomosis termino-terminal. Luego se reparó el defecto del fondo del saco de Douglas con una plastia perineal, para lo cual se utilizó una malla de polipropileno. Este proceder es una buena alternativa para el tratamiento quirúrgico en quienes presentan hernias perineales, pues permite un cierre mejor, disecar el saco herniario y reducirlo adecuadamente.

The case report of a 86 years elderly is presented with evisceration of the small bowel through the perineum. The urgent surgical exploration of the abdomen was carried out and it was observed the perforation of the Douglas pouch and the 50 cm prominence of impacted small bowel, so that the bowel resection of the whole affected segment and end to end anastomosis was carried out. Then the Douglas pouch defect was repaired with a perineal plasty, for which a polypropylene mesh was used. This procedure is a good alternative for the surgical treatment in those who present perineal hernias, because it allows a better closing, to dissect the hernial sack and to reduce it appropriately.

Spontaneous perforation of small intestine followed by rupture of the cystic artery: the natural history of Vascular Ehlers-Danlos Syndrome

Vascular Ehlers-Danlos Syndrome (VEDS) is a rare autosomal dominant disorder caused by mutations in the COL3A1 or COL1A1 genes. Its mortality is secondary to sudden and spontaneous rupture of arteries or hollow organs. The genotype influences the distribution of arterial pathology with aneurysms of intra-abdominal visceral arteries being relatively uncommon. We describe the case of a young man with probable VEDS who died of a spontaneous rupture and dissection of the cystic artery. The patient initially presented with abdominal pain due to an unrecognized spontaneous perforation of the small intestine complicated by sepsis. We postulate that inflammatory mediators may have triggered the arterial rupture due to remodeling and weakening of vessel walls. The phenotype of the patient's vascular damage included bilateral spontaneous carotid-cavernous sinus fistulae and dissection with pseudoaneurysm formation of large- and medium-sized arteries, predominantly the abdominal aorta and its branches. The autopsy uncovered a long history of vascular events that may have been asymptomatic. These findings along with a positive family history supported the VEDS diagnosis. Loeys-Dietz, Marfan, and familial thoracic aortic aneurysm and dissection syndromes were ruled out based on the absence of arterial tortuosity, eye abnormalities, bone overgrowth, and the distribution of vascular damage among other features. Interestingly, microscopic examination of the hippocampus revealed a focus of neuronal heterotopia, commonly associated with epilepsy; however, the patient had no history of seizures. The natural course of VEDS involves the rupture and dissection of arteries that, if unrecognized, can lead to a rapid death after bleeding into free spaces.

Factores de riesgo de dehiscencia de anastomosis de intestino delgado realizadas por reparo de lesiones de origen traumático penetrante en el Hospital Nacional Rosales / Risk factors for small bowel anastomosis dehiscence performed for repair of penetrating traumatic injuries at the Rosales National Hospital

En el manejo de las lesiones de intestino delgado se puede necesitar la utilización de líneas de sutura, hasta la resección de un segmento y anastomosis reconstructiva. Estos procedimientos pueden presentar complicaciones agudas y tardías entre las que destaca la dehiscencia de anastomosis. El objetivo del presente estudio fue el de investigar los factores relacionados a la dehiscencia de la anastomosis intestinal en contexto de trauma abdominal penetrante. Se utilizó un estudio observacional analítico de casos y controles no apareados, en pacientes que acudieron a la unidad de emergencia del Hospital Nacional Rosales que presentaron (casos) o no (controles) dehiscencia de anastomosis intestinales posterior a resección de un segmento por trauma penetrante por arma de fuego o arma blanca, en un periodo especifico del tiempo. Se obtuvo una tasa de dehiscencia de anastomosis de 19.14%, siendo el género masculino el más afectado, el mecanismo de lesión más frecuente fueron las heridas por arma de fuego, y el sitio más frecuentemente dañado fue el yeyuno. Los factores de riesgo que presentaron significancia estadística para dehiscencia fueron: el nivel de la lesión (p=0.009), centímetros resecados (p=0.000), número total de lesiones (p=0.001). Hipotensión perioperatoria (p=0.038) y las lesiones concomitantes (p=0-003). El control de daños se comportó como un factor protector para evitar las dehiscencias de anastomosis. En nuestro estudio, lesión en el yeyuno o ambos, centímetros resecados, número total de lesiones, hipotensión perioperatoria y tener lesiones concomitantes fueron factores de riesgo de dehiscencia de anastomosis

Retención de cápsula endoscópica como complicación de enteritis actínica: reporte de un caso / Retention of capsule endoscopy as a complication of radiation enteritis: a case report

La cápsula endoscópica es un método, que ha modificado el enfoque diagnóstico de numerosos procesos patológicos en el intestino delgado, sin embargo presenta complicaciones como la retención de la misma. Se estima en la literatura mundial que esta suele ocurrir en menos del 2% de los casos. Femenino de 40 años de edad, con antecedente de cáncer de cuello uterino (2011) en tratamiento con quimioterapia, radioterapia convencional y braquiterapia, que presenta cuadro clínico caracterizado por dolor urente en mesogastrio, y emesis de aspecto biliosos. Ruidos hidroaéreos presentes, dolor a la palpación de mesogastrio sin irritación peritoneal. Radiografía de abdomen y ecosonograma abdominal normales. TAC abdomino pélvica con contraste oral con adecuada progresión de contraste hasta el recto. Se practica gastroscopia y colonoscopia sin evidencia de alteraciones. En vista de persistencia de sintomatología se indica realización de cápsula endoscópica observando en íleon distal, a los 246 minutos del paso duodenal, área muy congestiva, con una úlcera circunferencial friable, que no permite el avance de la misma. Se indica tratamiento médico con laxantes por 72 horas, el cual es infructuoso, por lo cual es llevada a mesa operatoria por presentar signos francos de obstrucción intestinal. Los hallazgos fueron: adherencias en flanco y fosa ilíaca derecha, las cuales fueron liberadas, y segmento de íleon a 10 cm de la válvula ileocecal con inflamación franca, practicándose resección y anastomosis termino-lateral. El estudio histopatológico reportó enteritis crónica activa exulcerada, necrosis fibrinoide de pequeños vasos, y fibrosis en la submucosa. Paciente con post-operatorio exitoso decidiéndose el egreso de la institución. Excelente correlación entre los hallazgos de la cápsula endoscópica y la intervención quirúrgica. Los hallazgos de la cirugía se encuentran relacionados al uso de radioterapia convencional, por lo cual recomendamos la realización de pexia...

Capsule endoscopy is a method that has changed the diagnostic approach to many pathological processes in the small intestine, but it has complications such as retention of the same, is estimated in the literature that this usually occurs in less than 2% cases. Women 40 years of age, with a history of cervical cancer (2011) undergoing chemotherapy, conventional radiation therapy, and brachytherapy, presenting clinical picture characterized by burning pain in midgut, and bilious emesis aspect. Present bowel sounds, tenderness of mesogastrium without peritoneal irritation. Abdominal radiography and abdominal ultrasonography normal. Pelvic CT with oral contrast Abdomino with progression adequate contrast to the rectum. Gastroscopy and colonoscopy was performed without evidence of tampering. In view of the persistence of symptoms embodiment shown in watching endoscopic capsule distal ileum, to 246 minutes of step duodenal study, very congestive area with a circumferential friable ulcer which does not allow the advance thereof. Indicated medical treatment with laxatives for 72 hours being fruitless, operating table being carried by presenting overt signs of intestinal obstruction. The findings were: adhesions flank and right lower quadrant, which were released and ileal segment 10 cm from the ileocecal valve with frank inflammation resection and end-side anastomosis. Histopathological study reported chronic active enteritis exulcerada, fibrinoid necrosis of small vessels, and fibrosis in the submucosa. Postoperative patient deciding successful graduation from the institution. Excellent correlation between the findings of capsule endoscopy and surgery. The findings at surgery are related to the use of conventional radiotherapy, so we recommend an pexia of the organs that are in the radiation field, prior to it, and intestinal transit before indicating capsule endoscopy

Tumor neuroendocrino de Íleon: a propósito de un caso / Ileum's neuroendocrine tumor: report of a case

Los tumores neuroendocrinos (TNE) del aparato gastrointestinal representan menos del 5% de las neoplasias del aparato gastrointestinal siendo el intestino delgado, en especial el íleon, donde se presentan mayor frecuencia (30%). Se originan del sistema endocrino difuso gastrointestinal y tienen capacidad de secretar péptidos y aminas bioactivas, principalmente la 5-hidroxitriptamina (5-HT) o serotonina. La Organización mundial de la salud (OMS) los clasifica de acuerdo al grado de diferenciación y conducta biológica en 5 grados. Las manifestaciones clínicas pueden estar ausentes o ser inespecíficas, su hallazgo, como en el caso de nuestra paciente, puede ser casual. Se reporta el caso de paciente femenino de 56 años la cual consultó por distensión abdominal y dolor anorrectal, realizándose colonoscopia con ileoscopia encontrando tumor subepitelial en íleon terminal con inmunohistoquímica que reportó: Tumor neuroendocrino bien diferenciado. El tratamiento de los TNE varía desde la resección quirúrgica en los estadíos menos avanzados hasta tratamiento quirúrgico asociado a quimioterapia y radioterapia en los más avanzados con una tasa de supervivencia a los 5 y 10 años de 73 y 65% para tumores bien diferenciado. De allí la importancia del diagnóstico precoz. Asimismo resaltar la canulación de retiro de la válvula ileocecal durante la colonoscopia de pesquisa.

The gastrointestinal neuroendocrine tumors (NET) represent less than 5% of the gastrointestinal tract neoplasms, being the small bowel, specially ileum, the most frequent location (30%). They originate from the diffuse endocrine gastrointestinal system and are able to secrete peptides and bioactive amines, mainly the 5-hidroxitryptamine (5-HT) or serotonine. The World Health Organization (WHO) classifies them according to its differentiation grade and biological behavior in 5 grades. The clinical manifestations could be absent or non specifics. Its finding, as in our patient case, can be casual. We report a case of a 56 years old female patient who complained of abdominal distention and anorectal pain. A colonoscopy with ileoscopy was performed finding a subepithelial tumor in the terminal ileum which inmunohistochemestry reported: Well differentiated neuroendocrine tumor. The treatment of NET varies from surgical resection alone in the less advanced stages, to surgical treatment associated to chemotherapy and radiotherapy in the most advanced stages, with a survival rate of 73 and 65% in the 5 and 10 years for the well differentiated tumors, being very important its early diagnosis. Equally must be highlighted the canulation of ileum cecal valve during a screening colonoscopy.

[Prevalence of intra abdominal injuries due to penetrating trauma in Gorgan, Iran [2002-07]]

Trauma is the most common cause of death in all individuals between 1 and 44 years and the third most common cause of death regardless of age. The abdomen is the third most commonly injured region of the body. Some intra abdominal organ injured more than others, related to mechanism of injury, size and location of organ in abdominal cavity. This study was carried out to determine the prevalence of intra abdominal injuries due to penetrating trauma. This retrospective descriptive study was done on 114 patients admitted to 5 Azar hospital in Gorgan, Iran due to penetrating abdominal trauma during 2002-07. Gender, age, type of injury causes of trauma and hospitlalization period were obtained form patients files. 92.1% of patients were male. The mean age of subjects was 24.8 years [9-70 years] with highest frequency between 20-24 years. Two [1.8%] deaths directly related to abdominal stab wounds related to hemorrhagic shock. The most common cause of penetrating abdominal injury was knife wound [78.9%]. The mean time spent in hospital was 4.6 +/- 2.8 days. In 53 patients, cause of trauma were either related to pentration into peritoneum or passing through in. Small intestine injuries [14%], rupture of diaphragm and concurrent lung injuries [7%] were the common damage organs. This study showed that the knife was the main cause of abdominal penetrate trauma and peritoneum was the most common damage tissue

Videoenteroscopia de balón único con prototipo Olympus: experiencia preliminar / Single-balloon videoenteroscopy olympus prototype: preliminary experience

Introducción: La enteroscopia de balón único es una técnica segura con alto alcance diagnóstico y terapéutico. Sin embargo, existe la dificultad para el manejo de accesorios mientras mayor es la profundidad de inserción. Objetivo: Mostrar ventajas en el diagnóstico y tratamiento de patología del intestino delgado utilizando un prototipo Olympus con canal 3,2 mm. Pacientes y métodos: 18 procedimientos en 13 pacientes. Diciembre 2009-Abril 2010. Se utilizó el prototipo Olympus X SIF 180 JY, con canal 3.2 mm y canal externo de irrigación. Se usaron accesorios endoscópicos de tecnología convencional para colonoscopia. Se registraron datos demográficos, indicaciones, vía de acceso, tiempo del procedimiento, profundidad de inserción, hallazgos y terapéutica. Resultados: 13 pacientes: 9 femenino, 4 masculino, edad promedio: 47,61 años. Indicaciones principales: sangrado digestivo oscuro (4), Diarrea crónica (4), síndrome de poliposis (3). Procedimientos. Vía anterógrada 13, retrógrada 4, combinado 1. Tiempo promedio: 40,46 minutos anterógrada, 36,35 minutos retrógrada. Profundidad de inserción: 201,53 cm anterógrada, 95 cm retrograda. Estudio normal: 46,15 % de los pacientes, hallazgos positivos: 53,84%. Terapéutica: 5 (27,7%): clips (2), inyección con adrenalina+argón (1), polipectomía (1), dilatación de estenosis (1). No hubo complicaciones. Conclusión: el prototipo Olympus X SIF 180 JY cuenta con canal terapéutico que permite la utilización de accesorios endoscópicos de tecnología convencional con menor dificultad de deslizamiento a mayor profundidad de inserción y canal de irrigación externo que mejora la visibilidad del campo. Ambas características favorecerían la realización de procedimientos terapéuticos.

Introduction: The single balloon enteroscopy is a safe technique with high diagnostic and therapeutic yield. However, there is the difficulty to manage attachments while the greater the depth of insertion. Objective: To show benefits in the diagnosis and treatment of diseases of the small bowel using a prototype Olympus with 3.2 mm channel. Patients and Methods: 18 procedures in 13 patients. December 2009-April 2010. We used the prototype Olympus SIF 180 JY X, with 3.2 mm channel and external canal irrigation. Standard endoscopic accessories were used for colonoscopy. Recorded demographic data, indications, route of access, procedure time, insertion depth, and therapeutic findings. Results: 13 patients: 9 women, 4 men, mean age: 47.61 years. Main indications: obscure gastrointestinal bleeding (4), chronic diarrhea (4), polyposis syndrome (3). Procedures. 13 antegrade, 4 retrograde, combined 1. Average Time: 40.46 minutes antegrade, retrograde 36.35 minutes. Depth of insertion: 201.53 cm antegrade, retrograde 95 cm. Study normal: 46.15% of patients, positive findings: 53.84%, with active bleeding lymphangioma (1), Dieulafoy lesion (1), celiac disease (1), Crohn's (1), polyposis (3). Therapeutics 5 (27.7%) clips (2), adrenaline injection + argon (1), polypectomy (1), dilatation of stenosis (1). There were no complications. Conclusion: The prototype Olympus SIF 180 JY X has therapeutic channel allows the use of standard endoscopic accessories more easily slip deeper insertion and external irrigation canal which enhances the visibility of the field. Both features favor the therapeutic procedures.

Adenocarcinoma primário multicêntrico com 12 focos: relato de caso e revisão da literatura / Multicenter primary adenocarcinoma with 12 foci: case report and literature review

Relata-se caso raro de adenocarcinoma primário multicêntrico sincrônico em intestino delgado, apêndice cecal e intestino grosso, em homem de 82 anos, com quadro de abdome agudo inflamatório. Foi submetido à laparotomia exploradora, observando-se lesão intestinal estenosante e infiltrativa no ângulo hepático e múltiplas aderências entre as alças do intestino delgado. Foi realizada hemicolectomia direita. O estudo anatomopatológico mostrou 12 focos de adenocarcinomas primários comprometendo intestino delgado (oito focos), válvula ileocecal, apêndice cecal e intestino grosso (cólon ascendente e transverso).

A rare case of synchronous multicenter primary adenocarcinoma in the small intestine, cecal appendix and large intestine, in an 82-year-old man with a condition of acute abdominal inflammation, is reported. He underwent exploratory laparotomy, and a stenosing and infiltrative intestinal lesion was seen in the hepatic angle, along with multiple adherences between the loops of the small intestine. Right hemicolectomy was performed. The anatomopathological evaluation showed 12 foci of primary adenocarcinomas affecting the small intestine (eight foci), ileocecal valve, cecal appendix and large intestine (ascending and transverse colon).

Hemorragia digestiva média e outras indicações de exame com a capsula endoscópica: resultados em uma série consecutiva de 187 pacientes / Avarage gastrointestinal bleeding and other indications of capsule endoscopy examination with the: results in a consecutive series of 187 patients

Objetivo: verificar as indicações e os resultados do emprego da cápsula endoscópica em uma série consecutiva de pacientes, analisando-se, em especial, os casos de hemorragia de causa obscura e também a relação no momento em que o exame foi efetuado em relação à atividade de sangramento. Análises especiais ainda para os casos de exames inconclusivos, cápsulas retidas e lesões fora do delgado. Material e Métodos: 187 pacientes consecutivos submetidos ao exame do intestino delgado pela cápsula foram analisados. Utilizou-se a cápsula da empresa Given, específica para o delgado (versões M2A e PillCam SB), e as análises de imagens foram efetuadas no software específico deste método, versão 5.1. Resultados: 70,5% (132 casos) dos exames foram indicados por hemorragia de causa obscura (64 casos) ou anemia de causa obscura (68 casos). Diarreia, dor abdominal, suspeita de pólipos e outras menos frequentes foram as demais indicações. Dos 187 casos, em 124 deles observaram-se lesões, sendo 101 lesões em delgado e 23 lesões fora do delgado. Em 29,9% dos casos, a cápsula não observou lesões e, em 3,7% do total de casos, o exame foi inconclusivo. Em 5 casos (2,6%), a cápsula ficou retida. As lesões vasculares do intestino delgado representaram o diagnóstico mais frequente e, quando da análise dos casos de hemorragia em relação ao momento do sangramento, demonstrou-se um percentual de 69,5% de encontro de lesões no paciente com sangramento ativo, 77,7% no paciente com sangramento recente e 64,6% no paciente examinado fora do episódio hemorrágico. Conclusões: a hemorragia digestiva ou a anemia, de causa obscura, foi a indicação mais frequente (70,5%) do exame do delgado com a cápsula endoscópica. Na análise dos resultados em 66,3% dos exames efetuados, a cápsula demonstrou lesões, inclusive fora do delgado. As lesões vasculares foram as mais encontradas e, nos casos de hemorragia/anemia de causa obscura, a capacidade da cápsula em encontrar lesões foi maior nos pacientes que efetuaram o exame durante o episódio hemorrágico, ou logo após do mesmo, do que em pacientes nos quais o exame foi feito distante deste episódio, embora estes resultados não tivessem relevância estatística. Exames inconclusivos tiveram um percentual de 3,7% dos casos e, em 2,6% dos casos, a cápsula ficou retida em estenoses do delgado.

Objectives: to verify the indications and results of the use of endoscopy capsule in a consecutive series of patients, especially the cases of obscure bleeding cause with the moment when the examination was made (related to bleeding activity). Special analysis for the cases not conclusive yet, retained capsules and lesions out of small bowel. Materials and Methods: 187 consecutive patients underwent the small bowel examination by the capsule were analyzed. A capsule from the Given company was used, it is specific for small bowel (M2A e PillCam SB) and the analyses were made in this brand-specific software, version 5,1. Results: in the analysis it was observed that 70,5% of them (132 cases) were indicated by obscure bleeding cause (64 cases) or obscure anemia cause (68 cases). Diarrhea, abdominal pain, suspected polyps and others least often were the other indications. From the 187 cases, in 124 of them were observed lesions, 101 of them in the small bowel and 23 lesions out of it. In 29,9% of the cases the capsule did not observed lesions and in 3,7% of all cases the examination was inconclusive. In 5 cases (2,6%) the capsule was retained. Vascular lesions of the small bowel were the most frequent diagnosis, and the bleeding causes analysis, in relation to the bleeding moment, 69,5% of lesions in the patient with the active bleeding were showed, 77,7% in the patient with recent bleeding and 64,6% in the patient whose examination was out of the bleeding episode. Conclusion: gastrointestinal bleeding and/or obscure anemia cause were the most frequent indication (70,5%) of the small bowel examination with the endoscopy capsule. In the results analysis, in 66,3% of the examinations made, the capsule showed lesion(s), even out of the small bowel. Vascular lesions were the most found and in the obscure bleeding/anemia cause cases the capsules capacity to find lesions was higher in patients that did the examination during the bleeding episode or just after it, than in patients that the examination was done far from the episode. Inconclusive examinations had a percentage of 3,7 of cases and in 2,6% of cases the capsule was retained in small bowel stenosis.

Perfuração intestinal por corpo estranho ingerido: relato de caso e revisão da literatura / Intestinal perforation by ingested foreign body: case report and literature review

Paciente com quadro sugestivo de obstrução intestinal. Submetido à laparotomia exploradora, encontrou-se perfuração de intestino delgado por corpo estranho ingerido (palito de bambu) e abscesso intra-abdominal. Realizadas drenagem de abscesso e enterorrafia. Paciente apresentou evolução complicada com infecção de sítio cirúrgico e deiscência de sutura. A maioria dos corpos estranhos ingeridos passa por todo o trato gastrointestinal sem intercorrências, entretanto, em 1% dos casos ocorrem complicações com perfuração e obstrução. A perfuração pode se manifestar por diversos quadros clínicos como sepse, obstrução e abscessos hepáticos ou abdominais; e o diagnóstico clínico, laboratorial e radiográfico é difícil. Embora rara, o cirurgião geral deve ter sempre em mente a possibilidade de perfuração gastrointestinal em pacientes que apresentam sintomas abdominais agudos atípicos. Em caso de dúvida, deve-se fazer a exploração abdominal.

A patient sought help in our emergency department with symptoms suggestive of intestinal obstruction. He was taken to the operating room and an exploratory laparotomy was performed, which revealed an abdominal abscess and intestinal perforation by ingested foreign body, a bamboo toothpick. The perforation was sutured and the abscess drained. The patient had complications in the postoperative period, with surgical site infection and suture dehiscence. The majority of ingested foreign bodies pass through the whole gastrointestinal tract without any problems, in 1% of the cases though there can be complications such as intestinal perforation. Perforations can present with many different clinical manifestations, such as obstruction, sepsis, hepatic or abdominal abscess and diagnosis is usually difficult. The general surgeon must always keep in mind this possibility in patients with atypical acute abdominal symptoms. Whenever in doubt, one should choose to operate.

review of 100 cases of colonic injuries admitted to Baghdad teaching hospital according to ACS grading system

In Iraq nearly 95% of colonic injuries are caused by penetrating trauma [gun shot, blast injuries, stab injuries, or iatrogenic trauma], blunt injuries are rare and commonly result from road traffic accidents or fall from height. While in the rest of the world, penetrating trauma accounts for 80-90% of cases. This higher rate of penetrating trauma in Iraq is due to the high rate of terrorism attacks with low and high velocity missiles. The aim is to study cases with colonic injuries according to ACS [American College of Surgeons] grading system, the surgical management applied and the postoperative outcome of each grade. This prospective study compromise [100] patients with documented colonic injuries admitted to the surgical wards at Baghdad Teaching Hospital spanning the years 2006 to 2008. The parameters used in this study include: age, gender, mechanism of injury, part of the colon involved by injury, the grade of the injury, other associated organ injuries, the method chosen to manage the injury and the outcome [uneventful recovery, postoperative morbidity and death]. Colonic injuries were caused by bullet injuries in 50% of cases, sigmoid colon was the most common involved part [32%], 64% of cases were of grade 2 ACS, the most common associated organ injury was small intestine [60%], colonic injuries were primarily sutured in 48% of cases, while other 48% of vases ended with colostomy. Morbidity postoperatively were recorded in 32% of cases, most frequently with grade 2 and in cases treated by colostomy. Postoperative Death was recorded in 14% of cases. According to our study, ACS grading system proves to be highly beneficial to the applied in the coarse of management of colonic injuries

Role of single layer interrupted extramucosal anastomosis in small intestine in patients of abdominal trauma

To have recent local evidence behind to support the utilization of single layer interrupted extramucosal suturing technique in patients presenting with abdominal trauma. This case series study was carried out in the Department of General Surgery, DHQ [BBS] Hospital, Abottabad from July 2008 to July 2009. All the patients either male or female patients admitted through emergency with small intestinal trauma were included in the study. Patients were put in a single group. The details of each procedure were explained to each patient. Out of 125 patients most of the patients were seen in age between 21-30 years i.e. 50 [48%] patients. Age range was 16 to 55 years. Out of 125 patients, 86 [69%] patients were male and 39 [31%] were females. Among them 90 [72%] patients were from rural areas and the remaining 35 [28%] patients were residing in urban areas. Among 125 patients, the majority 50 [40%] patients got injuries, in road transport accidents. It was concluded from the study that single layered extramucosal interrupted anastomosis is associated with less risk of dehiscence than the full thickness and continuous extramucosal anastomosis

Melanoma metastático causando intussuscepção do intestino delgado: diagnóstico por 18F-FDG PET/TC / Metastatic melanoma causing small bowel intussusception: diagnosis by 18F-FDG PET/CT

Melanoma maligno é uma doença comum e agressiva que frequentemente causa metástase para o intestino delgado. Este estudo ilustra um caso de intussuscepção do intestino delgado causada por uma lesão metastática de melanoma visualizada à 18F-FDG PET/TC em uma paciente de 48 anos idade que realizou exame de reestadiamento.

Malignant melanoma is a common and aggressive disease that frequently causes metastases to the small bowel. This study illustrates a case of small bowel intussusception secondary to metastatic melanoma visualized at 18F-FDG PET/CT in a 48-year-old woman who had this examination for restaging purposes.

Intestinal injury from blunt abdominal trauma: a study of 47 cases

To determine the cause, presentation, anatomical distribution, diagnostic method, management and outcome of intestinal injuries from blunt abdominal trauma. The study included 47 patients who underwent laparotomy for intestinal injuries from blunt abdominal trauma over a period of 4 years. A retrospective study was conducted and the patients were analyzed with respect to the cause, presentation, anatomical distribution, diagnostic methods, associated injuries, treatment and mortality. 47 patients with 62 major injuries to the bowel and mesentery due to blunt abdominal trauma were reviewed. The male to female ratio was 8.4:1 and the average age was 34.98 years. There were 44 injuries to the small intestine including 1 duodenal injury, 11 colonic injuries and 7 injuries to the mesentry. 26 patients were injured in road traffic accidents. Out of 29 patients with intestinal perforation, free peritoneal air was present on plain abdominal and chest radiography in 23 patients. 18 patients underwent laparotomy on the basis of clinical findings alone. The commonest injury was a perforation at the antimesentric border of the small bowel. Treatment consisted of simple closure of the perforation, resection and anastomosis and repair followed by protective colostomy for colonic perforations. 3 [6.38%] deaths were recorded, while 8 [17.02%] patients developed major complications. Although early recognition of intestinal injuries from blunt abdominal trauma is difficult, it is very important due to its tremendous infectious potential. Intestinal perforations are often associated with severe injuries which are probably be the determining factors in survival

Resección laparoscópica mano asistida: de tumor del estroma gastrointestinal de Yeyuno / Laparoscopic hand resection assisted: gastrointestinal stromal tumor of ileum

Los tumores del intestino delgado son relativamente raros con una incidencia de 5 por ciento. Entre estos se encuentran los tumores del estroma gastrointestinal que son un grupo de neoplasias de origen mesenquimal y constituyen el 0,1 por ciento al 3 por ciento de los tumores del tracto digestivo. La presentación clínica es inespecífica, generalmente los pacientes consultan por hemorragia digestiva superior, dolor o tumor palpable. La determinación de marcadores es fundamental para la confirmación patológica y se sustenta con los estudios inmunohistoquímicos basados en la expresión de CD117 (receptor c-kit), CD34, desmina y proteína S100, para diferenciarlos de otros tumores mesenquimales, neurales y neuroendocrinos. El comportamiento clínico de este tipo de tumores es difícil de predecir. La resección quirúrgica con márgenes libres de lesión es el tratamiento de elección para las lesiones localizadas.

Tumors of the small bowel are relative rare with an incidence of 5 %. These kinds lesions we find in the stroma gastrointestinal tumors, there are a group of neoplasm mesenquimal original. They are constitutive 0,1 % to 3 % of the digestive tract tumors. The clinical presentation is no specific generally the patients consult for superior digestive bleeding, pain or palpable mass. The market determination is important to the pathological confirmation and are sustention with immunohistochemestry studies based in the expression of CD117 (c-kit receptor), CD34, desmine and S100 protein, to be differential of another tumors how mesenchyme, neural, and neuroendocrines. The biological clinical courses of these kinds of tumors are difficult to predict. The surgical resection with free lesion margins is the treatment of choice for the localized lesions.

Small bowel perforations due to deliberate ingestion of injurious foreign bodies-a personal experience

Ingestion of foreign bodies is not an uncommon problem in our society. The patients usually ingest different types of foreign bodies either accidentally or deliberately. Rare in children but adults are not uncommonly affected and are either psychiatric patients or ingest foreign bodies accidentally. Life threatening complications may occur at times due to ingestion of sharp and pointed objects. An interesting case of ingestion of multiple injurious foreign bodies presenting with multiple small intestinal perforations is presented with review of literature

Lesões traumáticas de vísceras ocas / Injuries to the hollow viscera

Nos pacientes vítimas de traumatismo abdominal, contuso ou penetrante, além dos cuidados iniciais de estabilização, diagnóstico cuidadoso de lesões associadas e tratamento cirúrgico imediato em situações óbvias, devemos estar atentos para possíveis lesões de vísceras ocas que podem se manifestar tardiamente, postergando o tratamento definitivo, com conseqüente piora do prognóstico. Baseado na forte suspeita, analisando o mecanismo do trauma e lesões encontradas na avaliação inicial, o lavado peritoneal diagnóstico e exames de imagem devem ser empregados em conjunto, para confirmar ou afastar a existência de lesão de vísceras ocas. Atualmente, não dispomos de exames com especificidade e sensibilidade suficientes para, isoladamente, definir o diagnóstico. Dentre os órgãos intra cavitários não sólidos envolvidos nos traumatismos abdominais, destaca-se o intestino delgado como o mais acometido nas lesões penetrantes, seguido pelo cólon, estômago e duodeno. As lesões de vísceras ocas são menos freqüentes em traumatismos contusos, porém, geralmente, apresentam-se com maior gravidade e associadas a outras lesões. O tratamento é cirúrgico, em geral com o reparo primário da víscera, sendo a tática operatória guiada pela gravidade das lesões e condições gerais do paciente.

In abdominal blunt or penetrating trauma patients, despite of the initial assessment and stabilization, careful diagnosis of associated injuries and immediate treatment in obvious cases, we must be concerned about missing injuries of hollow viscera that can disclose itself later, delaying definitive treatment, with consequent worse prognosis. Based in high suspicion related to the mechanism of trauma and associated injuries in the initial evaluation, diagnostic peritoneal lavage and radiological exams must be indicated in the effort to confirm the existence of hollow visceral injuries. Currently, there is no method with such specificity and sensitivity to define diagnosis by itself. Among the organs injured in abdominal trauma, the small bowel is the most frequent in penetrating wounds, followed by colon, stomach and duodenum. The hollow viscera injuries are less common in blunt trauma, however usually associated to higher severity and other injuries. The treatment is surgical, usually with primary repair, guided by the anatomical injury severity and patient general conditions.