Diagnóstico prenatal de atresia de yeyuno con ecografía 3D con reconstrucción en superficie (HDlive): reporte de caso y revisión de la literatura / Antenatal diagnosis of jejunal atresia by 3D HDlive ultrasound: Case report and literature review

Resumen Objetivos: Reportar el caso de una paciente con diagnóstico prenatal de atresia de yeyuno y hacer una revisión de la literatura en torno al resultado y al diagnóstico de esta entidad, implementando el uso de métodos no convencionales: ecografía tridimensional (3D) o resonancia magnética fetal (RM). Materiales y métodos: Se reporta el caso de una gestante de 18 años, remitida a la Unidad de Medicina Materno-Fetal, Genética y Reproducción del Hospital Virgen del Rocío de Sevilla (España), por feto con imagen quística abdominal, peristáltica, compatible con atresia de yeyuno, la cual se confirmó con ecografía 3D modo HDlive. Se realizó una búsqueda bibliográfica en Medline/PubMed, LILACS y Google Scholar, restringiendo por tipo de idioma (inglés y español) y fecha de publicación (enero de 1995 a junio de 2020). Se incluyeron estudios primarios de reportes y series de caso, que abordaran el resultado y el diagnóstico prenatal de esta patología. Resultados: La búsqueda identificó 1.033 títulos, de los cuales cuatro estudios cumplieron con los criterios de inclusión, estos fueron reporte o series de casos. En total se reportaron doce fetos con diagnóstico prenatal de atresia de yeyuno detectada con métodos no convencionales. Una gestación finalizó con óbito a la semana 26 de gestación y en todos los demás casos, el diagnóstico se ratificó durante el periodo neonatal, requiriendo la resección del segmento comprometido. Dos neonatos desarrollaron síndrome de intestino corto como consecuencia de una resección intestinal amplia. El resto experimentó una evolución posoperatoria favorable. Conclusión: La literatura disponible en torno al diagnóstico prenatal de atresia de yeyuno utilizando métodos no convencionales es escasa y se limita a reporte o series de casos. La literatura revisada sugiere que, en presencia de dilatación intestinal, la ecografía 3D y la resonancia magnética fetal podrían tener cierta utilidad a la hora de caracterizar la porción atrésica y establecer el diagnóstico diferencial. Se requieren más estudios que evalúen la utilidad diagnóstica de estas dos alternativas.

Abstract Objectives: To report the case of a patient with a prenatal diagnosis of jejunal atresia and to review the literature regarding the results and prenatal diagnosis of this entity, implementing the use of non-conventional methods (3D ultrasound or magnetic resonance imaging). Material and methods: Report of a case of an 18-year-old pregnant woman referred to the Maternal-Fetal Medicine, Genetics and Reproduction Unit of the Virgen del Rocío Hospital in Seville due to fetus with abdominal peristaltic cystic image, consistent with jejunal atresia, confirmed with 3D HDLive mode ultrasound. A bibliographic search was carried out in Medline/PubMed, Google Scholar and LILACS, restricting by type of language (English and Spanish) and date of publication (January 1995 to June 2020). Primary studies of reports and case series relating to the outcome and prenatal diagnosis of this pathology were included. Results: The search identified 1,033 titles, of which four studies met the inclusion criteria, these being reports or case series. A total of twelve fetuses with a prenatal diagnosis of jejunal atresia detected with unconventional methods were reported. In all cases, the prenatal diagnosis was confirmed during the neonatal period, which required resection of the compromised segment; one of them died and two neonates developed short bowel syndrome because of a wide bowel resection. The postoperative course in the remaining cases was favorable. Conclusion: The available literature on the prenatal diagnosis of jejunal atresia using non-conventional methods is scarce and is limited to case reports or case series. The literature reviewed suggests that, in the presence of intestinal dilation, 3D ultrasound and magnetic resonance imaging could be of some use in characterizing the atretic portion and establishing the differential diagnosis. More studies are required to evaluate the diagnostic utility of these two alternatives.

Características ultrassonográficas de fígado, vesícula biliar, rins, vesícula urinária e jejuno em coelhos jovens e adultos / Ultrasound features of liver, gallbladder kidneys, urinary bladder and jejunum in young and adult rabbits

O presente trabalho descreveu características e comparou mensurações do fígado, vesícula biliar, rins, vesícula urinária e jejuno de coelhos da raça Nova Zelândia Branco (NZB) jovens e adultos. O grupo dos jovens foi composto por 39 coelhos de ambos os sexos (20 machos e 19 fêmeas), desmamados aos 30-31 dias de idade, sendo as avaliações realizadas aos 35, 56 e 77 dias de idade. O grupo dos adultos foi composto por 23 fêmeas e 15 machos, com idade superior a 6 meses, sendo realizada uma avaliação ultrassonográfica por animal. O exame consistiu na avaliação do fígado, vesícula biliar, rins direito e esquerdo, jejuno e vesícula urinária. Todos os animais foram pesados antes dos exames. O peso médio dos animais aumentou (p<0,05) dos 35 dias até a idade adulta. Tanto nos adultos quanto nos jovens, o fígado apresentou-se predominantemente isoecogênico ao rim direito e com textura homogênea. A vesícula biliar apresentou-se em formato ovoide alongado, variando de piriforme à amendoado, com conteúdo anecogênico, não sendo visível em 2,6% dos coelhos jovens e em 26,3% dos adultos. O comprimento e a largura da vesícula biliar nas idades de 35, 56, 77 dias e adultos foram: 1,06 e 0,39; 1,44 e 0,53; 1,41 e 0,58; 1,57 e 0,67cm, respectivamente. Considerando jovens e adultos, as mensurações da vesícula biliar e dos rins esquerdo e direito apresentaram correlação positiva (p<0,05) com o peso. Os rins apresentaram-se no formato de elipse e com superfície regular, com aumento (p<0,05) dos 35 dias à idade adulta. Houve correlação positiva (p<0,05) entre os volumes renais direito e esquerdo. A descrição da vesícula urinária mais encontrada (86%) foi a com conteúdo anecogênico, com pequenas estruturas ecogênicas livres no lúmen, tanto em jovens quanto em adultos. Não houve diferença (p>0,05) da espessura das camadas do jejuno entre as idades, apresentando média de 0,23 cm para todos os animais. Estes são os primeiros dados brasileiros de características ultrassonográficas de fígado, vesícula biliar, rins, jejuno e vesícula urinária para coelhos NZB de 35, 56 e 77 dias de vida e adultos.(AU)

This study described characteristics and measurements of the liver, gallbladder, kidney, urinary bladder and jejunum of young and adults New Zealand White (NZW) rabbits. The young rabbits's group was composed of 39 rabbits of both sexes (20 males and 19 females), weaned at 30-31 days of age, and the evaluations carried out at 35, 56 and 77 days of age. The adults group was composed of 23 females and 15 males, with more than 6 months of age, and one ultrasonographic evaluation per animal. The exam consisted in the evaluation of liver, gallbladder, right and left kidneys, jejunum and urinary bladder. All the animals were weighed before the evaluations. The average weight increased (p<0.05) from 35 days to adults. Both in adult and in young rabbits, the liver presented predominantly isoechogenic in relation of right kidney and with homogeneous texture. The gallbladder had an elongated ovoid shape, ranging for pear-shaped to almond, with anechogenic content, not being visible in 2.6% of young rabbits and 26.3% of adults. The length and width were 1.06 and 0.39; 1.44 and 0.53; 1.41 and 0.58; 1.57 and 0.67cm, respectively at 35, 56, 77 days and adults. For young and adults rabbits, the gallbladder and the left and right kidneys were positively correlated (p<0.05) with weight. The kidneys had an ellipse shape with smooth surface, increasing (p>0.05) from 35 days to adulthood. There was a positive correlation (p<0.05) between the right and left kidney volumes. The description of urinary bladder more frequently (86%) observed was anechogenic content, with small free echogenic structure within the lumen, both in young and in adult rabbits. There was no difference (p>0.05) in the thickness of the layers of the jejunum among ages, with the mean of 0.23cm for all animals. With the results, the first Brazilian ultrasonographic data for liver, gallbladder, kidney, jejunum and urinary bladder were defined to NZW rabbits in 35, 56 and 77days of life, as well as adults.(AU)

Leakage of Jejunal End of Roux Limb after Total Gastrectomy: Management with a Placement of a Covered Metallic Stent: Case Report

Postoperative leakage is a serious complication in patients after gastric surgery. It can lead to a rapid deterioration in the patient's condition and quality of life. Treatment is guided by the type of anastomosis and the patient's clinical status. The role of interventional radiology in gastrointestinal tract is evolving. Metallic stent placement has shown encouraging results for the palliation of gastrointestinal tract obstruction and fistula in malignant patients. We encountered a case of the leakage of jejunal end of Roux limb after total gastrectomy. This patient required a drainage procedure with long-term parenteral nutrition. We performed peroral placement of a covered metallic stent to avoid surgery and long-term parenteral nutrition, and he resumed adequate oral intake immediately after stent placement. This minimally invasive procedure is very promising for the treatment of a gastrointestinal fistula to avoid surgery and long-term parenteral nutritional support in selected cases.