Osificación heterotópica mesentérica precoz posabdomen abierto y su manejo quirúrgico: presentación de un caso / Mesenteric heterotopic ossification after open abdomen and its surgical management: presentation of a case

OBJETIVO: Reportar el caso de un paciente con antecedente de múltiples cirugías por peritonitis y abdomen abierto, con hallazgo intraoperatorio de osificación heterotópica en el mesenterio. CASO CLÍNICO: Paciente masculino de 59 años, con antecedente de apendicectomía complicada hace 12 meses, que en esa oportunidad requirió manejo de abdomen abierto, colectomía derecha e ileostomía terminal. Un año posapendicectomía reingresa para reconstitución de tránsito con hallazgo intraoperatorio de masa calcificada en mesenterio, de 15 x 10 x 6 cm, cuyo estudio histológico informa osificación heterotópica mesentérica. Esta entidad es de baja frecuencia, asociada al antecedente de trauma y cirugía abdominal, y se ha descrito como causa de morbimortalidad. El manejo quirúrgico resectivo es factible por equipos con experiencia. CONCLUSIÓN: Se describe un caso con antecedente de abdomen abierto, con posterior hallazgo de osificación heterotópica mesentérica. Este caso clínico es representativo por sus factores de riesgos clásicos y manejo empleado para su resolución.

OBJECTIVE: Report the case of a patient with a history of multiple surgeries due to peritonitis and open abdomen, with intraoperative finding of mesenetrioc heterotopic ossification. CLINICAL CASE: A 59-year-old male patient with a history of complicated appendectomy 12 months ago, which requires the management of an open abdomen, right colectomy and terminal ileostomy. One year after appendectomy, is readmitted for transit reconstitution. Intraoperative finding were calcified mass in mesentery, of 15 x 10 x 6 cm, whose histological study reports mesenteric heterotopic ossification. This entity has low frequency, and is associated with a history of trauma and abdominal surgery, is described as a cause of morbidity and mortality. Resective surgical management is feasible for experienced teams. CONCLUSION: A case with antecedent of open abdomen is described, with later finding of mesenteric heterotopic ossification. This clinical case is representative for its classic risk factors and management used for its resolution.

Comparative study of peritoneal adhesions after intraperitoneal implantation in rats of meshes of polypropylene versus polypropylene/polyglecaprone versus polyester/porcine collagen

Abstract Purpose To Compare the extent and intensity of adhesions formed between the intra-abdominal organs and the intraperitoneal implants of polypropylene mesh versus polypropylene/polyglecaprone versus polyester/porcine collagen used for correction of abdominal wall defect in rats. Methods After the defect in the abdominal wall, thirty Wistar rats were placed in three groups (ten animals each) for intraperitoneal mesh implant: polypropylene group, polypropylene/polyglecaprone group, and polyester/porcine collagen group. The macroscopic evaluation of the extent and intensity of adhesions was performed 21 days after the implant. Results The polypropylene group had a higher statistically significant impairment due to visceral adhesions (p value = 0.002) and a higher degree of intense adherence in relation to polypropylene/polyglecaprone and polyester/porcine collagen groups (p value<0.001). The polyester/porcine collagen group showed more intense adhesions than the polypropylene/polyglecaprone group (p value=0.035). Conclusions The intraperitoneal implantation of polypropylene meshes to correct defects of the abdominal wall caused the appearance of extensive and firm adhesions to intra-abdominal structures. The use of polypropylene/polyglecaprone or polyester/porcine collagen tissue-separating meshes reduces the number and degree of adhesions formed.

The effect of pycnogenol on lymphatic nodes and adhesion during in a peritoneal adhesion model in rats

Abstract Purpose: To investigate the effects of pycnogenol on peritoneal adhesions and additionally to investigate the immunohistochemical effects of free oxygen radicals and reactive lymph nodes detected in the adhesive tissue that was sampled surrounding the cecum on intra-abdominal adhesions. Methods: Twenty-seven Wistar Albino rats were divided into three groups. In group 1 (sham), laparotomy was performed and stitched up. In group 2 (control), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and each rat was intraperitoneally administered 2 cc of saline. In group 3 (experimental), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and each rat was intraperitoneally administered a sterile Pycnogenol derivative. The rats in all groups were re-laparotomized on postoperative day 7; samples were obtained from the peritoneal tissue surrounding the cecum, and the rats were sacrificed. Results: In group 3, there was a statistically significant difference in terms of inflammation, lymph node size, and free oxygen radicals; these parameters tended to increase. In terms of fibrosis evaluated using H&E and MT, there was no significant difference between groups 2 and 3. Conclusions: No positive outcomes indicating that pycnogenol reduces intra-abdominal adhesions were obtained. However, it caused severe inflammation in the tissue. Moreover, a significant increase in lymph node size was detected secondary to inflammation. Additionally, in immunohistochemical analyses conducted to detect oxidative stress, pycnogenol increased the production of free oxygen radicals in the tissue.

Comparative study of polyglactin 910 and simple catgut in the formation of intraperitoneal adhesions

Abstract Purpose: To compare polyglactin 910 and simple catgut sutures for the incidence of intraperitoneal adhesions. Methods: Twenty female Wistar rats were placed into two groups. Group 1 received ischemic sutures and Group 2 received polyglactin 910. Five sutures inductive of adhesions in each rat were made. After 14 days, the rats were euthanized with an assessment of the presence of adhesions, the number of sutures involved and classification according to the Granat et al. scale described by Ozel et al17. Results: In total, 19 of the 20 rats presented adhesions, with nine from Group 1 and ten from Group 2. There was a smaller number of affected sutures in Group 1, while in Group 2 the majority of the sutures formed adhesions (p=0.0197). According to the Granat et al. scale, Group 1 predominately developed fine, filamentous adhesions or thickening in a restricted area. Group 2 mainly presented extensive, thick adhesions with the involvement of the viscera (p=0.0055). Conclusion: Polyglactin 910 sutures formed more adhesions that were more extensive and thicker than the simple catgut sutures.

Peritoneal adhesions type i, iii and total collagen on polypropylene and coated polypropylene meshes: experimental study in rats / Aderências peritoneais tipo i, iii e colágeno total em telas de polipropileno e revestidas: estudo experimental em ratos

ABSTRACT Background: Hernia correction is a routinely performed treatment in surgical practice. The improvement of the operative technique and available materials certainly has been a great benefit to the quality of surgical results. The insertion of prostheses for hernia correction is well-founded in the literature, and has become the standard of treatment when this type of disease is discussed. Aim: To evaluate two available prostheses: the polypropylene and polypropylene coated ones in an experimental model. Methods: Seven prostheses of each kind were inserted into Wistar rats (Ratus norvegicus albinus) in the anterior abdominal wall of the animal in direct contact with the viscera. After 90 days follow-up were analyzed the intra-abdominal adhesions, and also performed immunohistochemical evaluation and videomorphometry of the total, type I and type III collagen. Histological analysis was also performed with hematoxylin-eosin to evaluate cell types present in each mesh. Results: At 90 days the adhesions were not different among the groups (p=0.335). Total collagen likewise was not statistically different (p=0.810). Statistically there was more type III collagen in the coated polypropylene group (p=0.039) while type I was not different among the prostheses (p=0.050). The lymphocytes were statistically more present in the polypropylene group (p=0.041). Conclusion: The coated prosthesis was not different from the polypropylene one regarding the adhesion. Total and type I collagen were not different among the groups, while type III collagen was more present on the coated mesh. There was a greater number of lymphocytes on the polypropylene mesh.

RESUMO Racional: A correção herniária é tratamento realizado rotineiramente na prática cirúrgica. O aprimoramento da técnica operatória e dos materiais disponíveis trouxe grande benefício na qualidade dos resultados cirúrgicos. A inserção de próteses para correção herniária é bem embasada na literatura e tornou-se o padrão de tratamento. Objetivo: Avaliar em modelo experimental dois tipos de próteses diferentes, de polipropileno e polipropileno revestido. Métodos: Foram inseridas sete próteses de cada tipo em ratos Wistar (Ratus norvegicus albinus) na parede abdominal anterior do animal em contato direto com as vísceras. Após o seguimento de 90 dias analisaram-se as aderências intra-abdominais, bem como avaliação por imunoistoquímica e videomorfometria do colágeno total, tipo I e tipo III. Também, fez-se análise histológica com hematoxylina-eosina para avaliação dos tipos celulares presentes em cada tela. Resultados: Aos 90 dias as aderências não foram diferentes entre os grupos (p=0,335). O colágeno total igualmente não foi estatisticamente diferente (p=0,810). O colágeno tipo III foi estatisticamente maior no grupo polipropileno revestido (p=0,039) enquanto o tipo I não diferiu entre as próteses (p=0,050). Os linfócitos foram estatisticamente mais presentes no grupo polipropileno (p=0,041). Conclusão: A prótese revestida não foi diferente da de polipropileno na variável aderência. O colágeno total e tipo I não foram diferentes entre os grupos enquanto que o colágeno tipo III foi mais presente na tela revestida. O número de linfócitos foi maior na tela de polipropileno.

Pode a tela de poliéster coberta com colágeno diminuir as taxas aderências intraperitoneais na correção de hérnia incisional? / May polyester with collagen coating mesh decrease the rate of intraperitoneal adhesions in incisional hernia repair?

RACIONAL: Entre as telas utilizadas na reparação de hérnias incisionais na técnica aberta, a de polipropileno é a mais utilizada devido à flexibilidade, estimulação do crescimento celular, resposta inflamatória satisfatória, fácil manipulação e baixo preço. No entanto, induz a formação de aderências, quando em contato com os conteúdos intra-abdominais. OBJETIVO: Avaliar as aderências formadas após a colocação intraperitoneal da tela de polipropileno e a tela de poliéster coberta com colágeno. MÉTODO: Foram utilizadas 26 ratas Wistar fêmeas, randomizadas em três grupos. No grupo 0 (sham) não houve colocação de prótese, apenas laparotomia; no grupo 1 foi implantada a prótese de polipropileno na superfície peritoneal; e no grupo 2, a prótese composta por poliéster coberta por colágeno. Todos os animais foram mortos 21 dias após o procedimento e avaliados quanto às vísceras envolvidas nas aderências, grau das aderências, percentual da tela acometimento por aderências e a força necessária para a sua ruptura. RESULTADOS: Não houve diferença de peso entre os grupos. O grupo 0 não apresentou aderência. Os grupos 1 e 2 apresentaram aderências na superfície da prótese, predominante no omento. O grau de aderências, superfície acometida não teve diferença representativa entre os grupos. A cobertura de colágeno não demonstrou aderências. As aderências ocorreram na borda livre da tela, em contato com a face de poliéster. Análise do tipo de superfície comprometida por aderências, o grupo polipropileno teve 80% e o grupo poliéster com colágeno apenas 10% (p<0,005). CONCLUSÃO: Para os parâmetros avaliados aderência, grau e força máxima de ruptura não houve diferença. No entanto, a tela de polipropileno teve superfície acometida pela aderência significativamente maior em relação à tela de poliéster protegida com colágeno.

BACKGROUND: Among meshes used in incisional hernias in open technique repair, the polypropylene is the most commonly used due to flexibility, cellular growth stimulation, satisfactory inflammatory response, easy manipulation and low price. However, it induces adhesions formation when in contact with the intra-abdominal contents. AIM: To evaluate the formation of adhesions after polypropylene and collagen coated polyester mesh with intraperitoneal placement. METHODS: Twenty six female Wistar rats were randomized in three groups. In the group 0 (sham) there was no prosthesis placement, in the polypropylene (group 1) the prosthesis was placed at the peritoneal surface and in the group 2, collagen coated polyester mesh was placed. The rats were killed on postoperative day 21 to evaluate adhesions regarding its degree, mesh percentage of involvement, bowel involvement and strength needed to cause rupture. RESULTS: There was no difference in weight between groups. The group 0 did not develop any adhesions. The groups 1 and 2 developed prosthetic mesh surface adhesions, mostly in the omentum. There was no difference in adhesion degree and percentage of surface involvement between groups. The collagen coated mesh did not develop adhesions. The adhesions occurred at the free edge of the mesh, in contact with the polyester. The Polypropylene group presented 80% of the surface involved with adhesions, while the collagen coated polyester group presented 10% (p<0,005). CONCLUSION: There was no difference between adhesion, degree of adhesion and strength needed to cause rupture. However, the polypropylene mesh presented significantly higher surface of adhesion when compared to the collagen coated polyester mesh.

Estudo comparativo de aderências intraperitoneais associadas ao uso das telas de polipropileno e de malha leve de polipropileno revestida com ácido graxo ômega-3 / Comparative study of intraperitoneal adhesions associated with the use of meshes of polypropylene and polypropylene coated with omega-3 fatty acid

OBJETIVO: Comparar as aderências entre dois grupos de ratas Wistar submetidas à colocação intraperitoneal da tela de polipropileno e malha leve de polipropileno revestida com ácido graxo ômega-3. MÉTODOS: Foram utilizadas 27 ratas Wistar randomizadas em três grupos. No grupo 0 não houve colocação de prótese, no grupo 1 houve implantação da prótese de polipropileno e no grupo 2, implantação de prótese de polipropileno revestida com ácido graxo ômega-3. Foi avaliadas a presença de aderências, grau, força de ruptura, percentual de área recoberta e retração das telas aferidas. RESULTADOS: O grupo 0 não apresentou aderência. Os grupos 1 e 2 apresentaram aderência na superfície da prótese, omento, fígado e alça intestinal. Foram encontradas aderências grau 1 e 2 em 100% do grupo polipropileno revestida com ácido graxo ômega-3 e em 60% do grupo polipropileno. As demais eram aderências grau 3, e diferiram significativamente entre os grupos (p< 0,001). A força de ruptura da aderência na tela polipropileno revestida com ácido graxo ômega-3 foi significativamente maior do que na tela de polipropileno (p= 0,016). Não houve diferença na retração das telas ou superfície acometida pelas telas. A análise da tela revestida com ácido graxo ômega-3 demonstrou distribuição preferencialmente nas bordas em relação ao polipropileno, com predomínio no centro. CONCLUSÃO: O tipo de aderência, percentual de superfície acometida e retração não foram significativamente diferentes entre as telas. A tela de baixo peso apresentou menor grau de aderências, e, estas, necessitaram força maior para ruptura, possivelmente pelo predomínio de sua ocorrência nas bordas da tela.

OBJECTIVE: To compare intraperitoneal adhesion formation with placement of polypropylene mesh and use of lightweight polypropylene mesh coated with omega-3 fatty in rats. METHODS: Twenty-seven Wistar rats were randomized into three groups. In group 0 no mesh was placed; in group 1 we implanted a polypropylene mesh; and in group 2 there was implantation of a polypropylene mesh coated with omega-3 fatty acid. We evaluated adhesions presence and degree, breaking strength, percentage of area covered and retraction of the implanted meshes. RESULTS: Group 0 had no adhesion. Groups 1 and 2 showed adhesions on the surface of the mesh, omentum, liver and intestinal loops. There were grades 1 and 2 adhesions in 100% of the polypropylene coated group and in 60% of the polypropylene group. The remaining were grade 3 adhesions, and differed significantly between groups (p <0.001). The breaking strength of adhesions on the polypropylene coated group was significantly higher than with the polypropylene alone (p = 0.016). There was no difference in mesh retraction or area covered by the mesh. The analysis of the mesh coated with omega-3 fatty acid distribution showed adhesions preferentially located at the edges when compared to polypropylene, predominantly in the center. CONCLUSION: The type of adhesions, percentage of surface affected and retraction were not significantly different between meshes. The fatty acids coated mesh had a lower degree of adhesions and these required a greater force to rupture, possibly by their occurrence at the edges of the mesh.

Hematoma retroperitoneal de causa infrecuente: a propósito de un caso / Retroperitoneal hematoma of unusual cause: a case report

The spontaneous retroperitoneal hematoma (SRH) is defined as a spontaneous hematic collection located in any of the retroperitoneal compartments. The most frequently encountered cause of retroperitoneal hemorrhage is a ruptured abdominal aortic aneurysm, followed by renal and adrenal tumors, along with some other less common causes. Performing accurate diagnosis of patients at admission has proven to be difficult, given that the clinical presentation is ample and variable and may mimic other pictures of abdominal or lower back pain. Imaging techniques, mainly angiography, computed tomography, and MR Imaging, represent a fundamental tool for both timely diagnosis and proper management of the condition. We report the case of a 56-year-old male patient with diagnosis of HIV, who presented with a history of abdominal pain and palpable abdominal mass. After a thorough imaging evaluation, patient was diagnosed with retroperitoneal hematoma, whose histological analysis revealed a Burkitt lymphoma.

El hematoma retroperitoneal espontáneo (HRE) se define como una colección hemática espontánea, situada en cualquiera de los compartimentos retroperitoneales. Dentro de las causas más frecuentes se encuentran las roturas de aneurisma de aorta abdominal, tumores renales y suprarrenales, entre otras. Habitualmente es difícil realizar el diagnóstico al ingreso del paciente, ya que la presentación clínica es variable y puede simular otros cuadros de dolor abdominal o lumbar. Las técnicas de imagen, especialmente la angiografía, tomografía computada y resonancia magnética, son una herramienta fundamental en el diagnóstico y manejo oportuno del cuadro. Presentamos el caso de un varón de 56 años de edad con diagnóstico de VIH en tratamiento, que debutó como un cuadro de dolor y masa abdominal palpable. Luego de un acabado estudio de imágenes, se diagnosticó un HRE cuyo estudio histológico reveló un Linfoma de Burkitt.

Evaluation of peritoneal adhesions formation and tissue response to polypropylene - poli (2-hydroxyethyl methacrylate)-(polyHEMA) implant on rats' abdominal wall / Avaliação da formação de aderências peritoneais e da resposta tecidual ao implante de poli (2-hidroxietil dimetacrilato)-(poliHEMA) na parede abdominal de ratos

PURPOSE: To verify if the composit poli (2-hydroxyethyl methacrylate)-PolyHEMA/polypropylene mesh implanted in the female rat's abdominal wall could be suitable for the prevention of peritoneal adhesions, and for the evaluation of the tecidual response produced by this biomaterial. METHODS: Polypropylene meshes (Group PP, n=20) and polypropylene meshes coated with a layer of poli (2-hydroxyethyl methacrylate)-PolyHEMA (Group PH, n=20) were implanted on the abdominal wall of Wistar female rats. Ten animals from each group were submitted to euthanasia at 15 and 30 days of the postoperative period. RESULTS: The animals from the group PP presented visceral adhesions on the mesh surface, which was not observed in the ones from group PH. At the histopathological examination foreign body response was observed in both groups, whilst there was a greater intensity of inflammatory response in group PH on both moments. CONCLUSION: The poli (2-hydroxyethyl methacrylate) polyHEMA hydrogel associated to polypropylene mesh reduces visceral adhesion formation in rats, although it may be associated to greater inflammatory reaction.

OBJETIVO: Verificar se compósito poli 2-hidroxietil dimetacrilato (PoliHEMA) / tela de polipropileno implantado na parede abdominal de ratas seria adequado para prevenção de aderências peritoneais e avaliar a resposta tecidual desencadeada por este biomaterial. MÉTODOS: Foram implantadas telas de polipropileno - Grupo PP (n=20) e telas de polipropileno revestidas por uma camada de poli 2 (hidroxietil dimetacrilato)-PolyHEMA - Grupo PH (n=20) na parede abdominal de ratas da linhagem Wistar. Dez animais de cada grupo foram submetidos à eutanásia aos 15 e 30 dias de pós-operatório. RESULTADOS: Os animais do grupo PP apresentaram aderências viscerais na superfície da tela, o que não foi observado nos do grupo PH. Observou-se no exame histopatológico resposta tipo corpo estranho nos dois grupos sendo que no grupo PH houve maior intensidade de resposta inflamatória nos dois momentos. CONCLUSÃO: O hidrogel de poliHEMA quando associado à tela de polipropileno reduz a formação de aderências viscerais em ratos, embora possa estar associado à reação inflamatória mais intensa.

Experimental model of the formation of pelvic adhesions by videolaparoscopic in female rabbits / Modelo experimental de formação de aderências pélvicas por videolaparoscopia em coelhas

PURPOSE: To verify the frequency of postsurgical pelvic adhesion formation in an experimental animal model using videolaparoscopy. METHODS: Experimental study in a sample of 11 non-pregnant female rabbits, aged 5 to 7 months. After general anesthesia, access to the abdominal cavity was performed by an open puncture technique, with 10mm optics, placing two other 5 mm trochars under direct visualization, in the iliac fossae. Then a fragment of peritoneum was resected, followed by electrocauterization. In 21 days, the videolaparoscopy was repeated, and adhesion formation and score was looked at, with biopsies at the surgical site. RESULTS: 54 percent of adhesion formation was observed, and the median score of adhesions was 6 (minimum of 3 and maximum of 10), all of them found in the bladder and the anterior abdominal wall. CONCLUSION: The method used presents a high frequency of intra-abdominal adhesion formation.

OBJETIVO: Verificar a freqüência da formação de aderências pélvicas pós-cirúrgicas, em um modelo experimental animal, por videolaparoscopia. MÉTODOS: Estudo experimental, em uma amostra de 11 coelhas, não prenhas, com idade entre cinco e sete meses. Após anestesia geral, o acesso da cavidade abdominal foi efetuado por técnica de punção aberta, com óptica de 10 mm, colocando-se outros dois trocateres de 5 mm, sob visão direta, nas fossas ilíacas. Realizou-se, então, ressecção de fragmento de peritônio, seguida de cauterização com eletrocautério. Em 21 dias, foi repetida a videolaparoscopia, verificando-se a formação e escore de aderências e realizando-se biópsias do local da cirurgia. RESULTADOS: Observou-se 54,5 por cento de formação de aderências, sendo o escore total mediano de aderências seis (mínimo de três e máximo de 10), todas encontradas na bexiga e na parede abdominal anterior. CONCLUSÃO: O procedimento utilizado apresentou alta freqüência de formação de aderências intra-abdominais.

Disseminated tuberculosis presenting as mesenteric and cerebral abscess in HIV infection: case report

Disseminated tuberculosis in HIV infection involves multiple organs. Pulmonary and lymph node involvement are the commonest form of tuberculosis in HIV infection [1, 2]. Other forms of tuberculosis in the absence of lung and lymph node involvement are rare. Various forms of abdominal [3, 4] and neurological [5, 6] tubercular involvement in HIV infection have been reported. But tuberculosis presenting simultaneously with mesenteric and brain abscess has not been reported yet. We report a case of disseminated tuberculosis presenting as mesenteric and cerebral abscess in a HIV case without involving lung and lymph nodes. Bone marrow smears and fine needle aspiration cytology (FNAC) from mesenteric lesion were positive for acid fast bacilli (AFB) and the diagnosis of tuberculosis was confirmed by positive polymerase chain reaction (PCR). He responded well to treatment with anti tubercular drugs.

Polylactic acid film versus acellular porcine small intestinal submucosa mesh in peritoneal adhesion formation in rats / Filme ácido poli-lático versus tela de submucosa intestinal suína na formação de aderências peritoneais em ratos

PURPOSE: To assess intraperitoneal adhesion formation in rats after the single implantation of intraperitoneal polypropylene mesh versus SIS mesh, and the effect of PAF as a polypropylene mesh barrier. METHODS: A total of 55 albino rats randomized into three groups were assessed. The type of adhesions, the percentage of mash covered with adhesions, and the rupture strength of the adhesions were evaluated. RESULTS: The type 2 and 3 adhesions were more frequent in group 1 (polypropylene mesh) and group 3 (Polypropylene+PAF), while type 0 and 1 adhesions were more frequent in group 2 (SIS). The mean rupture strength was 1,58 N (±0,719N) in group 1, 0,42 N (±0,432N) in group 2 and 1,23 N (±0,432N) in group 3. Over 50% of the mash was covered with adhesions in 12 (80%) cases of the group 1, in 4 (20%) cases of the group 2 and in 16 (84,2%) cases of the group 3. Group 2 differed significantly (p<0.001) from the other groups. CONCLUSIONS: Implantation of intraperitoneal polypropylene mesh yielded higher rates of adhesion and the use of PAF as a mesh barrier didn't reduced the rates of adhesion. SIS mesh implantation revealed lower rates of peritoneal adhesions.

OBJETIVO: Avaliar a formação de aderência intraperitoneal em ratos após o implante peritoneal da tela de polipropileno comparada à tela de SIS, e o efeito do PAF como barreira anti-aderente à tela de polipropileno. MÉTODOS: 55 ratos albinos foram randomizados em três grupos. O tipo de aderência, o percentual de tela coberta por aderência, e a força de rupturas das aderências foram avaliadas. RESULTADOS: Os tipos de aderência 2 e 3 foram mais freqüentes no grupo 1 (polipropileno) e no grupo 3 (polipropileno+PAF); as do tipo 0 e 1 foram mais freqüentes no grupo 2 (SIS). A força media de ruptura foi de 1,58N (±0,719N) no grupo 1, 0,42N (±0,432N) no grupo 2 e 1,23N (±0,432N) no grupo3. Mais de 50% da tela estava coberta por aderências em 12 (80%) casos do grupo 1, em 4 (20%) casos do grupo 2 e em 16 (84,2%) casos do grupo 3. O grupo 2 foi significativamente diferente (p<0.001) dos outros grupos. CONCLUSÕES: O uso intraperitoneal da tela de polipropileno levou a elevados índices de aderência, e o uso de PAF como barreira anti-aderente não reduziu os índices de aderência. O implante intraperitoneal de SIS revelou índices baixos de aderências peritoneais.

Comparative study of hand sewn single layer anastomosis of dog's bowel / Estudo comparativo das anastomoses manuais em plano único do intestino delgado de cães

BACKGROUND: Two-layer intestinal anastomosis increases the inflammatory response while single-layer anastomosis results in a better wound healing. However the four main kinds of stitches which may be chosen in performing single layer intestinal sutures never before had been comparatively studied. AIM: To compare the four more commonly used types of single layer surgical anastomosis sutures of the digestive tract. METHODS: Six mongrel dogs were operated, each one receiving two anastomosis: one at 30 cm from de Treitz angle - sero-submucosal technique, and the other at 60 cm - total technique. This placement was alternatively inverted. The four more commonly used types of single layer surgical anastomosis sutures of the digestive tract, namely: sero-submucosal stitches tied in the lumen, over the submucosa; sero-submucosal stitches tied in the exterior of the organ, over the serosa; total stitches tied in the lumen, over the mucosa; and total sutures tied in the exterior, over the serosa (Gambee's stitches) were tested. After euthanasia (7th post-operative day) macro and microscopic features were evaluated. Friedman's test was applied for morphometry and for evaluation of the peritoneal adhesions. RESULTS: Statistical significance was demonstrated through major residual acute inflammation and proliferation in total sutures and more profuse adhesions with the sero-submucosal stitches tied in the lumen. The sero-submucosal stitches tied in the exterior over the serosa, had excellent realignment and regeneration of the layers. CONCLUSION: The sero-submucosal stitches tied in the exterior, over the serosa, were the best ones.

RACIONAL: As anastomoses intestinais em dois planos aumentam a resposta inflamatória tecidual, enquanto que a anastomose em plano único resulta em um lúmen maior com menos danos às bordas teciduais. Entretanto, os quatro tipos de suturas mais comumente utilizados em suturas intestinais nunca foram antes estudados comparativamente. OBJETIVO: Comparar os quatro tipos de sutura do tubo digestivo em plano único mais freqüentemente utilizados para anastomoses manuais do tubo digestivo. MÉTODOS: Seis cães de raça indefinida foram operados, cada um recebendo duas anastomoses: uma a 30 cm do ângulo de Treitz - técnica sero-submucosa, e a outra a 60 cm - técnica total. Esta localização foi aleatoriamente invertida. Os quatro tipos de sutura em plano único mais freqüentemente utilizados para anastomoses manuais do tubo digestivo, denominados: pontos extramucoso atados no lúmen da víscera, sobre a submucosa, pontos extramucosos atados no exterior, sobre a serosa, pontos totais atados no lúmen, sobre a mucosa, e pontos totais especiais de Gambee atados no exterior sobre a serosa, foram testados. Eutanásia e necropsia parcial no 7º dia pós-operatório permitiu avaliação de aspectos macro e microscópicos. O teste de Friedman's foi aplicado para a morfometria e avaliação das aderências peritoniais. RESULTADOS: Foi demonstrada diferença estatisticamente significante para a inflamação residual aguda e maior proliferação nas suturas totais, bem como na maior ocorrência de aderências com pontos extramucosos atados no lúmen da víscera, sobre a submucosa. A sutura extramucosa com nós atados na serosa teve regeneração das bordas e alinhamento excelentes. CONCLUSÃO: A sutura extramucosa com nós atados na serosa mostrou-se a melhor.

Prolapsed uterus with huge rectocele and omentocele following cervical amputation: a rare and unusual case presentation.

Pelvic organ prolapse is a common condition whose incidence is increasing. Many cases of prolapse of the posterior vaginal wall occur along with other pelvic support defects. Pelvic surgeons who treat rectocele must have an excellent understanding of the normal anatomy, interactions of the connective tissue and muscular supports of the pelvis, and the relationship between anatomy and function. Pelvic pressure, the need to splint the perineum to defecate, impaired sexual relations, difficult defecation, and faecal incontinence are some of the symptoms that have been described in patients with rectocele.

Primary omental torsion in children. the pre-disposing factors and role of laparoscopy in diagnosis and treatment

To determine the predisposing factors and to evaluate the role of laparoscopy in the diagnosis and management of primary omental torsion in children. We retrospectively reviewed the clinical records of all children treated for primary omental torsion from August 1999 to December 2004 at King Khalid University Hospital, Riyadh, Saudi Arabia. Demographic data, clinical presentation, diagnostic and therapeutic modalities were evaluated. Follow-up was also obtained. Six children were included in the study. Their age ranging between 9-12 years [average 10.4 years]. All of them presented with right lower quadrant [RLQ] pain mimicking appendicitis. The duration of symptoms varied from 3-5 days prior to presentation. Localized RLQ tenderness with guarding was demonstrated in all patients. All children were noted to be obese. Only one patient had low grade fever and nausea. None of the patients had an elevated white blood cell count. Laparoscopic exploration was carried out in all cases for possible appendicitis. Appendix was found to be normal and torted omentum was clearly seen in all cases. The infarcted omentum was removed laparoscopically; all patients had uneventful recovery and were discharged on second postoperative day. Pathological examination showed necrotic infarcted omentum with no other abnormalities. Follow-up documented complete resolution of the patient's symptoms. Clinical presentation of primary omental torsion mimics that of acute appendicitis. Its diagnosis is usually difficult and almost impossible pre-operatively. Obesity, paucity of gastrointestinal symptoms and relatively long duration of symptoms should increase the index of suspicion. We believe that the laparoscopic approach is an excellent tool for the diagnosis and treatment for the primary omental torsion

Transmural Migration of Surgical Sponge Evacuated by Defecation: Mimicking an Intraperitoneal Gossypiboma

The spontaneous defecation of the surpical retained sponge is very rare. Here, we report a case of migrating surgical sponge that was retained in the colon and it was evacuated by defecation.