Trombosis segmentaria sigmoidea consecuente a neoplasia maligna de colon. A propósito de un caso interesante / Sigmoid segmental thrombosis consequent to colon malignant neoplasia. On the purpose of a case

RESUMEN Se presentó un caso de una paciente de 78 años de edad, procedente del municipio de Calimete, con antecedentes patológicos personales de infarto agudo miocárdico sin elevación del segmento ST e hipertensión arterial. Llegó a la Unidad de Cuidados Intensivos de Emergencia, de Colón con un estado toxico infeccioso severo. Fue intervenida quirúrgicamente con el diagnóstico presuntivo de una trombosis mesentérica. Se constató dicho diagnóstico complementario a una neoplasia maligna de colon sigmoides. Falleció producto a un shock séptico refractario a aminas. En la necropsia se reportaron hallazgos de interés.

ABSTRACT The authors present the case of a 78-years-old female patient from the municipality of Calimete, with personal pathological antecedents of acute myocardial infarct without ST segment elevation and arterial hypertension. She arrived to the Emergency Intensive Care Unit of Colon with a severe toxic-infectious status. She underwent a surgery with a presumptive mesenteric thrombosis. It was stated that diagnosis, complementary to a sigmoid colon malignant neoplasia. She died as a product of an amine-refractory septic shock. The autopsy showed findings of interest.

Infecção do trato urinário de repetição por fístula enterovesical secundária a doença diverticular do cólon: um relato de caso / Recurrent urinary tract infection due to enterovesical fistula secondary to colon diverticular disease: a case report

INTRODUÇÃO: As fístulas enterovesicais (FEV) são comunicações patológicas entre a bexiga e as alças intestinais pélvicas. Trata-se de uma rara complicação decorrente de doenças inflamatórias e neoplásicas da pelve, além de casos resultantes de iatrogenia, e associa-se a altos índices de morbimortalidade. RELATO DO CASO: Trata-se de um paciente de 61 anos com um quadro de dor e distensão abdominal, vômitos, parada de eliminação de fezes e flatos. APP: Hipertenso, diabético, com antecedentes de disfunção vesical e infecções do trato urinário de repetição (ITUr) nos últimos três anos. Por meio da realização de ressonância magnética de abdômen e pelve, diagnosticou-se FEV associada à doença diverticular (DDC) do sigmoide. A conduta estabelecida consistiu em colectomia parcial com rebaixamento de colo e cistectomia parcial com colocação cirúrgica de cateter duplo jota à esquerda. DISCUSSÃO: Embora consista de afecção primária do trato digestivo, normalmente o paciente com DDC associada a FEV procura atendimento médico em decorrência de queixas do trato urinário. Nesse caso, a demora no diagnóstico fez com que a queixa principal fosse do trato digestivo e com antecedentes de queixas urinárias. CONCLUSÃO: Apesar de pouco frequente, a ocorrência de ITUr associada à DDC deve ser sempre considerada no diagnóstico diferencial das ITUr pela alta morbimortalidade.

INTRODUCTION: Enterovesical fistula are pathological connections between the bladder and pelvic intestinal segments. It consists of a rare complication of neoplastic and inflammatory pelvic disorders, in addition to iatrogenic or traumatic injuries, and correlates with both high morbidity and mortality indexes. CASE REPORT: Male patient, 61 years old, admitted at the hospital clinics featuring abdominal pain and distension, vomiting and fecal retention. Patient's pathological precedents include high blood pressure, diabetes mellitus, vesical dysfunction and recurrent urinary tract infection on the past three years. Magnetic resonance imaging of abdomen and pelvis revealed enterovesical fistula in association with colon diverticular disease of the sigmoid. Management of choice consisted of partial colectomy with bowel lowering and partial cystectomy with surgical double-J stent insertion. DISCUSSION: Although consisting of a gastrointestinal primary affection, patients with enterovesical fistula usually search for medical help charging urinary tract features. In this particular case, our patient was admitted with gastrointestinal symptoms, reasoned by diagnostic delay, as the patient had already attended at multiple centers with urinary symptoms. CONCLUSION: Despite being an unusual affection, recurrent urinary tract infection associated with colon diverticular disease must always be considered at differential diagnosis of recurrent urinary tract infection as it concurs with high morbidity and mortality.

Lower gastrointestinal bleeding as a result of fistula between the iliac artery and sigmoid colon in patient with advanced testicular cancer

Fistula between arteries and the gastrointestinal tract are a rare cause of gastrointestinal bleeding, but potentially fatal. The recognition and early treatment can modify the patient prognosis. We report a case of a patient with previous surgery for seminoma of cryptorchidic testicle, with massive lower gastrointestinal bleeding. We performed the diagnosis and surgical treatment of the fistula between left external iliac artery and sigmoid colon. The patient was successfully treated by external iliac artery ligation and left colectomy.

Endometriosis extrapélvica semejando cáncer colorrectal estenosante: Reporte de dos casos / Colorectal cancer endometriosis resembling stenosing extrapelvic: Report of two cases

Presentamos a dos mujeres -de 40 y 42 años- con endometriosis colorrectal, ambas con antecedente de endometriosis pélvica y episodios de rectorragia simultáneos con la menstruación. En las evaluaciones endoscópicas detectamos una tumoración sigmoidea y una tumoración rectosigmoidea respectivamente, que aparentaron corresponder a cáncer colorrectal estenosante de origen epitelial.

We present two women of 40 and 42 years with colorectal endometriosis, both with a history of pelvic endometriosis and simultaneous episodes of rectal bleeding with menstruation. In endoscopic evaluations detected a sigmoid tumor and rectosigmoid tumor respectively, which apparently corresponds to stenosing colorectal cancer of epithelial origin.

Isolated Bowel Endometriosis Resembling a Myogenic Tumor on Endoscopic Ultrasonography

No abstract available.

Postmenopausal intestinal obstructive endometriosis: case report and review of the literature / Endometriose intestinal obstrutiva na pós-menopausa: relato de caso e revisão da literatura

CONTEXT: Endometriosis is characterized by the presence of endometrial tissue outside the uterine cavity, which is commonly detected in gynecological practice but rarely reported as a coloproctological disorder. The objective of the present report was to discuss a rare case of postmenopausal intestinal endometriosis simulating a malignant lesion, following a review of the literature. CASE REPORT: A 74-year-old woman with complaints of hematochezia and tenesmus of two months' duration accompanied by liquid feces and pelvic pain, but with no other gastrointestinal or gynecological complaints, was referred to our service. She had been menopausal for 22 years, with no hormone replacement treatment, and had undergone panhysterectomy three years before the referral to us, due to endometrial thickening and a right adnexal cyst. Five months before this referral, she had undergone laparotomy due to acute obstructive abdomen, which revealed a tumor mass involving the small bowel. Anatomopathological examination of the enterectomy suggested a hypothesis of intestinal endometriosis. A proctological examination was normal. Computed tomography of the pelvis revealed thickening of the rectosigmoid transition and colonoscopy revealed friable tumor formation in the rectum. A biopsy of the lesion revealed mucosal fragments of endometrial type, which led to a review of the previous anatomopathological examination. The patient underwent rectosigmoidectomy with protective transversotomy, with a good postoperative course, and anatomical examination confirmed the intestinal endometriosis. The patient subsequently suffered a stenosing recurrence of the lesion and has undergone colostomy since then.

CONTEXTO: A endometriose caracteriza-se pela presença de tecido endometrial fora da cavidade uterina, e a etiopatogenia ainda apresenta controvérsias. O objetivo desta publicação é apresentar e discutir, após revisão da literatura, um raro caso de endometriose intestinal na pós-menopausa que simulava uma lesão maligna. RELATO DE CASO: Mulher de 74 anos apresentou-se com queixas de hematoquezia e tenesmo há dois meses. Relatou também aparecimento de fezes líquidas e dor pélvica no mesmo período, negando outras queixas gastrointestinais ou ginecológicas. Como antecedentes de interesse, revelou que era menopausada há 22 anos, sem terapia de reposição hormonal e realizou uma pan-histerectomia há três anos por espessamento endometrial e cisto anexial direito. Há cinco meses foi submetida a laparotomia exploradora por abdome agudo obstrutivo, com o achado de uma massa tumoral envolvendo alças de delgado. O exame anatomopatológico da enterectomia sugeriu a hipótese de endometriose intestinal. O exame proctológico era normal. A tomografia computadorizada da pelve mostrou um espessamento da transição retossigmóide e a colonoscopia, uma tumoração friável e estenosante no reto alto. A biópsia da lesão revelou fragmentos de mucosa tipo endometrial, que motivou a revisão do anatomopatológico anterior. A paciente foi submetida a retossigmoidectomia abdominal com transversostomia protetora, tendo boa evolução no pós-operatório. O anatomopatológico confirmou endometriose intestinal. Evoluiu com recidiva estenosante da lesão e pemanece colostomizada desde então.

Adult idiopathic ileosigmoid intussusception prolapsing per rectum.

Ileosigmoid intussusception can lead to ischemia and necrosis of either the ileum or sigmoid colon. Ileosigmoid intussusception as a mass prolapsing per rectum in an adult has not been previously reported. We report a 50-year-old man with such a presentation. He recovered uneventfully after subtotal colectomy.

Observations on the pattern of vomiting and morbidity in patients with acute sigmoid volvulus.

BACKGROUND: Vomiting is usually a late and an infrequent symptom of colonic obstructions. Contrary to this general rule, it occurs early and more frequently in some cases of sigmoid volvulus. AIM: To study the clinical significance of vomiting in patients with sigmoid volvulus. SETTING: Teaching hospital in Western Orissa, India STUDY DESIGN: Prospective observational study MATERIAL AND METHODS: Prospectively enrolled subjects with sigmoid volvulus diagnosed on the basis of clinical, radiological and laparotomy evidence were included in the study carried out in a tertiary care centre in India. Detailed history was obtained from them, especially to elicit information about the occurrence of various symptoms. Information regarding type of vomiting was also obtained. Efforts were made to exclude other causes of vomiting. Statistical tests such as Chi-Square test, Fisher's exact test or Student's t test were used. RESULTS: Ninety-three consecutive subjects with sigmoid volvulus were enrolled. Five patients with possible other aetiologies for vomiting and seven patients with compound sigmoid volvulus were eliminated from further analysis. Two patterns of vomiting were noted in 81 evaluable patients with sigmoid volvulus. In 33 patients (Group A), vomiting preceded or coincided with the onset of other abdominal symptoms (Type 1 vomiting). In 48 patients (Group B) vomiting occurred after the onset of other abdominal symptoms (Type 2 vomiting). The period between the onset of these symptoms and that of vomiting varied from a few hours to several days. Group A patients sought medical help much earlier than those of Group B. Incidences of circulatory shock (24% vs. 8%), haemorrhagic ascites (21% vs. 6%) and colonic gangrene (64% vs. 35%) were significantly higher in Group A than in Group B. The mortality rate (15% vs. 4%) was higher in Group A as well. About 25% (n = 7) of Group A patients in contrast to 4% (n=2) of Group B required hospitalization exceeding 3 weeks. Vomitus was predominantly non-bilious (21 out of 33 patients) in Group A (64%) and bilious (10 out of 11 patients) in Group B (91%). CONCLUSION: Type 1 vomiting appears to be an indicator of more severe presentation and is associated with an increased morbidity and mortality. This study suggests that the pattern of vomiting could be a simple and useful predictor of prognosis in sigmoid volvulus.

Significance of rectosigmoid polyp as a predictor of proximal colonic polyp

The association between rectosigmoid polyps and polyps in the more proximal colon is still a matter of debate, and the need for colonoscopy in patients with rectosigmoid polyps that are detected by flexible sigmoidoscopy is controversial. The aim of this study was to determine whether or not certain characteristics of rectosigmoid polyps are associated with the presence and characteristics of proximal colonic polyps. Seven hundred and twenty-eight patients who underwent total colonoscopy between October 1995 and June 1998 and who had colorectal polyps were retrospectively analyzed. Patients with inflammatory bowel diseases, familial adenomatous polyposis, or any advanced cancer were excluded. The odds ratio (OR) and 95% confidence interval (CI) of prevalence of proximal colonic polyps according to the patients age and sex, as well as the characteristics of rectosigmoid polyps, were calculated. Advanced adenoma was defined as an adenoma larger than 10 mm or an adenoma of any size with villous component, high-grade dysplasia or invasive carcinoma. Among 728 patients with colorectal polyps, 356 patients (48.9%) had polyps only in the rectosigmoid region, 193 patients (26.5%) had polyps only in the proximal colon, and 179 patients (24.6%) had polyps in both the rectosigmoid and proximal colon. In 535 patients with rectosigmoid polyps, the prevalence of proximal colonic polyps, neoplastic polyps and advanced adenomas were 33.4%, 27.3% and 2.9%, respectively. The prevalence of proximal colonic polyps in patients with rectosigmoid polyps was found to be significantly related to the male gender and elderly patients, in addition to the neoplastic histology of the rectosigmoid polyps. However, the prevalence of the proximal colonic polyps was not related to the size, number and shape of rectosigmoid polyps. In 179 patients with both rectosigmoid and proximal colonic polyps, the characteristics of proximal colonic polyps such as size, number and shape were similar to those of rectosigmoid polyps. We recommend total colonoscopic examination in all patients with rectosigmoid adenomas, regardless of the size, number, and shape, especially in elderly males.

Fístula colecistoduodenal: manejo laparoscópico con sutura mecánica / Cholecystoduodenal fistula: laparoscopic management with mechanical suture

La patología biliar constituye la más frecuente indicación quirúrgica a nivel nacional e internacional. La resolución laparoscópica de la colelitiasis simple es aceptada hoy como el gold standard, aun cuando el fantasma de la yatrogenia de la vía biliar sigue rondando. Avanzados grados de inflamación aguda, vesículas escleroatróficas, fístulas colecistoduodenales o colecistocoledocianas conforman un grupo de mayor dificultad técnica y que puede requerir de conversión o cirugía abierta para su resolución. Aunque inicialmente la fístula colecistoduodenal constituía una clara contraindicación al método laparoscópico, la adquisición de mayor experiencia permite solucionarla a satisfacción por esta vía. Presentamos un caso resuelto por vía laparoscópica con ayuda de sutura mecánica, en el Hospital Naval de Punta Arenas

Obstrucción intestinal por vólvulo de sigmoide / Intestinal obstruction by sygmoid volvulus

El vólvulo del sigmoides es una patología rara e infrecuente en niños y por lo tanto de baja sospecha y diagnóstico tardío. Puede ocurrir en distintos sitios del colon, siendo la forma de presentación mas frecuente a nivel del sigmoides (70 por ciento ). Se manifiesta como obstrucción intestinal baja (90 por ciento) y masas palpable (42 por ciento). Se describe asociación con retardo mental, E. de Hirschprung, sífilis congénita, constipación crónica y dieta rica en fibras (población africana). El diagnóstico se realiza por enema baritada, el que a su vez puede ser terapéutico si no existen complicaciones. Se describe cronicidad en algunos casos, con patrón de torsión y destorsión y vasos prominentes en la raíz de mesenterio que explicaría mayor resistencia a isquemia y necrosis. En casos específicos con necrosis delimitadas se describe anastomosis término terminal primaria. Se describe el único caso ocurrido en los últimos 15 años en el Servicio de Cirugía, Hospital Roberto del Río

Complicated sigmoid diverticulosis.

BACKGROUND: To evaluate the outcome of patients treated for complications of sigmoid diverticular disease. METHODS: Fifteen patients (11 women; aged 54-80 years) were treated over a 6-year period in a community hospital. Five patients presented with perforation and peritonitis, 3 with colovesical fistula, 2 with colovaginal fistula, 2 with recurrent phlegmon and 3 with bleeding. Six patients (5 with perforation, 1 colovesical fistula with hematuria) underwent emergency surgery. Six patients (2 with colovesical fistula, 2 colovaginal fistula and 2 recurrent phlegmon) underwent planned sigmoid resection. All 3 patients with bleeding were treated conservatively. RESULTS: One patient with a colovesical fistula and severe hematuria died 72 hours later with septicemia. All 5 patients with peritonitis survived; two had an eventful post-operative period and were in hospital for nearly 3 months. All 5 developed wound sepsis. Six patients who had a planned procedure had uneventful recovery. The 3 patients who presented with bleeding recovered. CONCLUSION: Complicated diverticular disease carries a high morbidity and mortality especially when operated on as an emergency. Interval sigmoid resection should be offered to patients who have recovered from an acute complication.

Presentación de dos casos de neumatosis cistoide intestinal asociado a fístulas rectovesical y sigmoidovesical y hallazgo incidental a la colonoscopia

Se presentan dos casos de neumatosis cistoide intestinal asociados a fistula rectovesical y sigmoidovesical uno de ellos diagnosticado durante la colonoscopia. Revisión de la literatura

Síndrome de Chilaiditi associada a volvo de cólon sigmóide / Chilaiditi syndrome associeted to volvulus of the sigmoid colon

A interposiçao do cólon entre o fígado e a cúpula diafragmática (síndrome de Chilaiditi) associada a volvo de cólon sigmóide constitui causa rara de abdome agudo obstrutivo, embora o volvo de sigmóide seja uma das principais causas de obstruçao intestinal mecânica no Brasil. Os autores apresentam um caso desta associaçao, ainda nao descrita na literatura, cujo diagnóstico foi sugerido pelos estudos radiológicos e confirmado cirurgicamente.

Vólvulos del colon durante el embarazo: 2 casos clínicos / Colon volvulus in pregnancy: 2 clinical cases

Se presenta 2 casos clínicos de vólvulos del colon durante el embarazo. Una paciente de 22 años portadora de un embarazo de 20 semanas se complica con un vólvulo de ciego que fue diagnosticado con el auxilio de la radiografía simple de abdomen y tratado mediante una cecostomía de tubo con buena evolución postoperatoria. Otra paciente de 39 años con un embarazo de 34 semanas se presenta con un vólvulo de sigmoides que se intentó destorcer en forma endoscópica,fracasando debido a la comprensión extrínseca provocada por el útero grávido. Durante la intervención se comprobó recuperación de la vitalidad del asa, efectuándose una colomesoplastía que solucionó la urgencia, evitando un acolostomía con evoluación postoperatoria sin incidentes. Ambas pacientes tuvieron un parto de término normal con feto vivo y sano. La paciente del megacolon complicado con un vólvulo del sigmoides fue intervenida efectivamente 18 meses después del parto, realizándose un aresección anterior de rectosigmoides y un aesfinteromiomectomía anal con fines de biopsia que reveló una enfermedad de Hirschsprung de segmento corto. En el seguimiento a largo plazo completan 9 y 8 años respectivamente y se encuentran asintomáticas desde el punto de vista digestivo. La escasa incidencia de los vólvulos durante el embarazo impide acumular experiencia sobre el tema. El diagnostico requiere de un alto grado de sospecha clínica, puesto que la necrosis de asa agrava en forma drástica el pronóstico tanto materno como fetal. La radiografía simple del abdomen es el examen de mayor relevancia en el diagnóstico de esta complicación. En los casos de vólvulo cecal agudo lo más llamativo es un gran nivel único ectópico asociado a asas del intestino delgado dilatadas. En el vólvulo del sigmoides destacan 2 niveles hidroáereos con un asa dilatada que ha perdido las haustras. En el postoperatorio de una cesárea se plantea el diagnóstico diferencial con el síndrome de Ogilvie

Volvulo de sigmoides: estudio de los pacientes operados en el Hospital Nacional Cayetano Heredia 1969-1989 / Sigmoid volvulus: study of the patients with operative treatment in Hospital Nacional Cayetano Heredia 1969-1989

Se realizó una evaluación retrospectiva de 57 pacientes operados por vúlvulo de sigmoides en el HNCH. Edad promedio de 51 años. Predominó el sexo masculino. La gestación se presentó en 4 casos. Tiempo de enfermedad promedio 3.9 dias. Las manifestaciones clínicas más frecuentes fueron: dolor y distensión abdominal (100 por ciento), no eliminación de heces y flatos (94.7 por ciento), ruidos hidroaéreos disminuidos o ausentes (78.9 por ciento), vómitos (56.1 por ciento). El estudio radiológico fue característico de esta patología. Los principales hallazgos operatorios fueron: sigmoides isquémicos y peritonitis. Las técnicas quirúrgicas realizadas: desvolvulación (36.8 por ciento) y resección primaria con anastomosis termino-terminal (28.1 por ciento) o con colostomía a lo Hartmann (28.1 por ciento). Las complicaciones post-operatorias más frecuentes: compromiso respiratorio (33.3 por ciento) e infección de herida operatoria (25 por ciento) La causa más frecuentes de reintervención quirúrgica fue evisceración. Permanencia hospitalaria promedio de 17.5 dias. La recurrencia y mortalidad fue de 7 por ciento respectivamente

Tratamento cirúrgico da obstruçäo intestinal / Surgical treatment of intestinal obstruction

A etiologia da obstruçäo intestinal (O.I.) vem se alterando desde o início do século. Nesta série, os autores estudaram 121 casos de O.I. tratados cirurgicamente; as bridas foram as causas mais comuns de obstruçäo intestinal alta (O.I.A.) com incidência de 43,03% do total de 79 pacientes operados; as hérnias apareceram como a segunda causa nas O.I.A. com 16,45% dos casos. O câncer colo-retal foi a principal causa de obstruçäo intestinal baixa (O.I.B) com 78,81% dos casos e o volvo do sigmóide ocorreu em 14,28% dos casos de O.I.B. As complicaçöes apareceram em 15,70% dos pacientes operados, sendo que a infecçäo de parede abdominal foi a mais comum. A mortalidade operatória total foi de 9,09%