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1.
Rev. méd. panacea ; 9(1): 57-60, ene.-abr. 2020. ilus
Article in Spanish | LIPECS, LILACS, LIPECS | ID: biblio-1121546

ABSTRACT

Reporte de caso: La literatura manifiesta que el quiste de uraco es raro, por lo cual el diagnóstico es aún más difícil de establecer, debido a que solo se presentan síntomas cuando ya existe una complicación, por tanto se puede suponer que algunas personas sean poseedoras de un quiste de uraco y sin presentar sintomatología, siguen con sus actividades de la vida sin problemas. A continuación, presentamos el caso de una paciente, que ingreso con una clínica sugerente de abdomen agudo por apendicitis, pero los exámenes de imágenes revelaron otro diagnóstico, confirmándose con la intervención quirúrgica y posteriormente anatomía patológica. (AU)


Case report: The literature states that the urachus cyst is rare, so the diagnosis is even more difficult to establish, because symptoms only manifest when a complication already exists, so it can be assumed that many people have a urachus cyst, and without having symptoms, they continue with their life activities without problems. Next, we present the case of a patient, who admitted to a clinic suggestive of an acute abdomen due to appendicitis, but the imaging tests revealed another diagnosis, confirming with the surgical intervention and subsequently pathological anatomy. (AU)


Subject(s)
Humans , Female , Adult , Appendicitis , Urachal Cyst/complications , Diagnosis, Differential , Abdomen, Acute/diagnosis
2.
Prensa méd. argent ; 105(10): 678-679, oct 2019.
Article in Spanish | LILACS, BINACIS, BNUY, UY-BNMED | ID: biblio-1025946

ABSTRACT

Diagnostic laparoscopy is a surgical diagnostic procedure used to examine the organs inside the abdomen by mean of an optic fiber. The patient with acute abdominal pain and with a not clearly etiology, can represent a great challenge at the moment to perform a definitive diagnosis at urgency. The paraclinic studies must be required considering the particular characteristics of each patient and its clinical presentation at the moment of the medical attention. Considering the more frequent indications for the laparoscopic approach, the diagnostic laparoscopy, occupies the third place after the acute appendicitis and the acute cholecistitis. The aim of this report was to consider a casuistic of 356 patients with acute abdominal pain of uncertain etiology, studied by the authors. Of these patients, the 88% were females. From the rsults obtained, it becomes evident that the video diagnostic laparoscopy proved to be an effective technique in the emergency department with benefit for the patients, mainly for acute cases


Subject(s)
Humans , Epidemiology, Descriptive , Retrospective Studies , Laparoscopy/rehabilitation , Emergencies , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Abdomen, Acute/therapy
3.
Rev. Col. Bras. Cir ; 46(6): e20192285, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1057186

ABSTRACT

RESUMO Objetivo: estabelecer a correlação entre dados objetivos coletados na avaliação inicial e os desfechos nos casos de dor abdominal aguda. Métodos: estudo retrospectivo, de caso controle, em que foram revisados prontuários de pacientes atendidos em um serviço de urgência e emergência no ano de 2016, diagnosticados com dor abdominal e pélvica. Resultados: de 2.352 prontuários avaliados, 330 foram considerados válidos para o estudo. Destes pacientes, 235 (71,2%) receberam alta e os 95 (28,8%) restantes foram internados, submetidos à cirurgia ou morreram. A análise estatística demonstrou que sexo masculino, idade ≥50 anos, temperatura axilar >37,3ºC, anemia, leucocitose >10.000/mm3, neutrocitose acima de 7.700/mm3, linfopenia <2.000/mm3 e hiperamilasemia são variáveis isoladamente associadas a pior desfecho. Conclusão: a presença de três ou mais das variáveis avaliadas aumenta fortemente a chance de um paciente sofrer os desfechos de cirurgia ou morte, sendo a chance de óbito tanto maior quanto maior o número de variáveis presentes.


ABSTRACT Objective: to establish a correlation between objective data collected at the initial evaluation and the outcomes in cases of acute abdominal pain. Methods: we conducted a retrospective, case-control study in which we reviewed medical records of patients treated at an emergency room in 2016, diagnosed with abdominal and pelvic pain. Results: of the 2,352 medical records evaluated, we considered 330 valid for the study. Of these patients, 235 (71.2%) were discharged and the remaining 95 (28.8%) were hospitalized, submitted to surgery, or died. The statistical analysis demonstrated that male gender, age ≥50, axillary temperature >37.3ºC, anemia, leukocytosis >10,000/mm3, neutrophil count above 7,700/mm3, lymphocyte count less than 2,000/mm3 and hyperamylasemia were variables in independently associated with worse outcome. Conclusion: the presence of three or more of the evaluated variables greatly increases the chances of a patient suffering the outcomes of surgery or death, the chance of death being greater the greater the number of variables present.


Subject(s)
Humans , Male , Female , Child, Preschool , Child , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Abdominal Pain/diagnosis , Abdomen, Acute/diagnosis , Abdominal Pain/etiology , Abdominal Pain/physiopathology , Case-Control Studies , Sex Factors , Retrospective Studies , Risk Factors , Emergency Service, Hospital , Abdomen, Acute/etiology , Abdomen, Acute/physiopathology , Middle Aged
5.
Rev. Assoc. Med. Bras. (1992) ; 63(6): 484-487, June 2017. graf
Article in English | LILACS | ID: biblio-896364

ABSTRACT

Summary Perforated gastric carcinoma is a rare condition that is hard to diagnose preoperatively. It is associated with advanced cancer stages and has a high mortality, particularly in cases presenting preoperative shock. Few studies have investigated the presentation and adequate management of these carcinomas. In addition, there are no reports in the literature on perforations extending to the spleen, as described in this case, making the management of these lesions challenging. Our article reports a case of gastric tumor perforation extending to the spleen, which presented as a perforated acute abdomen. The patient was treated with total gastrectomy and D2 lymph node resection with splenectomy and progressed well with current survival of one year at disease stage IV.


Resumo A neoplasia gástrica perfurada é uma condição incomum e de difícil diagnóstico pré-operatório, estando relacionada a estágios avançados e com alta mortalidade, principalmente na presença de choque pré-operatório. Poucos estudos foram feitos quanto a sua forma de apresentação e ao tratamento adequado. Além disso, não há nenhum relato em literatura quanto à extensão da perfuração para o baço, como é descrito neste caso, tornando mais difícil a conduta. Este artigo relata um caso de perfuração de neoplasia gástrica com extensão para o baço, que se apresentou como abdome agudo perfurativo. Submetido a gastrectomia total e ressecção linfonodal D2 com esplenectomia, apresentou boa evolução e sobrevida atual de 1 ano, em um estadiamento IV da doença.


Subject(s)
Humans , Male , Stomach Neoplasms/diagnosis , Adenocarcinoma/diagnosis , Spontaneous Perforation/diagnosis , Abdomen, Acute/diagnosis , Stomach Neoplasms/surgery , Stomach Neoplasms/complications , Adenocarcinoma/surgery , Adenocarcinoma/complications , Disease-Free Survival , Diagnosis, Differential , Spontaneous Perforation , Spontaneous Perforation/etiology , Gastrectomy , Middle Aged , Neoplasm Staging
6.
J. vasc. bras ; 16(1): f:48-l:51, Jan.-Mar. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-841407

ABSTRACT

Resumo Relatamos o caso de uma menina de 12 anos que deu entrada na unidade de emergência com quadro de abdome agudo hemorrágico, massa abdominal pulsátil e instabilidade hemodinâmica. Confirmado o diagnóstico de aneurisma roto de artéria ilíaca direita, foi realizada correção cirúrgica de emergência por reparo aberto com reconstrução extra-anatômica, utilizando enxerto sintético de fino calibre, compatível com a anatomia. O tratamento foi bem-sucedido e a criança apresentou evolução favorável em curto prazo.


Abstract We describe the case of a 12-year-old girl who presented at the emergency department with hemorrhagic acute abdomen, an abdominal pulsating mass and hemodynamic instability. A diagnosis of ruptured right iliac artery aneurysm was confirmed and an emergency open repair procedure was performed with extra-anatomic reconstruction, using a small-caliber synthetic graft, compatible with her anatomy. The treatment was successful and the child was doing well at short-term follow-up.


Subject(s)
Humans , Female , Child , Aneurysm, Ruptured/surgery , Child , Iliac Aneurysm/surgery , Iliac Artery , Abdomen, Acute/complications , Abdomen, Acute/diagnosis , Blood Vessel Prosthesis
7.
J. vasc. bras ; 16(1): f:43-l:47, Jan.-Mar. 2017. ilus
Article in Portuguese | LILACS | ID: biblio-849080

ABSTRACT

A trombose de veia porta é uma causa rara de abdome agudo vascular e está diretamente relacionada a trombofilias hereditárias ou adquiridas. O caso de um paciente de 60 anos, sexo masculino, com quadro clínico de isquemia mesentérica confirmada por exame de imagem é apresentado. Foi submetido a enterectomia e enteroanastomose e, após esplenoportografia que detectou trombose de veia porta, indicou-se tratamento medicamentoso com infusão contínua de ativador tecidual do plasminogênio recombinante (Alteplase) através de cateterismo seletivo da artéria mesentérica superior. Trata-se de um tratamento inovador. Obteve-se sucesso na recanalização do sistema porta. O paciente evoluiu com quadro de sepse abdominal, necessitando de assistência em terapia intensiva por 25 dias. Evoluiu bem e recebeu alta hospitalar com o uso de anticoagulante. O artigo apresenta uma breve revisão de literatura e discussão do caso clínico


Portal vein thrombosis is a rare vascular cause of acute abdomen and it is directly related to hereditary or acquired thrombophilias. This article presents the case of a 60-year-old male patient, with clinical signs of mesenteric ischemia that was confirmed by imaging examination. He underwent enterectomy and enteroanastomosis and, after detection of portal vein thrombosis by splenoportography, he was prescribed drug-based treatment with continuous infusion of recombinant tissue plasminogen activator (Alteplase) via selective catheterization of the superior mesenteric artery. This is a treatment innovation. The portal system was successfully recanalized. However, the patient developed abdominal sepsis and required intensive care for 25 days. His clinical status improved and he was discharged with a prescription for oral anticoagulant. This article presents a brief review of the literature and a discussion of portal vein thrombosis


Subject(s)
Humans , Male , Middle Aged , Catheterization/methods , Mesenteric Artery, Superior , Portal Vein , Thrombosis/therapy , Abdomen, Acute/diagnosis , Abdomen, Acute/therapy , Anticoagulants/therapeutic use , Mesenteric Ischemia/diagnosis , Mesenteric Ischemia/therapy , Risk Factors , Splenic Vein , Thrombolytic Therapy/methods , Tomography, X-Ray Computed/methods
8.
Rev. Soc. Bras. Clín. Méd ; 15(1): 43-45, 2017.
Article in Portuguese | LILACS | ID: biblio-833141

ABSTRACT

A ruptura esplênica é uma complicação possível da malária. É importante pela dificuldade diagnóstica, pois um elevado índice de suspeição é necessário para um diagnóstico atempado. Pode condicionar uma hemorragia intraperitoneal e deve ser considerada no diagnóstico diferencial de quadros de dor abdominal, hipotensão e diminuição do hematócrito. Os autores descrevem o caso de um homem de 59 anos, com ruptura esplênica secundária à malária por Plasmodium falciparum, tendo realizado esplenectomia urgente. Com a apresentação do caso, os autores pretendem chamar a atenção para a necessidade de incluir esta afecção no diagnóstico diferencial dos doentes com malária e hipotensão refractária.


Splenic rupture is a possible complication of malaria. Due to its difficult diagnosis, it is important, because a high level of suspicion is needed for a timely diagnosis. It results in intraperitoneal bleeding and should be considered in the differential diagnosis of abdominal pain, hypotension and low hematocrit. The authors report the case of a 59-year old man with splenic rupture secondary to malarial infection by Plasmodium Falciparum, who was treated with urgent splenectomy. This case is presented to remind the clinicians of include this entity in the differential diagnosis of patients with malaria and refractory hypotension.


Subject(s)
Humans , Male , Middle Aged , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Abdomen, Acute/surgery , Malaria/complications , Plasmodium falciparum , Rupture, Spontaneous/diagnosis , Rupture, Spontaneous/etiology , Rupture, Spontaneous/surgery , Spleen/abnormalities , Spleen/surgery , Splenic Rupture/diagnosis , Splenic Rupture/etiology , Splenic Rupture/surgery
9.
Article in Portuguese | LILACS | ID: biblio-882905

ABSTRACT

A etiologia mais comumente relacionada ao quadro de abdome agudo inflamatório na criança é a apendicite aguda. O diagnóstico é essencialmente clínico, mas quando houver dúvida diagnóstica, podem ser empregados métodos de imagem. A conduta varia de acordo com o estágio da doença.


The etiology most commonly related to inflammatory acute abdomen in children is acute appendicitis. The diagnosis is primarily clinical, but imaging methods can be used when there is diagnostic uncertainty. Management varies according to the stage of the disease.


Subject(s)
Abdomen, Acute/diagnosis , Appendicitis/drug therapy , Appendicitis/surgery , Pediatrics , Child
10.
Rev. argent. coloproctología ; 26(2): 40-44, jul. 2015. graf
Article in Spanish | LILACS | ID: biblio-973148

ABSTRACT

INTRODUCCIÓN: Se define al término “Abdomen Agudo” como al dolor abdominal de aparición repentina e intensidad severa que requiere una medida terapéutica inmediata. Debe ser considerado una emergencia médica. El cuadro clínico de apendicitis aguda presenta las características antes mencionadas, por lo que el diagnóstico certero y precoz es de importancia relevante. No siempre puede realizarse a un diagnóstico fiable y preciso con la anamnesis, el examen físico y los resultados de laboratorio de análisis, por lo que el diagnóstico imagenológico juega un rol importante para decidir la conducta a seguir. La ecografía es un examen dinámico, en tiempo real, de bajo costo y repetible debido a que no presenta los efectos adversos de la radiación. Diferentes estudios demostraron que la tasa de apendicectomías negativas disminuyó a aproximadamente el 10% con el uso rutinario de la ecografía. OBJETIVO: Correlacionar los resultados ecográficos con el diagnóstico anatomopatológico de pacientes operados con diagnóstico de apendicitis. Determinar si es un método complementario confiable para establecer diagnóstico y determinar conducta. Evaluar la tasa de apendicectomías negativas. MATERIAL Y MÉTODOS: Éste estudio de cohorte retrospectivo relacionó la ecografía y los resultados de anatomía patológica de 219 pacientes con diagnóstico de apendicitis intervenidos quirúrgicamente, entre el 1º de enero y 30 de Junio de 2014. RESULTADOS: Se realizaron ecografía abdominal a la totalidad de los pacientes operados con diagnóstico de apendicitis. De éstas, el 60,3% fueron informadas positivas para dicho diagnóstico. Todos los apéndices resecados fueron enviados a anatomía patológica, confirmándose el diagnóstico de apendicitis en el 87,7% de las piezas. Ciento cincuenta casos fueron positivos en ecografía y anatomía patológica, lo que representa el 68,49%. Once casos fueron negativos en ecografía y anatomía patológica, lo que representa el 5,02%...


INTRODUCTION: It defines the term “acute abdomen” as the sudden onset abdominal pain and severe intensity that requires immediate therapeutic measure. Should be considered medical emergency. The clinical picture of acute appendicitis presents the above characteristics, so the accurate and early diagnosis is of significant importance. You cannot always be a reliable and accurate diagnosis with history, physical examination and laboratory results of analysis, so the diagnostic imaging plays an important role in deciding what action to take. Ultrasound testis a dynamic, real-time, low-cost, repeatable because no adverse effects of radiation. Different studies showed that negative appendectomy rate decreased to approximately 10%with routine use of ultrasound. OBJECTIVE: To correlate the sonosoon graphic findings with pathologic diagnosis of patients operated with a diagnosis of appendicitis. Determine if it is a complementary method to establish reliable diagnosis and determine be havior. Assessing the negative appendectomy rate. METHODS: This retrospective cohort study linked the ultrasound and pathology results of 219 patients diagnosed with appendicitis surgery between January 1 and June 30, 2014. RESULTS: Abdominal ultra sound to all operated patients diagnosed with appendicitis were performed. Of these, 60.3% were reported positive for the diagnosis. All resected appendices were sent to pathology, confirming the diagnosis of appendicitis in 87.7% of the parts. One hundred and fifty cases were positive in ultra sound and pathology, representing 68.49%. Eleven cases were negative on ultra sound and pathology, representing 5.02%...


Subject(s)
Male , Female , Humans , Adolescent , Adult , Young Adult , Middle Aged , Aged , Abdomen, Acute/diagnosis , Appendicitis/diagnostic imaging , Appendicitis/surgery , Appendicitis/pathology , Ultrasonography , Early Diagnosis , Appendectomy , Sensitivity and Specificity , Retrospective Studies
11.
Educ. med. super ; 28(4): 643-651, oct.-dic. 2014. tab
Article in Spanish | LILACS | ID: lil-745117

ABSTRACT

Introducción: en Cuba, la expectativa de vida de la población se ha elevado considerablemente lo que hace necesaria la capacitación para un mejor desempeño de los profesionales de la salud. Objetivo: valorar los conocimientos adquiridos para el tratamiento del abdomen agudo quirúrgico en el adulto mayor en la carrera de Medicina. Métodos: se evaluaron grupos representativos con estudiantes de Medicina y docentes de la Facultad General Calixto García, mediante entrevistas de profundidad. Resultados: los estudiantes evaluaron de excelente o bien los conocimientos adquiridos sobre los síndromes abdominales agudos durante su rotación por cirugía, el 69,4 por ciento consideró que el programa de la asignatura incluye contenidos que posibilitan evaluar la urgencia abdominal del adulto mayor, el 18,4 por ciento entendió que el programa no brinda esa posibilidad y un 12,2 por ciento desconocía este hecho, el 90,8 por ciento de los estudiantes consideró que es necesaria una propuesta de modificación de los temas relacionados con el abdomen agudo en la asignatura Cirugía General, el 66,7 por ciento de los docentes opinaron que son insuficientes los contenidos impartidos en la asignatura relacionados con el tratamiento quirúrgico del abdomen agudo del anciano, para lograr las habilidades necesarias en los futuros profesionales, el 33,3 por ciento consideran que los contenidos son suficientes. Conclusión: el envejecimiento poblacional exige un mejor desempeño de los profesionales de la salud para elevar la calidad de vida del adulto mayor. El programa de la asignatura Cirugía General, que se imparte en la carrera de Medicina necesita una revisión curricular de acuerdo al contexto actual.


Introduction: life expectancy of the Cuban population has considerably risen, so the training of the health professionals is necessary to improve their performance. Objective: to assess the knowledge on treatment of acute surgical abdomen in the older adult in the medical studies. Methods: Representative groups of medical students and professors from Calixto Garcia medical school were evaluated through in-depth interviews. Results: the evaluation given by students about the acquired knowledge on the acute abdominal syndromes during their rotation in the surgery service was excellent or good. In the group, 69.4 percent stated that the subject curriculum included the elements that make the evaluation of abdominal emergency possible in the older adult whereas 18.4 percent did not and 12.2 percent ignored this fact; 90.8 percent of students deemed necessary a proposal of changing topics related to acute abdomen treatment in the general surgery subject and 66.7 percent of the professors expressed that in the present surgery curriculum, the contents taught as to the surgical treatment of the acute abdomen in the elderly was not enough for the future medical professionals to attain the necessary skills, but 33.3 percent considered these same contents as adequate. Conclusions: population aging demands better performance of health professionals to raise the quality of life of the older adult. The General Surgery subject curriculum taught in the medical studies needs to be revised in line with the present context.


Subject(s)
Humans , Aged , Abdomen, Acute/surgery , Abdomen, Acute/diagnosis , Curriculum/standards , Education, Medical/methods , Cuba , Interviews as Topic/methods
12.
Rev. med. Rosario ; 80(3): 129-134, sept.-dic. 2014. ilus
Article in Spanish | LILACS | ID: lil-740632

ABSTRACT

La gastritis enfisematosa (GE) es una entidad poco frecuente, descripta por primera vez por Fraenkel en 1889. Se caracteriza por la invasión de la pared gástrica por gérmenes productores de gas, y se asocia a una alta morbimortalidad. Se describen en la bibliografía diferentes factores de riesgo que favorecerían su desarrollo, entre ellos ingesta de cáusticos, diabetes, abuso de alcohol, isquemia gástrica y cirugía de estómago. El cuadro clínico se caracteriza por dolor abdominal agudo y progresivo asociado a repercusión sistémica, sepsis severa, shock séptico, disfunción orgánica múltiple y muerte. Los métodos de diagnóstico por imágenes cumplen un rol fundamental en su abordaje, siendo la tomografía computada multidetector (TCMD) el método de elección, ya que cuenta con la capacidad de mostrar la presencia de gas en el interior de la pared gástrica (neumatosis gástrica) en asociación con el aumento de su espesor, siendo estos dos hallazgos la clave en el diagnóstico. También se encuentra presente un aumento de la densidad del tejido perigástrico compatible con cambios de tipo inflamatorio o infeccioso, y en algunas ocasiones se asocia a neumatosis portal. Se realiza una actualización del tema enfatizando el rol de la TCMD para su diagnóstico.


Emphysematous gastritis (EG) is a rare entity first described in 1889. It is characterized by the invasion of the gastric wall by gas-producing bacteria, and is associated with high morbidity and mortality. The clinical picture is characterized by acute abdominal pain associated with progressive systemic repercussions, severe sepsis, septic shock, multiple organ dysfunction, and death. Imaging methods play a fundamental role in the diagnosis. Multidetector Computed Tomography (MDCT) is the method of choice, since it has the ability to show the presence of gas within the gastric wall (gastric pneumatosis) in association with increased wall thickness. These two features are key findings for diagnosis. Increased density of perigastric tissue is frequently present, due to infectious or inflammatory changes; sometimes portal pneumatosis is present as well. An update on EG is presented, emphasizing the role of MDCT in diagnosis.


Subject(s)
Humans , Male , Adult , Emphysema/pathology , Gastritis/pathology , Pneumatosis Cystoides Intestinalis/pathology , Diagnostic Techniques and Procedures , Tomography/methods , Abdomen, Acute/diagnosis , Melena/diagnosis
13.
Rev. Soc. Bras. Clín. Méd ; 12(4)nov. 2014. ilus
Article in Portuguese | LILACS | ID: lil-730236

ABSTRACT

O hematoma espontâneo do músculo reto abdominal é uma condição incomum, causado pela concentração de sangue emsua própria bainha muscular, sem associação com traumas, mas pelo rompimento dos vasos epigástricos ou por lesão da própria musculatura. O presente trabalho relata o caso de uma idosa de 75 anos que apresentou, após crises de tosse, intensa dor abdominal e equimose periumbilical e em flancos, simulando abdome agudo, caracterizado como hematoma espontâneo do músculo reto abdominal após exames de imagem. A paciente foi submetida a tratamento conservador, mas, no 20° dia após o quadro agudo, evoluiu com abscesso local, sendo tratada com drenagens e antibióticos. Ressalta-se a importância do reconhecimento do quadro na prática clínica, pois sua semelhança com outras condições abdominais agudas pode levar a intervenções cirúrgicas desnecessárias...


Spontaneous rectus sheath hematoma is a rare situation, caused by the accumulation of blood inside the rectus abdominal muscle sheath, not associated with trauma, because of rupture of epigastric vessels or muscle lesion. This paper reports the case ofa 75-year old woman, who presented severe abdominal pain and ecchymosis, identified as spontaneous rectus sheath hematoma after imaging. She was treated conservatively, but an abscess was drained and used antibiotics on the 20th day after the beginning of pain, finally resolving the case. This report reinforces the need for recognizing this situation in clinical practice, because it is similar to other acute abdominal conditions, and it could lead to an unnecessary surgery...


Subject(s)
Humans , Female , Aged , Abdomen, Acute/diagnosis , Hematoma , Rectus Abdominis
14.
Medicina (B.Aires) ; 74(6): 448-450, dic. 2014.
Article in Spanish | LILACS | ID: lil-750487

ABSTRACT

La apendagitis epiploica primaria es una enfermedad relativamente infrecuente dentro de los diagnósticos diferenciales del abdomen agudo. Describimos las características clínicas y evolución de una serie de 73 casos de apendagitis epiploica primaria. Se realizó una búsqueda de imágenes ecográficas y tomográficas con diagnóstico de apendagitis en el sistema de información hospitalario electrónico del Hospital Alemán entre abril del 2007 y julio del 2013 y posteriormente se revisaron sus historias clínicas. Se incluyeron 73 casos; la edad promedio fue de 45 años (± 16), 54 (74%) eran varones. El motivo de consulta fue dolor abdominal: en fosa ilíaca izquierda en 65 (el 89% de los casos); en fosa ilíaca derecha en seis (8%) y en otras localizaciones en dos (3%). Se les realizó ecografía abdominal a 44 (60%), tomografía computarizada a 21 (29%), y ambos estudios a 8 (11%). En el 49% de los casos se solicitó interconsulta con el servicio de cirugía. Recibieron tratamiento con antibióticos 15 (21%) pacientes, de los cuales el 73% fue indicado por un médico clínico. Recibieron tratamiento ambulatorio con antiinflamatorios no esteroides 67 (92%); dos requirieron cirugía laparoscópica, dos internación y dos opiáceos. La apendagitis epiploica es infrecuente dentro de los diagnósticos diferenciales de abdomen agudo, pero es una entidad que no debe ser desconocida por los médicos para prevenir intervenciones innecesarias y el uso excesivo de antibióticos.


Primary epiploic appendagitis is a relatively rare disease in the differential diagnosis of acute abdomen, nonetheless it is an entity that should not be ignored by physicians and surgeons in order to prevent unnecessary interventions and overuse of antibiotics. To substantiate this concept a search was conducted at the Hospital Aleman, Buenos Aires between April 2007 and July 2013. The aim was clinical histories containing sonographic and tomographic images with diagnosis of omental appendagitis; and subsequently their electronic medical records were reviewed. The clinical features and outcome of a case series of 73 primary omental appendagitis were selected; the mean age was 45 years (± 16); 54 (74%) were men. Abdominal pain (left lower quadrant in 89% of cases) was the most common symptom. Abdominal ultrasound was performed on 44 (60%) of patients, computed tomography on 21 (29%), and both studies on 8 (11%) of cases in this series. In 49% of cases surgery consultation was requested. Fifteen patients (21%) were treated with antibiotics, 73% of them were prescribed by a clinician. Sixty seven patients (92%) were treated as outpatients with non steroidal anti-inflammatory drugs (NSAIDs); two required laparoscopic surgery, two required hospitalization and two others were treated with opioids. Epiploic apendagitis is uncommon in the differential diagnosis of acute abdomen, but is an entity that should not be ignored by physicians to prevent unnecessary interventions and overuse of antibiotics.


Subject(s)
Adult , Female , Humans , Male , Middle Aged , Colitis/diagnosis , Abdomen, Acute/diagnosis , Abdomen, Acute/etiology , Analgesics, Opioid/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Colitis/complications , Colitis/therapy , Diagnosis, Differential , Laparoscopy , Rare Diseases , Retrospective Studies
16.
Rev. bras. ciênc. saúde ; 17(4): 371-376, 2013. ilus
Article in Portuguese | LILACS | ID: lil-786755

ABSTRACT

Objetivo: Relatar o caso vivenciado na prática de enfermagem, no manejo de complicações de pele periestoma,e avaliar as mudanças clínicas obtidas após a utilização de protetores cutâneos. Relato de caso: O estudo foi desenvolvido em uma paciente estomizada de 57 anos, cuja pele periestoma apresentava extensa dermatite periestomal com aspecto brilhante, altamente exsudativa, irritativa e dolorosa, em que o dispositivo para estomia mantinha-se adaptado por menos de 24 horas. Conclusão: Após o manejo dos protetores cutâneos, houve evolução satisfatória em relação à lesão periestomal e no emocional, o que resultou no fechamento da ileostomia.


Objective: To report a case experienced in nursing practice regarding the management of peristomal skin complications, as well as to evaluate the clinical changes obtained after the use of skin protectors. Case report: this study was developed in a patient with stoma 57, whose skin had extensive peristomal dermatitis, glossy, highly exudative, irritating and painful, who had a device installed for ostomy adapted forless than 24 hours. Conclusion: After the management of skin protectors, there was satisfactory progress in relation to peristomal and emotional injury, which resulted in the closure of the ileostomy.


Subject(s)
Humans , Female , Middle Aged , Abdomen, Acute/complications , Abdomen, Acute/diagnosis , Skin Diseases, Eczematous/complications , Skin Diseases, Eczematous/rehabilitation , Peritoneal Stomata , Wounds and Injuries , Administration, Cutaneous , Skin Diseases, Eczematous/diagnosis , Epidemiology, Descriptive , Cutaneous Fistula/surgery , Skin Absorption
17.
Radiol. bras ; 45(6): 345-350, out.-dez. 2012. ilus
Article in Portuguese | LILACS | ID: lil-660796

ABSTRACT

O objetivo deste trabalho é descrever os principais achados em tomografia computadorizada e ressonância magnética em pacientes com dor abdominal aguda decorrente de doença inflamatória pélvica. Dois radiologistas em consenso selecionaram e analisaram exames de tomografia computadorizada e ressonância magnética, realizados entre janeiro de 2010 e dezembro de 2011, de pacientes com quadro comprovado de doença inflamatória pélvica levando a um quadro de abdome agudo. Os principais achados foram coleções líquidas intracavitárias, realce anômalo na escavação pélvica e densificação dos planos adiposos anexiais. A doença inflamatória pélvica é uma das principais causas de dor abdominal em mulheres em idade reprodutiva e tem sido progressivamente diagnosticada mediante uso da tomografia computadorizada e ressonância magnética, que complementam o papel da ultrassonografia. É crucial que os radiologistas se familiarizem com os principais aspectos diagnósticos em imagem seccional desta causa comum de abdome agudo.


The present study was aimed at describing key computed tomography and magnetic resonance imaging findings in patients with acute abdominal pain derived from pelvic inflammatory disease. Two radiologists consensually selected and analyzed computed tomography and magnetic resonance imaging studies performed between January 2010 and December 2011 in patients with proven pelvic inflammatory disease leading to presentation of acute abdomen. Main findings included presence of intracavitary fluid collections, anomalous enhancement of the pelvic excavation and densification of adnexal fat planes. Pelvic inflammatory disease is one of the leading causes of abdominal pain in women of childbearing age and it has been increasingly been diagnosed by means of computed tomography and magnetic resonance imaging supplementing the role of ultrasonography. It is crucial that radiologists become familiar with the main sectional imaging findings in the diagnosis of this common cause of acute abdomen.


Subject(s)
Humans , Female , Abdomen, Acute/diagnosis , Pelvic Inflammatory Disease/diagnosis , Pelvic Inflammatory Disease/etiology , Abdominal Pain , Fallopian Tubes , Magnetic Resonance Spectroscopy , Acute-Phase Reaction/etiology , Salpingitis , Tomography, X-Ray Computed
18.
Radiol. bras ; 44(5): 333-335, set.-out. 2011. ilus
Article in Portuguese | LILACS | ID: lil-612938

ABSTRACT

Os autores apresentam um caso de síndrome de Chilaiditi em uma mulher de 56 anos de idade. Mesmo tratando-se de condição benigna com rara indicação cirúrgica, reveste-se de grande importância pela implicação de urgência operatória que representa o diagnóstico equivocado de pneumoperitônio nesses pacientes. É realizada revisão da literatura, com ênfase na fisiopatologia, propedêutica e tratamento desta entidade.


The authors report a case of Chilaiditi's syndrome in a 56-year-old woman. Although this is a benign condition with rare surgical indication, it has great importance for implying surgical emergency in cases where such condition is equivocally diagnosed as pneumoperitoneum. A literature review is performed with emphasis on pathophysiology, diagnostic work-up and treatment of this entity.


Subject(s)
Humans , Female , Middle Aged , Abdomen, Acute , Abdomen, Acute/diagnosis , Colon/abnormalities , Diaphragm/abnormalities , Liver/abnormalities , Pneumoperitoneum , Radiography, Thoracic , Syndrome
19.
Rev. Asoc. Méd. Argent ; 124(3): 24-25, sept. 2011. ilus
Article in Spanish | LILACS | ID: lil-646666

ABSTRACT

La apendagitis epiploica aguda se presenta comúnmente con dolor agudo en el cuadrante inferior del abdomen. Es importante diagnosticar correctamente esta condición debido a que sus características clínicas son similares a las de la diverticulitis aguda o, con menor frecuencia, la apendicitis aguda, y el error puede conducir a una cirugía innecesaria. Las características en tomografia computada (TC) de la apendagitis epiploica aguda incluyen una lesión oval de 1,5 a 3,5 cm de diámetro, con una atenuación similar a la de la grasa vecina y con cambios inflamatorios, en contacto con la pared anterior del colon sigmoideo. Las condiciones que pueden confundirse con apendagitis epiploica aguda en la TC incluyen el infarto agudo de epiplón, la paniculitis mesentérica, un tumor de contenido graso, y los procesos inflamatorios agudos primarios o secundarios del colon. Presentamos una paciente en la que el reconocimiento de esta enfermedad en la TC permitió la indicación del tratamiento adecuado, evitando una cirugía innecesaria.


Acute epiploic appendagitis most commonly presents with acute lower quadrant pain. It is important to correctly diagnose this condition, beca- use Its clinical features are similar to those of acute diverticulitis or, less commonly, acute appendicitis, and the mistake may lead to unnecessary surgery. The computed tomography (CY) fea tu res of acute epiploic appendagitis include an oval lesion 1.5 - 3.5 cm in diameter, with attenuation similar to that of fat and with surrounding inflammatory changes, that abuts the anterior sigmoid colon wall. The conditions that may mimic acute epiploic appendagitis at CT include acute omental infarction, mesenteric panniculitis, a fat-containing tumor, and primary and secondary acute inflammatory processes in the large bowel. We report a female patient in which the recognition of this condition on CT images allowed appropriate management, and prevented an unnecessary surgery.


Subject(s)
Humans , Adult , Female , Abdomen, Acute/diagnosis , Abdomen, Acute , Tomography, X-Ray Computed , Acute Disease , Colon/injuries , Diagnostic Imaging
20.
Salud(i)ciencia (Impresa) ; 18(5): 437-440, ago. 2011.
Article in Spanish | LILACS | ID: lil-620054

ABSTRACT

La utilidad de la resonancia magnética para el diagnóstico en el abdomen agudo en el embarazo está demostrada. Permite evaluar el ángulo de inclinación cecal para intentar identificar el apéndice en una paciente embarazada con diagnóstico presuntivo de apendicitis. Se requiere una elevada sospecha diagnóstica para determinar que una embarazada con antecedentes de cirugía bariátrica padece un cuadro de obstrucción de intestino delgado. Los métodos de diagnóstico por imágenes no siempre resultan útiles en esta ocasión. Estos métodos carecen de la sensibilidad suficiente como para reemplazar el examen clínico oportuno de una embarazada con diagnóstico presuntivo de apendicitis. La demora del tratamiento incrementa la morbilidad. El tratamiento conservador de una ruptura apendicular se basa sobre la información retrospectiva. Sólo existen publicaciones de casos aislados sobre el empleo de esta estrategia en las embarazadas.


Subject(s)
Humans , Female , Pregnancy , Abdomen, Acute/diagnosis , Abdomen, Acute , Pregnancy Complications/diagnosis , Pregnancy Complications , Magnetic Resonance Spectroscopy/instrumentation , Magnetic Resonance Spectroscopy
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