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1.
Article in Portuguese | LILACS | ID: biblio-1369019

ABSTRACT

RESUMO: Obstrução intestinal é a manifestação clínica mais frequente de tumores de cólon sendo esses, em sua maioria, localizados no cólon descendente e reto-sigmoide. A cirurgia de emergência para obstrução intestinal é associada a altos riscos de mortalidade e de morbidade e a abordagem ideal permanece controversa. Procedimentos em vários estágios e o uso de stents como ponte para cirurgia são opções promissoras. É apresentado um caso de paciente de 61 anos, com abdome agudo obstrutivo secundário à neoplasia colorretal, com ênfase em seu diagnóstico e tratamento. (AU)


ABSTRACT: Intestinal obstruction is the most frequent clinical manifestation of colon tumors, most of which are located in the descending and recto-sigmoid colon. Emergency bowel obstruction surgery is associated with high mortality and morbidity risks and the ideal approach remains controversial. Multi-stage procedures and the use of stents as bridges for surgery are promising options. A case of a 61-year-old patient with an acute obstructive abdomen secondary to colorectal neoplasm is presented, with emphasis on its diagnosis and treatment. (AU)


Subject(s)
Humans , Female , Middle Aged , Colorectal Neoplasms , Colectomy , Abdomen, Acute , Intestinal Obstruction/surgery , Megacolon/diagnosis
2.
Rev. Méd. Inst. Mex. Seguro Soc ; 59(6): 579-584, 01-dic-2021. ilus
Article in Spanish | LILACS | ID: biblio-1357673

ABSTRACT

Introducción: el sarcoma fibromixoide de bajo grado (LGFMS) se considera un tumor de tejidos blandos raro, que tiene tendencia a surgir del tronco y de las extremidades inferiores, su localización en el área intraabdominal se considera poco común. Objetivo: describir un caso de LGFMS primario de colon transverso perforado con metástasis hepática. Caso clínico: describimos el caso de un paciente masculino de 57 años con dolor abdominal de inicio súbito; en la cirugía se encontró un tumor con absceso y perforación en el colon transverso que infiltraba hasta la raíz del mesenterio. Se realizó hemicolectomía izquierda extendida con colostomía de colon ascendente. Más tarde, en una exploración posoperatoria, se encontró que tenía enfermedad hepática metastásica. Conclusiones: este caso es único en términos de ubicación y presentación. Es un recordatorio del diagnóstico diferencial del dolor abdominal agudo. Hasta donde sabemos, es el primer caso de LGFMS del colon con metástasis hepática sincrónica.


Background: Low grade fibromyxoid sarcoma (LGFMS) is considered a rare soft tissue tumor and has a tendency to arise from deep soft tissue of the trunk and lower extremities, the intraabdominal area is considered a rare location. Objective: To describe the first case of a LGFMS arising from the transverse colon with liver metastasis Clinical case: We describe a 57-years-old male patient with abdominal pain of sudden onset; at surgery he was found to have an abscessed tumor in the transverse colon that infiltrated to mesentery root. An extended left hemicolectomy was performed with ascending colon colostomy. Later on, a postoperative scan he was found to have metastatic liver disease Conclusions: This case is unique in terms of the location and presentation. It's a reminder of differential diagnosis of acute abdominal pain. To our knowledge is the first case of a LGFMS of the colon with synchronous liver metastasis.


Subject(s)
Humans , Male , Female , Colonic Neoplasms , Intestinal Perforation , Neoplasm Metastasis , Sarcoma , Tertiary Healthcare , Colostomy , Abdominal Pain , Colectomy , Colon , Colon, Ascending , Liver Diseases
3.
Rev. cuba. cir ; 60(3): e1117, 2021.
Article in Spanish | LILACS, CUMED | ID: biblio-1347393

ABSTRACT

Introducción: El plastrón apendicular es una tumoración inflamatoria constituida por el apéndice inflamado, vísceras adyacentes y epiplón mayor. Puede contener o no pus (absceso/flemón). Objetivo: Precisar si está indicada la apendicectomía de urgencia o de intervalo en los pacientes con plastrón y/o absceso apendicular sometidos a tratamiento no quirúrgico inicial. Métodos: Se realizó una revisión en las bases de datos bibliográficas Web of Science, PubMed, Medline y Lilacs, mediante el motor de búsqueda Google académico. Se seleccionaron 28 artículos en inglés y español; 20 (71,2 por ciento) correspondieron al quinquenio 2016-20 y el 96,4 por ciento de autores extranjeros. Desarrollo: El estándar actual es el tratamiento no quirúrgico inicial del plastrón y el drenaje percutáneo del absceso. La apendicectomía de intervalo tiene un beneficio mínimo y puede conducir a un aumento de los costos, estancia hospitalaria, antibioticoterapia intravenosa y de la morbilidad. Se debe realizar un seguimiento cuidadoso en enfermos con riesgo de enfermedad inflamatoria intestinal o cáncer de colon, sin importar qué opción se elija (operación de intervalo u observación). Conclusiones: La apendicectomía de urgencia no es recomendable porque el componente inflamatorio la hace técnicamente difícil, puede necesitar una colectomía y aumentar la morbilidad, aunque actualmente, la apendicectomía laparoscópica de urgencia puede ser más rentable y segura. La decisión posterior de la apendicectomía a intervalos sigue siendo discutible. El intervalo recomendado varía entre 6 y 8 semanas, tres y seis meses después de la normalización clínico humoral(AU)


Introduction: Appendiceal plastron is an inflammatory tumor made up of inflamed appendix, adjacent viscera and greater omentum. It may or may not contain pus (abscess/phlegmon). Objective: To specify whether emergency or interval appendectomy is indicated in patients with appendicular abscess and/or plastron who had undergone initial nonsurgical treatment. Methods: A review was carried out in the bibliographic databases Web of Science, PubMed, Medline and Lilacs, using the search engine Google Scholar. Twenty-eight articles were selected, in English and Spanish; twenty (71.2 percent) corresponded to the quinquennium 2016-20, while 96.4 percent were written by foreign authors. Development: The current standard is the initial nonsurgical treatment of the plastron and percutaneous drainage of the abscess. Interval appendectomy has minimal benefits and can lead to increased costs, hospital stay, intravenous antibiotic therapy and morbidity. Patients at risk for inflammatory bowel disease or colon cancer should be carefully followed up, regardless of which option is chosen (interval operation or observation). Conclusions: Emergency appendectomy is not recommended because the inflammatory component makes it technically difficult; it may require colectomy and increase morbidity, although currently, emergency laparoscopic appendectomy may be more profitable and safer. The subsequent decision for interval appendectomy remains debatable. The recommended interval varies from six to eight weeks, three and six months after clinical-humoral normalization(AU)


Subject(s)
Humans , Appendectomy/methods , Inflammatory Bowel Diseases/epidemiology , Abscess/etiology , Emergencies , Databases, Bibliographic , Colectomy/methods , Search Engine/methods
4.
Gac. méd. Méx ; 157(2): 154-159, mar.-abr. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1279095

ABSTRACT

Resumen Antecedentes: La colitis ulcerosa crónica idiopática (CUCI) es una enfermedad con inflamación crónica de la mucosa del colon de origen multifactorial. El objetivo de este trabajo es identificar posibles cambios en el comportamiento de la CUCI en un hospital de referencia. Métodos: Se incluyeron nuevos casos de CUCI confirmados por histopatología de enero del 2007 a diciembre del 2014. Resultados: Se incluyeron un total de 189 pacientes. La media de nuevos casos anuales de CUCI fue de 23.6. Este estudio incorpora 95 pacientes de sexo masculino (50 %) y 94 de sexo femenino (50 %), con una edad promedio al diagnóstico de 44.6 años. La frecuencia de pancolitis fue del 77 %, en comparación con el 59 % en el periodo anterior. Las manifestaciones extraintestinales (MEI) estuvieron presentes en el 55.8 % y las colectomías en el 5.2 %. Conclusión: Algunas características de la enfermedad han cambiado con el tiempo: aumento de la frecuencia de pancolitis y MEI, así como disminución de la tasa de colectomías.


Abstract Background: Chronic idiopathic ulcerative colitis (CIUC) is a disease with multifactorial chronic inflammation of the colonic mucosa. In Mexico, there are studies that show an increase in the frequency of new cases. The purpose of this work was to identify possible changes in CIUC behavior in a referral hospital. Methods: New ulcerative colitis (UC) cases confirmed by histopathology from January 2007 to December 2014 were included. Results: A total of 189 patients were included. Mean number of UC annual new cases was 23.6. The study included 95 male patients (50 %) and 94 female patients (50 %), with an average age of 44.6 years at diagnosis. The frequency of pancolitis was 77 %, in comparison with 59 % in the previous period. Extra-intestinal manifestations (EIM) were present in 55.8 % and colectomies in 5.2 %. Conclusion: Some characteristics of the disease have changed over time: there is an increased frequency of pancolitis and EIM, as well as a decrease in the rate of colectomies.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Colitis, Ulcerative/epidemiology , Colitis, Ulcerative/surgery , Colitis, Ulcerative/complications , Comorbidity , Incidence , Retrospective Studies , Sex Distribution , Colectomy/statistics & numerical data , Age Distribution , Tertiary Care Centers/statistics & numerical data , Mexico/epidemiology
5.
Arch. argent. pediatr ; 119(2): e158-e162, abril 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1152049

ABSTRACT

La dilatación segmentaria intestinal es una entidad congénita extremadamente rara, caracterizada por la dilatación local del intestino que no se debe a la obstrucción distal ni a la ausencia de células ganglionares. Se presenta el caso clínico de una paciente en el período neonatal con la presentación típicamente descrita en esta enfermedad en ausencia de comorbilidades, forma clínica poco descrita en la bibliografía. Se desarrolla también la resolución quirúrgica con resección segmentaria y los hallazgos anatomopatológicos.


Segmental dilatation of the intestine is an extremely rare congenital entity characterized by a local dilation of the intestine without distal obstruction or the absence of ganglion cells. We present the case of a patient in the neonatal period with typical clinical features in absence of other comorbidities, shortly published in the bibliography. We also describe the surgical resolution and the pathological results.


Subject(s)
Humans , Female , Infant, Newborn , Intestinal Obstruction/diagnostic imaging , Colectomy , Dilatation
6.
Autops. Case Rep ; 11: e2021319, 2021. graf
Article in English | LILACS | ID: biblio-1285395

ABSTRACT

Background The bowel is the most common site of extragenital endometriosis, with involvement of the locoregional sigmoid colon and anterior rectum seen most often. The clinical presentation varies depending on how soon patients seek medical care, thus requiring changes in management strategies. Endometriosis can cause a life-threatening surgical emergency with progressive obliteration of the bowel lumen leading to obstruction and late complications including toxic megacolon and transmural necrosis. Case presentation We report the case of a 41-year-old woman presenting with an acute abdomen and complete large bowel obstruction complicated by sepsis and toxic megacolon. The patient underwent emergency total colectomy with ileostomy. Medical history was significant for chronic, vague, and episodic lower abdominal pain self-medicated with herbal tea and laxatives. Pathologic examination demonstrated colonic endometriosis within the bowel wall as the cause of obstruction, ischemia, and transmural necrosis. Conclusions Although a rare clinical entity, this case highlights two important points. First, it demonstrates the value of performing proper and complete clinical work up to rule out or in all possible causes of colonic obstruction, including intestinal endometriosis. Second, it suggests a potential benefit of a formalized multidisciplinary approach, including surgery, in the management of medically unresponsive endometriosis. In conclusion, this case shows that endometriosis can cause life-threatening colonic obstruction in women of childbearing age. Prompt early intervention is warranted, particularly when obstruction is only partial and ischemia has not supervened, to conceivably prevent the development of a toxic megacolon requiring colectomy and avoid late complications.


Subject(s)
Humans , Female , Adult , Endometriosis , Megacolon, Toxic , Colectomy , Abdomen, Acute
8.
An. Fac. Cienc. Méd. (Asunción) ; 54(2): 151-156, 2021.
Article in Spanish | LILACS | ID: biblio-1281113

ABSTRACT

La Colitis Ulcerativa (CU) es una enfermedad crónica multifactorial de etiología desconocida caracterizada por la presencia de inflamación difusa en la mucosa colónica en presencia de diarrea sanguinolenta asociada con urgencia y tenesmo rectal. Una mujer de 51 años, acudió al Servicio de Urgencias por rectorragia con molestias en hipogastrio y tenesmo, además un mes y medio de deposiciones liquidas, sensación febril intermitente, anorexia, nauseas sin vómitos y pérdida de peso de aprox. 10 kilos en 1 mes, con un abdomen distendido, levemente depresible, doloroso en hipogastrio. La colonoscopía y anatomía patológica informan una Rectocolitis Ulcerativa Pancolónica. La paciente continua con mala evolución a pesar de tratamiento médico, por lo que se decide el manejo quirúrgico con una colectomía subtotal con confección de ileostomía y fístula mucosa de sigmoides por colitis aguda grave refractaria al tratamiento. El manejo médico previo al manejo quirúrgico en este caso se vio limitado por la disponibilidad de fármacos. Esto resalta la necesidad del conocimiento del manejo multidisciplinario de las patologías colorectales.


Ulcerative Colitis (UC) is a multifactorial chronic disease of unknown etiology characterized by the presence of diffuse inflammation in the colonic mucosa and often the presence of bloody diarrhea associated with rectal urgency. A 51-year-old woman came to the emergency room due to rectal bleeding with hypogastric pain and tenesmus, in addition to a month and a half of diarrhea, intermittent fever, anorexia, nausea without vomiting and weight loss of approx. 10 kilos in 1 month, with a distended abdomen, slightly depressible, painful in the hypogastrium. Colonoscopy and pathological anatomy report a Pancolonic Ulcerative Rectocolitis. The patient continues with poor evolution despite medical treatment, so a surgical approach is decided with a subtotal colectomy, terminal ileostomy and sigmoid fistula due to severe acute colitis refractory to treatment. Medical treatment prior to a surgical approach in this case was limited by the availability of drugs. This highlights the need for a multidisciplinary management of colorectal pathologies.


Subject(s)
Anorexia , Colitis, Ulcerative , Chronic Disease , Colectomy , Diarrhea , Colon, Sigmoid , Abdomen
9.
Rev. argent. cir ; 112(4): 508-516, dic. 2020. graf, il, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-1288163

ABSTRACT

RESUMEN Antecedentes: la fístula anastomótica (FA) es una de las complicaciones más severas de la cirugía colo rrectal. Su desarrollo obedece a múltiples factores dependientes del paciente y la técnica operatoria; entre estos últimos podemos mencionar la vascularización de los cabos como uno de los principales. La angiografía fluorescente (AF) permite la evaluación de ese factor en tiempo real durante la cirugía. Objetivo: describir la experiencia en el uso de la AF durante la cirugía colorrectal en un Hospital Uni versitario de la ciudad de Buenos Aires, registrar el cambio de conducta quirúrgica inducido por el uso de la AF y la incidencia de FA. Material y métodos: entre enero de 2016 y junio de 2018 se incluyeron 37 pacientes sometidos a resecciones colónicas programadas y con evaluación de la perfusión con AF. Resultados: la AF pudo realizarse en todos los pacientes con un tiempo operatorio extra de 3 a 9 mi nutos, registrando un cambio de conducta en 4 (10,81%) pacientes. Se registraron 2 (5,41%) fístulas anastomóticas. Conclusiones: la AF con verde de indocianina durante la cirugía colorrectal fue factible, sumó mínima complejidad y tiempo a la operación tradicional, y permitió cambiar la conducta en la sección intestinal en el 11% de los casos, con baja tasa de fístulas anastomóticas.


ABSTRACT Background: Anastomotic leak (AL) is one of the most feared complication of colorectal surgery. Its development is dependent of patient and surgery factors. Of these, bowel perfusion is one of the most important. Fluorescent angiography (FA) allows the identification in real time of the bowel perfusion. Objective: to describe the experience in the use of FA during colorectal surgery in a University Hospital setting in Buenos Aires, to register the change in surgical plan according to the FA findings and record the incidence of AL. Material y methods: Between January 2016 and June 2018, 37 patients with scheduled colorectal resections and FA bowel perfusion assessment were included. Results: Perfusion assessment with FA was possible in all cases with an extra operative time of 3 to 9 minutes, a change in surgical plan was registered in 4 cases (10.81%) and 2 AL were recorded (5.41%). Conclusions: FA during colorectal surgery is feasible, with minimum extra operative time and results in a change in surgical plan in 11% of the cases, and low rate of anastomotic fistula.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Fluorescein Angiography , Colorectal Neoplasms/surgery , Colon/surgery , Colectomy , Colorectal Surgery , Anastomotic Leak
11.
Int. j. morphol ; 38(5): 1212-1216, oct. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1134427

ABSTRACT

RESUMEN: La ingestión de mondadientes (IM) constituye un evento poco frecuente (se han publicado alrededor de 157 casos a nivel mundial), pero puede causar perforaciones intestinales (PI), con peritonitis, sepsis e incluso muerte. Este hecho, determina la necesidad de intervenir quirúrgicamente a la mayoría de estos pacientes. El objetivo de este manuscrito fue informar resultados del tratamiento quirúrgico de 3 casos de PI por IM. Caso 1: hombre de 52 años, con perforación duodenal y de la vesícula biliar. Caso 2: Mujer de 54 años con perforación cecal. Caso 3: hombre de 72 años, con perforación de colon izquierdo y lesión esplénica. Todos fueron hospitalizados por dolor abdominal y fiebre. En dos casos el diagnóstico se verificó por tomografía y en uno por ecotomografía. Los tres casos fueron intervenidos quirúrgicamente a través de laparotomía. Intervenciones: Caso 1: se realizó colecistectomía y sutura duodenal. Caso 2: se realizó hemicolectomía derecha e ileotransverso anastomosis. Caso 3: se realizó hemicolectomía izquierda y esplenectomía. En todos los casos se encontró el mondadientes. Todos los pacientes evolucionaron de forma satisfactoria, sin complicaciones postoperatorias. La IPD es una emergencia quirúrgica. Las PI son comunes y la peritonitis asociada es frecuente. El pronóstico depende de un diagnóstico precoz y un tratamiento oportuno.


SUMMARY: Toothpick ingestion (TPI) is a rare event, but can cause intestinal perforation (IP), peritonitis, sepsis, and even death (approximately 157 cases have been published worldwide). This fact determines the need for surgical intervention in most of these patients. The aim of this manuscript was to report the results of the surgical treatment in 3 cases of IP by TPI. The report involves the following: Case 1: A 52-year-old man, with duodenal and gallbladder perforation. Case 2: A 54-year-old woman with cecal perforation. Case 3: A 72-year-old man, with perforation of the left colon and splenic rupture. All were hospitalized for abdominal pain and fever. In two of the cases the diagnosis was verified by tomography and in one by ultrasound. All three patients underwent laparotomy. In the first case (1), cholecystectomy and duodenal suture were performed; in the second case (2) right hemicolectomy and ileo-transverse anastomosis were performed, and in the third case (3), Left hemicolectomy and splenectomy were performed. Toothpick was found in all cases. The patients in this report all evolved satisfactorily without postoperative complications. In conclusion, TPI is a surgical emergency. IP are common and the associated peritonitis is high. Prognosis depends on early diagnosis and timely treatment.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Foreign Bodies/surgery , Intestinal Perforation/surgery , Cholecystectomy , Abdominal Pain/etiology , Treatment Outcome , Colectomy , Foreign Bodies/complications , Intestinal Perforation/etiology
12.
Rev. cuba. cir ; 59(3): e918, jul.-set. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144442

ABSTRACT

RESUMEN Introducción: Los tumores miofibroblásticos son tumores benignos de origen mesenquimal, de etiología incierta, y frecuente en niños y jóvenes. Objetivo: Describir un nuevo caso de tumor miofibroblástico abdominal. Caso clínico: Se presenta una paciente de 20 años con antecedentes de salud con dolor en abdomen derecho, se realiza tomografía de abdomen contrastada que informa una masa hiperdensa no homogénea en flanco derecho. Se realiza resección quirúrgica del tumor y el estudio anatomopatológico informa un tumor miofibroblástico inflamatorio. Su pronóstico es favorable porque es una entidad benigna y no metastiza. Conclusiones: Los tumores miofibroblásticos de colon son infrecuentes, benignos, que al diagnosticarlos deben resecarse ampliamente para evitar la recidiva(AU)


ABSTRACT Introduction: Myofibroblastic tumors are benign tumors of mesenchymal origin, of uncertain etiology, and frequent in children and young people. Objective: To describe a new case of abdominal myofibroblastic tumor. Clinical case: The case is presented of a 20-year-old female patient with a health history and pain in the right abdomen. Contrasted abdominal tomography is performed, which shows an inhomogeneous hyperdense mass in the right flank. Surgical resection of the tumor was performed. The pathological study reported an inflammatory myofibroblastic tumor. Its prognosis is favorable because it is a benign entity that does not metastasize. Conclusions: Colon myofibroblastic tumors are infrequent, benign, and when diagnosed, they must be widely removed to avoid recurrence(AU)


Subject(s)
Humans , Female , Young Adult , Abdominal Pain/etiology , Colectomy/methods , Granuloma, Plasma Cell/diagnostic imaging , Neoplasms, Muscle Tissue/diagnosis
13.
J. coloproctol. (Rio J., Impr.) ; 40(3): 237-242, July-Sept. 2020. tab, ilus
Article in English | LILACS | ID: biblio-1134985

ABSTRACT

Abstract Introduction: Minimally invasive colectomy has been performed for some years for many patients worldwide without much complications compared to the open approach. In this study we explained our experience regarding a modification in laparoscopic total colectomy and removing the specimen with Natural Orifice Specimen Extraction (NOSE) through rectum using a plastic cover for the first time. Methods and material: This was an experimental study on a new technique of total colectomy with a small modification. Total colectomy was performed based on 7 port laparoscopic approach. Rectum was sparred. Colon was then taken out through the anal canal using a plastic cover. Results: Thirteen patients underwent laparoscopic total colectomy by removal of the specimen through rectum. Mean age of patients was 42.23 ± 8.15 years. Mean duration of operation was 130 ± 32.4 min. All patients had an uneventful postoperative hospitalization. Discussion: Laparoscopic total colectomy has been proven to have superior benefits than the open approach. In NOSE technique, colon is removed from the anal canal without any complication or consuming much time. This technique might have less pain and removes the complications associated with an incision on the skin to remove the specimen. Also, due to low price of a usual plastic cover, it can be used instead of other techniques to remove the specimen through the rectum.


Resumo Introdução: A colectomia minimamente invasiva vem sendo realizada há alguns anos em muitos pacientes no mundo inteiro, apresentando menos intercorrências do que a abordagem aberta. Neste estudo, os autores relatam sua experiência com uma modificação da colectomia total laparoscópica e extração de espécime em orifício natural (NOSE) pelo reto, usando uma cobertura plástica pela primeira vez. Métodos e materiais: Este foi um estudo experimental sobre uma nova técnica de colectomia total com uma pequena modificação. A colectomia total foi realizada com base na abordagem laparoscópica de sete portas. O reto foi poupado. O cólon foi então retirado pelo canal anal usando uma cobertura plástica. Resultados: Treze pacientes foram submetidos a colectomia total laparoscópica por remoção do espécime pelo reto. A idade média dos pacientes foi de 42,23 ± 8,15 anos. A duração média da operação foi de 130 ± 32,4 minutos. Para todos os pacientes, a internação pós-operatória transcorreu sem intercorrências. Discussão: Foi comprovado que a colectomia total laparoscópica apresenta benefícios superiores à abordagem aberta. Na técnica NOSE, o cólon é removido mais rapidamente do canal anal, sem nenhuma intercorrência. Essa técnica pode causar menos dor e remove as complicações associadas a uma incisão na pele para remover o espécime. Além disso, devido ao baixo preço de uma cobertura plástica comum, ela pode ser usada no lugar de outras técnicas para remover o espécime pelo reto.


Subject(s)
Humans , Male , Female , Laparoscopy/methods , Colectomy/methods , Natural Orifice Endoscopic Surgery , Colon/surgery , Colorectal Surgery , Minimally Invasive Surgical Procedures
14.
Prensa méd. argent ; 106(6): 352-356, 20200000.
Article in Spanish | LILACS, BINACIS | ID: biblio-1367043

ABSTRACT

El hemangioma de colon y recto es una entidad poco frecuente. El tipo cavernoso, es aún más raro por lo que existen pocos reportes de esta patología. Afecta mayormente al recto y al sigmoides, y el modo de presentación más común es la proctorragia indolora en el 90% de los casos. Más frecuente en adultos jóvenes. Esta entidad para su diagnóstico requiere alta sospecha y la realización de los estudios pertinentes ya que suele confundírsela con patologías más comunes. En esta revisión se presenta el caso de un paciente masculino de 58 años con un hemangioma cavernoso de colon transverso que se manifestó inicialmente como hematoquecia asociada a astenia. Luego de realizar estudios complementarios, se decide conducta quirúrgica. Se realizó resección de colon transverso con buena evolución postoperatoria. El resultado de anatomía patológica nos informa Hemangioma Cavernoso de colon transverso.


The hemangioma of the colon and rectum is a rare entity. The cavernous type is even more rare, so there are few reports of this pathology. It mainly affects the rectum and the sigmoid, and the most common presentation is painless proctorrhagia in 90% of cases. More frequent in young adults. This entity for its diagnosis requires high suspicion and the realization of the pertinent studies since it is usually confused with more common pathologies. In this review we present the case of a 58-year-old male patient with a cavernous hemangioma of the transverse colon that initially manifested as hematochezia associated with asthenia. After performing complementary studies, surgical behavior is decided. Transverse colon resection was performed with good postoperative evolution. The result of pathological anatomy informs us Cavernous hemangioma of transverse colon


Subject(s)
Humans , Male , Middle Aged , Colectomy , Colon, Transverse/surgery , Hemangioma/pathology , Hemangioma, Cavernous/pathology
15.
Prensa méd. argent ; 106(5): 305-312, 20200000. graf, tab
Article in English | LILACS, BINACIS | ID: biblio-1367286

ABSTRACT

Antecedentes: Los TNE-GEP son raros y se originan en el sistema endocrino localizado en el tubo gastrointestinal (carcinoides) y en el páncreas (tumores insulares) con una gran variedad de presentaciones clínicas. Diseño: Cooperativo, Retrospectivo y protocolizado Material y Métodos: Entre enero del 2005 y diciembre del 2018, un trabajo cooperativo, con el Servicio de Guardia Central del HNC, Servicio de Cirugía General "Pablo Luis Mirizzi" del HNC y Clínica Privada Caraffa, se intervinieron quirúrgicamente 24 pacientes con TNEGEP. Del total, 14 pertenecían al sexo femenino (58.3 %) y los 10 restantes al masculino (41.6 %), con un rango etario entre 20 y 82 años de edad con un promedio de 55.3 años. Resultados: La localizaciones fueron 4 de estómago (16.6 %), 14 en intestino (58.3 %) y finalmente 6 en la cabeza del páncreas (25 %). En relación al estómago en los 4 pacientes se llevó a cabo una gastrectomía total y la anatomía patológica en tres demostró carcinoma neuroendocrino de bajo grado y el cuarto de alto grado, falleciendo esta última. Las lesiones de intestino 5 de apéndice menores de 1 cm. La anatomía patológica fue apendicitis aguda más, un Carcinoma neuroendocrino de bajo grado. En región ileocecal, en cuatro se realizó hemicolectomía derecha. En tres eran carcinoma de bajo grado que viven y cuarto de alto grado con mtts hepáticas que falleció. En tres de íleon todos fueron oclusivos, llevándose a cabo resecciones intestinales, en dos carcinomas de bajo grado y ultimo de moderado grado con metástasis (mtts) hepáticas que vive. Los tumores de colon fueron, uno ascendente con mtts hepáticas y se realizó colectomía derecha más resecciones hepáticas, siendo la anatomía patológica un carcinoma de alto grado y otro un colon descendente de bajo grado. Las 6 lesiones de páncreas, 3 fueron no funcionantes y otras tres funcionantes. A todos se les practico DPC. Conclusiones: Los TNE-GEP son una patología rara cuya frecuencia es de aparición constante. Con la mejora de los métodos de imágenes, nos encontramos ante un aumento de la presunción preoperatoria y ante sus mejores posibilidades oncológicas, una patología que todo cirujano debe conocer y pensar.


Background: Neuroendocrine tumors (NET) of the gastrointestinal tract (GIT)- are rare and are originated in the endocrine system located in the gastrointestinal tract (carcinoids) and in the pancreas (islet cell tumors) with a variety of clinical presentations. Design: Cooperative, retrospective. Method: Between January 2005 and December 2018, a cooperative work in the Central Guard Service of the HNC, General Surgery Service "Pablo Luis Mirizzi" of the HNC and Caraffa Private Clinic, 24 patients with NET-GIT underwent surgical treatment. Of the total, 14 were females (58.3%) and the remaining 10 (41.6%) were men aged 20 to 82 years, with an average of 55.3 years. Results: The locations were 4 in the stomach (16.6%), 14 in the intestine (58.3%) and finally, 6 in the head of the pancreas (25%). In relation to the stomach, in 4 patients total gastrectomies were performed, and the pathological anatomy in three demonstrated a low-grade of neuroendocrine carcinoma and in the fourth a high degree; the latter. 5 patients died with a clinical presentation of acute appendicitis. The pathological anatomy was further acute appendicitis, a low-grade of neuroendocrine carcinoma.In the ileum-cecal region,and four of it underwent a right colectomy. In three there was a low-grade living and fourth high-grade carcinoma with liver mtts who died. In three of the ileum all were occlusive, carrying out intestinal resections, in two low- and last-grade moderate-grade carcinomas with living liver metastasis (mtts).. The colonic tumors were, one ascending with hepatic mtts and right colectomy more liver resections, with pathological anatomy being a high-grade carcinoma and another a low-grade in the descending colon. From the 6 pancreatic lesions, 3 were non-functioning and three functioning. All patients were operated of CPD. Conclusion: NET-GIT is a rare pathology but whose frequency is in constantly rise With improved imaging methods, we are faced with an increase in preoperative presumption and in the face of its best oncological possibilities, a pathology that every surgeon must know and think about.


Subject(s)
Humans , Adult , Middle Aged , Aged , Retrospective Studies , Colectomy , Neuroendocrine Tumors/therapy , Protocols , Gastrointestinal Tract/surgery , Gastrectomy
16.
Rev. cir. (Impr.) ; 72(3): 209-216, jun. 2020. tab, graf, ilus
Article in Spanish | LILACS | ID: biblio-1115544

ABSTRACT

Resumen Introducción: Si bien la anastomosis intracorpórea (AI) ha demostrado beneficios clínicos sobre la anastomosis extracorpórea (AE) en la hemicolectomía derecha laparoscópica (HDL), su aplicación ha sido limitada por su dificultad técnica y curva de aprendizaje más larga. El presente estudio busca desarrollar y evaluar un modelo simulado para entrenar este procedimiento. Materiales y Método: Se desarrolló un modelo en base a tejido ex vivo, con colon porcino e intestino bovino, montados en un simulador de laparoscopía. Este se modificó sucesivamente en base a entrevistas semiestructuradas a cirujanos hasta lograr el modelo final. Para evaluar apariencia y reacción al modelo, coloproctólogos, cirujanos y residentes previamente expuestos a entrenamiento simulado, realizaron una ileotransverso anastomosis mecánica en el modelo y luego contestaron una encuesta. Resultados: Doce sujetos participaron. Cuatro coloproctólogos, 4 residentes de coloproctología, 2 residentes de cirugía general, 1 cirujano general y 1 cirujano digestivo. El 91,6% valoró positivamente la ergonomía lograda, mientras que el 83,3% y 75% valoraron positivamente el uso del instrumental y la relación anatómica entre estructuras, respectivamente. Todos los participantes consideraron el modelo útil para entrenar sutura manual laparoscópica, el 91,6% para entrenar enterotomías y 83,3% para entrenar el uso de endograpadora. Todos declararon que el módulo permite entender y reflexionar sobre la técnica propuesta. Conclusión: Este modelo desarrollado sería útil para entrenar habilidades críticas para realizar una AI en HDL. Su incorporación a un programa de entrenamiento en laparoscopía avanzada podría contribuir a acortar la curva de aprendizaje de este procedimiento.


Introduction: Although intracorporeal anastomosis has demonstrated clinical benefits over extracorporeal anastomosis in laparoscopic right hemicolectomy, its application has been limited due to its technical difficulty and longer learning curve. The present study aims to develop and evaluate a simulated model to train this procedure. Materials and Method: An ex vivo tissue model was developed with porcine colon and bovine small bowel mounted in a laparoscopic simulator. This was subsequently modified based on semi-structured interviews to experts until the final model was achieved. To evaluate appearance and reaction to the model, the participants performed an ileocolic mechanical anastomosis in the model and answered a survey. Results: Twelve subjects participated. Four colorectal surgeons, 4 colorectal surgery fellows, 2 residents of general surgery, 1 general surgeon and 1 upper digestive surgeon. Of all subjects, 91.6%, 83.3% and 75% deemed ergonomics achieved, the use of instruments, and the anatomical relationship between structures as similar to reality, respectively. All participants deemed the model useful to train laparoscopic manual suturing, while 91.6% and 83.3% of them considered it useful to train enterotomies and the use of an endostapler, respectively. All declared that the model allows to understand the proposed technique. Conclusion: This model would be useful to train critical skills to perform an intracorporeal anastomosis in laparoscopic right hemicolectomy. Its incorporation into an advanced simulated laparoscopy training program could help shorten the learning curve of this procedure.


Subject(s)
Anastomosis, Surgical/methods , Surgeons/education , Simulation Training/methods , Surveys and Questionnaires , Laparoscopy/methods , Colectomy/methods
17.
Rev. cuba. cir ; 59(2): e935, abr.-jun. 2020. tab, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126414

ABSTRACT

RESUMEN Introducción: El cáncer avanzado es aquel que crece fuera del órgano en el cual se originó. La resección quirúrgica es el método más eficaz para lograr la curación de cáncer colorrectal en 50 por ciento de los casos. Objetivo: Evaluar los resultados del tratamiento multidisciplinar, realizado a pacientes con diagnóstico de cáncer colorrectal avanzado. Método: Se realizó un estudio observacional, descriptivo, ambispectivo y de corte transversal en el Hospital Clínico Quirúrgico "Hermanos Ameijeiras" entre enero de 2013 y diciembre de 2018. La muestra fue de 219 casos. Resultados: El 34,2 por ciento de los pacientes tenían entre 70 y 79 años. Hubo predominio de localización en colon ascendente (37,4 por ciento), en 57,1 por ciento fue moderadamente diferenciado y en 34,2 por ciento en estadio IIIA. El 7,8 por ciento de los pacientes tuvo recaída con metástasis, de ellos, 70,5 por ciento en hígado. En 72,6 por ciento la vía de acceso fue laparoscópica. En 50,7 por ciento se realizó hemicolectomía derecha. Las complicaciones se observaron en 25 pacientes (35,2 por ciento). El 91,3 por ciento de los casos recibió terapia adyuvante. En 27,4 por ciento hubo recurrencia. En el análisis del tiempo libre de enfermedad y de la supervivencia se obtuvieron buenos resultados. Conclusiones: El tratamiento combinado, secuencial y multidisciplinario en enfermedad maligna colorrectal avanzada ha demostrado beneficios clínicos y mayor supervivencia. Con una morbilidad y mortalidad relacionada con el proceder quirúrgico aceptable independientemente la vía de acceso empleada(AU)


ABSTRACT Introduction: advanced cancer is cancer that has grown outside the organ in which it originated. Surgical resection is the most effective method to achieve colorectal cancer cure in 50 % of cases. Objectives: the objective was to evaluate the results of the multidisciplinary treatment, carried out on patients diagnosed with advanced colorectal cancer. Method: it is an observational, descriptive, ambispective and cross-sectional study at the "Hermanos Ameijeiras" Surgical Clinical Hospital between January 2013 and December 2018. The sample was 219 cases. Results: 34.2 percent of the patients were between 70 and 79 years old. 56.2 percent were women. There was a predominance of localization in the ascending colon (37.4 percent), in 57.1 percent it was moderately differentiated and in 34.2 percent in stage IIIA. 7.8 percent of the patients had a metastatic relapse, 70.5 percent of them in the liver. In 72.6 percent, the access route was laparoscopic. Right hemicolectomy was performed in 50.7 percent. Complications were observed in 25 patients (35.2 percent). 91.3 percent of the cases received adjuvant therapy. In 27.4 percent there was recurrence. Good results were obtained in the analysis of disease-free time and survival. Conclusion: we conclude that combined, sequential, and multidisciplinary treatment in advanced colorectal malignancy has demonstrated clinical benefits and increased survival. With an acceptable morbidity and mortality related to the surgical procedure regardless of the access route used. Multivisceral and / or en bloc resections and maximum resection manage to increase the free interval of disease progression and alleviate symptoms(AU)


Subject(s)
Humans , Male , Female , Aged , Colorectal Neoplasms/diagnosis , Colectomy/methods , Colon, Ascending/injuries , Neoplasm Metastasis/drug therapy , Epidemiology, Descriptive , Cross-Sectional Studies , Observational Studies as Topic
18.
Rev. argent. coloproctología ; 31(2): 63-69, jun. 2020. ilus, tab
Article in English, Spanish | LILACS | ID: biblio-1117012

ABSTRACT

Introducción: La introducción del sistema Da Vinci, ha revolucionado el campo de la cirugía mínima invasiva en el cual el cirujano tiene control de la cámara 3D y los instrumentos son de gran destreza y confort ergonómico, acortando la curva de aprendizaje quirúrgica. Objetivo: Describir nuestra experiencia inicial de cirugía robótica colorectal en un hospital de comunidad cerrada de la Ciudad Autónoma de Buenos Aires. Materiales y Método: Estudio retrospectivo descriptivo sobre una base prospectiva de cirugías colorectales robóticas realizadas por el mismo equipo quirúrgico desde mayo de 2016 a abril de 2019. Resultados: Se operaron 41 pacientes. Trece de ellos fueron colectomías derechas, 17 colectomías izquierdas y 11 cirugías de recto. El tiempo quirúrgico promedio fue de 170 minutos (90-330), la estadía hospitalaria de 4 días (3-30), la tasa de conversión de 7,31% (3/41 pacientes) y la tasa de dehiscencia anastomótica del 9,75% (4/41 pacientes). Morbilidad global del 19.5% (8/41 pacientes). Conclusión: Hemos repasado los resultados iniciales de nuestra experiencia en cirugía robótica colorectal en un número reducido de casos, pero suficiente para evaluar la seguridad y reproducibilidad del método al comienzo de una curva de aprendizaje.


Introduction: The introduction of the Da Vinci System, has revolved the field of invasive minimal surgery in which the surgeon has control of the 3d camera and the instruments are of great strength and ergonomic comfort by cutting the surgical learning curve. Objective: Of this preliminary presentation is to describe our initial experience of colorectal robotic surgery in a closed community hospital of the Autonomous City of Buenos Aires. Materials and Method: Retrospective descriptive study on a prospective basis of robotic colorectal surgeries performed by the same surgical team from May 2016 to April 2019.Results: 41 patients were operated. 13 of them were right colectomies, 17 left colectomies and 11 rectum surgeries. The average surgical time was 170 minutes (90-330), the average hospital stay of 4 days (3-30), the conversion rate of 7.31% (3/41 patients) and the anastomotic dehiscence rate of 9 , 75% (4/41 patients). Overall morbidity of 19.5% (8/41 patients).Conclusion: We have reviewed the initial results of our experience in colorectal robotic surgery in a reduced number of cases but sufficient to evaluate the security and reproducibility of the methodic learning of a learning curve.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Colorectal Neoplasms/surgery , Colorectal Surgery/methods , Robotic Surgical Procedures/methods , Retrospective Studies , Treatment Outcome , Colectomy/methods , Minimally Invasive Surgical Procedures/methods , Proctectomy/methods , Hospitals, Community
19.
J. coloproctol. (Rio J., Impr.) ; 40(1): 8-11, Jan.-Mar. 2020.
Article in English | LILACS | ID: biblio-1090847

ABSTRACT

Abstract Introduction Peritoneal antibiotic or normal saline lavage is seen to be beneficial in order to reduce the pain or infection risk through laparoscopic surgeries. It can also be applied for laparoscopic colectomy surgeries. In this study, we have compared the effects of antibiotic solution lavage (gentamycin-clindamycin) with normal saline lavage in patients undergoing laparoscopic colectomy surgery. Method In this double-blind Randomized Controlled Trial (RCT), 40 patients undergoing laparoscopic colectomy surgery were divided into antibiotic and normal saline lavage groups (20 patients in each group). Post-operational pain, need for painkiller, white blood cells count, C-reactive protein level, duration of hospitalization and wound infection were compared in 30 days between the groups. Results Antibiotic lavage group had significantly less pain than the normal saline group (p < 0.05) through 3, 6, 12 and 24 h after surgery. C-reactive protein level, white blood cells count, painkiller use, and hospitalization duration were significantly lower in antibiotic group. However, there was no difference regarding wound or intra-abdominal infection between the both groups. Conclusion Using gentamicin-clindamycin peritonea lavage helps patients undergoing laparoscopic colectomy surgery in pain reduction, need for painkillers and hospitalization duration.


Resumo Introdução A lavagem peritoneal com antibiótico ou com soro fisiológico normal é benéfica para reduzir o risco de dor ou de infecção durante cirurgias laparoscópicas, além de poder ser aplicada também em colectomias laparoscópicas. Neste estudo, comparamos os efeitos da lavagem com solução antibiótica (gentamicina-clindamicina) e da lavagem com solução salina normal em pacientes submetidos à colectomia laparoscópica. Método Neste Ensaio Clínico Randomizado (ECR), controlado e duplo-cego, 40 pacientes submetidos à colectomia laparoscópica foram divididos em dois grupos (20 pacientes em cada grupo) para receberem antibiótico ou solução salina normal. Dor pós-operatória, necessidade de analgésico, contagem de leucócitos, nível de proteína C-reativa, tempo de internação e infecção da ferida foram comparados entre os grupos em 30 dias. Resultados De forma significativa, o Grupo Antibiótico apresentou menos dor que o Grupo Salina Normal (p < 0,05) em 3, 6, 12 e 24 horas após a cirurgia. O nível de proteína C-reativa, a contagem de leucócitos, o uso de analgésicos e o tempo de internação foram significativamente menores no Grupo Antibiótico. Porém, não houve diferença em relação à infecção da ferida ou intra-abdominal entre os dois grupos. Conclusão O uso da lavagem peritoneal com gentamicina-clindamicina ajuda a reduzir a dor, a necessidade de analgésicos e o tempo de internação de pacientes submetidos à colectomia laparoscópica.


Subject(s)
Humans , Pain, Postoperative/drug therapy , Surgical Wound Infection/drug therapy , Peritoneal Lavage , Laparoscopy , Colectomy/methods , Anti-Bacterial Agents/therapeutic use , Clindamycin/therapeutic use , Gentamicins/therapeutic use , Double-Blind Method , Saline Solution/therapeutic use , Length of Stay
20.
Article in English | WPRIM | ID: wpr-785425

ABSTRACT

PURPOSE: As robotic surgery is increasingly performed in patients with colorectal diseases, understanding proper port placement for robotic colorectal surgery is necessary. This review summarizes current port placement during robotic surgery for colorectal diseases and provides future perspective on port placements.METHODS: PubMed were searched from January 2009 to December 2018 using a combination of the search terms “robotic” [MeSH], “colon” [MeSH], “rectum” [MeSH], “colorectal” [MeSH], and “colorectal surgery” [MeSH]. Studies related to port placement were identified and included in the current study if they used the da Vinci S, Si, or Xi robotic system and if they described port placement.RESULTS: This review included 77 studies including a total of 3,145 operations. Fifty studies described port placement for left-sided and mesorectal excision; 17, 3, and 7 studies assessed port placement for right-sided colectomy, rectopexy, transanal surgery, respectively; and one study assessed surgery with reduced port placement. Recent literatures show that the single-docking technique included mobilization of the second and third robotic arms for the different parts without movement of patient cart and similar to previous dual or triple-docking technique. Besides, use of the da Vinci Xi system allowed a more simplified port configuration.CONCLUSION: Robot-assisted colorectal surgery can be efficiently achieved with successful port placement without movement of patient cart dependent on the type of surgery and the robotic system.


Subject(s)
Arm , Colectomy , Colon , Colorectal Surgery , Humans , Rectum , Robotic Surgical Procedures , Robotics
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