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1.
Rev. colomb. cir ; 37(3): 518-524, junio 14, 2022. fig
Article in Spanish | LILACS | ID: biblio-1378849

ABSTRACT

Introducción. La esclerosis sistémica es una enfermedad del colágeno de etiología autoinmune, con manifestaciones gastrointestinales hasta en un 90 % de los pacientes. Aunque es infrecuente, se han descrito algunos casos de vólvulos colónicos, pero es extremadamente rara la presentación de vólvulo cecal y del colon sigmoide en un mismo paciente. Caso clínico.Paciente femenina de 65 años, con antecedente de esclerosis sistémica, quien consultó a urgencias por dolor y distensión abdominal, asociados a emesis, con ausencia de flatos y deposiciones. Por imágenes sugestivas de obstrucción intestinal con zona de transición en el colon sigmoide se indicó laparotomía exploratoria, con hallazgo de vólvulo del sigmoide. Posteriormente reingresó por sintomatología similar, con imágenes sugestivas de vólvulo cecal. Se realizó hemicolectomía derecha con ileostomía y posterior cierre de ileostomía en misma hospitalización. Discusión. El vólvulo del colon sigmoide y ciego en un mismo paciente es una condición muy infrecuente. Existen pocos casos reportados en la literatura. Conclusión. La resección del segmento colónico afectado es el estándar de manejo quirúrgico.


Introduction. Systemic sclerosis is a collagen disease of autoimmune etiology, with gastrointestinal manifestations in up to 90% of patients. Although infrequent, some cases of colonic volvulus have been described, but the presentation of cecal and sigmoid colon volvulus in the same patient is extremely rarely. Clinical case. A 65-year-old female patient, with a history of systemic sclerosis, who consulted the emergency room due to abdominal pain and distension, associated with emesis and absence of flatus and stools. Due to images suggestive of intestinal obstruction with a transition zone in the sigmoid colon, an exploratory laparotomy was indicated, with the finding of a sigmoid volvulus. She was later readmitted for similar symptoms, with images suggestive of cecal volvulus. Right hemicolectomy was performed with ileostomy and subsequent closure of the ileostomy in the same hospitalization. Discussion. Volvulus of the sigmoid and cecum in the same patient is a very rare condition. There are few cases reported in the literature. Conclusion. Resection of the affected colonic segment is the standard of care management.


Subject(s)
Humans , Scleroderma, Systemic , Intestinal Volvulus , Colon, Sigmoid , Cecum , Colectomy , Intestinal Obstruction
2.
Rev. colomb. gastroenterol ; 37(2): 201-205, Jan.-June 2022. graf
Article in English | LILACS | ID: biblio-1394949

ABSTRACT

Abstract The care of patients with enterocutaneous fistula constitutes a significant challenge owing to the alterations it usually brings about. For successful treatment, it is necessary to manage fluids and electrolytes adequately, provide practical nutritional support, and control sepsis until its eradication; thus, many fistulae close spontaneously. We present the case of a 36-year-old male patient with a four-month history of fecal-like umbilical secretion. When performing the fistulogram, we confirmed a fistulous tract of 9 cm, which ended at the level of the sigmoid colon, a rare location. In cases where the enterocutaneous fistula does not close, and surgical treatment is indicated, it is imperative to maximize perioperative care, decrease surgical time, choose the correct surgical technique, and prepare the patient for surgery to avoid complications with a fatal outcome.


Resumen La atención de los pacientes con fístula enterocutánea constituye un gran reto, por las alteraciones con las que suelen acompañarse. Para lograr un tratamiento exitoso es necesario realizar un adecuado manejo de los líquidos y electrolitos, brindar un apoyo nutricional eficaz y controlar la sepsis hasta lograr su erradicación; de esta manera, muchas fístulas cierran espontáneamente. Se expone el caso de un paciente de 36 años de edad, con un cuadro de secreción umbilical de aspecto fecaloideo de 4 meses de evolución. Al realizar la fistulografía se constató un trayecto fistuloso de 9 cm, el cual terminaba a nivel del colon sigmoide, localización poco frecuente. En los casos en que la fístula enterocutánea no cierre y tenga indicación de tratamiento quirúrgico, es necesario extremar los cuidados perioperatorios, minimizar el tiempo quirúrgico, elegir la técnica quirúrgica correcta y preparar al paciente para la cirugía, de modo que se eviten complicaciones que pueden tener un desenlace fatal.


Subject(s)
Humans , Male , Adult , Colon, Sigmoid , Diverticulitis, Colonic , Fistula , Therapeutics , Bodily Secretions , Perioperative Care , Disease Eradication
3.
Int. j. morphol ; 40(3): 855-859, jun. 2022. ilus, tab
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1385666

ABSTRACT

RESUMEN: Gran parte de los pacientes con cáncer de colon (CC), son diagnosticados y tratados de forma electiva. Sin embargo, aproximadamente un 20 % de ellos debutará como una emergencia (obstrucción o perforación). El objetivo de este estudio fue determinar morbilidad postoperatoria (MPO) y supervivencia global (SVG) en pacientes resecados por CC perforado (CCP). Serie de casos retrospectiva de pacientes con CCP, sometidos a colectomía y linfadenectomía, de forma consecutiva, en Clínica RedSalud Mayor y Hospital de Temuco, Chile, entre 2010 y 2019. Las variables resultados fueron SVG y MPO. Otras variables de interés fueron: tiempo quirúrgico, resecabilidad, número de linfonodos resecados, estancia hospitalaria, mortalidad operatoria, recurrencia y supervivencia libre de enfermedad (SLE). Los pacientes fueron seguidos de forma clínica. Se utilizó estadística descriptiva, con medidas de tendencia central y dispersión; y análisis de SV con curvas de Kaplan Meier. Se intervinieron 15 pacientes (60 % mujeres), con una mediana de edad de 62 años. La localización más frecuente fue sigmoides (6 casos; 40,0 %). La resecabilidad de la serie fue 100 %. La medianas del tiempo quirúrgico, número de linfonodos resecados y estancia hospitalaria; fueron 80 min, 20 y 5 días respectivamente. La MPO fue 26,7 % (4 casos). Con una mediana de seguimiento de 36 meses, se verificó una recurrencia de 40,0 %. Por otra parte, la SVG y SLE a 5 años fue 46,7 % y 33,3 % respectivamente. Los resultados obtenidos, en términos de MPO y SVG, fueron similares a series internacionales.


SUMMARY: Most patients with colon cancer (CC) are diagnosed and treated electively. However, a fifth of them will debut as an emergency (obstruction or perforation). The aim of this study was to determine postoperative morbidity (POM) and overall survival (OS) in patients resected by perforated CC (PCC). Retrospective case series of patients with PCC undergoing colectomy and lymphadenectomy, consecutively, at RedSalud Mayor Clinic and Temuco hospital, Chile, between 2010 and 2019. The outcome variable were POM and OS. Other variables of interest were surgical time, resectability, number of resected lymph nodes, hospital stay, mortality, recurrence, and disease-free survival (DFS). Patients were followed clinically. Descriptive statistics was used (measures of central tendency and dispersion), and OS analysis was applying Kaplan Meier curves.15 patients (60 % women) were intervened, with a median age of 62 years. The most frequent location was the sigmoid colon (6 cases, 40.0 %). Resectability of the series was 100 %. Median surgical time, number of lymph nodes resected, and hospital stay; they were 80 min, 20 and 5 days respectively. POM was 26.7 % (4 cases). With a median follow-up of 36 months, recurrence was 40.0 %. On the other hand, OS and DFS at 5 years were 46.7 % and 33.3 %, respectively. The observed results, in terms of POM and OS, were like international series.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Colectomy , Colonic Neoplasms/surgery , Colonic Neoplasms/complications , Intestinal Perforation/etiology , Postoperative Complications , Colon, Sigmoid , Survival Analysis , Retrospective Studies , Follow-Up Studies , Emergencies , Lymph Node Excision , Neoplasm Recurrence, Local
4.
Rev. colomb. gastroenterol ; 37(1): 103-106, Jan.-Mar. 2022. graf
Article in English | LILACS | ID: biblio-1376913

ABSTRACT

Abstract In the spectrum of patients with intestinal obstruction, volvulus is one of the least frequent etiologies (5-15 %). Synchronous volvulus of two colonic segments in a patient is regarded as rare, with few cases reported in the literature. The present report of synchronous cecal and sigmoid volvulus documents one of them: a patient who underwent subtotal colectomy and formation of ileostomy. Although the preoperative diagnosis of this entity is rare, it should be considered in these intraoperative findings for both intraoperative management, with resection and anastomosis or resection and stoma, and postoperative management. It has a significant impact on mortality if patients are treated with broad-spectrum antibiotic coverage, given the bacterial translocation and sepsis that they experience.


Resumen En el espectro de los pacientes con obstrucción intestinal, el vólvulo es una de las etiologías menos frecuentes, siendo esta del 5 % al 15 %. La presentación sincrónica de dos segmentos colónicos volvulados en el mismo paciente se considera una entidad rara, con pocos casos reportados en la literatura. El presente caso de vólvulo sincrónico del ciego y del sigmoide documenta uno de ellos, en un paciente que se llevó a colectomía subtotal con ileostomía. Aunque el diagnóstico preoperatorio de esta entidad es poco frecuente, se debe tener en cuenta a la hora de encontrarse estos hallazgos intraquirúrgicos para el manejo tanto intraoperatorio, con resección y anastomosis o resección y estoma, como posoperatorios, lo que tiene un impacto importante en la mortalidad, si se manejan los pacientes con cubrimiento antibiótico de amplio espectro, dada la translocación bacteriana y septicemias con los que cursan estos pacientes.


Subject(s)
Humans , Male , Middle Aged , Colon, Sigmoid , Ileostomy , Cecum , Colectomy , Intestinal Volvulus , Mortality , Intestinal Obstruction
5.
J. coloproctol. (Rio J., Impr.) ; 41(4): 447-450, Out.-Dec. 2021. ilus
Article in English | LILACS | ID: biblio-1356432

ABSTRACT

Sigmoid volvulus is a frequent cause of intestinal obstruction. Its management has evolved with the use of laparoscopic surgery, achieving an elective sigmoid resection with anastomosis after a flexible endoscopic detorsion. A female patient was admitted to the emergency room with abdominal pain, distention, and constipation. The abdominal computed tomography showed a whirled sigmoid mesentery in addition to dilated sigmoid loops, and coffee bean sign. The patient successfully underwent a flexible endoscopic detorsion and was scheduled for elective sigmoid colectomy with rectal superior artery preservation and primary anastomosis. During the sigmoid resection, the superior rectal artery preservation is related to a better prognostic, with less bleeding, anastomotic leakage, and hospital stay. Currently, there are few reports of the laparoscopic preservation of the superior rectal artery in patients with sigmoid volvulus. (AU)


Subject(s)
Humans , Female , Middle Aged , Colon, Sigmoid/surgery , Laparoscopy , Intestinal Volvulus/surgery , Colon, Sigmoid/diagnostic imaging , Intestinal Volvulus/diagnostic imaging
6.
Rev. colomb. gastroenterol ; 36(1): 93-97, ene.-mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1251527

ABSTRACT

Resumen El hemangioma cavernoso de colon es una neoplasia vascular benigna, muy poco frecuente. Se realiza una breve descripción del cuadro clínico, diagnóstico y tratamiento de un paciente joven con un hemangioma cavernoso en el sigmoides. Se trata de un paciente de 18 años de edad quien consultó al servicio de urgencias por un cuadro clínico consistente en sangrado rectal indoloro asociado con disnea, astenia y adinamia; el paciente ingresó con signos vitales estables, posteriormente, se realizaron estudios complementarios, entre ellos un hemograma, que reportó un síndrome anémico grave que lleva al estudio de su causa. Se realizó una colonoscopia que reportó una lesión a nivel del sigmoides compatible con hemangioma colónico. El paciente es llevado a cirugía (laparotomía), se realizó una hemicolectomía y se confirmó el diagnostico por estudio de patología.


Abstract Cavernous hemangioma of the colon is a very rare benign vascular neoplasm. The following is a brief description of the symptoms, diagnosis, and treatment of a young patient with a cavernous hemangioma of the sigmoid colon. An 18-year-old man consulted the emergency department due to painless rectal bleeding associated with dyspnea, asthenia, and adynamia. The patient was admitted with stable vital signs, and complementary studies, including a blood count, reported severe anemic syndrome leading to the study of the cause of the disease. A colonoscopy was performed, finding a sigmoid lesion compatible with colon hemangioma. The patient was taken to surgery (laparotomy), a hemicolectomy was performed, and the diagnosis was confirmed by pathology study.


Subject(s)
Humans , Male , Adolescent , Colon, Sigmoid , Hemangioma, Cavernous , Colonoscopy , Laparotomy
7.
Article in Chinese | WPRIM | ID: wpr-921571

ABSTRACT

We reported a case of irreducible indirect inguinal hernia caused by sigmoid colon cancer entering the right groin.The patient complained about a right groin mass for more than 60 years with progressive enlargement for 3 years and pain for half a month.Abdominal CT examination at admission showed rectum and sigmoid colon hernia in the right inguinal area and thickening of sigmoid colon wall.Electronic colonoscopy and pathological diagnosis showed sigmoid colon cancer.Therefore,the result of preliminary diagnosis was irreducible indirect inguinal hernia caused by sigmoid colon cancer entering the right groin.We converted laparoscopic exploration to laparotomy followed by radical sigmoidectomy and employed end-to-end anastomosis of descending colon and rectum in combination with repair of right inguinal hernia.The patient recovered well after operation and was discharged.


Subject(s)
Colon, Sigmoid/surgery , Groin , Hernia, Inguinal/surgery , Humans , Laparoscopy , Sigmoid Neoplasms/surgery
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
10.
Rev. argent. coloproctología ; 31(3): 97-103, sept. 2020. tab
Article in Spanish | LILACS | ID: biblio-1128567

ABSTRACT

Introducción: La sigmoidectomía por diverticulitis perforada es una cirugía de urgencia comúnmente realizada por cirujanos generales. Está descripta la correlación positiva entre el volumen del cirujano y los mejores resultados postoperatorios. Sin embargo, existe escasa evidencia de la influencia de la especialización en cirugía colorrectal sobre los resultados de la sigmoidectomía laparoscópica por diverticulitis perforada. Objetivo: Evaluar el impacto de la especialización en cirugía colorrectal en los resultados postoperatorios de la sigmoidectomía laparoscópica por diverticulitis Hinchey III. Diseño: Estudio retrospectivo sobre una base de datos cargada de forma prospectiva. Material y métodos: Se incluyeron pacientes sometidos a sigmoidectomía laparoscópica por diverticulitis perforada Hinchey III. La muestra fue dividida en dos grupos: pacientes operados por un cirujano colorrectal (CC) y aquellos operados por un cirujano general (CG). Las variables demográficas, operatorias y postoperatorias fueron comparadas entre los grupos. El objetivo primario fue determinar si existían diferencias en la proporción de anastomosis primaria, morbilidad y mortalidad a 30 días entre los grupos. Resultados: Se incluyeron 101 pacientes en el análisis; 58 operados por CC y 43 por CG. Los pacientes operados por CC presentaron una mayor proporción de anastomosis primaria (CC: 98,3% vs. CG: 67,4%, p<0,001). Los CG realizaron más estomas (CC: 13,8% vs. CG: 46,5%, p<0,001), presentaron un mayor índice de conversión (CC: 20,6% vs. CG: 39,5%, p=0,03) y una mayor estadía hospitalaria (CC: 6,2 vs. CG: 10,8 días, p<0,001). La morbilidad global (CC: 34,4% vs. CG: 46,5%, p=0.22), dehiscencia anastomótica (CC: 3,5% vs. CG: 6,8%, p=0.48) y la mortalidad (CC: 1,7% vs. CG: 9,3 %, p=0,08) fueron similares entre ambos grupos. Conclusión: La sigmoidectomía laparoscópica de urgencia realizada por CG presenta similar morbilidad y mortalidad postoperatoria que la realizada por CC. Sin embargo, la participación del especialista se asoció a una mayor frecuencia de anastomosis primarias, menos estomas y una estadía hospitalaria más corta.


Background: Sigmoid resection for perforated diverticulitis is one of the most common emergency surgeries and often performed by general surgeons. Relationship between high-volume surgeons and improved postoperative outcomes is well established. However, the influence of colorectal specialization on outcomes after emergency laparoscopic sigmoidectomy for perforated diverticulitis is not well described. Aim: Evaluate the impact of colorectal surgery training on the outcomes after emergency laparoscopic sigmoid resection for Hinchey III diverticulitis. Design: Retrospective analysis of prospectively collected database.Method: Patients undergoing emergent laparoscopic sigmoid resection for perforated (Hinchey III) diverticulitis were identified and stratified by involvement of colorectal or general surgeon. This study was conducted from 2000 to 2018 at a teaching hospital. Primary outcome measures were primary anastomosis, postoperative morbidity and mortality.Results: A total of 101 patients were identified; 58 by colorectal and 43 by general surgeons. Patients in the colorectal surgeon group had higher rates of primary anastomosis (CS: 98, 2% vs. GS: 67, 4%, p<0.001). General surgeons performed more ostomies (CS: 13, 8% vs. GS: 46, 5%, p<0.001), had a higher conversion rate (CS: 20, 6% vs. GS: 39, 5%, p=0.03) and longer mean length of hospital stay (CS: 6, 2 vs. GS: 10, 8 days, p<0.001). Overall morbidity (CS: 34, 4% vs. GS: 46, 5%, p=0.22), anastomotic leak rate (CC: 3,5% vs. CG: 6,8%, p=0.48) and mortality (CS: 1, 7% vs. GS: 9,3 %, p=0.08) were similar between groups. Conclusion: Emergency laparoscopic sigmoid resection by general surgeons wasn ́t associated with higher rates of postoperative morbidity, anastomotic leakage or mortality. However, patients operated by colorectal surgeons had higher rates of primary anastomosis, lower rates of ostomy, conversion and shorter length of hospital stay.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Laparoscopy/methods , Colorectal Surgery/methods , Diverticulitis, Colonic/surgery , Intestinal Perforation/surgery , Peritonitis/surgery , Peritonitis/complications , Postoperative Complications , Colon, Sigmoid/surgery , Preoperative Care , Anastomosis, Surgical/methods
11.
Rev. cuba. cir ; 59(2): e933, abr.-jun. 2020. graf
Article in Spanish | LILACS, CUMED | ID: biblio-1126421

ABSTRACT

RESUMEN Introducción: La migración de una prótesis en la vía biliar es una complicación muy poco frecuente que normalmente se expulsa de forma natural, pero en raras ocasiones puede cursar con complicaciones severas. Objetivo: Describir una complicación rara por migración de una prótesis biliar. Caso clínico: Se presenta un paciente de sexo masculino de 75 años, portador de stent biliar que presenta una perforación de sigma secundaria a migración de la prótesis. Conclusiones: Las migraciones protésicas deben vigilarse y si no se eliminan de manera espontánea o el paciente presenta síntomas, se debe proceder a su retirada endoscópica o quirúrgica(AU)


ABSTRACT Introduction: Migration of a prosthesis in the bile duct is a very rare complication normally expelled in a natural way, but on rare occasions it can lead to severe complications. Objective: To describe a rare complication due to migration of biliary prosthesis. Clinical case: A case is presented of a 75-year-old male patient with a biliary stent who presented a sigmoid perforation secondary to migration of the prosthesis. Conclusions: Prosthetic migrations should be monitored and, if they are not eliminated spontaneously or the patient presents with symptoms, they should be removed endoscopically or surgically(AU)


Subject(s)
Humans , Male , Aged , Prostheses and Implants/adverse effects , Colon, Sigmoid/surgery , Bile Ducts/diagnostic imaging , Radiography, Abdominal/methods , Self Expandable Metallic Stents
12.
Int. braz. j. urol ; 46(1): 108-115, Jan.-Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1056353

ABSTRACT

ABSTRACT Objective: Cystectomy with urinary diversion is the gold standard for muscle invasive bladder cancer. It also may be performed as part of pelvic exenteration for non-urologic malignancy, neurogenic bladder dysfunction, and chronic conditions that result in a non-functional bladder (e.g., interstitial cystitis, radiation cystitis). Our objective is to describe the surgical technique of urinary diversion using large intestine as a conduit whilst creating an end colostomy, thereby avoiding a primary bowel anastomosis and to show its applicability with respect to urologic conditions. Materials and Methods: We retrospectively reviewed five cases from a single institution that utilized the described method of urinary diversion with large intestine. We describe operative times, hospital length of stay (LOS), and describe post-operative complications. Results: Five patients with a variety of urologic and oncologic pathology underwent the described procedures. Their operative times ranged from 5 hours to 11 hours and one patient experienced a Clavien III complication. Conclusion: We describe five patients who underwent this procedure for various medical indications, and describe their outcomes, and believe dual diversion of urinary and gastrointestinal systems with colon as a urinary conduit to be an excellent surgical option for the appropriate surgical candidate.


Subject(s)
Humans , Male , Adult , Colon, Sigmoid/surgery , Colostomy/methods , Urinary Diversion/methods , Urinary Bladder Diseases/surgery , Anastomosis, Surgical , Cystectomy/methods , Reproducibility of Results , Treatment Outcome , Operative Time , Length of Stay , Medical Illustration , Middle Aged
13.
Article in English | WPRIM | ID: wpr-811417

ABSTRACT

PURPOSE: The Oral-anal Transit Test (OTT) is a simple method of obtaining information about colonic transit. We aim to assess the correlation of OTT with the neuromuscular integrity of the colon determined by colonic manometry (CM).METHODS: All patients who had OTT followed by CM were evaluated. Less than 6 of 24 markers remaining on OTT was considered normal. CM was performed per previously published guidelines. A normal CM was defined as at least one High Amplitude Propagating Contraction progressing from the most proximal sensor through the sigmoid colon.RESULTS: A total of 34 patients underwent both OTT and CM (44% male, age 4–18 years, mean 11.5 years, 97% functional constipation +/− soiling, Hirschsprung's Disease). Of normal and abnormal OTT patients, 85.7% (6/7) and 18.5% (5/27) respectively had normal CM. When all markers progressed to at least the sigmoid colon, this was 100% predictive against colonic inertia. Greater than 50% of patients with manometric isolated sigmoid dysfunction had markers proximal to the recto-sigmoid.CONCLUSION: OTT and CM are both valuable studies that assess different aspects of colonic function. OTT can be used as a screening test to rule out colonic inertia. However, the most proximal extent of remaining markers does not predict the anatomical extent of the manometric abnormality, particularly in isolated sigmoid dysfunction.


Subject(s)
Child , Colon , Colon, Sigmoid , Constipation , Fecal Incontinence , Humans , Male , Manometry , Mass Screening , Methods , Soil
14.
Rev. colomb. gastroenterol ; 35(1): 25-32, 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1115598

ABSTRACT

Resumen Introducción: el cáncer de colon y recto (CCR) se origina a partir de pólipos adenomatosos y serrados. Por tanto, se recomienda que todos los pólipos colónicos sean resecados y enviados a patología. Sin embargo, en los pólipos diminutos (<5 mm) del recto y del sigmoides existe controversia sobre esta conducta, razón por la cual se ha planteado la estrategia de resecar y descartar o dejar in situ, a partir de la utilización de endoscopios avanzados (con una imagen de banda angosta [Narrow Band Imaging, NBI] u otras), y se logre concordancia con la histopatología, superior al 90 %. En nuestro medio, no hay estudios prospectivos con luz blanca sobre la prevalencia y las características histológicas de estos pólipos en el recto y el sigmoides. Por esta razón, se desarrolló este trabajo. Materiales y métodos: estudio de prevalencia analítica, prospectivo. Se incluyeron las colonoscopias de tamización realizadas en la Unidad de Gastroenterología de la Clínica Fundadores de Bogotá, entre enero y julio de 2018. Resultados: se incluyeron 719 pacientes. La prevalencia de pólipos diminutos en el recto y el sigmoides fue del 27 % (intervalo de confianza [IC], 95 %: 23,7-30,2 %). El 50 % eran pólipos adenomatosos, mientras que en 8 casos se presentó una displasia de alto grado (DAG). Entre los pólipos diminutos, 3 fueron tumores neuroendocrinos. No hubo cáncer en ninguna de las lesiones. Conclusiones: la mitad de los pólipos diminutos encontrados fueron adenomatosos y 8 (0,83 %) tuvieron DAG. Recomendamos resecar todos los pólipos diminutos hasta que los estudios locales realizados con NBI u otra tecnología demostrasen la capacidad para discriminar en más del 90 % los pólipos hiperplásicos (dejarlos in situ) o adenomatosos (resecarlos).


Abstract Introduction: Because colorectal cancer (CRC) originates from adenomatous and serrated polyps, it is recommended that all colonic polyps be resected and sent to pathology. However, there is controversy over this recommendation in the case of rectal and sigmoid polyps measuring less than 5 mm. Strategies using advanced NBI endoscopes to either "resect and discard" or leave "in situ" have been proposed. Concordance with histopathology of over 90% has been achieved. No prospective studies of the prevalence and histological characteristics of these rectal and sigmoid polyps had been done with white light in this country, so we undertook this study. Materials and methods: This is an analytical and prospective prevalence study. Screening colonoscopies performed in the gastroenterology unit of Clínica Fundadores in Bogotá between January and July 2018 were included. Results: Seven hundred nineteen patients were included. The prevalence of tiny polyps in the rectum and sigmoid colon was 27% (95% CI: 23.7 to 30.2%). Fifty percent were adenomatous, but eight cases had high grade dysplasia. Among the tiny polyps, three were neuroendocrine tumors. There was no cancer in any of the lesions. Conclusions: Half of the tiny polyps found were adenomatous, and eight (0.83%) had high grade dysplasia. We recommend resecting all tiny polyps until local studies conducted with NBI or other technology demonstrate the ability to discriminate between the more than 90% hyperplastic polyps (leaving them in situ) and adenomatous polyps (resect them).


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Polyps , Colon, Sigmoid , Colonic Polyps , Prevalence , Colonoscopy , Adenomatous Polyps
15.
ABCD arq. bras. cir. dig ; 33(3): e1546, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152618

ABSTRACT

ABSTRACT Background: The Hartmann procedure remains the treatment of choice for most surgeons for the urgent surgical treatment of perforated diverticulitis; however, it is associated with high rates of ostomy non-reversion and postoperative morbidity. Aim: To study the results after the Hartmann vs. resection with primary anastomosis, with or without ileostomy, for the treatment of perforated diverticulitis with purulent or fecal peritonitis (Hinchey grade III or IV), and to compare the advantages between the two forms of treatment. Method: Systematic search in the literature of observational and randomized articles comparing resection with primary anastomosis vs. Hartmann's procedure in the emergency treatment of perforated diverticulitis. Analyze as primary outcomes the mortality after the emergency operation and the general morbidity after it. As secondary outcomes, severe morbidity after emergency surgery, rates of non-reversion of the ostomy, general and severe morbidity after reversion. Results: There were no significant differences between surgical procedures for mortality, general morbidity and severe morbidity. However, the differences were statistically significant, favoring primary anastomosis in comparison with the Hartmann procedure in the outcome rates of stoma non-reversion, general morbidity and severe morbidity after reversion. Conclusion: Primary anastomosis is a good alternative to the Hartmann procedure, with no increase in mortality and morbidity, and with better results in the operation for intestinal transit reconstruction.


RESUMO Racional: O procedimento a Hartmann permanece sendo o tratamento de escolha da maioria dos cirurgiões para o tratamento cirúrgico de urgência da diverticulite perfurada, entretanto está associado com altas taxas de não reversão da ostomia e de morbidade pós-operatória. Objetivo: Estudar os resultados após o procedimento de Hartmann vs. ressecção com anastomose primária, com ou sem ileostomia, para o tratamento da diverticulite perfurada com peritonite purulenta ou fecal (grau de Hinchey III ou IV), e comparar as vantagens entre as duas formas de tratamento. Método: Busca sistemática na literatura de artigos observacionais e randomizados comparando ressecção com anastomose primária vs. procedimento de Hartmann no tratamento de urgência da diverticulite perfurada. Analisar como desfechos primários a mortalidade após a operação de urgência e a morbidade geral após ela; como desfechos secundários, a morbidade severa após a operação de urgência, as taxas de não reversão da ostomia, a morbidade geral e severa após a reversão. Resultados: Não houve diferenças significativas entre os procedimentos cirúrgicos para mortalidade, morbidade geral e morbidade severa. Contudo, as diferenças foram significativas estatisticamente favorecendo anastomose primária na comparação com procedimento de Hartmann nos desfechos taxas de não reversão do estoma, morbidade geral e morbidade severa após reversão. Conclusão: A anastomose primária apresenta-se como boa alternativa ao procedimento de Hartmann, sem aumento de mortalidade e morbidade, e com melhores resultados na operação de reconstrução do trânsito intestinal.


Subject(s)
Humans , Peritonitis/etiology , Colon, Sigmoid/surgery , Digestive System Surgical Procedures/adverse effects , Diverticulitis/surgery , Diverticulitis/complications , Intestinal Perforation/surgery , Peritonitis/surgery , Postoperative Complications , Digestive System Surgical Procedures/methods , Anastomosis, Surgical/methods , Colostomy/adverse effects , Ileostomy/adverse effects , Treatment Outcome , Diverticulitis/pathology , Intestinal Perforation/pathology
16.
Rev. cir. (Impr.) ; 71(4): 318-322, ago. 2019. tab, ilus
Article in Spanish | LILACS | ID: biblio-1058278

ABSTRACT

INTRODUCCIÓN: La enfermedad diverticular de colon sigmoides representa la principal causa de fistulización del colon a órganos vecinos. OBJETIVO: Describir variables clínicas y terapia quirúrgica de esta entidad. MATERIALES Y MÉTODO: Revisión retrospectiva de los casos de fístulas colónicas de origen diverticular (FCD) operados en forma electiva en un centro terciario. RESULTADOS: En un periodo de 30 años se realizó cirugía resectiva por una FCD en 49 pacientes. Los órganos más afectados fueron la vejiga en 33 casos (68%) y la vagina en 6 (12%). La cirugía efectuada fue la sigmoidectomía en 48 casos (5 con una ileostomía de protección) y una operación de Hartmann. La vía de abordaje fue laparoscópica en 4 pacientes y la morbilidad global de la serie fue 20%, sin mortalidad. Con un seguimiento promedio de 87 meses (extremos 16-178) no hubo casos de recidiva de la fístula. CONCLUSIONES: La FCD representa el 26% de los casos intervenidos por una enfermedad diverticular de colon sigmoides, lo que probablemente refleja un diagnóstico tardío. La fístula colovesical (FCV) es la fístula más común por esta causa y en la mitad de los casos tienen una presentación silenciosa. Las fístulas colovaginales ocurren en mujeres histerectomizadas. La cirugía resectiva del colon en pacientes con riesgo normal es la cirugía estándar con buenos resultados a corto y largo plazo. La cirugía laparoscópica es factible y segura especialmente en los casos de FCV.


BACKGROUND: Fistula formation is a well-known complication of diverticular disease (FCD). AIM: Determine the clinical presentation and surgical management of this kind of fistulas. MATERIALS AND METHODS: Retrospective revision of all consecutive scheduled cases operated on in a terciary public centre in a thirty-years period. RESULTS: Forty-nine patients with a segmental resection of sigmoid colon were analized. Colovesical fistulas were the most common type (n = 33), followed by colovaginal (n = 6). Resection with anastomosis was performed in 48 cases and Hartmann type operation in one. Laparoscopic procedure was made in 4 cases without conversion. Complication rate was 20% and two patients were reoperated on, without mortality in this series. Follow up showed no case of recurrence. CONCLUSIONS: FDC represent 26% of cases operated on in our series. Colovesical fistula is the most common type, followed by colovaginal fistula in histerectomized women. Resection and primary anastomosis should be the treatment of choice in average risk patients with acceptable morbidity and good long-term results. Laparoscopic approach is safe, specifically in patients with colovesical fistulas.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Intestinal Fistula/surgery , Colonic Diseases/surgery , Colon, Sigmoid/surgery , Retrospective Studies , Follow-Up Studies , Intestinal Fistula/complications , Treatment Outcome , Colonic Diseases/etiology , Diverticular Diseases/complications
17.
Autops. Case Rep ; 9(2): e2019102, Abr.-Jun. 2019. ilus
Article in English | LILACS | ID: biblio-1015113

ABSTRACT

Gallstone ileus is a rare (1%­4%) complication of gallstone disease. Gallstones entering the gastrointestinal tract by penetration may cause obstruction at any point along their course through the tract; however, they have a predilection to obstruct the smaller-caliber lumen of the small intestine (80.1%) or stomach (14.2%). The condition is seen more commonly in the elderly who often have significant co-morbidities. Gallstone ileus causing large bowel obstruction is rare. We report the case of a 95-year-old woman who presented with a history of abdominal pain without fever, nausea, vomiting, or diarrhea. Computed tomography of the abdomen and pelvis with oral contrast revealed a high-density structure within the lumen of the distal sigmoid colon, initially suspected to be a foreign body. Medical management failed and surgical intervention was not possible. Autopsy revealed peritonitis and a rupture of the sigmoid colon at the site of a cylindrical stone found impacted in an area of fibrotic narrowing with multiple diverticula. A necrotic, thick-walled gallbladder had an irregular stone in its lumen that was a fracture match with the stone in the sigmoid. Adhesions, but no discrete fistula, were identified between the gallbladder and the adjacent transverse colon. The immediate cause of death was peritonitis caused by colonic perforation by the gallstone impacted at an area of diverticular narrowing. To our knowledge, such autopsy findings have not been previously reported.


Subject(s)
Humans , Female , Aged, 80 and over , Colon, Sigmoid/injuries , Gallstones/pathology , Peritonitis/pathology , Autopsy , Diverticulum , Intestinal Perforation/complications
18.
Arch. argent. pediatr ; 117(1): 68-71, feb. 2019. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-983784

ABSTRACT

Los schwannomas son tumores que se originan de las células de Schwann de los nervios periféricos. Su localización en el colon es extremadamente rara y no se han descrito, en la literatura, casos en niños. Por lo general, estos tumores son asintomáticos, pero pueden producir síntomas inespecíficos y gastrointestinales. La presentación como invaginación intestinal es muy infrecuente. Se expone el caso clínico de una paciente de 11 años de edad con un schwannoma de colon manifestado clínicamente como invaginación intestinal de sigma con dolor abdominal, rectorragia y estreñimiento de 10 días de evolución, que precisó resección intestinal con márgenes quirúrgicos libres, con buena evolución posoperatoria.


Schwannomas are tumours originating in the Schwann cells of the peripheral nerves. The appearance in the colon is extremely rare, and there are no known cases in the literature of schwannomas of the colon and rectum described in children. These tumours are usually asymptomatic, but can produce non-specific and gastrointestinal symptoms. The clinical presentation as intestinal intussusception is infrequent. We present a case of an 11-year-old girl with sigmoid swchannoma presented clinically as a colonic intussusception with abdominal pain, rectal bleeding and constipation of 10 days. An intestinal resection with free surgical margins was performed.


Subject(s)
Humans , Female , Child , Colon, Sigmoid , Gastrointestinal Neoplasms , Intussusception , Neurilemmoma
19.
Neurointervention ; : 9-16, 2019.
Article in English | WPRIM | ID: wpr-741678

ABSTRACT

Intracranial and spinal dural arteriovenous fistulas (DAVFs) are vascular pathologies of the dural membrane with arteriovenous shunts. They are abnormal communications between arteries and veins or dural venous sinuses that sit between the two sheets of the dura mater. The dura propria faces the surface of brain, and the osteal dura faces the bone. The location of the shunt points is not distributed homogeneously on the surface of the dural membrane, but there are certain areas susceptible to DAVFs. The dura mater of the olfactory groove, falx cerebri, inferior sagittal sinus, tentorium cerebelli, and falx cerebelli, and the dura mater at the level of the spinal cord are composed only of dura propria, and these areas are derived from neural crest cells. The dura mater of the cavernous sinus, transverse sinus, sigmoid sinus, and anterior condylar confluence surrounding the hypoglossal canal are composed of both dura propria and osteal dura; this group is derived from mesoderm. Although the cause of this heterogeneity has not yet been determined, there are some specific characteristics and tendencies in terms of the embryological features. The possible reasons for the segmental susceptibility to DAVFs are summarized based on the embryology of the dura mater.


Subject(s)
Arteries , Brain , Cavernous Sinus , Central Nervous System Vascular Malformations , Colon, Sigmoid , Dura Mater , Embryology , Membranes , Mesoderm , Neural Crest , Pathology , Population Characteristics , Spinal Cord , Veins
20.
Annals of Coloproctology ; : 282-284, 2019.
Article in English | WPRIM | ID: wpr-762326

ABSTRACT

In past decades, hepatic portal venous gas (HPVG) has rarely been reported, and the mortality rate has been very high. In most cases, surgical intervention was needed. Presently, abdominal computed tomography can be conveniently used to diagnose HPVG, which has various underlying causes and benign courses. We present the case of a patient with HPVG due to anastomosis leakage after a sigmoidectomy for diverticulitis; the patient was cured with conservative management.


Subject(s)
Colon, Sigmoid , Diverticulitis , Humans , Mortality
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