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1.
Rev. cuba. cir ; 60(2): e1024, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1280223

ABSTRACT

Introducción: El divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal. Por lo general, cursa asintomático, y su diagnóstico es transoperatorio. Cuando presenta síntomas se deben a sus complicaciones, de las cuales la perforación constituye solo el 0,5 por ciento. Objetivo: Describir las características clínico-quirúrgicas de la presentación de un paciente con divertículo de Meckel perforado por cuerpo extraño. Caso clínico: Paciente adulto de 46 años de sexo masculino, piel blanca, que acude con dolor generalizado en el abdomen que se trasladó a Fosa Ilíaca Derecha, con febrícula. Se interviene quirúrgicamente y se halla divertículo de Meckel perforado por cuerpo extraño. Conclusiones: El pronóstico de esta enfermedad depende de la evolución, diagnóstico precoz y tratamiento aplicado en las distintas complicaciones, así como de la decisión de realizar tratamiento quirúrgico en los hallazgos casuales(AU)


Introduction: Meckel's diverticulum is the most frequent congenital anomaly of the gastrointestinal tract. It is generally asymptomatic, with an intraoperative diagnosis. When it presents symptoms, they are due to its complications, of which perforation accounts for only 0.5 percent. Objective: To describe the clinical-surgical characteristics of a patient who presented with a Meckel's diverticulum perforated by a foreign body. Clinical case: 46-year-old adult patient of the male sex and white skin, who presents with generalized pain in the abdomen that moved to the right iliac fossa and low-grade fever. The patient underwent surgery and a Meckel's diverticulum was found, perforated by a foreign body. Conclusions: The prognosis of this disease depends on the evolution, early diagnosis and applied treatment according to the different complications, as well as on the decision to perform surgical treatment in accidental findings(AU)


Subject(s)
Humans , Male , Middle Aged , Gastrointestinal Tract/abnormalities , Diverticulitis/surgery , Foreign Bodies/etiology , Meckel Diverticulum/complications , Early Diagnosis
3.
Rev. cir. (Impr.) ; 72(4): 347-349, ago. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1138721

ABSTRACT

Resumen Introducción: Los hongos dematiáceos se caracterizan por la presencia de abundante melanina en su pared celular. Presentan una distribución mundial, siendo más comunes en climas tropicales y subtropicales. Producen infecciones cutáneas y subcutáneas, además de enfermedades alérgicas, neumonías, abscesos cerebrales o infecciones diseminadas. Caso Clínico: Presentamos el caso de un paciente con adenocarcinoma de recto intervenido quirúrgicamente con hallazgo incidental de divertículo de Meckel y en el cual en el estudio anatomopatológico reveló la presencia de un hongo dematiáceo


Introduction: Dematiaceous fungi are characterized by the presence of brown melanine or melanine like pigments in their cell wall. They are generally distributed worldwide, being more common in tropical and subtropical climates. The clinical syndromes are often cutaneous and subcutaneous infections, but can be also responsible of allergic diseases, pneumonias, cerebral abscesses or disseminated infections. Clinical Case: We present the case of a patient with a diagnosis of rectal adenocarcinoma intervening surgically and with an incidental finding of Meckel's Diverticulum. The anatomopathological study revealed the presence of a dematiaceous fungi.


Subject(s)
Humans , Male , Aged , Diverticulitis/surgery , Alternaria/pathogenicity , Meckel Diverticulum/surgery , Colostomy/methods
4.
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
5.
Clin. biomed. res ; 40(1): 27-32, 2020.
Article in Portuguese | LILACS | ID: biblio-1116850

ABSTRACT

Introdução: O fechamento de estomas, embora rotineiramente performado, ainda não pode ser considerado um procedimento simples. Nós reportamos, desta forma, a morbidade, mortalidade e fatores de riscos associados a este procedimento em um período de dez anos. Métodos: Revisão retrospectiva de 252 prontuários (149 homens; 103 mulheres), com uma média de 56 anos de idade (18 a 89 anos), que foram submetidos a fechamento de estomas, com análise de complicações clínicas e cirúrgicas, características relacionadas ao estoma, entre outros. Admissão em UTI, complicações precoces (até 30 dias) (classificação de Clavien-Dindo), e tardias, além de óbito, foram analisados. Os testes T de Student, ANOVA, Qui-Quadrado de Pearson, exato de Fischer e de Mann-Whitney foram utilizados para análise paramétrica e não-paramétrica. Resultados: Tumores colorretais (64%) e diverticulite (10%) foram as principais causas para a confecção do estoma. 112 (44,4%) dos pacientes tiveram pelo menos uma complicação cirúrgica. As complicações precoces foram infecção de ferida operatória (13%), fistula e deiscência anastomótica/intestinal (9%), abscessos de cavidade ou parede abdominais (8,3%); tardiamente houveram 36 casos de hérnia incisional (14,2%) e uma estenose intestinal (0,3%). Comorbidades levaram a 10% maior probabilidade de ter uma ou mais complicações cirúrgicas, e todas as cinco mortes ocorreram nestes pacientes (2%). Estomas de intestino grosso, maior tempo operatório e admissão em UTI estiveram significamente relacionados a aumento da morbidade. Conclusão: Pacientes com comorbidades e estomas de intestino grosso tiveram mais risco de complicações. Cuidados pré e perioperatórios, e melhor seleção de pacientes são importantes na redução da morbimortalidade.(AU)


Introduction: Although routinely performed, stoma closure cannot as yet be considered a simple procedure. We report here the morbidity, mortality and risk factors associated with this procedure over a 10-year period. Methods: The medical records of 252 patients (149 men; 103 women), with a mean age of 56 years (18 to 89 years), who underwent stoma closure were retrospectively reviewed for postoperative clinical and surgical complications, stoma-related features, among others. ICU admission, early surgical complications (within 30 days) according to the Clavien-Dindo classification, late surgical complications, and death were analyzed. Student's t-test, ANOVA, Pearson's chi-square test, Fisher's exact test, and MannWhitney U test were used for parametric and nonparametric data. Results: Colorectal tumors (64%) and diverticulitis (10%) were the main reasons for stoma surgery. Overall, 112 (44.4%) patients had at least one surgical complication. Early complications included surgical wound infection (13%), fistula and anastomotic/ intestinal dehiscence (9%), and abdominal wall or intra-abdominal abscesses (8.3%). Late complications included 36 (14.2%) cases of incisional hernia and one case (0.3%) of stricture. Patients with comorbidities were 10% more likely to have one or more surgical complications, and all 5 deaths occurred in these patients (2%). Large-bowel ostomies, longer operative time and ICU admission were significantly related to increased morbidity. Conclusion: Patients with an increased number of comorbidities and large-bowel ostomies are at higher risk for complications. Pre- and perioperative care and accurate patient selection are important to reduce morbidity and mortality.(AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Postoperative Complications/epidemiology , Surgical Stomas/adverse effects , Postoperative Complications/mortality , Surgical Wound Infection/epidemiology , Time Factors , Tobacco Use Disorder/epidemiology , Colorectal Neoplasms/surgery , Retrospective Studies , Risk Factors , Diverticulitis/surgery , Hypertension/epidemiology
6.
Rev. argent. cir ; 110(2): 101-105, jun. 2018. ilus, tab
Article in Spanish | LILACS | ID: biblio-957902

ABSTRACT

Antecedentes: la diverticulitis cecal es una patología poco común en los países occidentales. Clínicamente es indistinguible de una apendicitis aguda. Objetivos: exhibir los resultados de acuerdo con diferentes abordajes terapéuticos. Material y métodos: se presentan cinco casos de diverticulitis cecal tratados en nuestra institución entre enero de 2013 y diciembre de 2015. Revisión retrospectiva de historias clínicas e imágenes. Revisión de la literatura. Resultados: fueron incluidos cinco pacientes. En cuatro hubo resolución quirúrgica y uno tuvo buena evolución con tratamiento médico. Conclusiones: si bien es poco frecuente, la diverticulitis cecal debe considerarse dentro de los diagnósticos diferenciales frente a un cuadro de dolor abdominal localizado en fosa ilíaca derecha acompañado de estudios por imágenes no categóricos de apendicitis aguda.


Background: cecal diverticulitis is a rare disease in western countries. It is clinically indistinguishable from acute appendicitis. Objetive: to show outcome with different therapeutic approaches. Material and methods: we present five cases of cecal diverticulitis treated at our institution between January 2013 and December 2015. Retrospective review of medical records and images. Review of the literature. Results: five patients were included. Four cases required surgical treatment while one patient resolved with medical treatment. Conclusions: Although it is rare, cecal diverticulitis must be considered within the differential diagnoses in the face of abdominal pain located in the right iliac fossa and non-categorical imaging of acute appendicitis.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Diverticulitis/surgery , Typhlitis/pathology , Gentamicins/administration & dosage , Tomography, X-Ray Computed , Abdominal Pain/complications , Ultrasonography , Laparoscopy , Colectomy/methods , Diverticulitis/drug therapy , Diverticulitis/diagnostic imaging , Abdomen, Acute/complications , Metronidazole/administration & dosage
7.
Gastroenterol. latinoam ; 29(supl.1): S28-S31, 2018.
Article in Spanish | LILACS | ID: biblio-1117652

ABSTRACT

The presence of colonic diverticulae is a common occurrence in middle-aged and elderly patients. Most of them will remain asymptomatic for life; however, between 10-25% will go on to develop acute diverticulitis (AD). Traditionally, AD has been thought of as a disease having a bacterial etiology with a high recurrence rate and a significant proportion of underlying colorectal cancer. This has been the foundation for conventional treatment with antibiotics and an indication for resective surgery after a second episode. Also, a routine colonoscopy has been recommended on the resolution of inflammatory symptoms, to rule out malignancy. Recent evidence has questioned the appropriateness of this traditional approach to AD. In this review, we critically appraise the need for antibiotics, prophylactic surgery and endoscopic follow-up after AD.


La presencia de divertículos en el colon es un hallazgo frecuente en la población mayor de 60 años. Si bien la mayoría nunca presentará síntomas, 10-25% desarrollará una diverticulitis aguda (DA). Tradicionalmente se ha postulado que la DA es una enfermedad de etiología bacteriana, con una alta tasa de recurrencia, y un porcentaje importante de casos en que puede confundirse con un cáncer colorrectal. Debido a esto el manejo clásico incluye antibióticos e históricamente se ha recomendado una cirugía resectiva del segmento afectado después de un segundo episodio. También se ha tenido como dogma el realizar una colonoscopia de control una vez resuelto el episodio agudo, para descartar una neoplasia subyacente. Sin embargo, la nueva evidencia disponible ha cuestionado la idoneidad de este enfoque clásico frente a la DA. En esta revisión analizamos de manera crítica la necesidad del uso de antibióticos, la cirugía profiláctica y el control endoscópico posterior a DA.


Subject(s)
Humans , Diverticulitis/surgery , Diverticulitis/drug therapy , Recurrence , Acute Disease , Colonoscopy , Elective Surgical Procedures , Patient Selection , Anti-Bacterial Agents/therapeutic use
8.
ABCD arq. bras. cir. dig ; 28(2): 102-104, Apr-Jun/2015. tab
Article in English | LILACS | ID: lil-751846

ABSTRACT

BACKGROUND: Only few studies have examined the impact of racial differences on the age of onset, course and outcomes of diverticulitis. AIM: To provide data about the epidemiology of diverticulitis in northern Israel, and to determine whether ethnicity is a predictor of age of onset, complications, and need for surgery. METHODS: Was conducted a retrospective review of the charts of all patients diagnosed with a first episode of diverticulitis in our hospital between 2005 and 2012. RESULTS: Were found 638 patients with a first episode of acute diverticulitis in the eight year interval. Israeli Arabs developed a first episode of diverticulitis at a younger age compared to Jews (51.2 vs 63.8 years, p<0.01). Arabs living in rural areas developed diverticulitis at a younger age than Arabs living in urban centers (49.4 vs 54.5 years, P=0.03). Jewish and Arabic men developed diverticulitis at younger age compared to their female counterparts (59.9 vs 66.09, p<0.01, and 47.31 vs 56.93, p<0.01, respectively). Arabs were more likely [odds ratio (OR)=1.81 ,95% confidence interval (CI)1.12-2.90, p=0.017] than Jews to require surgical treatment (urgent or elective) for diverticulitis. CONCLUSIONS: Israeli Arabs tend to develop diverticulitis at a younger age and are more likely to require surgical treatment for diverticulitis compared to Jews. Arabs living in rural areas develop diverticulitis at a younger age than Arabs living in urban centers. These findings highlight a need to address the root cause for ethnic differences in onset, course and outcome of acute diverticulitis. .


RACIONAL: Somente poucos estudos examinaram o impacto das diferenças raciais na idade de início, curso e os resultados da diverticulite. OBJETIVO: Fornecer dados sobre a epidemiologia da diverticulite no norte de Israel, e determinar se a etnia é preditor de idade de início, complicações e necessidade de tratamento cirúrgico. MÉTODOS: Foi realizado estudo retrospectivo dos prontuários de todos os pacientes diagnosticados com um primeiro episódio de diverticulite em nosso hospital entre 2005 e 2012. RESULTADOS: Foram encontrados 638 pacientes com um primeiro episódio de diverticulite aguda no intervalo de oito anos. Os árabes israelenses desenvolveram o primeiro episódio de diverticulite em idade mais jovem em comparação com os judeus (51,2 vs 63,8 anos, p<0,01). Árabes que vivem em áreas rurais a diverticulite foi desenvolvida em idade mais jovem do que os árabes que vivem em centros urbanos (49,4 vs 54,5 anos, p=0,03). Homens judeus e árabes desenvolveram diverticulite em idade mais jovem em comparação com os seus homólogos do sexo feminino (59,9 vs 66,09, p<0,01, e 47,31 vs 56,93, p<0,01, respectivamente). Os árabes eram mais prováveis ​​do que os judeus de necessitar de tratamento cirúrgico (urgência ou eletiva) para a diverticulite [odds ratio (OR)=1,81, intervalo de confiança de 95% (CI) 1,12-2,90, p=0,017]. CONCLUSÕES: Os árabes israelenses tendem a desenvolver diverticulite em idade mais jovem e são mais propensos a necessitar de tratamento cirúrgico para a diverticulite em comparação com os judeus. Árabes que vivem em áreas rurais desenvolvem diverticulite em idade mais jovem do que os árabes que vivem em centros urbanos. Estes resultados destacam a necessidade de abordar a causa raiz para diferenças étnicas em início, o curso e o resultado da diverticulite aguda. .


Subject(s)
Aged , Female , Humans , Male , Middle Aged , Colonic Diseases/epidemiology , Colonic Diseases/surgery , Diverticulitis/epidemiology , Diverticulitis/surgery , Acute Disease , Age Factors , Arabs , Israel , Jews , Retrospective Studies
9.
Cir. parag ; 38(1): 28-31, jun. 2014. ilus, tab
Article in Spanish | LILACS, BDNPAR | ID: biblio-972555

ABSTRACT

Se describen cinco casos de diverticulitis cecal: todos presentaban dolor leve a moderado en fosa iliaca derecha sin otros signos de toxicidad. Todos fueron intervenidos con diagnóstico inicial de apendicitis aguda. Tres casos no presentaron duda de ser diverticulitis cecal durante cirugía y se realizó diverticulectomía, en los otros dos se realizó colectomía derecha y anastomosis (por importante proceso inflamatorio y sospecha de cáncer). Uno de los casos con colectomía presentó dehiscencia, falla multiorgánica y óbito.


We describe five cases of cecal diverticulitis: all of them present with mild or moderate pain in right lower quadrant without other toxicity sign. In all of them the initial diagnosis was acute appendicitis. At the surgery, three cases present no doubt of cecal diverticulitis and diverticulectomy was made, in the two others right colectomy with anastomosis was perform (because of important inflammation and suspicious of cancer). One of the colectomy cases present dehiscence, organ failure and death.


Subject(s)
Male , Female , Humans , Adolescent , Adult , Middle Aged , Appendicitis/surgery , Diverticulitis/surgery , Diverticulum
10.
Medicina (B.Aires) ; 74(2): 121-123, abr. 2014. tab
Article in Spanish | LILACS | ID: lil-708592

ABSTRACT

El dabigatrán es un nuevo inhibidor directo de la trombina, de administración oral, empleado para la prevención de eventos tromboembólicos en pacientes con fibrilación auricular no valvular. A diferencia de la warfarina, no se dispone de un antídoto conocido. La hemodiálisis ha sido sugerida como un método para remover el dabigatrán y reducir el efecto anticoagulante. Se presenta el caso de un paciente con antecedente de fibrilación auricular y medicado con dabigatrán, que fue admitido en el hospital para una cirugía abdominal de urgencia. A las seis horas de la última dosis recibida, los estudios de coagulación mostraban alteración. Ante la falta de antídoto para revertir los efectos, se decidió realizar hemodiálisis. Luego de tres horas de diálisis los parámetros de coagulación tendieron a normalizarse y el paciente fue operado sin presentar hemorragias anormales durante la cirugía o en el postoperatorio.


Dabigatran is an oral anticoagulant from the class of the direct thrombin inhibitors, indicated for prevention of thromboembolic events in patients with non valvular atrial fibrillation. Unlike warfarin, dabigatran has no known antidote. Hemodialysis has been suggested as a method for removing dabigatran and thereby reducing its anticoagulant effect. We report the case of a patient with a known history of atrial fibrillation, treated with dabigatran, who was admitted for emergency abdominal surgery. At six hours after the last dose received, coagulation studies were altered. In absence of an antidote to reverse its effects, it was decided to perform hemodialysis. After three hours of dialysis coagulation parameters were improved and the patient underwent surgery without showing abnormal bleeding during surgery or in the postoperative period.


Subject(s)
Aged, 80 and over , Humans , Male , Antithrombins/blood , Benzimidazoles/blood , Diverticulitis/surgery , Emergencies , Renal Dialysis , beta-Alanine/analogs & derivatives , Antithrombins/therapeutic use , Atrial Fibrillation/blood , Atrial Fibrillation/drug therapy , Blood Coagulation Tests , Benzimidazoles/therapeutic use , Dabigatran , Diverticulitis/blood , beta-Alanine/blood , beta-Alanine/therapeutic use
11.
Rev. argent. coloproctología ; 25(1): 15-22, mar. 2014. tab
Article in Spanish | LILACS | ID: lil-752827

ABSTRACT

Introducción: en las últimas décadas la utilización del abordaje laparoscópico en el tratamiento de enfermedades colorrectales, ha experimentado un auge significativo, logrando disminuir la morbimortalidad del tratamiento. Estos beneficios se pierden ante la necesidad de conversión. Objetivos: nos propusimos identificar los factores preoperatorios predictivos de conversión del procedimiento laparoscópico, en el tratamiento electivo de la enfermedad diverticular validando su aplicación, y evaluar las consecuencias de la conversión. Material y método: se realizó un estudio retrospectivo, descriptivo, observacional de los pacientes con diagnóstico de enfermedad diverticular, operados electivamente por técnica laparoscópica, en el Servicio de Coloproctología del Hospital Británico de Buenos Aires, durante el período comprendido entre junio de 1993 y junio de 2011. Se evaluaron las siguientes variables: edad, sexo, el índice de masa corporal, el riesgo quirúrgico según la American Society of Anesthesiologists (ASA), existencia de cirugías previas, motivo de indicación de cirugía, el tiempo operatorio, la recuperación del tránsito intestinal y la duración de la estadía hospitalaria. Se realizó un análisis univariado de las variables preoperatorias e intraoperatorias. Utilizando la prueba t de Student, se tomó estadísticamente significativo un valor de p < 0,05. Comparamos la morbilidad en relación a dichas variables. Resultados: se realizaron 126 procedimientos, 97 exclusivamente por laparoscopía y 29 requirieron de una laparotomía para su resolución. La edad promedio de la serie fue de 62,3 años de edad (rango 31-88). Setenta y nueve correspondiendo al sexo masculino (62.9%) y 47 al sexo femenino (37.3%). El IMC promedio fue de 25,1 kg/m2. Ochenta y cuatro pacientes fueron clasificados como ASA 1; 35, ASA 2 y 7, ASA 3... (TRUNCADO).


Background: in recent decades the use of laparoscopy in the treatment of colorectal diseases, has experienced an increase significant, achieving treatment reduce morbidity and mortality. These benefits are lost with the conversion. Objectives: we proposed identify preoperative factors predictive of conversion of laparoscopic procedure in the elective treatment of diverticular disease, validating their application, and evaluate consequences of the conversion. Material and methods: retrospective, descriptive, observational study of patients with diagnosis of diverticular disease, were electively operated by laparoscopic technique in the service of Coloproctology British Hospital of Buenos Aires during the period between June 1993 and June 2011. Following variables were evaluated: age, sex, body mass index, surgical risk according to the American Society of Anesthesiologists (ASA), existence of previous surgery, reason for surgery indication, operative time, recovery of intestinal transit and time of hospital stay. A univariate analysis of preoperative and intraoperative variables was performed. Using the Student t test, a P value <0.05 was statistically significant take. We compared morbidity in relation to these variables. Results: one hundred and twenty-six procedures were performed. Ninety-seven exclusively by laparoscopy and 29 laparotomy required for resolution. The average age of the series was 62.3 years (range 31-88). Seventy-nine corresponding males (62.9%) and 47 females (37.3%). The average BMI was 25.1 kg/m2. Eighty-four patients were classified as ASA 1, 35, 2 and 7 ASA, ASA 3. Seventy-four patients had a history of previous abdominal surgery (58.7%). Ninety-four (74.6%) patients corresponded to uncomplicated diverticulitis, and 32 (25.3%) present complicated diverticulitis. Operative time was 175 minutes for the laparoscopic group, while for the conversion group was 262 minutes. The conversion rate of the series was 23% (29/126)... (TRUNCADO).


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Aged, 80 and over , Diverticulitis/surgery , Diverticulum/surgery , Laparoscopy/methods , Body Mass Index , Elective Surgical Procedures , Intraoperative Care , Patient Selection
12.
Article in Portuguese | LILACS | ID: biblio-882614

ABSTRACT

Durante as últimas décadas, novos conhecimentos sobre a história natural da diverticulite aguda (DA) modificaram os paradigmas a respeito do tratamento. Estudos recentes demonstraram um papel menos importante da antibioticoterapia agressiva e intervenção cirúrgica na diverticulite crônica ou recorrente do que antes se achava necessário.1


During the last decades, new knowledge about the acute diverticulitis natural history have modified treatment paradigms. Recent studies demonstrate a smaller role for aggressive antibiotic and surgical intervention for chronic or recurrent diverticulitis than was previously thought necessary.


Subject(s)
Diverticulitis/diagnosis , Diverticulitis/drug therapy , Diverticulitis/surgery
13.
Gastroenterol. latinoam ; 25(supl.1): S42-S45, 2014. tab
Article in Spanish | LILACS | ID: lil-766739

ABSTRACT

Diverticular disease has increased in incidence, and the need for emergency surgery has decreased at the expense of elective surgery. Nearly 25 percent of diverticulitis will require surgery. In elective indications of surgery this should be individualized considering the likelihood of recurrence, the patient’s condition, the lifestyle and the type of crisis the patient has had. Currently, elective surgery should be ideally laparoscopic because it is accompanied by better recovery and fewer complications. In the emergency setting, surgical indications will be abscesses and local perforations that do not yield to medical management or puncture. In a good number of these cases it is feasible to do resection and primary anastomosis. In cases of purulent peritonitis we can also make resection and anastomosis with or without protection or eventually laparoscopic lavage and deferred elective resection in selected cases. For fecal peritonitis or in very compromised patients in situations described above it is safer to do Hartmann’s operation.


La enfermedad diverticular ha aumentado su incidencia, bajando la necesidad de cirugía de urgencia a expensas de la electiva. Cerca de 25 por ciento de los casos de diverticulitis requerirán cirugía. La indicación electiva de cirugía debe ser individualizada considerando la probabilidad de recurrencia, las condiciones del paciente, su estilo de vida y el tipo de crisis que ha tenido. Actualmente la cirugía electiva debiera ser idealmente laparoscópica por llevar aparejada mejor recuperación y menores complicaciones. En las indicaciones de urgencia están los abscesos y perforaciones locales que no ceden a manejo médico o por punción. En un buen número de estos casos es factible realizar resección y anastomosis primaria. En peritonitis purulenta podemos hacer también resección y anastomosis con o sin protección o eventualmente aseo laparoscópico y cirugía definitiva electiva en casos seleccionados. Para peritonitis fecaloidea o en pacientes muy comprometidos en las situaciones antes descritas lo más seguro es la operación de Hartmann.


Subject(s)
Humans , Diverticulitis/surgery , Diverticulum/complications
14.
Rev. chil. cir ; 64(4): 368-372, ago. 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-646966

ABSTRACT

Background: The usual surgical management of acute diverticulitis is Hartmann operation that is associated with high rates of complications and mortality. Recently, less invasive procedures, that avoid ostomies have been proposed as treatment, Alm: To analyze the results of laparoscopic peritoneal lavage in patients with acute diverticulitis. Material and Methods: Prospective analysis of seven patients age 25 to 61 years (four males) admitted for a first episode of acute diverticulitis classified as Hinchey II or III, in whom a percutaneous drainage of collections was not possible. All were subjected to a laparoscopic peritoneal lavage and debridement. Results: The mean body mass index of patients was 30.3 kg/m². Operative time was 55 +/- 28 min and there was no need for ostomies or conversion to open surgery. Two patients had complications. One required a percutaneous drainage of a collection and other required an open surgical procedure for peritoneal lavage. Patients stayed with nil per os for 2 +/- 1 days, required antimicrobials for 14 +/- 4 days and stayed in the hospital for 8 +/- 4 days. Conclusions: Laparoscopic peritoneal lavage is a good alternative surgical procedure for the treatment of acute diverticulitis.


Introducción: Tradicionalmente, el manejo quirúrgico de la diverticulitis aguda complicada (DAC) ha sido la operación de Hartmann. Sin embargo, ésta presenta tasas de morbilidad de 59 por ciento y mortalidad hasta de 12 por ciento. Han aparecido algunos procedimientos no resectivos con algunas ventajas operatorias y que evitarían la confección de una ostomía. Objetivo: Analizar resultados quirúrgicos de una serie de pacientes con DAC sometidos a lavado peritoneal sin resección por vía laparoscópica (LPL). Pacientes y Métodos: Serie de registro prospectiva de siete pacientes, que ingresaron con diagnóstico de DAC Hinchey II en que no fue posible el drenaje percutáneo de las colecciones y pacientes categorizados como Hinchey III, operados entre octubre de 2008 y noviembre de 2010. Resultados: Cuatro pacientes eran de sexo masculino. La edad media fue de 49 años, con un IMC de 30,3 kg/m². Todos los pacientes ingresaron con su primer episodio de DA. El tiempo operatorio fue de 55 +/- 28 minutos. No hubo necesidad de ostomía ni conversión. Dos pacientes presentaron complicaciones que requirieron de nuevos procedimientos durante su estadía. El tiempo de reposo digestivo fue de 2 +/- 1 días y la duración del esquema antibiótico fue de 14 +/- 4 días. La estadía hospitalaria fue de 8 +/- 4 días. Conclusiones: El LPL representa una alternativa al manejo quirúrgico tradicional. Las ventajas teóricas son bajas tasas de morbimortalidad, estadía hospitalaria más corta y sin la eventual necesidad teórica de una ostomía. Esta técnica requiere ser validada en el contexto de un estudio aleatorizado con claridad en criterios de inclusión y exclusión.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Diverticulitis/surgery , Drainage/methods , Laparoscopy/methods , Peritoneal Lavage/methods , Acute Disease , Diverticulitis/complications , Length of Stay , Postoperative Complications , Prospective Studies
15.
Int. j. morphol ; 28(4): 1273-1276, dic. 2010. ilus
Article in English | LILACS | ID: lil-582922

ABSTRACT

The ileal diverticulum (Meckel's diverticulum) is a congenital out pouching located in the distal ileum which occurs due to the failure of obliteration of the yolk stalk. The peak age in which this anomaly is mostly found is the pediatric age especially below the age of two. Hence it is noted as an uncommon cause of intestinal obstruction and fatality in adult life. We present a case of a 26 year old man with abdominal pain and vomiting for 6 days associated fever for 3 days. Emergency laparotomy revealed ileal diverticulitis with small bowel obstruction. Ileal diverculectomy with ileal resection and ileoileal anastamosis was performed. However, the patient developed renal dysfunction leading to Multiorgan Dysfunction Syndrome and died on the fourth post operative day. This anatomic anomaly is rare in adult patients and is difficult to diagnose early due to its bizarre presentation resulting in high mortality in them. Hence we find this case of interest.


El divertículo de ileal o de Meckel es una evaginación congénita en el íleon distal, que se produce debido a la falta de obliteración del conducto vitelino. La edad en que esta anomalía frecuentemente se encuentra es la pediátrica, especialmente en menores de dos años. Por lo tanto, es una causa infrecuente de obstrucción intestinal y de escasa fatalidad en adultos. A continuación presentamos un caso de un hombre de 26 años, que presentaba un cuadro febril de 3 días y dolor abdominal y vómitos durante 6 días. Una laparotomía de emergencia reveló diverticulitis ileal, con obstrucción del intestino delgado. Fue realizada una diverculectomía ileal con resección ileal y anastomosis ileoileal. Sin embargo, el paciente desarrolló insuficiencia renal que condujo a una disfunción multiorgánica y síndrome de muerte al cuarto día postoperatorio. Esta anomalía anatómica es rara observarla en pacientes adultos y difícil de diagnosticar a tiempo, debido a su singular presentación y frecuentemente resulta en una alta mortalidad en estos pacientes.


Subject(s)
Humans , Male , Adult , Diverticulitis/surgery , Diverticulitis/pathology , Meckel Diverticulum/surgery , Meckel Diverticulum/pathology , Fatal Outcome , Intestinal Obstruction/etiology
16.
Rev. chil. cir ; 61(6): 544-546, dic. 2009. ilus
Article in Spanish | LILACS | ID: lil-556688

ABSTRACT

We present an unfrequent case of acute diverticulitis mimmicking acute prostatitis. Case report: A 72-year-old man suffering from hypogastric and genital pain, fever and dysuria, with an edematous and tender prostate at physical examination, was initially diagnosed of acute prostatitis. 24 hours later the patient developed left lower quadrant pain and abdominal distension. A CT scan was performed, showing pneumoperitoneum and acute sigmoid diverticulitis signs. The patient underwent a Hartmann's procedure.


Presentamos un caso infrecuente de diverticulitis aguda con manifestaciones clínicas sugerentes de prostatitis aguda. Caso clínico: Varón de 72 años, presenta dolor hipogástrico y en región genital, fiebre y disuria, palpándose una próstata edematosa y dolorosa al tacto rectal, por lo que es inicialmente diagnosticado de prostatitis aguda. A las 24 horas el paciente desarrolla un cuadro de distensión abdominal y dolor en fosa ilíaca izquierda. Una TC abdominal mostró neumoperitoneo y signos de diverticulitis aguda. Se intervino al paciente realizando una intervención de Hartmann.


Subject(s)
Humans , Male , Aged , Diverticulitis/surgery , Diverticulitis/complications , Diverticulitis/diagnosis , Prostatitis/etiology , Acute Disease , Urologic Diseases/etiology , Intestinal Perforation
17.
Rev. chil. cir ; 61(5): 443-447, oct. 2009. tab
Article in Spanish | LILACS | ID: lil-582102

ABSTRACT

Laparoscopic surgery diminihes the morbidity of colorrectal surgery. These benefits are lost if the surgery is converted to an open procedure. We searched for predictive factors of conversión in patients with diverticular disease. A study of 79 patients who underwent laparoscopic sigmoid resection was performed, comparing those who underwent conversión and those who didn't. Material and Methods: A retrospective cohort study was done in a third level hospital of the patients who required laparoscopic sigmoidectomy during the last 7 years. Analysis: The t Student, test and the exact Fisher test were used. We considered p < 0.05 (95 percent confidence interval) as statistically significant. Results: The pre operative variables of age, sex, BMI, ASA, previous abdominal surgery, complicated or uncomplicated diverticulitis, and type of surgery were considered. Post operative variables considered were operative time, bleeding, return of bowel function, and hospital stay. No factor was identified as predictive of conversión. There was a statistically significant difference between both groups when surgical time (p = 0.0030) and operative bleeding (p = 0.0272) were compared. Conclusions: We failed to identify a single factor predictive of conversión to an open procedure. We think it is more probable that a confluence of different variables lead to this result. The patients in whom the conversión was performed had more bleeding and prolonged surgical times, which makes them more prone to post operative complications.


La laparoscopia disminuye la morbilidad de la cirugía colorrectal. Estos beneficios se pierden con la conversión. Buscamos factores predictivos de conversión en pacientes con enfermedad diverticular. Se realizó un estudio retrospectivo de 79 pacientes en quienes se realizó sigmoidectomía laparoscópica y se comparó los pacientes que requirieron conversión y los que no. Material y Métodos: Se hizo un estudio de cohorte retrospectivo en un hospital de tercer nivel de los pacientes a los que se realizó sigmoidectomía laparoscópica. Análisis: Se utilizó las pruebas t de Student y prueba exacta de Fisher. Se tomó como estadísticamente significativo un valor de p < 0,05 (intervalo de confianza 95 por ciento). Resultados: Se valoraron las variables pre operatorias de edad, sexo, IMC, clasificación ASA, cirugía abdominal previa, diverticulitis complicada o no complicada y tipo de cirugía. Variables post operatorias que se consideraron fueron tiempo quirúrgico, sangrado intra operatorio, retorno a función intestinal y estancia hospitalaria. No se identificó ningún factor predictivo de conversión. Si hubo diferencia estadísticamente significativa entre ambos grupos en cuanto al tiempo quirúrgico (p = 0,0030) y al sangrado intra operatorio (p = 0,0272). Conclusiones: No identificamos ningún factor predictivo de conversión en el tratamiento de la enfermedad diverticular por laparoscopia. Creemos que no hay un factor único que pueda ser utilizado para esto, más bien, es la confluencia de ciertas variables lo que conlleva a este resultado. Los pacientes en los que se realizó la conversión tienen mayor sangrado y tiempo quirúrgico, lo que pudiera hacer que sean más propicios a tener complicaciones post operatorias.


Subject(s)
Humans , Male , Adult , Female , Middle Aged , Colectomy/methods , Colon, Sigmoid/surgery , Diverticulitis/surgery , Laparoscopy/methods , Body Mass Index , Colectomy/adverse effects , Length of Stay , Laparoscopy/adverse effects , Prognosis , Retrospective Studies , Risk Factors
18.
Rev. chil. cir ; 60(2): 154-157, abr. 2008. ilus, tab
Article in Spanish | LILACS | ID: lil-497964

ABSTRACT

Introducción: La incidencia de diverticulitis apendicular es de 0,004 por ciento a 2,1 por ciento en diferentes series. Reporte de caso: Paciente masculino de 30 años de edad que consulta por un cuadro de 7 días de evolución con dolor abdominal localizado en la fosa ilíaca derecha. Con el diagnóstico de apendicitis aguda es sometido a apendicectomía encontrándose un apéndice inflamado en la punta y cubierto de fibrina. A la histología se observa un divertículo apendicular edematoso e infiltrado por polimorfonucleares y peritonitis periapendicular. La pared del apéndice se encuentra sin signos inflamatorios y el lumen es de diámetro normal. El paciente evoluciona sin complicaciones en el postoperatorio y es dado de alta en buenas condiciones. Discusión: La diverticulitis apendicular se manifiesta con dolor abdominal insidioso que puede preceder hasta en 14 días a la cirugía. Algunos pacientes mencionan episodios de dolor previo similares al actual. La ecografía y la tomografía abdominal son inespecíficas para el diagnóstico, y el tratamiento es el mismo de la apendicitis: la apendicectomía. Debido a que el tratamiento es tardío comparado con la apendicitis aguda, los pacientes que sufren de diverticulitis apendicular tienen una mayor incidencia de complicaciones en el postoperatorio. Nuestro paciente presentó algunas de estas características y cursó un postoperatorio sin complicaciones.


The incidence of appendiceal diverticulitis varies from 0.004 percent to 2.1 percent in different series. We report a 30 years old male that consulted for 7 days of abdominal pain located at the right lower quadrant. He was operated with the diagnosis of acute appendicitis. During surgery, a distally inflamed appendix covered with fibrin was observed. Pathology reported an edematous diverticulum infiltrated by polymorphonuclear cells and periappendiceal peritonitis. The appendiceal wall was normal and the appendiceal lumen diameter was preserved. Postoperative evolution was uneventful and the patient was discharged in good conditions. Appendiceal diverticulitis manifest as insidious abdominal pain lasting 1 to 14 days before surgery. Some patients had previous episodes of pain. Abdominal ultrasound and computed tomography are unspecific for the diagnosis of appendiceal diverticulitis and the treatment is just the same as for acute appendicitis: appendectomy.


Subject(s)
Humans , Male , Adult , Appendicitis/surgery , Diverticulitis/surgery , Appendectomy , Appendix/pathology , Treatment Outcome
19.
Rev. cuba. cir ; 44(4)oct.-dic. 2005. ilus
Article in Spanish | LILACS, CUMED | ID: lil-449784

ABSTRACT

Los divertículos esofágicos por pulsión son los que con mayor frecuencia se diagnostican en el esófago. En el Hospital Clinicoquirúrgico Hermanos Ameijeiras se estudiaron 8 pacientes en el período de 1992 a 1995 y de 1999 a 2002. La media de edad fue de 59 años y el 50 por ciento de los casos eran del sexo masculino. Del total de casos, 7 fueron divertículos faringoesofágicos y 1, epifrénico. Los tamaños variaron entre 1 cm a 12 cm, con una media de 3,9 cm y el tamaño de los cuellos entre 1 cm y 3 cm, con una media de 2,1 cm. A 5 de los divertículos de Zenker se les realizó diverticulectomía y a 2, diverticulopexia, siempre con miotomía del cricofaríngeo. En el caso del divertículo epifrénico se realizó diverticulectomía. Ninguna de las técnicas se asoció a complicaciones(AU)


The divertículos esofágicos for pulsión is those that are diagnosed in the esophagus with more frequency. In the Hospital Clinicoquirúrgico Siblings Ameijeiras 8 patients were studied in the period from 1992 to 1995 and of 1999 at 2002. The age stocking was of 59 years and 50 percent of the cases they were of the masculine sex. Of the total of cases, 7 were divertículos faringoesofágicos and 1, epifrénico. The sizes varied among 1 cm to 12 cm, with a stocking of 3,9 cm and the size of the necks between 1 cm and 3 cm, with a stocking of 2,1 cm. AT 5 of the divertículos of Zenker were carried out diverticulectomía and at 2, diverticulopexia, always with miotomía of the cricofaríngeo. In the case of the divertículo epifrénico he/she was carried out diverticulectomía. None of the techniques associated to complications(AU)


Subject(s)
Humans , Male , Middle Aged , Thoracotomy/methods , Zenker Diverticulum/surgery , Myotomy/adverse effects , Diverticulitis/surgery
20.
Rev. AMRIGS ; 49(1): 41-43, jan.-mar. 2005. ilus
Article in Portuguese | LILACS | ID: biblio-875418

ABSTRACT

Os divertículos de intestino delgado são pseudodivertículos, formados apenas por mucosa. São raros e tem maior incidência em idosos. Em geral, evoluem de forma satisfatória com tratamento conservador. Sua importância clínica é devida a complicações tais como dor abdominal, inflamação ou perfuração, diarréia e/ou má absorção, hemorragia e pseudo-obstrução. Relatamos um caso de diverticulite de intestino delgado, descrevendo suas características clínicas e cirúrgicas (AU)


Small bowel diverticula are pseudodiverticula consisting of mucosa only. They are unusual and have higher incidence in older people. In general, the outcome is satisfactory with conservative treatment. Their clinical relevance is due to complications such as chronic abdominal pain, inflammation or perforation, diarrhea and/or malabsortion, hemorrhage and pseudo-obstruction. We describe a case of diverticulitis of the small bowel with its clinical and surgical characteristics (AU)


Subject(s)
Humans , Female , Aged, 80 and over , Diverticulitis/diagnosis , Intestine, Small , Diverticulitis/surgery , Jejunum
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