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1.
Rev. colomb. cir ; 37(1): 83-89, 20211217. tab
Article in Spanish | LILACS | ID: biblio-1355312

ABSTRACT

Introducción. Las adherencias postoperatorias son la causa más frecuente de obstrucción de intestino delgado. La clínica sugiere el diagnóstico, pero de manera poco precisa la causa y el sitio de la obstrucción. La tomografía computarizada contrastada es el estudio óptimo y permite identificar de manera oportuna a los pacientes que requieren intervención quirúrgica. El objetivo de este estudio fue analizar la correlación entre la clínica y el sitio de obstrucción detectado en la tomografía computarizada contrastada de abdomen, en pacientes con sospecha diagnóstica de obstrucción de intestino delgado por adherencias. Métodos. Estudio prospectivo, transversal y analítico de pacientes con sospecha clínica de obstrucción de intestino delgado por adherencias y antecedentes quirúrgicos y su correlación con el sitio de obstrucción detectado en la tomografía computarizada de abdomen contrastada, de pacientes atendidos entre marzo de 2016 y febrero de 2019 en un hospital de segundo nivel. Resultados. Se incluyeron 41 pacientes, la media de edad fue de 59 años y el género masculino el más comprometido (68,3 %, n=28); la ausencia de evacuaciones estuvo presente en 97,5 % (p=0,026). La tomografía computarizada contrastada mostró el sitio de obstrucción en 73 % de los pacientes y la localización de la obstrucción más prevalente fue en íleon distal (31,7 %, n=13). Se asoció a leucocitosis (p=0,041) y a dolor más intenso (p=0,049), sin presentar irritación peritoneal. Conclusión. La obstrucción localizada en el íleon distal se caracterizó por presentar más dolor y mayor recuento leucocitario, sin correlación como factor de riesgo para requerir tratamiento quirúrgico.


Introduction. Postoperative adhesions are the most common cause of small bowel obstruction. The clinical presentation suggests the diagnosis, but imprecisely the cause and the site of the obstruction. Contrast computed tomography is the optimal study and allows the timely identification of patients requiring surgical intervention. The objective of this study was to analyze the correlation between the symptoms and the obstruction site detected in the abdominal contrasted computed tomography in patients with suspected diagnosis of small bowel obstruction due to adhesions. Methods. Prospective, cross-sectional and analytical study of patients with clinical suspicion of small bowel obstruction due to adhesions and surgical history, and its correlation with the obstruction site detected in the abdominal contrasted computed tomography, during March 2016 to February 2019 in a secondary level hospital. Results. Forty-one patients were included, the mean age was 59 years and the male gender was the most frequent (68.3%, n=28); the absence of evacuations was present in 97.5% (p=0.026). Contrast computed tomography showed the obstruction site in 73% of the patients. The most prevalent location of the obstruction was in the distal ileum (31.7%, n=13). It was associated with leukocytosis (p=0.041) and more intense pain (p=0.049), without presenting peritoneal irritation. Conclusion. The obstruction located in the distal ileum was characterized by more pain and a higher white blood cell count, without correlation as a risk factor for requiring surgical treatment


Subject(s)
Humans , Intestinal Obstruction , Tissue Adhesions , Diagnosis , Intestine, Small
2.
Rev. Méd. Inst. Mex. Seguro Soc ; 59(6): 560-567, 01-dic-2021. ilus, tab
Article in Spanish | LILACS | ID: biblio-1357659

ABSTRACT

Introducción: el sangrado gastrointestinal de origen oscuro es una entidad poco frecuente y se reserva a los casos en los que ya se ha realizado exploración del intestino delgado (endoscópica/radiológica) sin encontrar la causa. Actualmente el estándar de oro es la videocápsula, que se ha descrito como una técnica segura, útil y eficaz para el diagnóstico y tratamiento de las enfermedades del intestino delgado. Objetivo: describir variables demográficas, indicaciones, hallazgos, segmento explorado, tratamiento y tiempo de procedimiento quirúrgico de la enteroscopía transoperatoria en 15 pacientes con diagnóstico de sangrado de tubo digestivo de origen oscuro. Material y métodos: se incluyeron 15 pacientes adultos con el diagnóstico de sangrado de origen oscuro con panendoscopía y colonoscopía negativa a sangrado. A todos se les realizó laparotomía exploradora y enteroscopía transoperatoria con un gastroduodenoscopio. Resultados: se realizaron 15 enteroscopías transoperatorias con gastroduodenoscopio; 10 en mujeres y 5 en hombres, con promedio de edad de 67.2 años. Se exploró la tercera y cuarta porción del duodeno, yeyuno e íleon terminal. Los diagnósticos encontrados fueron enfermedad de Crohn en 1 paciente (6.66%), adenomas en 2 (13.3%), divertículo yeyunal en 6 (40%) y angiectasias en 6 casos (40%). La localización fue en yeyuno [12 casos (80%)] e íleon [3 casos (20%)]. Conclusiones: la enteroscopía intraoperatoria es una alternativa diagnóstica en el sangrado de origen oscuro cuando no se cuente con la enteroscopía doble balón o la videocápsula endoscópica.


Background: Bleeding of dark origin is a rare entity and it is reserved for cases in which exploration of the small intestine has already been performed (endoscopic / radiological) without finding the cause. Currently, the gold standard is the videocapsule which has been described as a safe, useful and effective technique for the diagnosis and treatment of diseases of the small intestine. Objective: The objective was to describe demographic variables, indications, findings, explored segment, treatment and time of the surgical procedure of the intraoperative enteroscopy in 15 patients with a diagnosis of gastrointestinal bleeding of dark origin. Material and methods: 15 adult patients with the diagnosis of bleeding of dark origin with panendoscopy and negative colonoscopy to bleeding were included. All of these underwent exploratory laparotomy and intraoperative enteroscopy with a gastroduodenoscope. Results: 15 intraoperative enteroscopies were performed with a gastroduodenoscope; 10 women and 5 men with an average age of 67.2 years. Third and fourth portions of the duodenum, jejunum, and terminal ileum were explored. The diagnoses found were Crohn's disease 1 (6.66%), Adenomas 2 (13.3%), jejunal diverticulum 6 (40%) and angiectasias in 6 cases (40%). The location was in jejunum, 12 cases (80%) and ileum, 3 cases (20%). Conclusions: Intraoperative enteroscopy is a diagnostic alternative in bleeding of dark origin when there is no double balloon enteroscopy or endoscopic video capsule.


Subject(s)
Humans , Male , Female , Surgical Procedures, Operative , Crohn Disease , Colonoscopy , Endoscopes, Gastrointestinal , Mexico , Adenoma , Diverticulum , Gastrointestinal Tract , Duodenum , Endoscopy , Hemorrhage , Intestine, Small , Jejunum , Laparotomy
3.
Arq. gastroenterol ; 58(3): 322-328, July-Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1345302

ABSTRACT

ABSTRACT BACKGROUND: Crohn's disease (CD) is an inflammatory bowel disease characterized by a chronic and recurrent inflammation of the gastrointestinal tract caused by an interaction of genetic and environmental factors. OBJECTIVE: To compare the quality and acceptance of two different oral contrast volumes for computed tomography enterography in Crohn's disease patients. METHODS: A cross-sectional study was conducted in 58 consecutive Crohn's disease patients who randomly received an oral contrast agent composed of 78.75 g polyethylene glycol diluted in either 1,000 mL or 2,000 mL of water. An examination was performed to evaluate the presence of inflammation or complications in the small bowel. The variables included the quality of intestinal segment filling and luminal distension, and oral contrast agent acceptance and tolerance in the patients. Statistical analysis included descriptive statistics and association tests. RESULTS: A total of 58 patients were assessed, in which 58.6% were female, 34.5% exhibited clinically-active disease, and 63.8% were receiving biologic therapy. As for comparative analysis between the two different volumes of oral contrast, no statistically significant difference was found regarding bowel loop filling (P=0.58) and adequate luminal distension (P=0.45). Patients who received a larger volume (2,000 mL) exhibited side-effects more frequently (51.7% vs 31.0%; P=0.06) and had greater difficulty ingesting the agent (65.5% vs 37.9%; P=0.07) compared with a volume of 1,000 mL. CONCLUSION: The quality of computed tomography enterography was not influenced by the contrast volume. However, acceptance and tolerance were better in the 1,000 mL group.


RESUMO CONTEXTO: A doença de Crohn (DC) é uma doença inflamatória intestinal caracterizada por uma inflamação crônica e recorrente do trato gastrointestinal causada por uma interação de fatores genéticos e ambientais. OBJETIVO: Comparar a qualidade e aceitação de dois volumes diferentes de contraste oral para enterografia por tomografia computadorizada em pacientes com doença de Crohn. MÉTODOS: Um estudo transversal foi conduzido em 58 pacientes com doença de Crohn que receberam aleatoriamente um agente de contraste oral composto por 78,75 g de polietilenoglicol diluído em 1.000 mL ou 2.000 mL de água. Um exame foi realizado para avaliar a presença de inflamação ou complicações no intestino delgado. As variáveis incluíram a qualidade do preenchimento do segmento intestinal e distensão luminal e aceitação e tolerância do contraste oral nos pacientes. A análise estatística incluiu estatística descritiva e testes de associação. RESULTADOS: Foram avaliados 58 pacientes, dos quais 58,6% eram mulheres, 34,5% apresentavam doença clinicamente ativa e 63,8% estavam recebendo terapia biológica. Quanto à análise comparativa entre os dois diferentes volumes de contraste oral, não foi encontrada diferença estatisticamente significativa em relação ao enchimento da alça intestinal (P=0,58) e distensão luminal adequada (P=0,45). Pacientes que receberam um volume maior (2.000 mL) exibiram efeitos colaterais com mais frequência (51,7% vs 31,0%; P=0,06) e tiveram maior dificuldade para ingerir o agente (65,5% vs 37,9%; P=0,07) em comparação com um volume de 1.000 mL. CONCLUSÃO: A qualidade da entero-tomografia computadorizada não foi influenciada pelo volume de contraste. No entanto, aceitação e tolerância foram melhores no grupo de 1.000 mL.


Subject(s)
Humans , Female , Crohn Disease/diagnostic imaging , Contrast Media , Magnetic Resonance Imaging , Tomography, X-Ray Computed , Cross-Sectional Studies , Intestine, Small
4.
Biomédica (Bogotá) ; 41(3): 504-530, jul.-set. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1345400

ABSTRACT

Resumen Introducción. Los edulcorantes son aditivos que se consumen en los alimentos. Pueden ser naturales (sacarosa y estevia) o artificiales (sucralosa). Actualmente, se consumen rutinariamente en múltiples productos, y sus efectos en la mucosa y la microbiota del intestino delgado aún son controversiales. Objetivo. Relacionar el consumo de edulcorantes y su efecto en el sistema inmunitario y la microbiota del intestino delgado en ratones CD1. Materiales y métodos. Se utilizaron 54 ratones CD1 de tres semanas de edad divididos en tres grupos: un grupo de tres semanas sin tratamiento, un grupo tratado durante seis semanas y un grupo tratado durante 12 semanas. Se les administró sacarosa, sucralosa y estevia. A partir del intestino delgado, se obtuvieron linfocitos B CD19+ y células IgA+, TGF-ß (Transforming Growth Factor-beta) o el factor de crecimiento transformador beta (TGF-beta), IL-12 e IL-17 de las placas de Peyer y de la lámina propia. De los sólidos intestinales se obtuvo el ADN para identificar las especies bacterianas. Resultados. Después del consumo de sacarosa y sucralosa durante 12 semanas, se redujeron las comunidades bacterianas, la IgA+ y el TGF-beta, se aumentó el CD19+, y además, se incrementaron la IL-12 y la IL-17 en las placas de Peyer; en la lámina propia, aumentaron todos estos valores. En cambio, con la estevia mejoraron la diversidad bacteriana y el porcentaje de linfocitos CD19+, y hubo poco incremento de IgA+, TGF-ß e IL-17, pero con disminución de la IL-17. Conclusión. La sacarosa y la sucralosa alteraron negativamente la diversidad bacteriana y los parámetros inmunitarios después de 12 semanas, en contraste con la estevia que resultó benéfica para la mucosa intestinal.


Abstract Introduction: Sweeteners are additives used in different foods. They can be natural (sucrose and stevia) or artificial (sucralose). Currently, they are routinely consumed in multiple products and their effects on the mucosa of the small intestine and its microbiota are still controversial. Objective: To relate the consumption of sweeteners and their effect on the immune system and the microbiota of the small intestine in CD1 mice. Materials and methods: We used 54 three-week-old CD1 mice divided into three groups in the experiments: 1) A group of three weeks without treatment, 2) a group treated for six weeks, and 3) a group treated for 12 weeks using sucrose, sucralose, and stevia. We obtained CD19+ B lymphocytes, IgA+ antibodies, transforming growth factor-beta (TGF-b), and interleukins 12 and 17 (IL-12 and -17) from Peyer's patches and lamina propria cells while DNA was obtained from intestinal solids to identify bacterial species. Results: After 12 weeks, sucrose and sucralose consumption caused a reduction in bacterial communities with an increase in CD19+, a decrease in IgA+ and TGF-b, and an increase in IL-12 and -17 in the Peyer's patches while in the lamina propria there was an increase in all parameters. In contrast, stevia led to an improvement in bacterial diversity and percentage of CD19+ lymphocytes with minimal increase in IgA+, TGF-b, and IL-12, and a decrease in IL-17. Conclusion: Sucrose and sucralose caused negative alterations in bacterial diversity and immune parameters after 12 weeks; in contrast, stevia was beneficial for the intestinal mucosa.


Subject(s)
Sweetening Agents , Gastrointestinal Microbiome , Sucrose , Stevia , Intestine, Small
5.
Rev. colomb. cir ; 36(4): 732-737, 20210000. fig
Article in Spanish | LILACS | ID: biblio-1291284

ABSTRACT

Introducción. El enterocele es causado por un defecto herniario del piso pélvico, siendo el más común la hernia interrecto-vaginal. Se produce por un debilitamiento del piso pélvico, por diversos factores, entre ellos, las cirugías en la región pélvica, el estreñimiento crónico o las patologías que aumentan la presión intraabdominal, el antecedente de prolapso rectal o vaginal, y también, factores congénitos. Presentación de caso. Paciente femenina de 84 años de edad, con antecedentes de un parto eutócico y múltiples procedimientos quirúrgicos, entre ellos histerectomía hace 40 años y rectosigmoidectomía por enfermedad diverticular complicada hace 6 años, quien cuatro meses antes presenta constipación crónica, que empeora en los días previos a su ingreso, con dolor perineal intenso y salida de asas intestinales a nivel de la región perineal, que la obliga a consultar a Urgencias. Al encontrarse con asas intestinales expuestas, con cambios de coloración, es intervenida quirúrgicamente con resultado satisfactorio, postquirúrgico inmediato optimo y seguimiento por consulta externa por 3 meses sin evidencia de recidiva. Discusión. La hernia interrecto-vaginal tiene una incidencia baja y una presentación clínica variada. El único tratamiento es quirúrgico


Introduction. The enterocele is produced by an hernia defect of the pelvic floor, being the most common the interrecto-vaginal hernia. It is produced by weakness of the pelvic floor for multiples factors, among them surgeries of the pelvic region, chronic constipation or pathologies that increase intra-abdominal pressure, a history of rectal or vaginal prolapse, and congenital factors. Case report. A 84-year-old female patient, with a history of eutocic delivery and multiple surgical procedures, including hysterectomy 40 years ago and rectosigmoidectomy for complicated diverticular disease 6 years ago, presented four months earlier with chronic constipation, which worsens in the days before her admission, with intense perineal pain and exit of intestinal loops at the level of the perineal region, which forced her to consult the emergency room. At examination the intestinal loops were found exposed, with color changes, she underwent surgery with satisfactory results, optimal immediate postoperative and outpatient follow-up for 3 months with no evidence of recurrence. Discussion. Interrecto-vaginal hernia has a low incidence and a varied clinical presentation. The only treatment is surgery


Subject(s)
Humans , Perineum , Douglas' Pouch , Hernia , Pelvic Floor , Intestine, Small
6.
Oncol. (Guayaquil) ; 31(2): 114-121, 31 de agosto 2021.
Article in Spanish | LILACS | ID: biblio-1284436

ABSTRACT

Introducción: El linfoma de células T intestinal epiteliotrópico monomórfico es una neoplasia derivada de linfocitos intraepiteliales. La etiología es desconocida, pero se ha asociado a enfermedad celíaca o a síndrome de malabsorción, aunque en la actualidad se considera un linfoma esporádico. La histopatología se caracteriza por linfocitos de tamaño intermedio a pequeño, con mínimo pleomorfismo, que generalmente expresan CD8 y CD56. Reporte de caso: Mujer de 60 años con dispepsia de larga evolución, fue ingresada por dolor abdominal agudo, diarrea, nausea, vómito bilioso y pérdida de peso. En los estudios se determinó anemia microcítica hipocrómica y desequilibrio hidroelectrolítico. Se evidenció por tomografía de abdomen una lesión nodular esplénica y engrosamiento concéntrico segmentario de yeyuno e íleon distal asociado a la presencia de líquido libre en cavidad abdominal, se consideró una masa tumoral. Evolución: Se realizó una laparotomía exploratoria con resección de yeyuno-transverso, en patología se determinó la presencia de 3 tumores: a nivel de yeyuno de 16x8.5x6 cm, en el íleon distal de 13x6.5x3 cm y en el ciego de 5x4x2cm con histología de linfoma no Hodgkin T de alto grado, intestinal primario, de tipo monomórfico epiteliotrópico (MEITL). Fue dada de alta diez días después. Dos semanas luego desarrollo sepsis de foco urinario, deshidratación, síndrome de intestino corto, hiper-amonemia y neumonía de focos múltiples con derrame pleural bilateral. Falleció al sexto día de hospitalización. Conclusiones: El MEITL es una neoplasia agresiva primaria intestinal de reciente identificación y pobre pronóstico. No se conocen en su totalidad los mecanismos moleculares asociados a esta entidad. El caso presentado demostró un curso clínico similar al reportado en la literatura.


Introduction: Monomorphic epitheliotropic intestinal T-cell lymphoma is a derived neoplasia of intraepithelial lymphocytes. The etiology is unknown, but it has been associated with celiac disease or malabsorption syndrome, although it is currently considered a sporadic lymphoma. Histopatholo-gy is characterized by medium to small lymphocytes with minimal pleo-morphism, which generally express CD8 and CD56. Case report: A 60-year-old woman with long-standing dyspepsia was admitted for acute abdominal pain, diarrhea, nausea, bilious vomiting, and weight loss. In the studies, hypochromic microcytic anemia and fluid and electrolyte imbalance were determined. A splenic nodular lesion and segmental concentric thickening of the jejunum and distal ileum associated with the presence of free fluid in the abdominal cavity was evidenced by abdominal tomography, it was considered a tumor mass. Evolution: An exploratory laparotomy was performed with transverse jejunum resection, in pathol-ogy the presence of 3 tumors was determined: at the jejunum level of 16x8.5x6 cm, in the distal ileum of 13x6.5x3 cm and in the cecum of 5x4x2cm with histology of high-grade non-Hodgkin T lymphoma, primary intestinal, epitheliotropic monomorphic type (MEITL). She was discharged ten days later. Two weeks later, she developed sepsis with a urinary focus, dehydration, short bowel syn-drome, hyper-amonemia, and multiple-focus pneumonia with bilateral pleural effusion. He died on the sixth day of hospitalization. Conclusions: MEITL is a recently identified aggressive primary intestinal neoplasm and poor prog-nosis. The molecular mechanisms associated with this entity are not fully known. The case presented showed a clinical course similar to that reported in the literature.


Introdução: O linfoma intestinal monomórfico epiteliotrópico de células T é uma neoplasia derivada de linfócitos intraepiteliais. A etiologia é desconhecida, mas tem sido associada à doença celíaca ou síndrome de má absorção, embora seja atualmente considerado um linfoma esporádico. A histopatologia é caracterizada por linfócitos médios a pequenos com pleomorfismo mínimo, que geralmente expressam CD8 e CD56. Relato do caso: Mulher de 60 anos com dispepsia de longa data foi admitida por dor abdominal aguda, diarreia, náuseas, vômitos biliosos e perda de peso. Nos estudos, foram determinados a anemia microcítica hipocrômica e o desequilíbrio hidroeletrolítico. Lesão nodular esplênica e espessamento concêntrico segmentar do jejuno e íleo distal associado à presença de líquido livre na cavidade abdominal foi evidenciado pela tomografia abdominal, considerada massa tumoral. Evolução: Foi realizada laparotomia exploradora com ressecção transversa do jejuno, na anatomia patológica foi determinada a presença de 3 tumores: ao nível do jejuno de 16x8,5x6 cm, no íleo distal de 13x6,5x3 cm e no ceco de 5x4x2cm com histologia de epiteliotrópico monomórfico monomórfico tipo linfoma T intestinal primário não-Hodgkin (MEITL). Ela teve alta dez dias depois. Duas semanas depois, desenvolvimento de sepse de foco urinário, desidratação, síndrome do intestino curto, hiperamonemia e pneumonia de foco múltiplo com derrame pleural bilateral. Ele morreu no sexto dia de internação. Conclusões: MEITL é uma neoplasia intestinal primária agressiva recentemente identificada e de mau prognóstico. Os mecanismos moleculares associados a esta entidade não são totalmente conhecidos. O caso apresentado apresentou evolução clínica semelhante à relatada na literatura.


Subject(s)
Humans , Middle Aged , Lymphoma, T-Cell , Lymphoma, B-Cell, Marginal Zone , Case Reports , Intestinal Neoplasms , Intestine, Small
7.
Arch. argent. pediatr ; 119(5): e441-e472, oct. 2021. tab, ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1292123

ABSTRACT

La falla intestinal secundaria a síndrome de intestino corto en pediatría es una entidad poco frecuente, de alta morbimortalidad. Requiere de un equipo interdisciplinario para su abordaje, lo cual ha demostrado que disminuye la morbimortalidad y aumenta la posibilidad de que los pacientes logren la autonomía intestinal. Existe una falta de evidencia científica en diferentes abordajes de la patología. Consideramos necesario el desarrollo de esta Guía para el Manejo Clínico construida sobre la base de la metodología Delphi modificada, en la Asociación Argentina de Nutrición Enteral y Parenteral, por 16 expertos que se reunieron para discutir y consensuar los principales aspectos de tratamiento clínico. Se analizaron 4 aspectos: definiciones y epidemiología; nutrición enteral, nutrición parenteral; tratamientos farmacológicos y quirúrgicos,y criterios de derivación a centros de alta complejidad. Sin duda este documento será de utilidad para los pacientes, los profesionales y las instituciones, así como para los diferentes financiadores del sistema de salud.


Intestinal failure secondary to short bowel syndrome in pediatrics, is a rare condition with high morbimortality. A follow up multidisciplinary team is necessary to minimize complications and optimize the intestinal rehabilitation. There are no gold standard guidelines for the management of this group of complex patients. The development of clinical guidelines may contribute for an adequate management of patients with intestinal failure and short bowel syndrome. This Clinical Guideline for the Management was developed by 16 experts based on modified Delphi methodology. The meetings were held at the Argentinian Association of Enteral and Parenteral Nutrition (Asociación Argentina de Nutrición Enteral y Parenteral); the topics analyzed were definitions, epidemiology, enteral and parenteral nutrition, pharmacological and surgical treatments, and criteria for referring patients to intestinal rehabilitation centers. The document is aimed to provide basic scientific knowledge for medical institutions, health providers, healthcare providers, patients and families.


Subject(s)
Humans , Child , Pediatrics , Short Bowel Syndrome/complications , Short Bowel Syndrome/therapy , Parenteral Nutrition , Intestine, Small , Intestines
8.
Rev. colomb. gastroenterol ; 36(supl.1): 47-51, abr. 2021. graf
Article in Spanish | LILACS | ID: biblio-1251546

ABSTRACT

Resumen La neumatosis quística intestinal se refiere a la presencia de gas dentro de la pared del intestino delgado o grueso, puede ser asintomática y potencialmente mortal cuando se presentan complicaciones. Las causas de esta entidad incluyen enfermedades pulmonares, sistémicas, intestinales, medicamentosas, causas iatrogénicas y traumáticas. Se presenta el caso de un hombre de 35 años de edad sin antecedentes de importancia que consultó por dolor en el hemiabdomen inferior, con un diagnóstico imagenológico de neumatosis quística intestinal, neumoperitoneo y peritonitis, complicación secundaria a esta patología, por lo que se realizó el manejo quirúrgico, laparotomía y resección de segmento colónico, que se analizó histopatológicamente y se confirmó el diagnostico; finalmente, fue dado de alta después de finalizar el tratamiento antibiótico.


Abstract Cystic intestinal pneumatosis refers to the presence of gas within the wall of the small or large intestine. It can be asymptomatic and life-threatening when complications occur. The causes of this entity include pulmonary, systemic, intestinal, drug, iatrogenic and traumatic factors. The following is the case of a 35-year-old man who presented with pain in his lower hemiabdomen and had no previous medical history. Imaging scans showed intestinal cystic pneumatosis and secondary pneumoperitoneum and peritonitis. The patient was taken to laparotomy, and a colonic segment was resected and sent to pathology. The diagnosis was confirmed by a biopsy. The patient was discharged after completing antibiotic treatment.


Subject(s)
Humans , Male , Adult , Peritonitis , Pneumatosis Cystoides Intestinalis , Gases , Intestine, Large , Intestine, Small
9.
Arq. gastroenterol ; 58(1): 26-31, Jan.-Mar. 2021. tab
Article in English | LILACS | ID: biblio-1248982

ABSTRACT

ABSTRACT BACKGROUND: Worldwide, colorectal cancer (CRC) and gastric cancer (GC) are the third and the fifth most prevalent, respectively. Diarrhea is a common symptom in patients on chemotherapy or radiotherapy treatment and can reduce treatment tolerance. Surgical resections and chemotherapy change the intestinal microbiota that can lead to lactose intolerance, small intestinal bacterial overgrowth (SIBO). OBJECTIVE: The aim of the study was to evaluate the frequency of diarrhea in patients with CRC and GC on chemotherapy with SIBO or intolerance of lactose. METHODS: This is a descriptive and observational study with patients of both sexes, over 18 years old, in treatment in the Gastro-Oncology outpatient clinic of the Federal University of São Paulo. Patients with a confirmed diagnosis of CRC or GC during chemotherapy treatment were included. To detect bacterial overgrowth and lactose intolerance, breath hydrogen test with lactulose and lactose was done. Number and aspects of the evacuations and toxicity degree were collected. For the nutritional assessment, weight and height were performed to calculate the BMI. and the Patient Generated Subjective Global Assessment (PG-SGA). RESULTS: A total of 33 patients were included, 29 with CRC and 3 with GC. Most of them were male (57.57%), mean age of 60.03±10.01 years and in chemotherapy with fluoropyrimidine and oxaliplatin (54.5%). Diarrhea was present in 57.6% and 30.3% had toxicity grade 2. According to the BMI, 78.9% were eutrophics, obese or overweight, but according to PG-SGA, 84.9% had moderate or severe nutritional risk grade. Between patients, 45% had lactose intolerance and 9% SIBO. Diarrhea grade 2-3 was observed in 66.6% of patients with SIBO and 66.7% of that with lactose intolerance. No statistical difference was observed between patients with SIBO or lactose intolerance and grade of diarrhea. CONCLUSION: Diarrhea was a frequent symptom in chemotherapy patients with gastric or colorectal cancer independent of the presence of SIBO or lactose intolerance. Surgery and chemotherapy treatment impacted in the intestinal habit of patients. Diagnosis of other causes of diarrhea may contribute to a better tolerance to treatment and quality of life.


RESUMO CONTEXTO: Mundialmente, o câncer colorretal (CCR) e gástrico (CG) são a terceira e a quinta causa de câncer mais prevalente, respectivamente. A diarreia é um sintoma comum entre os pacientes em quimioterapia ou radioterapia e pode reduzir a tolerância ao tratamento. Quimioterapia e ressecções cirúrgicas causam alterações da microbiota intestinal que podem levar a intolerância à lactose e ao supercrescimento bacteriano do intestino delgado (SBID). OBJETIVO: Avaliar a presença de diarreia nos pacientes com câncer colorretal e gástrico em quimioterapia e a presença de SBID ou intolerância à lactose. MÉTODOS: Foi realizado um estudo descritivo, observacional com pacientes ambulatoriais de ambos os sexos, maiores de 18 anos, em tratamento no ambulatório de gastro-oncologia da Universidade Federal de São Paulo. Foram incluídos pacientes com diagnóstico confirmado de CCR ou CG durante tratamento quimioterápico. Para detectar supercrescimento bacteriano e intolerância à lactose, foram realizados testes respiratórios com lactulose e lactose respectivamente. Número, aspecto das evacuações e grau de toxicidade foram coletados. Para a avaliação nutricional foram aferidos peso e altura para cálculo do IMC e para avaliação do risco nutricional foi realizada a avaliação subjetiva global produzida pelo próprio paciente (ASG-PPP). RESULTADOS: Foram incluídos 33 pacientes, 29 com CCR e 3 com CG. A maioria era do sexo masculino (57,5%) com média de idade 60,03±10,01 anos e em tratamento quimioterápico com fluoropirimidina e oxaliplatina (54,5%). Diarreia foi relatada por 57,6% dos pacientes sendo em 30% grau 2. Pelo IMC, 78,9% apresentavam eutrofia, sobrepeso ou obesidade grau 1, mas pela ASG-PPP 84,9 apresentavam risco nutricional moderado ou severo. Entre os pacientes 9% apresentavam SBID e 45% intolerância à lactose. Diarreia grau 2-3 foi observada em 66,6% daqueles pacientes com SBID e 66,7% dos com intolerância à lactose. Não encontramos diferenças estatísticas entre os pacientes com SBID ou intolerância à lactose e intensidade de diarreia. CONCLUSÃO: Diarreia foi um sintoma frequente entre os pacientes com câncer gástrico ou colorretal em quimioterapia independente da presença de SBID ou intolerância à lactose. Cirurgia e quimioterapia impactaram no hábito intestinal dos pacientes. O diagnóstico de outras causas de diarreia pode contribuir para a melhor tolerância do tratamento e qualidade de vida.


Subject(s)
Humans , Male , Female , Adolescent , Aged , Stomach Neoplasms , Colorectal Neoplasms/drug therapy , Lactose Intolerance/diagnosis , Quality of Life , Breath Tests , Hydrogen , Intestine, Small , Lactose , Middle Aged
10.
Article in English | WPRIM | ID: wpr-922616

ABSTRACT

Inflammatory myofibroblastoma (IMT) is a rare solid tumor, and its etiology and pathogenesis are unclear. Crohn's disease is a non-specific intestinal inflammatory disease. The clinical manifestations, laboratory examinations, and imaging examinations of IMT are not specific, making diagnosis difficult. A case of Crohn's disease combined with IMT of abdominal wall was admitted to the Department of Gastroenterology at the Third Xiangya Hospital, Central South University, on Nov. 21, 2017. This patient was admitted to our hospital because of repeated right lower abdominal pain for 4 years. A 6 cm×5 cm mass was palpated in the right lower abdomen. After completing the transanal double-balloon enteroscopy and computed tomographic enterography for the small intestinal, the cause was still unidentified. The patient underwent surgery due to an abdominal wall mass with intestinal fistula on Sept. 12, 2018 and recovered well currently. According to histopathology and immunohistochemistry, he was diagnosed with Crohn's disease combined with IMT. Up to July 2020, the patients still took azathioprine regularly, without abdominal pain, abdominal distension, and other discomfort, and the quality of his life was good.


Subject(s)
Abdominal Pain , Abdominal Wall/surgery , Crohn Disease/complications , Humans , Intestine, Small , Male , Neoplasms, Muscle Tissue/surgery
11.
Article in English | WPRIM | ID: wpr-922591

ABSTRACT

OBJECTIVES@#At present, there are many studies on Crohn's disease of terminal ileum and colon, but few studies on Crohn's disease of small intestine alone. This study aims to analyze the clinical features and therapeutic effect of small bowel in adult patients with Crohn's disease so as to strengthen the diagnosis and treatment for this disease.@*METHODS@#From July 1, 2015 to October 31, 2018, patients with small bowel Crohn's disease at Department of Gastroenterology, Third Xiangya Hospital of Central South University, were enrolled. At the same time, patients' demographics and clinical data were collected.@*RESULTS@#A total of 44 patients were small bowel Crohn's disease. Among them, 40 patients were male. The age at diagnosis was (35.8±10.3) years old and disease duration was (35.2±59.5) months. The subtypes included 29(65.9%) of ileum, 7(15.9%) of jejunum, 8(18.2%) of ileum with jejunum. There were 27(61.4%) of stricture behavior, 4(9.1%) of penetrating behavior, and 13(29.5%) of non-stricture and non-penetrating behavior. Endoscopic visible stricture (29/85, 34.1%) was common, followed by longitudinal ulcers (27/85, 31.8%). Non-caseate granulomatous were found in 2 cases (4.5%). The score of Crohn's disease activity index was correlated to hemoglobin, hematocrit, and erythrocyte sedimentation rate (all @*CONCLUSIONS@#Patients with ileum account for a large proportion in patients with small bowel Crohn's disease. Stricture is more common in small bowel Crohn's disease. Stricture and longitudinal ulcer are more common under enteroscopy. Crohn's disease activity index is correlated to hemoglobin, red blood cell specific volume, and erythrocyte sedimentation rate. The most common complication is intestinal obstruction. Mesalazine is less effective on small bowel Crohn's disease.


Subject(s)
Adult , Crohn Disease/drug therapy , Endoscopy, Gastrointestinal , Humans , Ileum , Intestinal Obstruction/etiology , Intestine, Small , Male , Middle Aged
12.
Rev. méd. hondur ; 89(1, supl): 23-27, 2021. ilus
Article in Spanish | LILACS | ID: biblio-1280947

ABSTRACT

Antecedentes: La hemorragia gastrointestinal oculta representa aproximadamente del 5%-10% del total de las hemorragias digestivas. Descripción del caso clínico: Paciente femenina de 62 años, procedente de Santa Cruz de Yojoa, Cortés, sin comorbilidades, con episodios intermitentes de melena de un año de evolución; evaluada y manejada con hierro parenteral y transfusiones sanguíneas. Se le realizó protocolo diagnóstico, sin encontrar origen del sangrado. Fue sometida a laparoscopía diagnóstica en junio del 2019, realizándole apendicectomía, resección yeyunal, colecistectomía y ooforectomía; cursando asintomática luego de la cirugía. En diciembre, reinicia con melena, 3-4 episodios diarios, abundante cantidad (aproximadamente 300 ml). Evaluada nuevamente sin lograr identificar el origen del sangrado, por lo cual se realizó vídeo capsula endoscópica que reportó, restos hemáticos sin observar sitio de sangrado. Se llevó a cabo enteroscopía de empuje y duodenoscopía observando sitio de sangrado cercano a la papila duodenal. Se decide realizar angiotomografía, la cual fue compatible con sangrado digestivo a nivel de la II y III porción del duodeno. Luego se efectúa arteriografía selectiva de vasos abdominales, evidenciando fuga de medio de contraste originada en la rama de la arteria hepática derecha de origen en la mesentérica superior. Finalmente se procedió a la aplicación de 2 hemoclip vía endoscópica obteniendo un resultado satisfactorio.Conclusiones: El tipo de lesión responsable de la hemorragia del intestino delgado depende de la edad del paciente. Los factores de riesgo de hemorragia recurrente por angioectasia incluyen el número de lesiones, la edad avanzada, comorbilidades y la terapia anticoagulante...(AU)


Subject(s)
Humans , Female , Middle Aged , Endoscopy, Gastrointestinal/methods , Angiodysplasia , Gastrointestinal Hemorrhage/diagnosis , Intestine, Small
13.
Autops. Case Rep ; 11: e2021288, 2021. tab, graf
Article in English | LILACS | ID: biblio-1249005

ABSTRACT

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare variant of the inflammatory myofibroblastic tumor. It has an aggressive clinical course and a high rate of recurrence. EIMS primarily affects children and young adults. Hereby, we report this entity in a 4-month-old infant who presented with an abdominal mass. Imaging studies revealed a large hypodense mesentery-based lesion involving the right half and mid-region of the abdomen. The mass with an attached segment of the small bowel was excised in toto. Grossly, a large encapsulated tumor was identified arising from the mesentery of the small bowel. The histological examination showed a tumor consisting of epithelioid to spindle cells loosely arranged in a myxoid background with numerous blood vessels and lymphoplasmacytic inflammatory infiltrate. On immunohistochemistry, the tumor cells showed positivity for ALK1 (nuclear), desmin, SMA, CD68, and focal positivity for CD30. A final diagnosis of EIMS of the small intestine was rendered. To the best of our knowledge, this case is the youngest reported case in literature.


Subject(s)
Humans , Female , Infant , Sarcoma , Intestinal Neoplasms/pathology , Immunohistochemistry , Epithelioid Cells/pathology , Anaplastic Lymphoma Kinase , Intestine, Small , Mesentery
14.
Autops. Case Rep ; 11: e2021255, 2021. graf
Article in English | LILACS | ID: biblio-1153189

ABSTRACT

Undifferentiated or anaplastic thyroid carcinoma (ATC) is rare and one of the most aggressive human malignancies. The tumor is usually voluminous and fast-growing and mostly affects older women. The most common sites of distant metastases are the lungs, brain, and bones. Herein, we describe the case of a 66-year-old woman with a history of bilateral breast carcinoma and ATC, who presented with an acute abdomen and subsequently died. At autopsy, an isolated metastasis of ATC in the small intestine leading to bowel perforation was found. Moreover, there was adenocarcinoma in the descending colon. The review of extra-abdominal malignancies metastasizing to bowel and coincidence of breast and thyroid carcinoma is included.


Subject(s)
Humans , Female , Aged , Breast Neoplasms , Thyroid Carcinoma, Anaplastic , Intestinal Perforation/etiology , Neoplasm Metastasis , Autopsy , Fatal Outcome , Intestine, Small/injuries
15.
ABCD arq. bras. cir. dig ; 34(4): e1634, 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1360005

ABSTRACT

RESUMO - RACIONAL: Os fatores relacionados à perda de peso nos pacientes obesos submetidos à cirurgia bariátrica sempre foram exaustivamente estudados na tentativa de propor a melhor técnica cirúrgica com maior perda de peso e resolução as comorbidades à longo prazo. Os pacientes apresentam variações anatômicas no que tange o comprimento do intestino delgado. Há estudos que demonstram alterações de peso nos pacientes que apresentam diferentes comprimentos das alças intestinais na técnica do by-pass em Y de Roux. O presente trabalho realizou um estudo entre a influência do IMC, a perda de peso e o comprimento da alça comum nos resultados cirúrgicos à longo prazo. MÉTODOS: Estudo transversal descritivo pela análise retrospectiva de 112 prontuários de pacientes submetidos à cirurgia bariátrica aberta pela técnica do bypass gástrico no Hospital de Clínicas -UFPR. Os dados foram correlacionados em programas estatísticos para este fim. RESULTADOS: Dos 112 pacientes, 83,03% eram do sexo feminino, média de idade de 41,52 anos. O comprimento médio do intestino delgado total dos pacientes foi de 5,02 metros. Houve uma relação diretamente proporcional entre o comprimento do intestino delgado e a perda de peso (p=0,0428). CONCLUSÃO: Há uma ampla gama de variáveis relacionadas à perda de peso nos pacientes submetidos à cirurgia bariátrica, tais como a técnica utilizada, o comprimento das alças no by-pass gástrico em Y de Roux e a rotina de acompanhamento nutricional e físico do paciente. É importante considerar os detalhes técnicos do procedimento cirúrgico, e verificar a perda de peso avaliando-se o paciente como um todo e outras variáveis.


ABSTRACT - BACKGROUND: Factors related to weight loss in obese patients undergoing bariatric surgery have always been exhaustively studied in an attempt to propose the best surgical technique with greater weight loss and long-term resolution of comorbidities. Patients present anatomical variations regarding the length of the small intestine. Some studies demonstrate weight changes in patients with different lengths of the intestinal loops in the Roux-en-Y bypass technique. The present work carried out a study on the influence of body mass index, weight loss, and common loop length on long-term surgical outcomes. METHODS: This is a descriptive cross-sectional study by retrospective analysis of 112 medical records of patients undergoing open bariatric surgery using the gastric bypass technique at University Hospital - UFPR. The data were correlated in statistical programs for this purpose. RESULTS: Out of 112 patients, 83.03% were women, with mean age of 41.52 years. The mean length of the total small bowel of the patients was 5.02 m. There was a directly proportional relationship between the length of the small intestine and weight loss (p=0.0428). CONCLUSION: There is a wide range of variables related to weight loss in patients undergoing bariatric surgery, such as the technique used, the length of the loops in the Roux-en-Y gastric bypass, and the routine of nutritional and physical monitoring of the patient. It is important to assess the technical details of the surgical procedure and to verify the weight loss by evaluating integrally the patient and other variables.


Subject(s)
Humans , Female , Adult , Obesity, Morbid , Weight Loss , Cross-Sectional Studies , Retrospective Studies , Intestine, Small/surgery
16.
Arq. bras. med. vet. zootec. (Online) ; 72(6): 2165-2174, Nov.-Dec. 2020. tab, graf, ilus
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1142295

ABSTRACT

Xenarthras (Mammalia, Dasypodidae) das espécies Dasypus novemcinctus e Euphractus sexcinctus tiveram sua anatomia científica estudada em relação à topografia dos intestinos delgado e grosso, suas relações peritoniais, morfologia externa e irrigação. Medidas dos diferentes segmentos intestinais e do número de vasos a eles destinados foram tomadas para fins comparativos. O método previu: fixação (formol 7%); injeção de látex; dissecação e fotodocumentação. Espacialmente, embora os intestinos sejam fixados por dupla membrana peritoneal, como em outros vertebrados, nestes a serosa conectou o duodeno, o jejuno, o íleo e os cólons em um único ligamento fixado no dorso do animal. Duodeno e pâncreas, intraperitoniais, como o reto, fixaram-se nas pelves maior e menor, respectivamente e dorsalmente. Vasos derivados do tronco celíaco mesentérico e da aorta percorreram o interior do mesoduodeno, do mesentério comum, do mesocólon e do mesorreto, estando estes, ao longo de seus trajetos, relacionados às cadeias linfonodulares intestinais. O modelo de rotação peritoneal, a morfologia externa, bem como o modelo de vascularização intestinal, foram interpretados como basais, diferindo dos vertebrados recentes, conforme o suporte literário.(AU)


Xenarthras (Mammalia, Dasypodidae) of the species Dasypus novemcinctus and Euphractus sexcinctus had their scientific anatomy studied in relation to the topography of the small and large intestines, their peritoneal relationships, external morphology and irrigation. Measurements of the different intestinal segments and the number of vessels destined for them were taken for comparative purposes. The method predicted: fixation (7% formaldehyde); latex injection; dissection and photo documentation. Spatially, the intestines, although fixed by a double peritoneal membrane, as in other vertebrates, in these, the serosa connected the duodenum, jejunum, ileum, and the colon in a single ligament fixed to the animal's back. Duodenum and pancreas, intraperitoneal, like the rectum, were fixed in the major and minor pelvis respectively and dorsally. Vessels derived from the mesenteric celiac trunk and the aorta traveled through the interior of the mesoduodenum, common mesentery, mesocolon and mesoride, being related to the lymph node chains along their pathways. The peritoneal rotation model, the external morphology as well as the model of intestinal vascularization were interpreted as basal, differing from recent vertebrates, according to literary support.(AU)


Subject(s)
Animals , Peritoneum/blood supply , Serous Membrane/blood supply , Cingulata/anatomy & histology , Intestine, Large/anatomy & histology , Intestine, Small/anatomy & histology , Mesenteric Arteries
17.
Arq. gastroenterol ; 57(4): 471-476, Oct.-Dec. 2020. tab
Article in English | LILACS | ID: biblio-1142349

ABSTRACT

ABSTRACT BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is one of the most common forms of chronic liver disease worldwide. Approximately 20% of individuals with NAFLD develop nonalcoholic steatohepatitis (NASH), which is associated with increased risk of cirrhosis, portal hypertension, and hepatocellular carcinoma. Intestinal microflora, including small intestinal bacterial overgrowth (SIBO), appear to play an important role in the pathogenesis of the disease, as demonstrated in several clinical and experimental studies, by altering intestinal permeability and allowing bacterial endotoxins to enter the circulation. OBJECTIVE: To determine the relationship between SIBO and endotoxin serum levels with clinical, laboratory, and histopathological aspects of NAFLD and the relationship between SIBO and endotoxin serum levels before and after antibiotic therapy. METHODS: Adult patients with a histological diagnosis of NAFLD, without cirrhosis were included. A comprehensive biochemistry panel, lactulose breath test (for diagnosis of SIBO), and serum endotoxin measurement (chromogenic LAL assay) were performed. SIBO was treated with metronidazole 250 mg q8h for 10 days and refractory cases were given ciprofloxacin 500 mg q12h for 10 days. RESULTS: Overall, 42 patients with a histopathological diagnosis of NAFLD were examined. The prevalence of SIBO was 26.2%. Comparison of demographic and biochemical parameters between patients with SIBO and those without SIBO revealed no statistically significant differences, except for use of proton pump inhibitors, which was significantly more frequent in patients with positive breath testing. The presence of SIBO was also associated with greater severity of hepatocellular ballooning on liver biopsy. Although the sample, as a whole, have elevated circulating endotoxin levels, we found no significant differences in this parameter between the groups with and without SIBO. Endotoxin values before and after antibiotic treatment did not differ, even on paired analysis, suggesting absence of any relationship between these factors. Serum endotoxin levels were inversely correlated with HDL levels, and directly correlated with triglyceride levels. CONCLUSION: Serum endotoxin levels did not differ between patients with and without SIBO, nor did these levels change after antibacterial therapy, virtually ruling out the possibility that elevated endotoxinemia in non-cirrhotic patients with NAFLD is associated with SIBO. Presence of SIBO was associated with greater severity of ballooning degeneration on liver biopsy, but not with a significantly higher prevalence of NASH. Additional studies are needed to evaluate the reproducibility and importance of this finding in patients with NAFLD and SIBO.


RESUMO CONTEXTO: A doença hepática gordurosa não alcoólica (DHGNA) é uma das doenças hepáticas crônicas mais comuns em todo o mundo. Aproximadamente 20% dos indivíduos com DHGNA desenvolvem esteato-hepatite não alcoólica (EHNA) que está associada a maior risco de cirrose, hipertensão portal e/ou carcinoma hepatocelular. Alterações da microflora intestinal, incluindo o supercrescimento bacteriano intestinal (SBI), parecem ter um papel importante na patogênese da doença, como demonstrado em estudos clínicos e experimentais, pela alteração da permeabilidade intestinal e permitindo que endotoxinas bacterianas alcancem a circulação sanguínea. OBJETIVO: Determinar a relação entre o SBI e níveis de endotoxina sérica em pacientes não cirróticos com DHGNA, com os aspectos clínicos, laboratoriais e histopatológicos da doença e a relação entre SBI e níveis séricos de endotoxina antes e após tratamento com antibiótico. MÉTODOS: Foram incluídos pacientes maiores de 18 anos e com diagnóstico histológico de DHGNA, sem cirrose. Foram realizados: avaliação bioquímica geral, teste do H2 expirado com lactulose para diagnóstico de SBI e dosagem de endotoxina sérica - ensaio cromogênico para LAL. Para o tratamento do SBI utilizamos o metronidazol 250 mg de 8/8 horas por 10 dias e para os casos de retratamento foi utilizado ciprofloxacino 500 mg de 12/12 horas por 10 dias. RESULTADOS: Incluímos 42 pacientes com diagnóstico histopatológico de DHGNA. A prevalência de SBI foi de 26,2%. Quando comparamos o grupo dos pacientes com SBI com aquele sem SBI e analisamos suas variáveis demográficas e bioquímicas, não encontramos diferença estatisticamente significante entre elas, exceto pela utilização de inibidores de bomba de próton, que foi significantemente mais frequente nos pacientes com teste respiratório positivo. A presença de SBI também esteve associada à maior intensidade de balonização na biópsia hepática, quando comparados àqueles sem SBI. Embora o grupo como um todo apresentasse elevação dos níveis circulantes de endotoxinas, não pudemos encontrar diferenças estatísticas entre os grupos com e sem SBI. Os valores de endotoxinas pré e pós tratamento antibiótico não diferiram entre si, mesmo em análise pareada, sugerindo ausência de relação entre esses fatores. Os níveis de endotoxina sérica apresentaram correlação inversa com os níveis de HDL e correlação direta com os níveis de triglicerídeos. CONCLUSÃO: Níveis de endotoxinas séricas não diferiram entre os pacientes com e sem SBI, e que esses níveis não se modificaram após tratamento medicamentoso da proliferação bacteriana, praticamente excluindo a possibilidade de que os níveis elevados de endotoxemia estejam relacionados à SBI. A presença dessa proliferação bacteriana esteve associada à maior intensidade de balonização na biópsia hepática, mas não à maior prevalência de EHNA entre os portadores de SBI. Estudos complementares são necessários para avaliar a reprodutibilidade e a importância desse achado em portadores de DHGNA com SBI.


Subject(s)
Humans , Adult , Non-alcoholic Fatty Liver Disease/complications , Reproducibility of Results , Endotoxins , Intestine, Small , Liver Cirrhosis , Liver Neoplasms
18.
Medisan ; 24(5) ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1135211

ABSTRACT

Se presenta el caso clínico de una anciana de 86 años de edad con evisceración del intestino delgado a través del periné. Se efectuó la exploración quirúrgica urgente del abdomen y se observó la perforación del fondo del saco de Douglas y la salida de 50 cm de intestino delgado estrangulado, de manera que se realizó la resección intestinal de todo el segmento afectado y anastomosis termino-terminal. Luego se reparó el defecto del fondo del saco de Douglas con una plastia perineal, para lo cual se utilizó una malla de polipropileno. Este proceder es una buena alternativa para el tratamiento quirúrgico en quienes presentan hernias perineales, pues permite un cierre mejor, disecar el saco herniario y reducirlo adecuadamente.


The case report of a 86 years elderly is presented with evisceration of the small bowel through the perineum. The urgent surgical exploration of the abdomen was carried out and it was observed the perforation of the Douglas pouch and the 50 cm prominence of impacted small bowel, so that the bowel resection of the whole affected segment and end to end anastomosis was carried out. Then the Douglas pouch defect was repaired with a perineal plasty, for which a polypropylene mesh was used. This procedure is a good alternative for the surgical treatment in those who present perineal hernias, because it allows a better closing, to dissect the hernial sack and to reduce it appropriately.


Subject(s)
Pelvic Floor/surgery , Douglas' Pouch/surgery , Intestine, Small/surgery , Perineum/surgery , Aged , Douglas' Pouch/injuries , Intestine, Small/injuries
19.
Arq. gastroenterol ; 57(3): 283-288, July-Sept. 2020. tab
Article in English | LILACS | ID: biblio-1131671

ABSTRACT

ABSTRACT BACKGROUND: Small intestinal bacterial overgrowth (SIBO) appears to be common in patients with Crohn's disease (CD). The rate of SIBO has been estimated at 25%-88% in this setting. However, different demographic, socioeconomic, and disease-related factors may exist between South American and North American or European populations that may limit the generalization of these findings, as the data are mainly derived from North American or European studies. OBJECTIVE: We studied the prevalence and predictors of SIBO in CD outpatients. METHODS: In this retrospective study, between June 2011 and June 2016, the medical records of 110 CD patients were assessed for presence of SIBO using the H2/CH4 glucose breath test. Univariate analysis was performed to investigate the potential association between SIBO and demographic, disease-related data, systemic markers of inflammation (C-reactive protein and erythrocyte sedimentation rate). RESULTS: The SIBO rate was high in CD patients (30%). Patients with and without SIBO were comparable according to demographics, systemic inflammatory biomarkers, and disease characteristics, except to the stricturing phenotype more common in the SIBO-positive CD patients (48.5% vs 19.5%, P=0.001). CONCLUSION: In Brazilian CD patients, SIBO is a highly prevalent condition. Stricturing phenotype demonstrated association with SIBO. An individualized screening plan followed by the timely treatment for SIBO should be carried out as part of quality of care improvement in CD individuals.


RESUMO CONTEXTO: O supercrescimento bacteriano de intestino delgado (SBID) parece ser comum em pacientes com doença de Crohn (DC). A taxa de SBID tem sido estimada entre 25-88% neste cenário. Entretanto, diferenças demográficas, socioeconômicas e dos fatores relacionados à doença podem existir entre as populações da América do Sul e da América do Norte ou europeias que podem limitar a generalização destes achados, uma vez que os dados são derivados principalmente de estudos norte-americanos ou europeus. OBJETIVO: Estudar a prevalência e os preditores de SBID em pacientes ambulatoriais com DC. MÉTODOS: Neste estudo retrospectivo os registros médicos de 110 pacientes com DC que haviam sido submetidos ao teste respiratório do hidrogênio e metano expirados para o diagnóstico de SBID, entre junho de 2011 e junho de 2016, foram avaliados. Análise univariada foi realizada para investigar a potencial associação entre SBID com os dados demográficos, relacionados à DC e marcadores sistêmicos de inflamação (proteína C-reativa e velocidade de hemossedimentação). RESULTADOS: A prevalência de SBID foi elevada em pacientes com DC (30%). Os pacientes com e sem SBID foram comparáveis de acordo com os dados demográficos e de biomarcadores de inflamação sistêmica, bem como das características da DC, exceto pelo fenótipo estenosante, mais comum nos pacientes com DC e SBID (48,5% vs 19,5%, P=0,001). CONCLUSÃO: Em pacientes brasileiros com DC, SBID é uma condição altamente prevalente. O fenótipo estenosante demonstrou associação com o SBID. O planejamento de um screening individualizado seguido por tratamento apropriado para SBID deve ser incluído como parte da melhoria na qualidade de cuidados a ser oferecida para os pacientes com DC.


Subject(s)
Humans , Crohn Disease/complications , Crohn Disease/epidemiology , Referral and Consultation , Brazil , Breath Tests , Prevalence , Retrospective Studies , Intestine, Small
20.
Medicentro (Villa Clara) ; 24(2): 360-372, abr.-jun. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1124997

ABSTRACT

RESUMEN Las hernias internas son una causa poco frecuente de obstrucción del intestino delgado (representan menos del 5 %). La hernia pericecal ocupa alrededor de la décima parte de las hernias internas; mientras que, la hernia paracecal constituye una de sus cuatro variantes, las que a su vez, pueden ser congénitas o adquiridas. Se presentó un paciente masculino de 98 años de edad, operado por obstrucción intestinal debido a hernia paracecal, que requirió resección de intestino y anastomosis, con evolución favorable. En la búsqueda realizada en Cochrane no se encontró ningún otro caso publicado por autores cubanos. Se revisó la literatura al respecto y se insistió en la necesidad de tener presente dicho diagnóstico en el actuar diario del cirujano, ya que se comporta con una alta mortalidad sino se sospecha, debido a que cursa generalmente con compromiso vascular.


ABSTRACT Internal hernias are an uncommon cause of small bowel obstruction (they represent less than 5%). The pericaecal hernia occupies about a tenth of the internal hernias while the paracaecal hernia is one of its four variants, which in turn can be congenital or acquired. We present a 98-year-old male patient operated on bowel obstruction due to paracaecal hernia, which required bowel resection and anastomosis, with favourable evolution. No other case published by Cuban authors was found when searching in Cochrane Library. Literature on this subject was also reviewed, insisting on the need for surgeons to bear this diagnosis in mind in their daily work, since it is manifested with a high mortality if it is not suspected, because it generally involves vascular compromise.


Subject(s)
Hernia/complications , Intestinal Obstruction/etiology , Intestine, Small/surgery
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