Enfermedad diverticular yeyuno-ileal complicada tratada quirúrgicamente: serie de 12 casos y revisión de literatura / Complicated jejunoileal diverticular disease: a 12 cases' serie and literature review

Objetivo: Realizar un análisis retrospectivo de una serie de casos de diverticulitis yeyuno-ileal complicadas tratadas quirúrgicamente en nuestro servicio durante el periodo comprendido entre los años 2002 al 2015. Materiales y métodos: Se trató quirúrgicamente 12 casos de diverticulosis yeyuno-ileal complicadas, 7 mujeres y 5 varones. La edad media fue 76 años. La presentación clínica en todos los casos fue dolor abdominal agudo, uno de ellos con hemorragia digestiva. Todos presentaron leucocitosis, neutrofilia y aumento de reactantes de fase aguda. A todos los pacientes se les realizó TAC abdominal urgente. Resultados: En 11 casos hubo congruencia entre estudio de imagen y hallazgos quirúrgicos. La localización de los divertículos fue yeyuno (9) e íleon (3). Siempre se realizó laparotomía exploradora urgente encontrándose perforación diverticular con peritonitis (7 casos), perforación diverticular con absceso (4 casos) y en un caso un área isquémica con perforación diverticular tras embolización. Se realizó siempre resección intestinal y anastomosis. En ningún caso se conocía previamente el diagnóstico de diverticulosis yeyuno-ileal. Nuestras complicaciones fueron: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusiones: La diverticulitis yetuno-ileal es una entidad infrecuente, suele ser la forma de debut de una enfermedad diverticular no conocida previamente. El TAC abdominal es de gran utilidad diagnóstica. La resección del segmento afecto es el tratamiento de elección

Objective: To perform a retrospective analysis of a series of complicated JID (jejunoileal diverticulitis) cases surgically treated in our service during the period from 2002 to 2015. Materials and methods: We treated 12 cases of jejunoileal complicated diverticulosis. 7 women and 5 men. The mean age was 76 years. The clinical presentation in all cases was acute abdominal pain, one with gastrointestinal bleeding. All cases had leukocytosis, neutrophilia and increased acute phase reactants. All patients underwent emergency abdominal CT. Results: In 11 cases, there was consistency between imaging studies and surgical findings. Diverticula were located: jejunum (9) and ileum (3). Urgent exploratory laparotomy was always done and findings were: diverticular perforation with peritonitis (7 cases), diverticular perforation with abscess (4 cases) and in one case an ischemic area with diverticular perforation after embolization. Intestinal resection and anastomosis was performed in all cases. There were no patients, in which the diagnosis of diverticulosis jejunoileal was previously known. Complications were: Clavien I (2), Clavien IIIa (1), Clavien IVb (1), Clavien V (1). Conclusions: Jejunoileal diverticulitis is a rare entity, usually the first sign of onset of diverticular disease not previously known. Abdominal CT is of great diagnostic value. Resection of the affected segment is the treatment of choice

Obstrucción colónica por cálculo / Colonic obstruction by gallstone

El íleo biliar es una rara complicación de la colelitiasis, que se caracteriza por presentar clínicamente una obstrucción intestinal mecánica intraluminal, secundaria a la impactación de un cálculo biliar en el tubo digestivo, debido a la existencia de una fístula bilio-entérica. El diagnóstico preoperatorio es difícil, ya que presenta síntomas y signos de obstrucción intestinal, los cuales son muy inespecíficos para sospechar un íleo biliar. El tratamiento de elección en el manejo del íleo biliar es el quirúrgico. Habitualmente se realiza una cirugía en dos tiempos, enterolitotomía como único gesto, sin embargo no hay una técnica quirúrgica definitiva estandarizada. Presentamos el caso de una paciente de 70 años que acude al Departamento de Urgencias con el diagnóstico clínico de obstrucción intestinal mecánica baja, de cuatro días de evolución, como consecuencia de un cálculo impactado en colon sigmoides.

Gallstone ileus is a rare complication of cholelithiasis, which is characterized by clinically presenting as an intraluminal mechanical intestinal obstruction secondary to the impaction of a gallstone in the digestive tract, due to the existence of a biliary-enteric fistula. The preoperative diagnosis is difficult, since it presents symptoms and signs of intestinal obstruction, which are very unspecific to suspect a Biliary Ileus. The treatment of choice in the management of gallstone ileus is surgery; usually is performed in two stages, whole lithotomy as the only gesture, however there is no standardized definitive surgical technique. We present the case of a 70-year-old patient, who attended the emergency department with the clinical diagnosis of low mechanical bowel obstruction, four days of evolution, as a result of a stone impacted in the sigmoid colon.

Oclusión intestinal por nudo ileosigmoideo / Intestinal occlusion by Ileosigmoid Knot

La oclusión intestinal es una causa frecuente de abdomen agudo quirúrgico. Dentro de sus múltiples casusas se encuentra el nudo ileosigmoideo, entidad rara en el mundo, pero puede verse con relativa frecuencia en algunas latitudes geográficas como Asia, Medio Oriente y otros países del continente africano. El objetivo de este trabajo es presentar cuatro casos de pacientes con oclusión intestinal por nudo ileosigmoideo en los hospitales Souro Sanu de Bobo Diulaso, Burkina Faso y Wa Regional Hospital, de Gana. Se intervinieron quirúrgicamente, se hizo resección en bloque de los segmentos ileales y sigmoideos gangrenados con anastomosis íleo-ascendente y colostomía de tipo Hartman. Los pacientes evolucionaron satisfactoriamente y luego de tres meses se restableció definitivamente el tránsito intestinal. Se realizó una revisión de la literatura(AU)

Intestinal occlusion is a frequent cause of surgical acute abdomen. Among its multiple causes are the ileosigmoid knot, a rare entity worldwide, which is relatively frequent in some geographic areas such as Asia, Middle East and Africa. The objective of this paper was to present four patients with intestinal occlusion due to ileosigmoid knot in Souro Sanu of Bobo Diulaso hospitals in Burkina Faso and Wa Regional Hospital in Ghana. They were operated on through block resection of gangrenous ileal and sigmoid segments with ascending ileoanastomosis and Hartrman-type colostomy. The patients recovered satisfactorily and three months later, the intestinal transfer was finally re-established. A literature review on the topic was made(AU)

Detour technique, Dipping technique, or IIeal bladder flap technique for surgical correction of uretero-ileal anastomotic stricture in orthotopic ileal neobladder

ABSTRACTBackground:Uretero-ileal anastomotic stricture (UIAS) is a urological complication after ileal neobladder, the initial management being endourological intervention. If this fails or stricture recurs, surgical intervention will be indicated.Design and Participants:From 1994 to 2013, 129 patients were treated for UIAS after unsuccessful endourological intervention. Unilateral UIAS was present in 101 patients, and bilateral in 28 patients; total procedures were 157. The previous ileal neobladder techniques were Hautmann neobladder, detubularized U shape, or spherical shape neobladder.Surgical procedures:Dipping technique was performed in 74 UIAS. Detour technique was done in 60 renal units. Ileal Bladder flap was indicated in 23 renal units. Each procedure ended with insertion of double J, abdominal drain, and indwelling catheter.Results:Follow-up was done for 12 to 36 months. Patency of the anastomosis was found in 91.7 % of cases. Thirteen patients (8.3%) underwent antegrade dilatation and insertion of double J.Conclusion:After endourological treatment for uretero-ileal anastomotic failure, basically three techniques may be indicated: dipping technique, detour technique, and ileal bladder flap. The indications are dependent on the length of the stenotic/dilated ureteral segment. Better results for long length of stenotic ureter are obtained with detour technique; for short length stenotic ureter dipping technique; when the stenotic segment is 5 cm or more with a short ureter, the ileal tube flap is indicated. The use of double J stent is mandatory in the majority of cases. Early intervention is the rule for protecting renal units from progressive loss of function.

Ileosigmoid Knot: A Rare Cause of Intestinal Obstruction.

Ileosigmoid knotting also known as compound volvulus or double volvulus is a rare cause of intestinal obstruction. Here, we present a case of acute intestinal obstruction in shock. The patient was resuscitated taken up for an emergency exploratory laparotomy, which revealed a large volume of hemorrhagic fluid and dilated gangrenous loops of ileum and sigmoid. A loop of ileum had encircled the base of sigmoid to form a knot resulting in gangrene of both the ileum and the sigmoid colon. Resection of gangrenous ileum and sigmoid colon with ileo-ileal and colorectal anastomosis with a temporary diversion colostomy was done.

Terminal ileum duplication: an unusual case of small bowel obstruction / Duplicación del ileon terminal: un caso inusual de obstrucción del intestino delgado

Duplications of the alimentary tract are uncommon congenital anomalies that usually present during infancy and early childhood. The case of an adolescent presenting with small bowel obstruction secondary to a duplication cyst is presented and the challenges in the management described.

Las duplicaciones del aparato digestivo constituyen anomalías congénitas poco frecuentes que suelen presentarse durante la infancia y niñez temprana. Se presenta el caso de un adolescente con obstrucción del intestino delgado secundaria a un quiste de duplicación, y se describen los desafíos del tratamiento.

Intususcepción ileocólica en adulto secundaria a enterocilitis por Salmonella enteriditis / Ileocolic intussusception in an adult secondary to Salmonella enteriditis

Introduction: Intussusception is defined as the invagination of a segment of the gastrointestinal tract into an adjacent portion. Adult intussusception is rare accounting for only 5 percent or less of all causes of intestinal obstruction; in 90 percent of these cases a leading point will be demostrable. Case report: A female patient, 35 years-old, was admitted into our institution complaining of 5 days of colicky abdominal pain associated to diarrhea without peritoneal sing. Abdominal ultrasonography showed the classic features of intussusceotion; target or doughnut sing and the pseudokidney sing. The study was completed with a computed abdominal tomography scan, confirming the sonographic findings. The surgical exploration revealed that the terminal ileum, cecum, appendix, and 10 cm of ascending colon were intussuscepted into the remaining colon. Abdominal inflammatory free-fluid was aspirated for culture. A right hemicolectomy with primary anastomosis was performed. The culture report finding of the abdominal liquid was Salmonella enteritidis. The histology reported an edematous thickened terminal ileum wall with Peyer´s patches infiltrated by polymorphonuclear cells. Discussion: The cause of intussusception in patients with infectious enterocolitis caused by Salmonella enteritidis could be related to stimulation of the intestinal mucosa causing inflamatory changes of the Peyer´s patches resulting in an edematous mass in the terminal ileum acting as a leading point for intussusception. Although rare, Salmonella infections should be considered among the precipiting causes of adult ileocolic intussusception.

Introducción: La intususcepción se define como la invaginación de un segmento intestinal dentro otro segmento adyacente. En adultos, la intususcepción es infrecuente dando cuenta del 5 por ciento o menos de todas las causas de obstrucción intestinal; en estos casos se podrá demostrar una causa en 90 por ciento de los pacientes. Reporte de caso: Paciente femenino de 35 años de edad, hospitalizada por un cuadro clínico de 5 días de evolución con dolor abdominal cólico, diarrea y ausencia de signos de irritación peritoneal. La ecografía abdominal mostró los signos clásicos de intususcepción; el "signo del blanco o del donut" y el "signo del pseudo-riñon". El estudio se completó con una tomografía abdominal, la cual confirmó los hallazgos de la ecografía. La exploración quirúrgica demostró que el íleon terminal, ciego, apéndice y 10 cm de colon ascendente. Se encontró líquido inflamatorio que se aspiró para cultivo. La cirugía consistió en una hemicolectomía derecha con anastomosis primaria. El resultado del cultivo fue positivo para Salmonella enteritidis. La histología demostró edema y engrosamiento de la pared del íleon terminal con infiltración polimorfonuclear de las placas de Peyer. Discusión: La causa de intususcepción en pacientes con enterocolitis infecciosa por Salmonella enteritidis está relacionada con la inflamación de la mucosa intestinal y de las placas de Peyer, lo que resulta en una masa edematosa en el íleon terminal que actúa como "punto tractor" para la intususcepción. Las infecciones por Salmonella deben considerarse entre las causas precipitantes de intususcepción en adultos.

Midgut volvulus after laparoscopic appendectomy / Volvo de intestino delgado após apendicectomia laparoscópica

The authors report a case of a 13-year old child who was submitted to a laparoscopic appendectomy and developed, during the postoperative period, an intestinal obstruction caused by small bowel volvulus in the absence of a congenital malrotation.

Relato do caso de uma criança de 13 anos de idade submetida à apendicectomia laparoscópica e que, no pós-operatório, desenvolveu quadro de obstrução intestinal, decorrente de um volvo de intestino delgado, na ausência de má rotação intestinal.

Ileocolorectal intussusception due to caecal hamartoma / Intususcepción íleocolorectal causada por hamartoma de ciego

Although 75% of intussusceptions occur within the first two years of life, they can also develop in teenage years. This is a case report of a 13-year old boy with an ileocolorectal intussusception from a large caecal hamartoma (10 x 6 x 2 cm3) adjacent to the ileocaecal valve. Partial resection of the ascending colon and terminal ileum was performed, and the pathology of the resected mass revealed a hamartoma. Ileocolorectal intussusception secondary to hamartoma represents a particularly rare event in the paediatric population. With early surgical intervention, this patient's outcome was uneventful.

Aunque el 75% de las intususcepciones ocurren en los primeros dos años de vida, pueden también desarrollarse en el período de la adolescencia. Éste es el reporte del caso de un niño de 13 años con una intususcepción ileocolorectal a partir de un hamartoma de ciego de gran tamaño (10 x 6 x 2 cm3) adyacente a la válvula ileocecal. Se realizó una resección parcial del colon ascendente y el íleo terminal, y la patología de la masa resecada reveló un hamartoma. La intususcepción íleocolorectal derivada secundariamente a partir de un hamartoma, representa un caso particularmente raro dentro de la población pediátrica. Una intervención quirúrgica temprana, hizo posible que este paciente tuviera una evolución clínica sin graves consecuencias.

Ileosigmoid knot: a case report and literature review of 280 cases

Ileosigmoid knotting, also known as compound volvulus or double volvulus, is a rare cause of intestinal obstruction. In this condition the ileum wraps around the base of the sigmoid colon and forms a knot. Ileosigmoid knotting is an unusual entity in the West, but is comparatively common in certain Africa, Asian and Middle Eastern nations. The condition is serious, generally progressing rapidly to gangrene. Awareness of the condition is essential for prompt diagnosis and optimal management. This report describes a case in a 60-year-old male and describes the management of this rare condition. An additional 280 recent cases in the English literature are reviewed as to etiopathogenesis, presentation, diagnostic modalities, surgical interventions and outcome

Estudo retrospectivo das itussuscepções em cães / Retrospective study of canine intussusception

Intussuscepção é uma causa comum de obstruções intestinais em pequenos animais. No presente estudo foram analisados, retrospectivamente, prontuários de 97 cães com diagnóstico de intussuscepção intestinal no período de Janeiro de 2000 a Julho de 2007. Foram avaliados dados referentes a raça, idade e sexo do animal, sintomas clínicos, meios de diagnóstico, tratamento e evolução do quadro. Animais com idade inferior a um ano apresentaram maior ocorrência. Diversos fatores foram relacionados como predisponentes, sendo a intoxicação prévia por carbamatos presente em 13 cães. A porção mais acometida foi a junção ileo-cólica e a enterectomia e enteroanastomose foram realizadas em 71% dos animais. Apenas três animais, não submetidos a enterectomia no primeiro procedimento, apresentaram recidiva do quadro. Três animais foram a óbito após a intervenção cirúrgica. O número expressivo de casos analisados associado à ausência de dados regionais até então existentes contribuiu para o conhecimento da afecção e de seu tratamento

Intussusception is a common cause of bowel obstruction in small animals. In this study, 97 records of dogs with diagnosis of intestinal intussusceptions between the period of January/2000 and July/2007 were retrospectively reviewed. Analyzed data included symptoms, predisposing factors, means of diagnosis, treatment and evolution. Animals with less than one year showed more occurrences. Many findings could be related to predisposing factor, where previous intoxications with carbamates showed to be the most important (13dogs). The most affected portion by intussusceptions was the ileum-colic junction and enterectomy was necessary in 71% of the animals. Only three animals, not submitted to enterectomy in the first procedure, showed recurrence of intussusception. Three animals came to death after surgery. The expressive number of analyzed cases allied to absence of regional data contributed to the knowledge of the disease and its treatment.

Invaginación ileocecal como forma de presentación de linfoma no Hodgkin en un paciente con SIDA / Ileocolic intussusception due to a large B cell lymphoma in a patient with AIDS

La invaginación intestinal es poco frecuente en el adulto. Aquí se describe el caso de un paciente adulto con SIDA que desarrolló una invaginación ileocólica secundaria a un linfoma de células B localizado en el ciego. Los hallazgos quirúrgicos fueron: íleon libre de tumor, invaginado en el ciego infiltrado por la neoplasia. Se realizó la resección del hemicolon derecho debido a la tumoración localizada en el ciego, causante de la invaginación. Se revisó la literatura inglesa y española sobre este tema.

Adult intussusception is rare. Here, we describe a case of an AIDS adult patient who developed an ileocolic intussusception secondary to a large B cell lymphoma of the cecum. Surgical findings included the ileon free of the tumor and invaginated within the cecum with infiltrating neoplasm. Surgical treatment included the resection of the right hemicolon because of the tumor, located in the cecum, causing intussusception. The english and spanish literature is reviewed.

Torsión del apéndice cecal asociada a invaginación intestinal / Torsion of the vermiform appendix associated with intussusception

La torsión del apéndice vermiforme es muy rara; en la literatura sólo han sido referidos 25 casos. El aquí informado es el primero asociado a invaginación intestinal. Se trató de una niña de dos meses de edad quien súbitamente dio muestras de dolor. En la exploración quirúrgica se encontró invaginación ileocecal apretada, que fue corregida. Cuatro días después fue necesario reoperar, encontrando torsión y perforación del apéndice cecal; se practicó apendicectomía. Por datos de obstrucción y peritonitis se requirió nueva exploración quirúrgica en la que se encontró dehiscencia del muñón y perforación cecal. Una vez corregidas estas complicaciones, la paciente evolucionó satisfactoriamente y fue dada de alta en buenas condiciones.

BACKGROUND: Vermiform appendix torsion is a rare condition, with only 25 cases recorded in the international literature. Our patient is the first case associated with intussusception. CASE REPORT: A 2-month-old female infant suddenly developed severe abdominal pain due to ileoceal intussusception. During surgical exploration, a tight intussusception was reduced. Three days later, a new laparotomy was required and we found torsion and perforation of the vermiform appendix. The patient underwent appendectomy, but there was dehiscence of the appendiceal stump and cecal perforation requiring a new surgical exploration. The patient had an uneventful recovery.

Endometriosis del íleon como causa de obstrucción intestinal: Report of two cases / Ileal endometriosis as a cause of intestinal obstruction. Report of two cases

Endometriosis is a common, chronic, benign, estrogen dependent gynecological disorder associated to pelvic pain and infertility. Its main characteristic is the presence of endometrial tissue outside the uterus. The prevalence of pelvic endometriosis ranges between 6% and 10% women during their reproductive years. Clinical symptoms of pelvic endometriosis are pelvic pain, dysmenorrhea, dispareunia and infertility. Distal ileum endometriosis is an uncommon cause of intestinal obstruction with a frequency of 7% to 23% of all cases with intestinal involvement. We report two patients, 30 and 34 years old, with terminal ileum endometriosis and intestinal obstruction that required surgery and intestinal resection. Both patients are well one year after the operation.

Results of typhoid perforation management: our experience in Bir Hospital, Nepal.

OBJECTIVE: To determine the demographic characteristics, clinical features, operative findings and postoperative complications in patients operated for typhoid enteric perforation. METHODS: A retrospective study was carried out in the Department of General Surgery, Bir Hospital since 2002 to April 2004. Among 189 patients who underwent laparotomy for hollow viscus perforation in two years, ileal perforation was found in 102 patients. RESULTS: The sex ratio of the patients was 4.66:1, in favor of male, with age range of 14-78 years and mean age 28.35 years. Most of the patients (80.39 %) presented with history of fever for two weeks. Half of the patients presented within 24 hours of onset of generalized abdominal pain. Majority (65.67%) had a solitary perforation on the antimesenteric border of terminal ileum. Eighty one percent of patients had trimming of the ulcer margins and primary closure. Complications included wound infection (35.3%), wound dehiscence (17.6%), fecal fistula (7.84%) and hospital mortality (6.86%). CONCLUSION: Typhoid ulcer perforation is common among developing nations, including Nepal. Postoperative complications following surgical management of perforation are high and increases mortality.

Surgical complications of cocaine body-packing: a survey of Jamaican hospitals / Complicaciones Quirúrgicas del Empaquetamiento Corporal de Cocaína

Body-packing is a common method of smuggling cocaine. Complications requiring surgery do not occur with sufficient frequency to allow any individual surgeon to determine patterns of presentation and the best approach to the conduct of surgery. A survey of all surgical units in Jamaica was conducted. A case was any patient requiring surgery for cocaine body-packing since and including the first reported case in 1987. Seventeen cases were identified. There were 11 cases of bowel obstruction, two of delayed passage of pellets, three of ruptured pellets with cocaine toxicity and one patient panicked and requested surgery. The distal ileum was the commonest site of obstruction in the normal gastrointestinal tract. In all three cases with cocaine poisoning, the ruptured packets were encountered in the upper gastrointestinal tract and several other partially ruptured packets were also found, implying that poor packaging was the cause of rupture. Obstructing packets should be removed but non-obstructing, unruptured packets encountered in the colon may safely be allowed to pass spontaneously. All cases of packet rupture with cocaine toxicity should have immediate surgery

El empaquetamiento dentro del organismo de seres humanos es un método común del contrabando la cocaína. Las complicaciones que requieren cirugía no ocurren con frecuencia suficiente como para permitir al cirujano determinar patrones de presentación de los casos, y el mejor enfoque en cuanto a la conducta quirúrgica a seguir. En este sentido, se llevó a cabo una investigación en todas las unidades quirúrgicas de Jamaica. Se tomó como caso cualquier paciente que hubiere requerido cirugía por haber empaquetado cocaína dentro de su cuerpo, desde que ocurriera el primer caso en 1987, e incluyendo éste. Se identificaron diecisiete casos. Hubo 11 casos de obstrucción intestinal, dos pasajes retardados de cápsulas, tres por cápsulas rotas con intoxicación por cocaína, y un paciente que preso de pánico, pidió ser intervenido quirúrgicamente. El íleo distal fue el sitio más común de la obstrucción en el tracto gastrointestinal normal. En los tres casos de envenenamiento por cocaína envenenar, las paquetes rotos se encontraban en el tracto gastrointestinal superior, y se encontraron también varios otros paquetes parcialmente rotos, lo cual indicaba que el pobre empaquetamiento fue la causa del rompimiento. Los paquetes que causan obstrucción deben ser retirados, pero los que se hallan en el colon sin causar obstrucción y sin estar rotos, puede dejárseles con seguridad ser excretados espontáneamente. Todos los casos de rompimiento de paquetes con intoxicación por cocaína deben ser sometidos a cirugía de manera inmediata

Ileo biliar: breve revisión a propósito de dos casos clínicos / Biliary ileus: brief review on purpose of 2 clinical case

Gallstone ileus is not frequent, responsible for 1-3 percent of mechanical intestinal obstructions. Its incidence increase considerable with age, being more frequent in women. In its pathogenesis a stone migrates from the gallbladder to the intestinal lumen through and entero-biliary fistula, usually of the cholecystoduodenal type, impacting in the lower ileum. Clinical manifestations correspond to that of a mechanical ileus, which evolves insidiously with partial recovery periods. The diagnosis is established by clinical suspicion, abdominal plain film and ultrasound. Clinical suspicion has the highest predictive value. The treatment is eminently surgical, although there is still debate about the best moment to repair the biliary tract. We present 2 clinical cases

Laparoscopic-assisted resection of ileal lipoma causing ileo-ileo-colic intussusception

Adult intussusception is rare, and the majority of cases has an underlying cause that requires surgical resection. We report a case of a 39 yr-old man with ileo-ileo-colic intussusception caused by ileal lipoma that was successfully managed by a laparoscopic-assisted surgical maneuver. Using a three-cannula technique, ileo-colic intussusception was reduced laparoscopically. Then, through a 4-cm transverse incision in the right lower quadrant abdomen, ileo-ileal intussusception was reduced manually, and a resection of the tumor-bearing ileal segment and end-to-end anastomosis was performed extracorporeally. Although the role of laparoscopy in managing intussusception is not clearly defined, laparoscopy may be an alternative approach to the surgical treatment of adult intussusception in selected cases.