RESUMO
El adenocarcinoma de intestino delgado es una patología poco frecuente, y menos aún de la unión ileocutánea. Tener una ileostomía en el contexto de una cirugía por enfermedad inflamatoria intestinal se ha descrito dentro de los factores predisponentes. Se reporta un caso de adenocarcinoma de unión ileocutánea 34 años posterior a panproctocolectomía por colitis ulcerosa. Se discute la presentación, estudio y posterior tratamiento quirúrgico, además de breve revisión de la literatura.
Small bowel adenocarcinoma is a rare disease, and even more of the ileo-cutaneous junction. Having an end-ileostomy after surgery for inflammatory bowel disease has been described among the predisposing factors. A case of ileo-cutaneous junction carcinoma is reported 34 years after total proctocolectomy for ulcerative colitis. We discuss the clinical presentation, diagnostic studies, and treatment, including a brief review.
RESUMO
The volvulus of the colon is a relatively common cause of colonic obstruction, mainly in the sigmoid colon, less frequent in the caecum, and rarely in the transverse colon. Multidetector tomography (MDCT) is able to establish the diagnosis showing dilated loops of proximal right and transverse colon, which depend on the time scale of evolution, with an abrupt transition site at the splenic flexure and a secondary torsion of the transverse colon mesentery. Volvulus of the transverse requires surgical detorsion in adults. Among the therapeutic options, simple detorsion or detorsion associated with a colopexy are included, but both have high rates of recurrence compared to resection techniques. Surgical resection of the involved segment is required prior to gangrene and perforation. Resection with or without primary anastomosis is the treatment of choice and prevents recurrence. The transverse colon volvulus is a disease of very low frequency and clinical diagnosis may be difficult. The management remains controversial. We stress that although many surgeons will never see a case of transverse colon volvulus, it should be considered as a differential diagnosis of intermittent abdominal pain or acute intestinal obstruction.