Complicações gastrintestinais em usuários de cocaína/crack: revisão da literatura / Gastrointestinal complications among users of cocaine / crack-a literature review

O consumo de cocaína/crack atinge todos os extratos sociais e grande parcela da população, principalmente os jovens. Esse abuso leva à ampla gama de complicações sistêmicas. No trato gastrintestinal, pode se expressar por manifestações como perfuração gastroduodenal aguda, colite isquêmica, infarto, isquemia intestinal e, raramente, hemorragia maciça. Seu mecanismo fisiopatológico parece ser o vasoespasmo ou vasoconstrição, que pode levar à isquemia, inclusive com necrose transmural. É importante a atenção e vigilância para o abuso de cocaína/crack ao deparar com paciente com dor abdominal inexplicável. (AU)

Cocaine/crack have being consumed by a large portion of the population especially by youth and reaching all social levels. This abuse leads to a wide range of systemic complications. In the gastrointestinal tract, the drug can lead to manifestations such as acute gastroduodenal perforation, ischemic colitis, infarction, intestinal ischemia and, rarely, massive hemorrhage. The most accepted pathophysiological mechanism is vasospasm or vasoconstriction which can lead to ischemia, including transmural necrosis. It is important that physicians to be aware and search recent history of abuse of crack / cocaine when faced with a patient with unexplained abdominal pain. (AU)

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CT Findings of Colonic Complications Associated with Colon Cancer

A broad spectrum of colonic complications can occur in patients with colon cancer. Clinically, some of these complications can obscure the presence of underlying malignancies in the colon and these complications may require emergency surgical management. The complications of the colon that can be associated with colon cancer include obstruction, perforation, abscess formation, acute appendicitis, ischemic colitis and intussusception. Although the majority of these complications only rarely occur, familiarity with the various manifestations of colon cancer complications will facilitate making an accurate diagnosis and administering prompt management in these situations. The purpose of this pictorial essay is to review the CT appearance of the colonic complications associated with colon cancer.

Colitis isquémica no oclusiva gangrenosa: criterios diagnósticos con tomografia computada multidetector / Gangrenous non occlusive ischemic colitis: diagnostic criteria with multidetector computed axial tomography (mdct)

Introduction: Ischemia constitutes the major cause of colitis in patients over the age of 50. The vast majority of cases are a self-limited with good prognosis. There is a sub-group of patients which develop transmural ischemia leading to parietal necrosis, perforation and peritonitis, with secundan/ sepsis-related mortality. Objective to record luminal, parietal and peritoneal findings in patients with colonic necrosis of ischemic ethiology so as to provide a timely diagnosis. Material and Methods: In a retrospective study, both medical records and imaging studies of 12 patiens (7 male, 5 female), ranging from 46 to 91 years of age (mean age: 70.3 years) with necrosis secondary to nonocclusive ischemic colitis (IC) were revised. Patient's status (out-patient, in-patient) as well as risk factors and symptoms were documented. All patients underwent Multidetector Row Computed Axial Tomography (MDCT). Results: Six patients presented to the emergency unit because of abdominal pain and six patients developed symptoms during hospitalization for other causes. Parietal assessment showed absence of contrast enhancement in 11 cases out of 12 (91.6 percent), and mural or vascular pneumatosis in 5 cases (41.6 percent). Wall thickening was seen in 4 patients (33 percent), and pericolonic gas was found in 3 cases (25 percent). If we consider both ileus and pericolonic inflamatory changes as nonspecific findings, the absence of colon mural enhancement was the only marker of severe parietal injury in 3 patients (25 percent). Conclusion: Classical signs of IC -such as wall thickening- are unlikely to be found in advanced cases presenting mural gangrene. Lack of post-contrast parietal enhancement is a finding that correlates with presence of necrosis, and maybe the only tomographic marker of irreversible transmural ischemic lesion of the colon.

Introducción: La isquemia constituye la principal causa de colitis en pacientes mayores de 50 años. La mayor parte de los casos cursa un cuadro autolimitado, de buen pronóstico. Existe un subgrupo de pacientes que presentan isquemia transmural con necrosis parietal y mortalidad determinada por peritonitis y sepsis secundaria. Objetivo: Documentar los hallazgos lu mínales, parietales y peritoneales en pacientes con necrosis colónica de etiología isquémica, que permitan un diagnóstico oportuno. Material y Métodos: Revisión retrospectiva de fichas clínicas y estudios tomográficos de doce pacientes (7 hombres, 5 mujeres) cuyas edades varían entre los 46-91 años (promedio: 70.3 años) con necrosis secundaria a colitis isquémica (Cl) no oclusiva, documentando el status del paciente (ambulatorio, hospitalizado), factores de riesgo y síntomas al ingreso. Los doce pacientes fueron sometidos a tomografía computada multidetector (TCMD). Resultados: Seis pacientes consultaron al servicio de urgencia por dolor abdominal y 6 debutaron durante hospitalización por otra causa. La evaluación parietal demostró ausencia de impregnación en 11/12 casos (91.6 por ciento) y neumatosis mural o vascular en 5/12 casos (41.6 por ciento). Engrosamiento parietal fue visible en 4/12 casos (33 por ciento) y gas pericolónico en 3/12 casos (25 por ciento). Considerando el íleo y la alteración de la densidad del tejido adiposo pericolónico como hallazgos inespecíficos, en 3/12 pacientes (25 por ciento) la ausencia de impregnación mural del colon era el único marcador de lesión parietal severa. Conclusión: Signos clásicos de Cl como engrosamiento parietal son infrecuentes de encontrar en casos avanzados con gangrena mural. La falta de impregnación parietal post contraste se correlaciona con la presencia de necrosis y puede ser el único marcador tomográfico de lesión isquémica transmural irreversible del colon, en ausencia de neumatosis o evidencias de perforación intestinal.

Megacolon tóxico secundario a colitis isquémica en un caso / Toxic megacolon secondary to ischemic colitis in 1 case

We report a 67 years old male that consulted due to bloody diarrhea of several months of evolution and emaciation. According to endoscopic and radiological findings, the diagnosis of severe ulcerative colitis was made. Fifteen days after admission, the patient was subjected to an emergency total colectomy due to a toxic megacolon. The pathological study showed an eschemic colitis with extensive longitudinal ulcers in the antimesenteric border, presence of granulation tissue with inflammation and transmural fibrosis. Intestinal transit was reconstituted 6 months later and after 12 months of follow up, the patient is in good conditions