Enteritis eosinofílica, una causa extraña de abdomen agudo. reporte de caso clínico / Eosinophilic enteritis, a strange cause of acute abdomen Clinical case report

La enteritis eosinofílica, es una patología rara, caracterizada por infiltración de eosinófilos en una o más capas histológicas en diferentes niveles del tracto gastrointestinal, siendo el estómago e intestino delgado los más afectados; su cuadro clínico, inespecífico, caracterizado por dolor abdominal, náusea, vómito, diarrea o estreñimiento, pérdida de peso y ascitis, con presencia o ausencia de eosinofilia en la biometría. Reporte de caso Paciente masculino de 51 años de edad, acudió a emergencia por distensión abdominal y náusea, al examen físico en la palpación intenso dolor y distención abdominal, percusión timpánico y abolición de ruidos hidroaéreos. La analítica reportó leucocitosis con neutrofilia, radiografía de abdomen íleo adinámico, en la ecografía abdominal presencia de imágenes tubulares con aspecto de diana, asociado a líquido libre purulento en fosa ilíaca derecha y fondo de saco vésico rectal. Un cuadro clínico compatible con abdomen agudo de resolución quirúrgica, se realizó laparotomía exploratoria (AU);

The eosinophilic enteritis is a rare pathology, characterized by infiltration of eosinophils in one or more histological layers at different levels of the gastrointestinal tract, the stomach and small intestine being the most affected; its nonspecific clinical picture, characterized by abdominal pain, nausea, vomiting, diarrhea or constipation, weight loss and ascites, with the presence or absence of eosinophilia in the biometry. Enteritis eosinofílica, una causa extraña de abdomen agudo. reporte de caso clínico Eosinophilic enteritis, a strange cause of acute abdomen year-old male patient came to the emergency room due to abdominal distention and nausea, to physical examination on palpation, intense abdominal pain and distention, tympanic percussion and abolition of air-fluid sounds. Laboratory analysis reported leukocytosis with neutrophilia, abdominal ileus adynamic radiography, abdominal ultrasound presence of tubular images with a target appearance, associated with free purulent fluid in the right iliac fossa and rectal vesicum fundus. A clinical picture compatible with an acute abdomen with surgical resolution, an exploratory laparotomy was performed (AU);

A case of CMV disease of the jejunum in a patient with non-Hodgkin's lymphoma

CMV infection may occur anywhere in the gastrointestinal tract. Among the small intestine, ileum is the most common site of CMV disease and infection of jejunum is a rare one in patients with CMV gastroenteritis. Although rare, the reason why the recognition of this diagnosis is important is that it cause the lethal hemorrhage and perforation of gastrointestinal tract when its diagnosis and treatment was delayed. Rapid diagnosis are able to using the immunohistochemical stain in shell vial culture of infected specimen or peripheral neutrophils preparation in viremic patients within 8 to 36 hours. The treatment of choice is antiviral agent or surgical resection. We experienced a case of CMV disease of jejunum in patient with non-Hodgkin's lymphoma who showed severe ulceration in jejunum and massive intestinal hemorrhage, and he survived after successful treatment with segmental resection of jejunum and intravenous ganciclovir.

Tratamiento quirúrgico de las complicaciones intestinales de la radioterapia pélvica / Surgical treatment of intestinal complications of pelvic radiotherapy

One hundred forty patients treated for intestinal complications of pelvic irradiation are presented. The most common clinical expression was radiation rectitis, complicated with rectovaginal fistulas in 58 percent of cases. These patients were subjected to Parks procedure for fistula repair with satisfactory results. Half the operated patients remained with an ostomy as a definitive sequel and overall perioperative mortality in these patients was 10 percent. radiation enteritis has a high operative mortality due to delays in diagnosis and to severe septic complications. It must be suspected in irradiated patients presenting with chronic diarrhea and weigh loss. Urological complications and involvement of several intestinal segments are bad prognostic factors. Resections and anastomoses with undamaged segments are the safest surgical procedures. Improvements of radiation techniques and the use of a reabsorbable mesh to seal the pelvis during radiation therapy are adequate preventive measures

Enteritis actínica: resultados del tratamiento quirúrgico / Radiation enteropathy: results of surgical therapy

We reviewed the results of surgical therapy for radiation enteropathy in 18 consecutive patients. Fifteen (83%) were females and the age ranged from 31 to 81 years old. The indication for radiotherapy was cancer of the cervix in 10 patients (56). The mjean radiation dose was 5190 rads (range 4000 to 7000). Of 23 radiation lesions, 12 (52%) were located in the ileon, 10 in the rectum and 1 in the sigmoid. Fibrosis and stenosis was the most frequent lesion (70%) followed by fistulae (22%) and proctitis in 2 patients. Ressection or derivation was the surgical treatment employed in 22 of the 23 lesions. For lesions of the ileon, we performed ressection and anastomosis in 7 patients and derivation in 5. For rectal lesions we performed ressection, endoanal descent and colo-anal anastomosis in 7 patients anterior ressection in 2 and colostomy in 1. complications were observed in 5 patients (28%) and 1 patient died (5%). After a mean follow up of 56 months, 5 patients have died from recurrence of the original neoplastic lesions. We feel that surgical treatment allows improvement in quality of life of patients with radiation entreropathy

Tratamiento quirúrgico de la enteritis actínica: ¿se debe ser más agresivo? / Surgical treatment of actinic enteritis: the treatment must be more agressive?

Revisamos la experiencia en el tratamiento quirúrgico de las lesiones intestinales por radioterapia realizadas entre 1979-1984, en este servicio, comparando la morbimortalidad con un tratamiento quirúrgico más agresivo iniciado en 1985. Se revisan las fichas de 57 pacientes operados entre enero de 1979 y junio de 1988. Todas las enfermas fueron tratadas con radioterapia externa y 36/57 recibieron además braquiterapia. Entre 1979 y 1984 se practicaron 42 intervenciones; 33/42 fueron colostomías con una morbilidad de 43% y una mortalidad de 7%. Entre 1985 y 1988 se efectuaron 52 operaciones; 18/52 fueron resecciones del rectosigmoides con anastomosis coloanal; en 18/52 se reconstruyó el tránsito intestinal; en 3/52 pacientes se practicó resección del íleon con anastomosis ileotransverso. La morbilidad fue de 21% y la mortalidad de 1,9%. Las complicaciones de la cirugía del intestino dañado por radiación, han disminuido en los últimos años, probablemente por un tratamiento más precoz y agresivo, junto con un adecuado cuidado pre, intra y postoperatorio

Ileostomias na urgência / Ileostomies in urgencies

Estudaram-se 26 doentes portadores de abdome agudo decorrente de complicacoes de doencas intestinais em que se praticou a ileostomia na operacao inicial ou na reoperacao. O grupo maior de doentes era portador de enterites e colites infecciosas e nao-infecciosas. Outros apresentavam insuficiencia vascular, neoplasmas benigno e maligno ou outras doencas intestinais.O trabalho permitiu concluir que a ileostomia "per se" nao e responsavel pelo agravamento das condicoes clinicas dos doentes a ela submetidos e que, se houver duvida quanto a viabilidade de uma anastomose intestinal na vigencia de peritonite ou obstrucao e/ou necrose, a opcao deve ser pela ileostomia primaria, porque a mortalidade dos doentes submetidos a ileostomia na reoperacao e significativamente maior