ABSTRACT
BACKGROUND: Diverticular disease is common in industrialized countries. Computed tomography has been used as the preferred diagnostic method; although different scales haves been described to classify the disease, none of them encompass total disease aspects and behaviour. OBJETIVE: To analyze the patients with acute diverticulitis confirmed by computed tomography at the ABC Medical Center Campus Observatorio from January 1, 2010 to December 31, 2012, in whom pericolic free air in the form of bubbles was identified by computed tomography and if this finding can be considered as a prognostic factor for the disease. METHODS: A series of 124 patients was analyzed who had acute diverticulitis confirmed by computed tomography, in order to identify the presence of pericolic bubbles. RESULTS: Of the 124 patients, 29 presented with pericolic bubbles detected by computed tomography; of these, 62.1% had localized peritoneal signs at the time of the initial assessment, (P<.001); leukocytosis (13.33 vs 11.16, P<.001) and band count (0.97 vs 0.48, P<.001) was higher in this group. Patients with pericolonic bubbles had a longer hospital stay (5.5days vs 4.3days, P<.001) and started and tolerated liquids later (4.24days vs. 3.02days, P<.001) than the group of patients without this finding. CONCLUSIONS: The presence of pericolic bubbles in patients with acute diverticulitis can be related to a more aggressive course of the disease.
Subject(s)
Air , Diverticulitis, Colonic/diagnostic imaging , Tomography, X-Ray Computed , Acute Disease , Aged , Conservative Treatment , Diverticulitis, Colonic/complications , Diverticulitis, Colonic/surgery , Diverticulitis, Colonic/therapy , Enteral Nutrition , Female , Humans , Length of Stay/statistics & numerical data , Leukocytosis/etiology , Male , Middle Aged , Peritoneal Cavity/diagnostic imaging , Peritonitis/diagnosis , Peritonitis/etiology , Prognosis , Retrospective Studies , Severity of Illness IndexABSTRACT
BACKGROUND: Small bowel volvulus is a rare cause of intestinal obstruction in adult patients. This disease is more common in children and its aetiology and management is different to that in adults. CLINICAL CASE: A 30 year-old male with sarcoidosis presents with acute abdomen and clinical data of intestinal obstruction. Small bowel volvulus is diagnosed by a contrast abdominal tomography and an exploratory laparotomy is performed with devolvulation and no intestinal resection. In the days following surgery, he developed a recurrent small bowel volvulus, which was again managed with surgery, but without intestinal resection. Medical treatment for sarcoidosis was started, and with his clinical progress being satisfactory,he was discharged to home. CONCLUSIONS: Making an early and correct diagnosis of small bowel volvulus prevents large intestinal resections. Many surgical procedures have been described with a high rate of complications. Therefore, conservative surgical management (no intestinal resection) is recommended as the best treatment with the lowest morbidity and mortality rate.
