ABSTRACT
Since the publication of the 2008 guidelines on the diagnosis and treatment of diverticular disease of the colon by the Asociación Mexicana de Gastroenterología, significant advances have been made in the knowledge of that disease. A systematic review of articles published in the medical literature from January 2008 to July 2018 was carried out to revise and update the 2008 guidelines and provide new evidence-based recommendations. All high-quality articles in Spanish and English published within that time frame were included. The final versions of the 43 statements accepted in the three rounds of voting, utilizing the Delphi method, were written, and the quality of evidence and strength of the recommendations were established for each statement, utilizing the GRADE system. The present consensus contains new data on the definition, classification, epidemiology, pathophysiology, and risk factors of diverticular disease of the colon. Special emphasis is given to the usefulness of computed tomography and colonoscopy, as well as to the endoscopic methods for controlling bleeding. Outpatient treatment of uncomplicated diverticulitis is discussed, as well as the role of rifaximin and mesalazine in the management of complicated acute diverticulitis. Both its minimally invasive alternatives and surgical options are described, stressing their indications, limitations, and contraindications. The new statements provide guidelines based on updated scientific evidence. Each statement is discussed, and its quality of evidence and the strength of the recommendation are presented.
Subject(s)
Colonic Diseases/therapy , Diverticular Diseases/therapy , Consensus , Delphi Technique , Diverticulitis/therapy , Guidelines as Topic , Humans , MexicoSubject(s)
Ascites/diagnosis , Mesenteric Cyst/diagnosis , Aged , Diagnosis, Differential , Female , HumansABSTRACT
Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD.
Subject(s)
Fundoplication , Gastroesophageal Reflux/surgery , Postoperative Complications , Fundoplication/methods , Humans , Laparoscopy , Postoperative Complications/diagnosis , Postoperative Complications/physiopathology , Postoperative Complications/therapy , Recurrence , Treatment OutcomeABSTRACT
UNLABELLED: The clinical and histological findings of a patient with a primary omental leiomyosarcoma are described. CASE REPORT: A 29 years old female patient presented with a 11 month history of constipation, progressive abdominal swelling and weight gain over the last 4 months. On physical examination a large abdominal tumor was found. An ultrasonographic evaluation disclosed a giant mass with a mixed content, of approximately 40 x 17 cm size. Two days latter a celiotomy was done, finding the tumor mass depending of the great omentum, with high vascularity and no evidence of metastasis. A complete resection was performed. The histopathologic report was of primary omental leiomyosarcoma. This tumor is very rare and the case presented is possibly the sixth in the indexed world literature.
