ABSTRACT
Actinomycosis is an infrequent chronic infectious disease. In most cases the diagnosis is made postoperatively because of its unusual clinical presentation. Moreover, abdominal actinomycosis may mimic cancer, inflammatory bowel disease, or diverticulitis. Delay in diagnosis leading to inadequate management and unnecessary procedures has been reported. We report the case of a 49-year-old woman with large bowel obstruction secondary to extensive pelvic actinomycosis involving the rectosigmoid and cecum. She required emergency surgery, which involved both resection and colostomy. A review of the literature on abdominal actinomycosis during the last 50 years is also reported. Rarely has emergency surgery been described in this condition. Although the incidence of actinomycosis has decreased, the abdominal-pelvic form has been increasing over the past 10 years secondary to increased prolonged use of the intrauterine device. As the clinical spectrum of actinomycosis has dramatically changed, so have the therapeutic considerations. Aggressive surgical management in advanced cases with multiorganic involvement seems to have reemerged in recent years. Consideration of actinomycosis in a woman with prolonged use of an intrauterine device and symptoms of bowel obstruction could help to improve the preoperative diagnosis and management of this rare disease.
Subject(s)
Actinomycosis/diagnosis , Intestinal Obstruction/diagnosis , Pelvic Inflammatory Disease/microbiology , Abdomen/microbiology , Aged , Diagnosis, Differential , Female , Humans , Intrauterine Devices/adverse effects , Male , Middle Aged , Pelvic Inflammatory Disease/diagnosisABSTRACT
Intestinal stoma creation has been performed using both open and laparoscopic surgery. However, each technique still has disadvantages. We created the intestinal stoma through one incision, with the use of the laparoscope in a gasless fashion. This method has not been reported previously. Fourteen adult patients underwent this technique between February 1996 and December 1998. Indications for stoma creation were for various anorectal disease processes, most commonly for purposes of hygiene in patients with spinal cord injury. The average operative time to perform the stoma was 58 (range, 15-78) minutes, with minimal blood loss (<35 ml). Follow-up ranged from 1 to 22 months. Two cases (14 percent) were converted secondary to severe adhesions. All nonconverted patients were able to tolerate a regular diet within two days of surgery. There was only one stoma-related complication. Two patients (14 percent) died of comorbidities during follow-up. In conclusion, the initial experience with gasless laparoscopic-assisted intestinal stoma creation through a single incision is encouraging. Patients requiring ostomy creation as a single intervention may benefit from this approach.
Subject(s)
Intestines/surgery , Laparoscopy/methods , Surgical Stomas , Adult , Aged , Humans , Middle AgedABSTRACT
Reportamos dos casos quirúrgicos de obstrucción intestinal causados por bezoares del intestino delgado. El primero en un paciente femenina de 63 años, alcohólica, cuya sintomatología comienza en 48 horas después de ingerir abundante cantidad de licor y embutidos (chorizos). Se le practica laparotomía exploradora y se obtiene por enterotomía un bezoar del material plástico. El segundo caso, una paciente de 73 años cuyo cudro clínico fue atendido 24 horas por copiosa ingesta de higos. El hallazgo operatorio fue un fitobezoar intestinal. Se discuten los factores epidemiológicos y etiológicos, y el manejo de los pacientes con estos cuerpos extraños
