RESUMO
Post-operative fever is common following emergency surgery. Investigation and management of post-operative fever can be challenging when a clear source of sepsis is not evident or the underlying source of infection is not recognised. We herein report a case of secondary pulmonary tuberculosis presenting as post-operative fever following emergency laparotomy for a perforated duodenal ulcer. This case of tuberculosis was diagnosed on day 41 post-operatively and prior inconclusive results meant that we relied mainly on re-visiting history and examination in order to identify 3 targeted investigations: plain chest X-ray, sputum sample and blood test. Accordingly, the co-management of this complex patient achieved a good outcome.
Assuntos
Febre de Causa Desconhecida/microbiologia , Complicações Pós-Operatórias/microbiologia , Tuberculose Pulmonar/complicações , Antituberculosos/uso terapêutico , Diagnóstico Tardio , Diagnóstico Diferencial , Quimioterapia Combinada , Duodenopatias/diagnóstico por imagem , Duodenopatias/cirurgia , Humanos , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Pneumoperitônio/diagnóstico por imagem , Pneumoperitônio/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose Pulmonar/diagnóstico , Tuberculose Pulmonar/tratamento farmacológicoAssuntos
Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/microbiologia , Hepatopatias/epidemiologia , Hepatopatias/microbiologia , Infecções Estreptocócicas/epidemiologia , Streptococcus bovis/isolamento & purificação , Neoplasias Colorretais/fisiopatologia , Comorbidade , Feminino , Humanos , Hepatopatias/fisiopatologia , Masculino , Prevalência , Prognóstico , Medição de Risco , Infecções Estreptocócicas/diagnóstico , Taxa de Sobrevida , Reino Unido/epidemiologiaRESUMO
Colorectal carcinoma is one of the most common cancers encountered in the western world and increasingly in the developing world as well. This conditions results in considerable morbidity and mortality. As a result of the impact colorectal carcinoma has on society, a considerable amount of research has gone into elucidating the molecular mechanisms of this disease. This has led to a proliferation in the understanding of the molecular aetiology of the disease. Such research has revealed the underlying mechanisms to be complex and diverse, with no single molecular cause for the development of colorectal cancer. In this review, we look at the basic underlying molecular mechanisms of colorectal cancer and also briefly explore its implications with regards to clinical applications. We look at how this information relates to the prognosis and also its potential use in screening. A medline and pubmed search was conducted using the keywords colorectal carcinoma, molecular biology of colorectal carcinoma, mutations, and the relevant articles were used for this review. Bibliographies of these articles were also searched for relevant articles. There is considerable information available on the pathogenesis of colorectal carcinoma and such knowledge is beginning to impact on clinical practice.
