RESUMO
The technique of normothermic total hepatic vascular occlusion (THVO) is achieved by concomitant clamping of the inferior vena cava above and below the liver in addition to portal inflow occlusion. In this study we investigated the use of THVO for 45 min in a rabbit model with acute cholestasis of 10 days' duration. In rabbits with normal preoperative liver functions (control group), serum total bilirubin, glutamic-pyruvic transaminase (SGPT), glutamic-oxaloacetic transaminase (SGOT), alkaline phosphate, and gamma-glutamyltranspeptidase levels returned to normal ranges within a week after THVO. In the group with persistent cholestasis THVO was performed 10 days after ligation of the extrahepatic bile duct. Total bilirubin and canalicular enzymes remained high while the SGOT and SGPT peaked and almost returned to the preoperative levels at 7 days following THVO in this group. A third group of animals also underwent THVO 10 days after ligation of their extrahepatic bile ducts with relief of the obstruction with a Teflon stent immediately after THVO. This group also showed the trend of normalization of liver canalicular and parenchymal enzymes and bilirubin by the end of 7 days. This study demonstrated the feasibility of THVO in rabbits with acute extrahepatic cholestasis whether the extrahepatic biliary obstruction persisted or not.
Assuntos
Colestase Extra-Hepática/cirurgia , Hepatopatia Veno-Oclusiva/metabolismo , Doença Aguda , Animais , Colestase Extra-Hepática/complicações , Colestase Extra-Hepática/metabolismo , Seguimentos , Hepatopatia Veno-Oclusiva/complicações , Masculino , Coelhos , Veia Cava InferiorRESUMO
Thirty-eight patients were treated for acute sigmoid volvulus in 9 years. Non operative decompression treatment was performed in 7 patients, and 31 patients underwent exploratory laparatomy (25 for suspected bowel necrosis and 6 for unsuccessful non operative treatment). Sigmoid resection and reanastomosis was performed in 5 of the 12 cases with gangrenous bowel and 10 of the 19 with viable bowel. There were no mortality and no morbidity related to the anastomoses. The results have shown that reanastomosis after sigmoid resection could be performed safely in selected cases of acute sigmoid volvulus even if there is bowel gangrene.