RESUMO
Internal hernia of the supravesical fossa is an unusual cause of small bowel obstruction. We report the case of a patient without previous abdominal surgery with an acute abdominal obstruction in which laparoscopic exploration revealed a strangulated internal supravesical hernia. To help clinicians with their pre-operative diagnosis and to better understand the clinical management of this unusual internal hernia, a description of the anatomy of the supravesical fossa is included in this case report.
Assuntos
Hérnia Abdominal/complicações , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Idoso , Hérnia Abdominal/diagnóstico por imagem , Humanos , Doenças do Íleo/cirurgia , Obstrução Intestinal/cirurgia , Laparoscopia , Masculino , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
OBJECTIVE: To compare the efficacy of double gloving with an inner coloured pair of gloves and double gloving with classic gloves, for prompt detection of perforation during a single standard operation. DESIGN: Prospective, randomised study. SETTING: Teaching hospital, France. SUBJECTS: 100 Consecutive patients with haematological malignancy or AIDS, who were referred for implantation of a vascular access port. INTERVENTIONS: Insertion of a central line with an implantable chamber under local anaesthesia. The use of double gloving with an inner coloured pair or with classic gloves was decided preoperatively by random allocation. MAIN OUTCOME MEASURES: Visual detection of one or more perforations on one or more gloves during operation, localisation of the perforation(s), and post-operative evaluation of the water tightness of the gloves. RESULTS: There were a total of 14 perforations of the outer gloves, 9 were detected during operation in the coloured inner pair group compared with none in the standard gloves group. Postoperative testing showed that there were no undetected perforations in the coloured inner pair group compared with 5 in the standard gloves group. CONCLUSIONS: Double gloving with a coloured inner pair is effective in the peroperative detection of accidental perforations in surgical gloves.
Assuntos
Luvas Cirúrgicas , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Síndrome da Imunodeficiência Adquirida/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo Venoso Central , Cateteres de Demora , Falha de Equipamento , Feminino , Doenças Hematológicas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/cirurgia , Estudos ProspectivosAssuntos
Doenças do Íleo/etiologia , Perfuração Intestinal/etiologia , Linite Plástica/complicações , Neoplasias Gástricas/complicações , Adulto , Terapia Combinada , Feminino , Humanos , Doenças do Íleo/patologia , Doenças do Íleo/cirurgia , Perfuração Intestinal/patologia , Perfuração Intestinal/cirurgia , Linite Plástica/patologia , Linite Plástica/terapia , Neoplasias Gástricas/patologia , Neoplasias Gástricas/terapiaRESUMO
This prospective study examined the presence of foreign bodies in postoperative adhesion specimens and parietal peritoneum removed in a given patient at the same operative site. Fifty-two consecutive patients were enrolled. A significantly larger number of foreign bodies were observed in adhesion specimens than in peritoneum specimens. Inflammatory processes were also found to develop preferentially on the perioneum. In man, foreign bodies participate in the mechanism of development of postoperative intraperitoneal adhesions.
Assuntos
Corpos Estranhos , Complicações Intraoperatórias , Cavidade Peritoneal , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
Among hepatic hemangiomas (the most common solid hepatic tumor in adults), "giant hemangiomas" are those defined by a diameter greater than 4 cm. The natural history of such lesions is unclear, and many surgical procedures have been described. In five women and one man (mean age 49), we successfully used enucleation of the tumor under blood inflow control. This technique was made possible by a cleavage plane between the hepatic parenchyma and the hemangioma. This straightforward and safe procedure required a low rate of transfusion (mean 200 mL/patient) and spared a maximum amount of hepatic tissue.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Hemangioma Cavernoso/cirurgia , Hemostasia Cirúrgica/métodos , Neoplasias Hepáticas/cirurgia , Transfusão de Sangue , Transfusão de Sangue Autóloga , Feminino , Humanos , Cuidados Intraoperatórios , Fígado/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
From 1990 to 1993, programmed surgery was performed in four patients with histologically low grade malignant gastric lymphomas of mucosa-associated lymphoid tissue (MALT) (partial gastrectomy = 1, total gastrectomy = 3). These small cell lymphomas have the B phenotype and are uncommon. The clinical course is usually slow and classically limited to the stomach. As for other gastric lymphomas, there is still a certain amount of discussion as to the best therapeutic choice between surgery, chemotherapy and radiotherapy. Certain elements in the literature can help in managing these low grade gastric lymphomas. Recent publications report on a prospective study on primary lymphomas of the digestive tract, a clinical trial on single drug chemotherapy alone and the relationships between Helicobacter pylori and MALT lymphoma.
Assuntos
Linfoma de Zona Marginal Tipo Células B/patologia , Neoplasias Gástricas/patologia , Adulto , Feminino , Gastrectomia , Humanos , Linfoma de Zona Marginal Tipo Células B/classificação , Linfoma de Zona Marginal Tipo Células B/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Gástricas/classificação , Neoplasias Gástricas/cirurgiaRESUMO
Usually considered as totally unoffensive, antalgic suppositories can, under certain conditions, lead to extensive anorectal injury with anatomic, functional and legal implications which we evaluated on the basis of two cases and a review of the literature. Clinicians, surgeons, pathologists and pharmaceutical firms should be aware of these pathophysiological events. Consumer information is required to reduce the risk of self-medication. There are characteristic psychologic situations and "dose-dependent" toxic effects which, as the saying goes "errare humanum est, perseverare diabolicum". Careful use of scientific knowledge and wise decisions by both experts and judges are required to avoid misinterpreting the pathogenesis of this particular anatomoclinical entity.
Assuntos
Analgésicos , Doenças do Ânus/induzido quimicamente , Doenças Retais/induzido quimicamente , Feminino , Humanos , Inflamação/induzido quimicamente , Pessoa de Meia-Idade , Necrose , Transtornos Relacionados ao Uso de Substâncias , Supositórios , Úlcera/induzido quimicamenteRESUMO
Our experience with 168 consecutive implantable chamber catheters over a one year period led us to establish the criteria for this implantation technique. Implantation should be carried out under local anaesthesia and be well tolerated and comfortable for the patient who is often weak. It should be a first indication technique in order to save the venous capital. Based on our experience, subclavian implantation corresponds best to these criteria.
Assuntos
Síndrome da Imunodeficiência Adquirida/cirurgia , Cateteres de Demora , Doenças Hematológicas/cirurgia , Neoplasias/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológicoRESUMO
Postoperative intraperitoneal adhesions are known to occur after conventional surgery. The prospective study that we have performed in 1992 shows that the frequency of postoperative intraperitoneal adhesions is very high (93% of patients). It is higher than was stated 20 years ago, while so-called "spontaneous" adhesions seem to be decreasing. The histological study of postoperative intraperitoneal adhesions shows a specific evolution in time and a very high frequency of foreign bodies (starch, variably decayed textile fibers) (92%). The very great frequency of such foreign bodies in postoperative intraperitoneal adhesions, logically involving them in the genesis of this condition, may be an argument in favor of the new surgical techniques, especially of celioscopy.
Assuntos
Corpos Estranhos/patologia , Obstrução Intestinal/etiologia , Doenças Peritoneais/patologia , Aderências Teciduais/patologia , Idoso , Feminino , Corpos Estranhos/complicações , Humanos , Obstrução Intestinal/cirurgia , Laparotomia , Masculino , Pessoa de Meia-Idade , Doenças Peritoneais/complicações , Doenças Peritoneais/cirurgia , Complicações Pós-Operatórias , Estudos Prospectivos , Aderências Teciduais/complicaçõesAssuntos
Fístula Biliar/etiologia , Hematoma/complicações , Hepatopatias/complicações , Fígado/lesões , Veia Porta , Acidentes de Trânsito , Adulto , Fístula Biliar/diagnóstico por imagem , Fístula Biliar/cirurgia , Fístula/diagnóstico por imagem , Fístula/etiologia , Fístula/cirurgia , Hematoma/diagnóstico por imagem , Hematoma/cirurgia , Hepatectomia , Humanos , Fígado/diagnóstico por imagem , Fígado/cirurgia , Hepatopatias/diagnóstico por imagem , Hepatopatias/cirurgia , Masculino , Tomografia Computadorizada por Raios X , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/etiologia , Doenças Vasculares/cirurgiaRESUMO
We report about one case of cystic lymphangioma of the jejunum in a 27-year-old woman admitted to hospital for abdominal pain. The study of this case and the review of the literature enabled us to bring out the main characteristics of the lesion: rarity in adults, benignancy, mode of occurrence--most often painful--, radiological--and particularly CT--features, diagnosis based on histological findings only, and lastly, treatment with surgical exeresis that must be complete to prevent recurrence.
Assuntos
Dor Abdominal/etiologia , Linfangioma/complicações , Mesentério/fisiopatologia , Neoplasias Peritoneais/complicações , Doença Aguda , Adulto , Feminino , Humanos , Linfangioma/diagnóstico por imagem , Linfangioma/cirurgia , Mesentério/diagnóstico por imagem , Mesentério/cirurgia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/cirurgia , Tomografia Computadorizada por Raios XRESUMO
An experimental study on 15 piglets allowed defining the technical procedure and controlling the anatomical and functional results of various modes of restoration of the ileocolic tract after resection with a terminolateral tubing including and intracolic ileal sleeve. Coloileal fixation was ensured only by a few seromuscular sutures and adhesion with "Tissucol". The clinical application of this procedure was very satisfactory for 9 recent right colectomies, thus confirming the results previously observed for 33 ileal perforations in Africa. The ileocolic tubing technique is easy, reliable, morbidity-free, and causes no leakage of intestinal fluid, no intestinal ischemia and no stenosis. As it prevents coloileal reflux, this assembly may prevent ileitis after right colectomy. Its valvular effect also contributes in the mechanical regulation of transit. The assembly produces a system that can be compared to the ileocecal valve.