RESUMO
INTRODUCTION: Early complications associated with percutaneous endoscopic gastrostomy are well documented. Late complications associated with retained gastrostomy flange are rare. It is unclear why some patients with retained gastrostomy flange (internal bumper) develop mechanical obstruction and others do not. We report a case of mechanical obstruction with perforation occurring 6 months after the tube was cut. PATIENT AND METHODS: A 76-year-old hemiplegic patient with no swallowing reflex and who previously was on long-term percutaneous gastrostomy feeding tube underwent removal of the feeding tube but the internal bumper was left in situ due to encrustation. RESULTS: Due to migration of the retained flange, the patient developed small bowel obstruction. CONCLUSIONS: Retained internal bumper is potentially dangerous and we recommend endoscopic retrieval of such flange.
Assuntos
Endoscopia Gastrointestinal/efeitos adversos , Migração de Corpo Estranho/complicações , Gastrostomia/efeitos adversos , Obstrução Intestinal/etiologia , Perfuração Intestinal/etiologia , Intestino Delgado , Instrumentos Cirúrgicos , Idoso , Remoção de Dispositivo , Migração de Corpo Estranho/diagnóstico por imagem , Gastrostomia/instrumentação , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Perfuração Intestinal/diagnóstico por imagem , Perfuração Intestinal/cirurgia , Intestino Delgado/cirurgia , Masculino , RadiografiaRESUMO
It is generally accepted that antiphospholipid syndrome remains a major medical problem characterised by hypercoagulability, arterial and venous thrombosis and thrombocytopenia. It is unclear how best to treat these patients should they require emergency surgery. If a lupus anticoagulant is present, hypercoagulability may occur de novo but surgical interventions along with sepsis are two important predisposing factors. We describe three patients with primary antiphospholipid syndrome and discuss the implications for surgery.
