RESUMO
We have read the article by Pérez-Santiago L et al. on the conservative or surgical management of pneumatosis intestinalis (PI). Recently we saw a case of a 18-year-old female diagnosed with anorexia nervosa who presented due to general malaise, asthenia, and inability to walk following an episode of abdominal pain, vomiting and diarrhea (10-15 stools daily, some of them bloody). Physical examination revealed signs of malnutrition and dehydration, and a distended, tender abdomen with no signs of peritoneal irritation. Laboratory chemistry tests revealed macrocytic anemia and metabolic alkalosis. An abdominal CT scan showed pancolonic pneumatosis, with greater involvement of the cecum, ascending and transverse colon, as well as pneumoperitoneum and gas in branches of the superior mesenteric and portal veins.
Assuntos
Anorexia Nervosa , Pneumatose Cistoide Intestinal , Pneumoperitônio , Adolescente , Anorexia Nervosa/complicações , Feminino , Humanos , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/etiologia , Veia Porta , Tomografia Computadorizada por Raios XRESUMO
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Assuntos
Humanos , Feminino , Idoso , Neoplasias do Colo/diagnóstico por imagem , Neoplasias do Colo/cirurgia , Adenocarcinoma/patologia , Carcinoma Neuroendócrino/patologia , Neoplasias do Colo/patologia , Anemia/complicações , Colo Transverso/patologia , Tomografia Computadorizada por Raios X , Colectomia/métodos , Neoplasias do Ceco/diagnóstico por imagem , Neoplasias do Ceco/patologiaAssuntos
Adenocarcinoma/secundário , Neoplasias do Colo/patologia , Neoplasias Hepáticas/secundário , Neoplasias Primárias Múltiplas/patologia , Tumores Neuroendócrinos/secundário , Adenocarcinoma/cirurgia , Idoso , Anemia/etiologia , Neoplasias do Ceco/complicações , Neoplasias do Ceco/patologia , Neoplasias do Ceco/cirurgia , Colectomia , Neoplasias do Colo/complicações , Neoplasias do Colo/cirurgia , Feminino , Hemorragia Gastrointestinal/etiologia , Hepatectomia/métodos , Humanos , Neoplasias Hepáticas/cirurgia , Neoplasias Primárias Múltiplas/cirurgia , Tumores Neuroendócrinos/cirurgiaRESUMO
OBJECTIVE: To find out if the patients' age affects the treatment of abdominal hernias and the results in relation of the age increase. DESIGN: Retrospective and prospective study. SETTING: University hospital, Spain. SUBJECTS: 664 patients aged 70 years or more operated on for abdominal hernia between 1986-1998. Patients were divided into three groups: 443 aged 70-79; 202 aged 80-89; and 19 patients aged 90 years or more. MAIN OUTCOME MEASURES: Perioperative risk, type of surgery and deaths. RESULTS: 117 women (52%) had femoral hernias, compared with 32 men (7%) (p = 0.0001). The incidence of femoral hernia over 80 years of age was 79/221 (36%) compared with 70/443 (16%) among patients in their seventies (p = 0.0001). 97 of the patients aged 70-79 (22%) were operated on as emergencies, 107 of those aged 80-89 (53%), and 17 in patients 90 or older (89%, p = 0.0001). The mortality rate was 1% in the 70-79 group (n = 6), 5% (n = 10) in the 80-89 group, and 3/19 died in the over 90 group (p = 0.0001). No deaths were reported after elective surgery. CONCLUSION: Emergency operations in elderly patients with abdominal wall hernias are increasingly more common as the patient get older. As result, there is an unacceptable increase in postoperative mortality.
