Trombosis venosa mesentérica y portal como causa infrecuente de obstrucción e isquemia intestinal en paciente joven. Reporte de caso / Mesenteric and Portal Venous Thrombosis as an infrequent cause of intestinal Obstruction and Ischemia in young patients. A case report

Resumen La isquemia mesentérica aguda se asocia a una mortalidad de entre el 50 y el 100%, la causa más rara de esta es la trombosis venosa de los vasos mesentéricos (5%) y portal (1%). Las manifestaciones clínicas son diversas, siendo el dolor abdominal el principal síntoma. La tomografía computarizada con contraste intravenoso en fase portal es la imagen más precisa para el diagnóstico. El tratamiento en fase aguda se basa en anticoagulación, fluidos intravenosos, antibióticos profilácticos, descanso intestinal y descompresión. La laparotomía de control de daños, incluida la resección intestinal y el abdomen abierto, pueden estar justificados en última instancia para pacientes con necrosis intestinal y sepsis. Caso clínico: Hombre de 35 años, sin antecedentes de importancia, solo tabaquismo desde hace 15 años. Refirió que 5 días previos comenzó a presentar dolor en el epigastrio tipo cólico, de intensidad moderada, posteriormente refirió que el dolor se generalizó y aumentó de intensidad, acompañado de náusea, vómito, intolerancia a la vía oral y alza térmica. Al examen físico tuvo datos de respuesta inflamatoria sistémica, estaba consciente y orientado, con abdomen doloroso a la palpación superficial y profunda a nivel generalizado, pero acentuado en el flanco derecho, rebote positivo con resistencia, timpanismo generalizado, peristalsis ausente. Se ingresó a quirófano a laparotomía exploradora, encontrando lesión a intestinal isquémica-necrótica a 190-240 cm del ángulo de Treitz, y 400 cc de líquido hemático; se realizó resección de la parte intestinal afectada, con entero-enteroanastomosis término-terminal manual. Se envió pieza a patología, y se reportó un proceso inflamatorio agudo con necrosis transmural y congestión vascular. Ante estos hallazgos se realizó angiotomografía abdominal que reportó defecto de llenado en la vena mesentérica superior, secundario a trombosis que se extendía hasta la confluencia y la vena porta. Conclusión: La trombosis venosa mesentérica y portal es una patología muy infrecuente en pacientes jóvenes sin factores de riesgo en los que se presenta dolor abdominal. El diagnóstico es complejo debido a que los datos clínicos y de laboratorio son poco específicos. Sin embargo, debemos tenerla en cuenta en el diagnóstico diferencial de etiologías de dolor abdominal.

Abstract Acute Mesenteric Ischemia is associated with a mortality rate between 50% and 100%; the rarest cause of this is venous thrombosis of the mesenteric (5%) and portal (1%) vessels. The clinical manifestations are diverse, with abdominal pain being the main symptom. Computed tomography with intravenous contrast in the portal phase is the most accurate image for diagnosis. Treatment in the acute phase is based on anticoagulation, intravenous fluids, prophylactic antibiotics, intestinal rest, and decompression. Damage control laparotomy, including bowel resection and open abdomen, may ultimately be warranted for patients with bowel necrosis and sepsis. Clinical case: 35-year-old man, with no significant history, only smoking for 15 years. For 5 days before, he reported crampy epigastric pain of moderate intensity. He subsequently reported that the pain became generalized and increased in intensity, accompanied by nausea, vomiting, oral intolerance, and temperature rise. The physical examination showed signs of a systemic inflammatory response, conscious and oriented, abdomen painful on superficial and deep palpation at a generalized level but accentuated on the right flank, positive rebound with resistance, generalized tympanism, absent peristalsis. The operating room was entered for exploratory laparotomy, finding an ischemic-necrotic intestinal lesion at 190 - 240 cm from the angle of Treitz, and 400cc of blood fluid. Resection of the affected intestinal part is performed, with entire manual terminal end anastomosis. The specimen was sent to pathology, reporting an acute inflammatory process with transmural necrosis and vascular congestion. Given these findings, abdominal CT angiography was performed, which reported a filling defect in the superior mesenteric vein, secondary to thrombosis that extended to the confluence and the portal vein. Conclusion: Mesenteric and portal venous thrombosis is a very rare pathology in young patients without risk factors in whom abdominal pain occurs. The diagnosis is complex because the clinical and laboratory data are not very specific. However, we must take it into account in the differential diagnosis of abdominal pain etiologies.

Bowel obstruction: signs indicating the need for urgent surgery.

Bowel obstruction is common in emergency departments. Obstruction is more common in the small bowel than in the large bowel. The most common cause is postsurgical adhesions. Nowadays, bowel obstruction is diagnosed with multidetector computed tomography (MDCT). MDCT studies for suspected bowel obstruction should focus on four points that need to be mentioned in the report: confirming the obstruction, determining whether there is a single transition point or whether the obstruction is found in a closed loop, establishing the cause of the obstruction, and seeking signs of complications. Identifying signs of ischemia is important in the management of the patient because it enables patients at higher risk of poor outcomes after conservation treatment who could benefit from early surgical intervention to avoid greater morbidity and mortality associated with strangulation and ischemia of the obstructed bowel loop.

Actualización de biomarcadores para la detección precoz de isquemia intestinal / Update on biomarkers for early detection of intestinal ischemia

La isquemia intestinal asocia una elevada mortalidad debida principalmente a un retraso en el diagnóstico. Sibien el angio tC es una herramienta sensible y específica, suele transcurrir demasiado tiempo hasta su realizacióndebido a una presentación clínica poco específica. en este tiempo la isquemia intestinal puede progresar a estadiosirreversibles con afectación sistémica. La obtención de biomarcadores precisos y de elevación precoz acortaría eltiempo diagnóstico de esta patología, lo que disminuiría su mortalidad asociada. Se sabe que las moléculas usadastradicionalmente, entre ellas el lactato, no tienen buena capacidad diagnóstica. no obstante, se ha observado unaelevada sensibilidad con el uso del esteroisómero D del lactato y la procalcitonina para detectar colitis isquémicatras cirugía de aorta, al tiempo que se recomienda valorar los niveles de dímero D para descartar isquemia mesen-térica aguda en pacientes con dolor abdominal. Otras moléculas con un potencial rendimiento diagnóstico sonla proteína ligadora de ácidos grasos intestinales (I-FaBp) y el péptido similar al glucagón de tipo 1 (GLp-1), aúnen investigación.(AU)

Intestinal ischemia associates high mortality rates, mainly due to a delay in diagnosis. although computed tomog-raphy angiography (Cta) remains a sensitive and specifi c tool, it usually takes quite long until it is done, due to anunspecific clinical presentation. In this time lapse, intestinal ischemia may progress to an irreversible stage withsigns of systemic failure. the acquisition of precise and early detection biomarkers for the disease would shortenthe time to diagnosis and hence its associated mortality. It is acknowledged that those molecules which have beenclassically used-lactate amongst them-do not have a proper diagnostic capacity. nevertheless, the D stereoisomerof lactate and procalcitonin have shown high sensitivity for detection of ischemic colitis after open aortic surgery,while D-dimer measurement is recommended to rule out acute mesenteric ischemia in patients with abdominalpain. Other molecules with a potential for diagnostic yield are intestinal fatty acid binding protein (i-FaBp) andglucagon-like peptide-1 (GLp-1), still under investigation.(AU)

Trombosis venosa mesentérica / Mesenteric venous thrombosis

La trombosis venosa mesentérica (TVM) es una entidad poco frecuente que puede presentarse de manera aguda, subaguda o crónica. Puede ocurrir de forma aislada o en el seno de una trombosis esplácnica (espleno-porto-mesentérica). Los casos sintomáticos suelen presentarse como dolor abdominal inespecífico, con o sin datos de sufrimiento intestinal, y el diagnóstico se realiza habitualmente mediante una prueba de imagen (TC abdominal o RMN) en pacientes con una alta sospecha clínica. Se recomienda un enfoque clínico-quirúrgico precoz para cribar aquellos pacientes con datos de alarma y que se beneficien de una laparotomía exploradora añadida al tratamiento anticoagulante, que es la piedra angular del tratamiento médico. La TVM suele asociar estados protrombóticos, siendo de especial interés clínico los trastornos hematológicos (síndromes mieloproliferativos y mutaciones del gen JAK2). Por otro lado, la tasa de supervivencia a los 5 años es del 70-82%, y la mortalidad global precoz puede llegar hasta el 20-32% (AU)

Mesenteric vein thrombosis (MVT) is a rare condition that can present acutely, subacutely, or chronically. MVT can be isolated or within a splanchnic thrombosis (spleno-porto-mesenteric). Symptomatic cases usually present as nonspecific abdominal pain, with or without signs of intestinal ischemia, and the diagnosis is usually made by imaging test (abdominal CT or MRI) in patients with high clinical suspicion. An early clinical-surgical approach is recommended to screen those patients with warning signs and who benefit from an exploratory laparotomy in addition to anticoagulant treatment, which is the cornerstone of medical treatment. MVT is usually associated with prothrombotic states, with hematological disorders (myeloproliferative syndromes and/or JAK2 gene mutations) being of special clinical relevance. On the other hand, the 5-year survival rate is 70-82% and early overall 30-day mortality from MVT can reach 20-32% (AU)

[Mesenteric venous thrombosis]. / Trombosis venosa mesentérica.

Mesenteric vein thrombosis (MVT) is a rare condition that can present acutely, subacutely, or chronically. MVT can be isolated or within a splanchnic thrombosis (spleno-porto-mesenteric). Symptomatic cases usually present as nonspecific abdominal pain, with or without signs of intestinal ischemia, and the diagnosis is usually made by imaging test (abdominal CT or MRI) in patients with high clinical suspicion. An early clinical-surgical approach is recommended to screen those patients with warning signs and who benefit from an exploratory laparotomy in addition to anticoagulant treatment, which is the cornerstone of medical treatment. MVT is usually associated with prothrombotic states, with hematological disorders (myeloproliferative syndromes and/or JAK2 gene mutations) being of special clinical relevance. On the other hand, the 5-year survival rate is 70-82% and early overall 30-day mortality from MVT can reach 20-32%.

Embarazo con miomatosis uterina complicado con isquemia intestinal: reporte de un caso / Pregnancy with uterine myomatosis complicated by intestinal ischemia: case report

Resumen Los miomas uterinos, también conocidos como fibromas o leiomiomas, son los tumores uterinos benignos más prevalentes. Afectan a las mujeres principalmente durante sus años reproductivos y se diagnostican hasta en un 70% de las mujeres blancas y en más del 80% de las mujeres de ascendencia africana durante su vida, con una prevalencia durante el embarazo del 2% al 10%. Pueden ser asintomáticos hasta en un 70% de las pacientes, y se estima que pueden ocurrir complicaciones en aproximadamente una de cada 10 mujeres embarazadas. Se han asociado a complicaciones y resultados adversos del embarazo, según su tamaño y ubicación en el útero, y pueden manifestarse de diferentes formas. Presentamos el caso de una mujer de 30 años, con embarazo en el tercer trimestre, quien consultó por dolor abdominal, con ecografías obstétricas durante su control prenatal que reportaban miomatosis uterina, quien presentó isquemia intestinal por un vólvulo de intestino delgado versus compresión extrínseca.

Abstract Uterine fibroids, also known as fibroids or leiomyomas, are the most prevalent benign uterine tumors, affecting women mainly during their reproductive years and are diagnosed in up to 70% of white women and more than 80% of women of African descent during their lifetime, with a prevalence during pregnancy of 2% to 10%; they may be asymptomatic in up to 70% of patients, and it is estimated that complications may occur in approximately one in 10 pregnant women. They have been associated with complications and adverse pregnancy outcomes, depending on their size and location in the uterus, they can manifest in different ways. We present the case of a 30-year-old woman, pregnant in the third trimester, who consulted for abdominal pain, with obstetric ultrasound scans during her prenatal check-up reporting uterine myomatosis, who presented intestinal ischemia due to small bowel volvulus versus extrinsic compression.

Isquemia mesentérica segmentaria como secuela de la COVID-19: Informe de un caso / Segmental mesenteric ischemia as a sequel to COVID-19: A case report

Coronaviruses can cause respiratory, gastrointestinal, and central nervous system diseases in humans and animals, have the ability to adapt through mutations, and are programmed to modify host tropism. SARS-CoV-2 infection (COVID-19) has been shown to be a highly thrombogenic disease, generating deep vein thrombosis, pulmonary embolism and acute ischemia, in patients even without previous pathology. Coronaviruses can cross the species barrier and infect humans with unexpected consequences for public health. The transmission rate of SARS-CoV-2 is higher compared to that of closely related SARS-CoV infections. Key residues of the spike protein have a higher binding affinity for ACE2. These may be the reason for the higher transmission rate of SARS-CoV-2. COVID-19 has been shown in some patients to be a highly thrombogenic disease, both venous and arterial, generating deep vein thrombosis, pulmonary embolism and acute ischemia, both in patients without previous pathology as with them.There is molecular evidence of the state of hyper coagulability in COVID-19; the first observations were made by Wang, in 2020, when analyzing the levels of fibrinogen and D-dimer in patients with COVID-19 and finding elevated levels up to 75% above the laboratory controls. We present the case of a 62-year-old male with mild symptoms of COVID-19 and outpatient management, at the end of the clinical disease he presented an acute abdomen secondary to mesenteric ischemia, with good postoperative evolution.

Los coronavirus pueden causar enfermedades respiratorias, gastrointestinales y del sistema nervioso central en seres humanos y animales; tienen la capacidad para adaptarse por medio de mutaciones y son programados para modificar el tropismo del huésped. La infección por el SARS-CoV-2 (COVID-19) genera trombosis venosa profunda, embolismo pulmonar y cuadros de isquemia aguda, en pacientes sin afección previa. Los coronavirus infectan a los seres humanos con consecuencias inesperadas para la salud pública. La tasa de transmisión de la infección por el SARS-CoV-2 es más alta en comparación con las infecciones por SARS-CoV estrechamente relacionadas. Los residuos clave de la proteína espiga tienen mayor afinidad de unión por el receptor de la enzima convertidora de angiotensina (ECA2). Esta puede ser la razón de la mayor tasa de transmisión de SARS-CoV-2. La COVID-19 ha demostrado, en algunos pacientes, ser una enfermedad altamente trombogénica, tanto venosa como arterial, dado que genera trombosis venosa profunda, embolismo pulmonar y cuadros de isquemia aguda, tanto en pacientes sin afecciones previas como con ellas. Existe evidencia molecular del estado de hipercoagulabilidad en la COVID-19; las primeras observaciones fueron realizadas por Wang en 2020, al analizar los niveles de fibrinógeno y dímero-D en pacientes con COVID-19, y encontrar niveles elevados hasta 75% por arriba de los controles de laboratorio. Se presenta el caso de un paciente masculino de 62 años, con un cuadro leve de COVID-19 y abordaje ambulatorio; al término de la enfermedad clínica presentó abdomen agudo secundario a isquemia mesentérica, con buena evolución en el posoperatorio.

Oral administration of n-3 fatty acids positively affect the mucosal lesions after experimental ischemic enteritis in the rat.

AIM: The purpose of the study was to evaluate the effect of oral administration of n-3 polyunsaturated fatty acids in experimental ischemic enteritis in rats. METHODS: Forty Wistar rats were submitted to control narrowing of the superior mesenteric artery and were divided in two groups: N3 polyunsaturated fatty acids, which received a high-molecular polymer solution of artificial total enteral nutrition enriched with n-3 fatty acids and CONTROL which received a high-molecular polymer solution of artificial total enteral nutrition. RESULTS: Reduction of the animals' body weight was observed in both groups, but there was no difference between the two groups. Regarding the level of cytokines interleukin (IL)-1b, IL-6, and tumor necrosis factor a (TNF-a) there was no statistically significant difference between the two groups. Ischemic lesions to the small bowel mucosa were observed in both groups. A statistically significant difference in the extent of intestinal lesions was observed between the two groups with the animals that received enteral nutrition enriched with n-3 fatty acid developing fewer lesions. CONCLUSION: Enteral nutrition enriched with n-3 polyunsaturated fatty acids reduces the mucosal lesions caused by mesenteric ischemia compared to standard enteral nutrition, by modifying the local, but not the systemic, immune, and inflammatory response.

OBJETIVO: El propósito del estudio fue evaluar el efecto de la administración oral de ácidos grasos poliinsaturados n-3 en enteritis isquémica experimental en ratas. MÉTODOS: 40 ratas Wistar fueron sometidas a un estrechamiento controlado de la arteria mesentérica superior y se dividieron en dos grupos: N3PUFA, que recibieron una solución de polímero de alto peso molecular de nutrición enteral total artificial enriquecida con ácidos grasos n-3 y CONTROL que recibió un alto -Solución de polímero molecular de nutrición enteral total artificial. RESULTADOS: Se observó una reducción del peso corporal de los animales en ambos grupos, pero no hubo diferencias entre los dos grupos. Con respecto al nivel de citocinas IL-1b, IL-6 y TNF-a, no hubo diferencia estadísticamente significativa entre los dos grupos. Se observaron lesiones isquémicas de la mucosa del intestino delgado en ambos grupos. Se observó una diferencia estadísticamente significativa en la extensión de las lesiones intestinales entre los dos grupos y los animales que recibieron nutrición enteral enriquecida con ácido graso n-3 desarrollaron menos lesiones. CONCLUSIÓN: La nutrición enteral enriquecida con ácidos grasos poliinsaturados n-3 reduce las lesiones mucosas causadas por isquemia mesentérica en comparación con la nutrición enteral estándar, al modificar la respuesta local, pero no sistémica, inmunitaria e inflamatoria.

Isquemia intestinal por trombosis mesentérica en paciente geriátrico, resuelta por intervencionismo. Reporte de caso / Intestinal Ischemia Due to Mesenteric Thrombosis in a Geriatric Patient, Solved by Intervention. Case Report

Resumen: La trombosis mesentérica representa una urgencia vascular condicionada por la interrupción abrupta del flujo sanguíneo, ya sea arterial o venoso; el cuadro clínico puede ser inespecífico, lo cual puede representar un reto diagnóstico. De acuerdo con su etiología vascular, se requiere un enfoque terapéutico diferente. Si hay sospecha clínica o signos de peritonitis, el diagnóstico por imagen puede apoyar a identificar la patología presentada. En esta ocasión, se presenta caso clínico de una paciente de 84 años que acude al servicio de urgencias por dolor abdominal generalizado, que condujo a la realización de un estudio de imagen diagnóstico para confirmar tal hallazgo.

Abstract: Mesenteric thrombosis represents a vascular urgency caused by the abrupt interruption of blood flow, whether arterial or venous; clinical presentation can be nonspecific, which can represent a diagnostic challenge. According to its vascular etiology, a different therapeutic approach is required. If there is clinical suspicion or signs of peritonitis, the imaging diagnosis can support to identify the presented pathology. On this occasion, there is a clinical case of an 84-year-old patient who goes to the emergency department for generalized abdominal pain, which led to a diagnostic imaging study, to confirm this finding.

Allogenic mesenchymal stem cell intravenous infusion in reparation of mild intestinal ischemia/reperfusion injury in New Zealand rabbits / Infusão intravenosa de células tronco mesenquimais alógenas na reparação da lesão branda de isquemia/reperfusão intestinal em coelhos Nova Zelândia

The present study aimed to evaluate the efficacy of mesenchymal stem cell (MSC) infusion, derived from adipose tissue, on reduction of local and remote tissue damage caused by the event of experimental intestinal I/R in New Zealand breed rabbits. For obtaining, characterization, and cultivation of MSC derived from adipose tissue (MSC-Adp), 3 juvenile animals (four months old) were used. The cells were considered to be viable for therapy after the fourth passage (in vitro phase). For the in vivo stage, 24 young adult animals (six months old) were used, weighing approximately 3.5 kg, in which were randomly divided into two groups, called: IR treated with MSC (I2H/R5H MSC 3D; I2H/R5H MSC 7D); IR treated with PBS (I2H/R5H PBS 3D; I2H/R5H PBS 7D). The animals were anesthetized and submitted to pre-retro-umbilical midline celiotomy. The extramural peri-intestinal marginal artery was located and clamped (predetermined and standardized region) with the aid of a vascular clip, promoting a 2 hour blood flow interruption. After this period, blood flow was reestablished, inhalatory anesthesia was suspended, and the animals awaken. After 5 hours of reperfusion, the treatments were performed by intravenous infusion according to the experimental groups. The animals were evaluated 72 hours and seven days after the treatment as for the macroscopic appearance (color and peristaltism) of the jejunal segment, and by histological evaluation of the ischemic segment for the presence or absence of destruction of the intestinal mucosa, edema, bleeding, dilation of lymph vessels, and presence of polymorphonuclear inflammatory cells, both in the mucosa and submucosa. The observed results revealed that the groups treated with MSC-Adp obtained smaller mucosal and submucosal lesions when compared to the groups treated with PBS. Also, MSC-Adp treated groups obtained controlled inflammatory response and higher mitotic rate, outcomes related to the therapeutic potential of MSC. Infusion of stem cells attenuated the lesions caused by intestinal I/R in both MSC groups when compared to the group treated with PBS.(AU)

O presente estudo teve como principal objetivo avaliar a eficácia da infusão células tronco mesenquimais (CTM) derivada de tecido adiposo sobre diminuição das lesões teciduais locais e remotas, causadas pelo evento de I/R intestinal experimental, em coelhos da raça Nova Zelândia. Para obtenção, cultivo e caracterização das CTM provenientes de tecido adiposo (ADCTM) foram utilizados 3 animais jovens. As células foram consideradas viáveis para terapia a partir da quarta passagem (fase in vitro). Para etapa in vivo foram utilizados 24 animais, adulto-jovens, pesando aproximadamente 3,5kg, divididos aleatoriamente em dois grupos experimentais, denominados IR Tratado com CTM (I2H/R5H CTM 3D; I2H/R5H CTM 7D); IR Tratado PBS (I2H/R5H PBS 3D; I2H/R5H PBS 7D). Os animais foram anestesiados e submetidos à celiotomia mediana pré-retroumbilical. A artéria marginal peri-intestinal extramural foi localizada e clampeada (região predeterminada e padronizada) com auxílio de um clipe vascular, promovendo uma interrupção do fluxo sanguíneo durante 2 horas. Após esse período, o fluxo sanguíneo foi restabelecido, a anestesia inalatória suspendida e os animais despertados. Após 5 horas de reperfusão realizou-se os tratamentos por infusão endovenosa, conforme grupos experimentais. Os animais foram avaliados 72 horas e sete dias após o tratamento quanto ao aspecto macroscópico (coloração e peristaltismo) do segmento jejunal e por meio de avaliação histológica do segmento isquemiado quanto à presença ou ausência de destruição de mucosa intestinal, edema, hemorragia, dilatação de vasos linfáticos e presença de células inflamatórias polimorfornucleares, tanto em mucosa quanto submucosa. Os resultados observados revelaram que os grupos tratados com ADCTM obtiveram menores lesões em mucosa e submucosa quando comprados aos grupos tratados com PBS. Ainda os grupos tratados com ADCTM obtiveram resposta inflamatória controlada e maior taxa mitótica, resultados relacionados ao potencial terapêutico das CTM.(AU)

Portograma aéreo y neumatosis intestinal como hallazgos incidentales en postoperatorio de cirugía abdominal / Hepatic portal venous gas and pneumatosis intestinalis as incidental findings in post-surgical abdominal surgery

Portograma aéreo o portograma de aire (PA), se define como la presencia de aire en el sistema venoso portomesentérico. Neumatosis intestinal (NI) se define como la presencia de aire en la pared intestinal, independiente de su causa o localización. La principal etiología de estas alteraciones es la isquemia intestinal aguda y en general, se consideran predictores de perforación intestinal y de mal pronóstico. Un pequeño grupo de pacientes con PA y/o NI pueden evolucionar sin complicaciones e incluso cursan sin manifestaciones clínicas. Presentamos el caso de una paciente con antecedente quirúrgico inmediato de gastrectomía total y reconstrucción en Y de Roux, que evidenció en tomografía computarizada (TC) de abdomen de control PA y NI, sin alteraciones clínicas significativas asociadas.

Hepatic portal venous gas (HPVG) is defined as the presence of air in the portal venous system. Pneumatosis intestinalis (PI) is defined as the presence of air within the bowel wall, regardless of its cause or location. Its main etiology is the intestinal ischemia and are generally considered predictors of intestinal perforation and wrong prognosis. A small group of patients with HPVG and PI may have a different clinical course, without complications and clinical manifestations. We report the case of a patient with immediate surgical history of total gastrectomy and Roux-en-Y reconstruction, which showed in computed tomography (CT) of the abdomen HPVG and PI, without associated clinically significant changes.

Vólvulo primario de íleon: una rara forma de obstrucción intestinal en el adulto: reporte de caso y revisión de la literatura / Primary volvulus of ileum: A rare form of intestinal obstruction in the adult: case report and literature review

Resumen Antecedentes El vólvulo de intestino delgado se produce por el giro anormal del intestino delgado alrededor del eje de su propio mesenterio, lo cual puede generar obstrucción intestinal, isquemia, infarto o perforación. Caso clínico Paciente masculino de 71 años que cursó con abdomen agudo. Sospechando cuadro de oclusión intestinal, se realizó exploración quirúrgica en la que se encontró como hallazgos vólvulo de intestino delgado en la válvula ileocecal, con isquemia y necrosis de 280 cm de intestino delgado, por lo cual se realizó resección intestinal e ileostomía terminal, preservando 320 cm de intestino delgado viable desde ángulo duodeno-yeyunal. Cursó con una evolución satisfactoria. Discusión El vólvulo de intestino delgado es una entidad infrecuente y una urgencia quirúrgica que amenaza la vida. Se debe sospechar en todos los pacientes que presenten dolor abdominal abrupto y signos de obstrucción intestinal, sin cirugía abdominal previa ni otras causas obvias. El diagnóstico precoz y la intervención quirúrgica inmediata son factores clave asociados con un mejor pronóstico para este grupo de pacientes.

Background The small bowel volvulus is caused by the abnormal rotation of the small intestine around the axis of its own mesentery. This can lead to intestinal obstruction, ischemia, infarction or perforation. Clinical case A 71-year-old male patient with an acute abdominal pain, suspicious for a bowel occlusion, performed a surgical exploration, finding small bowel volvulus at the ileocecal valve level, with necrosis and ischemia of 280 cm of the small intestine, resulting in intestinal resection and terminal ileostomy. Still preserving 320 cm of viable small intestine from the duodenojejunal angle, with a satisfactory evolution. Discussion Small bowel volvulus is an uncommon entity, and a life-threatening surgical emergency, that should be suspected in all patients with abrupt abdominal pain and signs of bowel obstruction, without previous abdominal surgery or other obvious causes. Early diagnosis and immediate surgical intervention are key factors associated with a better prognosis for this group of patients.

[Disseminated peritoneal hydatidosis manifested as intestinal ischaemia]. / Hidatidosis peritoneal diseminada manifestada como isquemia intestinal.

BACKGROUND: The hydatid disease, or echinococcosis, is endemic in Mediterranean countries, as well as in Australia, Asia, Africa, South America, and Canada. Among its complications is intraperitoneal rupture, a rare form of presentation, with highly variable symptoms. The treatment of choice is surgery plus adjuvant medical treatment in most patients. OBJECTIVE: A case is presented of a patient with disseminated peritoneal hydatidosis manifested as intestinal ischaemia. CLINICAL CASE: A 50-year-old male was admitted to the emergency room with a history of chronic abdominal pain that worsened in the last 24hours. He showed signs of sepsis in the physical examination and was subjected to surgery, in which intestinal ischaemia was found due to a disseminated peritoneal cystic disease, which had led to mesentery retraction. An intestinal resection with an end-ileostomy was performed. The results of the biopsy of the cystic lesions was disseminated peritoneal echinococcosis. Medical treatment was started with albendazole and praziquantel. CONCLUSION: This case shows a rare presentation of disseminated peritoneal hydatidosis, which led to intestinal ischaemia.

Effects of Potentilla Fulgens as Prophylactic Agent in Intestinal Ischemia Reperfusion Injury / Efectos de Potentilla fulgens como Agente Profiláctico en la Lesión por Isquemia-Reperfusión Intestinal

The purpose of this study, ischemia reperfusion injury in rats, Potentilla fulgens is to investigate the protective effects. Wistar albino rats (n= 30) weighing 180-220 g were used in the experiment. Group 1 animals underwent sham laparotomy without ischemia-reperfusion injury. Group 2 animals underwent laparotomy and occlusion of superior mesenteric arteries for 30 min followed by 20 min of reperfusion without pretreatment. The Potentilla fulgens group received 400 mg/kg/day Potentilla fulgens intraperitoneally 5 days before Ischemia-reperfusion injury. There was a significant difference between the group with ischemia-reperfusion group Potentilla fulgens (p<0.0001). In statistical analysis of the MDA level, data were obtained after a respective measurement in all groups. Potentilla fulgens group with ischemia-reperfusion group was a significant decrease in MDA (p<0.001). In the period after ischemia-reperfusion, marked PCNA immunoreactivities were observed in the nuclei of crypt and villus cell. In ischemia reperfusion group, the number of PCNA immunoreactivity is quite advanced and they extended throughout the middle part of the intestine folds. The number of TUNEL-positive nuclei were also developed. In ischemia-reperfusion plus P. fulgens group, the intestinal epithelium with only a few PCNA immunoreactive nuclei. TUNEL positive nuclei were noted in the gut lumen and mucosal close differentiated goblet cells. We showed that Potentilla fulgens extract significantly prevented mucosal lesions caused by intestinal ischemia-reperfusion.

El objetivo fue investigar los efectos protectores de Potentilla fulgens sobre la lesión por isquemia-reperfusión en ratas albinas Wistar (n= 30) con un peso de 180 g. En el grupo 1, los animales fueron sometidos a laparotomía simulada sin lesión por isquemia-reperfusión. En el Grupo 2, los animales fueron sometidos a laparotomía y oclusión de las arteria mesentérica superior durante 30 min seguido de 20 min de reperfusión sin pretratamiento. El grupo Potentilla fulgens recibió 400 mg/kg/día de P. fulgens por vía intraperitoneal 5 días antes de la lesión por isquemia-reperfusión. Hubo diferencias significativas entre el grupo de grupo con isquemia-reperfusión y el tratado con Potentilla fulgens (p<0,0001). En el análisis estadístico del nivel de malondialdehído (MDA), los datos se obtuvieron después de una medición respectiva en todos los grupos. Los grupos Potentilla fulgens y con isquemia-reperfusión tuvieron una disminución significativade MDA (p<0,0001). En el periodo después de la isquemia-reperfusión, se observó inmunorreactividad del marcador PCNA en los núcleos de las células de las criptas y vellosidades. En el grupo de isquemia-reperfusión, la inmunoreactividad a PCNA fue bastante avanzada y se extendió a lo largo de la parte media de los plieges intestinales. También aumentó el número de núcleos positivos a TUNEL. En el grupo isquemia-reperfusión tratado con P. fulgens, el epitelio intestinal mostró pocos núcleos inmunorreactivos a PCNA; núcleos positivos a TUNEL se observaron en el lumen intestinal y la mucosa, cerca de las células caliciformes diferenciadas. Demostramos que el extracto de P. fulgens disminuye significativamente lesiones de la mucosa intestinal causadas por la isquemia-reperfusión.

Isquemia intestinal, reconocimiento y manejo / Intestinal ischemia, diagnosis and treatment

Intestinal ischemia remains a high risk mortality disease. Early detection has a huge impact in survival. The development of new biochemical markers will be useful in ischemia screening. Computed tomography (CT) scan and AngioTC, has a great value to assess viability of small bowel areas. Basic treatment and even surgery have the best results in early diagnosis setting.

La isquemia intestinal continúa siendo una patología de alto riesgo de mortalidad. El reconocimiento clínico precoz tiene impacto en la sobrevida. Se están desarrollando nuevos marcadores bioquímicos para optimizar la pesquisa de isquemia. En estos casos, la tomografía computada (TC) multicorte y angioTC, son de gran utilidad para establecer la viabilidad de un segmento y la probabilidad de resección. En tratamiento general y quirúrgico si corresponde, tiene mejores resultados en escenarios de diagnóstico precoz.

[Procalcitonin as a marker of intra-abdominal infection]. / La procalcitonina como marcador de infección intraabdominal.

BACKGROUND: Procalcitonin is a quite specific biomarker of infection and in recent years has shown its superiority to others markers of inflammation, such as C-reactive protein, for the diagnosis and monitoring of a variety of infections. AIM: For this reason, several researchers have studied the potential role of procalcitonin for diagnosis and management of these infections. DISCUSSION: Intra-abdominal infections are a heterogeneous group of infections that, sometimes, pose difficult challenges to physicians. The published studies have produced mixed results, leading to controversy on the utility of this marker in intra-abdominal infections. CONCLUSIONS: This review summarizes these data and discuss the utility of procalcitonin in several intra abdominal infections, including postoperative infections.

Antecedentes: la procalcitonina es un marcador bastante específico de infección y en los últimos años se ha demostrado su superioridad, con respecto a otros marcadores de inflamación como la proteína C reactiva, para el diagnóstico y vigilancia de una gran variedad de infecciones. Objetivo: resumir los datos actualmente existentes y discutir la utilidad de la procalcitonina en diversas infecciones intrabdominales, incluidas las postoperatorias. Conclusiones: los resultados de estudios hasta ahora publicados son variables, lo que genera controversia en relación con su utilidad.

Isquemia intestinal / Intestinal ischemia

La isquemia intestinal está considerada como la causa más letal del síndrome de abdomen agudo; su consecuencia, el infarto del intestino delgado, ocurre por fenómenos tromboembólicos e isquemia no oclusiva. El objetivo del presente artículo es proporcionar una revisión bibliográfica actualizada acerca del tema y facilitar la actuación del cirujano ante este problema de salud de repercusión sistémica y que no es tan infrecuente como se piensa(AU)

The intestinal ischemia is considered as the most lethal cause in the acute abdomen syndrome; its consequence, the small intestine infarction, takes place due to thromboembolic phenomena and non occlusive ischemia. The objective of the present work is to provide an updated literature review about the topic and to facilitate the surgeon's performance in front of this health problem of systemic repercussion which is not as uncommon as it is thought(AU)

Isquemia intestinal / Intestinal ischemia

La isquemia intestinal está considerada como la causa más letal del síndrome de abdomen agudo; su consecuencia, el infarto del intestino delgado, ocurre por fenómenos tromboembólicos e isquemia no oclusiva. El objetivo del presente artículo es proporcionar una revisión bibliográfica actualizada acerca del tema y facilitar la actuación del cirujano ante este problema de salud de repercusión sistémica y que no es tan infrecuente como se piensa.

The intestinal ischemia is considered as the most lethal cause in the acute abdomen syndrome; its consequence, the small intestine infarction, takes place due to thromboembolic phenomena and non occlusive ischemia. The objective of the present work is to provide an updated literature review about the topic and to facilitate the surgeon's performance in front of this health problem of systemic repercussion which is not as uncommon as it is thought.

Vólvulo de ciego con compromiso vascular. Presentación de un caso / Volvulus of cecum with vascular compromise. A case report

El vólvulo del ciego es una condición clínica infrecuente y representa solamente el 1% de los casos de oclusión intestinal en el adulto. Los pacientes con esta entidad usualmente presentan un cuadro clínico de dolor abdominal intermitente, vómitos y no expulsión de heces por el recto. Se muestra el caso clínico de una paciente intervenida quirúrgicamente por un síndrome oclusivo, donde se comprobó un vólvulo del ciego con compromiso vascular. El objetivo de esta revisión es describir las características clínicas de la enfermedad, discutir las causas, así como las estrategias de tratamiento ante esta difícil situación.

The volvulus of cecum is a clinical rare condition and represents only 1% of the cases of intestinal occlusion in adults. Usually, patients suffering from this condition, present a clinical chart of intermittent abdominal pain, vomits and non-excretion of feces from the rectum. The clinical case of a patient who underwent a surgery due to an occlusive syndrome is presented, where a volvulus of cecum with vascular compromise was identified. This medical literature review was aimed at describing the clinical characteristics of this condition analyzing causes and treatment strategies regarding this complex situation as well.

Isquemia mesentérica aguda: evaluación con tomografía computada multidetector / Acute mesenteric ischemia: evaluation with multidetector computed tomography

Acute mesenteric ischemia encompasses a group of diseases with a high morbidity and mortality. Surgical treatment is frequently delayed due to difficulties in making a prompt clinical diagnosis. Mutislice computed tomography has emerged as a useful tool in the detection of intestinal ischemia and the spectrum of vascular pathology that produce it. The physiopathologic basis of intestinal ischemic damage, the spectrum of bowel, peritoneal and vascular findings as well as optimization of the computed tomography technique are discussed.

Las distintas variantes de isquemia mesentérica aguda constituyen un grupo de patologías con alta morbimortalidad. Suelen ser de difícil diagnóstico clínico, lo que frecuentemente deriva en un retraso en el tratamiento quirúrgico. La tomografía computada mutidetector ha surgido como una herramienta de gran utilidad en la detección de la isquemia intestinal y de la patología vascular causal. Se discute la fisiopatología del daño isquémico mesentérico, el espectro de alteraciones posibles del intestino delgado, peritoneo y vasculatura abdominal según la etiología, y se revisarán los parámetros para optimizar el estudio tomográfico en la evaluación de esta patología.