RESUMEN
BACKGROUND: The prevalence of morbid obesity is increasing steadily among women of reproductive age. In addition to the well-known comorbidities of the disease, it has been shown that the pregnancy outcome for obese women is worse than for women with a normal body mass index. This study aimed to evaluate the pregnancy and perinatal outcomes for women who underwent laparoscopic adjustable gastric banding (LAGB) because of morbid obesity. METHODS: This prospective, population-based study was conducted in a general surgery clinic of a tertiary hospital serving as a referral center for bariatric operations. All the patients underwent LAGB by the pars flaccida technique. A database containing information regarding age, pre- and postoperative weight and body mass index, weight gain, and LAGB-related or -unrelated complications during pregnancy was constructed for all women of childbearing age who underwent LAGB. A questionnaire was designed to provide perinatal data concerning both mother and neonate. RESULTS: The 74 women enrolled in this study had 81 single tone pregnancies. Their body mass index decreased significantly after LAGB, from 43.3 +/- 5.8 to 30.3 +/- 3 kg/m2 at conception (p < 0.0001). The average time to the first live birth after surgery was 27 +/- 3 months. Band slippage was diagnosed and treated laparoscopically in two patients (2.4%). Weight gain during pregnancy was 10.6 +/- 2.1 kg. The rates of pregnancy-induced hypertension and gestational diabetes were 7.4% and 16% of all pregnancies, respectively. In 17 cases (20%), cesarean section was performed. Delivery occurred after 39.1 weeks of gestation. The mean birth weight was 3.09 +/- 0.5 kg. Major congenital anomalies, postnatal hypoglycemia, symptomatic polycythemia or neonatal death were not recorded. CONCLUSIONS: The findings show that LAGB is safe for both mother and newborn during gestation and delivery.
Asunto(s)
Gastroplastia , Laparoscopía , Obesidad Mórbida/cirugía , Embarazo , Aumento de Peso , Femenino , Humanos , Recién Nacido , Complicaciones del Embarazo , Resultado del EmbarazoRESUMEN
BACKGROUND: Laparoscopic adjustable gastric banding is a safe and effective procedure for the management of morbid obesity. However, band slippage is a common complication with variable presentation that can be rectified by a second laparoscopic procedure. METHODS: We studied case series of 125 consecutive patients who suffered from band slippage between November 1996 and May 2001 from a group of 1,480 laparoscopic adjustable gastric banding procedures performed during this time. The decision of whether to remove or replace/reposition the band was made prior to the operation, although the specific method used when replacement or repositioning was deemed suitable was determined by the operative findings. A laparoscopic approach was used in all but three patients. RESULTS: A total of 125 patients (8.4%) suffered band slippage (posterior slippage, 82.4%; anterior slippage, 17.6%). In 70 patients (56%), the band was removed, whereas in 55 patients (44%) it was repositioned or replaced immediately. Of these 55 patients, six underwent later removal, five due to recurrent slippage and one due to erosion. Fourteen patients suffered complications, including gastric perforation (n = 8), intraoperative bleeding (n = 1), postoperative fever (n = 3), aspiration pneumonia (n = 1), upper gastrointestinal bleeding (n = 1), and pulmonary embolism (n = 1). CONCLUSION: Band slippage is not a rare complication after laparoscopic adjustable gastric banding. The decision to remove or replace the band or convert to another bariatric procedure should be made preoperatively, taking both patient preference and etiology into consideration. Short-term results indicate that band salvage is successful when the patient population is chosen correctly.
Asunto(s)
Gastroplastia/efectos adversos , Adulto , Gastroplastia/métodos , Humanos , Laparoscopía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/terapia , ReoperaciónRESUMEN
OBJECTIVE: Enhanced red blood cell (RBC) aggregation has an adverse effect on microcirculatory blood flow and tissue oxygenation. It has been previously shown that obesity is associated with increased RBC aggregation. The objectives of the present study were to further characterize obesity-related RBC aggregation and to examine whether the enhanced aggregation is a plasma- or cellular-dependent process. METHODS: Obese (body mass index (BMI)=40+/-6.3 kg/m2, n=22) and nonobese (BMI=24+/-3.4 kg/m2, n=18) individuals were evaluated for inflammation markers and aggregation parameters. Aggregation parameters were derived from the distribution of RBC population into aggregate sizes, and from the variation of the distribution as a function of flow-derived shear stress, using a cell flow properties analyzer. To differentiate plasmatic from cellular factors, we determined the aggregation in the presence of autologous plasma or dextran-500 kDa and calculated the plasma factor (PF) in the obese group. PF ranges from 0 to 1. When the PF=1, the aggregation is all due to plasmatic factors, when PF=0, the altered aggregation depends entirely on cellular factors, whereas 0Asunto(s)
Agregación Eritrocitaria
, Obesidad Mórbida/sangre
, Adulto
, Antropometría
, Índice de Masa Corporal
, Femenino
, Hemorreología
, Humanos
, Mediadores de Inflamación/sangre
, Masculino
, Persona de Mediana Edad
, Obesidad Mórbida/patología
, Estrés Mecánico
RESUMEN
BACKGROUND: Since the 1980s, bypass operations have been largely replaced by gastric restrictive operations. One of the most commonly performed operations for gastric restriction is vertical banded gastroplasty (VBG). However, the results are often disappointing. Adjustable gastric banding (AGB) is a viable alternative to VBG, and the ability to perform this surgery laparoscopically makes it an attractive option for patients in need of revisional surgery. It allows for refashioning of the gastric pouch in patients with a dilation of the pouch or disruption of the staple line. METHODS: A total of 48 patients were referred to our center due to post-VBG weight gain. All patients underwent preoperative evaluation to determine the cause for failure of the operation. All patients found suitable for revisional surgery underwent laparoscopic placement of an adjustable band. RESULTS: All but one of the operations were completed laparoscopically; one patient required conversion to open surgery prior to band placement via laparoscopy. This patient needed a blood transfusion. Postoperative band erosion occurred in one patient; laparoscopy surgery was used successfully for removal of the band and suturing of the stomach. CONCLUSIONS: Our short-term results indicate that revisional operation for morbid obesity using laparoscopic AGB is a safe procedure when performed cautiously. It enables early patient mobilization and discharge with good functional results and fewer perioperative complications.
Asunto(s)
Gastroplastia/métodos , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/cirugía , Adulto , Índice de Masa Corporal , Falla de Equipo , Estudios de Factibilidad , Femenino , Gastroplastia/instrumentación , Humanos , Laparotomía , Masculino , Recurrencia , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento , Aumento de PesoRESUMEN
BACKGROUND: Morbid obesity is effectively treated by restrictive surgery. A severe complication associated with gastric banding is gastric erosion. We review here our experience over a 5-year period. METHODS: A total of 1496 patients underwent gastric banding. Eighty-five percent of patients were available for follow-up. When band erosion was diagnosed, laparoscopic removal was performed. RESULTS: Band erosion was identified in 17 patients (1.13%). The time from primary operation to diagnosis of band erosion ranged from 3 weeks to 45 months (mean, 19 months). Clinical manifestations included weight gain in 2 (11.6%), band system leak in 1 (5.8%), chronic port-cutaneous fistula in 2 (11.6%), neglected peritonitis in 1 (5.8%), left subphrenic abscess in 2 (11.6%), but most commonly, protracted port-site infection that occurred in 7 patients (40.6%). CONCLUSIONS: Patients were effectively treated by band removal and suturing of the stomach wall. We suggest that different pathologies contribute to the same complication depending upon the time of presentation. We recommend a high index of suspicion in order to diagnose this life-threatening complication.
Asunto(s)
Gastroplastia/instrumentación , Gastroplastia/métodos , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Adulto , Remoción de Dispositivos/métodos , Equipos Desechables/normas , Falla de Equipo , Reacción a Cuerpo Extraño , Gastroplastia/efectos adversos , Humanos , Laparoscopía/efectos adversos , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Siliconas/efectos adversos , Siliconas/metabolismo , Equipo Quirúrgico/efectos adversosRESUMEN
BACKGROUND: Laparoscopic adjustable silicone gastric banding (LASGB) was used as the initial bariatric procedure for more than 36 months. The efficacy and safety of LASGB were studied. METHODS: Patients were followed up prospectively in a multidisciplinary center for the perioperative and long-term courses, and for complications. RESULTS: Between November 1996 and May 1999, 715 patients underwent surgery. The mean age was 34.6 years (range, 16-72) years, and the mean body mass index (BMI) was 43.1 kg/m2 (range, 35-66 kg/m2). The mean operative time was 78 min (range, 36-165 min), and the postoperative hospitalization time was 1.2 days (range, 1-8 days). There were six intraoperative complications (0.8%), eight early postoperative complications (1.1%), and no deaths. For follow-up evaluation, 614 patients (86%) were available. Late complications included band slippage or pouch dilation in 53 patients (7.4%), band erosion in 3 patients, and port complications in 18 patients. In 57(7.9%) patients, 69 major reoperations were performed. In patients with a follow-up period longer than 24 months, the average BMI dropped from 43.3 kg/m2 (range, 35-66 kg/m2) to 32.1 kg/m2 (range, 21-45 kg/m2). CONCLUSION: Laparoscopic adjustable silicone gastric banding is safe, with a lower complication rate than any other bariatric procedure. Most reoperations can be performed laparoscopically with low morbidity and short hospitalizations. On the basis of intermediate-term follow-up evaluation, it is an effective procedure for weight-reducing purposes.
Asunto(s)
Gastroplastia/métodos , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/cirugía , Adolescente , Adulto , Anciano , Índice de Masa Corporal , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Periodo Posoperatorio , Estudios Prospectivos , ReoperaciónRESUMEN
BACKGROUND: Laparoscopic adjustable silicone gastric banding (LASGB) is the bariatric operation of choice in our institution for most morbidly obese patients. The advantage of LASGB is a minimally invasive procedure, with low systemic and operative complication rates. However this procedure is not free from significant postoperative problems that may arise at a later stage. PATIENTS AND METHODS: 950 patients underwent LASGB between November 1996 and May 2000, with a median follow-up of 21 months. 3 patients (0.31%), developed band erosion 6 to 8 months following the original procedure. Laparoscopic band removal was attempted in all 3 patients. The charts of all patients were reviewed for the postoperative course of the original operation as well as the removal of the band. RESULTS: 2 patients presented with abscess formation at the port site, and 1 patient suffered from a gastric fistula at the port site 6 months following surgery. In all patients the immediate postoperative course was not smooth; 2 patients developed a subphrenic collection drained percutaneously, and one patient had fever, treated empirically with intravenous antibiotics. In all 3 patients, no leak was demonstrated by CT and barium meal. The diagnosis of band erosion was confirmed by gastroscopy, which demonstrated part of the band eroding through the gastric wall. All patients were operated laparoscopically. The band was removed and the gastric wall was sutured. The postoperative course was uneventful and patients left the hospital within 3 days. CONCLUSION: LapBand erosion following LASGB is very rare and may occur months following the operation. The postoperative course suggests that the erosion is the consequence of a minute stomach wall injury during the primary operation. Diagnosis is essential and the treatment of choice is laparoscopic band removal with suturing of the stomach wall. It is possible that a minute injury to the gastric wall during the initial procedure is the underlying cause of this complication.
Asunto(s)
Mucosa Gástrica/lesiones , Gastroplastia/efectos adversos , Gastroplastia/métodos , Gastroscopía/efectos adversos , Gastroscopía/métodos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Reoperación/métodos , Adulto , Índice de Masa Corporal , Falla de Equipo , Femenino , Estudios de Seguimiento , Gastroplastia/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/diagnóstico , Siliconas , Técnicas de Sutura , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: The routine cutoff age of surgery for morbid obesity is 55 years. A minimally invasive surgical approach, however, may enable its safe use in older individuals. METHODS: Laparoscopic adjustable silicon gastric banding (LASGB) was performed in 18 patients 60 years or older. The perioperative course, early and late complications, and long-term follow-up all were recorded. RESULTS: Of 398 patients who underwent LASBG until November 1998 (mean age, 38.1 years), 18 were 60 years or older (mean, 63.6 years). The mean body mass index (BMI) was 44.4 (range, 35-64.7). There were no intraoperative complications. However, four patients had late complications requiring reoperation. The mean operative time was 65 min; the mean hospital stay was 1.3 days; and the mean follow-up period was 21.9 months. The BMI dropped from 44.2 to 30.5, and all comorbid conditions improved markedly: Diabetes mellitus resolved in 71% of the patients, hypertension in 33%, and sleep apnea in 100%. CONCLUSION: According to the findings from this study, LASGB is feasible, safe, and effective in the elderly, and most benefit from resolution or marked improvement of comorbid conditions.
Asunto(s)
Gastroplastia/métodos , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Factores de Edad , Anciano , Índice de Masa Corporal , Enfermedad Crónica , Femenino , Humanos , Israel , Masculino , Persona de Mediana Edad , Obesidad Mórbida/diagnóstico , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Siliconas , Resultado del Tratamiento , Pérdida de PesoRESUMEN
We performed a laparoscopic splenectomy (LS) in 60 patients (age 9-83, 45 females) with idiopathic thrombocytopenic purpura (ITP) who did not achieve sustained remission on steroid therapy. Using a modified procedure, the mean duration of LS was 78 min (range 25-240 min) and surgery was associated with only 5% major and 5% minor complications. Ten patients had a platelet count less than 50 x 10(9)/l during surgery despite the administration of immune globulin (0.4 g/kg x 3-5 days) or pulsed oral dexamethasone (40 mg/day x 4 days). Three patients were refractory to these therapies and underwent LS with a platelet count less than 5 x 10(9)/l. Bleeding complications during or after surgery were rare (5%). Accessory spleens were removed in eight patients. Convalescence was rapid and the mean hospital stay was 2.3 days (range 1-7 days). The patients were followed for a mean of 16 months (range 1-36 months), and 49 patients (84%) are in complete remission. Seven patients (12.5%) relapsed despite an initial good response in 6 of them. Two patients underwent laparoscopic removal of accessory spleens with excellent response. We conclude that LS for ITP is safe and effective and associated with low morbidity and fast recovery. Thus, LS may be considered earlier in the course of ITP.
Asunto(s)
Laparoscopía , Púrpura Trombocitopénica Idiopática/cirugía , Esplenectomía/métodos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Dexametasona/uso terapéutico , Transfusión de Eritrocitos , Femenino , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Masculino , Persona de Mediana Edad , Recuento de Plaquetas , RecurrenciaRESUMEN
BACKGROUND: The management of extensive, recurrent limb desmoid tumors is extremely difficult. The failure of multimodality treatments, such as repeated resections, radiotherapy, systemic chemotherapy, or endocrine manipulations, can end up with multilating surgery or even amputation, similar problems sometimes encountered in soft tissue sarcoma of the limbs. The high rate of limb salvage achieved by isolated limb perfusion (ILP) with tumor necrosis factor (TNF) and melphalan for extensive, high-grade soft tissue sarcoma led us to implement this modality in difficult cases of limb desmoids. METHODS: During a 4-year period, 6 patients aged 14 to 52 years were treated. All were significantly symptomatic and candidates for amputation or mutilating surgery. Five had lower and one had upper limb lesions. Two had multifocal disease. At ILP, 3 to 4 mg TNF and 1 to 1.5 mg/kg melphalan were delivered during a 90-minute period. One patient had a double perfusion. All patients underwent definitive resective operation 6 to 8 weeks after perfusion. RESULTS: No systemic complications were observed, and local complications included reversible skin redness and blisters. Response rate was 83% with 33% (2 of 6) complete response and 50% (3 of 6) partial response. In 1 patient less than 50% regression was observed. Limb salvage rate was 100%; even the patient with stabilization of disease could be locally resected. Local recurrence during a follow-up period of 7 to 55 months (median 45 months) occurred in 2 patients at 8 and 24 months, respectively; the first underwent amputation, whereas for the second a wide excision was possible. CONCLUSIONS: ILP with TNF and melphalan can be used as a limb preservation modality in patients with recurrent desmoids and significant symptoms who would otherwise require multilating surgery to control their neoplasm.
Asunto(s)
Antineoplásicos Alquilantes/administración & dosificación , Extremidades , Fibromatosis Agresiva/tratamiento farmacológico , Melfalán/administración & dosificación , Factor de Necrosis Tumoral alfa/administración & dosificación , Adolescente , Adulto , Antineoplásicos Alquilantes/uso terapéutico , Quimioterapia Combinada , Extremidades/irrigación sanguínea , Femenino , Fibromatosis Agresiva/patología , Humanos , Masculino , Melfalán/uso terapéutico , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Perfusión , Proteínas Recombinantes/administración & dosificación , Proteínas Recombinantes/uso terapéutico , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/uso terapéuticoRESUMEN
BACKGROUND: Laparoscopic adjustable silicone gastric banding (LASGB) has been performed as the initial procedure for weight reduction in the authors' institution for the past 22 months. The efficacy and safety of the procedure were studied. METHODS: Patients were followed up prospectively during the perioperative and long-term course and for complications. RESULTS: 391 patients, aged 16-72 years, with a mean body mass index (BMI) of 43.1 (range 33-66) were operated on. The laparoscopic procedure was completed in all but four. The mean operative time was 78 min (range 36-165), and the mean postoperative hospital stay was 1.2 days (range 1-8). There were four (1%) intraoperative complications: pneumothorax in one patient, bleeding in two patients, and injury to the stomach in one. Early postoperative complications were subphrenic abscess in two patients and band malposition in five. Of the patients operated on, 356 (91%) were available for follow-up. Over an average follow-up period of 13 months (range 1-22), band slippage occurred in 16 patients (4.1%), resistant port infection in 1, and longstanding pain in the port area in 9. There were 2 cases of port migration. A total of 26 (6.4%) reoperations were performed: early band repositioning (5), bleeding port site (1), late band repositioning (13), band removal (5), and local relocation of the port (2). All abdominal operations were performed laparoscopically. During the 18-month follow-up, the average BMI dropped from 43.1 to 29.8. CONCLUSION: LASGB is a safe procedure, with low early complication rates. Most reoperations may be performed laparoscopically, with subsequent low morbidity and short hospitalizations. On intermediate-term follow-up itseems to be an effective bariatric procedure.
Asunto(s)
Gastroplastia/efectos adversos , Gastroplastia/métodos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Obesidad Mórbida/cirugía , Adolescente , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Reoperación/estadística & datos numéricos , Resultado del Tratamiento , Pérdida de PesoRESUMEN
BACKGROUND AND OBJECTIVES: The prognosis for recurrent multifocal limb soft tissue sarcoma (STS) is dismal due to systemic spread. However, many of these patients undergo amputation due to ineffective local control. The purpose of the present study was to determine whether isolated limb perfusion (ILP) with tumor necrosis factor (TNF) and melphalan permits limb salvage and palliation for such patients. METHODS: Of 53 STS patients treated with hyperthermic ILP with TNF (3-4 mg) and melphalan (1-1.5 mg/kg), 13 (25%) had multifocal STS and were candidates for amputation. RESULTS: The overall response rate was 92% (12/13) with 38% complete response and 54% partial response. Two patients died during the early postoperative period. Limb salvage was achieved in 85% of patients. One patient (8%) had only stable disease and underwent amputation. Local recurrence occurred in 38% but did not result in amputation. CONCLUSIONS: Although the number of patients in this study is too small to allow definitive conclusions, it seems that ILP/TNF offer limb salvage and palliation for recurrent multifocal STS patients.
Asunto(s)
Antineoplásicos Alquilantes/administración & dosificación , Quimioterapia del Cáncer por Perfusión Regional , Hipertermia Inducida , Melfalán/administración & dosificación , Sarcoma/terapia , Neoplasias de los Tejidos Blandos/terapia , Factor de Necrosis Tumoral alfa/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Terapia Combinada , Quimioterapia Combinada , Extremidades , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
BACKGROUND: Although the classic form of Kaposi sarcoma is considered indolent and benign, at times its evolution is more severe, with an acute onset and debilitating complications necessitating aggressive treatment and even amputation. OBJECTIVE: To evaluate the efficacy of hyperthermic isolated limb perfusion (ILP) with tumor necrosis factor alpha and melphalan as a limb-sparing modality for extensive regional Kaposi sarcoma. SETTING: University hospital and national referral center. PATIENTS: Five patients, aged 60 to 82 years, with extensive, symptomatic, classic Kaposi sarcoma of the lower limb were operated on. All were candidates for amputation owing to debilitating symptoms. INTERVENTIONS: Patients underwent ILP through the iliac (n = 2), femoral (n = 2), and popliteal (n = 1) vessels. Tumor necrosis factor alpha, 4 mg, and melphalan, 1.5 mg/kg body weight, were perfused for an overall time of 90 minutes. The limb was heated to 40 degrees C. Clinical and pathological responses were recorded for all patients after 6 to 8 weeks. RESULTS: The overall response rate was 100%: 1 of 5 patients had complete response and 4 of 5 had partial response. Two patients had progression of disease 2 months after ILP but one of them was asymptomatic and did not require any further treatment. The second patient underwent amputation. Thus, limb preservation was achieved in 80% (4 of 5 patients). Median follow-up was 24 months. There were no deaths associated with treatment or major system complications. Local complications were all reversible. CONCLUSION: These findings suggest that hyperthermic ILP with tumor necrosis factor alpha and melphalan can be considered an effective palliative and limb-sparing treatment modality for extensive Kaposi sarcoma.
Asunto(s)
Antineoplásicos Alquilantes/administración & dosificación , Pierna , Melfalán/administración & dosificación , Sarcoma de Kaposi/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/administración & dosificación , Anciano , Anciano de 80 o más Años , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , PerfusiónRESUMEN
Soft tissue sarcomas are exceedingly rare, making up less than 1% of all solid malignancies. In the retroperitoneum, they tend to be large when diagnosed and are a therapeutic challenge to the surgical oncologist. Our experience with 51 patients with retroperitoneal sarcomas operated on during the past 4 years is presented. 37 were primary and 26 presented as recurrent tumors. The group included many different histological subtypes, the majority being high grade tumors. Complete resection was achieved in 84%, necessitating extensive surgery, but was not possible in 8 patients (16%) who underwent partial resection or biopsy only. There was 1 perioperative fatality (2%). 18 (35%) suffered complications, all of which were reversible. The estimated 5-year survival in the complete resection group is 40%, while none of those who underwent partial resection survived more than 2 years. There was significantly better survival in patients with primary, low grade sarcomas which were smaller than 8 cm, compared to those with high-grade, recurrent sarcomas larger than 8 cm. Local recurrence developed in 8 patients of the complete resection group (18%), 2 months to 3 years after surgery. These data show that despite the concept of retroperitoneal sarcomas as being aggressive, invasive tumors with a poor prognosis, the prognosis is not unusually bad. With proper surgical technique, resectability may be high, with improved overall survival.
Asunto(s)
Neoplasias Retroperitoneales/cirugía , Sarcoma/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Reoperación , Neoplasias Retroperitoneales/mortalidad , Estudios Retrospectivos , Sarcoma/mortalidad , Tasa de SupervivenciaRESUMEN
Three young patients suffering from inflammatory bowel disease were admitted to our hospital during the past year for extensive intestinal rupture caused by disproportionately minor trauma. There was almost no concomitant intra-abdominal injury. We believe that a minimal direct or acceleration/deceleration trauma to a preexisting diseased intestine might have caused extensive damage that was not apparent on admission. It was concluded that these patients should be carefully monitored and that their relative intestinal vulnerability should be borne in mind during diagnosis of and therapeutic planning for their condition.