RESUMEN
BACKGROUND Gastroesophageal reflux disease (GERD) is a common condition that may be refractory to medical treatment with proton pump inhibitors (PPIs). Laparoscopic Nissen fundoplication is the recommended surgical treatment for GERD and is safe and effective. This report is of a rare case of internal gastroduodenal hernia as a late complication of laparoscopic Nissen fundoplication for the management of GERD in a 19-year-old woman. CASE REPORT A 19-year-old woman was admitted to the emergency department with a three-day history of epigastric pain, anorexia, and altered bowel habit. She had a history of GERD that was treated two years previously by laparoscopic Nissen fundoplication. On the most recent hospital admission, abdominal computed tomography (CT) showed an internal hernia of the gastroduodenal junction through the tissues used as a fundoplication wrap of the abdominal esophagus. The imaging findings were confirmed at exploratory laparoscopy, at which time surgical takedown of the fundoplication was performed. CONCLUSIONS This report is of a rare case of gastroduodenal hernia through a fundoplication wrap two years after a Nissen fundoplication. However, clinicians should be aware of this rare diagnosis in patients with a history of Nissen fundoplication who present with acute upper gastrointestinal symptoms.
Asunto(s)
Fundoplicación/efectos adversos , Reflujo Gastroesofágico/cirugía , Hernia/etiología , Herniorrafia , Enfermedades Intestinales/cirugía , Complicaciones Posoperatorias/cirugía , Gastropatías/cirugía , Femenino , Humanos , Laparoscopía/efectos adversos , Adulto JovenRESUMEN
BACKGROUND: The problem of managing adhesional small bowel obstruction (ASBO) is still unsolved. A conservative medical attitude is privileged even if it is associated to a high rate of recurrences, while surgery is applied to cases showing no improvement after 48-72 h. Adhesiolysis via laparotomy has been the standard surgical management, but it causes other adhesions in a vicious circle. The aim of the study is to evaluate the advantages of early laparoscopic adhesiolysis as an alternative approach. METHODS: From January 2010 to April 2017, 107 patients were admitted with a diagnosis of ASBO. Patients underwent medical treatment, early surgery, emergency surgery or delayed surgery after failure of medical treatment. A retrospective review and explorative statistical analysis were performed using graphical diagnostic plots, Mann-Whitney (MW) test, Kolmogorov-Smirnov (KS) test, exact binomial test, and χ 2 test. RESULTS: Medical treatment led to resolution in the 77.3% of cases, but patients exhibit much more recurrences than those in the surgical group (χ 2 p < .001). They also show a longer fasting time (MW p = .027; KS p = .102), a doubled number of radiological exams (MW p < .001; KS p < .001), and more major complications than those in the early surgery group. Early surgery group is associated to shorter fasting time (MW p < .001; KS p < .001), much shorter hospital stay (MW p < .001; KS p = .002) and a smaller number of radiological exams (MW p = .005; KS p = .002) compared with delayed surgery group. The laparoscopic group shows significantly earlier regain of intestinal transit (MW p < .001; KS p = .002), shorter fasting time (MW p = .002; KS p = .008), reduced number of radiological exams (MW p = .003; KS p = .014), reduced hospital stay (MW p < .001; KS p = .005), and no more complications than the open surgery group. CONCLUSIONS: Early laparoscopic surgery can be proposed as an effective alternative treatment for ASBO.
Asunto(s)
Obstrucción Intestinal/cirugía , Intestino Delgado/cirugía , Laparoscopía/métodos , Adherencias Tisulares/cirugía , Femenino , Humanos , Obstrucción Intestinal/etiología , Tiempo de Internación , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Tiempo , Adherencias Tisulares/complicaciones , Resultado del TratamientoRESUMEN
Background Chronic Kidney disease is a major health problem in the world. Native arteriovenous Fistula (AVF) is well established as the best vascular access for haemodialysis. Little is known about the outcome of AVF in sub-Saharan Africa. We aim to analyze the outcome of patients undergoing AVF creation during the pilot program established at the Douala general hospital (DGH). Method This was hospital-based, longitudinal study with a retrospective phase (April 2010-January 2014) and a prospective phase (January 2014-April 2014). All consecutive patients operated for AVF creation were included in this study. Socio-demographics data, functionality, and complications were analyzed. Results Eighty-one patients including 52 men were enrolled in this study (49 prospectively and 32 retrospectively). The mean age was 52, 3 years (range 18-81 years). Hypertension (66, 7%), diabetes (17, 3%), and HIV (8, 6%) were the most observed co-morbidities. About 96.3% of AVF were native and 3.7% were prosthetic graft. Radiocephalic AVF was performed at a rate of 77.8%. The primary function rate was 97.7% and the mean follow-up period 43.4 weeks. The overall rate of complications was 44.4% of whom 30.5% were early, 30.5% secondary, and 39% lasted. The treatment of these complications was conservative in 48.7% of cases. Conclusions The results of the pilot program of AVF creation at the DGH are encouraging. However, the sustainability of this project requires human capacity building.
Asunto(s)
Catéteres de Permanencia , Fallo Renal Crónico/terapia , Diálisis Peritoneal/métodos , Diálisis Renal/métodos , Dispositivos de Acceso Vascular , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Camerún , Países en Desarrollo , Femenino , Estudios de Seguimiento , Hospitales Generales , Humanos , Fallo Renal Crónico/diagnóstico , Fallo Renal Crónico/mortalidad , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Evaluación de Necesidades , Evaluación de Resultado en la Atención de Salud , Diálisis Peritoneal/estadística & datos numéricos , Proyectos Piloto , Diálisis Renal/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo , Adulto JovenRESUMEN
Lymphorrhea is a rare but potentially serious complication following various surgical procedures. Uncontrolled lymph drainage may lead to infection and prolonged hospital stay. Currently, there is no standard effective treatment. Early management usually involves bed rest, drainage and pressure dressings. These methods are associated with prolonged recovery and high recurrence rates. We report a case of lymphorrhea from the groin wound after an aortic valve replacement. The patient presented with significant lymph drainage from the postoperative inguinal wound. Lymphorrhea was successfully treated with a long-acting somatostatin analogue, lanreotide. No recurrence was observed after 1 and 6 months of patient follow-up. This case report demonstrates the successful use of lanreotide in the control of lymphorrhea following groin dissection for vascular access.
Asunto(s)
Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Enfermedades Linfáticas/tratamiento farmacológico , Péptidos Cíclicos/uso terapéutico , Somatostatina/análogos & derivados , Anciano , Humanos , Enfermedades Linfáticas/etiología , Masculino , Punciones , Somatostatina/uso terapéutico , Factores de Tiempo , Resultado del TratamientoRESUMEN
A 52-year-old woman was admitted because of epigastralgia, anorexia and recently increased vomiting, 2 years after silastic ring vertical gastroplasty. On gastroscopy, a tumor mass was visualized in the pouch near the "neo-pylorus". Biopsies confirmed adenocarcinoma. She underwent total gastrectomy, and has no evidence of recurrence at 1 year. The literature on gastric carcinoma after gastroplasty is reviewed.