RESUMEN
BACKGROUND: Caecal volvulus is an uncommon cause of intestinal obstruction. Its clinical presentation is non-specific, with the diagnosis usually confirmed by barium enema and abdominal computed tomography. Treatment depends on many factors, and minimally invasive approaches are becoming the treatment of choice. CLINIC CASE: A 54 years old female, admitted to the Emergency Department with clinical symptoms of intestinal obstruction. On physical examination she had a palpable, firm, and tympanitic mass in the right abdomen, with peritoneal irritation. The radiographs of the abdomen, barium enema and abdominal computed tomography showed caecal volvulus. As she showed a full remission after the barium enema, with no clinical or biochemical data of systemic inflammatory response syndrome or peritoneal irritation, she was discharged to her home. Two weeks later, a laparoscopic right hemicolectomy was performed with an ileo-transverse extracorporeal anastomosis. Her progress was satisfactory, and she was discharged 4 days after surgery due to improvement. CONCLUSION: Caecal volvulus is a rare cause of intestinal obstruction, with high mortality rates, and is caused by excessive mobility of the caecum. Its incidence is increasing. Treatment depends on many factors. Early non-surgical untwisting, followed by an elective laparoscopic surgical procedure offers several advantages and reduces mortality.
Asunto(s)
Enfermedades del Ciego/cirugía , Colectomía/métodos , Procedimientos Quirúrgicos Electivos/métodos , Vólvulo Intestinal/cirugía , Laparoscopía/métodos , Anastomosis Quirúrgica , Sulfato de Bario , Enfermedades del Ciego/diagnóstico por imagen , Enfermedad Crónica , Colon/irrigación sanguínea , Medios de Contraste , Urgencias Médicas , Enema , Femenino , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Enfermedades del Íleon/cirugía , Íleon/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/terapia , Vólvulo Intestinal/complicaciones , Vólvulo Intestinal/diagnóstico por imagen , Isquemia/complicaciones , Persona de Mediana Edad , Peritonitis/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Colorectal surgery has advanced notably since the introduction of the mechanical suture and the minimally invasive approach. Robotic surgery began in order to satisfy the needs of the patient-doctor relationship, and migrated to the area of colorectal surgery. An initial report is presented on the experience of managing colorectal disease using robot-assisted surgery, as well as an analysis of the current role of this platform. MATERIAL AND METHODS: A retrospective study was conducted in order to review five patients with colorectal disease operated using a robot-assisted technique over one year in the initial phase of the learning curve. Gender, age, diagnosis and surgical indication, surgery performed, surgical time, conversion, bleeding, post-operative complications, and hospital stay, were analysed and described. A literature review was performed on the role of robotic assisted surgery in colorectal disease and cancer. RESULTS: The study included 5 patients, 3 men and 2 women, with a mean age of 62.2 years. Two of them were low anterior resections with colorectal primary anastomoses, one of them extended with a loop protection ileostomy, a Frykman-Goldberg procedure, and two left hemicolectomies with primary anastomoses. The mean operating time was 6hours and robot-assisted 4hours 20minutes. There were no conversions and the mean hospital stay was 5 days. CONCLUSION: This technology is currently being used worldwide in different surgical centres because of its advantages that have been clinically demonstrated by various studies. We report the first colorectal surgical cases in Mexico, with promising results. There is enough evidence to support and recommend the use of this technology as a viable and safe option.