RESUMEN
Crohn's disease located in the esophagus is rare, being exceptional as the initial manifestation of the disease. Erosive ulcerative esophagitis, stricture and fistula are forms of presentation, as in other esophageal pathologies, so the differential diagnosis is broad. The histologic features of esophageal Crohn's disease can be nonspecific and increase the diagnostic challenge. Esophageal Crohn's disease should be included in the differential diagnosis of esophageal strictures and may require esophagectomy if medical-endoscopic treatment is not effective.
Asunto(s)
Enfermedad de Crohn , Enfermedades del Esófago , Estenosis Esofágica , Esofagitis , Enfermedad de Crohn/patología , Enfermedades del Esófago/diagnóstico por imagen , Enfermedades del Esófago/etiología , Estenosis Esofágica/diagnóstico por imagen , Estenosis Esofágica/etiología , Esofagitis/diagnóstico , HumanosRESUMEN
INTRODUCTION: Laparoscopic gastrectomy has emerged in recent years as an effective technique for the treatment of morbid obesity due to low mortality morbidity rates. Its complications include dehiscence suture line, and others such as splenic infarction. We discuss a case of splenic infarction after laparoscopic gastrectomy. CLINICAL CASE: 45 year old male with a BMI of 37.8 kg/m2, diabetes-II for 15 years, the last five in treatment with insulin, a fasting blood glucose around 140mg/dl, HbA1c of 7.3mg/dl and microangiopathy diabetic nephropathy. The patient underwent a laparoscopic sleeve gastrectomy and he was discharged from hospital 48hours later. 1 month later he presented at the hospital for epigastric pain and fever up to 40° C. An intra abdominal abscess was detected and there was no leakage. The spleen was normal. He was treated with radiological drainage. 9 months later the patient consulted again due to epigastric pain in upper left quadrant, associated with low-grade fever. Thoraco-abdominal CT images compatible with splenic infarction. Currently patient remains asymptomatic one year after surgery. DISCUSSION: Laparoscopic sleeve gastrectomy is one of the most popular procedures of bariatric surgery. Less common complications include abscess and the splenic infarction. Usually patients are asymptomatic, but sometimes cause fever and pain. Initial treatment should be conservative. Only in selected cases, would splenectomy be indicated. CONCLUSIONS: Splenic infarction is usually an early complication, but we should keep it in mind as a long term complication for patients with persistent fever and abdominal pain after laparoscopic gastrectomy.
Asunto(s)
Gastrectomía , Laparoscopía , Complicaciones Posoperatorias/etiología , Infarto del Bazo/etiología , Tratamiento Conservador , Diabetes Mellitus Tipo 2/complicaciones , Drenaje , Gastrectomía/efectos adversos , Humanos , Laparoscopía/efectos adversos , Masculino , Persona de Mediana Edad , Obesidad Mórbida/complicaciones , Obesidad Mórbida/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Complicaciones Posoperatorias/cirugía , Complicaciones Posoperatorias/terapia , Infarto del Bazo/diagnóstico por imagen , Infarto del Bazo/terapia , Infecciones Estreptocócicas/complicaciones , Tomografía Computarizada por Rayos XRESUMEN
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Asunto(s)
Humanos , Femenino , Adulto Joven , Fundoplicación/efectos adversos , Hipoglucemia/etiología , Reflujo Gastroesofágico/cirugía , Síndrome de Vaciamiento Rápido/diagnóstico , Complicaciones Posoperatorias , Factores de RiesgoAsunto(s)
Síndrome de Vaciamiento Rápido/etiología , Fundoplicación/efectos adversos , Hipoglucemia/etiología , Antiulcerosos/uso terapéutico , Terapia Combinada , Diagnóstico Diferencial , Carbohidratos de la Dieta/farmacocinética , Síndrome de Vaciamiento Rápido/diagnóstico , Síndrome de Vaciamiento Rápido/dietoterapia , Síndrome de Vaciamiento Rápido/fisiopatología , Esomeprazol/uso terapéutico , Femenino , Vaciamiento Gástrico , Reflujo Gastroesofágico/tratamiento farmacológico , Reflujo Gastroesofágico/cirugía , Hormonas Gastrointestinales/metabolismo , Humanos , Insulinoma/diagnóstico , Periodo Posprandial , Adulto JovenRESUMEN
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Asunto(s)
Humanos , Malformaciones Arteriovenosas/patología , Yeyuno/irrigación sanguíneaRESUMEN
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Asunto(s)
Humanos , Masculino , Anciano , Enfermedades del Esófago/complicaciones , Enfermedades del Esófago/patología , Hematoma/complicaciones , Hematoma/patología , Hemoperitoneo/etiología , Hemoperitoneo/patología , Enfermedades del Esófago/cirugía , Hematoma/cirugía , Hemoperitoneo/cirugía , Rotura Espontánea/cirugía , Rotura Espontánea/complicacionesAsunto(s)
Enfermedades del Esófago/complicaciones , Enfermedades del Esófago/patología , Hematoma/complicaciones , Hematoma/patología , Hemoperitoneo/etiología , Hemoperitoneo/patología , Anciano , Enfermedades del Esófago/cirugía , Hematoma/cirugía , Hemoperitoneo/cirugía , Humanos , Masculino , Rotura Espontánea/complicaciones , Rotura Espontánea/cirugíaRESUMEN
The majority of epiphrenic diverticula arise due to a peristaltic mechanism caused by an oesophageal motor disturbance that establishes a barrier effect and causes mucosal and submucosal herniation through a weak point in the muscular layer. Intraluminal oesophageal manometry and video-radiology are important in assessing these patients, since they define the characteristics of the functional disorder, as well as the true relationship between the symptoms of the patient and the diverticulum. Surgical treatment is indicated in symptomatic patients, more so if there are respiratory complications. Left posterolateral thoracotomy followed by diverticulotomy, oesophageal cardiomyotomy and anti-reflux have been considered the surgery technique of choice. Oesophageal myotomy must go beyond, in a proximal direction, the neck of the diverticulum, and, in a distal direction, must progress 1-2 cm into the gastric wall. The laparoscopic approach has won many followers since it has been shown to be both safe and effective as open surgery, adding to the advantages of minimally invasive surgery.