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PURPOSE: Accidental ureteric injury during colorectal surgery is a rare but dreadful event. It is associated with a higher risk of urinary tract infection (UTI) and acute kidney injury (AKI). Prophylactic placement of double J stents could improve ureteral identification and decrease the chance of accidental ureteral injury. METHODS: We searched MEDLINE, Cochrane, Central Register of Clinical Trials, and Web of Science for studies published until March 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p-values inferior to 0.10 and I2 > 25% considered significant. Statistical analysis was conducted in RStudio version 4.4.1. RESULTS: Eleven observational studies were included, comprising 71,784 patients. Among them, 11,723 (16.4%) were submitted to a prophylactic ureteral stent while 59,961 (83.6%) were not. There was no significant difference in ureteral injury between the groups (0.66% vs 0.8%; OR 1.45; 95% CI 0.43-4.87; p = 0.552; I2 = 56%). Prophylactic stent placement was associated with an increase in AKI (1.7% vs. 0.56%; OR 1.54; 95% CI 1.24-1.91; p < 0.001; I2 = 44%), operative time (MD 24.8 min; 95% CI 4.9-44.8; p = 0.01; I2 = 91%), and a decrease in mortality (OR 0.11; 95% CI 0.05-0.23; p < 0.001; I2 = 42%). No differences were observed in UTI, hematuria, length of hospital stays, and reoperation. CONCLUSION: In colorectal surgery, prophylactic ureteral stents were associated with increased AKI and operative time. No significant difference was observed in ureteral injury, UTI, hematuria, length of hospital stays, and reoperation.
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Introducción. El dolor abdominal es uno de los principales motivos de admisión a urgencias y una de las causas más frecuentes es la enfermedad diverticular, que aumenta su prevalencia en el adulto mayor. Sin embargo, la diverticulitis del intestino delgado es una enfermedad infrecuente y en la mayoría de casos es asintomática. No obstante, la perforación de un divertículo intestinal es una complicación común de esta patología, por lo que debe ser considerado como un diagnóstico diferencial de abdomen agudo en este grupo poblacional. Caso clínico. Paciente masculino de 71 años, quien consultó por dolor abdominal de inicio súbito, con signos de irritación peritoneal al examen físico. Dado su deterioro hemodinámico fue llevado a cirugía y en la laparotomía exploratoria se halló una diverticulitis aguda perforada de yeyuno e íleon distal. Resultados. El paciente cursó con una adecuada evolución postoperatoria, sin reingresos. Conclusión. La diverticulitis aguda yeyuno-ileal es una causa importante, pero no frecuente de perforación intestinal. Hay muy pocos casos reportados en la literatura, lo que la convierte en un reto diagnóstico para el médico de urgencias y el cirujano general. No obstante, debe ser considerado como un diagnóstico diferencial en adultos mayores con abdomen agudo.
Introduction. Abdominal pain is one of the main reasons for admission to the emergency room and one of the most frequent causes is diverticular disease, which increases its prevalence in the elderly. However, diverticulitis of the small bowel is rare and in most cases asymptomatic. However, perforation of an intestinal diverticulum is a common complication of this pathology and should be considered as a differential diagnosis of acute abdomen in this population group. Clinical case. A71-year-old male patient presented with abdominal pain of sudden onset, with signs of peritoneal irritation. Given his hemodynamic deterioration, he was taken to surgery and in the exploratory laparotomy an acute perforated diverticulitis of the jejunum and distal ileum was found. Results. The patient had an adequate postoperative evolution, without readmissions. Conclusion. Acute jejuno-ileal diverticulitis is an important but uncommon cause of intestinal perforation. There are very few cases reported in the literature, which makes it a diagnostic challenge for the emergency physician and general surgeon. However, it should be considered as a differential diagnosis in older adults with acute abdomen.
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Humanos , Dolor Abdominal , Diverticulitis , Abdomen Agudo , Íleon , Intestino Delgado , YeyunoRESUMEN
Introducción: el divertículo de Meckel es la anomalía congénita más frecuente del tracto gastrointestinal. Puede presentarse con hemorragia, obstrucción intestinal o diverticulitis, complicaciones que disminuyen con la edad, por lo que en el adulto el diagnóstico suele ser incidental. El tratamiento de las complicaciones es quirúrgico, mediante diverticulectomía o resección segmentaria del intestino delgado, dependiendo de sus características morfológicas. Objetivo: analizar nuestra experiencia en el manejo del divertículo de Meckel complicado en un período de 15 años. Diseño: estudio descriptivo, observacional, transversal, retrospectivo. Material y métodos: se revisaron las historias clínicas de los pacientes operados por divertículo de Meckel complicado en el Servicio de Cirugía General del Hospital San Roque durante el periodo 2007-2022. Se registraron datos demográficos, presentación clínica, diagnóstico preoperatorio, tratamiento quirúrgico, complicaciones postoperatorias y hallazgos histopatológicos. Resultados: se incluyeron 25 pacientes, 21 (84%) hombres, 3 menores de 18 años. La presentación clínica fue un síndrome de fosa iliaca derecha en el 80% de los casos, obstrucción intestinal en el 16% y hemorragia en el 4%. En solo 2 casos se realizó el diagnóstico preoperatorio, confirmado mediante tomografía computada. Se realizó diverticulectomía en el 68% de los pacientes y resección segmentaria el 32%. El abordaje fue laparotómico en el 64%, principalmente en el periodo inicial y laparoscópico en el 36%. Hubo una complicación IIIb de Clavien-Dindo en un paciente pediátrico tratado con drenaje percutáneo. En un solo paciente (4%), que se presentó con hemorragia digestiva masiva, se encontró epitelio de tipo gástrico y páncreas ectópico en el divertículo. Conclusiones: En nuestra experiencia el divertículo de Meckel complicado se presentó predominantemente en hombres. La complicación más frecuente en el adulto fue la diverticulitis. El diagnóstico preoperatorio fue infrecuente y realizado por tomografía computada. La diverticulectomía es suficiente en la mayoría de los casos. Actualmente, la laparoscopia es una herramienta segura, rentable y eficiente que permite el diagnóstico y tratamiento oportunos de esta entidad. (AU)
Introduction: Meckel's diverticulum is the most common congenital malformation of the gastrointestinal tract. It can present with bleeding, intesti-nal obstruction or diverticulitis, complications that decrease with age, so in adults the diagnosis is usually incidental. Treatment of complications is surgical, through diverticulectomy or segmental resection of the small intestine, depending on its morphological characteristics. Objective: to analyze our experience in the management of complicated Meckel's diverticulum over a period of 15 years. Design: descriptive, observational, cross-sectional, retrospective study. Materials and methods: the medical records of patients operated on for complicated Meckel's diverticulum in the General Surgery Service of the San Roque Hospital during the period 2007-2022 were reviewed. Demo-graphic data, clinical presentation, preoperative diagnosis, surgical treatment, postoperative complications, and histopathological findings were recorded. Results: twenty-five patients were included, 21 (84%) men, 3 under 18 years of age. The clinical presentation was a right iliac fossa syndrome in 80% of cases, intestinal obstruction in 16% and hemorrhage in 4%. In only 2 cases was the preoperative diagnosis made, confirmed by computed tomography. Diverticulectomy was performed in 68% of patients and segmental resection in 32%. The approach was by laparotomy in 64%, mainly in the initial period, and by laparoscopy in 36%. There was a Clavien-Dindo IIIb complication in a pediatric patient treated with percutaneous drain-age. In only one patient (4%), who presented with massive gastrointestinal bleeding, gastric-type epithelium and ectopic pancreas were found in the diverticulum. Conclusions: In our experience, complicated Meckel's diverticulum occurred predominantly in men. The most frequent complication in adults was diverticulitis. Preoperative diagnosis was infrequent and was made by computed tomography. Diverticulectomy is sufficient in most cases. Currently, laparoscopy is a safe, profitable and efficient tool that allows for the timely diagnosis and treatment of this entity. (AU)
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Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Laparoscopía/métodos , Diverticulitis , Divertículo Ileal/cirugía , Divertículo Ileal/diagnóstico , Tomografía Computarizada por Rayos X , Estudios Epidemiológicos , Epidemiología Descriptiva , Distribución por Edad y SexoRESUMEN
Introducción. Los datos epidemiológicos de la diverticulitis en Colombia son limitados. El objetivo de este artículo fue caracterizar una población que ingresó con diverticulitis aguda al Hospital Universitario San Vicente Fundación, un centro de referencia de la ciudad de Medellín, Colombia, para analizar la presentación y comportamiento de la enfermedad en la población local, con estadísticas propias y desenlaces de la enfermedad en los últimos años. Métodos. Estudio observacional retrospectivo, descriptivo, entre enero de 2015 y diciembre de 2019. Se hizo un estudio exploratorio uni-, bi- y multivariado de factores de riesgo para fallo en el tratamiento y la mortalidad. Resultados. Se incluyeron 103 pacientes. Se presentó principalmente en mujeres y la edad promedio fue de 65 años. La diverticulitis Hinchey Ia fue la más frecuente (41,7 %) y el manejo médico fue exitoso en todos los casos, mientras que en las tipo III y IV, todos se manejaron de forma quirúrgica, con tasas de éxito entre el 50 y el 64 %. La presencia de signos de irritación peritoneal al examen físico, el recuento de leucocitos y la PCR, el ingreso a la Unidad de Cuidados Intensivos y la mortalidad aumentaron de forma directamente proporcional con el estadio de Hinchey. Conclusiones. Existe una relación directamente proporcional entre la clasificación de Hinchey y los signos de respuesta inflamatoria clínicos y paraclínicos, la necesidad de manejo quirúrgico, la estancia en la Unidad de Cuidados Intensivos y la mortalidad.
Introduction. Epidemiological data on diverticulitis in Colombia are limited. The objective of this article was to characterize a population that was admitted with acute diverticulitis to the San Vicente Fundación University Hospital, a reference center in the city of Medellín, Colombia, to analyze the presentation and behavior of the disease in the local population, with its own statistics, and outcomes of the disease in recent years. Methods. Retrospective descriptive observational study between January 2015 and December 2019. An exploratory uni-, bi- and multivariate study of risk factors for treatment failure and mortality was performed. Results. A total of 103 patients were included. The most frequent Hinchey classification was Ia (41.7%). It occurs mainly in women, mean age 65 years. Hinchey Ia diverticulitis is the most frequent and medical management is successful in 100% of cases; while in III and IV, 100% were managed surgically with success rates between 50 and 64%. The presence of peritoneal signs on physical examination, leukocyte count and CRP, ICU admission and mortality increased directly proportional with Hinchey stage. Conclusions. There is a directly proportional relationship between Hinchey staging with clinical and paraclinical signs of inflammatory response, need for surgical management, ICU stay and mortality.
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Humanos , Diverticulitis , Divertículo del Colon , Enfermedades Diverticulares , Diverticulosis del Colon , Diagnóstico , Tratamiento ConservadorRESUMEN
To determine if preoperative-intraoperative factors such as age, comorbidities, American Society of Anesthesiologists (ASA) classification, body mass index (BMI), and severity of peritonitis affect the rate of morbidity and mortality in patients undergoing a primary anastomosis (PA) or Hartmann Procedure (HP) for perforated diverticulitis. This is a systematic review and meta-analysis, conducted according to PRISMA, with an electronic search of the PubMed, Medline, Cochrane Library, and Google Scholar databases. The search retrieved 614 studies, of which 11 were included. Preoperative-Intraoperative factors including age, ASA classification, BMI, severity of peritonitis, and comorbidities were collected. Primary endpoints were mortality and postoperative complications including sepsis, surgical site infection, wound dehiscence, hemorrhage, postoperative ileus, stoma complications, anastomotic leak, and stump leakage. 133,304 patients were included, of whom 126,504 (94.9%) underwent a HP and 6800 (5.1%) underwent a PA. There was no difference between the groups with regards to comorbidities (p = 0.32), BMI (p = 0.28), or severity of peritonitis (p = 0.09). There was no difference in mortality [RR 0.76 (0.44-1.33); p = 0.33]; [RR 0.66 (0.33-1.35); p = 0.25]. More non-surgical postoperative complications occurred in the HP group (p = 0.02). There was a significant association in the HP group between the severity of peritonitis and mortality (p = 0.01), and surgical site infection (p = 0.01). In patients with perforated diverticulitis, PA can be chosen. Age, comorbidities, and BMI do not influence postoperative outcomes. The severity of peritonitis should be taken into account as a predictor of postoperative morbidity and mortality.
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Perforación Intestinal , Peritonitis , Complicaciones Posoperatorias , Humanos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/mortalidad , Perforación Intestinal/mortalidad , Perforación Intestinal/cirugía , Peritonitis/mortalidad , Peritonitis/cirugía , Peritonitis/etiología , Índice de Masa Corporal , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Periodo Preoperatorio , Diverticulitis/cirugía , Diverticulitis/complicaciones , Diverticulitis/mortalidad , Índice de Severidad de la Enfermedad , Factores de Edad , Comorbilidad , Periodo Intraoperatorio , MorbilidadRESUMEN
Diverticula at the jejuno-ileum are rare. They correspond mostly to pseudo diverticula and usually go unnoticed. Among symptomatic patients the clinical presentation is heterogeneous. We present 3 cases of it most frequent complication: acute jejunal diverticulitis
La presencia de divertículos a nivel de yeyuno-íleon es infrecuente. Ellos corresponden mayormente a pseudo divertículos y suelen pasar desapercibidos. Entre los casos sintomáticos, la presentación clínica es heterogénea. Presentamos 3 casos de diverticulitis aguda yeyunal que es la complicación más frecuente.
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Humanos , Masculino , Femenino , Anciano , Anciano de 80 o más Años , Enfermedad Aguda , Diverticulitis/complicaciones , Diverticulitis/terapia , Enfermedades del Yeyuno/complicaciones , Enfermedades del Yeyuno/terapia , Dolor Abdominal/etiología , Tomógrafos Computarizados por Rayos X , Antibacterianos/uso terapéuticoRESUMEN
A 40-year-old female with a 24-hour course of abdominal pain suggestive of acute appendicitis. An emergency laparotomy was performed, finding plastron in the cecum and ascending colon, color changes, with purulent liquid and 5 cm in diameter, fixed to Toldt's. It was decided to perform a right hemicolectomy with an ileotransverse end-to-side anastomosis with adequate postsurgical evolution. The histopathological report showed acute purulent diverticulitis of the cecum, which is very low incidence in the Mexican population, that's why this case report is carried out.
Mujer de 40 de años con cuadro de dolor abdominal de 24 h de evolución clínicamente sugestiva de apendicitis aguda. Se realiza laparotomía de urgencia, encontrando plastrón en ciego y colon ascendente, irregular, pétreo, con cambios de coloración, de 5 cm de diámetro, fijo a la fascia de Toldt, con líquido purulento. Se decide realizar hemicolectomía derecha con ileotransverso anastomosis terminolateral, con adecuada evolución posquirúrgica. El reporte histopatológico mostró diverticulitis aguda purulenta de ciego, lo cual es de baja incidencia en la población mexicana, motivo por el que se realiza este reporte de caso.
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Apendicitis , Enfermedades del Ciego , Diverticulitis , Femenino , Humanos , Adulto , Enfermedades del Ciego/diagnóstico , Enfermedades del Ciego/cirugía , Diverticulitis/complicaciones , Diverticulitis/diagnóstico , Diverticulitis/cirugía , Ciego/cirugía , Apendicitis/diagnóstico , Apendicitis/cirugía , Colectomía , Diagnóstico DiferencialRESUMEN
RESUMEN La diverticulosis es la presencia de divertículos en el tránsito intestinal, diverticulitis es la inflamación de los divertículos y ocurre en menos del 5% de pacientes con diverticulosis. El tratamiento quirúrgico de la diverticulitis aguda se aplica en los casos complicados. Tradicionalmente la operación de Hartmann es el procedimiento estándar en los casos de Diverticulitis aguda Hinchey III y IV, actualmente se recomienda individualizar el tratamiento quirúrgico en los casos de peritonitis purulenta no fecaloidea siendo el lavado peritoneal laparoscópico una opción factible. Objetivo : Describir los resultados del tratamiento quirúrgico de 4 pacientes con el diagnóstico de diverticulitis aguda Hinchey III sometidos al Lavado peritoneal en un centro privado. Material y métodos: Estudio descriptivo retrospectivo tipo serie de casos. Se recopiló información de historias clínicas para la descripción de los casos. Resultados: En los 4 pacientes intervenidos mediante el Lavado peritoneal laparoscópico, ninguno tuvo complicaciones postoperatorias ni mortalidad. Conclusiones: A juicio de los autores los beneficios del lavado peritoneal laparoscópico repercuten en una adecuada evolución postquirúrgica y generan calidad de vida en los pacientes intervenidos.
SUMMARY Diverticulosis is defined as the presence of diverticula in the intestine, when these diverticula become inflamed diverticulitis occurs, but this complication happens in less than 5% of these patients. Surgical treatment is indicated in complicated diverticulitis cases. Traditionally, the Hartmann procedure is carried out in patients with Hinchey III and IV acute diverticulitis. Currently, individualized surgical procedures are indicated in patients with non-fecal purulent peritonitis with laparoscopic peritoneal lavage as an optional choice. Objective: To report the results of laparoscopic peritoneal lavage in four patients with Hinchey III acute diverticulitis performed at a private clinic. Methods: Case series for which a review of patient clinical files was done. Results: No post-operative complications or mortality was found. Conclusions: based on authors judge, laparoscopic peritoneal lavage leads to an adequate post-operative evolution resulting in better quality of life.
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El divertículo de Meckel es una malformación congénita que suele presentarse como un hallazgo incidental asintomático. Puede complicarse por procesos inflamatorios o tumores, cursando con sintomatología abdominal sumamente inespecífica, lo que complica su diagnóstico oportuno. Aunque la incidencia de neoplasias malignas en estos divertículos es baja, los tumores neuroendocrinos son los más representativos. Presentamos el caso de una paciente de 72 años que consultó por dolor abdominal y deposiciones melénicas, con múltiples nódulos intrahepáticos sugestivos de tumores neuroendocrinos y hallazgo intraoperatorio incidental de diverticulitis aguda de Meckel con metástasis peridiverticular de un tumor neuroendocrino. (AU)
Meckel's diverticulum is a congenital malformation that usually presents as an incidental finding. It can be complicated by inflammatory processes or tumors, with non-specific abdominal symptoms which delay its timely diagnosis. Although the incidence of malignant neoplasms in these diver-ticula is low, neuroendocrine tumors are the most representative. We present the case of a 72-year-old female patient who consulted for abdominal pain and melenic bowel movements, with multiple intrahepatic nodules suggestive of neuroendocrine tumors and an incidental intraoperative finding of acute Meckel's diverticulitis with peridiverticular metastasis of a neuroendocrine tumor. (AU)
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Humanos , Femenino , Anciano de 80 o más Años , Tumores Neuroendocrinos/cirugía , Tumores Neuroendocrinos/diagnóstico , Divertículo Ileal/cirugía , Divertículo Ileal/diagnóstico , Dolor Abdominal , Comorbilidad , ColectomíaRESUMEN
Meckel's diverticulum corresponds to the aberrant involution of the omphalo-mesenteric canal or vitelline duct, which is located at the level of the antimesenteric border of the terminal ileum. It is the most common structural anomaly of the gastrointestinal tract, it is almost always asymptomatic and its diagnosis is usually incidental, however the complication with diverticulitis is an unusual condition. We describe the case of a 65-year-oldman, who was admitted from another institution with a diagnosis of acute abdomen. On physical examination, he presented signs of peritoneal irritation with evidence of leukocytosis and neutrophilia in the admission blood count. Computerized tomography of the abdomen with intra venous contrast was performed, which was interpreted as complicated Meckel's diverticulitis, being corroborated during the surgical act and confirmed by pathological anatomy. Meckel's diverticulitis is a rare entity, however it is important to recognize it within the differential diagnoses of acute abdomen, which will allow prompt intervention and a favorable outcome.
El divertículo de Meckel (DM) corresponde a la involución aberrante del canal onfalo-mesentérico o conducto vitelino, el cual se ubica a nivel del borde antimesentérico del íleon terminal. Es la anomalía estructural más común del tracto gastrointestinal, casi siempre es asintomático y su diagnóstico por lo general es incidental, sin embargo, la complicación con diverticulitis es una condición poco usual. Describimos el caso de un hombre de 65 años, que ingresó referido de otra institución con diagnóstico de abdomen agudo, al examen físico presentó signos de irritación peritoneal con evidencia de leucocitosis y neutrofilia en hemograma de ingreso. Se realizó tomografía computarizada de abdomen con contraste endovenoso, la cual se interpretó como diverticulitis de Meckel complicada, siendo corroborado durante el acto quirúrgico y confirmado mediante anatomía patológica. La diverticulitis de Meckel es una entidad rara, sin embargo, es importante reconocerla dentro de los diagnósticos diferenciales de abdomen agudo, lo cual permitirá una pronta intervención y un favorable desenlace.
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Abdomen Agudo , Diverticulitis , Divertículo Ileal , Masculino , Humanos , Divertículo Ileal/diagnóstico , Divertículo Ileal/diagnóstico por imagen , Abdomen Agudo/etiología , Tomografía Computarizada por Rayos X , Diverticulitis/complicaciones , Diverticulitis/diagnóstico por imagen , Diverticulitis/cirugía , Diagnóstico DiferencialRESUMEN
Resumen El divertículo de Meckel (DM) corresponde a la involución aberrante del canal onfalo-mesentérico o conducto vitelino, el cual se ubica a nivel del borde antimesentérico del íleon terminal. Es la anomalía estructural más común del tracto gastrointestinal, casi siempre es asintomático y su diagnóstico por lo general es incidental, sin embargo, la complica ción con diverticulitis es una condición poco usual. Describimos el caso de un hombre de 65 años, que ingresó referido de otra institución con diagnóstico de abdomen agudo, al examen físico presentó signos de irritación peritoneal con evidencia de leucocitosis y neutrofilia en hemograma de ingreso. Se realizó tomografía computarizada de abdomen con contraste endovenoso, la cual se interpretó como diverticulitis de Meckel complicada, siendo corroborado durante el acto quirúrgico y confirmado mediante anatomía patológica. La diverticulitis de Meckel es una entidad rara, sin embargo, es importante reconocerla dentro de los diagnósticos diferenciales de abdomen agudo, lo cual permitirá una pronta intervención y un favorable desenlace.
Abstract Meckel's diverticulum corresponds to the aberrant invo lution of the omphalo-mesenteric canal or vitelline duct, which is located at the level of the antimesenteric border of the terminal ileum. It is the most common structural anomaly of the gastrointestinal tract, it is almost always asymptomatic and its diagnosis is usually incidental, how ever the complication with diverticulitis is an unusual con dition. We describe the case of a 65-year-oldman, who was admitted from another institution with a diagnosis of acute abdomen. On physical examination, he presented signs of peritoneal irritation with evidence of leukocytosis and neutrophilia in the admission blood count. Computerized tomography of the abdomen with intra venous contrast was performed, which was interpreted as complicated Meckel's diverticulitis, being corroborated during the surgical act and confirmed by pathological anatomy. Meckel's diverticulitis is a rare entity, however it is important to recognize it within the differential diagnoses of acute abdomen, which will allow prompt intervention and a favorable outcome.
RESUMEN
La diverticulitis apendicular es una enfermedad poco frecuente, con una incidencia aproximada de 1%. Se define por la presencia de divertículos verdaderos o falsos en la pared del apéndice cecal. Durante la fase aguda posee una clínica indistinguible a la apendicitis, sin embargo en ocasiones presenta características clínicas particulares que la distinguen de la apendicitis aguda, tales como la presencia de dolor abdominal insidioso o intermitente y/o ausencia de sintomatología gastrointestinal (náuseas, vómitos o anorexia). En la diverticulitis apendicular las técnicas imagenológicas son de utilidad limitada al otorgar información inespecífica, por lo que el diagnóstico tiende a realizarse mediante el estudio anatomopatológico del apéndice posterior a una intervención quirúrgica en paciente con cuadro clínico compatible con apendicitis aguda. El tratamiento de elección corresponde a la apendicectomía, lo que permite evitar complicaciones futuras como por ejemplo perforación apendicular, neoplasias, entre otros. Se obtuvieron los datos de fuentes como Pubmed y Scielo. Específicamente la búsqueda de artículos originales y de revisiones sistemáticas, preferentemente menores a 15 años de publicación en revistas científicas de alto índice de impacto, con las palabras "diverticulitis apendicular", "diverticulosis" y "complicaciones diverticulares".
Appendiceal diverticulitis is a rare disease with an incidence of approximately 1%. It is defined by the presence of true or false diverticula in the wall of the cecal appendix. During the acute phase, it has symptoms that are indistinguishable from appendicitis, however, it sometimes presents particular clinical characteristics that distinguish it from acute appendicitis, such as the presence of insidious or intermittent abdominal pain and/or the absence of gastrointestinal symptoms (nausea, vomiting, or anorexia). In appendiceal diverticulitis, imaging techniques are of limited utility as they provide non-specific information, so the diagnosis tends to be made through the pathology study of the treatment after surgery in a patient with a clinical picture compatible with acute appendicitis. The treatment of choice corresponds to appendectomy, which allows avoiding future complications such as appendiceal perforation, neoplasms, among others. Data were obtained from sources such as Pubmed and Scielo, specifically searching for original articles and systematic reviews with the words "apendicular diverticulitis", "diverticulosis" and "diverticular complications". The criteria used were articles mainly under 5 years of publication in high-impact scientific journals.
RESUMEN
PURPOSE: Recently, treatment of Hinchey III diverticulitis by laparoscopic peritoneal lavage has been questioned. Moreover, long-term outcomes have been scarcely reported. Primary outcome was to determine the recurrence rate of diverticulitis after a successful laparoscopic peritoneal lavage in Hinchey III diverticulitis. Secondary outcomes were identification of associated risk factors for recurrence and elective sigmoidectomy rate. METHODS: A retrospective cohort study in a tertiary referral center was performed. Patients with Hinchey III diverticulitis who underwent a successful laparoscopic peritoneal lavage between June 2006 and December 2019 were eligible. Diverticulitis recurrence was analyzed according to the Kaplan-Meier and log-rank test, censoring for death, loss of follow-up, or elective sigmoid resection in the absence of recurrence. Risk factors for recurrence were identified using Cox regression analysis. RESULTS: Sixty-nine patients had a successful laparoscopic peritoneal lavage (mean age: 63 years; 53.6% women). Four patients had an elective sigmoid resection without recurrences. Recurrence rate was 42% (n = 29) after a median follow-up of 63 months. The cumulative global recurrence at 1, 3, and 5 years was 30% (95% CI, 20-43%), 37.5% (95% CI, 27-51%), and 48.9% (95% CI, 36-64%), respectively. Smoking (HR, 2.87; 95% CI, 1.22-6.5; p = 0.016) and episodes of diverticulitis prior to laparoscopic peritoneal lavage (HR, 5.2; 95% CI, 2.11-12.81; p < 0.001) were independently associated with an increased risk of recurrence. CONCLUSIONS: Diverticulitis recurrence after a successful laparoscopic peritoneal lavage is high, decreasing after the first year of follow-up. Smoking and previous episodes of acute diverticulitis independently increase the risk of new episodes of diverticulitis.
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Diverticulitis del Colon , Diverticulitis , Perforación Intestinal , Laparoscopía , Peritonitis , Humanos , Femenino , Persona de Mediana Edad , Masculino , Diverticulitis del Colon/complicaciones , Lavado Peritoneal/efectos adversos , Estudios Retrospectivos , Diverticulitis/terapia , Factores de Riesgo , Laparoscopía/efectos adversos , Peritonitis/etiología , Peritonitis/cirugía , Perforación Intestinal/cirugía , Resultado del TratamientoRESUMEN
PURPOSE: In the West, diverticular disease is located mainly in the left colon. However, it can also present in the right colon, with an incidence of 1% to 2% in Caucasians. The purpose of this study was to describe our experience in right-sided acute diverticulitis (RD). METHODS: In this retrospective study, 410 patients with acute diverticulitis treated from 2013 to 2020 were included in a university hospital in Córdoba, Argentina. Colonic diverticulitis was stratified into 2 groups; RD and left-sided acute diverticulitis. Demographic and clinical variables, laboratory and imaging findings, type of treatment, follow-up, and recurrence were analyzed. RESULTS: Sixteen patients (3.9%) with RD were identified; 62.5% were male and the mean age was 40.7±11.7 years. A total of 81.3% were Caucasian and 18.7% Native American. Significant differences were found between both groups of diverticulitis; patients with RD were younger (P=0.001), with lower BMI (P=0.01), comorbidity rate (P=0.01), Charlson comorbidity index (P=0.02), hospital stay (P=0.01), severity according to the Hinchey classification (P=0.001) and had a lower recurrence rate (P=0.001). There were no significant differences in sex (P=0.95), duration of pain until admission (P=0.05), laboratory findings (P=0.23) and treatment (P=0.34). CONCLUSION: Conservative treatment predominated in RD, with a lower rate of complications and recurrences, providing data that support conservative therapy as initial treatment in RD in our environment.
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La diverticulosis cecal es una entidad poco común, representando el 3,6% de los casos de enfermedad diverticular y su complicación más frecuente es la diverticulitis. Caso clínico : Presentamos el caso de un paciente de 79 años quien consultó por presentar dolor en fosa ilíaca derecha, náuseas y escalofríos; laboratorio leucocitos 16900uL (neutrófilos 79%), proteína C reactiva 4,51mg/l. Se realiza laparoscopia evidenciando tumor de ciego de 2 x 3cm de coloración violácea con signos de inflamación pericecal, se realizó hemicolectomía derecha. El informe histopatológico informó divertículo verdadero isquémico de ciego. Conclusión : La diverticulitis cecal es una patología poco frecuente que puede presentarse como un abdomen agudo, por lo que se debe mantener un alto índice de sospecha en pacientes mayores de 40 años de edad. El abordaje laparoscópico es un método seguro y eficaz para el diagnóstico y tratamiento de estos pacientes(AU)
Cecal diverticulosis is an uncommon condition, representing 3.6% of diverticular disease cases, with its most common complication being diverticulitis. Case report: We present the case of a 79-year-old patient who consulted for right iliac fossa pain, nausea, and chills; laboratory findings showing a white blood cell count of 16,900/µL (neutrophils 79%) and C-reactive protein of 4.51 mg/L. Laparoscopy revealed a 2 x 3 cm purple-colored cecal tumor with signs of pericecal inflammation, right hemicolectomy was performed. Histopathological analysis confirmed a true ischemic cecal diverticulum. Conclusion: Cecal diverticulitis is an infrequent condition that can mimic an acute abdomen, necessitating a high index of suspicion, especially in patients over 40 years of age. Laparoscopic approach proves to be a safe and effective method for diagnosis and treatment in these patients(AU)
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Humanos , Masculino , Anciano , DiverticulitisRESUMEN
Introduction: Right colon diverticulitis (RCD) is an uncommon condition in Western populations, but its incidence has increased over the last decades. Due to its rarity, many surgeons are unfamiliar with this disease, which is often mistakenly diagnosed as acute appendicitis. The lack of data about the diagnosis and management of RCD in Western populations makes it difficult to establish the optimal therapeutic strategy. Objective: To evaluate the outcomes of patients treated for acute RCD and to propose a therapeutic algorithm for the diagnosis and treatment. Methods: A retrospective analysis of the medical records of patients treated for acute RCD between 2008 and 2020 by a single experienced colorectal surgeon was performed. Results: In total, 12 patients were identified, 8 male and 4 female subjects, with a mean age of 49.6 years; 9 of these patients were of Western origin. The median follow-up time was of 49 months (range: 12 to 144 months). The most frequent symptoms were abdominal pain (100%) and fever (66%). Diagnostic errors in imaging exams occurred in four patients. A total of 6 patients were managed clinically, and the other 6 underwent surgical treatment with right colectomy (n = 5) and total colectomy (n = 1), 2 via laparoscopy and 4 through a laparotomy. The anatomopathological examination confirmed RCD in all operated patients. There was no incidental finding of neoplasia and there were no deaths during the study period. Conclusion: Uncomplicated RCD can be treated conservatively with a high success rate. Recurrent cases that impact quality of life or complicated forms of RCD should undergo surgical treatment, preferably through a right laparoscopic colectomy. The authors present a diagnostic and therapeutic algorithm to facilitate the diagnosis and to guide the management of this uncommon disease. (AU)
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Diverticulitis del Colon/terapia , Diverticulitis del Colon/diagnóstico por imagen , Algoritmos , Estudios RetrospectivosRESUMEN
INTRODUCTION: Hartmann's procedure (HP) is the conventional treatment in patients with complicated diverticulitis. Segmental resection with primary anastomosis (PA) is a treatment alternative for those patients. Our aim was to compare the postoperative results of HP and PA in patients with complicated diverticulitis (Hinchey stage III). METHODS: A case-control study was conducted on patients operated on for purulent Hinchey stage III diverticulitis, within the time frame of 2000 and 2019. RESULTS: Twenty-seven patients that underwent PA were compared with 27 that underwent HP. The patients that underwent HP had a greater probability of morbidity at 30 days (OR 3.5; 95% CI 1.13-11.25), as well as a greater probability of major complications (OR 10.9; 95% CI 1.26-95.05). CONCLUSION: The patients that underwent segmental resection and PA presented with lower morbidity rates and higher stoma reversal rates than the patients that underwent HP.
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Diverticulitis del Colon , Diverticulitis , Perforación Intestinal , Humanos , Diverticulitis del Colon/cirugía , Diverticulitis del Colon/complicaciones , Estudios de Casos y Controles , Perforación Intestinal/etiología , Diverticulitis/cirugía , Diverticulitis/complicaciones , Anastomosis Quirúrgica/efectos adversosRESUMEN
Objetivo: Presentar un caso de diverticulitis apendicular y compararlo con la literatura actual. Material y M étodo: Registro clínico de un paciente que ingresa a urgencias del Hospital Padre Hurtado, incluyendo cuadro clínico, imagenología, manejo quirúrgico y anatomía patológica. Resultados: Paciente se presenta con cuadro de dolor abdominal atípico, con imagen sugerente de apendicitis diverticular. En pabellón se logra completar apendicectomía laparoscópica con buena evolución posterior. Al estudio patológico se confirman características histológicas de diverticulitis perforada apendicular. Discusión: Se presenta un cuadro clínico que se condice con lo descrito en la literatura actual, aportando imágenes características, tanto de radiología como histopatología. Conclusión: Debido a su mayor riesgo de perforación y mortalidad, la diverticulitis apendicular es una patología que debe considerarse en los diagnósticos diferenciales de dolores abdominales atípicos, en hombres mayores de 30 años, especialmente con los hallazgos imagenológicos característicos.
Objective: To present a clinical case of appendiceal diverticulitis and compare it to contemporary literature. Material and Method: Clinical record of a patient who attends the emergency service of Hospital Padre Hurtado, including clinical presentation, image studies, surgical management and histopathology studies. Results: A patient presents with atypical abdominal pain, image studies suggest appendiceal diverticulitis. Laparoscopic appendectomy was performed with optimal postoperative results. Pathological biopsy studies confirm histological characteristics of a perforated appendiceal diverticulitis. Discussion: A clinical case is presented, which correlates well with contemporary literature of the subject. We provide characteristic image and histopathological studies. Conclusion: Due to its higher perforation rate and mortality, appendiceal diverticulitis is a pathology which must be considered in the differential diagnosis of atypical abdominal pain, in males over 30 years old, especially with characteristic image studies.
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Humanos , Masculino , Persona de Mediana Edad , Apendicectomía , Diverticulitis/cirugía , Diverticulitis/diagnóstico por imagen , Abdomen Agudo/etiología , Apéndice/patología , Dolor Abdominal/etiología , Laparoscopía , Diverticulitis/patologíaRESUMEN
RESUMEN Antecedentes: la reconstrucciónn del tránsito intestinal luego de una operación de Hartmann es un procedimiento habitualmente complejo y con alta morbilidad. Objetivo: analizar la tasa de reconstrucción después de la cirugía de Hartmann y resultados posoperatorios en nuestra experiencia. Material y métodos: análisis retrospectivo de pacientes a los que se les practicó la reconstrucción del tránsito intestinal posterior a una cirugía de Hartmann en un período 16 años. Revisamos la bibliografía y nuestra base de datos. Luego traspasamos la información disponible a una grilla de datos construida con variables habitualmente analizadas en la literatura. Finalmente, analizamos los resultados mediante medidas básicas de tendencia central. Resultados: en 16 años realizamos 92 operaciones de Hartmann, de las cuales 69 (75%) llegaron a la reconstrucción. Edad promedio: 58 años. El 52% de los pacientes fueron hombres. La operación de Hartmann fue de urgencia en el 48% y 58% resultaron malignas. Tiempo transcurrido hasta la reconstrucción: en promedio, 9 meses, y el 90% (N 62) de los casos se realizó por vía laparoscópica. Morbilidad general 38% y ajustada a los grados III y IV de Clavien-Dindo fue 11,5%. No hubo mortalidad. Conclusión: los resultados obtenidos son semejantes a los publicados y nuestra experiencia nos motiva a continuar eligiendo el abordaje laparoscópico.
ABSTRACT Background: Background: Stoma reversal after Hartman's operation is usually a complex procedure and is associated high morbidity. Objective: To analyze the rate of reversal after the Hartmann's procedure and the postoperative outcomes in our experience. Material and methods: We conducted a retrospective analysis of patients undergoing reversal after the Hartmann's procedure over a 16-year period with review of the literature and of our database and transferred the available information to a data grid constructed with variables commonly analyzed in the literature. Finally, we analyzed the results using basic measures of central tendency. Results: Over a 16-year period, we performed 92 Hartmann's operations; 69 (75%) reached the reversal stage. Mean age was 58 years and 52% were men. Forty-eight percent of the Hartmann's procedures were emergency surgeries and 58% were due to cancer. Mean time to reversal was 9 months and 90% (n = 62) were laparoscopic procedures. Overall morbidity and adjusted for complications grade III and IV of the Clavien-Dindo classification were 38% and 11.5%, respectively. None of the patients died. Conclusion: The results obtained are similar to those published and our experience motivates us to continue choosing the laparoscopic approach.
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Humanos , Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Adulto Joven , Colostomía/estadística & datos numéricos , Ileostomía/estadística & datos numéricos , Laparoscopía/estadística & datos numéricos , Intestinos/cirugía , Estudios Retrospectivos , Morbilidad , Fístula de la Vejiga Urinaria/cirugía , Fístula Intestinal/cirugíaRESUMEN
Mujer de 59 años, con antecedentes de diverticulosis de colon, que acude por dolor en la región inguinal y en el miembro inferior izquierdo de dos meses de evolución. En una primera instancia, la paciente se presentó con clínica de sepsis y se objetivó un eritema en el miembro inferior izquierdo, asociado a celulitis y crepitación subcutánea. La TC mostraba una colección hidroaérea en psoas y retroperitoneal que asciende hasta la cavidad abdominal hallándose una diverticulitis perforada. El tratamiento quirúrgico se basó en el drenaje de la colección retroperitoneal y sigmoidectomía, seguido de una fasciotomía, desbridamiento y lavado del muslo. La perforación de un divertículo puede formar un absceso intraperitoneal desarrollando una peritonitis o un absceso retroperitoneal, derivando en una translocación bacteriana hacia la extremidad inferior, debido a la comunicación existente en el anillo crural, generando una fascitis necrotizante del miembro.