RESUMEN
INTRODUCTION: Omental infarction describes ischemic torsion of the distal portion of the omentum and constitutes an infrequent cause of acute abdominal pain in childhood of which few cases are known. Objec tive: To analyze through a clinical case the characteristics and management of this pathology, to consider this entity in the differential diagnosis of acute abdominal pain. CLINICAL CASE: An 11-year- old child consulted the emergency department due to a 48-hour history of continuous abdominal pain, which had progressively increased. On the physical examination, the patient presented pain in the right side of the abdomen and the epigastric area, with no signs of peritoneal irritation, and was overweight (BMI 91st percentile). Biochemical analysis showed a slight increase in c-reactive protein (CRP) 41.31 mg/L (reference value < 3.0 mg/L) without leukocytosis and normal ultrasound study, without visualization of the appendix. Due to persistent pain, increased CRP, and absence of appen dix visualization in the ultrasound, the study was completed with an abdomen and pelvis CT scan which showed trabeculation of the fat of the anterior right subhepatic space, thus diagnosing omental infarction. The patient was hospitalized for conservative management with analgesia, anti-inflamma tory drugs, and fluid therapy, presenting good evolution in the first 48 hours. CONCLUSION: Omental infarction is an infrequent cause of acute abdominal pain in childhood. Imaging studies play a funda mental role in the differential diagnosis of this entity with other clinical conditions of similar course, thus avoiding unnecessary surgical interventions.
Asunto(s)
Abdomen Agudo , Enfermedades Peritoneales , Enfermedades Vasculares , Abdomen Agudo/diagnóstico , Abdomen Agudo/etiología , Abdomen Agudo/cirugía , Dolor Abdominal/complicaciones , Dolor Abdominal/patología , Niño , Humanos , Infarto/diagnóstico , Infarto/etiología , Infarto/patología , Epiplón/patología , Epiplón/cirugía , Enfermedades Peritoneales/diagnóstico , Enfermedades Peritoneales/patología , Enfermedades Peritoneales/cirugía , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/patologíaRESUMEN
A 2-year-old female patient, admitted in the emergency room, presented diarrhea for 5 days and bloody stools in the last 24 hours. Physical examination revealed no significant findings. Ultrasound was initially performed, showing an elongated, well delimited and solid mass occupying since right hypocondrium until left iliac fossa, displacing adjacent structures. In sequence, magnetic resonance imaging was performed for confirmation of findings suggestive of omentum lipoma. After 1 week, the surgical resection was performed by videolaparoscopic acess. During 2-year follow-up, there was no sign of recurrence.
Asunto(s)
Lipoma , Epiplón , Niño , Preescolar , Femenino , Humanos , Lipoma/diagnóstico por imagen , Lipoma/cirugía , Imagen por Resonancia Magnética , Epiplón/diagnóstico por imagen , Epiplón/cirugía , UltrasonografíaRESUMEN
ABSTRACT A 2-year-old female patient, admitted in the emergency room, presented diarrhea for 5 days and bloody stools in the last 24 hours. Physical examination revealed no significant findings. Ultrasound was initially performed, showing an elongated, well delimited and solid mass occupying since right hypocondrium until left iliac fossa, displacing adjacent structures. In sequence, magnetic resonance imaging was performed for confirmation of findings suggestive of omentum lipoma. After 1 week, the surgical resection was performed by videolaparoscopic acess. During 2-year follow-up, there was no sign of recurrence.
Asunto(s)
Humanos , Femenino , Preescolar , Niño , Epiplón/cirugía , Epiplón/diagnóstico por imagen , Lipoma/cirugía , Lipoma/diagnóstico por imagen , Imagen por Resonancia Magnética , UltrasonografíaRESUMEN
Haemorrhagic events in patients diagnosed with coronavirus disease 19 (COVID-19) are infrequent but reports have accumulated since the beginning of the pandemic. The pathophysiological mechanisms are unclear, but endothelial damage secondary to systemic vasculitis and the onset of anticoagulation therapy, both associated with severe forms of the infection, have been proposed to play a role in the development of this complication. We present the case of a 66-year-old man who presented to the emergency department with acute abdominal pain, hypotension and decrease of consciousness, a few hours after being discharged after a prolonged hospitalisation of 26 days due to severe SARS-CoV-2 pneumonia. Initial resuscitation was carried out and, when haemodynamic stabilisation was achieved, a computed tomography scan showed contrast extravasation at the topography of the greater omentum. Urgent angiography revealing contrast extravasation originating in a pseudoaneurysm dependent on the right gastroepiploic artery was done, and embolisation with cyanoacrylate was performed at the bleeding point. Owing to persistent haemodynamic instability despite angiographic treatment and aggressive resuscitation, emergency laparotomy was indicated. Partial resection of the greater omentum was carried out and histopathologic examination showed a 5cm×4cm×6cm haematoma, with no signs of abnormalities such as aneurysm or malignancy. No rebleeding occurred. Spontaneous haemorrhage of the greater omentum associated with haemoperitoneum is a serious condition, with reported mortality rates exceeding 30%. This case highlights a very infrequent but potentially life-threatening complication in a patient diagnosed with COVID-19 on anticoagulation therapy.
Asunto(s)
COVID-19/complicaciones , Hemoperitoneo/etiología , Hemorragia/virología , Epiplón/cirugía , Enfermedades Peritoneales/virología , Anciano , Hemoperitoneo/cirugía , Hemorragia/cirugía , Humanos , Masculino , Enfermedades Peritoneales/cirugíaRESUMEN
Hérnia é uma protrusão de vísceras através de um orifício adquirido, tendo como constituintes o anel, conteúdo e saco herniário. As hérnias escrotais ocorrem quando, por algum defeito no anel inguinal, alguma víscera se desloca por ele, chegando até a bolsa escrotal. Sua etiologia não é completamenteelucidada, sendo a elevação da pressão intra-abdominal um dos prováveis desencadeadores. Em caninos, essa é uma condição rara e os poucos relatos citam em animais jovens. Objetivou-se descrever a ocorrência de uma hérnia escrotal unilateral esquerda com protrusão de omento maior em um cão da raça Dachshund com 14 anos de idade e com 12,1 kg de peso corporal. Para a redução do conteúdo à cavidade abdominal, foi necessária a realização de incisão na região inguinal cranial, abertura do saco herniário e a orquiectomia. Destaca-se a importância do tratamento cirúrgico da hérnia escrotal, bem como a inclusão dessa afecção no diagnóstico diferencial para afecções testiculares de cães adultos ou idosos.
Hernia is a protrusion of viscera through an acquired orifice, having as constituents the ring, contents and hernial sac. Scrotal hernias occur when, due to a defect in the inguinal ring, some viscera travel through it, reaching the scrotum. Its etiology is not completely elucidated, and the increase in intra-abdominal pressure is one of the probable triggers. In canines, this is a rare condition and the few reports mention it in young animals. The objective was to describe the occurrence of a left unilateral scrotal hernia with protrusion of the greater omentum in a 14-year-old Dachshund dog weighing 12.1 kg of body weight. To reduce the content of the abdominal cavity, it was necessary to make an incision in the cranial inguinal region, open the hernial sac and orchiectomy. The importance of surgical treatment of scrotal hernia is highlighted, as well as the inclusion of this condition in the differential diagnosis for testicular disorders of adult or elderly dogs.
Asunto(s)
Animales , Perros , Perros/cirugía , Herniorrafia/veterinaria , Hernia/diagnóstico , Epiplón/cirugíaRESUMEN
Hérnia é uma protrusão de vísceras através de um orifício adquirido, tendo como constituintes o anel, conteúdo e saco herniário. As hérnias escrotais ocorrem quando, por algum defeito no anel inguinal, alguma víscera se desloca por ele, chegando até a bolsa escrotal. Sua etiologia não é completamenteelucidada, sendo a elevação da pressão intra-abdominal um dos prováveis desencadeadores. Em caninos, essa é uma condição rara e os poucos relatos citam em animais jovens. Objetivou-se descrever a ocorrência de uma hérnia escrotal unilateral esquerda com protrusão de omento maior em um cão da raça Dachshund com 14 anos de idade e com 12,1 kg de peso corporal. Para a redução do conteúdo à cavidade abdominal, foi necessária a realização de incisão na região inguinal cranial, abertura do saco herniário e a orquiectomia. Destaca-se a importância do tratamento cirúrgico da hérnia escrotal, bem como a inclusão dessa afecção no diagnóstico diferencial para afecções testiculares de cães adultos ou idosos.
Hernia is a protrusion of viscera through an acquired orifice, having as constituents the ring, contents and hernial sac. Scrotal hernias occur when, due to a defect in the inguinal ring, some viscera travel through it, reaching the scrotum. Its etiology is not completely elucidated, and the increase in intra-abdominal pressure is one of the probable triggers. In canines, this is a rare condition and the few reports mention it in young animals. The objective was to describe the occurrence of a left unilateral scrotal hernia with protrusion of the greater omentum in a 14-year-old Dachshund dog weighing 12.1 kg of body weight. To reduce the content of the abdominal cavity, it was necessary to make an incision in the cranial inguinal region, open the hernial sac and orchiectomy. The importance of surgical treatment of scrotal hernia is highlighted, as well as the inclusion of this condition in the differential diagnosis for testicular disorders of adult or elderly dogs.
Asunto(s)
Animales , Perros , Testículo/cirugía , Perros/cirugía , Hernia/veterinaria , Epiplón/cirugía , Herniorrafia/veterinaria , Conducto Inguinal/cirugíaRESUMEN
Hérnia é uma protrusão de vísceras através de um orifício adquirido, tendo como constituintes o anel, conteúdo e saco herniário. As hérnias escrotais ocorrem quando, por algum defeito no anel inguinal, alguma víscera se desloca por ele, chegando até a bolsa escrotal. Sua etiologia não é completamenteelucidada, sendo a elevação da pressão intra-abdominal um dos prováveis desencadeadores. Em caninos, essa é uma condição rara e os poucos relatos citam em animais jovens. Objetivou-se descrever a ocorrência de uma hérnia escrotal unilateral esquerda com protrusão de omento maior em um cão da raça Dachshund com 14 anos de idade e com 12,1 kg de peso corporal. Para a redução do conteúdo à cavidade abdominal, foi necessária a realização de incisão na região inguinal cranial, abertura do saco herniário e a orquiectomia. Destaca-se a importância do tratamento cirúrgico da hérnia escrotal, bem como a inclusão dessa afecção no diagnóstico diferencial para afecções testiculares de cães adultos ou idosos.(AU)
Hernia is a protrusion of viscera through an acquired orifice, having as constituents the ring, contents and hernial sac. Scrotal hernias occur when, due to a defect in the inguinal ring, some viscera travel through it, reaching the scrotum. Its etiology is not completely elucidated, and the increase in intra-abdominal pressure is one of the probable triggers. In canines, this is a rare condition and the few reports mention it in young animals. The objective was to describe the occurrence of a left unilateral scrotal hernia with protrusion of the greater omentum in a 14-year-old Dachshund dog weighing 12.1 kg of body weight. To reduce the content of the abdominal cavity, it was necessary to make an incision in the cranial inguinal region, open the hernial sac and orchiectomy. The importance of surgical treatment of scrotal hernia is highlighted, as well as the inclusion of this condition in the differential diagnosis for testicular disorders of adult or elderly dogs.(AU)
Asunto(s)
Animales , Perros , Perros/cirugía , Hernia/diagnóstico , Epiplón/cirugía , Herniorrafia/veterinariaRESUMEN
OBJECTIVE: A recent meta-analysis of 3 randomized controlled trials reported reduced incidence and severity of postesophagectomy anastomotic dehiscence with anastomotic omentoplasty. Unfortunately, these trials excluded neoadjuvant patients who received chemoradiation. We aimed to determine whether anastomotic omentoplasty was associated with differential postesophagectomy anastomotic complications after neoadjuvant chemoradiotherapy. METHODS: Data for patients who underwent minimally invasive esophagectomy following neoadjuvant chemoradiotherapy were abstracted (n = 245; 2001-2016; omentoplasty = 147 [60%]). Propensity for omentoplasty was estimated on 21 pretreatment variables, using augmented inverse probability of treatment weights, and used to determine the adjusted proportion of adverse anastomotic outcomes, major morbidity, and 30-day/in-hospital mortality. RESULTS: Overall, anastomotic leak rate was 15%; leak-associated mortality was 13% (n = 5 out of 37). Leak rates (omentoplasty n = 24 [16%] vs no omentoplasty n = 13 [13%]; P = .512) and incidence of any major complications (48% vs 48%; P = .958) were similar. Leaks requiring surgical intervention occurred in 12 patients (5% vs 5%; P = .904). Propensity weighting achieved excellent balance across all 21 pretreatment variables (before weighting, standardized differences ranged from -0.23 to 0.35; postweighting standardized differences ranged from -0.09 to 0.07). In propensity-weighted data, omentoplasty was not associated with differential adjusted risk of anastomotic leak (13.2% vs 14.3%; P = .83), major morbidity (27.9% vs 32.6%; P = .44), or mortality (6.7% vs 4.8%; P = .61). CONCLUSIONS: Within the limits of our sample size and statistical approach, our study failed to find evidence that anastomotic omentoplasty during esophagectomy after neoadjuvant chemoradiation reduced anastomotic leak rate or need for leak-related reoperation.
Asunto(s)
Fuga Anastomótica , Neoplasias Esofágicas/terapia , Esofagectomía/efectos adversos , Epiplón/cirugía , Anciano , Fuga Anastomótica/mortalidad , Fuga Anastomótica/cirugía , Quimioradioterapia/efectos adversos , Quimioradioterapia/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Neoadyuvante/efectos adversos , Terapia Neoadyuvante/estadística & datos numéricos , Puntaje de Propensión , Estudios Prospectivos , Procedimientos de Cirugía PlásticaRESUMEN
Resumen: Introducción: el infarto segmentario idiopático de epiplón mayor es una excepcional causa de cuadro agudo de abdomen en el adulto. Caso clínico: se presenta el caso de un adulto joven que se operó de urgencia con diagnóstico de apendicitis aguda y el abordo por vía laparoscópica, comprobándose en la exploración un infarto segmentario de epiplón mayor que se resolvió mediante la omentectomía parcial con buena evolución y alta precoz. Discusión: si bien el diagnóstico imagenológico de infarto de epiplón mayor es posible dada su baja incidencia y las características de presentación clínica, su diagnóstico habitualmente es intraoperatorio. Su tratamiento es la omentectomía laparoscópica del sector afectado. Con diagnóstico preoperatorio, puede admitirse una conducta expectante, aunque la persistencia de la sintomatología es causa de reingreso y prolongación del tratamiento definitivo.
Summary: Introduction: idiopathic segmental infarction of the greater omentum constitutes an exceptional cause of an acute condition in adults. Clinical case: study presents the clinical case of a young adult who underwent an emergency laparoscopic appendectomy for the treamtent of acute apenditicis. The exploration revealed a segmental infarction of the greater omentum that was resolved by partial omentectomy. Evolution was good and the patient was allowed an early discharge. Discussion: despite the fact an image diagnosis of infarction of the greater omentum is possible, its low incidence and the characteristics of its clinical presentation result in it usually being diagnosed during surgery. Treatment consists in laparoscopic omentenctomy of the affected area. Preoperative diagnosis may allow for watchful waiting, although persistence of symptoms requires readmission to hospital and extension of the definitive treatment.
Resumo: Introdução: o infarto segmentar idiopático do grande omento é uma causa excepcional de quadro agudo de abdômen no adulto. Caso clínico: apresenta-se um caso clínico de um adulto jovem operado de urgência por via laparoscópica com diagnóstico de apendicite aguda comprovando-se na exploração um infarto segmentar de grande omento solucionado por uma omentectomia parcial com boa evolução e alta precoce. Discussão: embora o diagnóstico por técnicas de imagem de infarto do grande omento seja possível, seu diagnóstico habitualmente es intraoperatório devido à sua baja incidência e as características da apresentação clínica. O tratamento é a omentectomia laparoscópica do segmento afetado. Com diagnóstico pré-operatório, pode-se admitir uma conduta expectante, embora a persistência de sintomatologia é causa de re-internação e prolongamento do tratamento definitivo.
Asunto(s)
Masculino , Adulto , Epiplón/cirugía , Infarto , Laparoscopía , Abdomen AgudoRESUMEN
Apresentamos o caso de um paciente de 70 anos de idade que evoluiu com extenso defeito cutâneo em parede torácica anterior após ter sido submetido a revascularização do miocárdio e mediastinite pós-operatória. Pela impossibilidade de utilização de retalhos cutâneos e musculares da região, fizemos a reconstrução com a rotação de retalho de omento baseado na artéria gastroepiploica esquerda e enxerto de pele em malha.
We report the case of a 70-year-old patient who developed an extensive skin defect in the anterior chest wall after undergoing myocardial revascularization and postoperative mediastinitis. Owing to the impossibility of using cutaneous and muscular flaps on the region, we performed the reconstruction with an omentum flap based on the left gastroepiploic artery and meshed skin graft.
Asunto(s)
Humanos , Masculino , Anciano , Epiplón , Complicaciones Posoperatorias , Colgajos Quirúrgicos , Procedimientos de Cirugía Plástica , Pared Torácica , Epiplón/cirugía , Epiplón/lesiones , Complicaciones Posoperatorias/diagnóstico , Colgajos Quirúrgicos/cirugía , Procedimientos de Cirugía Plástica/métodos , Pared Torácica/cirugía , Pared Torácica/lesionesRESUMEN
BACKGROUND AND OBJECTIVES: The ultrasonically activated scalpel is a surgical instrument that is used in minimally invasive surgery to safely cut and seal vessels. This study reported the experimental observations of the use of a laparoscopic ultrasonic scalpel, including its safety and feasibility. in sealing vessels of different diameters in an in vivo animal model during both physiological and supraphysiological blood pressure (BP) conditions. METHODS: One healthy female swine was used. We performed resections of the omentum, biopsies in different regions of the liver, and a hysterectomy. Vessels with diameters ranging from 2 to 10 mm were sealed with the ultrasonic scalpel under regular hemodynamic conditions and during pharmacologically induced arterial hypertension (BP challenge). RESULTS: For 10 random cuts made in the omentum and during the hysterectomy, the ultrasonic scalpel was effective and fast, with no immediate or delayed bleeding. Bipolar energy, sutures, and hemoclips were not required to control bleeding. No bleeding was observed in sealed vessels up to 8 mm, even during BP challenges sustained for longer than 5 minutes. When testing vessels of 10 mm, bleeding occurred in 1 common iliac vein before 10 minutes of waiting (the point of bleeding was easily identified) and bleeding occurred in 1 of the common iliac arteries during the BP challenge. CONCLUSION: Our findings corroborate that the ultrasonic scalpel can safely seal arteries up to 8 mm in diameter to prevent or control bleeding during laparoscopic procedures, even when BP exceeds normal levels.
Asunto(s)
Hemostasis Quirúrgica/instrumentación , Terapia por Ultrasonido/instrumentación , Animales , Biopsia/instrumentación , Hemorragia/terapia , Histerectomía/instrumentación , Laparoscopía , Hígado/patología , Modelos Animales , Epiplón/cirugía , PorcinosRESUMEN
BACKGROUND: Omental torsion is an infrequent cause of acute abdomen and its symptoms are non-specific, often presenting with pain at the right iliac fossa as the only symptom. Its aetiology remains unknown, but different risk factors have been associated with the disease, including obesity, congenital malformations, and tumours. These risk factors have been classified as predisposing or triggering, primary or secondary, and external or internal. CLINICAL CASE: The is a case of a 24-year-old male who complained about pain in the right iliac fossa without any other symptoms. The diagnosis was acute appendicitis, but during the laparoscopic approach, omental torsion was found. CONCLUSION: The diagnosis of omental torsion is is complex. However, computed tomography and ultrasound have been used successfully. The treatment for omental torsion is the resection of necrotised tissue by a laparoscopic approach.
Asunto(s)
Errores Diagnósticos , Epiplón/cirugía , Enfermedades Peritoneales/diagnóstico , Anomalía Torsional/diagnóstico , Abdomen Agudo/etiología , Apendicectomía , Apendicitis/diagnóstico , Urgencias Médicas , Humanos , Laparoscopía , Masculino , Enfermedades Peritoneales/complicaciones , Enfermedades Peritoneales/cirugía , Factores de Riesgo , Anomalía Torsional/complicaciones , Anomalía Torsional/cirugía , Adulto JovenRESUMEN
PURPOSE: To determine the incidence of enterocutaneous fistulas (ECFs) developed after elective incisional hernia (IH) repair using intraperitoneal uncoated polypropylene (PPE) mesh. METHODS: This is a retrospective descriptive study of a prospective cohort of patients undergoing elective IH repair using intraperitoneal uncoated PPE mesh at the Department of General Surgery of a high complexity University Hospital. RESULTS: Between January 1992 and December 2013, 695 IH repairs were performed using intraperitoneal uncoated PPE mesh. The omentum was placed between the mesh and bowel in 507 patients (73 %). In 188 patients (27 %) it was not possible to place the omentum between the mesh and bowel; therefore, in 69 patients (9.92 %) the PPE mesh was placed over the bowel, whereas in 119 patients (17.12 %) a Vicryl® mesh was placed between the bowel and PPE mesh. Six hundred and seventy-eight (97.5 %) IH repairs were open whereas 17 (2.5 %) were laparoscopic. Postoperative complications consisted of seroma (5.9 %), hematoma (4.3 %), wound infection (4.8 %), and mesh infection (4.0 %). Recurrence of IH occurred in 52 patients (7.4 %) after a mean follow-up of 59 months. Four (0.5 %) patients required additional surgery due to intestinal occlusion. Neither acute nor chronic ECFs were encountered during follow-up in 695 patients. CONCLUSION: Based on these results, the placement of intraperitoneal uncoated PPE mesh for elective IH repair might be a safe procedure that is not associated with ECF formation.
Asunto(s)
Hernia Ventral/cirugía , Herniorrafia/efectos adversos , Hernia Incisional/cirugía , Fístula Intestinal/etiología , Mallas Quirúrgicas/efectos adversos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Procedimientos Quirúrgicos Electivos/efectos adversos , Femenino , Herniorrafia/instrumentación , Humanos , Incidencia , Fístula Intestinal/epidemiología , Masculino , Persona de Mediana Edad , Epiplón/cirugía , Peritoneo/cirugía , Polipropilenos , Estudios Retrospectivos , Adulto JovenRESUMEN
Introducción: la sutura y epiploplastia de la úlcera perforada con tratamiento médico posterior para erradicar el Helicobacter pylori, ha disminuido la recurrencia de la úlcera péptica, lo cual renueva el interés en este proceder ante las técnicas definitivas.Objetivos: determinar la eficacia a mediano plazo de este proceder en pacientes operados de úlcera péptica perforada. Métodos: se realizó un estudio observacional analítico en el Hospital Universitario Manuel Ascunce Domenech de Camagüey, desde enero de 2010 hasta diciembre de 2013. El estudio estuvo conformado por los pacientes operados de úlcera perforada con más de un año de evolución (45 casos). Los datos obtenidos se procesaron mediante el paquete estadístico SPSS para Windows versión 15.0, con técnica estadística de comparación de la prueba de hipótesis de proporciones en una computadora Pentium IV. Resultados: el sexo más afectado fue el masculino y predominó en la cuarta y quinta décadas de la vida. La localización más frecuente de la perforación fue duodenal y la mayoría, menores de 1 cm. Las complicaciones posoperatorias más frecuentes fueron las infecciones respiratorias. El tabaquismo y la ingestión de café fueron los factores de riesgo actuales más frecuentes. La mayoría de los pacientes recibieron tratamiento médico completo en el posoperatorio, con buenos resultados de acuerdo a la clasificación de Visick y en la endoscopia realizada, donde solo una paciente presentó enfermedad ulcerosa. Conclusiones: se comprobó que la sutura y epiploplastia de la úlcera perforada con tratamiento médico posterior completo es eficaz a mediano plazo(AU)
Introduction: suture and epiploplasty of perforated ulcer using further medical treatment for helicobacter pylori eradication has decreased recurrence of peptic ulcer, renewing interest in this proceeding in contrast to final techniques. Objective: determine the medium term efficacy of this procedure in patients undergoing surgery for perforated peptic ulcer. Methods: an observational study was conducted at Manuel Ascunce Domenech University Hospital in Camagüey, from January 2010 to December 2013. The study consisted of patients operated on for perforated ulcer over a year (45 cases). The obtained data were processed using SPSS for Windows version 15.0, with statistical technique of comparing the proportions hypothesis test on a Pentium IV computer. Results: the most affected patients were male aging forty and fifty. The most frequent location was duodenal perforation and most of them less than 1 cm. The most frequent postoperative complications were respiratory infections. Smoking habits and coffee intake were the most common risk factors. Most patients received full medical treatment in the postoperative period, with good results according to Visick classification and the endoscopy, where only one patient had ulcer disease. Conclusions: suture and perforated ulcer epiploplasty with subsequent full medical treatment, definitively, cure patients(AU)
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Úlcera Gástrica/complicaciones , Úlcera Péptica Perforada/cirugía , Técnicas de Sutura , Epiplón/cirugía , Infecciones por Helicobacter/terapia , Factores de Riesgo , Interpretación Estadística de Datos , Estudio ObservacionalRESUMEN
Introducción: la sutura y epiploplastia de la úlcera perforada con tratamiento médico posterior para erradicar el Helicobacter pylori, ha disminuido la recurrencia de la úlcera péptica, lo cual renueva el interés en este proceder ante las técnicas definitivas. Objetivos: determinar la eficacia a mediano plazo de este proceder en pacientes operados de úlcera péptica perforada. Métodos: se realizó un estudio observacional analítico en el Hospital Universitario "Manuel Ascunce Domenech" de Camagüey, desde enero de 2010 hasta diciembre de 2013. El estudio estuvo conformado por los pacientes operados de úlcera perforada con más de un año de evolución (45 casos). Los datos obtenidos se procesaron mediante el paquete estadístico SPSS para Windows versión 15.0, con técnica estadística de comparación de la prueba de hipótesis de proporciones en una computadora Pentium IV. Resultados: el sexo más afectado fue el masculino y predominó en la cuarta y quinta décadas de la vida. La localización más frecuente de la perforación fue duodenal y la mayoría, menores de 1 cm. Las complicaciones posoperatorias más frecuentes fueron las infecciones respiratorias. El tabaquismo y la ingestión de café fueron los factores de riesgo actuales más frecuentes. La mayoría de los pacientes recibieron tratamiento médico completo en el posoperatorio, con buenos resultados de acuerdo a la clasificación de Visick y en la endoscopia realizada, donde solo una paciente presentó enfermedad ulcerosa. Conclusiones: se comprobó que la sutura y epiploplastia de la úlcera perforada con tratamiento médico posterior completo es eficaz a mediano plazo(AU)
Introduction: suture and epiploplasty of perforated ulcer using further medical treatment for helicobacter pylori eradication has decreased recurrence of peptic ulcer, renewing interest in this proceeding in contrast to final techniques. Objective: determine the medium term efficacy of this procedure in patients undergoing surgery for perforated peptic ulcer. Methods: an observational study was conducted at Manuel Ascunce Domenech University Hospital in Camagüey, from January 2010 to December 2013. The study consisted of patients operated on for perforated ulcer over a year (45 cases). The obtained data were processed using SPSS for Windows version 15.0, with statistical technique of comparing the proportions hypothesis test on a Pentium IV computer. Results: the most affected patients were male aging forty and fifty. The most frequent location was duodenal perforation and most of them less than 1 cm. The most frequent postoperative complications were respiratory infections. Smoking habits and coffee intake were the most common risk factors. Most patients received full medical treatment in the postoperative period, with good results according to Visick classification and the endoscopy, where only one patient had ulcer disease. Conclusions: suture and perforated ulcer epiploplasty with subsequent full medical treatment, definitively, cure patients(AU)
Asunto(s)
Humanos , Masculino , Adulto , Persona de Mediana Edad , Interpretación Estadística de Datos , Infecciones por Helicobacter/terapia , Epiplón/cirugía , Úlcera Péptica Perforada/cirugía , Factores de Riesgo , Técnicas de Sutura , Estudio Observacional , Úlcera Gástrica/complicacionesRESUMEN
INTRODUCTION: Complete ureteral avulsion is one of the most serious complications of ureteroscopy. The aim of this report was to look for a good solution to full-length complete ureteral avulsion. CASE PRESENTATION: A 40-year-old man underwent ureteroscopic management. Full-length complete avulsion of ureter occurred during ureteroscopy. Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis were performed 6 hours after ureteral avulsion. The patient was followed-up during 34 months. Double-J tube was removed at 3 months after operation. Twenty three months after the first operation, the patient developed hydronephrosis because of a new ureter upside stone, then rigid ureteroscopy and holmium laser lithotripsy were used successfully. CONCLUSION: Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis may be a good choice for full-length complete ureteral avulsion.
Asunto(s)
Uréter/lesiones , Enfermedades Ureterales/etiología , Enfermedades Ureterales/cirugía , Ureteroscopía/efectos adversos , Ureterostomía/métodos , Adulto , Anastomosis Quirúrgica , Manejo de la Enfermedad , Humanos , Hidronefrosis/cirugía , Masculino , Epiplón/cirugía , Resultado del Tratamiento , Urolitiasis/cirugíaRESUMEN
BACKGROUND: Visceral obesity has been considered a risk factor for metabolic and cardiovascular complications. In an attempt to reduce the visceral adipose tissue, omentectomy has been proposed to be performed along with bariatric surgery. OBJECTIVE: The goal of this study was to evaluate whether omentectomy associated with sleeve gastrectomy (SG) is beneficial to the inflammatory and metabolic profile of rats fed a standard diet (STD) or high-fat diet (HFD). SETTING: University hospital, Brazil. METHODS: For this experiment, male Wistar rats were randomly divided into 6 groups as follows: sham surgery (STD+L or HFD+L), SG alone (STD+SG or HFD+SG), or SG with omentectomy (STD+SGO or HFD+SGO). Anthropometric data and metabolic profiles were evaluated, and the tissue expression of inflammatory markers in the visceral adipose tissue was measured. RESULTS: In rats with diet-induced obesity treated with SG with or without omentectomy, there was a reduction in weight (HFD+SG: P<.01 and HFD+SGO: P<.05), adiposity (HFD+SG: P<.001 and HFD+SGO: P<.05), plasma levels of glucose (HFD+SG: P<.01 and HFD+SGO: P<.01), plasma levels of C-peptide (HFD+SG: P<.01 and HFD+SGO: P<.001), plasma levels of insulin (HFD+SG: P<.05 and HFD+SGO: P<.001), plasma levels of total cholesterol (HFD+SG: P<.01 and HFD+SGO: P<.01), and tissue expression of TNF-α (HFD+SG: P<.001 and HFD+SGO: P<.01), but there was no statistically significant difference between the groups in which omentectomy was performed or was not. CONCLUSION: In this study, we did not observe additional beneficial effects due to omentectomy associated with SG in the metabolic profile and tissue expression of inflammatory markers.
Asunto(s)
Cirugía Bariátrica/métodos , Gastrectomía/métodos , Obesidad Mórbida/cirugía , Epiplón/cirugía , Animales , Biomarcadores/metabolismo , Colesterol/metabolismo , Citocinas/metabolismo , Dieta Alta en Grasa , Grasa Intraabdominal/anatomía & histología , Masculino , Distribución Aleatoria , Ratas Wistar , Pérdida de Peso/fisiologíaRESUMEN
ABSTRACT Introduction Complete ureteral avulsion is one of the most serious complications of ureteroscopy. The aim of this report was to look for a good solution to full-length complete ureteral avulsion. Case presentation A 40-year-old man underwent ureteroscopic management. Full-length complete avulsion of ureter occurred during ureteroscopy. Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis were performed 6 hours after ureteral avulsion. The patient was followed-up during 34 months. Double-J tube was removed at 3 months after operation. Twenty three months after the first operation, the patient developed hydronephrosis because of a new ureter upside stone, then rigid ureteroscopy and holmium laser lithotripsy were used successfully. Conclusion Pyeloureterostomy plus greater omentum investment outside the avulsed ureter and ureterovesical anastomosis may be a good choice for full-length complete ureteral avulsion.
Asunto(s)
Humanos , Masculino , Adulto , Uréter/lesiones , Enfermedades Ureterales/cirugía , Enfermedades Ureterales/etiología , Ureterostomía/métodos , Ureteroscopía/efectos adversos , Epiplón/cirugía , Anastomosis Quirúrgica , Resultado del Tratamiento , Manejo de la Enfermedad , Urolitiasis/cirugía , Hidronefrosis/cirugíaRESUMEN
BACKGROUND: Mesenteric lymphangioma are rare tumours. They usually present early on in life, if congenital, or soon after trauma. The usual sites of presentation of lymphangiomas are in the neck, and axillae. In the abdomen they are more common in the mesentery, primarily of the ileum, or retroperitoneal. OBJECTIVE: A rare case is presented of a mesenteric lymphangioma. CLINICAL CASE: It involves an elderly African-American male, many years after trauma, and characterised with early satiety, causing weight loss, but without gastric outlet obstruction or vomiting. Its diagnosis, management and review of literature are presented. CONCLUSIONS: Mesenteric cysts are rare tumours that should be included as differential diagnosis in elderly patients with a history of previous abdominal trauma.