RESUMEN
Colonic lymphoma is a rare malignant gastrointestinal tumor that can be revealed by an exceptional and serious complication: intestinal obstruction. Treatment is based on surgery and chemotherapy. We here report a case of diffuse colonic large B-cell lymphoma revealed by occlusion and diagnosed based on the examination of surgical specimen in a 64-year-old man who was in complete remission after six courses of R-CHOP.
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Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias del Colon , Ciclofosfamida , Doxorrubicina , Obstrucción Intestinal , Linfoma de Células B Grandes Difuso , Prednisona , Rituximab , Vincristina , Humanos , Masculino , Persona de Mediana Edad , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/cirugía , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/complicaciones , Neoplasias del Colon/patología , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/patología , Ciclofosfamida/administración & dosificación , Vincristina/administración & dosificación , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Prednisona/administración & dosificación , Doxorrubicina/administración & dosificación , Rituximab/administración & dosificación , Inducción de RemisiónRESUMEN
Introduction: Actinomycosis is an uncommon inflammatory bacterial disease caused by Actinomyces species, especially Actinomyces Israeli. Abdominopelvic forms are relatively rare and may involve the colon as a solid mass, mimicking a malignant tumor. Case presentation: A 68-year-old Tunisian man, with a history of diabetes, hypertension, penicillin allergy, and renal failure, presented to the emergency department with abdominal pain, vomiting, and bowel obstruction. CT scan showed an acute intestinal obstruction upstream with obstructive tissular mass at the sigmoid colon. Emergency surgery revealed a sigmoid mass and a pre-perforative cecum. Total colectomy was performed, with ileostomy and distal end closure. Histological examination confirmed Actinomyces infection. The patient was then placed on long-term doxycycline and Bactrim, with no recurrence over a 9-month follow-up period. Conclusion: Abdominal actinomycosis, though rare, presents diagnostic challenges. It can be mistaken for malignancy, leading to unnecessary surgery in non-complicated cases, since it is effectively treated by antibiotics. In complicated cases, a combined approach involving both surgery and antibiotic therapy is necessary until the infection is completely eradicated.
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Actinomicosis , Obstrucción Intestinal , Humanos , Actinomicosis/diagnóstico , Actinomicosis/complicaciones , Masculino , Anciano , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/microbiología , Obstrucción Intestinal/etiología , Diagnóstico Diferencial , Colon Sigmoide/patología , Colon Sigmoide/microbiología , Tomografía Computarizada por Rayos XRESUMEN
Mesenteric cysts have been documented as a rare occurrence in children. They are mostly renowned to be benign intra-abdominal tumors with no known etiology. The symptoms are non-specific ranging from being asymptomatic to an acute abdomen. Most of the diagnoses are made below the age of 10 years with devoid of reports for the early neonatal occurrences. We report a case of an early neonatal mesenteric cyst in a 5-day-old female patient who presented with signs of intestinal obstruction markedly by abdominal distension, vomiting, and absolute constipation. Abdominal X-ray showed evidence of small bowel obstruction while abdominal ultrasound and computed tomography (CT) scan were used to reach the diagnosis of a mesenteric cyst, all laboratory baseline investigations were within a normal range. On laparotomy a 12 by 13 cm cyst that was firmly adhering to the proximal ileal wall was meticulously dissected, complete cystectomy was done with no segmental resection. Histopathologically there were no signs of malignancy and the patient successfully recovered with no signs of recurrences after being followed for a year and a half. Being a rare case in the early neonatal period with unspecific presentations; mesenteric cyst should be considered as one of the diagnoses best to be managed by surgical excision to prevent recurrences.
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Obstrucción Intestinal , Laparotomía , Quiste Mesentérico , Tomografía Computarizada por Rayos X , Humanos , Quiste Mesentérico/diagnóstico , Quiste Mesentérico/cirugía , Quiste Mesentérico/patología , Femenino , Recién Nacido , Laparotomía/métodos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico , Ultrasonografía , Estudios de Seguimiento , Vómitos/etiología , Estreñimiento/etiología , Radiografía AbdominalRESUMEN
ABSTRACT: Transmesentric hernias are a type of internal hernia, in which there is herniation of bowel loops through a defect in the mesentery. They present with a wide variety of symptoms without any specific radiological features, leading to a delay in diagnosis and high mortality rate. Here, we present a case series of four patients with this rare but fatal cause of small bowel obstruction. Three children presented to the emergency department with small bowel obstruction. The other baby was a preterm neonate with an antenatal scan showing small bowel obstruction. All children underwent emergency laparotomy and were found to have a mesenteric defect with herniation and gangrene of the small bowel. Resection anastomosis of the gangrenous segment and closure of the mesenteric defect were done. The differential for small bowel obstruction in children should include transmesentric hernia. Laboratory or imaging investigations are often inconclusive. Timely exploration can save lives in this rare but life-threatening condition.
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Obstrucción Intestinal , Laparotomía , Mesenterio , Humanos , Mesenterio/cirugía , Mesenterio/anomalías , Masculino , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico , Femenino , Recién Nacido , Laparotomía/métodos , Lactante , Resultado Fatal , Intestino Delgado/cirugía , Diagnóstico Diferencial , Hernia Interna/cirugía , Hernia Interna/complicaciones , Hernia Interna/diagnóstico , Gangrena/cirugía , Gangrena/etiología , Hernia Abdominal/cirugía , Hernia Abdominal/diagnóstico , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico por imagen , Hernia Abdominal/congénitoRESUMEN
The widespread occurrence and severity of tuberculosis make it a major global health concern. Abdominal issues often affect the intestine, peritoneum, and lymph nodes, with retroperitoneal involvement being rare. We herein present a case involving a 51-year-old man who experienced abdominal pain and fever. He had a history of pulmonary tuberculosis 1 year prior, which had been cured 6 months before presentation to our hospital. Abdominal unenhanced computed tomography revealed incomplete bowel obstruction. Abdominal enhanced computed tomography showed significant enlargement of the retroperitoneal lymph nodes, which were compressing the intestinal lumen. Colonoscopy indicated that the terminal ileum and colon were normal. Ultrasound-guided percutaneous lymph node aspiration was performed, and Mycobacterium tuberculosis fluorescence staining was positive. After anti-tuberculosis treatment, the patient's abdominal pain and fever improved. Retroperitoneal lymph node tuberculosis presents atypically, and obtaining histopathology early is therefore crucial for diagnosis and treatment.
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Obstrucción Intestinal , Ganglios Linfáticos , Tomografía Computarizada por Rayos X , Tuberculosis Ganglionar , Humanos , Masculino , Persona de Mediana Edad , Tuberculosis Ganglionar/diagnóstico , Tuberculosis Ganglionar/complicaciones , Tuberculosis Ganglionar/patología , Tuberculosis Ganglionar/tratamiento farmacológico , Obstrucción Intestinal/etiología , Obstrucción Intestinal/patología , Obstrucción Intestinal/diagnóstico , Ganglios Linfáticos/patología , Espacio Retroperitoneal/patología , Espacio Retroperitoneal/diagnóstico por imagen , Antituberculosos/uso terapéutico , Mycobacterium tuberculosis/aislamiento & purificaciónRESUMEN
Presentation of congenital diaphragmatic hernia in adulthood is rare. Further, most cases are attributable to Bochdalek and Morgagni hernias with central tendon hernias being particularly uncommon. We report a case of central congenital diaphragmatic hernia in an adult presenting as large intestinal obstruction and respiratory failure. Open repair of the hernia was performed, which brought about the resolution of the patient's symptoms. This case report highlights the possibility for congenital diaphragmatic hernia to present in adulthood and the importance of early diagnosis and treatment in these situations.
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Hernia Diafragmática , Hernias Diafragmáticas Congénitas , Obstrucción Intestinal , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/diagnóstico , Hernias Diafragmáticas Congénitas/complicaciones , Hernias Diafragmáticas Congénitas/cirugía , Hernias Diafragmáticas Congénitas/diagnóstico por imagen , Hernias Diafragmáticas Congénitas/diagnóstico , Hernia Diafragmática/complicaciones , Hernia Diafragmática/diagnóstico por imagen , Hernia Diafragmática/cirugía , Hernia Diafragmática/diagnóstico , Masculino , Femenino , Adulto , Insuficiencia Respiratoria/etiología , Tomografía Computarizada por Rayos X , Diagnóstico DiferencialRESUMEN
PURPOSE: Inflammatory factors play an important role in the onset and progression of colorectal cancer (CRC). This study aimed to develop and validate a novel scoring system that utilizes specific inflammatory factor indicators to predict intestinal obstruction in CRC patients. METHODS: This study conducted a retrospective analysis of 1,470 CRC patients who underwent surgical resection between January 2013 and July 2018. These patients were randomly allocated to the training group (n = 1060) and the validation group (n = 410). Univariate and multivariate logistic regression analyses were performed to identify independent predictive factors for intestinal obstruction. The CRC peculiar inflammation score (CPIS), comprising lymphocyte-to-monocyte ratio (LMR), prognostic nutrition index (PNI), and alanine transaminase-to-lymphocyte ratio index (ALRI) scores, was significantly associated with the occurrence of intestinal obstruction. A nomogram combining CPIS with other clinical features was developed to predict this occurrence. Model accuracy was assessed by determining the area under the receiver operating characteristic (ROC) curve (AUC). RESULTS: The CPIS generated by multi-factor logistic regression was as follows: - 1.576 × LMR - 0.067 × PNI + 0.018 × ALRI. Using CPIS cutoff values of 50% (- 7.188) and 85% (- 6.144), three predictive groups were established. Patients with a high CPIS had a significantly higher risk of intestinal obstruction than those with a low CPIS (odds ratio [OR]: 10.0, confidence interval [CI]: 5.85-17.08, P < 0.001). The predictive nomogram demonstrated good calibration and discrimination abilities. The AUC of the ROC curve for the obstruction nomogram was 0.813 (95% CI: 0.777-0.850) in the training set and 0.806 (95% CI: 0.752-0.860) in the validation set. The calibration curve exhibited neither bias nor high credibility. Decision curve analysis indicated the utility of this predictive model. CONCLUSION: CRC-associated intestinal obstruction is closely linked to inflammatory markers in patients. CPIS is a CRC-specific inflammatory predictive score based on a combination of inflammatory-related indicators. A high CPIS serves as a strong indicator of intestinal obstruction. Its integration with other clinical factors and preoperative inflammatory-specific indicators significantly enhances the diagnosis and treatment of CRC patients with intestinal obstruction.
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Neoplasias Colorrectales , Inflamación , Obstrucción Intestinal , Nomogramas , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico , Masculino , Femenino , Neoplasias Colorrectales/complicaciones , Neoplasias Colorrectales/diagnóstico , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Inflamación/complicaciones , Pronóstico , Linfocitos , Curva ROC , Evaluación Nutricional , Monocitos , Recuento de LinfocitosRESUMEN
Cystic Fibrosis (CF) is a complex disorder that requires multidisciplinary expertise for effective management. The GALAXY study estimated the prevalence of constipation to be about 25% among People with Cystic Fibrosis (PwCF), identifying it as one of the common gastrointestinal (GI) symptoms within this patient population. Quality of Life (QoL) assessments uncovered high patient dissatisfaction, highlighting the imperative need for enhanced treatment strategies. Similarly, Distal Intestinal Obstruction Syndrome (DIOS) is a unique condition exclusive to PwCF that, if left undiagnosed, can lead to considerable morbidity and mortality. Given the broad spectrum of differential diagnoses for abdominal pain, including constipation and DIOS, it is paramount for healthcare providers to possess a clear understanding of these conditions. This paper aims to delineate various differentials for abdominal pain while elucidating the pathogenesis, diagnostic criteria, and treatment options for managing constipation and DIOS in PwCF.
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Estreñimiento , Fibrosis Quística , Humanos , Diagnóstico Diferencial , Estreñimiento/diagnóstico , Estreñimiento/terapia , Estreñimiento/etiología , Fibrosis Quística/diagnóstico , Fibrosis Quística/complicaciones , Fibrosis Quística/terapia , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/terapia , Obstrucción Intestinal/etiología , Dolor Abdominal/etiología , Dolor Abdominal/diagnóstico , Calidad de VidaRESUMEN
Internal hernias, in particular, hernia of the foramen of Winslow, are rare and occur in typical sites. Laparotomy is common in these cases while laparoscopic surgery is rarely used in such urgent cases. However, modern diagnosis and treatment including computed tomography and laparoscopy allowing minimally invasive interventions are not an exception for patients with hernia of the foramen of Winslow. This approach is effective for this problem and prevents adverse outcomes of disease.
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Obstrucción Intestinal , Laparoscopía , Tomografía Computarizada por Rayos X , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico , Laparoscopía/métodos , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Herniorrafia/métodos , Masculino , Enfermedades del Colon/cirugía , Enfermedades del Colon/etiología , Enfermedades del Colon/diagnóstico , Laparotomía/métodos , Hernia Interna/complicaciones , Hernia Interna/cirugía , Hernia Interna/diagnóstico , Hernia Interna/etiología , Femenino , Enfermedad Aguda , Persona de Mediana EdadRESUMEN
BACKGROUND: Anisakiasis, a zoonotic disease caused by the nematode Anisakis, poses a significant concern for public health, particularly in regions with high consumption of raw or undercooked fish. CASE PRESENTATION: We present a case report of a 41-year-old woman who developed severe abdominal symptoms, ultimately diagnosed with intestinal obstruction due to Anisakis infestation, requiring surgery. Despite the absence of prominent eosinophilia or specific radiological findings, the diagnosis was confirmed through histological examination, highlighting the importance of considering anisakiasis in patients with a history of raw seafood consumption. CONCLUSION: The case underscores the diagnostic challenges associated with anisakiasis, emphasizing the need for increased awareness among healthcare professionals and the public regarding the risks of consuming raw or undercooked seafood. Effective management requires a multidisciplinary approach, including clinical assessment, imaging studies, and histological evaluation, to ensure timely diagnosis and appropriate treatment.
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Anisakiasis , Obstrucción Intestinal , Humanos , Femenino , Adulto , Obstrucción Intestinal/etiología , Obstrucción Intestinal/parasitología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico , Anisakiasis/complicaciones , Anisakiasis/diagnóstico , Animales , Anisakis/aislamiento & purificación , Alimentos Marinos/parasitologíaRESUMEN
OBJECTIVE: To investigate the diagnostic value of D-dimer, platelet-lymphocyte rate (PLR) and CT signs for intestinal ischemia in patients with bowel obstruction. METHODS: We retrospectively analyzed the clinical and imaging data of 105 patients diagnosed with bowel obstruction, and performed univariate and multivariate analyses to determine the independent risk factors for intestinal ischemia in patients with bowel obstruction. Moreover, the receiver operating characteristic curve (ROC) was plotted to examine the diagnostic value of D-dimer, PLR and CT signs in patients with bowel obstruction. Besides, Kappa tests were used to assess inter-observer agreement. RESULTS: We included 56 men (53%) and 49 women (47%) with mean age of 66.05 ± 16 years. Univariate and multivariate analyses showed that D-dimer, PLR and two significant CT signs (i.e., increased unenhanced bowel-wall attenuation and mesenteric haziness) were independent risk factors for intestinal ischemia in patients with bowel obstruction. ROC analysis showed that the combined use of D-dimer, PLR and the said two CT signs had better performance than single indicators in predicting intestinal ischemia in patients with bowel obstruction. The area under the curve (AUC) of the joint model III was 0.925 [95%CI: 0.876-0.975], with a sensitivity of 79.2% [95CI%: 67.2-91.1] and a specificity of 91.2% [95%CI: 83.7-98.9]. CONCLUSION: The combined use of D-dimer, PLR and CT signs has high diagnostic value for intestinal ischemia in patients with bowel obstruction and will prompt surgical exploration to evaluate intestinal blood flow.
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Productos de Degradación de Fibrina-Fibrinógeno , Obstrucción Intestinal , Isquemia , Linfocitos , Tomografía Computarizada por Rayos X , Humanos , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Masculino , Femenino , Anciano , Obstrucción Intestinal/sangre , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico , Persona de Mediana Edad , Estudios Retrospectivos , Isquemia/sangre , Curva ROC , Intestinos/irrigación sanguínea , Intestinos/patología , Intestinos/diagnóstico por imagen , Plaquetas/patología , Plaquetas/metabolismo , Recuento de Plaquetas , Recuento de Linfocitos , Anciano de 80 o más Años , Factores de RiesgoRESUMEN
RATIONALE: Aggressive fibromatosis (AF) is a fibroblastic/myofibroblastic tumor known for its locally aggressive properties. Intra-abdominal AF primarily occurs in the small intestine mesentery, ileocolic mesocolon, omentum, retroperitoneum, and pelvis, and rarely originates from the intestinal wall. Here, we report a rare case of small bowel obstruction caused by duodenum-derived AF with ß-catenin (CTNNB1) T41A mutation. PATIENT CONCERNS: A 35-year-old male had a 4-month history of abdominal pain, nausea, and vomiting, which gradually worsened over time. DIAGNOSES: Based on the results of CT examination, histopathology and Sanger sequencing, the patient was diagnosed with small bowel obstruction caused by duodenum-derived AF. INTERVENTIONS: Due to the extensive adhesion between the tumor and surrounding tissue, it is extremely challenging to completely remove the tumor through surgical resection with negative margins in this case. In order not to damage the function of surrounding vital organs, gastrojejunostomy was performed to relieve the symptoms of small bowel obstruction. OUTCOMES: The patient experienced a successful recovery. It is important to note that this patient is still at risk of local recurrence and requires regular follow-up. LESSONS: The best treatment should be taken based on the individual patient to relieve symptoms and improve quality of life. Moreover, histopathology plays a crucial role in diagnosing and differentiating duodenum-derived AF. The detection of mutations in exon 3 of the CTNNB1 has become strong evidence for diagnosing duodenum-derived AF.
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Fibromatosis Agresiva , Obstrucción Intestinal , Mutación , beta Catenina , Humanos , Masculino , Adulto , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/genética , Obstrucción Intestinal/diagnóstico , beta Catenina/genética , Fibromatosis Agresiva/genética , Fibromatosis Agresiva/complicaciones , Fibromatosis Agresiva/diagnóstico , Fibromatosis Agresiva/cirugía , Intestino Delgado/patología , Neoplasias Duodenales/genética , Neoplasias Duodenales/cirugía , Neoplasias Duodenales/complicaciones , Neoplasias Duodenales/diagnósticoRESUMEN
PURPOSE: To characterise the investigations, management and ultimate diagnosis of neonates with distal intestinal obstruction. METHODS: Retrospective review of term (> 37 weeks) neonates with admission diagnosis of distal intestinal obstruction over 10 years (2012-2022). Patient pathways were identified and associations between presentations, response to treatments and outcome investigated. RESULTS: A total of 124 neonates were identified and all included. Initial management was colonic irrigation in 108, contrast enema in 4, and laparotomy in 12. Of those responding to irrigations none underwent contrast enema. Ultimately, 22 neonates proceeded to laparotomy. Overall, 106 had a suction rectal biopsy and 41 had genetic testing for cystic fibrosis. Final diagnosis was Hirschsprung disease (HD) in 67, meconium ileus with cystic fibrosis (CF) in 9, meconium plug syndrome in 19 (including 3 with CF), intestinal atresia in 10 and no formal diagnosis in 17. Median length of neonatal unit stay was 11 days (7-19). CONCLUSIONS: Initial management of neonates with distal bowel obstruction should be colonic irrigation since this is therapeutic in the majority and significantly reduces the need for contrast enema. These infants should all have suction rectal biopsy to investigate for HD unless another diagnosis is evident. If a meconium plug is passed, testing for CF is recommended. Evaluation and therapy are multimodal and time consuming, placing burden on resources and families.
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Medios de Contraste , Enema , Obstrucción Intestinal , Humanos , Recién Nacido , Estudios Retrospectivos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/terapia , Obstrucción Intestinal/diagnóstico , Enema/métodos , Masculino , Femenino , Irrigación Terapéutica/métodos , Laparotomía/métodos , Resultado del TratamientoRESUMEN
BACKGROUND: Adhesive small bowel obstruction (ASBO) is a leading cause of hospitalization in emergency surgery. The occurrence of bowel ischemia significantly increases the morbidity and mortality rates associated with this condition. Current clinical, biochemical and radiological parameters have poor predictive value for bowel ischemia. This study is designed to ascertain predictive elements for the progression to bowel ischemia in patients diagnosed with non-strangulated ASBO who are initially managed through conservative therapeutic approaches. METHODS: The study was based on the previously collected medical records of 128 patients admitted to the Department of Acute Care Surgery of Padua General Hospital, from August 2020 to April 2023, with a diagnosis of non-strangulated adhesive small bowel obstruction, who were then operated for failure of conservative treatment. The presence or absence of bowel ischemia was used to distinguish the two populations. Clinical, biochemical and radiological data were used to verify whether there is a correlation with the detection of bowel ischemia. RESULTS: We found that a Neutrophil-Lymphocyte ratio (NLR) > 6.8 (OR 2.9; 95% CI 1.41-6.21), the presence of mesenteric haziness (OR 2.56; 95% CI 1.11-5.88), decreased wall enhancement (OR 4.3; 95% CI 3.34-10.9) and free abdominal fluid (OR 2.64; 95% CI 1.08-6.16) were significantly associated with bowel ischemia at univariate analysis. At the multivariate logistic regression analysis, only NLR > 6.8 (OR 5.9; 95% CI 2.2-18.6) remained independent predictive factor for small bowel ischemia in non-strangulated adhesive small bowel obstruction, with 78% sensitivity and 65% specificity. CONCLUSIONS: NLR is a straightforward and reproducible parameter to predict bowel ischemia in cases of non-strangulated adhesive small bowel obstruction. Employing NLR during reevaluation of patients with this condition, who were initially treated conservatively, can help the acute care surgeons in the early prediction of bowel ischemia onset.
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Obstrucción Intestinal , Intestino Delgado , Linfocitos , Neutrófilos , Humanos , Estudios Retrospectivos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/cirugía , Masculino , Femenino , Anciano , Intestino Delgado/irrigación sanguínea , Intestino Delgado/patología , Persona de Mediana Edad , Linfocitos/patología , Adherencias Tisulares/diagnóstico , Isquemia/diagnóstico , Isquemia/etiología , Valor Predictivo de las Pruebas , Anciano de 80 o más Años , AdultoRESUMEN
RATIONALE: Urachal anomalies are rare and can present with various clinical manifestations. Urachal remnants, in particular, can be difficult to diagnose because of atypical symptoms at presentation. This study reports a case of intestinal obstruction in an infant secondary to an infected urachal cyst. PATIENTS CONCERNS: A 3-month-old boy with a known febrile urinary tract infection developed acute abdominal distension. DIAGNOSES: Abdominal ultrasound (US) and computed tomography (CT) revealed a nonspecific, ill-defined soft tissue density at the mid-abdomen, associated with intestinal obstruction. INTERVENTIONS: Emergency exploratory laparotomy was performed. The site of the obstruction was found to be at the mid-small bowel; the proximal small bowel was markedly distended, and the small bowel and sigmoid colon were adherent to urachal remnant. The urachal remnant was excised, and the peritoneal adhesions were lysed. OUTCOMES: The day after surgery, the patient was discharged without any complications. LESSONS: Intestinal obstruction is an exceedingly rare presentation of urachal remnants. This case highlights that urachal anomalies should be considered in the differential diagnosis in patients with intestinal obstruction and a concurrent febrile urinary tract infection.
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Obstrucción Intestinal , Quiste del Uraco , Infecciones Urinarias , Humanos , Masculino , Infecciones Urinarias/complicaciones , Infecciones Urinarias/diagnóstico , Quiste del Uraco/complicaciones , Quiste del Uraco/diagnóstico , Quiste del Uraco/cirugía , Lactante , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/cirugía , Fiebre/etiología , Diagnóstico Diferencial , Ultrasonografía/métodosRESUMEN
INTRODUCTION: Inguinal hernia is defined as a projection of an organ through the inguinal canal. This can be incarcerated as a consequence of continuous inflammation of the hernial sac, which will prevent its return, causing damage to the venous and lymphatic return of the viscera. The neutrophil-to-lymphocyte ratio (NLR) is an easily accessible inflammatory biomarker obtained from blood cell counts. Therefore, the objective was to determine if the NLR is useful as a predictor of intestinal resection in incarcerated inguinal hernias. MATERIAL AND METHOD: An observational, analytical, diagnostic test and retrospective study was carried out in a hospital in northern Peru from January 2013 to August 2019 in the Department of General Surgery and Emergency Surgery and Critical Care. Patients diagnosed with unilateral inguinal hernia with intestinal obstruction were included. For the relationship between the event and the exposure, it was analyzed using Chi square (χ2) and T-Student. The sensitivity, specificity, positive predictive value, negative predictive value of the NLR as well as the area under the ROC curve were found to determine the predictive accuracy. RESULTS: 161 patients with incarcerated inguinal hernia were studied: group I (20 patients with intestinal resection) and group II (141 patients without intestinal resection). The mean age in groups I and II were 69±16 and 60±17 years (p<0.05); the frequency in males was 70% in group I and 76% in group II (p>0.05). Intestinal obstruction and duration of incarceration >24 hours and the platelet-to-lymphocyte ratio demonstrated significant differences. With respect to NLR taking a cut-off point ≥6.5, a sensitivity of 75%, a specificity of 93.62%, a positive predictive value of 62.5% and a negative predictive value of 96.35% were observed; In addition, when analyzing with the ROC curve, a value of 5.14 was obtained as a predictor of intestinal resection with a sensitivity of 90% and a specificity of 84.4% (p<0.001). Therefore, the NLR >5.14 predicts intestinal resection in patients with incarcerated inguinal hernias with an area under the curve of 0.92 at the Belen Hospital of Trujillo. CONCLUSIONS: The neutrophil-to-lymphocyte ratio is useful for predicting intestinal resection with a diagnostic accuracy of 92%.
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Hernia Inguinal , Obstrucción Intestinal , Linfocitos , Neutrófilos , Humanos , Masculino , Hernia Inguinal/cirugía , Hernia Inguinal/diagnóstico , Hernia Inguinal/sangre , Femenino , Persona de Mediana Edad , Anciano , Estudios Retrospectivos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/sangre , Valor Predictivo de las Pruebas , Recuento de Linfocitos , Perú , Herniorrafia/métodos , Herniorrafia/efectos adversos , Intestinos/cirugía , Curva ROCRESUMEN
Wilkie syndrome is a rare pathology that generates intestinal obstruction due to a decrease of the aortomesenteric angle compromising the third portion of the duodenum. We describe a case of an 18-year-old female patient, diagnosed with Wilkie syndrome, with clinical symptoms of intestinal obstruction and weight loss. The diagnosis was made with abdominal CT. Wilkie syndrome is a rare pathology, which becomes a diagnostic challenge because it presents a similar picture to other more common pathologies. We recommend that it should be suspected in the presence of duodenal obstruction.
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Síndrome de la Arteria Mesentérica Superior , Humanos , Femenino , Adolescente , Síndrome de la Arteria Mesentérica Superior/diagnóstico , Síndrome de la Arteria Mesentérica Superior/complicaciones , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico , Obstrucción Duodenal/etiología , Obstrucción Duodenal/diagnóstico , Tomografía Computarizada por Rayos XRESUMEN
Colorectal cancer is the third most frequent type of malignancy in the United States, and the age at diagnosis is decreasing. Although the goal of screening is focused on prevention and early detection, a subset of patients inevitably presents as oncologic emergencies. Approximately 15% of patients with colorectal cancer will present as surgical emergencies, with the majority being due to either colonic perforation or obstruction. Patients presenting with colorectal emergencies are a challenging cohort, as they often present at an advanced stage with an increase in T stage, lymphovascular invasion, and metachronous liver disease.
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Neoplasias Colorrectales , Urgencias Médicas , Humanos , Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/terapia , Neoplasias Colorrectales/patología , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/terapia , Obstrucción Intestinal/etiología , Perforación Intestinal/diagnóstico , Perforación Intestinal/etiología , Perforación Intestinal/terapia , Perforación Intestinal/cirugíaRESUMEN
ABSTRACT: A femoral hernia is an uncommon and acquired hernia in the groin. Its incidence in adults is 2%-8% of all abdominal wall hernias, and it has a female-to-male ratio of 1.8:1. It is usually found in elderly patients and is associated with increased morbidity due to delays in diagnosis leading to a high incidence of incarceration and strangulation. Accurate preoperative diagnosis of femoral hernia is challenging, especially in obese patients in whom a small femoral hernia can be hidden under the groin fat. Unlike an inguinal hernia, it rarely reduces on its own and if asymptomatic and small, is often unnoticed by the elderly obese patient. Femoral hernia is often unsuspected and overlooked in males as it is predominant among females. Delay in diagnosis can lead to intestinal gangrene and high morbidity. We present a case of an incarcerated left femoral hernia in an elderly obese male who presented with acute intestinal obstruction. He was managed with resection of the gangrenous segment and double barrel ileostomy. Although uncommon in males, a femoral hernia has a high incidence of strangulation, and therefore should always be ruled out as a cause of acute intestinal obstruction in elderly patients. Therefore, never forget to examine the groin in case of intestinal obstruction.
Asunto(s)
Hernia Femoral , Obstrucción Intestinal , Humanos , Hernia Femoral/cirugía , Hernia Femoral/diagnóstico , Hernia Femoral/complicaciones , Masculino , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/cirugía , Anciano , Tomografía Computarizada por Rayos X , Obesidad/complicaciones , Gangrena/diagnóstico , Gangrena/cirugía , Diagnóstico DiferencialRESUMEN
Constipation encompasses symptoms of decreased colonic motility or difficulty with the defecation process. As a broad definition, this can be inclusive of functional constipation (FC) or colonic inertia, obstructed defecation (OD), and irritable bowel syndrome-constipation type (IBS-CS). After excluding IBS-C, FC and OD diagnosis and management require a multidisciplinary approach often involving nutritionists, pelvic floor therapists, urogynecologists, and colon and rectal surgeons. Differentiating the presence or absence of each can direct therapy and prognosticate chances for improvement in this often complex combination of disorders.