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.
Asunto(s)
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: An endoscopic intragastric balloon (IGB) placement is one of the minimally invasive methods of obesity treatment. One of the rare serious complications is mechanical bowel obstruction requiring operative management. We report a case of a male patient with small bowel obstruction due to IGB migration and the literature review of complications during IGB treatment. Detailed Case Description: A patient with a BMI of 28 kg/m2 was admitted to the hospital with spontaneous deflation of an IGB. Due to the suspected location of IGB in the ileum laparoscopy was performed. The enterotomy was performed and the IGB removed. The procedure and the postoperative period were uneventful. DISCUSSION: Spontaneous IGB ruptures are reported in the literature with a frequency ranging from 0.6 to 23%. The majority of deflated devices are spontaneously excreted with the stool with no abdominal symptoms. Only 0.38% of IGBs cause mechanical bowel obstruction of requiring surgical management. Based on our own experience and literature review, we propose the diagnostic and therapeutic algorithm. CONCLUSION: Complications after IGB placement can range from mild to severe, that is why it is so important to make an early diagnosis based on the emerging symptoms and to implement prompt management to reduce or avoid serious complications. Any patient reporting disturbing symptoms occurring over a pro- longed period of time requires hospitalization and careful observation for the occurrence of gastrointestinal obstruction. The ideal option is hospitalization in the center which implemented the IGB and start with the algorithm we proposed.
Asunto(s)
Migración de Cuerpo Extraño , Balón Gástrico , Obstrucción Intestinal , Humanos , Masculino , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Balón Gástrico/efectos adversos , Migración de Cuerpo Extraño/cirugía , Migración de Cuerpo Extraño/etiología , Obesidad Mórbida/cirugía , Resultado del Tratamiento , Intestino Delgado , Adulto , Laparoscopía/efectos adversos , Persona de Mediana EdadRESUMEN
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.
Asunto(s)
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.
Asunto(s)
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
A man in his late 30s presented with a history of recurrent colicky abdominal pain, bilious vomiting and intermittent mass formation in the lower abdomen. The mass was mobile, non-tender and fluctuant, and appeared in the right iliac fossa during episodes of pain and disappeared once the pain subsided. Contrast-enhanced CT (CECT) scan revealed a thick membrane-like structure covering the clumped small bowel loops, suggestive of an abdominal cocoon. A midline laparotomy was carried out with extensive adhesiolysis, and a membrane incision was performed. The final histopathological diagnosis was primary encapsulating peritoneal sclerosis. Encapsulating peritoneal sclerosis of idiopathic origin is rare and typically presents as an acute or subacute intestinal obstruction. A CECT scan is the diagnostic modality of choice, with a thick peritoneal membrane covering the small bowel loops being the hallmark sign. Surgical intervention is the preferred treatment for idiopathic cases, while medical management may address secondary causes.
Asunto(s)
Dolor Abdominal , Fibrosis Peritoneal , Tomografía Computarizada por Rayos X , Humanos , Masculino , Fibrosis Peritoneal/diagnóstico , Fibrosis Peritoneal/diagnóstico por imagen , Fibrosis Peritoneal/cirugía , Adulto , Dolor Abdominal/etiología , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Diagnóstico DiferencialRESUMEN
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.
Asunto(s)
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
INTRODUCTION AND PURPOSE OF THE STUDY: Small bowel obstruction (SBO) accounts for a substantial proportion of emergency surgical admissions. Malignancy is a common cause of obstruction, either due to a primary tumour or intra-abdominal metastases. However, little is known regarding the current treatment or outcomes of patients with malignant SBO. This study aimed to characterise the treatment of malignant SBO and identify areas for potential improvement and compare overall survival of patients with malignant SBO to patients with non-malignant SBO. MATERIALS AND METHODS: This was a subgroup analysis of a multicentre observational study of patients admitted with SBO. Details regarding these patients' diagnoses, treatments, and outcomes up to 1-year after admission were recorded. The primary outcome was overall survival in patients with malignant SBO. RESULTS: A total of 316 patients with small bowel obstruction were included, of whom 33 (10.4%) had malignant SBO. Out of the 33 patients with malignant SBO, 20 patients (60.6%) were treated with palliative intent although only 7 patients were seen by a palliative team during admission. Nutritional assessments were performed on 12 patients, and 11 of these patients received parenteral nutrition. 23 patients underwent surgery, with the most common surgical interventions being loop ileostomies (9 patients) and gastrointestinal bypasses (9 patients). 4 patients underwent right hemicolectomies, with a primary anastomosis formed and 1 patient had a right hemicolectomy with a terminal ileostomy. Median survival was 114 days, and no difference was seen in survival between patients treated with or without palliative intent. CONCLUSION: Malignant SBO is associated with significant risks of short-term complications and a poor prognosis. Consideration should be given to the early involvement of senior decision-makers upon patient admission is essential for optimal management and setting expectation for a realistic outcome.
Asunto(s)
Obstrucción Intestinal , Intestino Delgado , Cuidados Paliativos , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/mortalidad , Obstrucción Intestinal/cirugía , Masculino , Femenino , Anciano , Persona de Mediana Edad , Intestino Delgado/patología , Anciano de 80 o más Años , Resultado del Tratamiento , Adulto , Estudios de Cohortes , Tasa de Supervivencia , Neoplasias Intestinales/mortalidad , Neoplasias Intestinales/complicaciones , Neoplasias Intestinales/patología , Neoplasias Intestinales/cirugíaRESUMEN
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.
Asunto(s)
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.
Asunto(s)
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
BACKGROUND: Intestinal obstruction represents a severe intestinal disease associated with higher mortality rates. However, the determinants of mortality in patients with intestinal obstruction remain inadequately understood. This study sought to elucidate the potential risk factors associated with mortality in the context of intestinal obstruction during the COVID-19 pandemic. METHODS: A retrospective analysis was performed on a cohort of 227 patients diagnosed with intestinal obstruction at the First Hospital of Hebei Medical University, spanning the period from September 7, 2022, to January 7, 2023. The primary endpoint of the study was mortality within four weeks following discharge. Univariate and multivariable logistic regression models were utilized to evaluate the risk factors associated with mortality outcomes. RESULTS: A cohort of 227 patients diagnosed with intestinal obstruction (median age, 59.02 years [IQR, 48.95-70.85 years]) was included in our study. Malignant bowel obstruction (MBO) and COVID-19 were identified as independent risk factors for mortality among these patients. Notably, the mortality rate increased significantly to 38.46% when MBO was concomitant with COVID-19. Furthermore, postoperative pulmonary complications (PPC) (OR, 54.21 [death]; 95% CI, 3.17-926.31), gastric cancer (OR, 9.71 [death]; 95% CI, 1.38-68.18), VTE (Caprini Score ≥ 5) (OR, 7.64 [death]; 95% CI, 1.37-42.51), and COVID-19 (OR, 5.72 [death]; 95% CI, 1.01-32.29) were all determined to be independent risk factors for postoperative mortality. Additionally, gastric cancer could have emerged as one of the most severe risk factors for mortality in individuals with intestinal obstruction within the cohort of cancer patients, of which gastric cancer exhibited higher mortality rates compared to individuals with other forms of cancer. CONCLUSION: The study identifies MBO, gastric cancer, COVID-19, PPC, and VTE as potential risk factors for mortality in cases of intestinal obstruction. These findings highlight the necessity for continuous monitoring of indicators related to these mortality risk factors and their associated complications, thereby offering valuable insights for the management and treatment of intestinal obstruction.
Asunto(s)
COVID-19 , Obstrucción Intestinal , Humanos , Obstrucción Intestinal/mortalidad , Obstrucción Intestinal/etiología , Masculino , Persona de Mediana Edad , Femenino , COVID-19/complicaciones , COVID-19/mortalidad , Anciano , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2 , Complicaciones Posoperatorias/mortalidad , Complicaciones Posoperatorias/epidemiología , Neoplasias Gástricas/mortalidad , Neoplasias Gástricas/complicacionesRESUMEN
Enhanced Recovery After Surgery (ERAS) represents evidence-based transformation in perioperative care, which has been demonstrated to reduce both recovery times and postoperative complication rates. The aim of the present study was to evaluate the clinical significance of the ERAS program in comparison with conventional postoperative care. This longitudinal cohort observational study enrolled 120 consecutive patients diagnosed with intestinal obstruction caused by colorectal cancers, with 40 patients in the ERAS group and 80 patients receiving conventional postoperative care forming the non-ERAS group. Our study compares the effectiveness of ERAS protocols to non-ERAS methods, focusing on the time to first flatus, defecation, the resumption of normal diet, and early mobilization. The main endpoints are morbidity and hospitalization length. The results showed that despite a longer admission-to-surgery interval in the ERAS group, median hospitalization was significantly shorter compared to the non-ERAS group (p = 0.0002). The ERAS group showed a tendency towards a lower incidence of overall postoperative complications, indicating that implementing the ERAS protocol does not increase the risk of postoperative complications, ensuring the safety of enhanced recovery strategies for patients. Also, ERAS patients had notably fewer stomas than those in the non-ERAS group, indicating the potential effectiveness of reducing stoma necessity. This study shows that ERAS surpasses conventional care for colonic or rectal surgery patients, reducing hospital stays and costs while enhancing recovery. This highlights the comprehensive advantages of adopting ERAS in surgical settings.
Asunto(s)
Neoplasias Colorrectales , Recuperación Mejorada Después de la Cirugía , Obstrucción Intestinal , Complicaciones Posoperatorias , Humanos , Masculino , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/complicaciones , Femenino , Anciano , Persona de Mediana Edad , Estudios Longitudinales , Complicaciones Posoperatorias/prevención & control , Recuperación Mejorada Después de la Cirugía/normas , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Tiempo de Internación/estadística & datos numéricos , Estudios de Cohortes , Anciano de 80 o más Años , Recuperación de la Función , Cuidados Posoperatorios/métodos , Cuidados Posoperatorios/normasRESUMEN
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.
Asunto(s)
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
BACKGROUND: Superior mesenteric artery syndrome is a rare condition that has only around 400 reported cases so far. Typically, the superior mesenteric artery branches off the abdominal aorta at 45° to create an aortomesenteric distance of 10-28 mm, with the duodenum passing through. However, if this aortomesenteric angle reduces to less than 25°, the third portion of the duodenum becomes compressed between the SMA and aorta, causing mechanical obstruction. CASE PRESENTATION: This case report aims to demonstrate the diagnostic difficulties and the laparoscopic management of a 52-year-old Indian male presenting with abdominal pain and vomiting, with associated weight loss. Imaging was further suggestive of high intestinal obstruction, and he was later found to have superior mesenteric artery syndrome. CONCLUSION: Taking into account a significant reduction in morbidity, we propose laparoscopic duodenojejunostomy to be the new procedure of choice for superior mesenteric artery syndrome.
Asunto(s)
Laparoscopía , Síndrome de la Arteria Mesentérica Superior , Humanos , Síndrome de la Arteria Mesentérica Superior/cirugía , Síndrome de la Arteria Mesentérica Superior/diagnóstico por imagen , Síndrome de la Arteria Mesentérica Superior/diagnóstico , Masculino , Persona de Mediana Edad , Dolor Abdominal/etiología , Duodenostomía/métodos , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Vómitos/etiología , Yeyunostomía/métodos , Obstrucción Intestinal/cirugía , Obstrucción Intestinal/etiología , Obstrucción Intestinal/diagnóstico por imagenRESUMEN
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.
Asunto(s)
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.
Asunto(s)
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
PURPOSE: Nutrition support in inoperable bowel obstruction (IBO) remains challenging. Parenteral nutrition (PN) is recommended if the prognosis is > 2 months. An elemental diet (ED) is licensed for strictures in Crohn's disease but has not been used in malignant bowel obstruction. The aim of this study was to evaluate the use of ED in patients with IBO and provide a proof of concept of ED as an acceptable feeding option. METHODS: This was a mixed-methods single-arm feasibility study. The primary endpoint was to provide a 'proof of concept' of ED as an acceptable feeding option for patients with IBO. Secondary endpoints included taste acceptability, incidences of vomiting and pain, the proportion of women who tolerated ED, the number of cartons drunk, quality of life (QOL) and the number of women treated with chemotherapy. Patients (> 18 years) with CT-confirmed IBO who could tolerate 500 ml of liquid in 24 h remained on the trial for 2 weeks. RESULTS: A total of 29 patients were recruited; of those, 19 contributed to the analysis for the primary endpoint; 13 (68.4%) participants tolerated the ED; 26 patients contributed to MSAS and EORTC QLQ questionnaires at baseline to allow for the assessment of symptoms. At the start of the study, 18 (69%) of patients experienced vomiting, reducing to 4 (25%) by the end of day 15 of the study; 24 (92%) of patients reported pain at consent, reducing to 12 (75%) by the end of day 15. QOL scores improved from 36.2 (95% CI 27.7-44.7) at baseline to 53.1 (95% CI 40.3-66) at the end of day 15; 16 (84%) participants commenced chemotherapy within the first week of starting ED. The number of cartons across all participants showed a median of 1.3 cartons per day (range 0.8 to 2.5). CONCLUSION: ED is well tolerated by patients with IBO caused by gynaecological malignancies and may have a positive effect on symptom burden and QOL.
Asunto(s)
Estudios de Factibilidad , Alimentos Formulados , Neoplasias de los Genitales Femeninos , Obstrucción Intestinal , Nutrición Parenteral , Calidad de Vida , Humanos , Femenino , Persona de Mediana Edad , Obstrucción Intestinal/etiología , Obstrucción Intestinal/terapia , Neoplasias de los Genitales Femeninos/complicaciones , Anciano , Nutrición Parenteral/métodos , Adulto , Anciano de 80 o más AñosRESUMEN
BACKGROUND: A volvulus refers to the torsion or rotational twisting of a portion of the gastrointestinal tract, with a predilection for impacting the caecum and sigmoid colon, often resulting in the development of bowel obstruction. The risk factors associated are old age, chronic fecal impaction, psychiatric disorders, colonic dysmotility, prior abdominal surgical procedures, diabetes, and Hirschsprung's disease. Elderly are most commonly affected with sigmoid volvulus but there are few cases among young adults that culminate in grave complications. Although it is rare, but young individuals presenting with acute abdomen secondary to sigmoid volvulus need urgent attention. To prevent more invasive surgical procedures, endoscopic detorsion is preferred nowadays with complete recovery of patients. We present a case of young female who was successfully managed with endoscopic detorsion. CASE PRESENTATION: 27 years old Asian Pakistani female presented with worsening abdominal distention, constipation and vomiting since 2 days. On examination she was afebrile, vitally stable. Abdomen was distended, tympanic percussion with generalized tenderness. Abdominal radiograph was obtained which showed dilated bowel loops followed by Computed tomography of abdomen which was suggestive of Sigmoid volvulus causing intestinal obstruction. Patient was immediately moved to endoscopy unit and endoscopic detorsion of volvulus was done. For individuals who present with sigmoid volvulus and do not exhibit signs of peritonitis or colonic gangrene, the recommended course of action involves acute endoscopic detorsion, followed by scheduled surgical intervention. CONCLUSION: This case report emphasizes the significance of clinicians considering sigmoid volvulus as a rare but important cause when evaluating abdominal pain in young and otherwise healthy patients. A delay in diagnosis and treatment extending beyond 48 hours leads to colonic necrosis, amplifying the associated morbidity and mortality. Swift intervention is imperative to mitigate these complications and attain a conclusive remedy.