RESUMO
Eighty per cent of the intestinal occlusions in the small bowel are the result of adhesions, neoplasms or hernias. Approximately 4.3% of bowel occlusions are due to some type of bezoar. We report an 83 years old male who presented with a clinical picture of intestinal obstruction. He underwent hand-assisted laparoscopic exploration identifying an intraluminal non-fixed mass. Enterotomy was performed and a 3 x 4 cm yellowish mass was extracted. Histological analysis demonstrated a vegetal bezoar. Laparoscopic surgery is increasing its role in the management of intestinal occlusion.
Assuntos
Bezoares/complicações , Bezoares/cirurgia , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Humanos , Laparoscopia/métodos , Masculino , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
PURPOSE: The purpose of this study was to determine the incidence of anal sphincter injury and fecal incontinence after vaginal delivery. METHODS: This was a prospective, descriptive, observational study conducted over a three-year period in healthy primiparous females with previously intact anal sphincter and normal continence and without history of anorectal surgery. All patients completed a continence questionnaire and underwent endoanal ultrasound four to six weeks before and six weeks after delivery. RESULTS: Ninety-eight primiparous females had either instrumental (vacuum or forceps) vaginal delivery (n = 23) or noninstrumental vaginal delivery (n = 75). Twenty patients, 11 (48 percent) after instrumental delivery and 9 (12 percent) after noninstrumental vaginal delivery, had clinical sphincter tears that required primary repair. Twenty-eight patients (29 percent), 19 with previously repaired sphincter injury, had ultrasonographic defects that involved the external sphincter (n = 19) or both the internal and external sphincter (n = 9). Twenty-one patients (75 percent) with ultrasonographic sphincter defects had either major (n = 5) or minor (n = 16) fecal incontinence. CONCLUSION: Anal sphincter injuries, many of them undiagnosed at the time of delivery, are common in primiparous females after vaginal delivery, especially if vacuum or forceps are used. These injuries cause fecal incontinence in a significant proportion of the patients. Patients undergoing vaginal delivery should be aware of the risks of anal sphincter injury.
Assuntos
Canal Anal/lesões , Incontinência Fecal/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Adolescente , Adulto , Canal Anal/patologia , Parto Obstétrico , Feminino , Humanos , Incidência , Paridade , Gravidez , Estudos ProspectivosRESUMO
PURPOSE: The aim of this paper is to present the results obtained in five cases with a stoma created by the laparoscopic approach. PATIENTS AND METHOD: Analysis of five patients who required a stoma as treatment for their diseases or as a complementary management of another medical problem from March 1999 to May 1999. There were three women and two men. Mean age was 43 years (range 20-59 years). Two women had a rectovaginal fistula secondary to radiation proctitis, another woman presented an infected sacral wound, one man suffered a sphincteric lesion that required sphincteroplasty, and the other man had Fournier's gangrene. Surgical technique included the use of two ports, one at the umbilicus for the camera and the other at the site previously chosen for the stoma. RESULTS: Mean surgical time was 30 min (range 20-40 min), transoperative bleeding was meaningless; all stomas began to function during the first 24 h after the procedure. One patient began oral intake on the first day, three patients on the second day, and one patient was intubated in the intensive care unit and for this reason was unable to eat. All stomas achieved the objective sought and there were no complications related to the procedure. CONCLUSIONS: Stoma creation by the laparoscopic approach may offer advantages over the open-surgery technique.
Assuntos
Colostomia/métodos , Ileostomia/métodos , Laparoscopia , Adulto , Canal Anal/lesões , Canal Anal/cirurgia , Feminino , Gangrena de Fournier/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/complicações , Úlcera por Pressão/cirurgia , Lesões por Radiação/cirurgia , Fístula Retal/etiologia , Fístula Retal/cirurgia , Região Sacrococcígea , Resultado do Tratamento , Fístula Vaginal/etiologia , Fístula Vaginal/cirurgiaRESUMO
OBJECTIVE: To determine the extension of the lesion implicated on the mechanism of the anal sphincter with endoanal ultrasound in patients with simple fistulae, managed with fistulotomy versus fistulectomy. SITE: Central Military Hospital. Colon and Rectum Service. DESIGN OF STUDY: A prospective, comparative, descriptive and longitudinal study was performed. METHODS: A total of 40 patients with anal simple fistula were studied from march 1997 to march 1998. They were divided in two randomized groups: group A (n = 20) patients treated with fistulectomy, and group B (n = 20) patients managed with fistulotomy. Endoanal ultrasound was practice at the time of the diagnosis and six weeks later to identify integrity of both internal and external anal sphincter, and to register them in separate form. RESULTS: There were no significant differences in sex and age distribution, nor in type of fistula. The average of internal anal sphincter lesion in inter-sphincteric fistulae treated with fistulotomy was 8.5 mm versus 9.08 with fistulectomy (p > 0.05). The average of internal and external anal sphincter lesion in trans-sphincteric fistulae managed with fistulotomy was 9.25 mm versus 11.38 with fistulectomy (p < 0.05). The global analysis showed that the average of the lesion in the sphincter, mechanism was larger in the fistulectomy versus fistulotomy (p < 0.05). CONCLUSION: The major muscular injury made to the sphincter mechanism is caused mainly by the fistulectomy in comparison with the conventional fistulotomy.
Assuntos
Canal Anal/fisiologia , Endossonografia , Fístula Retal/cirurgia , Adolescente , Adulto , Canal Anal/diagnóstico por imagem , Canal Anal/lesões , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fístula Retal/diagnóstico por imagem , Fatores de TempoRESUMO
BACKGROUND: Surgical treatment for rectal cancer in the medium and lower third was traditionally abdominoperineal resection, but the possibility of sphincter preserving procedures has been emphasized in the last decades. PURPOSE: This review article was performed in order to discuss and analyze the surgical procedures available for treatment of rectal cancer. RESULTS: Surgical treatment of rectal cancer has changed due to a better understanding of the biological behavior of the tumor, improvement in diagnostic tests to stage the disease, and the development of better surgical techniques (surgical staplers) with the consequent increase in the possibility of sphincter-saving procedures. Adjuvant therapy has played a major role for improving the patient's prognosis. Even with all these improvements, the final outcome has not been changed in the last 15 years, and prospective studies are necessary to clarify the polemic issues still in debate: the development of better prognostic factors, more sensitive staging tests, the role of the complete mesorectal excision and pelvic lymphadenectomy, the adequacy of laparoscopic techniques in malignant disease, and the finding of the ideal scheme of adjuvant therapy. CONCLUSION: Significant progress has been made in the treatment of rectal cancer, but there are still important issues to be solved.