RESUMO
BACKGROUND: Crohn's disease was described for the first time in 1932. The association of acute appendicitis with this disease is very rare and when the cecum is involved, risk of fistula is very high. CASE REPORT: We present the case of a 48-year-old female who had been diagnosed with Crohn's disease several months earlier. The patient complained of intense abdominal pain in the right lower quadrant and was treated medically without improvement. Thus, laparascopic surgery was decided upon. DISCUSSION: The appendix was affected in 12-16% of all patients with Crohn's disease who had intestinal resection. CONCLUSIONS: If the cecum is not affected, appendectomy using laparascopic procedure with soft tissue drainage is adequate.
Assuntos
Apendicite/etiologia , Doença de Crohn/complicações , Feminino , Humanos , Doenças Inflamatórias Intestinais/complicações , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Crohn's disease was described for the first time in 1932. The association of acute appendicitis with this disease is very rare and when the cecum is involved, risk of fistula is very high. CASE REPORT: We present the case of a 48-year-old female who had been diagnosed with Crohn's disease several months earlier. The patient complained of intense abdominal pain in the right lower quadrant and was treated medically without improvement. Thus, laparascopic surgery was decided upon. DISCUSSION: The appendix was affected in 12-16% of all patients with Crohn's disease who had intestinal resection. CONCLUSIONS: If the cecum is not affected, appendectomy using laparascopic procedure with soft tissue drainage is adequate.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Apendicite/etiologia , Doença de Crohn/complicações , Doenças Inflamatórias Intestinais/complicaçõesRESUMO
BACKGROUND: Approximately 10% of all colorectal adenomas are constituted by villous adenomas. Their relationship with hydroelectrolytic depletion is rare. We report two cases with villous adenoma that presented hydroelectrolytic depletion with clinical and surgical management, exclusively. CLINICAL CASES: Case 1. Patient was a 76-year-old female with hypertension and 3 months evolution of symptoms such as asthenia, adynamia, unexplained weight loss, and abundant mucus with diarrhea. Serum potassium value was 2.2 mEq/l . Upon rectal exam we found a sessile, exophitic soft tumor with irregular surface of approximately 10 cm in diameter. We also performed a transanal resection of tumor reporting villous adenoma. The patient was discharged from the hospital at the 4th postoperative day with potassium values within normal limits. Case report 2. Patient was a 76-year-old female with diabetes and hypertension of long evolution. She reported a 4-month clinical evolution with non-bloody diarrhea and abundant mucus. She reported nausea, vomiting and no unexplained weight loss. Serum potassium value was 2.1 mEq/l . During the rectal exam we identified a sessile, polypoid, 5-cm diameter tumor that did not involve deep planes. In addition, we carried out a transanal resection of the polyp. The patient was discharged from the hospital on the 5th postoperative day. Potassium value was 4.3 mEq/l. CONCLUSIONS: Size and location of the villous adenoma are related to the production of mucus secretory diarrhea. The inhibiting well-known indomethacin of the prostaglandins has been used to decrease the mucus secretion. In every patient with presence of mucus, persistent diarrhea and occasional rectal bleeding of 1 month, it is necessary to carry out lower endoscopy to rule out the presence of villous adenoma.
Assuntos
Adenoma Viloso/complicações , Neoplasias Retais/complicações , Desequilíbrio Hidroeletrolítico/etiologia , Idoso , Feminino , Humanos , Índice de Gravidade de DoençaRESUMO
BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most common treatment in patients with ulcerative colitis. This procedure removes the entire colon, conserving the sphincteric complex and, therefore, preserving continence. The most important goal of this surgery is to improve quality of life. METHODS: We reviewed the files of patients who underwent restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis from January 1995 to December 2004 . We administered questionnaire SF-36 to evaluate quality of life. We used an observational, retrospective, and transversal method. RESULTS: Twenty J pouch procedures were done, of which files of 14 patients were reviewed. As far as quality of life, we were able to interview only eight patients and the average was as follows: physical function 75, physical status 50, corporal pain 51, general health 77, vitality 47.5, social function 62.50, emotional status 83 and mental health 74. DISCUSSION: Previous reports exist showing that proctocolectomy is a safe and effective procedure for patients with ulcerative colitis and where ileostomy is accompanied by one definitive, independent continent or pouch. CONCLUSIONS: The presence of stoma and fecal incontinence are factors that contribute to deterioration of quality of life after proctocolectomy; thus, both should be avoided. Of the patients who we interviewed, 87.5% consider that their health status has improved during 1 year.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Colite Ulcerativa/cirurgia , Proctocolectomia Restauradora , Qualidade de Vida , Estudos Transversais , Canal Anal/cirurgia , Íleo/cirurgia , Estudos RetrospectivosRESUMO
OBJECTIVE: To report for the first time in Mexico a case of anorectal tuberculosis as well as the revision of world-wide literature. BACKGROUND: In recent years the tuberculosis has had a significant increase, caused mainly by the epidemic of acquired immunodeficiency syndrome. The anorectal tuberculosis is a very rare presentation, their diagnosis requires a high index of suspicion since it can be confused with an infectious disease. CASE REPORT: Female of 50 years old, with atipic annal ulcers, treated at the being like perianal Crohn disease, the treatment with mesalazina and prednisona do not improve the disease. Thorax x-ray was made. The biopsies reported tuberculosis, initiating treatment with triple antifimic scheme, with good results at one month of medical treatment. COMENT: The biopsy is the main diagnostic method specific, the medical triple or quadruple treatment is the main management and surgical treatment is reserved for anal abscess and fistula.
Assuntos
Doenças Retais/diagnóstico , Tuberculose Gastrointestinal/diagnóstico , Doenças do Ânus/diagnóstico , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Restorative proctocolectomy with ileal pouch-anal anastomosis has become the most common treatment in patients with ulcerative colitis. This procedure removes the entire colon, conserving the sphincteric complex and, therefore, preserving continence. The most important goal of this surgery is to improve quality of life. METHODS: We reviewed the files of patients who underwent restorative proctocolectomy with ileal pouch-anal anastomosis for ulcerative colitis from January 1995 to December 2004 . We administered questionnaire SF-36 to evaluate quality of life. We used an observational, retrospective, and transversal method. RESULTS: Twenty "J" pouch procedures were done, of which files of 14 patients were reviewed. As far as quality of life, we were able to interview only eight patients and the average was as follows: physical function 75, physical status 50, corporal pain 51, general health 77, vitality 47.5, social function 62.50, emotional status 83 and mental health 74. DISCUSSION: Previous reports exist showing that proctocolectomy is a safe and effective procedure for patients with ulcerative colitis and where ileostomy is accompanied by one definitive, independent continent or pouch. CONCLUSIONS: The presence of stoma and fecal incontinence are factors that contribute to deterioration of quality of life after proctocolectomy; thus, both should be avoided. Of the patients who we interviewed, 87.5% consider that their health status has improved during 1 year.
Assuntos
Colite Ulcerativa/cirurgia , Proctocolectomia Restauradora , Qualidade de Vida , Adulto , Canal Anal/cirurgia , Estudos Transversais , Feminino , Humanos , Íleo/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: The presence of rectal diverticula is extremely rare; nevertheless, diverticular disease is considered a greater problem. We report a case of rectal diverticula in a patient with diverticular disease of the sigmoid. CLINICAL CASE: An 88-year-old male presented to the emergency room with hematochezia of several days evolution. During colonoscopy two diverticula were seen at 5 cm from the anal verge. DISCUSSION: Two theories exist to explain why rectal diverticula are rare, but other authors indicate its relationship to genetic alterations. Rectal diverticula are generally asymptomatic and surgical treatment only becomes necessary when these lesions progress to ulceration and abscess formation.