RESUMO
Background: Colonoscopy is a resource used for the diagnosis, treatment, and monitoring of benign and malignant colorectal pathologies. The incidence of perforation is 0.03%-0.65% in diagnostic colonoscopy; however, the incidence can be up to 10 times higher in therapeutic interventions, such as polypectomies, increasing the risk of complications up to 0.07-2.1%. Materials and methods. Case report of a 71-year-old female who presents a rare complication due to a perforation in the sigmoid which developed pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema as a complication of a diagnostic colonoscopy where a biopsy of a friable lesion was performed. Results: A 71-year-old female that went to the emergency room due to acute generalized abdominal colic spasm pain with a duration of 7 hours, associated with significant abdominal distension, malaise, diaphoresis, progressive dyspnea, and massive subcutaneous emphysema that developed after performing panendoscopy and colonoscopy for diverticulosis follow-up. An abdominal CT scan with double contrast was performed, reporting suggestive data of hollow viscus perforation, pneumoperitoneum, pneumomediastinum, pneumothorax, and massive subcutaneous emphysema in the thorax, neck, and skull base. She underwent an exploratory laparotomy finding a perforation in the sigmoid for which sigmoidectomy was performed, and for the pneumothorax and pneumomediastinum, endopleural tubes were placed in both hemithoraxes. The massive subcutaneous emphysema subsided with observation and oxygen. Conclusion: A rare complication of the use of colonoscopy as a diagnostic and therapeutic method is presented. The purpose of presenting this case is for the doctor who performs these interventions to suspect this complication in a timely manner, not delaying the diagnosis and carrying out an urgent therapeutic approach as in this case with exploratory laparotomy, finding the perforation site and carrying out the corresponding surgical management. We demonstrated that massive subcutaneous emphysema can be managed with observation if there is no other alarm data evident that required another surgical approach.
RESUMO
BACKGROUND: Cholecystectomy is one of the most performed abdominal surgical procedures, with approximately 1.5 million procedures performed annually in the United States of america. Most of the biliary duct injuries during laparoscopic cholecystectomy are due to a wrong perception of the anatomy. Two thirds of postsurgical stenosis develop within two and three years after repairing and the other third in the following ten years. OBJECTIVE: To show the adequacy for postoperative endoscopic access in Roux-in-Y biliodigestive diversions. METHOD: The best technique to repair biliary duct injuries is the Roux-in-Y hepaticojejunostomy or choledochojejunostomy, from this procedure we propose a surgical technique that consists to perform a perpendicular anastomosis between the defunctionalized jejunum loop and the duodenum for later endoscopic access of the Roux-en-Y biliodigestive diversion. RESULTS: The duodenal-jejunal perpendicular anastomosis procedure was performed in four patients with Roux-Y biliodigestive diversion. CONCLUSIONS: With the technique that is proposed, we have that advantage of keeping the anastomosis permanently open due to its rhomboidal design and because of the pylorus is kept intact alkaline reflux would not be a problem.
ANTECEDENTES: La colecistectomía es una de las cirugías más frecuentes, con aproximadamente 1.2 millones de procedimientos realizados anualmente solo en los Estados Unidos de América. La mayoría de las disrupciones biliares durante la colecistectomía laparoscópica se deben a una percepción errónea de la anatomía. Dos tercios de las estenosis posquirúrgicas se desarrollan 2-3 años después de la reparación y el otro tercio en los 10 años siguientes. OBJETIVO: Mostrar la adecuación para un acceso endoscópico posoperatorio en las derivaciones biliodigestivas en Y de Roux. MÉTODO: La mejor técnica quirúrgica reportada para la reparación de las disrupciones biliares es la anastomosis hepático-yeyuno o anastomosis colédoco-yeyuno en Y de Roux. Partiendo de este procedimiento, la variante quirúrgica que proponemos consiste en realizar una anastomosis perpendicular entre el asa desfuncionalizada de yeyuno y el duodeno para el posterior acceso endoscópico de la derivación biliodigestiva en Y de Roux. RESULTADOS: Se realizó el procedimiento en cuatro pacientes con derivación biliodigestiva en Y de Roux. CONCLUSIONES: El procedimiento que proponemos tiene la ventaja de mantener abierta la anastomosis debido a su diseño romboidal, y como el píloro se encuentra indemne, el reflujo gástrico alcalino no sería ningún problema.