RESUMO
There are several cases of liver abscesses caused by the ingestion of a foreign body, especially in the elderly. Fish bones or chicken bones are sharp foreign bodies that can migrate through the digestive tract to the liver parenchyma. We reported a 71-year-old man who presented to the emergency department with fever and epigastric pain. Computed tomography scan showed a liver abscess related to a long and sharp foreign body which is protruding from the left lobe of the liver. Systemic antibiotic treatment was initiated and later the foreign body was removed by laparoscopic surgery.
Existen numerosos casos publicados en la literatura que muestran abscesos hepáticos producidos por la ingestión de un cuerpo extraño, especialmente en ancianos. Los huesos de pollo, y con mayor frecuencia las espinas de pescado, pueden perforar el tubo digestivo y migrar hasta el parénquima hepático y originar un absceso. Reportamos el caso de un paciente de 71 años que acude a urgencias por dolor epigástrico y fiebre. Se realizó tomografía computarizada abdominal, que identificó un absceso hepático junto con un cuerpo extraño puntiforme que penetraba en el hígado. El paciente fue intervenido quirúrgicamente, realizando drenaje del absceso y retirada del cuerpo extraño mediante abordaje laparoscópico.
Assuntos
Corpos Estranhos , Abscesso Hepático , Idoso , Animais , Peixes , Corpos Estranhos/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Humanos , Abscesso Hepático/diagnóstico por imagem , Abscesso Hepático/etiologia , Masculino , Tomografia Computadorizada por Raios XRESUMO
INTRODUCTION: Duplicity of the common bile duct is an unusual congenital disorder. CASE REPORT: A 80-year-old woman with duplication of the common bile duct with retrograde endoscopic cholangiopancreatography (ERCP) who did not resolve the symptoms. DISCUSSION: Our case is a variant of type IV to the classification of duplicity of the common bile duct. The magnetic resonance cholangiography and presurgical ERCP allows assessment of the bile ducts, their caliber, and assessment of abnormalities. The treatment before duplicity of the common bile duct will depend on the clinic and the type of opening of the accessory common bile duct. CONCLUSIONS: It is important to perform a pre-surgical study and during surgery with intrasurgical cholangiography.
INTRODUCCIÓN: La duplicidad del conducto biliar común es una alteración congénita insólita. CASO CLÍNICO: Mujer de 80 años con duplicación de la vía biliar común con colangiopancreatografías retrógradas endoscópicas (CPRE) que no solventan la clínica. DISCUSIÓN: Nuestro caso es una variante del tipo IV de la clasificación de duplicidad del conducto biliar común. La colangiopancreatografía por resonancia magnética y la CPRE prequirúrgica permiten valorar las vías biliares, su calibre y sus posibles anormalidades. El tratamiento dependerá de la clínica y del tipo de apertura del conducto biliar común accesorio. CONCLUSIONES: Es importante realizar un estudio prequirúrgico y durante la cirugía con colangiografía intraoperatoria.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica , Colecistectomia Laparoscópica , Idoso de 80 Anos ou mais , Silicatos de Alumínio , Ductos Biliares , Colangiografia , Ducto Colédoco/diagnóstico por imagem , Ducto Colédoco/cirurgia , Feminino , HumanosRESUMO
INTRODUCTION: Duplicity of the common bile duct (BCBD) is an unusual congenital disorder. CASE REPORT: A 80-year-old woman with duplication of the common bile duct with retrograde endoscopic cholangiopancreatography (ERCP) who did not resolve the symptoms. DISCUSSION: Our case is a variant of type IV to the classification of DCBC. The MR cholangiography and presurgical ERCP allows assessment of the bile ducts, their caliber, and assessment of abnormalities. The treatment before DCBC will depend on the clinic and the type of opening of the CBCA. CONCLUSIONS: It is important to perform a pre-surgical study and during surgery with CIO.
INTRODUCCIÓN: La duplicidad del conducto biliar común (DCBC) es una alteración congénita insólita. CASO CLÍNICO: Mujer de 80 años con duplicación de la vía biliar común con colangiopancreatografía retrógrada endoscópica (CPRE) que no dilucida la clínica. DISCUSIÓN: Este caso es una variante del tipo IV de la clasificación de DCBC. La colangiorresonancia y la CPRE prequirúrgica permiten valorar las vías biliares, su calibre y las anormalidades. El tratamiento depende de la clínica y el tipo de apertura del conducto biliar común accesorio. CONCLUSIONES: Es importante realizar estudio prequirúrgico y durante la operación con colangiografía intraoperatoria.
Assuntos
Ducto Colédoco/anormalidades , Ducto Colédoco/cirurgia , Idoso de 80 Anos ou mais , Embolectomia com Balão , Colangiografia , Colangiopancreatografia Retrógrada Endoscópica , Colecistite/tratamento farmacológico , Colecistite/cirurgia , Doença Crônica , Terapia Combinada , Ducto Colédoco/diagnóstico por imagem , Feminino , Ducto Hepático Comum/anormalidades , Humanos , Imageamento por Ressonância Magnética , Próteses e Implantes , Esfinterotomia Endoscópica , Tomografia Computadorizada por Raios X , Ácido Ursodesoxicólico/uso terapêuticoRESUMO
La diarrea nosocomial, que es la adquirida en el ámbito hospitalario, suele ser producida por Clostridium difficile. Sin embargo, en raras ocasiones puede ocasionar un síndrome de distrés respiratorio. Por ello, el diagnóstico de dicha patología es difícil si no se sospecha. El tratamiento se basa en el uso de antibiótico vía oral. Se expone el caso de una paciente de 66 años con dicha patología tras la realización de pancreatectomía total.
Nosocomial (hospital-acquired) diarrhea is usually caused by Clostridium difficile. On rare occasions it can cause acute respiratory distress syndrome (ARDS). Therefore, this condition should be suspected in order to make a diagnosis. Treatment is based on oral antibiotics. We report the case of a 66-year-old female patient with ARDS secondary to Clostridium difficile colitis after total pancreatectomy.
Assuntos
Humanos , Feminino , Idoso , Síndrome do Desconforto Respiratório do Recém-Nascido/cirurgia , Infecções por Clostridium/complicações , Pancreatectomia , Síndrome do Desconforto Respiratório do Recém-Nascido/patologia , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico por imagemRESUMO
INTRODUCTION: In 2008, colorectal cancer represented the third most commonly diagnosed tumor in Spain, and the second tumor with more deaths. Despite the new potential biomarkers in colorectal cancer, there are many challenges that need to be overcome, resulting in a need for the standardization of its determinations. DISCUSSION: The continuous advance in tumor disease knowledge makes this review a summary of the current accepted, recommended and studied tumor markers for the diagnosis and monitoring of colorectal cancer, such as fecal markers, tissue markers and serological markers, and various prognostic markers on which there are different lines of treatment in colorectal cancer. CONCLUSIONS: Oncological guidelines recommend only a minority of tumor markers for routine use, such as the study of fecal occult blood, CEA determination in the postoperative followup, microsatellite instability to identify people susceptible to hereditary nonpolyposis colorectal cáncer, and mutation of APC in the diagnosis of familial adenomatous polyposis.
Assuntos
Adenocarcinoma/química , Biomarcadores Tumorais/análise , Neoplasias Colorretais/química , Adenocarcinoma/sangue , Proteínas Angiogênicas/sangue , Antígeno CA-19-9/análise , Antígeno Carcinoembrionário/análise , Cromossomos Humanos Par 18/genética , Neoplasias Colorretais/sangue , DNA de Neoplasias/análise , Fezes/química , Genes Neoplásicos , Humanos , Perda de Heterozigosidade , MicroRNAs/análise , Instabilidade de Microssatélites , Sangue Oculto , Guias de Prática Clínica como Assunto , Prevalência , RNA Neoplásico/análise , Sensibilidade e EspecificidadeRESUMO
INTRODUCTION: Angiogenesis and lymphangiogenesis are essential processes for the formation of blood and lymphatic vessels that allow tumour growth and spread. The binding of VEGF and VEGF-C factors with their receptors (VEGFR2, VEGFR3) in endothelial cells triggers signals that regulate these processes. We compared preoperative serum VEGF and VEGF-C levels with samples obtained after completion of surgery and adjuvant treatment in patients with gastric cancer. In addition, we determined the prognostic value and relationship to survival of serum VEGF and VEGF-C levels. METHODS: We used a prospective cohort study of 59 gastric cancer patients who underwent surgery. Serum VEGF and VEGF-C were measured by enzyme-linked immunosorbent assay (ELISA) the day before surgery and 6 months later, after completion of adjuvant treatment. RESULTS: Serum VEGF values decreased after treatment in patients with resectable tumours (mean ± SD) (405.42 ± 298.38 vs. 306.38 ± 212.47 pg/ml; p < 0.01), poorly differentiated and undifferentiated tumours (G3, G4) (438 ± 339.71 vs. 322.47 ± 210.71 pg/ml; p = 0.01), locally advanced gastric tumours (T4 stage) (424.27 ± 323.08 vs. 333.62 ± 221.72 pg/ml; p = 0.03) and tumours with a greater number of involved regional lymph nodes (N3) (442.38 ± 311.52 vs. 337.4 ± 203.64 pg/ml; p = 0.04). Serum preoperative VEGF values over 761 pg/ml were associated with shorter patient survival. The mean overall survival time for patients with serum VEGF levels higher than 761 pg/ml was 7 ± 2.99 months (95 % CI 1.14-12.86) while for patients with serum VEGF levels of less than 761 pg/ml was 21.18 ± 2.88 (95 % CI 15.54-26.83) The mean disease-specific survival time for patients with serum VEGF levels higher than 761 pg/ml was 6.25 ± 2.53 months (95 % CI 1.29-11.21) while for patients with serum VEGF levels of less than 761 pg/ml was 27.57 ± 3.45 (95 % CI 20.80-34.35). Multivariate analysis identified preoperative serum VEGF levels as an independent prognostic factor (HR = 0.144; p = 0.03). CONCLUSIONS: Serum VEGF levels decreased after the completion of treatment in patients with resected tumours, suggesting VEGF tracking may be useful in monitoring progression. Preoperative measurement of serum VEGF may help us identify patients with a poor prognosis.
Assuntos
Adenocarcinoma/sangue , Adenocarcinoma/cirurgia , Neoplasias Gástricas/sangue , Neoplasias Gástricas/cirurgia , Fator A de Crescimento do Endotélio Vascular/sangue , Fator C de Crescimento do Endotélio Vascular/sangue , Adenocarcinoma/diagnóstico , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrectomia , Humanos , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Período Pré-Operatório , Prognóstico , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/mortalidade , Análise de SobrevidaRESUMO
BACKGROUND: Diaphragmatic rupture can be missed during trauma diagnosis. Different pressures between the thorax and the abdomen allow the abdominal viscera to herniate into the chest cavity. Cardiorespiratory and abdominal symptoms may appear later due to passive compression and incarceration, respectively. CLINICAL CASE: We report the case of a 52-year-old female with abdominal pain and vomiting. Chest x-ray demonstrated an elevation of the right hemidiaphragm, and computed tomography showed herniation of small bowel and colon into the chest cavity with dilated small bowel due to a diaphragmatic hernia. CONCLUSIONS: History of traumatic events should be considered with high suspicion in the diagnostic process to avoid delayed diagnosis of this condition. The nonspecific symptoms of this condition often lead the patient to consult different specialists. A multidisciplinary approach is required and aimed at preventing an unnecessary increase of morbidity and mortality.
Assuntos
Hérnia Diafragmática Traumática/complicações , Doenças do Íleo/etiologia , Obstrução Intestinal/etiologia , Dor Abdominal/etiologia , Acidentes de Trânsito , Colo , Feminino , Refluxo Gastroesofágico/etiologia , Hérnia Diafragmática Traumática/diagnóstico por imagem , Hérnia Diafragmática Traumática/cirurgia , Herniorrafia , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Intestino Delgado , Pessoa de Meia-Idade , Pressão , Atelectasia Pulmonar/etiologia , Antro Pilórico , Radiografia , Fatores de TempoRESUMO
BACKGROUND: Gliomatosis peritonei is the metastatic implantation of mature glial tissue within the peritoneal cavity of patients with ovarian teratomas. There is no clear guidance for how long these patients should be followed up. CLINICAL CASE: We report the follow-up imaging findings of a 33-year-old female with abdominal distension and abdominal pain and who was postoperatively diagnosed with immature ovarian teratoma with gliomatosis peritonei. CONCLUSIONS: Differentiation of peritoneal implants seems to be important for prognosis. Malignant transformations after several years cannot be excluded. Therefore, new studies will determine if it is necessary to create guidelines for the postsurgical monitoring of these patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Glioma/secundário , Neoplasias Ovarianas/patologia , Ovariectomia , Neoplasias Peritoneais/secundário , Teratoma/secundário , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Apendicectomia , Ascite/diagnóstico por imagem , Ascite/etiologia , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Terapia Combinada , Etoposídeo/administração & dosagem , Feminino , Glioma/diagnóstico por imagem , Glioma/tratamento farmacológico , Hepatectomia , Humanos , Histerectomia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/cirurgia , Imagem Multimodal , Neoplasias Ovarianas/diagnóstico por imagem , Neoplasias Ovarianas/cirurgia , Neoplasias Peritoneais/diagnóstico por imagem , Neoplasias Peritoneais/tratamento farmacológico , Tomografia por Emissão de Pósitrons , Esplenectomia , Neoplasias Esplênicas/secundário , Neoplasias Esplênicas/cirurgia , Teratoma/diagnóstico por imagem , Teratoma/tratamento farmacológico , Teratoma/patologia , Teratoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: pylephlebitis is a rare complication of intraabdominal infections. Clinical presentation can be varied; therefore, it is necessary to carry out imaging tests for diagnosis. The treatment of choice is wide-spectrum antibiotic therapy and surgery for the source of infection. CLINICAL CASE: we report the case of a female with acute abdomen who was diagnosed with acute cholecystitis and right portal vein thrombosis. The patient underwent surgery and antibiotic treatment was necessary. CT scan showed hepatic infarction secondary to portal thrombosis. CONCLUSIONS: pylephlebitis presents high mortality rates without treatment; therefore, early diagnosis is necessary in order to initiate appropriate medical and surgical treatment.
Assuntos
Colecistite/complicações , Veia Porta , Sepse/etiologia , Tromboflebite/etiologia , Doença Aguda , Idoso , Feminino , HumanosRESUMO
BACKGROUND: angiomyofibroblastoma is a soft-tissue lesion. The vulvovaginal region of middle-aged females is the most frequent localization. Angiomyofibroblastoma is a well-circumscribed subcutaneous tumor at the vulva and perineum region. It is a painful and slow-growing tumor. It is often thought to represent a Bartholin's gland cyst. Treatment of choice is surgical excision. CLINICAL CASE: We describe the case of a 49-year-old female with a right vulvar tumor that had been growing for 2 years. Ultrasonography, computed tomography and magnetic resonance revealed a tumor at the right ischiorectal fossa. Diagnosis after surgical excision was angiomyofibroblastoma. CONCLUSIONS: angiomyofibroblastoma must be considered in the differential diagnosis of vulvovaginal tumors because its treatment differs from others lesions of that region.
Assuntos
Neoplasias de Tecido Muscular , Neoplasias Vulvares , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias de Tecido Muscular/diagnóstico , Neoplasias de Tecido Muscular/cirurgia , Neoplasias Vulvares/diagnóstico , Neoplasias Vulvares/cirurgiaRESUMO
Introducción: Los tumores del intestino delgado representan 25 % de las neoplasias gastrointestinales, de ellos 0.2 y 1 % corresponde a tumores del estroma gastrointestinal. Su presentación clínica más frecuente es la hemorragia digestiva, siendo los tumores del estroma gastrointestinal responsables en 1 % de los casos. Este tipo de neoplasias también puede ser el origen de intususcepción, proceso patológico infrecuente en la edad adulta por representar únicamente 5 % de todas las obstrucciones intestinales. Caso clínico: Mujer que acudió al servicio de urgencias por dolor abdominal y hemorragia digestiva baja. Las pruebas complementarias no resultaron concluyentes. Tras laparotomía exploradora se diagnosticó intususcepción y hemorragia digestiva baja subsecuente a tumor del estroma gastrointestinal. Conclusiones: La cirugía debe ser el último recurso diagnóstico y terapéutico, pero es necesaria en ocasiones debido a la dificultad para determinar la causa etiológica de la hemorragia y la obstrucción intestinal.
BACKGROUND: Small bowel tumors comprise 25% of gastrointestinal (GI) neoplasms, of which only between 0.2 and 1% correspond to gastrointestinal stromal tumors (GIST). GI bleeding is the most common presentation of GIST, being responsible in 1% of the cases. This type of neoplasm can also be the origin of an intussusception, which is an infrequent process during adult age, representing only 5% of all intestinal obstructions. CLINICAL CASE: We report a case of a patient who arrived at the emergency department due to abdominal pain and lower GI bleeding. The diagnostic process was not conclusive. After an exploratory laparotomy, the diagnosis was GI bleeding and intussusception due to GIST. CONCLUSIONS: Surgery must be the last diagnostic and therapeutic resource, but it is sometimes necessary to localize bleeding and intestinal obstruction site.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Doenças do Jejuno/etiologia , Hemorragia Gastrointestinal/etiologia , Intussuscepção/etiologia , Neoplasias do Jejuno/complicações , Tumores do Estroma Gastrointestinal/complicaçõesRESUMO
BACKGROUND: Small bowel tumors comprise 25% of gastrointestinal (GI) neoplasms, of which only between 0.2 and 1% correspond to gastrointestinal stromal tumors (GIST). GI bleeding is the most common presentation of GIST, being responsible in 1% of the cases. This type of neoplasm can also be the origin of an intussusception, which is an infrequent process during adult age, representing only 5% of all intestinal obstructions. CLINICAL CASE: We report a case of a patient who arrived at the emergency department due to abdominal pain and lower GI bleeding. The diagnostic process was not conclusive. After an exploratory laparotomy, the diagnosis was GI bleeding and intussusception due to GIST. CONCLUSIONS: Surgery must be the last diagnostic and therapeutic resource, but it is sometimes necessary to localize bleeding and intestinal obstruction site.