RESUMO

Introducción: El tratamiento de las Hernias Hiatales (HH) tipo III y IV es quirúrgico. Hay controversia sobre el refuerzo con malla. Nuestro objetivo fue comparar los resultados a largo plazo entre el uso o no de refuerzos protésicos. Materiales y Métodos: Cohorte prospectiva de 95 pacientes con HH tipo III y IV, entre los años 1997 y 2015 en el Hospital Clínico de la Universidad de Chile. Se evaluaron las características radiológicas, endoscópicas y funcionales pre y postoperatorias. Recidiva definida como recurrencia mayor a 3 cm. Análisis estadístico con chi2 y Test U-Mam-Whitney. P-value a 10 años) de HH tipo III y IV reparadas quirúrgicamente, no hay diferencias en la recidiva clínica con o sin el uso de mallas.

Introduction: The treatment of Hiatal Hernias (HH) type III and IV is surgical. There is controversy about reinforcement with mesh. Our objective was to compare the long-term results between the use or not of prosthetic reinforcements. Materials and Methods: Prospective cohort of 95 patients with HH type III and IV, between 1997 and 2015 at the Clinical Hospital of the University of Chile. Pre and postoperative radiological, endoscopic and functional characteristics were evaluated. Recurrence defined as a recurrence greater than 3 cm. Statistical analysis with chi2 and U-Mann-Whitney test. p-value 10 years) of surgically repaired type III and IV HH, there are no differences in clinical recurrence with or without the use of mesh.

RESUMO

PURPOSE: The purpose of this study is to determine the incidence of gastric tube abnormalities after SG and its relationship with esophagitis progression. METHODS: Retrospective study which included 459 patients in the postoperative period of SG who underwent an esophagogastroduodenoscopy in both pre- and postoperative periods. The main studied variables were presence of gastric tube abnormalities (dilation, neofundus, twist, and hiatal hernia) and esophagitis progression. RESULTS: Among the 459 patients who underwent SG, 393 (85.6%) were women, and 66 (14.4%) men, with mean age of 40.4 years. Mean preoperative BMI was 39.70 kg/m2. In total, 20.3% of the sample presented progression of esophagitis after surgery. Among the whole sample, 130 (28.3%) presented with an abnormality of the remnant gastric tube. The most common alteration was gastric dilation, which occurred in 16.1% of the patients, followed by gastric twist (10.7%), neofundus (7.4%), and hiatal hernia (0.2%). Patients who presented with any abnormality of the gastric tube were significantly prone to presenting esophagitis progression (p = 0.013). When analyzing each morphological abnormality isolated, there was no statistically significant correlation. CONCLUSION: Abnormalities of the gastric tube are not uncommon after SG and seems to contribute partially to the relevant rates of GERD and esophagitis after this surgery.

Assuntos

RESUMO

RESUMEN El vólvulo gástrico agudo (VGA) es una entidad infrecuente, con elevada mortalidad de hasta 50%, y su diagnóstico se basa en un alto nivel de sospecha clínica. En el paciente estable se puede plantear manejo no operatorio, pero en el inestable se impone el tratamiento quirúrgico. Presentamos el caso de un paciente con VGA e inestabilidad hemodinámica, en el cual se realizó laparotomía y devolvulación gástrica, pero falleció en el posoperatorio inmediato por shock refractario.

ABSTRACT Acute gastric volvulus (AGV) is an uncommon condition with high mortality (up to 50%) and its diagnosis is based on high level of suspicion. Conservative management can be attempted in stable patients, but the surgical approach is indicated in unstable cases. We report the case of a patient with AGV and hemodynamic instability who underwent laparotomy with reduction of the volvulus but who died in the immediate postoperative period due to refractory shock.

Assuntos

RESUMO

Background: Gastropexy is used to correct gastric dilatation volvulus, a disease that usually affects large and giant dogsand leads to death in 23.4 - 43% of patients. This study aimed to evaluate the biomechanical traction of 2 gastropexytechniques, incisional gastropexy and scarified gastropexy, in 10 dog cadavers. Incisional gastropexy comprises a singleincision in the abdominal wall and another incision in the stomach wall in the pyloric region followed by simple continuous sutures. The scarification technique creates scarification along the stomach borders of the pexy. Thereby, knowing thatboth techniques are successful, the biomechanical traction of each technique was compared.Materials, Methods & Results: A total of 10 animals without defined breed weighing from 6.4 - 43.0 kg were allocatedinto 2 equal groups (GE [scarified gastropexy] and GI [incisional gastropexy]). Incisional gastropexy was performed witha simple continuous suture pattern in the GI group and scarified gastropexy with an interrupted simple suture pattern wasperformed in the GE group. Absorbable 2-0 monofilament yarn (polygllecaprone 25) was used for sutures in both groups.Rectangular segments of the gastric antrum were collected from the right abdominal wall and from the bottom of thestomach at the left abdominal wall, which were subjected to a traction test. The scarification technique was easier, faster,and used less surgical sutures than the incisional technique. Both techniques were effective regardless of the site applied,with no significant differences. There was a difference in stretching depending on location.Discussion: The pathogenesis of gastric dilatation volvulus (GDV) is unknown. However, gas accumulation inside thegastric chamber may lead to organ dilation and consequently cause torsion of the cardia region and pyloric antrum, resulting in strangulation of blood vessels and nerves. This torsion could cause stomach ischemia followed by organ necrosis if...(AU)

Assuntos

RESUMO

Resumen El vólvulo gástrico es una entidad rara que puede presentarse de manera aguda o crónica y se acompaña de síntomas inespecíficos. Es fundamental su rápida identificación, ya que tiene alta mortalidad y el tratamiento oportuno de esta patología determina el pronóstico del paciente. A continuación, presentamos el caso de una paciente femenina de 89 años, que consulta por cuadro clínico de dolor torácico atípico, con documentación en radiografía de tórax de vólvulo gástrico organoaxial, en quien se realiza inicialmente devolvulación endoscópica con éxito. Sin embargo, en las imágenes de control se evidencia recurrencia del vólvulo, por lo cual se realizó manejo quirúrgico con hiatoplastia y funduplicatura tipo Toupet, además de gastrostomía percutánea de fijación, procedimiento realizado sin complicaciones, con los que se logró la devolvulación completa sin recurrencia.

Abstract Gastric volvulus is a rare condition that can occur acutely or chronically and is accompanied by nonspecific symptoms. Its rapid identification is critical since it has high mortality rate and timely treatment determines the patient's prognosis. The following is the case of an 89-year-old female patient who presented with atypical chest pain, with organoaxial gastric volvulus on chest X-ray, in whom endoscopic devolvulation was initially performed successfully. However, control imaging scans revealed recurrence. Therefore, surgical management included hiatoplasty and Toupet fundoplication, as well as percutaneous fixation gastrostomy, a procedure that was completed without complications and resulted in complete devolvulation without recurrence.

Assuntos

RESUMO

Background: Gastropexy is used to correct gastric dilatation volvulus, a disease that usually affects large and giant dogsand leads to death in 23.4 - 43% of patients. This study aimed to evaluate the biomechanical traction of 2 gastropexytechniques, incisional gastropexy and scarified gastropexy, in 10 dog cadavers. Incisional gastropexy comprises a singleincision in the abdominal wall and another incision in the stomach wall in the pyloric region followed by simple continuous sutures. The scarification technique creates scarification along the stomach borders of the pexy. Thereby, knowing thatboth techniques are successful, the biomechanical traction of each technique was compared.Materials, Methods & Results: A total of 10 animals without defined breed weighing from 6.4 - 43.0 kg were allocatedinto 2 equal groups (GE [scarified gastropexy] and GI [incisional gastropexy]). Incisional gastropexy was performed witha simple continuous suture pattern in the GI group and scarified gastropexy with an interrupted simple suture pattern wasperformed in the GE group. Absorbable 2-0 monofilament yarn (polygllecaprone 25) was used for sutures in both groups.Rectangular segments of the gastric antrum were collected from the right abdominal wall and from the bottom of thestomach at the left abdominal wall, which were subjected to a traction test. The scarification technique was easier, faster,and used less surgical sutures than the incisional technique. Both techniques were effective regardless of the site applied,with no significant differences. There was a difference in stretching depending on location.Discussion: The pathogenesis of gastric dilatation volvulus (GDV) is unknown. However, gas accumulation inside thegastric chamber may lead to organ dilation and consequently cause torsion of the cardia region and pyloric antrum, resulting in strangulation of blood vessels and nerves. This torsion could cause stomach ischemia followed by organ necrosis if...

Assuntos

RESUMO

BACKGROUND: Gastric volvulus is a rare condition, characterized by abnormal rotation of the stomach, causing obstruction with risk of ischemia, necrosis, and perforation. It is associated with high morbidity and mortality rates and, as it is life threatening, early diagnosis and treatment are crucial. METHODS: Retrospective study of medical records of intrathoracic gastric volvulus patients treated by video-laparoscopy from January 2000 to December 2018, in a University Hospital. RESULTS: Thirty patients (34 surgical procedures - 4 re-operations), 9 (30%) male and 21 (70%) female. The mean age was 57.65 ± 32.65 and the mean body mass index was 27.11 ± 3.5 kg/m2. The most prevalent symptoms were epigastric pain and dysphagia. In 41.17% of the cases, the contrast X-ray confirmed the diagnosis. All 34 cases were intrathoracic volvulus, 24 of which were organo-axial (70.58%). The surgical technique used was hiatoplasty, without mesh (25 cases; 73.52%) and with reinforcement mesh (9 cases; 26.47%), mostly associated with Nissen fundoplication (52.94%). The mean surgical time was 215.7 ± 62.9 minutes, with conversion in 5 cases (15.62%). Hospitalization ranged from 4 ± 2 days. There was no record of operative mortality, and symptom improvement occurred in 100% of patients. The mean follow-up time for patients was 41.8 ± 32.6 months. CONCLUSIONS: Surgical treatment should be indicated to reduce morbidity and mortality, and associated with improved symptoms and patient prognosis. Video-laparoscopic surgery on intrathoracic gastric volvulus proved to be safe and effective and should be the option of choice in the management of this disease.

Assuntos

RESUMO

Resumen Introducción: La hernia diafragmática complicada de presentación tardía constituye una urgencia quirúrgica. Los objetivos del presente estudio son la descripción de las características del diagnóstico de las hernias diafragmáticas de presentación tardía, tratamiento, resultados y la identificación del punto de corte entre el inicio de los síntomas y el desarrollo de necrosis. Pacientes y Métodos: Estudio retrospectivo de una serie de casos constituida por todos los pacientes operados por hernia diafragmática complicada de presentación tardía entre los años 2006 y 2016. Se midieron variables categóricas y continuas que se presentan con estadística descriptiva. Se utilizaron curvas Receiver Operating Characteristics (ROC) a las 6 y 12 h desde el inicio de los síntomas, para determinar el punto de corte del tiempo de presentación clínica en pacientes sometidos a resección de algún órgano. Una vez establecido el punto de corte se calcularon la sensibilidad; especificidad; las razones de verosimilitud positiva y negativa; los valores predictivos positivo y negativo; y la prevalencia. Resultados: La presentación clínica, estudio, diagnóstico y tratamiento fue similar a lo descrito en la literatura quirúrgica. Se estableció el punto de corte a las 12 h con sensibilidad de 80% y especificidad de 83%. Conclusiones: El diagnóstico y tratamiento de estos pacientes debería ser llevado a cabo antes de las 6 h desde el inicio de los síntomas. Aun cuando el universo descrito es reducido, se sugiere que después de las 12 h desde el momento de la estrangulación, los órganos comprometidos se encontrarán necróticos requiriendo resección quirúrgica.

Introduction: Late presentation of traumatic diaphragmatic hernia constitutes a true surgical emergency. The purposes of this study were to describe the diagnostic characteristics, treatment and outcomes of late presentation diaphragmatic hernias and to identify a cutoff point from the onset of symptoms to necrosis development. Patients and Methods: A retrospective series of cases constituted by all patients subjected to emergency diaphragmatic hernia repair form 2006 to 2016 was studied. Categorical and continuous variables were measured and analyzed with descriptive statistics. Receiver Operating Characteristics (ROC) curves at 6 and 12 hours from the onset of symptoms were used to determine the cutoff point for organ resection. Once stablished the cutoff point, sensitivity, specificity, positive and negative predictive values and prevalence were calculated. Results: Clinical presentation, diagnostic study and surgical treatment were similar to what has been already described. The cutoff point was defined at 12 hours from the onset of symptoms with 80% sensitivity and 83% sensibility. Conclusions: The diagnosis and treatment of these cases should be carried on before the first 6 hours after the onset of symptoms. Even though the universe of this study was small, we may suggest that after 12 hours form the onset of symptoms, the implicated organs would be found necrotic requiring surgical resection.

Assuntos

RESUMO

La hernia hiatal tipo IV es la más rara. Se puede reparar por vía abdominal o torácica y por la cirugía laparoscópica mínimo invasiva. Paciente de 67 años de edad, de sexo femenino, que presentaba desde hace más menos 5 meses cuadros de vómitos postprandiales inmediatos con repercusión en el estado nutricional, llega con deshidratación ligera al servicio de urgencias, se realiza panendoscopia digestiva superior de urgencia diagnosticándose una hernia paraesofágica con el estómago intratorácico, se complementó el estudio con una serie esófago-gastroduodenal corroborando el diagnóstico de vólvulo gástrico órgano-axial. Se discute el caso en colectivo y se decide su corrección quirúrgica por vía laparoscópica con evolución satisfactoria(AU)

The hiatal hernia type IV is the weirdest. It can be treated abdominal or thooracic via using lowest invasive laparoscopic surgery. 67 years old patient, famela, who was suffring from postprandial vomiting, affecting her nutritional condition.Patient gets to emergency suffering from light dehydration. An upper digestive panendoscopy is done.Diagnosis: Paraesophageal hernia in intrathoracic stomach the medical examinationwas complemented with a esophagus - gastorduodenal study, assuring the gastric volvulus axial- organ diagnosis. The case is analyzed by medical team and patient was treather surgically through laparoscopic surgery. Patient improved satisfactorily(AU)

Assuntos

RESUMO

Objetivo: Presentar un caso de vólvulo gástrico obstructivo. Caso clínico: Presentamos el caso de una paciente que inició con un episodio de obstrucción intestinal por una volvulación gástrica. El antecedente de otro episodio antiguo y la radiología de tórax alertaron de una posible hernia diafragmática crónica. La buena respuesta al tratamiento médico inicial permitió un estudio completo y una cirugía programada mediante abordaje laparoscópico.

Aim: To present a patient with gastric volvulus. Case report: A case of a female patient who started with an episode of intestinal obstruction due to gastric volvulus. The history of a former episode and chest radiology alerted us to a possible chronic diaphragmatic hernia. The patient's good response to initial medical treatment allowed a complete study and laparoscopic intervention.

Assuntos

RESUMO

BACKGROUND: Acute gastric volvulus is a rare, but potentially life-threatening, cause of upper gastrointestinal obstruction. CLINICAL CASE: Male of 60 years old with severe epigastric pain and abdominal distension with haematemesis on two occasions. The patient was haemodynamically stable, with abdominal distension and palpable epigastric fullness. Hematic cytology showed: haemoglobin 8.2g/dl and haematocrit 27%. Abdominal X-ray showed an elevation of left diaphragm with a hugely dilated stomach. A nasogastric tube was inserted. Endoscopy was performed. There was no active bleeding, but it was impossible to reach the duodenum due to the stomach distortion. The upper gastrointestinal X-ray study showed the appearance of an inverted stomach in the chest and an organoaxial gastric torsion. The CT scans of thorax and abdomen showed a gastric ascent into the thoracic cavity. Laparoscopic surgery was performed, finding the left hemi-diaphragm elevated, and the stomach, splenic angle of the colon, the spleen and tail of the pancreas were also raised. A linear gastrectomy (gastric sleeve) was performed. The postoperative progress was satisfactory. Oral feeding was started 72 hours after surgery, and the patient was discharged, and has remained asymptomatic during the following by 8 years. CONCLUSIONS: Emergency physicians must maintain a high level of suspicion in patients that present with signs and symptoms suggesting upper digestive tract occlusion. The gastric sleeve is an excellent alternative to avoid recurrence of gastric volvulus.

Assuntos

RESUMO

BACKGROUND: Gastric volvulus can be classified according to etiology as primary or secondary, according to anatomy as or mesenteroaxial, and according to onset as acute or chronic. Management of secondary gastric volvulus acute should always be surgery and the choice of surgical procedure for treatment is chosen according to etiology. Adherolysis and extraction of foreign bodies (suture, mesh, and gastric band) are important in those cases associated with previous abdominal surgery. Nissen fundoplication is a safe and effective procedure. Severe late complications of laparoscopic Nissen fundoplication are extremely rare occurrences. Among the reported complications is gastric volvulus. OBJECTIVE: Presentation of two cases and review of literature. CLINICAL CASES: Two cases of acute gastric volvulus secondary to laparoscopic Nissen fundoplication presenting with epigastric pain and nonproductive retching and treated by laparoscopy are described. Symptoms upon presentation, incidence, diagnosis, treatment and predisposing factors to gastric volvulus postfundoplication are discussed. CONCLUSION: Gastric volvulus rarely occurs as a complication of Nissen fundoplication with an incidence similar to others of late complications. The described mechanisms that originate gastric volvulus postfundoplication are related to adhesions, foreign bodies as suture (polyester), gastrostomy tubes and mesh, gastropexy and internal gastric herniation through a "transfundoplication" window. A high index of suspicion is required in those patients presenting with acute symptoms of gastric obstruction in the first year following laparoscopic Nissen fundoplication. Laparoscopic approach is safe with or without gastropexy, always correcting the underlying mechanisms that cause gastric volvulus.

Antecedentes: el vólvulo gástrico puede clasificarse por su etiología en primario o secundario, por su anatomía en órgano axial o mesentérico axial y por su presentación en crónico o agudo. El tratamiento del vólvulo gástrico secundario agudo siempre debe ser quirúrgico y la elección del procedimiento basarse en la etiología y en los casos asociados con cirugía previa será importante la lisis de adherencias y el retiro de cuerpos extraños (material de sutura, mallas, banda gástrica). La funduplicatura Nissen es un procedimiento seguro y efectivo que rara vez puede tener complicaciones tardías severas entre las que se encuentran el vólvulo gástrico. Objetivo: comunicar 2 casos y revisar la bibliografía médica. Casos clínicos: se describen 2 casos de vólvulo gástrico agudo secundarios a funduplicatura tipo Nissen laparoscópica, con síntomas de dolor epigástrico y vómito no productivo, ambos tratados por laparoscopia. Se revisan los síntomas de presentación, incidencia, diagnóstico, tratamiento y los factores predisponentes de vólvulo gástrico postfunduplicatura. Conclusión: el vólvulo gástrico rara vez puede ser una complicación de una funduplicatura Nissen con incidencia similar a la de otras de sus complicaciones tardías. Los mecanismos descritos que lo originan se relacionan con adherencias postquirúrgicas, material de sutura (poliéster), mallas, tubos de gastrostomía, gastropexia y por herniación gástrica interna a través del túnel "transfunduplicatura." En pacientes con síntomas de obstrucción gástrica dentro del primer año posterior a una funduplicatura Nissen laparoscópica se requiere un alto índice de sospecha. El tratamiento quirúrgico laparoscópico es seguro con o sin gastropexia para corregir los mecanismos que lo originan.

Assuntos

RESUMO

Vólvulo gástrico es la mal rotación del estómago en uno de sus ejes dentro de la cavidad abdominal pudiendo comprometer rápidamente la vida del paciente. El estómago anatómicamente es una víscera intraabdominal que está sujeta en varias de sus caras por ligamentos y estructuras que la mantienen relativamente fija en su posición, permitiéndole un rango de movimiento suficiente como para llevar a cabo su trabajo digestivo. Sin embargo, posee un eje natural sobre el cual tiende a pivotar cuando el movimiento es enérgico y amplio elevándose el riesgo de producirse una torsión en algunos de sus puntos no fijos. En otros casos desde el punto de vista patológico adquiriría también un eje transversal que le serviría a su vez de segundo eje de torsión, situación en especial frecuente en pacientes pediátricos. Si se diera el caso, puede producirse un vólvulo en los puntos previamente mencionados que como cualquier parte del tubo digestivo que sufre una compresión de su tejido someterá su vitalidad al peligro de isquemia y sufrimiento tisular, dando como presentación relacionada un cuadro de dolor moderado a severo y distensión abdominal que sumados a náuseas con o sin vómitos dan como resultado una signo sintomatología poco específica del Vólvulo Gástrico, razón por la cual su diagnóstico es difícil y necesaria su pronta resolución por los riesgos que conlleva; como es el caso del paciente describimos en éste caso.

Gastric volvulus is the wrong rotation of the stomach on one axis within the abdominal cavity can quickly compromise the patient's life. The stomach is anatomically an intra-abdominal organ that is subject to a number of its sides by ligaments and structures that remain relatively fixed in position, allowing a range of enough movement to carry out its digestive work. However, it has a natural axis around which tends to pivot when the movement is strong and broad and raises the risk of torsion can occur in some of its non-fixed points. In other cases the pathological point of view also acquires a transverse axis that would turn second torsion shaft, a situation particularly common in pediatric patients. If it were the case, a volvulus can occur in previously mentioned that as any part of the digestive tract that undergoes compression of the fabric shall submit its vitality to the danger of ischemia and tissue suffering, giving as related: pain points, severe abdominal distension, nausea with or without vomiting giving as a result unspecific diagnostic of gastric volvulus, which is why its diagnosis is difficult and necessary for their prompt resolution risks; as is the case of the patient we describe below.

RESUMO

Relata-se o estudo de caso de uma mulher jovem com sintomas de obstrução intestinal alta, por volvo gástrico associado com volvo cecal causado por má rotação intestinal. Inicialmente, o volvo gástrico foi diagnosticado e pode ser desfeito durante endoscopia digestiva alta. No entanto, sintomas persistentes de obstrução intestinal conduziram ao diagnóstico de volvo cecal, que foi corrigido cirurgicamente, por laparotomia e cecopexia. A paciente teve remissão total dos sinais e sintomas e foi encaminhada para acompanhamento ambulatorial, e não tem apresentado alterações por longo período.

The authors report the case of a young woman with symptoms of high intestinal obstruction due to gastric volvulus associated with cecal volvulus caused by intestinal malrotation. Initially, the gastric volvulus was diagnosed and reversed during high digestive endoscopy. However, persistent intestinal obstruction symptoms led to diagnosis of cecal volvulus, which was corrected by laparotomy and cecopexy. The patient showed complete remission of clinical symptoms and was referred to outpatient follow-up, which has been uneventful so far.

RESUMO

Giant hiatal hernia (GHH) with intrathoracic stomach is a rare condition. It is a type 3 or mixed hernia (with sliding and paraesophageal component) with more than 30 percent of the stomach protruding into the chest cavity. These hernias are usually associated with gastric rotation, mostly with organoaxial twist. They have nonspecific clinical manifestations, which include vomiting, and chest or epigastric pain. Complications such as volvulus, perforation, or gastric obstruction constitute a medical emergency. In many cases, these hernias can be detected incidentally on a chest radiograph. Imaging studies, mainly multidetector CT and upper gastro-intestinal series represent vital tools for diagnosis and anatomical characterization of these lesions. The treatment of GHH requires an open or laparoscopic surgical approach. We report the case of a patient evaluated in our department who was diagnosed with giant hiatal hernia with intrathoracic stomach and organoaxial gastric rotation.

La hernia hiatal gigante (HHG) con estómago intratorácico es una enfermedad poco frecuente. Corresponde a una hernia tipo 3 o mixta (componente por deslizamiento y paraesofágico) que contiene más del 30 por ciento del estómago a nivel del tórax. Es común que estas hernias se asocien a rotación gástrica, preferentemente del tipo órgano-axial. Sus manifestaciones clínicas son inespecíficas e incluyen vómitos y dolor torácico o epigástrico. Pueden presentar complicaciones como vólvulo, perforación u obstrucción gástrica, constituyendo una emergencia médica. En muchos casos pueden ser detectadas en forma incidental en una radiografía de tórax. El estudio dirigido con imágenes, particularmente tomografía computada multidetector y estudio baritado esófago-estómago-duodeno, resultan fundamentales para el diagnóstico y caracterización de la anatomía de estas lesiones. El tratamiento es quirúrgico, sea por cirugía abierta o laparoscópica. Presentamos el caso de una paciente evaluada en nuestro servicio, en quien se realizó el diagnóstico de HHG con estómago intratorácico, con rotación gástrica órgano-axial.

Assuntos

RESUMO

El vólvulo gástrico es una enfermedad muy rara que puede ser aguda o crónica y estar asociada a otras patologías. Es muy importante su rápida identificación porque de su tratamiento oportuno va a depender el pronóstico del paciente. Usualmente el manejo es quirúrgico con la gastropexia abierta o laparoscopia; sin embargo, puede intentarse un manejo endoscópico el cual es más rápido, sencillo y genera una menor morbilidad para los pacientes.Presentamos en este artículo dos casos de vólvulo gástrico que fueron devolvulados de manera endoscópica; se describe detalladamente la técnica y se hace una revisión de la literatura de esta extraña enfermedad.

Gastric volvulus is a very rare disease which may be either acute or chronic, and which may be associated with other pathologies. Quick identification of gastric volvulus is very important because the prognosis of the patient depends on opportune treatment. Usually open gastropexy or laparoscopy is performed. Nevertheless, endoscopic treatment can be tried since it is faster and simpler and results in less morbidity.In this article we present two cases of endoscopic devolvulation of gastric volvulus. The technique is described in detail and we present a review of the literature regarding this strange disease.

Assuntos

RESUMO

Context - gastric volvulus is an acquired, life-threatening condition in which the stomach rotates upon itself. Objective - to describe the application of laparoscopic gastropexy in the case of severe gastric volvulus presentedby an elderly female. Method - a 69 year old woman presenting severe abdominal pain with, retching and the incapacity to vomit, small dysphagia and sensation of post-prandial fullness was admitted to Hospital São Lucas de Governador Valadares, Brazil. Following clinical examination, the patient was submitted to plain and contrast x-rays of the abdomen and chest, computed tomography of the abdomen and upper gastrointestinal endoscopy. Laparoscopic gastropexy was performed in which the diaphragmatic hernia was reduced, the hiatus sutured, and anti-adhesive polypropylene mesh applied for fixation of the stomach. Results - the clinical, radiological and imaging features were typical of gastric volvulus. Rotation of the stomach was successfully corrected by laparoscopy and the patient was discharged from hospital three days after surgery. One month later, the patient was totally asymptomatic with respect to the igestive tract. Conclusions - an adult female patient suffering from acute gastric volvulus was successfully treated using a laparoscopic approach applied ten days after admission to hospital. Early diagnosis and the prompt surgical correction of such cases are crucial in reducing mortality in gastric volvulus.

Contexto- volvo gástrico é uma condição adquirida, com risco de vida, na qual o estômago sofre um deslocamento em torno de seu eixo. Objetivo- relatar a aplicação de gastropexia laparoscópica numa paciente idosa, apresentando volvo gástrico grave. Método- uma mulher de 69 anos de idade, apresentando dor abdominal severa, náusea e incapacidade de vomitar, pequena disfagia e sensação de plenitude pós-prandial foi admitida no Hospital São Lucas de Governador Valadares, Brasil. Após o exame clínico, foram realizadas radiografias do abdômen e peito (simples e de contraste), juntamente com tomografia de endoscopia superior. Após o diagnóstico, a paciente foi submetida à laparoscopia. A hérnia do diafragma foi reduzida junto com sutura hiatal, além da aplicação de uma tela de polipropileno anti-aderente para fixação do estômago. Resultados- as características clínicas, radiológicas e de imagem revelaram um volvulus gástrico típico. A rotação do estômago foi corrigida com sucesso através de laparoscopia e a paciente foi liberada do hospital após três dias da operação. Um mês após a cirurgia, a paciente encontrava-se totalmente assintomática no que diz respeito ao trato digestivo. Conclusões- uma paciente adulta, sofrendo de volvo gástrico agudo, foi tratada com sucesso através de procedimento laparoscópico realizado dez dias após a internação hospitalar. O diagnóstico precoce e a correção cirúrgica breve são essenciais para a redução da mortalidade em casos de volvo gástrico.

Assuntos

RESUMO

BACKGROUND: Gastric volvulus is frequently an asymptomatic disease, and it is usually diagnosed during radiographic examination of the superior digestive tract. The acute form, however, can spawn serious and lethal clinical consequences. This disease is defined by the anomalous rotation of the stomach over itself, and it can be classified according to type, extension, direction, etiology, and clinical presentation. AIM: To review the records from 38 patients with gastric volvulus diagnosed in the Hospital das Clínicas of University of São Paulo between 1968 and 2001. METHODS: This is retrospective analysis of 38 patient records. It was collected from each patient: name, age of first symptom appearance, gender, main clinical findings and complementary exams, volvulus type, extension, direction, etiology, and clinical presentation, therapeutic procedures, type of surgery performed, eventual recurrence, and long-term evolution. RESULTS: It was observed that occurrences of gastric volvulus are mainly secondary (75.8%). For the majority of patients (n=33), surgery was chosen as the treatment option: chronic disease in 29 cases and acute in four. Conservative treatment was reserved only for patients with no clinical conditions to surgical treatment. Anterior gastropexy was associated to high recurrence rates. Suturing the low gastric curve to the hepatic capsule and the transverse colon to the left subphrenic space (Tanner´s operation) seemed to be the technical treatment of choice for primary gastric volvulus. CONCLUSION: Treatment of gastric volvolus must be tailored according the etiology of the disease.

RACIONAL: O volvo gástrico é frequentemente condição assintomática e diagnosticado em exame radiológico feito por outras causas. A forma aguda, no entanto, pode ter consequências graves e letais. Ele é definido como rotação anômala do estômago nele próprio e classificado de acordo com o tipo, extensão, direção, causa e apresentação clínica. OBJETIVO: Apresentar aspectos clínicos e morfológicos de volvos gástricos. em 38 pacientes. MÉTODOS: Análise retrospectiva onde foram coletadas informações registradas sobre 38 pacientes a cerda da idade, surgimento do primeiro sintoma, gênero, principais achados clínicos, de exames complementares, tipo do volvo, causa, procedimentos terapêuticos, recidivas e evolução tardia. RESULTADOS: Em 75,8% o volvo foi secundário Na maioria dos pacientes a opção de tratamento foi cirúrgica. Ele era crônico em 29 e agudo em quatro pacientes. O tratamento conservador foi indicado somente aos sem condições clínicas para operações. Gastropexia anterior foi associada à alta taxa de recidiva. A sutura da pequena curvatura gástrica à cápsula hepática e cólon transverso na fossa subfrência esquerda (operação de Tanner) parece ser o tratamento de escolha nos volvos primários. CONCLUSÃO: O tratamento do volvo gástrico deve ser feito sob medida caso a caso e de acordo com a causa da doença.

Assuntos

RESUMO

A Síndrome da Dilatação Gástrica-Vólvulo (DGV) é uma emergência clínica e cirúrgica em pequenos animais. Essa condição está relacionada com vários efeitos fisiopatológicos que ocorrem devido a distensão e ao mal posicionamento do estômago. A DGV requer tratamento imediato e precisa de um protocolo adequado para que os riscos dessa infecção sejam calculados e controlados. A patologia está associada a um alto índice de mortalidade que varia de 30 a 45% dos animais tratados. É mais comumente descrita em cães de grande porte e de tórax profundo, e com prevalência em cães mais idosos. Fatores como superalimentação, exercício pós-prandial, aerofagia, fermentação bacteriana, produção de gás e retardo no esvaziamento gástrico são fatores predisponentes ao aparecimento da DGV. Neste trabalho são revisados os aspectos da fisiopatologia, diagnóstico e tratamento dessa síndrome(AU)

The gastric-volvulus dilatations (GVD) is a clinical and surgical emergency of small animal. This condition is related with many physiopatological effects resulting from distension and malpositioning of the stomach. The GVD demands immediate treatment and needs a proper procedure to minimize and control the risks of this affection. The pathology is associated with a high rate of mortality that varies from 30 to 45% of the treated animals. It is more prevalent in big size, deep chest and old dogs. Factors like overfeeding, postpradial activity, aerophagia, bacterial fermentation, gas production and emptying gastric retarded are considered to be predispose factors for the appearance of GVD. In this work the aspects of physiopatology, diagnostic and treatment of this syndrome is reviewed(AU)

Assuntos

RESUMO

A Síndrome da Dilatação Gástrica-Vólvulo (DGV) é uma emergência clínica e cirúrgica em pequenos animais. Essa condição está relacionada com vários efeitos fisiopatológicos que ocorrem devido a distensão e ao mal posicionamento do estômago. A DGV requer tratamento imediato e precisa de um protocolo adequado para que os riscos dessa infecção sejam calculados e controlados. A patologia está associada a um alto índice de mortalidade que varia de 30 a 45% dos animais tratados. É mais comumente descrita em cães de grande porte e de tórax profundo, e com prevalência em cães mais idosos. Fatores como superalimentação, exercício pós-prandial, aerofagia, fermentação bacteriana, produção de gás e retardo no esvaziamento gástrico são fatores predisponentes ao aparecimento da DGV. Neste trabalho são revisados os aspectos da fisiopatologia, diagnóstico e tratamento dessa síndrome

The gastric-volvulus dilatations (GVD) is a clinical and surgical emergency of small animal. This condition is related with many physiopatological effects resulting from distension and malpositioning of the stomach. The GVD demands immediate treatment and needs a proper procedure to minimize and control the risks of this affection. The pathology is associated with a high rate of mortality that varies from 30 to 45% of the treated animals. It is more prevalent in big size, deep chest and old dogs. Factors like overfeeding, postpradial activity, aerophagia, bacterial fermentation, gas production and emptying gastric retarded are considered to be predispose factors for the appearance of GVD. In this work the aspects of physiopatology, diagnostic and treatment of this syndrome is reviewed

Assuntos