RESUMO
Abstract Dieulafoy's lesion is a 1-3 mm vascular lesion in the submucosa and represents 1-2% of total GI bleeding; 80% are located in the stomach and 15% in the duodenum, while its finding in the rest of the GI tract is <5%. This work presents the case of a 79-year-old male patient who went into hypovolemic shock due to GI bleeding secondary to a rectal Dieulafoy's lesion with endoscopic and subsequent surgical management.
Resumen La lesión de Dieulafoy es una lesión vascular de 1-3 mm en la submucosa y representa del 1%-2% del total de hemorragias digestivas; 80% se localiza en el estómago y 15% en el duodeno, mientras que su hallazgo en el resto del tubo digestivo representa < 5%. En el siguiente trabajo se presenta el caso de un paciente masculino de 79 años que presentó choque hipovolémico por sangrado de tubo digestivo secundario a lesión de Dieulafoy rectal con manejo endoscópico inicial y posteriormente quirúrgico.
RESUMO
Los leiomiomas gástricos son tumoraciones submucosas benignas, poco comunes, que se originan del músculo liso. Clínicamente son asintomáticos, con buen pronóstico y con pocas complicaciones a largo plazo. Reportamos el caso de un joven de 16 años que se presenta a la clínica con melena y dolor abdominal. En la endoscopia se reporta una tumoración prepilórica, ulcerada y cubierta de fibrina. El estudio histopatológico mostró una neoplasia mesenquimal con positividad inmunohistoquimica para desmina y actina, así como negatividad para C-kit, DOG-1 y S-100, compatible con leiomioma gástrico. Fue intervenido quirúrgicamente realizándose antrectomía laparoscópica con reconstrucción en Y de Roux de manera exitosa.Gastric leiomyomas are rare, benign submucosal tumors originating from smooth muscle cells. They are usually asymptomatic, having good prognosis with limited long-term complications. A 16-year-old young man comes to our clinic and reports melena and abdominal pain. Upper endoscopy revealed a prepyloric, ulcerated, fibrin-covered tumor. Histopathological examination showed a positive immunohistochemical stain mesenchymal neoplasm for desmin and muscle actin, being negative for C-kit, DOG-1 and S100 proteins, consistent with gastric leiomyoma. Antrectomy with Roux-en-Y gastrojejunostomy was successfully performed.
Assuntos
Leiomioma , Hemorragia Gastrointestinal/etiologia , Humanos , Leiomioma/complicações , Leiomioma/cirurgiaRESUMO
INTRODUCTION AND AIMS: Double-balloon enteroscopy has been improving the visualization of the entire intestine for more than a decade. It is a complementary method in the study of intestinal diseases that enables biopsies to be taken and treatments to be administered. Our aim was to describe its main indications, insertion routes, diagnostic/therapeutic yield, and complications. MATERIALS AND METHODS: All patients referred to our unit with suspected small bowel pathology were included. The insertion route (oral/anal) was determined through diagnostic suspicion. The variables measured were: insertion route, small bowel examination extent, endoscopic diagnosis/treatment, biopsy/histopathology report, complications, and surgical findings. RESULTS: The study included 28 double-balloon enteroscopies performed on 23 patients, of which 10 were women and 13 were men (mean age of 52.95 years). The oral approach was the most widely used (n=21), the main indication was overt small bowel bleeding (n=16), and the general diagnostic yield was 65.21%. The therapeutic intervention rate was 39.1% and the procedure was effective in all the cases. The most widely used treatment was argon plasma therapy (n=7). The complication rate was 8.6%; one patient presented with low blood pressure due to active bleeding and another had deep mucosal laceration caused by the argon plasma. CONCLUSIONS: Double-balloon enteroscopy is a safe and efficacious method for the study and management of small bowel diseases, with an elevated diagnostic and therapeutic yield.
Assuntos
Enteroscopia de Duplo Balão , Enteropatias/diagnóstico por imagem , Enteropatias/terapia , Intestino Delgado/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Enteroscopia de Duplo Balão/efeitos adversos , Enteroscopia de Duplo Balão/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
BACKGROUND: Gallstone ileus is a non-strangulated mechanical obstruction of the small bowel or colon as a result of the passage of gallstones through a biliary enteric fistula. It is a rare complication of cholelithiasis, affects patients over 65 years, and the disease occurs predominantly in females. Preoperative diagnosis is difficult due to the lack of specific signs and symptoms in elderly patients with multiple comorbidities. CLINICAL CASE: A 93-year-old female presenting with a one-week history of upper gastrointestinal bleeding, electrolyte imbalance and community- acquired pneumonia pneumonia. During her prolonged hospital stay she presented an intestinal obstruction. The diagnosis of gallstone ileus was made by CT scan. Despite surgical treatment, she died due to late diagnosis. CONCLUSIONS: Gallstone ileus is a rare pathology, difficulty in diagnosis prolongs hospital stay, which directly influences mortality.
Assuntos
Delírio/etiologia , Cálculos Biliares/complicações , Hemorragia Gastrointestinal/etiologia , Doenças do Íleo/etiologia , Íleus/diagnóstico , Doenças do Jejuno/etiologia , Idoso de 80 Anos ou mais , Comorbidade , Diagnóstico Tardio , Úlcera Duodenal/complicações , Evolução Fatal , Feminino , Cálculos Biliares/cirurgia , Humanos , Doenças do Íleo/diagnóstico por imagem , Doenças do Íleo/cirurgia , Íleus/etiologia , Íleus/cirurgia , Fístula Intestinal/complicações , Fístula Intestinal/diagnóstico por imagem , Doenças do Jejuno/diagnóstico por imagem , Doenças do Jejuno/cirurgia , Sepse/etiologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: The gastrointestinal stromal tumours (GIST) are the most common soft tissue sarcomas of the digestive tract. They are usually found in the stomach (60-70%) and small intestine (25-30%) and, less commonly, in the oesophagus, mesentery, colon, or rectum. The symptoms present at diagnosis are, gastrointestinal bleeding, abdominal pain, abdominal mass, or intestinal obstruction. The type of symptomatology will depend on the location and size of the tumour. The definitive diagnosis is histopathological, with 95% of the tumours being positive for CD117. CLINICAL CASES: This is an observational and descriptive study of 5cases of small intestinal GIST that presented with gastrointestinal bleeding as the main symptom. The period from the initial symptom to the diagnosis varied from 1 to 84 months. The endoscopy was inconclusive in all of the patients, and the diagnosis was made using computed tomography and angiography. Treatment included resection in all patients. The histopathological results are also described. CONCLUSION: GIST can have multiple clinical pictures and unusual symptoms, such as obscure gastrointestinal bleeding. The use of computed tomography and angiography has shown to be an important tool in the diagnosis with patients with small intestine GISTs.
Assuntos
Hemorragia Gastrointestinal/etiologia , Tumores do Estroma Gastrointestinal/complicações , Neoplasias do Íleo/complicações , Neoplasias do Jejuno/complicações , Adulto , Idoso , Antineoplásicos/uso terapêutico , Terapia Combinada , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/terapia , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neoplasias do Íleo/diagnóstico por imagem , Neoplasias do Íleo/tratamento farmacológico , Neoplasias do Íleo/cirurgia , Ileostomia , Neoplasias do Jejuno/diagnóstico por imagem , Neoplasias do Jejuno/tratamento farmacológico , Neoplasias do Jejuno/cirurgia , Masculino , Pessoa de Meia-IdadeRESUMO
Se comunica un caso de heterotopia gástrica en rectosigmoides con sangrado rectal como manifestación clínica, por lo que se efectuó la revisión bibliográfica del tema. Caso: Varón de 21 años de edad con rectorragia de una semana de evolución. Durante el estudio del caso se tomaron biopsias de lesiones ulceradas en mucosa rectal, que fueron enviadas para su estudio histopatológico. Resultados: En la muestra recibida se observaron fragmentos entremezclados de mucosa de colon y mucosa gástrica de tipo oxíntico (fúndica) cuyos adenómeros se hallaban en estrecha relación con las criptas de Lieberkühn. Conclusión: La heterotopia gástrica es un hallazgo infrecuente, más aún cuando se observa en segmentos muy apartados en el colon distal. Suele acarrear un curso indolente y benigno, sin embargo, en ocasiones conlleva ciertas malformaciones asociadas o complicaciones derivadas de la misma actividad secretora fisiológica del tejido ectópico. Raramente puede experimentar malignización.
We report a case of gastric heterotopia in the rectum and sigmoid colon clinically presented as rectal bleeding; a review of the literature on the topic is also presented. Case: Twenty-one-year-old male who had experienced rectal bleeding for one week. biopsies from ulcerated lesions in the rectum were taken and sent forward for histopathological assessment. Results: In the sample received, fragments of colon mucosa and oxyntic (fundus) gastric mucosa, which adenomeres were closely related to the crypts of Lieberkuhn. Conclusion: Gastric heterotopia is an unusual finding, even less common when it is located in distant segments of the distal colon. Although usually being a condition with an indolent and benign evolution, it may also produce certain malformations o complications, consequence of the same secretory activity of the ectopic tissue. It rarely becomes a malignant disease.