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

El vólvulo gástrico es una condición potencialmente mortal, consistente en la rotación anormal del estómago sobre un eje sostenido por dos partes fijas. Produce síntomas inespecíficos, lo cual, junto con su baja incidencia, hace difícil el diagnóstico. Se hizo una revisión bibliográfica y se presentan dos pacientes con diagnóstico de vólvulo gástrico. En ambos, la presentación clínica fue aguda, pero con diferentes manifestaciones. El abordaje quirúrgico, en uno, fue mediante técnica abierta y, en el otro, mediante laparoscopia (gastrectomía vertical); esta última, con menor morbimortalidad y repercusión en las funciones fisiológicas y anatómicas del paciente. La vía laparoscópica permite abordajes mínimamente invasivos, poco reportada en la literatura, la cual puede ser una opción adecuada para el abordaje en estos pacientes.

Gastric volvulus is a life-threatening pathology characterized by the abnormal rotation of the stomach on an axis formed by two fixed parts, which causes nonspecific symptoms. Together, the low incidence and clinical presentation, makes it a challenging diagnosis. The aim of this article is to review the literature and to present two patients with acute gastric volvulus with different clinical presentation. The first was treated by an open technique and the second one by laparoscopic technique (vertical gastrectomy) which resulted in a lower morbidity and mortality with less impact on the physiological and anatomical functions. Few cases have been reported in the literature and it may be considered an appropriate option for the approach on these patients

Assuntos

RESUMO

Gastric dilatation-volvulus is an acute and life-threatening condition characterized by rapid accumulation of air and malposition of the stomach that requires veterinary intervention. Dirofilariasis is a disease caused by the nematode Dirofilaria immitis which can cause chronic and severe injuries in the animal’s cardiovascular system. In this study, a case of gastric dilatation volvulus syndrome and splenic rupture in a dog with incidental finding of dirofilariasis in its necropsy will be reported.

Assuntos

RESUMO

Gastric dilatation-volvulus is an acute and life-threatening condition characterized by rapid accumulation of air and malposition of the stomach that requires veterinary intervention. Dirofilariasis is a disease caused by the nematode Dirofilaria immitis which can cause chronic and severe injuries in the animals cardiovascular system. In this study, a case of gastric dilatation volvulus syndrome and splenic rupture in a dog with incidental finding of dirofilariasis in its necropsy will be reported.(AU)

Assuntos

RESUMO

The interposition of a portion of the colon between the liver and the diaphragm is called Chilaiditi sign and discovered incidentally during radiological study for other reasons and usually asymptomatic presentation. When the discovery is accompanied by clinical symptoms such as abdominal pain, nausea, vomiting, bloating, constipation called Chilaiditi Syndrome. The Chilaiditi sign is a very rare condition, and the Chilaiditi syndrome is even more, especially if associated with other acute diseases. We report the case of a man of 41 years was admitted with right upper quadrant abdominal pain, nausea, vomiting, difficulty was diagnosed with radiographic and tomographic images making the differential diagnosis with lung abscess and diaphragmatic hernia. The final diagnosis was Chilaiditi Syndrome associated with acute pancreatitis and penumonia.

La interposición de una parte del colon entre el hígado y el diafragma se llama signo de Chilaiditi, el cual se descubre de forma casual durante un estudio radiológico por otra causa. Su presentación suele ser asintomática. Cuando el hallazgo se acompaña de síntomas clínicos como dolor abdominal, náuseas, vómito, distensión abdominal o estreñimiento se llama síndrome de Chilaiditi. El signo de Chilaiditi es muy raro y aún lo es más el síndrome de Chilaiditi, sobre todo si se asocia con otras patologías agudas. Se presenta el caso clínico de un hombre de 41 años de edad que ingresó por dolor abdominal en el hipocondrio derecho, náuseas y vómito; hubo dificultad diagnóstica ante las imágenes radiológicas y tomográfícas, por lo que se hizo el diagnóstico diferencial con absceso pulmonar y hernia diafragmática. El diagnóstico final fue síndrome de Chilaiditi asociado a pancreatitis y neumonía.

Assuntos

RESUMO

Gastric volvulus is a rare condition resulting from rotation of the stomach beyond 180 degrees. It is a difficult condition to diagnose, mostly because it is rarely considered. Furthermore, the imaging findings are often subtle resulting in many cases being diagnosed at the time of surgery or, as in our case, at autopsy. We present the case of a 76-year-old man with an extensive medical history, including coronary artery disease with multiple bypass grafts, who became diaphoretic and nauseated while eating. His presumptive diagnosis at arrival to the hospital was an acute coronary event; however, his initial cardiac work-up was negative. A computed tomography scan revealed a type III hiatal hernia. The following day, after consistent complaints of nausea and episodes of nonbloody emesis, he suddenly became hypotensive, tachycardic and had an episode of coffee-ground emesis. Subsequently, the patient's condition suddenly deteriorated and resuscitation attempts were unsuccessful. The autopsy revealed a partially sliding hiatal hernia, which was consistent with the radiologic impression. Additionally, a gastric volvulus was present with extensive, focally transmural necrosis involving the body/fundus. Gastric volvulus is a rare entity with variable, nonspecific clinical presentations, which requires a high level of suspicion for radiologic diagnosis. Acute cases have a high mortality rate and require emergency surgery. This case highlights the value of autopsy in the diagnosis of unsuspected cases of gastric volvulus when death occurs prior to surgical intervention.

RESUMO

El vólvulo gástrico es una entidad poco frecuente que puede presentarse de forma aguda o crónica. El vólvulo agudo puede presentarse con la triada de Borchardt, el crónico puede ser asintomático y su diagnóstico es usualmente incidental. Se presenta el caso de un piloto de avión que presenta falta de aire a los medianos esfuerzos con tos relacionada con episodios de acidez gástrica sobre todo después de comidas profusas. La confirmación diagnóstica se realizó mediante estudios radiológicos simples y contrastados. Se realizó intervención quirúrgica y los síntomas desaparecieron sin otras alteraciones en un período de seguimiento de un año...

The gastric volvulus is a not very frequent entity that can show up in acute form or chronic. The acute volvulus can show up with the triad of Borchardt, the chronic one can be asymptomatic and its diagnosis is usually incidental. We present shows a case of an airplane pilot that presents dyspnea to the medium efforts with cough related with episodes of gastric acidity mainly after profuse foods. The diagnostic confirmation was carried out by means of radiological simple and contrasted studies. A surgical intervention was performed and the symptoms disappeared without other alterations in a period of pursuit of one year...

Assuntos

RESUMO

First described by Berti in 1866, gastric volvulus (GV) is an uncommon and potentially lethal entity. GV occurs when the stomach twists by more than 180º resulting in obstruction of the alimentary tract, visceral ischemia, necrosis, and perforation. It is classified according to the rotation axis in organoaxial, mesenteroaxial or a combination of both. The clinical presentation can be acute, and is usually severe or chronic, which sometimes may be asymptomatic. It predominantly occurs in the fifth decade of life, but children, mainly those under the age of 1 year, may be affected. No ethnicity or gender was observed to show predominance. This entity is related to gastric, diaphragmatic disorders as well as laxity of gastric ligaments. Acute GV may complicate with incarceration and strangulation of the stomach when gastric necrosis ensues. These cases show a mortality rate of 60%. The authors report the fatal case of a surgically treated GV in a 43-year-old female patient who looked for medical care only after 1 month of initial symptoms. Diagnosis was confirmed with a thoracic and abdominal axial computed tomography. Besides the entire stomach being herniated and twisted into the thoracic cavity, the pancreas was pulled up through the hiatal orifice, provoking acute pancreatitis. Because of gastric necrosis and perforation, gastroenteric fluid drained into the mediastinum and left pleural space. The postoperative outcome was unfavorable resulting in the patient's death. The authors call attention to the severeness of the disease, and therefore the need of precocity of diagnosis and surgical treatment.