RESUMO
INTRODUCTION: Gallstone ileus represents 4% of the causes of bowel obstruction in the general population, but increases to 25% in patients above the age of 65 years. Gallstone ileus does not present with unique symptoms, making diagnosis difficult. Its management is surgical, but there is no consensus as to which of the different surgical techniques is the procedure of choice. At present, there is no recent review of this pathology. AIM: To conduct an up-to-date review of this disease. MATERIALS AND METHODS: Articles published within the time frame of 2000 to 2014 were found utilizing the PUBMED, EMBASE, and Cochrane Library search engines with the terms "gallstone ileus" plus "review" and the following filters: "review", "full text", and "humans". RESULTS: The results of this review showed that gallstone ileus etiology was due to intestinal obstruction from a gallstone that migrated into the intestinal lumen through a bilioenteric fistula. The presence of 2 of the 3 Rigler's triad signs was considered diagnostic. Abdominal tomography was the imaging study of choice for gallstone ileus diagnosis and the surgical procedures for management were enterolithotomy, one-stage surgery, and two-stage surgery. Enterolithotomy had lower morbidity and mortality than the other 2 procedures. CONCLUSIONS: The aim of gallstone ileus treatment is to release the obstruction, which is done through enterolithotomy. It is the recommended technique for gallstone ileus management because of its lower morbidity and mortality, compared with the other techniques.
Assuntos
Cálculos Biliares/complicações , Íleus/etiologia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Cálculos Biliares/diagnóstico , Cálculos Biliares/fisiopatologia , Cálculos Biliares/cirurgia , Humanos , Íleus/diagnóstico , Íleus/fisiopatologia , Íleus/cirurgia , Resultado do TratamentoRESUMO
Analizar el beneficio de la goma de mascar y la metoclopramida en la prevención del íleo postoperatorio de laparotomía, Hospital Victorino Santaella Ruíz, octubre-noviembre 2009. Estudio prospectivo, cuasiexpemental. Un total de 60 pacientes post-operados de laparotomía fueron seleccionados y distribuidos equitativamente en 3 grupos: metoclopramida, goma de mascar y grupo control. Se registro el inicio de ruidos hidroaéreos, expulsión de flatos, evacuaciones y tolerancia completa a la vía oral en cada grupo. Los resultados fueron semetidos a un análisis de varianza de una sola vía y test de comparaciones múltiples. Con respecto al grupo control el grupo goma de mascar demostró ventaja al evaluar los factores ruidos hidroaéreos (p<0,05) y tolerancia completa a la vía oral (p<0.02). De la misma manera lo demostró el grupo metoclopramida (p<0,05) sobre el grupo control cuando se evaluó el factor flatos. Y en relación al factor evacuaciones ambos grupos terapéuticos demostraron igual superioridad sobre el grupo control (p<0.02). No se observaron diferencias significativas entre los grupos goma de mascar y metoclopramida. No se observaron diferencias significativas entre la administración de goma de mascar y metoclopramida, sin embargo al compararlos individualmente con el grupo control ambos mostraron beneficios estadísticamente significativos, que fueron mayores cuantitativamente en el grupo goma de mascar. En base a lo anterior y a otras ventajas como; la virtual ausencia de efectos secundarios, su bajo costo, su fácil y amplia disponibilidad, podemos recomendar el uso de goma de mascar para la prevención del íleo postoperatorio.
Analyze the benefit of chewing gum and metoclopramide in the prevention of postoperative ileus after laparotomy, Hospital Victorino Santaella Ruíz, octubre-november 2009. A prospective clinical trial carried out on 60 post-operatives of laparotomy patients. They were randomly assigned into three groups: metoclopramide, chewing gum and control group. The beginning of bowel sounds, flatus, bowel movements and complete food tolerance were recorded in each group. The data were analysed using the one-way variance method and the multiple comparison test. With respect to control group, the chewing gum group showed some statistical advantage when the factor, bowel sounds and complete food tolerance were compared (p<0,05) and (p<0.02) respectively. Metoclopramide showed advantage over the control group in regard to flatus factor (p<0,05). For the bowel movement factor, both therapeutic groups showed identical superiority compared to control group (p<0.02). There was no statistical diference between metoclopramide and chewing gum groups. There were not statistical difference between both therapeutic groups; nevertheless, when both of them were compared individually with the control group, the chewing gum group showed cuantitatively more advantages than metoclopramide group in the prevention of postoperative ileus. Based on the previously describe and other advantages as absence of side effects low cost and easy accessibility we can recommend the use of chewing gum in the prevention of postoperative ileus.
Assuntos
Goma de Mascar/análise , Íleus/fisiopatologia , Íleus/terapia , Laparotomia/efeitos adversos , Metoclopramida/administração & dosagem , Pseudo-Obstrução Intestinal/etiologiaRESUMO
OBJECTIVES: To characterize the time course and physiologic significance of decline in serum immunoreactive trypsinogen (IRT) levels in infants with cystic fibrosis (CF) by mode of diagnosis and genotype, and to examine IRT heritability. STUDY DESIGN: We studied longitudinal IRT measurements in 317 children with CF. We developed statistical models to describe IRT decline. Pancreatic disease severity (Mild or Severe) was assigned using CF genotype and was confirmed in 47 infants through fat malabsorption studies. RESULTS: Infants with severe disease exhibited IRT decline with non-detectable levels typically seen by 5 years of age. Infants with mild disease exhibited a decline in the first 2 years, asymptomatically approaching a level greater than published norms. IRT and fecal fat were inversely correlated. IRT values in infants with meconium ileus (MI) were significantly lower than newborn-screened infants at birth. The high proportion of shared variation in predicted IRT values among sibling pairs with severe disease suggests that IRT is heritable. CONCLUSIONS: IRT declines characteristically in infants with CF. Lower IRT values in newborns with MI suggest increased pancreatic injury. Furthermore, IRT is heritable among patients with severe disease suggesting genetic modifiers of early CF pancreatic injury. This study demonstrates heritability of a statistically modeled quantitative phenotype.