RESUMO
OBJECTIVE: Small bowel obstruction (SBO) is a common and important surgical emergency. Our aim in this study is to describe the clinical, laboratory, and computed tomography (CT) findings to facilitate the objective identification of SBO patients in need of operative treatment in this patient population. METHODS: This retrospective study included 340 patients hospitalized due to a preliminary diagnosis of ileus. Retrieved data of patients included age, gender, comorbidities, previous hospitalization due to ileus, surgical history, physical examination findings, complete blood count and biochemistry test results, and CT findings at admission. RESULTS: The study included 180 (52.9%) male and 160 (47.1%) female patients. Treatment was conservative in 216 patients and surgery in 124 patients. Of the patients included in the study, 36.4% needed surgery. Of the female patients, 38.90% received conservative treatment and 61.30% underwent surgery. Adhesions were the most common cause of obstruction in operated patients (43.50%). CONCLUSION: We have found that female gender, vomiting, guarding, rebound, C-reactive protein levels above 75 mg/L, increased bowel diameter, and a transition zone on CT images indicate a strong need for surgery, but a history of previous hospitalization for ileus may show that surgery may not be the best option.
OBJETIVO: Describir los hallazgos clínicos, de laboratorio y de tomografía computarizada (TC) para facilitar la identificación objetiva de los pacientes con obstrucción del intestino delgado que necesitan tratamiento quirúrgico. MÉTODO: Este estudio incluyó 340 pacientes. Los datos obtenidos fueron edad, sexo, comorbilidad, hospitalización previa debida a íleo, historia quirúrgica, hallazgos de la exploración física, hemograma completo y resultados de las pruebas bioquímicas, y hallazgos de la TC al ingreso. RESULTADOS: El estudio incluyó 180 (52.9%) varones y 160 (47.1%) mujeres. El tratamiento fue conservador en 216 pacientes y quirúrgico en 124 pacientes. De los pacientes incluidos en el estudio, el 36.4% necesitaron cirugía. De las mujeres, el 38.90% recibieron tratamiento conservador y el 61.30% se sometieron a cirugía. CONCLUSIONES: Encontramos que el sexo femenino, los vómitos, la guardia, el rebote, los niveles de proteína C reactiva superiores a 75 mg/l, el aumento del diámetro intestinal y una zona de transición en las imágenes de TC indican una fuerte necesidad de cirugía.
Assuntos
Obstrução Intestinal , Intestino Delgado , Tomografia Computadorizada por Raios X , Humanos , Feminino , Masculino , Estudos Retrospectivos , Pessoa de Meia-Idade , Idoso , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Obstrução Intestinal/diagnóstico por imagem , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Adulto , Idoso de 80 Anos ou mais , Íleus/etiologia , Íleus/diagnóstico por imagem , Proteína C-Reativa/análise , Tratamento Conservador , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/complicações , Aderências Teciduais/cirurgia , Adulto JovemRESUMO
BACKGROUND: Adhesive small bowel obstruction is one of the most common causes of surgical emergencies, representing about 15% of hospital admissions. Defining the need and timing of surgical intervention still remains a challenge. AIMS: To report the experience of using meglumine-based water-soluble contrast in a tertiary hospital in southern Brazil, comparing with the world literature. METHODS: Patients suspected of having adhesive small bowel obstruction, according to their clinical conditions, underwent an established protocol, consisting of the administration of water-soluble contrast, followed by plain abdominal radiograph within 12 hours and by a new clinical evaluation. The protocol was initiated after starting conservative management, including fasting and placement of a nasogastric tube, as well as intravenous fluid reposition. RESULTS: A total of 126 patients were submitted to the protocol. The water-soluble contrast test sensitivity and specificity after the first radiograph were 94.6 and 91.0%, respectively; after the second radiograph, these values were 92.3 and 100%. The general test values for sensitivity and specificity were 91.9 and 100%, respectively. CONCLUSIONS: The measure parameters evaluated in this study were similar to those found in the literature, contributing to endorse the importance of this test in the evaluation of patients with adhesive small bowel obstruction. The particular relevance of this study was the similar results that were found using a different type of meglumine-based contrast, which is available in Brazil.
Assuntos
Diatrizoato de Meglumina , Obstrução Intestinal , Humanos , Diatrizoato de Meglumina/uso terapêutico , Aderências Teciduais/diagnóstico por imagem , Meios de Contraste/uso terapêutico , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Meglumina/uso terapêutico , ÁguaRESUMO
OBJECTIVE: This study aimed to evaluate the effectiveness of skin appearance, striae gravidarum severity, and ultrasonographic "sliding sign" in predicting preoperative adhesions before repeat cesarean section delivery on the same patient and find the most useful one. METHODS: This was a prospective cohort study conducted on pregnant women with a history of cesarean section delivery. Davey's scoring system was used for stria evaluation. The scar was assessed using their visual appearance, and transabdominal ultrasonography was applied to detect sliding sign existence. Surgeons blinded to preoperative assessment graded the severity of intra-abdominal adhesions intraoperatively using Nair's scoring system. RESULTS: Of the 164 pregnant women with at least one previous cesarean section delivery, 73 (44.5%) had filmy or dense intra-abdominal adhesions. Statistically significant association was found between three groups regarding parity, previous cesarean number, scar appearance, total stria score, and sliding sign existence. Negative sliding sign had a likelihood ratio of 4.198 (95%CI 1.178-14.964) for the detection of intra-abdominal adhesions. Stria score and scar appearance were also valuable for detection adhesions with likelihood ratios of 1.518 (95%CI 1.045-2.205) and 2.405 (95%CI 0.851-6.796), respectively. After receiver operator characteristics curve analysis, striae score cutoff value in adhesion prediction was determined as 3.5. CONCLUSION: Stria score, scar appearance, and sliding sign are all significant predictors for intraperitoneal adhesions, and sliding sign, as an easy-to-apply, inexpensive, useful sonographic marker, is the most effective adhesion predictor before repeat cesarean section delivery compared to other known adhesion markers.
Assuntos
Cesárea , Cicatriz , Gravidez , Feminino , Humanos , Cesárea/efeitos adversos , Cicatriz/diagnóstico por imagem , Recesariana , Estudos Prospectivos , Aderências Teciduais/diagnóstico por imagemRESUMO
BACKGROUND: The aim of this study was to determine the prevalence of uterine synechiae in patients with recurrent miscarriages and to evaluate the diagnostic accuracy of transvaginal ultrasound and of hysterosonography. METHODS: Sixty non-pregnant patients with a history of at least three previous consecutive miscarriages were evaluated by transvaginal ultrasound, hysterosonography and hysteroscopy to detect uterine synechiae. Hysteroscopy was considered the gold standard. Agreement of findings disclosed by transvaginal ultrasound and by the hysterosonography were evaluated according to the Kappa coefficient and their significance was tested. Significance was established at < 0. 05 (Alpha error = 5%). Sensitivity, specificity, positive and negative predictive values were determined for each method. RESULTS: Uterine synechiae were identified in 16 patients (26.7%). The accuracy of the transvaginal ultrasound and of the hysterosonography was 78.9% and 92.7%, respectively. When compared to the transvaginal ultrasound, hysterosonography had a much greater sensitivity (78. % vs. 20.0%) and a higher degree of agreement with hysteroscopy (Kappa = 80% vs. Kappa = 27%). CONCLUSION: For diagnosis of uterine synechiae, hysterosonography had a higher level of agreement with hysteroscopy than the transvaginal ultrasound. In patients with recurrent miscarriages transvaginal ultrasound is not recommended for the investigation of uterine synechiae because of its low sensitivity. Hysterosonography, on the other hand, seems to offer an important contribution especially because it is a simple, low-cost and accurate method for diagnosis of uterine synechiae.
Assuntos
Aborto Habitual/diagnóstico por imagem , Histeroscopia/métodos , Ultrassonografia/métodos , Doenças Uterinas/diagnóstico por imagem , Aborto Habitual/epidemiologia , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Histeroscopia/economia , Histeroscopia/normas , Valor Preditivo dos Testes , Prevalência , Recidiva , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/epidemiologia , Ultrassonografia/economia , Ultrassonografia/normas , Doenças Uterinas/epidemiologia , VaginaAssuntos
Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/etiologia , Peritonite/complicações , Peritonite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Dor Abdominal/diagnóstico , Dor Abdominal/etiologia , Adulto , Seguimentos , Humanos , Obstrução Intestinal/cirurgia , Intestino Delgado , Laparotomia/métodos , Masculino , Medição de Risco , Índice de Gravidade de Doença , Síndrome , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/patologiaRESUMO
OBJECTIVE: We compare effectiveness between HSS and HSG for detection of endometrial abnormalities among patient with infertility. DESIGN OF THE STUDY: Prospective, cross section, comparative. MATERIAL AND METHODS: 33 patients were studied. HSS and HSG were carried out. The images of both studies were compared, settled down a presumptive diagnosis of normality or abnormality. The analysis included percentage of agreement, coefficient of agreement Kappa, square Ji, reason of verisimilitude. RESULTS: Of 33 studied patients was diagnostics correlation in 17 (52%). The pathologies with more correlation were congenital malformations and submucous miomas, with less correlation were adherences. Other opposing pathologies were polyps and corioplacentary remains. In 9 patients (27%) we find normality in both studies. When comparing the positive studies in each group we don't find differs statistically significant (P > 0.05). The association among both techniques was high (K = 0.70). The reason of verisimilitude of the tests was 98% for HSS and 90% for HSG. CONCLUSIONS: Both studies are useful to evaluate the uterine cavity. However histerosonography has bigger sensibility and specificity, besides is a quick, easy, and economic study, with less discomfort and complications than histerosalpingography.
Assuntos
Histerossalpingografia , Infertilidade Feminina/etiologia , Útero/diagnóstico por imagem , Adolescente , Adulto , Estudos Transversais , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/diagnóstico por imagem , Endométrio/anormalidades , Feminino , Humanos , Infertilidade Feminina/diagnóstico por imagem , Leiomioma/complicações , Leiomioma/diagnóstico por imagem , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e Especificidade , Aderências Teciduais/complicações , Aderências Teciduais/diagnóstico por imagem , Ultrassonografia , Doenças Uterinas/complicações , Doenças Uterinas/diagnóstico por imagemRESUMO
Se presenta un trabajo prospectivo, según nuestro conocimiento, el primero en el país, que demuestra la experiencia de nuestro grupo en esta novedosa técnica: la histerosonografía. La histerosonografía consiste en la instilación de solución salina estéril en la cavidad uterina, como medio de contraste para evaluar dicha cavidad así como también el endometrio y la capa subendometrial. Se estudiaron 64 pacientes, 57 con éxito; de éstas últimas se realizó histeroscopia en 42. Sobre el análisis comparativo entre la histerosonografía y la histeroscopia se basó nuestra presentación y conclusiones (AU)