RESUMO
PURPOSE: Neutropenic enterocolitis (NEC) is a severe complication of neutropenia. NEC is characterized by segmental ulceration, intramural inflammation, and necrosis. Factors present in patients who underwent colectomy have never been studied. The present study aimed to describe the clinical factors present in patients who underwent emergent colectomy for the treatment of neutropenic enterocolitis. METHODS: Patients admitted with neutropenic enterocolitis from November 2009 to May 2018 were retrospectively analyzed. Logistic regression analysis was used to determine clinical factors associated with emergent colectomy. RESULTS: Thirty-nine patients with NEC were identified. All patients had a hematological disorder. Medical treatment was the only management in 30 (76.9%) patients, and 9 (23.1%) patients underwent colectomy. No differences were found between the treatment groups regarding sex, age, or comorbidities. Patients were more likely to undergo colectomy if they developed abdominal distention (OR = 12, p = 0.027), hemodynamic failure (OR = 6, p = 0.042), respiratory failure (OR = 17.5, p = 0.002), multi-organic failure (OR = 9.6, p = 0.012), and if they required ICU admission (OR = 11.5, p = 0.007). Respiratory failure was the only independent risk factor for colectomy in multivariable analysis. In-hospital mortality for the medical and surgical treatment groups was 13.3% (n = 4) and 44.4% (n = 4), respectively (p = 0.043). CONCLUSIONS: In our study, most NEC patients were treated conservatively. Patients were more likely to undergo colectomy if they developed organ failures or required ICU admission. Early surgical consultation is suggested in all patients with NEC.
Assuntos
Colectomia/métodos , Enterocolite Neutropênica/cirurgia , Adulto , Idoso , Colectomia/mortalidade , Emergências , Enterocolite Neutropênica/mortalidade , Feminino , Mortalidade Hospitalar , Humanos , Masculino , México , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de RiscoRESUMO
The treatment of the intestinal malrotation with or without midgut volvulus with the Ladd procedure for laparoscopic way has been proposed by several authors since 1995. We carry out this treatment in a patient of 15 days old with intestinal malrotation and midgut volvulus. After clinical and radiologic diagnosis, the procedure consisted in the careful counterclock reduction of the volvulus, division of the Ladd's bands, incision of the common mesentery and appendectomy. The jejunum and ileum was positioned on the rigth and the colon on the left in the abdominal cavity. The postoperative evolution was appropiate. We recommend the laparoscopic Ladd's procedure like an alternative in the patients with midgut volvulus that fulfill minimum approaches during the preoperative study that allow to carry out the surgery with security.