RESUMO
Objetivo: El presente estudio describe el manejo médico y quirúrgico del vólvulo de sigmoides debido a dolicomegacolon andino en un hospital a una altitud mayor a 3000 msnm. Material y métodos: Estudio descriptivo, observacional, transversal de 418 pacientes con diagnóstico de vólvulo de sigmoides; admitidos inicialmente por cuadros de obstrucción intestinal, en el Hospital de Juliaca Carlos Monge - Puno, Perú, durante el periodo 2008-2012. Los datos fueron procesados a través del programa SPSS versión 21. Resultados: Se registraron 418 pacientes, la media de edad fue de 60 años, rango 18-89 años, con una proporción hombre/mujer de 3,5/1. El manejo no quirúrgico se hizo en 64 (15,4%), el tratamiento empleado fue de enema salino 20 casos 31% y sonda rectal 44 (69%), se presentó recurrencia en 27 pacientes (45%), los cuales tuvieron cirugía con resección anastomosis primaria, de estos la mortalidad correspondió a 8 pacientes (30%). De los 354 pacientes sometidos a manejo quirúrgico de emergencia 325 fueron sometidos a sigmoidectomia con anastomosis primaria (92%), mientras 29 tuvieron colostomía a lo Hartmann (8%), la morbilidad para ambos procedimientos fue de 52 casos (14,7%), la mortalidad para ambos procedimientos fue de 45 casos (12,7%). Conclusiones: El vólvulo sigmoides debido a megacolon andino tuvo una edad media de 60 años. El 15,4% tuvo manejo no quirúrgico, la tasa de recurrencia fue de 45%, mortalidad de 30%. El 84,7% tuvo manejo quirúrgico; el 92% tuvo resección anastomosis primaria y 8% colostomía a lo Hartmann, la morbilidad fue de 14,7% y la mortalidad de 12,7%.
Objective: The present study describes the medical and surgical management of sigmoid volvulus due to Andean dolicomegacolon in a hospital at an altitude above 3000 m. Material and methods: A descriptive, observational, crosssectional study of 418 patients diagnosed with sigmoid volvulus; Admitted initially due to intestinal obstruction, in the Hospital of Juliaca Carlos Monge. Puno-Perú, during the period 2008-2012. The data were processed through the SPSS software version 21. Results: A total of 418 patients were enrolled, the mean age was 60 years, range 18-89 years, and the male/female ratio was 3.5/1. Nonsurgical management was done in 64 (15.4%), the treatment used was saline enema 20 cases (31%) and rectal catheter 44 (69%), recurrence was present in 27 patients (45%), who had surgery with primary anastomosis resection, of which the mortality corresponded to 8 patients (30%). Of the 354 patients undergoing emergency surgical management, 325 were submitted to sigmoidectomy with primary anastomosis (92%), while 29 had Hartmann's colostomy (8%), the morbidity for both procedures was 52 cases (14.7%), Mortality for both procedures was 45 cases (12.7%). Conclusions: In patients with sigmoid volvulus due to Andean megacolon the mean age was 60 years. The 15.4% had non-surgical management, the recurrence rate was 45%, and mortality 30%. Patients with surgical management was 84.7%, from this group; 92% had primary anastomosis resection and 8% Hartmann colostomy, morbidity was 14.7% and mortality was 12.7%.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Doenças do Colo Sigmoide/epidemiologia , Volvo Intestinal/epidemiologia , Altitude , Megacolo/epidemiologia , Peru/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Recidiva , Doenças do Colo Sigmoide/cirurgia , Doenças do Colo Sigmoide/etiologia , Doenças do Colo Sigmoide/terapia , Anastomose Cirúrgica , Adaptação Fisiológica , Colostomia , Estudos Transversais , Volvo Intestinal/cirurgia , Volvo Intestinal/etiologia , Volvo Intestinal/terapia , Enema , Obstrução Intestinal/etiologia , Megacolo/cirurgia , Megacolo/etiologia , Megacolo/terapiaRESUMO
OBJECTIVE: The present study describes the medical and surgical management of sigmoid volvulus due to Andean dolicomegacolon in a hospital at an altitude above 3000 m. MATERIAL AND METHODS: A descriptive, observational, crosssectional study of 418 patients diagnosed with sigmoid volvulus; Admitted initially due to intestinal obstruction, in the Hospital of Juliaca Carlos Monge. Puno-Perú, during the period 2008-2012. The data were processed through the SPSS software version 21. RESULTS: A total of 418 patients were enrolled, the mean age was 60 years, range 18-89 years, and the male/female ratio was 3.5/1. Nonsurgical management was done in 64 (15.4%), the treatment used was saline enema 20 cases (31%) and rectal catheter 44 (69%), recurrence was present in 27 patients (45%), who had surgery with primary anastomosis resection, of which the mortality corresponded to 8 patients (30%). Of the 354 patients undergoing emergency surgical management, 325 were submitted to sigmoidectomy with primary anastomosis (92%), while 29 had Hartmann's colostomy (8%), the morbidity for both procedures was 52 cases (14.7%), Mortality for both procedures was 45 cases (12.7%). CONCLUSIONS: In patients with sigmoid volvulus due to Andean megacolon the mean age was 60 years. The 15.4% had non-surgical management, the recurrence rate was 45%, and mortality 30%. Patients with surgical management was 84.7%, from this group; 92% had primary anastomosis resection and 8% Hartmann colostomy, morbidity was 14.7% and mortality was 12.7%.
Assuntos
Altitude , Volvo Intestinal/epidemiologia , Megacolo/epidemiologia , Doenças do Colo Sigmoide/epidemiologia , Adaptação Fisiológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Colostomia , Estudos Transversais , Enema , Feminino , Humanos , Obstrução Intestinal/etiologia , Volvo Intestinal/etiologia , Volvo Intestinal/cirurgia , Volvo Intestinal/terapia , Masculino , Megacolo/etiologia , Megacolo/cirurgia , Megacolo/terapia , Pessoa de Meia-Idade , Peru/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Recidiva , Doenças do Colo Sigmoide/etiologia , Doenças do Colo Sigmoide/cirurgia , Doenças do Colo Sigmoide/terapia , Adulto JovemRESUMO
OBJECTIVE: To assess the role of screening and prophylactic surgery for intestinal rotational abnormalities (IRAs) in asymptomatic patients with heterotaxy. STUDY DESIGN: PubMed, Embase, and Cinahl were searched electronically to determine the overall incidence of IRAs in heterotaxy; the detection rate of IRAs associated with screening; the incidence of midgut volvulus in patients without screening; and the incidence of morbidity and mortality after prophylactic and emergency Ladd procedures. Relevant data were computed with a meta-analysis of proportions. Between-study heterogeneity was assessed with the I(2) statistic. RESULTS: From 276 papers identified, 24 studies with a total of 1433 patients with heterotaxy were included for systematic review. No randomized study was identified. True incidence of IRA in heterotaxy could not be ascertained through meta-analysis. In patients who underwent screening, the incidence of IRA was 58%. Acute midgut volvulus occurred in 5.8% of those who did not undergo screening. Postoperative mortality after Ladd procedure mainly was associated with cardiac insufficiency, and overall it was significantly greater in the emergency group compared with the prophylactic group (18% vs 5.6%). The complication rate also was greater in case of emergency vs prophylactic abdominal surgery (27% vs 16%); adhesional small bowel obstruction was the most common complication overall (6%). CONCLUSION: The screen-detected incidences of IRA and acute midgut volvulus were significantly greater in heterotaxy than the normal population. Prophylactic Ladd procedure was associated with less morbidity and mortality compared with emergency surgery. A long-term prospective randomized trial is needed to define the indication for screening and prophylactic treatment of IRA in heterotaxy.
Assuntos
Anormalidades do Sistema Digestório/diagnóstico , Anormalidades do Sistema Digestório/cirurgia , Síndrome de Heterotaxia/diagnóstico , Síndrome de Heterotaxia/cirurgia , Volvo Intestinal/diagnóstico , Volvo Intestinal/cirurgia , Intestinos/anormalidades , Programas de Rastreamento/métodos , Anormalidades do Sistema Digestório/epidemiologia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Síndrome de Heterotaxia/epidemiologia , Humanos , Incidência , Volvo Intestinal/epidemiologia , Complicações Pós-Operatórias , Período Pós-Operatório , RotaçãoRESUMO
BACKGROUND: Small bowel volvulus is a rare cause of intestinal obstruction in adult patients. This disease is more common in children and its aetiology and management is different to that in adults. CLINICAL CASE: A 30 year-old male with sarcoidosis presents with acute abdomen and clinical data of intestinal obstruction. Small bowel volvulus is diagnosed by a contrast abdominal tomography and an exploratory laparotomy is performed with devolvulation and no intestinal resection. In the days following surgery, he developed a recurrent small bowel volvulus, which was again managed with surgery, but without intestinal resection. Medical treatment for sarcoidosis was started, and with his clinical progress being satisfactory,he was discharged to home. CONCLUSIONS: Making an early and correct diagnosis of small bowel volvulus prevents large intestinal resections. Many surgical procedures have been described with a high rate of complications. Therefore, conservative surgical management (no intestinal resection) is recommended as the best treatment with the lowest morbidity and mortality rate.
Assuntos
Volvo Intestinal/cirurgia , Intestino Delgado/cirurgia , Adulto , Humanos , Íleus/etiologia , Imunossupressores/uso terapêutico , Incidência , Obstrução Intestinal/etiologia , Volvo Intestinal/complicações , Volvo Intestinal/diagnóstico por imagem , Volvo Intestinal/epidemiologia , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/patologia , Laparotomia , Masculino , Mesentério/patologia , Complicações Pós-Operatórias/etiologia , Recidiva , Sarcoidose/complicações , Sarcoidose/tratamento farmacológico , Tomografia Computadorizada EspiralRESUMO
The etiology of Megacolon is multiple. One of these causes and the most frequent is Chagas disease. Its complication: sigmoid volvulus was de main diagnosis in the admitted patients at the Bolivian and Japanese Gastroenterological Institute of Cochabamba Bolivia. It usually affects people of a low economic income. In this Gastroenterological Hospital a transversal and prospective study has been done, in order to know the real incidence and the physiopathology of this disease. In a six year period, from 2000 to 2006, 8.954 patients were admitted to the Hospital: of these, 814 (9.09%), where diagnosticated as lower intestinal obstruction. In 608 (74.7%) the final diagnosis was sigmoid torsion. Radiological diagnosis was made in 84% of the patients and endoscopic decompression was successful in 88.7%. As reported in the medical literature, the main cause of megacolon in this part of the world is Chagas disease. In our investigation 22% (98 patients), were serology positive to Chagas disease, and another 21.44% (95 patients) were serology negative. They were coca leaf chewers. One of coca leaf compounds is cocaine which blocks the adrenaline and noradrenaline degradation by mean of monoamine oxidase inactivation. These two hormones stay a long term of time in the target organ: the large bowel. By this mean chronic and persistent vessel constriction develops intestinal wall atrophy and lower resistance to the intraintestinal pressure.
Assuntos
Doença de Chagas/complicações , Volvo Intestinal/etiologia , Megacolo/etiologia , Doenças do Colo Sigmoide/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bolívia/epidemiologia , Estimulantes do Sistema Nervoso Central/toxicidade , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Doença de Chagas/fisiopatologia , Coca/toxicidade , Estudos Transversais , Feminino , Humanos , Incidência , Volvo Intestinal/diagnóstico , Volvo Intestinal/epidemiologia , Volvo Intestinal/fisiopatologia , Masculino , Megacolo/diagnóstico , Megacolo/epidemiologia , Pessoa de Meia-Idade , Prevalência , Estudos Prospectivos , Fatores de Risco , Doenças do Colo Sigmoide/diagnóstico , Doenças do Colo Sigmoide/epidemiologia , Doenças do Colo Sigmoide/fisiopatologia , Adulto JovemRESUMO
El presente trabajo de investigación titulado "Manejo del Vólvulo de Sigmoides". La investigación estuvo orientada a determinar los resultados del manejo de los pacientes con vólvulo de sigmoides en el Hospital PNP Luis N Sáenz en el periodo comprendido del 1 de Enero del 2004 al 31 de Diciembre del 2012, para ello se realizó un estudio, descriptivo, retrospectivo, de casos. La muestra seleccionada estuvo comprendida por 397 pacientes, que ingresaron al servicio de cirugía general del Hospital PNP Luis N Sáenz en el periodo que comprende el estudio. Los instrumentos empleados estuvieron conformados por una ficha de recolección de datos convenientemente elaborada para los fines de estudio. La frecuencia del Vólvulo de Sigmoides en el servicio de cirugía del Hospital PNP Luis N Sáenz en el periodo que. corresponde al estudio, es del 10.04 por ciento, el grupo etario más frecuente está entre los 60 y 69 años de edad (27.7 por ciento); el 78.3 por ciento (311) fueron del sexo masculino y 21.7 por ciento (86) del sexo femenino; el antecedente fisiológico más frecuente fue la constipación crónica (46.3 por ciento); en el 100 por ciento de los pacientes hubo dolor abdominal y no eliminación de heces y flatos; el diagnóstico definitivo se fundamentó, además de la evaluación clínica, en la Radiografía Simple de Abdomen en posición de pie en el 100 por ciento de los casos; Se operaron 333 pacientes (83.9 por ciento); de estos el procedimiento más frecuente fue la sigmoidectomía y anastomosis primaria termino terminal en el 77.6 por ciento de los casos. Hubo complicaciones en 53 pacientes operados siendo la más frecuente las bridas y adherencias postoperatorias. La mortalidad fue del 11.3 por ciento; siendo la causa más frecuente la sepsis abdominal y shock séptico. Hubo asociación estadísticamente significativa de mortalidad con el tratamiento quirúrgico, con el antecedente fisiológico de constipación, con la corta estancia hospitalaria, con el sexo femenino y con...
Assuntos
Humanos , Masculino , Adulto , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Megacolo , Morbidade , Volvo Intestinal/cirurgia , Volvo Intestinal/epidemiologia , Estudo Observacional , Estudos Retrospectivos , Estudos TransversaisRESUMO
OBJECTIVE: To characterize the natural history of intestinal failure (IF) among 14 pediatric centers during the intestinal transplantation era. STUDY DESIGN: The Pediatric Intestinal Failure Consortium performed a retrospective analysis of clinical and outcome data for a multicenter cohort of infants with IF. Entry criteria included infants <12 months receiving parenteral nutrition (PN) for >60 continuous days. Enteral autonomy was defined as discontinuation of PN for >3 consecutive months. Values are presented as median (25th, 75th percentiles) or as number (%). RESULTS: 272 infants with a gestational age of 34 weeks (30, 36) and birth weight of 2.1 kg (1.2, 2.7) were followed for 25.7 months (11.2, 40.9). Residual small bowel length in 144 patients was 41 cm (25.0, 65.5). Diagnoses were necrotizing enterocolitis (71, 26%), gastroschisis (44, 16%), atresia (27, 10%), volvulus (24, 9%), combinations of these diagnoses (46, 17%), aganglionosis (11, 4%), and other single or multiple diagnoses (48, 18%). Prescribed medications included oral antibiotics (207, 76%), H2 blockers (187, 69%), and proton pump inhibitors (156, 57%). Enteral feeding approaches varied among centers; 19% of the cohort received human milk. The cohort experienced 8.9 new catheter-related blood stream infections per 1000 catheter days. The cumulative incidences for enteral autonomy, death, and intestinal transplantation were 47%, 27%, and 26%, respectively. Enteral autonomy continued into the fifth year after study entry. CONCLUSIONS: Children with IF endure significant mortality and morbidity. Enteral autonomy may require years to achieve. Improved medical, nutritional, and surgical management may reduce time on PN, mortality, and need for transplantation.