RESUMO
INTRODUCTION: Perianal fistulizing Crohn's disease (CD) is a phenotype with a poor prognosis. There are no studies in our country. Our objective is to determine the clinical, sociodemographic and treatment characteristics of perianal fistulizing CD in a Colombian multicenter registry. MATERIALS AND METHODS: A retrospective, multicenter observational study was carried out, with prospective data collection, in the main reference centers for inflammatory Bowel disease (IBD) in the country. Continuous variables were expressed as medians and interquartile ranges. The categorical outcome variables were compared by the Chi-square test. RESULTS: Sixty-five patients with perianal fistulizing CD were documented, with a median age of appearance of perianal fistula of 31.0 years (range: 24-42), predominantly in men (61.5%; H:M ratio: 1.4:1). Complex perianal fistulas were more frequent than simple ones (75.35 vs. 24.6%). Regarding medical treatment, 66.2% of the patients received antibiotics, 64.6% steroids, 78.5% biological therapy, 47.7% non-cutting setons, and 46.2% required surgical management, other than seton placement. Only 29.2% achieved complete remission of the fistula, and 9.2% of the patients ended up in a definitive colostomy. CD patients with complex fistulas received more biological therapy, compared to CD patients with simple fistulas (84.8 vs. 56.3%; P: 0.038). CONCLUSIONS: Perianal fistulizing CD has a poor prognosis in our setting, only 3 out of 10 patients achieve complete remission despite treatment. A multidisciplinary management is essential for the comprehensive management of this difficult pathology.
Assuntos
Doença de Crohn , Fístula Retal , Humanos , Infliximab/uso terapêutico , Doença de Crohn/terapia , Doença de Crohn/tratamento farmacológico , Colômbia , Estudos Retrospectivos , Anticorpos Monoclonais/uso terapêutico , Resultado do Tratamento , Terapia Combinada , Fístula Retal/etiologia , Fístula Retal/terapia , Sistema de RegistrosRESUMO
Resumen La presentación de pacientes con cuerpos extraños a nivel rectal no es poco frecuente; sin embargo, hay pocas estadísticas sobre la epidemiología de esta entidad. La mayor parte de la literatura publicada hace mención a reporte de casos o series de casos. Los cuerpos extraños rectales son insertados de forma intencional o no intencional, y constituyen un reto diagnóstico y terapéutico para el médico; por lo que el médico a cargo requiere de la habilidad y conocimiento para extraer objetos de diferentes formas y tamaños. Los cuerpos extraños rectales son generalmente observados en la población adulta; en relación con la estimulación erótica o asalto sexual. Adicionalmente, algunos cuerpos extraños pueden ser ingeridos ocasionalmente, pasando a través del tracto gastrointestinal y alojándose en el recto, aunque esta situación es la menos común; en especial en pacientes con enfermedades mentales, trastornos visuales, alcohólicos o usuarios de prótesis dentales. La finalidad de esta revisión es establecer unas pautas de manejo y dar a conocer un algoritmo para el enfoque de los cuerpos extraños colorrectales.
Abstract Patients with foreign bodies in their rectums are not uncommon, but statistics on the epidemiology of this entity are scarce. Most of the literature published consists of case reports or case series. Foreign rectal bodies, whether inserted intentionally or unintentionally, constitute a diagnostic and therapeutic challenge for physicians who need skill and knowledge to extract objects of different shapes and sizes. Foreign rectal bodies are generally observed in the adult population in relation to erotic stimulation or sexual assault. Occasionally, foreign bodies are ingested and pass through the gastrointestinal tract to lodge in the rectum. Although this situation is the least common, it does occur, especially in patients with mental illnesses, visual disorders, or alcoholism and among users of dental prostheses. The purpose of this review is to establish management guidelines and to present an algorithm for the approach to colorectal foreign bodies.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Reto , Corpos Estranhos , Algoritmos , Trato GastrointestinalRESUMO
Introducción. El Síndrome Pospolipectomía es una causa rara de dolor abdominal posterior a resecciones de pólipos por colonoscopia, cuyo caso, en ciertos pacientes se debe considerar el manejo conservador. Métodos. Se revisa la literatura sobre el síndrome en mención y se reporta un caso. Resultados. Nuestra paciente presentó con cuadro de dolor abdominal posterior a una polipectomía colonoscópica, tratado mediante un manejo conservador con base en los hallazgos clínicos, tomográficos y paraclínicos. Su recuperación fue favorable y no requirió intervenciones adicionales. Conclusiones. El manejo conservador con líquidos endovenosos, antibióticos y suspensión de vía oral puede ser una opción en pacientes con síndrome pospolipectomía incluso, en contexto de ¨micro-perforaciones¨ cuando no haya irritación peritoneal
Post-polypectomy syndrome is a rare cause of acute abdominal pain following colonoscopic polyp resections. Conservative treatment may be considered in selected patients. We present a literature review of Post-polypectomy syndrome and report a case and our experience with a young female who presented with an acute abdominal pain following a colonoscopic polypectomy. We selected a conservative approach based on clinical findings, lab tests and CT results; the patient had complete recovery and no additional intervention was required. Conservative treatment with IV fluids, nothing by mouth and antibiotics can be an alternative treatment plan for selected patients with mini-perforations presenting without peritoneal irritation
Assuntos
Humanos , Pólipos do Colo , Colonoscopia , Ressecção Endoscópica de Mucosa , Perfuração IntestinalRESUMO
Introducción. Un bezoar se define como un elemento no digerible atrapado en algún punto del tubo digestivo, el cual puede ser ingerido de forma intencional o accidental. El primer reporte de un bezoar en la literatura médica lo hizo Baudamant en 1779. Caso clínico. Se presenta un caso de un bezoar de plástico, un cepillo dental, como causa de pancreatitis aguda y su manejo por laparoscopia, con una revisión de la literatura. Discusión y conclusiones. Aunque los bezoares gástricos son poco frecuentes, y más aún el de plástico, es importante tenerlos en cuenta como causa de pancreatitis aguda. Definitivamente, el abordaje laparoscópico es el ideal en pacientes sin obstrucción intestinal o inestabilidad hemodinámica
Introduction: A bezoar is defined as an indigestible element trapped somewhere in the gastrointestinal tract, which can be ingested intentionally or accidentally. The first report of a Bezoar in the medical literature was by W. Baudamant in 1779. Case report: We present the case of a plastic bezoar, a toothbrush, as the cause of acute pancreatitis and its management by laparoscopy, and a literature review. Discussion and conclusions: Although gastric bezoars are rare conditions, and furthermore so plastic bezoars, it is important to take them into account as a rare cause of acute pancreatitis. Definitely the laparoscopic approach is ideal for patients without intestinal obstruction or hemodynamic instability