RESUMO
BACKGROUND: Tuberculosis is frequently the form of presentation of human immunodeficiency virus (HIV) infection even in patients who have not developed acquired immune deficiency syndrome (AIDS). Nevertheless, pancreatic affection is uncommon. Tuberculosis of the pancreas (TBP) is a clinical rarity and mimics pancreatic carcinoma both clinically and radiologically. CLINICAL CASE: We present the case of a 42-year-old man with a 5-day evolution of moderate abdominal pain in the right lower quadrant and fever and vomiting without diarrhea. The patient had no history of abdominal surgery. CT scan revealed a heterogeneously enhancing, multicystic structure in the pancreatic head. Due to suspicion of malignancy, a pancreatoduodenectomy was performed with pathological result of pancreatic tuberculosis. The patient was discharged on the 10th postoperative day without surgical complications. He died 10 months later of Pneumocystis jirovecii pneumonia. By that time he had a positive serum HIV antibodies test. CONCLUSIONS: TBP diagnosis can be missed or significantly delayed because it is often not suspected prior to laparotomy unless there is evidence of pulmonary tuberculosis. TBP should be considered in the differential diagnosis of a mass in the head of the pancreas. The response to early antituberculosis treatment is very effective.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Dor Abdominal/etiologia , Febre/etiologia , Pancreatite/diagnóstico , Tuberculose Endócrina/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/complicações , Infecções Oportunistas Relacionadas com a AIDS/cirurgia , Adulto , Antituberculosos/uso terapêutico , Diagnóstico Tardio , Erros de Diagnóstico , Evolução Fatal , Soropositividade para HIV , Humanos , Masculino , Neoplasias Pancreáticas/diagnóstico , Pancreaticoduodenectomia , Pancreatite/complicações , Pancreatite/cirurgia , Pneumonia por Pneumocystis/complicações , Tuberculose Endócrina/complicações , Tuberculose Endócrina/tratamento farmacológico , Tuberculose Endócrina/cirurgiaRESUMO
BACKGROUND: Patients with ulcerative colitis (UC) or Crohn's disease (CD) have an increased risk for the development of colorectal dysplasia and carcinoma. Although appendiceal inflammation occurs histologically in 40-86% of colectomy specimens from patients with inflammatory bowel disease (IBD), appendiceal neoplasms have been reported only infrequently, and the notion of a direct association between IBD and appendiceal neoplasia is speculative. CLINICAL CASE: A 54-year-old male patient developed abdominal pain and bloody diarrhea 3 years prior. Colonoscopy and biopsy established the diagnosis of UC (proctosigmoiditis). Disease activity was moderate at the beginning and the patient initially received medical treatment with mesalazine and prednisone. He was admitted to our clinic for right lower abdominal pain. Physical examination revealed tenderness on palpation at this site. Laboratory tests were normal (including serum carcinoembryonic antigen and CA 19-9). Colonoscopy showed intrinsic compression of the cecum. The patient underwent partial cecum resection and extirpation of the mucocele. He presented postsurgical ileus resolved with medical treatment. Final histological report revealed cystadenoma of the appendix. At the 20-month follow-up, the patient was in satisfactory condition. CONCLUSIONS: We present the eighth patient, to our knowledge, with a primary cystadenoma of the appendix and UC. Special attention should be paid to patients with extraordinary symptoms during follow-up, even in UC patients.
Assuntos
Neoplasias do Apêndice/complicações , Colite Ulcerativa/complicações , Cistadenoma/complicações , Mucocele/etiologia , Dor Abdominal/etiologia , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/diagnóstico por imagem , Neoplasias do Apêndice/cirurgia , Calcinose/complicações , Calcinose/diagnóstico por imagem , Cistadenoma/diagnóstico , Cistadenoma/diagnóstico por imagem , Cistadenoma/cirurgia , Hemorragia Gastrointestinal/etiologia , Humanos , Íleus/etiologia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Proctite/complicações , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Intestinal lipomatosis is a rare disease with an incidence at autopsy ranging from 0.04 to 4.5%. Few cases have been reported in the medical literature. The condition is usually asymptomatic. Symptomatic cases usually present as obstruction or, less frequently, as bleeding. Intestinal barium studies, ultrasonography and computed tomography (CT) are useful diagnostic techniques. CLINICAL CASE: A 51-year-old male was evaluated for progressive abdominal pain, tachycardia, headache and nausea. One year before this examination, he was evaluated for gastrointestinal bleeding. Abdominal CT with contrast enhancement demonstrated multiple submucosal masses in stomach and small bowel. CT and barium examination features were typical of lipomas. No specific treatment, invasive procedures or surgery were performed for the asymptomatic intestinal lipomas. The patient has remained symptom-free for 1 year. CONCLUSIONS: Benign tumors of the small bowel are relatively rare, with lipoma being the most common type. The case reported here is considered to be unusual because stomach, duodenum, jejunum and ileum were affected. Lipomas are usually seen as smooth, nonulcerated filling defects. With these typical radiographic findings, preoperative diagnosis is possible keeping in mind this rare disease.
Assuntos
Enteropatias/diagnóstico , Intestino Delgado , Lipomatose/diagnóstico , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Introducción: La lipomatosis intestinal es una rara enfermedad con una incidencia en autopsias de 0.04 a 4.5 %. Pocos casos se han informado en la literatura médica. La condición es por lo general asintomática. Los casos sintomáticos se presentan con obstrucción o, con menor frecuencia, hemorragia. Los estudios con bario, ultrasonografía y tomografía computarizada son los procedimientos diagnósticos más comunes. Caso clínico: Hombre de 51 años de edad evaluado por dolor abdominal progresivo, taquicardia, cefalea y náusea. Fue estudiado un año antes por hemorragia gastrointestinal sin diagnóstico definitivo. La tomografía computarizada de abdomen con contraste demostró múltiples masas submucosas en estómago e intestino delgado. Las características del estudio con bario y tomografía computarizada fueron típicas de lipomatosis, por lo que no se realizaron procedimientos invasivos o quirúrgicos. El paciente se ha mantenido asintomático por un año. Conclusiones: Los tumores benignos del intestino delgado son relativamente raros, siendo el lipoma el tipo más común. El caso informado es inusual debido a la afección de estómago, duodeno, yeyuno e íleon. Los lipomas por lo general se presentan con superficie lisa y defectos de llenado no ulcerados. Con los hallazgos radiológicos típicos es posible hacer el diagnóstico preoperatorio si se considera esta rara enfermedad.
BACKGROUND: Intestinal lipomatosis is a rare disease with an incidence at autopsy ranging from 0.04 to 4.5%. Few cases have been reported in the medical literature. The condition is usually asymptomatic. Symptomatic cases usually present as obstruction or, less frequently, as bleeding. Intestinal barium studies, ultrasonography and computed tomography (CT) are useful diagnostic techniques. CLINICAL CASE: A 51-year-old male was evaluated for progressive abdominal pain, tachycardia, headache and nausea. One year before this examination, he was evaluated for gastrointestinal bleeding. Abdominal CT with contrast enhancement demonstrated multiple submucosal masses in stomach and small bowel. CT and barium examination features were typical of lipomas. No specific treatment, invasive procedures or surgery were performed for the asymptomatic intestinal lipomas. The patient has remained symptom-free for 1 year. CONCLUSIONS: Benign tumors of the small bowel are relatively rare, with lipoma being the most common type. The case reported here is considered to be unusual because stomach, duodenum, jejunum and ileum were affected. Lipomas are usually seen as smooth, nonulcerated filling defects. With these typical radiographic findings, preoperative diagnosis is possible keeping in mind this rare disease.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Enteropatias/diagnóstico , Intestino Delgado , Lipomatose/diagnósticoRESUMO
OBJECTIVE: To assess the mortality related factors of patients after relaparotomy on demand. BACKGROUND: In some patients, a relaparotomy after a primary laparotomy will be necessary, most due to acute complications. The relaparotomy can be planned or on demand based on the evolution of the patient. Which of these approaches is better is still a matter of debate. MATERIAL AND METHODS: Thirty three patients underwent relaparatomy on demand in a general surgery unit. RESULTS: Of 51 relaparotomies, 98% were positive. Nineteen of the 33 patients died, resulting in a mortality rate of 58%. The factors associated with mortality were development of an intestinal fistula (p < 0.02), wound infection (p < 0.03), generalized peritonitis in the primary surgery (p < 0.001), urgent primary laparotomy (p < 0.003), development of multiple organ failure (p < 0.005), and respiratory insufficiency (p < 0.01). CONCLUSIONS: Laparotomy on demand is useful in the treatment of patients with abdominal sepsis; however, the mortality is still very high.
Assuntos
Laparotomia/mortalidade , APACHE , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Fístula Intestinal/complicações , Masculino , Pessoa de Meia-Idade , Peritonite/complicações , Complicações Pós-Operatórias , Reoperação/mortalidade , Fatores de Risco , Sepse/cirurgia , Infecção da Ferida Cirúrgica/complicaçõesRESUMO
INTRODUCTION: Enterocutaneous fistula remains a major complication after abdominal surgery. MATERIAL AND METHODS: We reviewed the charts of patients over 70 years of age with enterocutaneous fistula who were seen in a general surgery department. Special interest was given to mortality-related factors. RESULTS: A total of 19 patients were seen. The median age was 76 years. All fistulas were postoperative. All patients were managed based on the phases of Chapman and Sheldon. The most common site of presentation was colon, followed by jejunum and duodenal fistulas. More than half of the patients were malnourished at time of presentation. Spontaneous closure presented in eight patients (47%), seven other patients required surgical treatment for closure of their fistulas. Closure of the fistulas was obtained in 15 patients (79%). Four patients died resulting in a mortality rate of 21%. The factors against spontaneous closure were high output (p < 0.03), jejunal fistulas (p < 0.05), hydroelectrolytic imbalance (p < 0.01) and multiple fistulas (p < 0.02). The factors related to mortality were high output (p < 0.04), hydroelectrolytic imbalance (p < 0.02), jejunal fistulas (p < 0.04) and sepsis (p < 0.01). CONCLUSION: Patients > 70 years of age with enterocutaneous fistulas have the same mortality reported in the overall population. Sepsis remains the most important cause of death in patients with enterocutaneous fistulas.
Assuntos
Fístula Cutânea/terapia , Fístula Intestinal/terapia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , MasculinoRESUMO
Enterocutaneous fistulas of the digestive tract is a major catastrophe of surgical practice. In most cases, they represent serious complications of abdominal surgery. A total of 90% of cases develop of a surgical complication or injury. Despite progress in the management of fistulas, they were traditionally associated with high morbidity and mortality rates. The three major complications of fistulas have been electrolyte disturbance, malnutrition and sepsis. Complications are strongly related to anatomic site of fistula, to biochemical and electrolyte content of discharge, output, and underlying pathology. The ultimate objective in management of patients with enterocutaneous fistulas is fistula closure. In 1964, Chapman proposed management for fistulas in which a set of priorities in treatment was emphasized. Medical treatment is intended to cure (spontaneous closure) or to prepare patients for surgery. It was recognized that adequate nutritional support is an essential part of treatment of enterocutaneous fistulas. Control of sepsis is a priority because sepsis is the most common cause of death. Uncontrolled sepsis should be attacked as early as possible. Although spontaneous closure has increased in most series, it is likely that the majority of patients will require an operation and this should be performed at the proper time.