Assuntos
Humanos , Masculino , Feminino , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/terapia , Equipe de Assistência ao Paciente , Radioterapia/métodos , Diagnóstico por Imagem , Colostomia/métodos , Biomarcadores Tumorais , Análise de Sobrevida , Diafragma da Pelve/cirurgia , Intervalo Livre de Doença , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Tratamento Farmacológico/métodos , Liberação de Cirurgia , Analgesia/métodos , Cuidados Intraoperatórios , Recidiva Local de Neoplasia/classificação , Antineoplásicos/uso terapêuticoRESUMO
PURPOSE: Hartmann's procedure is the resection of the rectosigmoid colon with an end colostomy formation and closure of the anorectal stump (1). Its reversal has a morbidity rate up to 58% (2, 3) with an incidence of fistulae formation of 4.08% (1). Herein, we present a robotic-assisted repair of a complex fistula that occurred as complication of Hartmann's reversal when the stapler was introduced inadvertently through the vaginal canal. PATIENT AND METHODS: Eighty-three-year-old female with past medical history of hysterectomy and ischemic colitis that required colectomy and colostomy placement in December 2020. In March 2022, the patient underwent a colostomy takedown, after which she reported fecaluria, urine leakage per vagina, and recurrent urinary tract infections. Cystoscopy and vaginoscopy revealed a large colovesical fistula, a staple in the bladder trigone, and several staples in the anterior vaginal wall. Robotically, extensive adhesiolysis was performed, the sigmoid was separated from the bladder, and the intact rectal stump was dissected free. The staple from the bladder trigone was removed. Bladder was closed in two layers with 3-0 V-Loc. Colorectal anastomosis was not feasible due to the short length of both ends. Therefore, a permanent colostomy was placed. RESULTS: Operative time was 454min., and estimated blood loss was 100cc. Discharged on postoperative day 4 with a JP drain and a 20Fr Foley catheter. Drain, and Foley were removed on postoperative days 9 and 23, respectively. No postoperative complications were reported. CONCLUSION: Robotic-assisted repair represents an effective approach for the management of colovesical fistulae after Hartmann's reversal.
Assuntos
Colostomia , Procedimentos Cirúrgicos Robóticos , Feminino , Humanos , Idoso de 80 Anos ou mais , Colostomia/métodos , Reto/cirurgia , Colo , Anastomose Cirúrgica/métodos , Reoperação/métodos , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Introducción: El cierre con pérdida masiva de tejido de la pared abdominal constituye un reto en la cirugía. Objetivo: Presentar un caso de cierre abdominal difícil donde se utilizó la técnica plicatura de la bolsa Bogotá hasta lograr aproximación de los planos cutáneo, muscular y aponeurótico. Caso clínico: Paciente recibido en emergencias con herida perforo-cortante en fosa lumbar izquierda. En la intervención se encontró hemoperitoneo por lesión esplénica, diafragmática y sección del ángulo esplénico del colon. Se le realizó esplenectomía, pleurostomía izquierda y rafia de lesión colónica. Pasadas cinco horas se reintervino por signos de choque y se encontró hematoma retroperitoneal y sección completa del polo superior del riñón izquierdo. Se le realizó nefrectomía izquierda. Al quinto día del posoperatorio mostró signos peritoneales y la exploración confirmó peritonitis fecaloidea por dehiscencia de sutura de colon. Se lavó cavidad y se le ejecutó colostomía tipo Devine. La pérdida masiva de pared abdominal obligó a emplear una plicatura de la bolsa Bogotá para aproximar ambos colgajos, se obtuvo aproximación paulatina hasta la síntesis de la pared. Conclusiones: El abdomen catastrófico es una condición grave y de difícil tratamiento. La bolsa Bogotá es una alternativa viable para esta condición y modificada con plicaturas paulatinas permite el acercamiento de los dos colgajos cutáneos y garantiza el cierre de la pared abdominal, además de ser una técnica fácil de usar y económica(AU)
Introduction: Closure with massive loss of abdominal wall tissue is a challenge in surgery. Objective: To report a case of difficult abdominal closure where the Bogotá bag technique was used until the approximation of the cutaneous, muscular and aponeurotic planes was achieved. Clinical case report: This patient was received in the emergency room with a perforating-cutting wound in the left lumbar fossa. In the intervention, hemoperitoneum was found due to splenic and diaphragmatic injury and section of the splenic flexure of the colon. Splenectomy, left pleurostomy and colonic injury raffia were performed. After five hours, the patient was operated again due to signs of shock. We found a retroperitoneal hematoma and a complete section of the upper pole of the left kidney. It was decided to perform left nephrectomy. On the fifth postoperative day, this patient showed peritoneal signs and examination confirmed fecal peritonitis due to dehiscence of the colon suture. Cavity was washed and a Devine-type colostomy was performed. The massive loss of the abdominal wall made it necessary to use a plication of the Bogotá bag to approximate both flaps, a gradual approximation was obtained until the synthesis of the wall. Conclusions: The catastrophic abdomen is a serious condition that is difficult to treat. The Bogotá bag is a viable alternative for this condition and modified with gradual plications, it allows the two skin flaps to approach each other and guarantees the closure of the abdominal wall, in addition to being an easy-to-use and economical technique(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Colostomia/métodos , Parede Abdominal/cirurgia , Colo Transverso/cirurgia , Serviço Hospitalar de Emergência , Esplenectomia/métodos , Relatório de Pesquisa , Nefrectomia/efeitos adversosRESUMO
OBJECTIVE: to establish the epidemiological profile of ostomized patients treated at the Health Care Service for Ostomy Patients in Juiz de Fora and region (SASPO/JF) and to quantify the pathologies that led to the stoma as well as the ostomy-related complications. METHOD: a retrospective study was carried out with the analysis of 496 medical records of patients registered at HCSOP/JF over 30 years and who remained in at the service in June 2018. The following variables were considered: age, sex, pathology that led to the stoma, type, time, location and complications of stomas. RESULTS: 53.43% were male patients and 46.57% female. The average age was 56.24 years among men and 58.40 years among women. Eight patients had two types of ostomies simultaneously and a total of 504 ostomies were as follows: 340 colostomies (67.46%), 117 ileostomies (23.21%) and 47 urostomies (9.33%). Additionally, 47.65% of the colostomies and 76.92% of the ileostomies were temporary, while all urostomies were permanent. In 70.24% of cases, the reason for making the stoma was malignancy. There were 277 stomas with one or more complications (54.96%). CONCLUSIONS: most of the ostomized patients were over 50 years old and the main diagnosis that led to the stoma was malignancy. Ileostomies had a higher percentage of complications than colostomies and urostomies and, for all types of stomas, the most frequent complication was dermatitis.
Assuntos
Neoplasias do Colo/cirurgia , Neoplasias Colorretais/cirurgia , Atenção à Saúde/estatística & dados numéricos , Estomia/métodos , Estomia/estatística & dados numéricos , Adulto , Idoso , Cirurgia Colorretal , Colostomia/métodos , Colostomia/estatística & dados numéricos , Feminino , Humanos , Ileostomia/métodos , Ileostomia/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
ABSTRACT Objective: to establish the epidemiological profile of ostomized patients treated at the Health Care Service for Ostomy Patients in Juiz de Fora and region (SASPO/JF) and to quantify the pathologies that led to the stoma as well as the ostomy-related complications. Method: a retrospective study was carried out with the analysis of 496 medical records of patients registered at HCSOP/JF over 30 years and who remained in at the service in June 2018. The following variables were considered: age, sex, pathology that led to the stoma, type, time, location and complications of stomas. Results: 53.43% were male patients and 46.57% female. The average age was 56.24 years among men and 58.40 years among women. Eight patients had two types of ostomies simultaneously and a total of 504 ostomies were as follows: 340 colostomies (67.46%), 117 ileostomies (23.21%) and 47 urostomies (9.33%). Additionally, 47.65% of the colostomies and 76.92% of the ileostomies were temporary, while all urostomies were permanent. In 70.24% of cases, the reason for making the stoma was malignancy. There were 277 stomas with one or more complications (54.96%). Conclusions: most of the ostomized patients were over 50 years old and the main diagnosis that led to the stoma was malignancy. Ileostomies had a higher percentage of complications than colostomies and urostomies and, for all types of stomas, the most frequent complication was dermatitis.
RESUMO Objetivo: elaborar o perfil epidemiológico dos pacientes estomizados atendidos no Serviço de Atenção à Saúde da Pessoa Ostomizada de Juiz de Fora e região (SASPO/JF) e quantificar tanto as patologias que levaram à confecção, quanto as complicações presentes nas estomias. Método: realizado estudo retrospectivo com análise de 496 prontuários de pacientes cadastrados no SASPO/JF ao longo de 30 anos e que permaneciam em atendimento no serviço em junho de 2018. Foram consideradas as seguintes variáveis: idade, sexo, patologia que levou à confecção do estoma, tipo, caráter temporal, localização e complicações das estomias. Resultados: 53,43% dos pacientes eram do sexo masculino e 46,57% do sexo feminino. A média de idade entre os homens foi de 56,24 anos e entre as mulheres foi de 58,40 anos. Oito pacientes apresentaram dois tipos de estomias simultaneamente e o total de 504 estomias foi distribuído da seguinte forma: 340 colostomias (67,46%), 117 ileostomias (23,21%) e 47 urostomias (9,33%). Além disso, 47,65% das colostomias e 76,92% das ileostomias foram temporárias, enquanto todas as urostomias foram permanentes. Em 70,24% dos casos, o motivo para confecção do estoma foi a neoplasia maligna. Foram encontrados 277 estomas com uma ou mais complicações (54,96%). Conclusão: as estomias predominaram em pacientes com mais de 50 anos e o principal diagnóstico que levou à confecção dos estomas foi a neoplasia maligna. As ileostomias apresentaram maior percentual de complicações do que as colostomias e urostomias e, para todos os tipos de estomas, a complicação mais frequente foi a dermatite.
Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Estomia/métodos , Estomia/estatística & dados numéricos , Neoplasias Colorretais/cirurgia , Neoplasias do Colo/cirurgia , Atenção à Saúde/estatística & dados numéricos , Colostomia/métodos , Colostomia/estatística & dados numéricos , Ileostomia/métodos , Ileostomia/estatística & dados numéricos , Estudos Retrospectivos , Cirurgia Colorretal , Pessoa de Meia-IdadeRESUMO
Resumen Introducción: Los hongos dematiáceos se caracterizan por la presencia de abundante melanina en su pared celular. Presentan una distribución mundial, siendo más comunes en climas tropicales y subtropicales. Producen infecciones cutáneas y subcutáneas, además de enfermedades alérgicas, neumonías, abscesos cerebrales o infecciones diseminadas. Caso Clínico: Presentamos el caso de un paciente con adenocarcinoma de recto intervenido quirúrgicamente con hallazgo incidental de divertículo de Meckel y en el cual en el estudio anatomopatológico reveló la presencia de un hongo dematiáceo
Introduction: Dematiaceous fungi are characterized by the presence of brown melanine or melanine like pigments in their cell wall. They are generally distributed worldwide, being more common in tropical and subtropical climates. The clinical syndromes are often cutaneous and subcutaneous infections, but can be also responsible of allergic diseases, pneumonias, cerebral abscesses or disseminated infections. Clinical Case: We present the case of a patient with a diagnosis of rectal adenocarcinoma intervening surgically and with an incidental finding of Meckel's Diverticulum. The anatomopathological study revealed the presence of a dematiaceous fungi.
Assuntos
Humanos , Masculino , Idoso , Diverticulite/cirurgia , Alternaria/patogenicidade , Divertículo Ileal/cirurgia , Colostomia/métodosRESUMO
ABSTRACT Objective: Cystectomy with urinary diversion is the gold standard for muscle invasive bladder cancer. It also may be performed as part of pelvic exenteration for non-urologic malignancy, neurogenic bladder dysfunction, and chronic conditions that result in a non-functional bladder (e.g., interstitial cystitis, radiation cystitis). Our objective is to describe the surgical technique of urinary diversion using large intestine as a conduit whilst creating an end colostomy, thereby avoiding a primary bowel anastomosis and to show its applicability with respect to urologic conditions. Materials and Methods: We retrospectively reviewed five cases from a single institution that utilized the described method of urinary diversion with large intestine. We describe operative times, hospital length of stay (LOS), and describe post-operative complications. Results: Five patients with a variety of urologic and oncologic pathology underwent the described procedures. Their operative times ranged from 5 hours to 11 hours and one patient experienced a Clavien III complication. Conclusion: We describe five patients who underwent this procedure for various medical indications, and describe their outcomes, and believe dual diversion of urinary and gastrointestinal systems with colon as a urinary conduit to be an excellent surgical option for the appropriate surgical candidate.
Assuntos
Humanos , Masculino , Adulto , Colo Sigmoide/cirurgia , Colostomia/métodos , Derivação Urinária/métodos , Doenças da Bexiga Urinária/cirurgia , Anastomose Cirúrgica , Cistectomia/métodos , Reprodutibilidade dos Testes , Resultado do Tratamento , Duração da Cirurgia , Tempo de Internação , Ilustração Médica , Pessoa de Meia-IdadeRESUMO
PURPOSE: We analyzed the morbidity and mortality associated with Hartmann's reversal (HR) and the risk factors for major complications and mortality. METHODS: The subjects of this retrospective study were patients who underwent HR in a high-volume center. We evaluated complications as categorical variables using univariate analyses. RESULTS: Between 2003 and 2018, 199 patients underwent HR at our hospital [56.5 years; body mass index (BMI): 26.3 kg/m2; American Society of Anesthesiology score (ASA) 3: 7.5%; 36.2% had hernias]. The mean time to HR was 20.2 months and the mean operation time was 302 min. The anastomosis was stapled in 71.4% and was performed in the low/medium rectum in 21.6%. Midline hernias were repaired with mesh in 80.1%. The mean hospitalization period was 10.1 days. Surgical site infection (SSI) developed in 27.1% of the patients, 94.4% of whom were treated at the bedside. BMI was a risk factor for SSI (27.8 vs. 25.6; p = 0.047). Major complications (Clavien-Dindo III-V) developed in 27 patients (13.5%), including anastomosis dehiscence in 2.5%. ASA, BMI, age, hernia repair, and rectal stump size were not associated with major complications. The mortality rate was 2.5%. An ASA of 3 was associated with high mortality (p = 0.03). CONCLUSION: Hartmann's reversal remains challenging but can have low complication and mortality rates if performed on selected patients in a reference center. An ASA of 3 was the only predictor of mortality.