RESUMO
BACKGROUND: Pelvic congestion syndrome is a condition not yet fully understood, hence provokes controversy. It is cause of up to 40% of visits to the doctor; affecting women of reproductive age who experience non-specific symptoms such as characteristic pelvic pain with more than six months of evolution and difficult to treat dyspareunia in which even narcotics are insufficient for control. OBJECTIVE: To recognize the vascular anatomy of the pelvic cavity and identify the characteristics of pelvic congestion syndrome demonstrable by computed tomography. MATERIAL AND METHODS: A descriptive, observational, cross-sectional and retrospective study at Hospital Angeles del Pedregal, in the Department of Radiology and Imaging with patients who reported imaging studies with key findings to recognize the pelvic congestion syndrome. All women with incidental finding of abnormal dilation of the gonadal vein were included, allowing to suggest pelvic congestion syndrome as a possible diagnosis. RESULTS: There were 17 cases (0.9%) of patients with abdominopelvic pain syndrome who underwent multislice computed tomography to 3 mm, with extension from the lung bases to the pubic symphysis. Predominance of left gonadal vein is conditioned by the anatomical arrangement of the left gonadal vein. During the arterial phase opacification of the gonadal vein was identified in 11 patients (65%), a circumstance that correlates with retrograde venous flow valve incompetence. In computed tomography findings of pelvic congestion syndrome were also identified 12 patients (70%) with abdominopelvic pain syndrome. CONCLUSIONS: Pelvic congestion syndrome is a rare condition that radiologists do not consider because they don't know it and the clinical diagnoses give no clinical data to suggest this condition. But if one takes into account the literature, it refers to it as the origin of up to 40% of the visits to the gynecologist, and there may be more cases that will increase its prevalence.
Assuntos
Dispareunia/diagnóstico por imagem , Genitália Feminina/irrigação sanguínea , Hiperemia/diagnóstico por imagem , Tomografia Computadorizada Multidetectores , Ovário/irrigação sanguínea , Dor Pélvica/diagnóstico por imagem , Varizes/diagnóstico por imagem , Adolescente , Adulto , Idoso , Estudos Transversais , Dispareunia/etiologia , Feminino , Humanos , Hiperemia/complicações , Pessoa de Meia-Idade , Dor Pélvica/etiologia , Flebografia/métodos , Estudos Retrospectivos , Varizes/complicações , Adulto JovemRESUMO
BACKGROUND: The Trousseau syndrome, first described in 1865, is the relationship of venous thromboembolisms and cancer. We present a case with rectal cancer and Trousseau syndrome. CLINICAL CASE: Female 40 years old, went to the Coloproctology Service for painless bleeding. A computed tomography report showed a tumor of 5 by 6 cm up 5 cm from the anal margin. Ultra-low anterior resection with colonic reservoir and loop ileostomy surgery was performed. The pathology report showed a semidiferenciate adenocarcinoma of the rectum and we established the stage as T3N0M0. Within 72 hours of her operation, she experienced sudden hypotension and painful abdominal distention. A second surgery was done finding necrosis of the colon from the splenic angle until the colonic reservoir with thrombi in the left colic artery, ischemic signs of bilateral fallopian tubes, ovaries, uterus, pelvic floor and the small intestine, 40 cm before ileostomy and ileon. Left hemicolectomy and colostomy was done. She was taken to intensive care where continuous administration of heparin was given; she died within 5 days because of multiorgan failure. CONCLUSIONS: The mechanism for this syndrome was unknown but there are several hypotheses, suggesting that hematological cancer patients are at an increased risk of deep vein thrombosis. Pancreatic cancer is the most common presentation with this syndrome (in 50% of cases). We suggested continuing with the standards of prevention of thromboembolism.
antecedentes: el síndrome de Trousseau se describió por primera vez en 1865; es la relación entre tromboembolismo venoso y cáncer. Objetivo: informar el caso de una paciente con cáncer de recto y síndrome de Trousseau. Caso clínico: paciente femenina de 40 años de edad que acudió al servicio de Coloproctología por rectorragia indolora. La TAC reportó un tumor de 5 por 6cm y del margen anal a 5cm. Se efectuó resección anterior ultrabaja, con reservorio colónico e ileostomía de protección. El reporte de patología fue de: adenocarcinoma semidiferenciado del recto, con clasificación T3N0M0. A las 72 horas del postoperatorio tuvo hipotensión arterial súbita y distensión abdominal dolorosa. En la reintervención quirúrgica se encontró: necrosis del colon desde el ángulo esplénico hasta el reservorio colónico, con trombos en meso, signos de isquemia en el útero, trompa de Falopio y ovarios, piso pélvico y 40 cm de intestino delgado, antes de la ileostomía e íleon. Se realizó hemicolectomía izquierda y colostomía. Se trasladó a la unidad de terapia intensiva donde continuó con la administración de heparina; falleció a los cinco días por insuficiencia multiorgánica. Conclusiones: el mecanismo de este síndrome se desconoce pero existen varias hipótesis: se ha sugerido que los cánceres hematológicos son los que tienen mayor riesgo de trombosis venosa profunda. El cáncer de páncreas se relaciona con este síndrome en 50% de los casos. Se sugiere continuar con las normas de prevención del tromboembolismo.
Assuntos
Adenocarcinoma/complicações , Isquemia/etiologia , Neoplasias Retais/complicações , Trombofilia/etiologia , Trombose Venosa/etiologia , Adenocarcinoma/diagnóstico , Adenocarcinoma/metabolismo , Adenocarcinoma/cirurgia , Adulto , Anticoagulantes/uso terapêutico , Colectomia , Colo/irrigação sanguínea , Bolsas Cólicas , Colostomia , Cisteína Endopeptidases/metabolismo , Cisteína Proteases/metabolismo , Evolução Fatal , Feminino , Hemorragia Gastrointestinal/etiologia , Genitália Feminina/irrigação sanguínea , Heparina/uso terapêutico , Humanos , Isquemia/cirurgia , Insuficiência de Múltiplos Órgãos , Proteínas de Neoplasias/metabolismo , Diafragma da Pelve/irrigação sanguínea , Complicações Pós-Operatórias/etiologia , Neoplasias Retais/diagnóstico , Neoplasias Retais/metabolismo , Neoplasias Retais/cirurgia , Reoperação , SíndromeRESUMO
Ultrasound allows evaluate in girls, the internal genitals development and their follow up during puberty. Doppler of the uterine arteries (UA) has demonstrated be a complementary parameter to detect the onset of puberty. Objective: To show through our experience, the correlation between the internal genital development and the Doppler of UA morphology in girls and adolescents. We analyzed in 84 ultrasounds (US); uterine morphology and the relation body/cervix, endometrial thickness, ovarian volume and the pattern of Doppler UA. We obtained a relationship between the anatomic changes usually studied and the patterns of the Doppler UA, since childhood to puberty. Conclusion: The diastolic flow changes in the UA can be complementary for the diagnosis of the degree of puberty.
El ultrasonido permite la evaluación del desarrollo de los genitales internos en las niñas y seguimiento a través de la pubertad. La curva del Doppler de arterias uterinas (AU) ha demostrado ser un parámetro complementario en la detección del inicio de la pubertad.Objetivo: mostrar la correlación del desarrollo de los genitales internos, con la morfología de las curvas Doppler de AU en niñas y adolescentes a través de nuestra experiencia. Analizamos en 85 ultrasonidos (US); morfología uterina, relación cuerpo/cervix, grosor endometrial, volumen ovárico y morfología de la curva del Doppler de AU. Constatamos una asociaciónentre los cambios morfológico estudiados habitualmente con los distintos patrones de las curvas del Doppler desde la niñez a la pubertad. Conclusión: Los cambios en el flujodiastólico de las arterias uterinas permiten complementar el diagnóstico del grado de progreso de la pubertad.
Assuntos
Humanos , Adolescente , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Artéria Uterina/crescimento & desenvolvimento , Artéria Uterina , Genitália Feminina/crescimento & desenvolvimento , Genitália Feminina , Fatores Etários , Genitália Feminina/irrigação sanguínea , Puberdade , Valores de ReferênciaRESUMO
Variations in anatomy were found quite frequently during bilateral gonadal vein dissection and resection for pelvic varices in the past 5 years (120 cases). In about one fourth of the cases, routine gonadal phlebography was not technically feasible or did not correlate exactly with the operative findings. Some cases of male varicocele showed recurrence after surgery. These facts, in addition to the scarce information provided by anatomy textbooks, induced us to study thoroughly the gonadal veins. One hundred cadaver dissections (200 veins) were done for length, diameter, number, and location of valves and collaterals, number of trunks in each side, and mode of termination in the renal vein and vena cava. Topographic division of the veins by thirds facilitated the information. Variations from the classic anatomic description were encountered frequently. As to the number of trunks, at the middle third, where the vein is usually divided, only 60% have one trunk on the left and only 75% have one on the right side. The rest are multiple; as many as four and six trunks in the lower third were found. The knowledge of these anatomic variations, not clearly described before, is of great importance to both surgeons and invasive radiologists and conducive to successful results.