Case Of Intestinal Necrosis Research Articles

INTUSSUSCEPTIONS IN ADULTS (ABOUT 06 CASES)

Background : Intussusception in adults is a rare condition that is difcult to diagnose due to its clinical polymorphism. Its diagnosis has become easier thanks to advances in medical imaging. The treatment of intussusceptions in adults is surgical because of the high incidence of causative organic lesions. Our work is a prospective study which aims to determine theObjective : clinical and etiological peculiarities of acute intussusceptions in adults, to specify the diagnostic and therapeutic difculties and to draw practical conclusions regarding the optimal therapeutic management of this rare condition. Our work is a retrospective study,Materials and methods: covering a series of 06 cases of acute intussusception operated on in the visceral surgery department of the Avicenne Military Hospital in Marrakech, over a period of 6 years, from January 2014 to May 2020. Data relating to clinical features, diagnosis, treatment and histological reports were collected and analyzed. Six cases of acute intussusceptions in adults were collected over a period of six years, amountingResults: one case per year. The average age was 52 with a female predominance of 66%. Four out of 6 patients had been seen urgently. The diagnosis was made preoperatively in all cases, ie 100% by using ultrasonography and CT. The ultrasound showed a "target" image in one case and a "pseudo- kidney" image in another. CT made it possible to make the diagnosis in all cases, and objectied an etiological diagnosis in 4 patients, ie 66.6% of cases. The pure enteric form was the most frequent (3 out of 6 cases), ie 50% of cases. There was one case of intestinal necrosis. Bowel resection was performed in 6 cases, or 100%. The cause of intussusception was found in all patients, including a benign tumor cause in 66.6% of cases. The immediate postoperative follow-up was straightforward in all patients We can conclude that the acute intussusception in adults is aConclusion: rare entity that should be considered in any patient with subacute abdominal pain. And we propose that oncological resection should be carried out in all cases of intestinal intussusception without attempting reduction regardless the site of the invagination, In view of the high rate of malignancy.

门静脉系统血栓致肠坏死病例1例并文献复习

门静脉系统血栓致肠坏死病例1例并文献复习

Epidemiological Profile of Intestinal Obstructions in Koutiala, Mali: About 65 Cases

Aim: To assess the epidemiological profile of intestinal obstructions at the Koutiala district hospital. Patients and Method: This was a prospective and descriptive study taking place from August 1, 2017 to April 30, 2020. The files of patients with acute intestinal obstruction in the general surgery department of the Koutiala district hospital were collected. In this study, patients operated on for acute intestinal obstruction were included. Non-operated patients were not included in the study. Result: The records of 65 patients operated on for acute intestinal obstruction were collected. The mean age was 32 ± 22 with extremes of 1 year and 94 years. 7 infants (10.8%) and 1 4-year-old child (1.5%) were identified. The 16 to 59 age group was more common. Males were the majority with 70.8% (n = 46). The sex ratio was 2.4. The rate of bowel obstruction in the general population in the circle was 8.1 cases per 100,000 population. According to provenance, patients came from inside the circle (rural areas) in 87.7% of the cases (n = 57) and from the city of Koutiala in 12.3% (n = 8). 33.9% of our patients had undergone laparotomy (n = 22). Patients consulted urgently in 93.8%. The etiologies are dominated by post-operative straps (33.8%) and volvulus (24.6%). We noted 12 cases of intestinal necrosis. Postoperative morbidity was 13.8% of cases (n = 9) and mortality of 6.1% of cases (n = 4). Conclusion: Bowel obstruction is one of the most frequent surgical emergencies in our circle. They most often affect young subjects and young adult males. The etiologies are dominated by the post-operative flanges. Complications remain elevated.

Midterm Outcomes of Endovascular Aortic Aneurysm Repair with Carbon Dioxide–Guided Angiography

Although iodinated contrast (IC) agents are commonly used in endovascular aneurysm repair (EVAR), perioperative use in patients with renal dysfunction or IC allergies is avoided. Carbon dioxide (CO2)-guided angiography is a promising alternative. We aimed to evaluate short-term and midterm outcomes of EVAR using CO2-guided angiography. Three hundred eighty-one patients who underwent EVAR from January 2012 to September 2016 were retrospectively reviewed and divided into an IC-EVAR group (n=351) and CO2-EVAR group (n=30). Subjects in the CO2-EVAR group had severe renal dysfunction (n=27) and IC allergy (n=4). Intraoperative, postoperative, and follow-up variables were compared. Compared with the IC-EVAR group, preoperative serum creatinine level was significantly higher (2.0 vs. 0.92mg/dL, P<0.0001) and mean IC dose was significantly lower (18 vs. 55mL,P<0.0001) in the CO2-EVAR group. The fluoroscopy time, operative time, number of stent grafts placed, and technical success rates of the groups were similar; no type I and/or type III endoleaks were detected on completion angiography. There was no acute kidney injury and one case of intestinal necrosis in the CO2-EVAR group, potentially due to cholesterol embolism. Postoperative endoleak, enlargement of aneurysms, survival, freedom from secondary intervention, and renal function change up to 3months, postoperatively, were similar between the groups. CO2-EVAR is technically feasible and exhibits prominent renal protection. However, consideration of the aortic lumen status remains an important challenge.

Neutrophil-to-Lymphocyte Ratio and Platelet-to-Lymphocyte Ratio Are Effective Predictors of Prognosis in Patients with Acute Mesenteric Arterial Embolism and Thrombosis

The neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been shown to be valuable prognostic markers for a variety of pathological conditions including solid tumors, sepsis, and others. However, the prognostic values of the NLR and PLR in patients with acute mesenteric arterial embolism (AMAE) and acute mesenteric arterial thrombosis (AMAT) have not been elucidated. The aim of this study was to determine the predictive value of the NLR and PLR for poor prognosis in patients with AMAE and AMAT. A total of 137 patients with AMAE (n=77) or AMAT (n=60) were divided into a poor outcome group (cases of intestinal necrosis or death) and a better outcome group (cases without intestinal necrosis who survived successfully), according to prognosis. Neutrophil, platelet, and lymphocyte counts were recorded before pharmacotherapy or surgery. The NLR and PLR were calculated, and logistic regression analysis was performed to test their prognostic values. The cutoff values for NLR and PLR were 11.05 and 156.26, respectively. The PLR was linearly associated with the NLR (R=0.769, P<0.001). NLR (odds ratio [OR]=6.835, 95% confidence interval [CI]=2.282-20.469, P=0.001), PLR (OR=4.871, 95% CI=1.627-14.587, P=0.005), and coronary heart disease (OR=3.388, 95% CI=1.156-9.929, P=0.026) were found to be independent prognostic factors for the patients. NLR ≥ 11.05, PLR ≥ 156.26, and coronary heart disease were shown to be risk factors for poor prognosis in patients with AMAE and AMAT. According to these factors, patients can be divided into 3 prognostic groups: good, NLR < 11.05 with PLR < 156.26; moderate, NLR < 11.05 with PLR ≥ 156.26 or NLR ≥ 11.05 with PLR < 156.26; and poor, NLR ≥ 11.05 with PLR ≥ 156.26.

Invagination Intestinale Aiguë De L’adulte: Aspects Diagnostiqsues, Thérapeutiques Et Étiologiques

Introduction: Acute intussusception is a rare clinical entity in adults where it accounts for only 1-2% of intestinal obstructions. The authors wanted to report cases of acute intussusception in adult patients, their diagnostic aspects, their management, and their etiologies. Patients and Methods: This study is a retrospective study of the medical files of patients of both sexes. They include adults over 15 years of age, operated between January 2010 and December 2014, who were diagnosed with obstruction due to acute intestinal intussusception. Results: Six cases of adult intestinal intussusception were collected. The average age was 26.5 years. The sex ratio was 1 and there were so many men as women. Five out of six patients were unstable on admission. The diagnosis was made preoperative in two cases out of six, 33.3%. Ultrasound revealed a target sign in two cases. The ileo-ileal form was the most frequent (5 cases out of 6) or 83.3%. Also, there were two cases of intestinal necrosis out of six. Intestinal resection was performed in five cases or 83.33%. The cause of intussusception was found in four cases out of six or 66.7%. Here, a tumor was the cause in half of the cases. Immediate surgical follow-up was uncomplicated in all patients. Conclusion: Acute intestinal intussusception of the adult is a very rare condition. The preoperative diagnosis of acute intussusception of the adult remains delicate. The ileo-ileal form is more frequent than the ileo-colic form in adults. Treatment is always surgical in adults.

A Case of Intestinal Necrosis Caused by a Massive Superior Mesenteric and Portal Vein Thrombus Associated with Salmonella Infection

A Case of Intestinal Necrosis Caused by a Massive Superior Mesenteric and Portal Vein Thrombus Associated with Salmonella Infection

Abdominal compartment syndrome resulting from postpartum hematoma of wall: a rare occurrence associated with a high risk of mortality

Objective of current study was to analyze and summarize the clinical features of postpartum abdominal hemorrhage with Abdominal Compartment Syndrome (ACS) to improve its diagnosis and treatment. A retrospective analysis of the clinical data of four cases of postpartum abdominal hemorrhage with ACS treated in our hospital from 2009 to 2014. Postpartum ACS is characterized by excessive blood loss. Symptoms mainly included oliguria, abdominal distention, shortness of breath, progressive decrease in hemoglobin and hematocrit, coagulation disorders, large volumes of ascites on computed tomography and B-type ultrasonography, and significant increases in intra-abdominal pressure. All four patients underwent surgical decompression and hemostasis, including one case of intestinal necrosis caused by ACS. Two patients fully recovered, while two patients died: one due to acute respiratory distress syndrome and one from lupus encephalopathy. Postpartum hemorrhage can lead to abdominal ACS, which is life-threatening. Physicians should attach great importance to timely diagnosis of this phenomena and early surgical decompression is key to successful treatment.

Sodium Polysterone Sulfonate-Induced Colonic Mucosal Necrosis in a Hypovolemic Patient With Acute Kidney Injury

Introduction: Sodium polystyrene sulfonate (SPS, Kayexalate®), an ion-exchange resin used in treating hyperkalemia, removes potassium by exchanging sodium ions for potassium ions in the intestine (especially the large intestine) before the resin is passed from the body. Although rare, intestinal necrosis (including fatalities) and other serious gastrointestinal events (e.g., bleeding, ischemic colitis, perforation) have been reported, especially when administered with sorbitol. Here, we present a patient with Kayexalate®-induced colonic necrosis in a hypovolemic patient with acute kidney injury (AKI). Case Report: An 80-year-old white male presented with multiple episodes of diarrhea, hypotension, and AKI (Cr 3.7). Physical examination was remarkable for generalized abdominal discomfort. Initial labs showed potassium of 5.7 for which he received a dose of Kayexalate® 30 grams orally. The following day, he continued to have diarrhea and developed abdominal distention. Due to his clinical deterioration, a CT abdomen pelvis was done, which showed colitis of the sigmoid colon and rectum. Temporary hemodialysis was initiated for electrolyte abnormalities in the setting of worsening renal function. He then began having hematochezia, prompting a colonoscopy, which revealed severe welldemarcated colitis in the rectosigmoid junction with a large amount of blood clots at the demarcation. In the next couple of days, his abdominal pain and distension significantly worsened, and an emergent exploratory laparotomy was performed. The sigmoid colon and rectum appeared to be very thickened and dilated with fibrinous debris on the serosal surfaces. Due to the amount of distension of the entire colon, a subtotal colectomy with an end ileostomy was performed. He recovered well postoperatively. His pathology report showed distal rectosigmoid ischemic colitis, with mucosal and focal submucosal necrosis and crystals consistent with Kayexelate®. Conclusion: SPS, particularly when used with sorbitol, has been associated with cases of intestinal necrosis and other serious GI adverse events. Due to the concern that sorbitol may increase the risk of intestinal necrosis, concomitant use of sorbitol is no longer recommended. Increased risk may be associated with a history of intestinal disease or surgery, hypovolemia, prematurity, and renal insufficiency or failure. Avoid Kayexalate® use in any postoperative patient until normal bowel function resumes or in patients at risk for constipation or impaction; discontinue use if constipation occurs. Also, in patients who received Kayexalate’, clinicians must keep a close watch on any gastrointestinal symptoms to prevent catastrophic complications.

Prevention of portal venous system thrombosis after splenectomy and devasculation

Objective To investigate the causes and prevention measures for patients with portal hypertension hypersplenism undergone splenectomy plus pericardial devascularization and post-operative portal vein thrombosis (portal vein thrombogenesis,PVT).Methods 178 cases of splenectomy plus devascularization from July 2013 to May 1994 in Cangzhou Central Hospital of Hebei Province,including 102 cases of early postoperative application of low molecular heparin anticoagulant for the prevention group,76 cases without anticoagulant medicine as control group.33 cases with PVT found by B ultrasound or CT scan,were treated with urokinase body intravenous thrombolysis,hepatic artery catheterization thrombolysis,intestinal resection of + Fogarty catheter embolectomy vein stump treatment respectively.Results The total incidence of thrombosis was 18.5％ (33/178),prevention group was 8.8％ (9/102),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ thrombus,in 1 cases,no intestine necrosis.The control group thrombosis rate was 31.6％ (24/76),including 7 cases in grade Ⅰ,Ⅲ,Ⅳ,thrombosis in 17 cases,5 cases of intestine necrosis,two groups of thrombosis rate were significantly differences (x2 =14.932,P =0.000).Thrombus disappeared completely in 7 cases,the thrombus grading decreased in 2 cases in the preventive group after thrombolysis,and thrombus disappeared completely in 6 cases,11 cases of thrombosis degraded in the control group after treatment of thrombolysis,1 case cured by TIPS with thrombolysis and thrombectomy,1 case died of sudden digestive tract bleeding,Among 5 cases of intestinal necrosis,4 cases died and 1 case undergone abdominal exploration being found with intestine & colon necrosis.Conclusions There are a variety of factors causing PVT after splenectomy and devascularization.Early anticoagulation can significantly reduce the incidence of PVT,early discovery and treatment can prevent severe outcome. Key words: Hypertension, portal vein; Splenectomy; Venous thrombosis ; Heparin

A CASE OF SMALL INTESTINAL NECROSIS ASSOCIATED WITH POTAL VENOUS GASS

We experienced a caseof intestinal necrosis which lacked remarkable abdominal symptoms and occurred during the postoperative course for gastric cancer. A 48-year-old man was diagnosed as having a Borrmann type II gastric cancer in the upper body on the greater curvature of the stomach. He underwent total gastrectomy, resection of the pancreatic tail and splenectomy. Postoperatively, the patient fell into anxiety neurosis and ingestion difficulty so that his hospital stay was prolonged. He complained of a slight abdominal pain and fell into shock on postoperative day 54. There was only a slight tenderness in the right lower abdomen. The abdominal echogram showed many high echoic spots in the right lobe of the liver, which were presumed to be air. Potal Venous Gass was diagnosed. He underwent exploratory laparotomy. The ileum was necrotized by about 2.5m proximal to the ileum end and a 15cm segment of the ileum was resected. Its histopathologic finding demonstratd ischemic enteritis.

Intestinal Necrosis Associated With Postoperative Orally Administered Sodium Polystyrene Sulfonate in Sorbitol

We estimated the incidence of intestinal necrosis in 752 hospitalized patients who had received sodium polystyrene sulfonate (SPS). Of these 752 patients, 117 were exposed within 1 week of surgery. Two cases of intestinal necrosis were discovered, both in patients who had received orally administered SPS in sorbitol within 1 week of surgery. Based on these two cases, the postoperative incidence of intestinal necrosis associated with SPS was 1.8%. For comparative purposes, we identified 862 patients who had undergone hemodialysis, renal transplantation, or cardiac transplantation, but did not receive SPS. No cases of idiopathic intestinal necrosis were found in this second group (P = 0.014). These data suggest that SPS in sorbitol-associated intestinal complications may be a relatively common occurrence in postoperatively exposed patients.