Obstructive Acute Abdomen Research Articles

Malrotación intestinal, cuadro agudo en paciente adulto

Introducción: El síndrome de Malrotación Intestinal (MI) es un trastorno anatómico producido por una rotación y fijación anómala del intestino medio en la cavidad abdominal durante el período embrionario. Existen 3 variantes subdivididas de acuerdo a sus hallazgos. El 90% se diagnostica en pacientes pediátricos con clínica de abdomen agudo obstructivo sin embargo en pacientes adultos se asocian síntomas crónicos que evidencian malnutrición y rara vez con un cuadro agudo únicamente. El vólvulo y una inadecuada respuesta al tratamiento clínico constituyen una urgencia quirúrgica por el riesgo de necrosis extensa. El tránsito intestinal es el gold estándar para su diagnóstico y la tomografía se puede considerar como complementario de apoyo para definir hallazgos extraintestinales.
 Objetivo: Describir un caso clínico de malrotación intestinal con cuadro agudo en un paciente adulto.
 Material y métodos: Estudio descriptivo retrospectivo, presentación de caso clínico
 Resultados: Se trata de un paciente masculino de 39 años sin antecedentes de interés que acude por cuadro de 24 horas de evolución caracterizado por distensión más dolor abdominal tipo cólico en epigastrio y marco colónico, de gran intensidad asociado a vómitos por 15 ocasiones de contenido alimentario y posterior bilioso con ruidos disminuidos y mate a la percusión difusa, se realiza Rx de abdomen evidenciándose niveles hidroaéreos, distensión de asas intestinales y válvulas conniventes visibles, se determina abdomen agudo obstructivo se coloca enema evacuante y sonda nasogástrica con producción inicial de 450ml y logrando canalizar flatos sin embargo a las 24 y 48 horas con producciones de 300ml/día por lo que se realiza tomografía que revela asas distendidas con contenido líquido y gaseoso y desplazamiento de las mismas hacia la derecha por lo que con tórpida evolución clínica se decide laparotomía a las 72 horas encontrándose ciego y colon ascendente sin fijación, asas yeyunales en bolsa peritoneal, ángulo de Treitz en hipocondrio derecho, asas yeyunales distendidas desde 40 centímetros de ángulo de Treitz hasta 180 centímetros hacia distal por lo que se cataloga como SMI tipo III A y B. Por íleo postquirúrgico con producciones elevadas en SNG se inicia NPT, que con adecuada evolución clínica se retira y se reinicia tolerancia a dieta progresiva que con paciente asintomático se prescribe el alta.
 Conclusiones: La mal rotación intestinal en adultos como causa de obstrucción intestinal suele ser infrecuente al igual que un cuadro agudo; y con mala evolución a medidas clínicas su tratamiento es quirúrgico.

N17 Profile of ostomy patients treated at a referral hospital for inflammatory bowel disease

Abstract Background As part of the surgical treatment of inflammatory bowel disease (IBD), sometimes is necessary the intestinal stoma. The aim of this study is to identify the profile of ostomy patients treated at a referral public hospital in IBD in Brazil. Methods This is a descriptive study with a quantitative approach. The sample consisted of all patients who underwent stoma surgery at a referral public hospital in IBD in Brazil. The inclusion criteria were: to have a medical diagnosis of Crohn’s Disease (CD) or Ulcerative Colitis (UC) and to have or have had intestinal stoma. Data collection was performed through the analysis of patient records. Results The number of patients attending the outpatient clinic is approximately 200 with UC and 150 with DC. The sample consisted of 33 patients, the majority of male gender (51.52%), age between 22 to 77 years (44.55 ± 15.10), literate (93.94%), self-declared white (84.85%), coming from the state of São Paulo (96.97%), smokers (6.06%), alcoholics (3.03%), married (63.64%) and the number of children ranged from 01 to 10. Regarding the characteristics related to IBD, 15 (45.45%) were diagnosed with CD, 6 (40%) were fistulising ileocolonic type and 18 (54.55%) were diagnosed with UC and most with pancolitis (88.89%). The average time of illness was 14.2 years. Among the causes of the stoma, the most frequent were perforating acute abdomen (n = 5, 15.15%), severe acute colitis (n = 4, 12.12%), obstructive acute abdomen (n = 4, 12.12%), toxic megacolon. (n = 3, 9.09%) and neoplasia (n = 2, 6.06%). Regarding the character of the surgery, 10 (30.30%) were urgency and emergency and 11 (33.33%) elective. Only 5 (15.15%) surgeries performed the previous demarcation of the stoma. Regarding the types of stoma, 4 (12.12%) had temporary colostomy and 3 (9.09%) permanent, 16 (48.48%) had temporary ileostomy and 3 (9.09%) permanent. The average time of stoma was 3.19 years. 2 (6.06%) colostomised and 9 (27.27%) ileostomised reversed the stoma. 2 (6.06%) patients refused intestinal reconstruction. Conclusion The study results showed us that IBD with more severe extension and behaviour can result in intestinal ostomy, either temporary or permanent. The characterisation of ostomised patients is necessary for the identification of nursing needs to be highlighted, such as the previous demarcation of the stoma.

Rare Cause of Obstructive Acute Abdomen by Phytobezoar: Orange Pomace.

Abstract Obstructive acute abdomen is considered the second most common type of acute abdomen in surgical emergency. Phytobezoars are rarely reported as etiological factors and affected patients may remain asymptomatic for many years. In most cases, diagnosis is difficult and this entity continues undiagnosed until surgery due to the absence of specific signs and symptoms. Although no gold standard exam is available for the diagnosis of intestinal phytobezoar, this hypothesis should be considered when encountering an obstructive acute abdomen. In this study, a case of acute abdomen caused by phytobezoar is reported.

Abdominal Complications After Lung Transplantation in a Brazilian Single Center

Surgical and nonsurgical abdominal complications have been described after lung transplantation. However, there is limited data on this event in this population. The objective of this study was to analyze the incidence of abdominal complications in patients undergoing lung transplantation at the Heart Institute of the Faculty of Medicine, University of São Paulo (InCor-HCFMUSP) between the years 2003 and 2016. The main causes of abdominal complications were inflammatory acute abdomen (7 patients; 14%), obstructive acute abdomen (9 patients; 18%), gastroparesis (4 patients; 8%), distal intestinal obstruction syndrome (4 patients; 8%), perforated acute abdomen (7 patients; 14%), cytomegalovirus (CMV; 6 patients; 12%), and other reasons (12 patients; 26%). Separating these patients according to Clavien-Dindo classification, we had 21 patients (43%) with complications grade II, 4 patients (8%) with complications grade IIIa, 7 patients (14%) with grade IIIb complications, 7 patients (14%) with grade IV complications, and 10 patients (21%) with grade complications V. In conclusion, abdominal disorders are seriously increased after lung transplantation and correlate with a high mortality. Early abdominal surgical complication has worse prognosis.

Perforation of pyometra presenting as obstructive acute abdomen and peritonitis: a case report

ABSTRACT We report a rare case of a 67-year-old postmenopausal woman presenting diffuse peritonitis secondary to spontaneous perforation of pyometra with obstructive acute abdomen. During laparotomy was performed subtotal abdominal hysterectomy with bilateral salpingo-oophorectomy. The histopathology found the presence of moderately differentiated uterine squamous cell carcinoma. Despite intensive care, the patient died due to multiple organ failure resulting from sepsis on postoperative day 1. This case shows the importance of clinical suspicion on the acute gynecological diseases presenting as a systemic disease in the emergency room.

Emergency surgery for complicated colorectal cancer in central Brazil

Objectiveto report clinical and pathological features of patients with colorectal cancer diagnosed during emergency abdominal surgery. Methodsrecords of 107 patients operated between 2006 and 2010 were reviewed. Resultsthere were 58 women and 49 men with mean age of 59.8 years. The most frequent symptoms were: abdominal pain (97.2%), no bowel movements (81.3%), vomiting (76.6%), and anorexia (40.2%). Patients were divided into five groups: obstructive acute abdomen (n=68), obstructive acute perforation (n=21), obstructive acute inflammation (n=13), abdominal sepsis (n=3), and severe gastrointestinal bleeding (n=2). Tumors were located in the rectosigmoid (51.4%), transverse colon (19.6%), ascendent colon (12.1%), descendent colon (11.2%), and 5.6% of the cases presented association of two colon tumors (synchronic tumors). The surgical treatment was: tumor resection with colostomy (85%), tumor resection with primary anastomosis (10.3%), and colostomy without tumor resection (4.7%). Immediate mortality occurred in 33.4% of the patients. Bivariate analysis of sex, tumor location and stage showed no relation to death (p>0.05%). Conclusionscolorectal cancer may be the cause of colon obstruction or perfuration in patients with nonspecific colonic complaints. Despite the high mortality rate, resection of tumor is feasible in most patients.

Obstrução intestinal por melanoma metastático: relato de caso

Melanoma is a highly malignant tumor and represents 3% of all cancers. Malignant melanoma is the most common metastatic tumor involving the gastrointestinal tract, the small bowel being the localization most frequently involved. Its clinical presentation is inespecific and an obstructive acute abdomen syndrome could be its first manifestation. The article is about a case of a 36 years-old patient, which had been submitted to resection of melanoma in the dorsal region in 2009. The patient developed acute intestinal obstruction and laparotomy showed intestinal intussusceptions caused by metastatic melanoma at 50 cm from the angle of Treitz. The specimen was sent for pathological, which confirmed the presence of metastatic melanoma in the small bowel. The treatment of metastatic melanoma involves systemic treatment and treatment of complications. Intestinal metastasis must be considered in any patient with gastrointestinal symptoms and previous history of melanoma and the surgical treatment should always be considered because it can occasionally provide long-term survival. Key-words: Melanoma. Metastasis. Intestinal obstruction. Intussesception. Surgery.

Complication related to colostomy orifice: intestinal evisceration

Intestinal evisceration at the site of a stoma is a rare event, with high morbimortality. Its clinical manifestation often occurs between the sixth and seventh days after surgery. The risk factors most frequently related to evisceration are: increased intra-abdominal pressure, digestive tract cancer surgery, emergency surgery and stomas in the surgical incision. The authors report the case of a male patient, aged 62, suffering from adenocarcinoma of the rectum with obstructive acute abdomen, who underwent loop transversotomy for decompression. On the fourth day after surgery, he had a bronchospasm crisis, with evisceration of ileum and colon through the colostomic hole. The association of some triggering factors, such as emergency surgery, colorectal malignant neoplasm, increased intra-abdominal pressure and technical failure of colostomy were decisive in the development of this rare peri-colostomy complication.

Rectal obstruction due to endometriosis

Although endometriosis is a disorder commonly found in reproductive-age women, it does not involve the bowel very often. The circumferential involvement of the rectum is rare and the obstructive symptoms can be difficult to differentiate from those of inflammatory or malignant diseases. We report two patients with rectal endometriosis whose first prominent symptoms were those of intestinal obstruction. A 26-year-old woman was admitted with obstructive symptoms. In order to alleviate the obstruction and extend the preoperative evaluation, a decompressive colostomy was done. The diagnosis of endometriosis was made by laparoscopy and biopsies of the thickened cul-de-sac peritoneum. Another woman, 40 years of age, was referred to us with a colostomy. She had undergone a laparotomy due to an obstructive acute abdomen a year before, and a frozen pelvis was found. Biopsy specimens had been collected and the pathological report revealed endometrioma. A rectosigmoidectomy, encompassing the stenotic rectal segment, was done along with primary anastomosis. The pathological examination confirmed rectal endometriosis. The conclusion is that, although rare, rectal endometriosis can cause significant stenosis of the organ, leading to obstructive symptoms. Despite its low frequency, it should always be considered in the differential diagnosis of rectal stenosis involving women of childbearing age.

Primary colonic type adenocarcinoma of the cecal appendix presented as obstructive acute abdominal syndrome

We reported a case with an obstructive acute abdomen, and emergency exploratory laparotomy was performed. Appendiceal neoplasm was observed adhered to the ileum, and an ileohemicolectomy was performed. From the histopathological point of view the neoplasm was an infiltrating colonic type adenocarcinoma of the appendix, with extension to the periapendicular adipose tissue and fixation of an adjacent ileal loop secondary to infiltration of the intestinal wall. The tumor produced a moderate luminal stenosis of the intestine, this explained the clinical manifestations of the patient. Post-operative evolution was satisfactory and there had been no signs of recurrence in the 5 years since the operation. Based upon the comparison of clinical characteristics, pathological behavior (in relation to the growth and dissemination), and therapeutic considerations, possibly colonic type adenocarcinoma of the appendix is a neoplasm similar to the carcinomas of ascending colon.

Síndrome de Chilaiditi associada a volvo de cólon sigmóide: relato de caso

INTRODUÇÃO: Este estudo tem como objetivo relatar um caso de Síndrome de Chilaiditi associada a volvo de cólon sigmóide. RELATO DE CASO: Paciente masculino, branco, 51 anos, admitido no Pronto-Socorro de Pelotas queixando parada da eliminação de gases e fezes, dor abdominal difusa com distensão e inapetência, aceitando somente líquido. Tem diagnóstico de retardo mental e constipação intestinal crônica. Foi realizado Rx de abdome agudo, sendo evidenciada distensão difusa de cólon, e sinais sugestivos de volvo de sigmóide com imagem de cólon transverso entre o fígado e o diafragma. O paciente foi submetido a laparotomia exploradora, sendo constatado volvo de sigmóide, megacólon difuso e interposição do cólon transverso entre o fígado e o diafragma. Procedeu-se a colectomia subtotal, com colostomia terminal em cólon ascendente e fechamento do reto remanescente, recebendo alta no 9º dia. DISCUSSÃO: A interposição do cólon entre o fígado e a cúpula diafragmática (síndrome de Chilaiditi), associada a volvo de cólon sigmóide, constitui causa rara de abdome agudo obstrutivo, embora o volvo de sigmóide seja uma das principais causas de obstrução intestinal mecânica no Brasil. Geralmente o tratamento é clínico, porém se associado a complicações o tratamento é cirúrgico.