Intestinal occlusion

肠闭塞
  • 文章类型: Case Reports
    背景:一次吻合胃旁路术(OAGB)后的胆石性肠梗阻是一种极为罕见的并发症。所提供的病例报告旨在强调这种情况的独特发生及其手术管理。了解临床表现,在这种情况下,诊断挑战和成功的手术干预对于参与减肥手术的医疗保健专业人员至关重要。
    方法:我们介绍一例OAGB后胆石性肠梗阻的病例报告,并讨论其诊断和手术治疗。一名66岁的女性,有OAGB病史,出现小肠梗阻症状。计算机断层扫描显示回肠远端有胆结石,造成阻塞。患者接受了腹腔镜辅助的肠切开取石术,在此期间,胆结石被拔除,肠切开术被关闭。患者恢复顺利,并在术后第四天出院。
    结论:胆石性肠梗阻应被视为OAGB后可能的并发症,和及时的手术干预通常需要其管理。本病例报告有助于有限的现有文献,提供对这种罕见并发症的管理的见解。
    BACKGROUND: Gallstone ileus following one anastomosis gastric bypass (OAGB) is an exceptionally rare complication. The presented case report aims to highlight the unique occurrence of this condition and its surgical management. Understanding the clinical presentation, diagnostic challenges and successful surgical intervention in such cases is crucial for healthcare professionals involved in bariatric surgery.
    METHODS: We present a case report of gallstone ileus following OAGB and discuss its diagnosis and surgical management. A 66-year-old female with a history of OAGB presented to the emergency room with symptoms of small bowel obstruction. Computed tomography scan revealed a gallstone impacted in the distal ileum, causing obstruction. The patient underwent a laparoscopically assisted enterolithotomy, during which the gallstone was extracted and the enterotomy was closed. The patient had an uneventful recovery and was discharged on postoperative day four.
    CONCLUSIONS: Gallstone ileus should be considered as a possible complication after OAGB, and prompt surgical intervention is usually required for its management. This case report contributes to the limited existing literature, providing insights into the management of this uncommon complication.
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  • 文章类型: Case Reports
    Recurrent gallstone ileus has a recurrence of 2-8.2% with a mortality of 12-20%, secondary to an enteric or cholecystic gallstone. A male patient with a diagnosis of intestinal occlusion secondary to biliary ileus and cholecystoduodenal fistula, performing enterotomy and closure in two planes with drainage placement. Two months after presenting the clinical of intestinal occlusion, medical management began and an abdominal tomography was performed, finding an image suggestive of recurrent gallstone ileus, treated with laparotomy.
    El íleo biliar recurrente tiene una frecuencia del 2-8.2% y una mortalidad del 12-20%, que se presenta de forma secundaria a un cálculo biliar entérico o colecístico. Varón que cursa con diagnóstico de oclusión intestinal secundaria a íleo biliar y fístula colecistoduodenal. Se realiza enterotomía y cierre en dos planos con colocación de drenaje. Dos meses después, el paciente presenta un cuadro clínico de oclusión intestinal, por lo que se inicia manejo médico y se realiza la correspondiente tomografía computarizada abdominal, encontrando una imagen sugestiva de íleo biliar recurrente, con manejo por laparotomía.
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  • 文章类型: Case Reports
    急性阑尾炎是急诊入院的常见原因之一。在极少数情况下,阑尾炎患者会出现肠梗阻等并发症。这些伴有阑尾周围脓肿的闭塞性阑尾炎的特殊病例通常发生在老年患者中,并且可以以侵袭性形式发展。尽管如此,一个有利的演变。我们介绍了一个80岁的男性患者,报告类似于闭塞性消化病理的症状:腹痛,肠道运输障碍,还有粪便呕吐.计算机断层扫描显示机械性肠梗阻。该患者有剖腹探查指征,以寻找梗阻的原因。腹膜腔检查显示闭塞性形式的急性坏疽性阑尾炎伴阑尾周围脓肿。进行阑尾切除术。总之,作为外科医生,我们必须始终考虑到急性阑尾炎可能是肠梗阻的原因,尤其是老年患者。
    Acute appendicitis represents one of the common causes of admission to the emergency department. In rare cases, patients with appendicitis can suffer complications such as intestinal obstruction. These particular cases of occlusive appendicitis with a periappendicular abscess usually occur in elderly patients and can develop in an aggressive form, nonetheless with a favorable evolution. We present a case of an 80-year-old male patient, reporting symptoms similar to an occlusive digestive pathology: abdominal pain, intestinal transit disorders, and fecal vomiting. A computerized tomography scan suggested a mechanical bowel obstruction. The patient had an exploratory laparotomy indication to find the cause of the obstruction. The peritoneal cavity inspection revealed an occlusive form of acute gangrenous appendicitis with a periappendicular abscess. An appendectomy was performed. In conclusion, as surgeons, we must always take into consideration that acute appendicitis can represent a cause of intestinal obstruction, especially in elderly patients.
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  • 文章类型: Case Reports
    原发性结直肠鳞状细胞癌(SCC)是一种极为罕见的结肠癌亚型,结直肠恶性肿瘤的发病率低于1%。我们报告了一例40岁的男性患者,该患者因急性肠梗阻症状而入院。结肠镜活检的组织病理学评估显示鳞状细胞癌。进行乙状结肠切除术。为了丰富医学文献,我们通过分析总结结直肠鳞癌的临床病例,病态,和这种罕见实体的治疗特征。
    Primary colorectal squamous cell carcinoma (SCC) is an extremely rare subtype of colon cancer, with an incidence of less than 1% of colorectal malignancies. We report a case of a 40-year-old male patient admitted to the emergency department with symptoms of acute intestinal obstruction. Histopathological evaluation of colonoscopic biopsies revealed squamous cell carcinoma. A sigmoidectomy was performed. In order to enrich the medical literature, we add our case to the collection of colorectal squamous cell carcinoma cases by analyzing and summarizing the clinical, pathological, and therapeutic features of this rare entity.
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  • 文章类型: Case Reports
    浆细胞肿瘤的胃肠道(GI)参与极为罕见。在这里,我们描述了一个74岁的高加索女人,她因腹痛引起我们的注意,食物呕吐,和体重减轻10公斤超过1年。腹部计算机断层扫描显示末端回肠周围增厚,患者接受了紧急20厘米长的回肠切除术。组织病理学和免疫表型分析显示回肠的浆细胞肿瘤。随后的调查发现了血清单克隆免疫球蛋白A成分,左颌的溶骨性病变,克隆性骨髓浆细胞浸润携带1q21扩增。鉴于浆细胞骨髓瘤(PCM)的最终诊断,患者接受了VMD(硼替佐米,melphalan,和地塞米松)化疗方案,12个月治疗后完全缓解。对于疾病复发,随后尝试了另外两种化疗方案.在诊断后4年的最后一次随访中,病人还活着。此病例引起了对浆细胞肿瘤的髓外表现的关注,即使罕见,作为一个及时的诊断似乎导致更好的预后。此外,它强调了多学科方法的相关性,涉及胃肠病学家,血液学家,和病理学家,这些肿瘤的诊断和治疗。
    Gastrointestinal (GI) involvement of plasma cell neoplasms is extremely rare. Herein, we describe the case of a 74-year-old Caucasian woman who came to our attention with abdominal pain, food vomiting, and weight loss of 10 kg over 1 year. A computed tomography scan of the abdomen revealed circumferential thickening of terminal ileum, for which the patient underwent an urgent 20-cm-long ileal resection. Histopathological and immunophenotypic analysis revealed a plasma cell neoplasm of the ileum. Subsequent investigations found a serum monoclonal immunoglobulin A component, an osteolytic lesion of the left jaw, and a clonal bone marrow plasma cell infiltrate carrying 1q21 amplification. Given the final diagnosis of plasma cell myeloma (PCM), the patient underwent a VMD (bortezomib, melphalan, and dexamethasone) chemotherapy regimen, achieving a complete remission after a 12-month treatment. For disease relapse, two further chemotherapy regimens were later attempted. At the last follow-up 4 years after the diagnosis, the patient is still alive. This case draws attention to the extramedullary presentation of plasma cell neoplasms, even if rare, as a prompt diagnosis seems to result in a better prognosis. In addition, it highlights the relevance of a multidisciplinary approach, involving gastroenterologists, hematologists, and pathologists, to the diagnosis and management of these neoplasms.
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  • 文章类型: Case Reports
    这是首例特发性巨大胰腺假性囊肿(ICPP)引起肠闭塞,文献报道了腹腔高压(IAH)和腹腔室隔综合征(ACS)。急诊IGPP的诊断是一个挑战,因为它很罕见,没有胰腺炎或胰腺外伤的病史和特定的临床表现。腹部对比增强计算机断层扫描(CECT)是诊断胰腺囊肿(PP)的金标准。文献中报道了不同类型的PP处理。
    方法:一名52岁的白种人女性因腹痛3天的病史进入急诊科,无法通过气体或粪便,恶心和呕吐,少尿和7天腹部肿胀和腿部肿胀的病史。体格检查显示腹胀,腹痛,腿部肿胀。CECT显示大量的囊性胰腺肿块,怀疑是肿瘤。实验室测试报告血清BUN水平高,肌酐和C反应蛋白和嗜中性白细胞增多。术前诊断ACS后,患者被带到手术室进行胰腺切除术。术后病程顺利。通过组织病理学检查诊断为IGPP。
    ICPP在紧急情况下很难诊断。尽管文献中描述了不同类型的ICPP排水,当不能排除囊性胰腺肿瘤时,胰腺切除术是首选的治疗方法.
    结论:IGPP是一种罕见的疾病,可能会导致肠道阻塞,IAH和ACS。如有必要,胰腺切除是安全的和治疗性的,具有可接受的发病率和死亡率。
    UNASSIGNED: This is the first case of idiopathic giant pancreatic pseudocyst (IGPP) causing intestinal occlusion, intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) reported in the literature. Diagnosis of IGPP in emergency is a challenge because of its rarity and the absence of a history of pancreatitis or pancreatic trauma and specific clinical presentation. Abdominal contrast-enhanced computed tomography (CECT) represents the gold standard in diagnosing of pancreatic cyst (PP). Different types of treatment of PP are reported in the literature.
    METHODS: A 52-year-old Caucasian female was admitted to the Emergency Department with a three-day history of abdominal pain, inability to pass gas or stool, nausea and vomiting, oliguria and a seven-day history of abdominal swelling and swollen legs. Physical examination revealed abdominal distention, abdominal pain, swelling in the legs. CECT showed a voluminous cystic pancreatic mass suspected of neoplasm. Laboratory tests reported high serum levels of BUN, creatinine and C-reactive protein and neutrophilic leukocytosis. After preoperative diagnosis of ACS, the patient was taken to the operating room for pancreatic resection. The postoperative course was uneventful. Diagnosis of IGPP was made by histopathological examination.
    UNASSIGNED: IGPP is difficult to diagnose in emergency. Although different types of drainage of IGPP are described in the literature, pancreatic resection represents the treatment of choice when a cystic pancreatic neoplasm cannot be excluded.
    CONCLUSIONS: IGPP is a rare disease that may cause intestinal occlusion, IAH and ACS. Pancreatic resection if necessary is safe and therapeutic with acceptable morbidity and mortality.
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  • 文章类型: Case Reports
    Emergency diagnosis of small bowel volvulus can be established in patients with acute intestinal obstruction, or even shock, or repeated abdominal pain often associated with motility disorders. This is a life-threatening complication of common incomplete mesentery, which is defined as an intestinal malrotation occurring very rarely in adults. Clinical symptoms are non-specific, hence the importance of knowing the radiological features, in particular scannographic features of this rare entity, thus enabling early therapeutic management. We here report the case of a 65-year-old patient admitted with total small bowel volvulus complicating common incomplete mesentery, diagnosed based on abdominal computed tomography (CT) scan and confirmed at surgery, who had favorable outcome.
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  • 文章类型: Journal Article
    背景:巨大食管裂孔旁疝(GPEH)是一种食管裂孔疝(HH),其包括超过30%的胃。当今修复的金标准形式是选择性情况下的腹腔镜腹部入路。腹腔镜HH修复的优点包括,术后疼痛减少,小切口,术后呼吸系统并发症减少,住院时间短。本文的目的是描述一名患有上段肠梗阻和GPEHIV型的患者,接受腹腔镜检查。
    方法:我们接受了一名59岁的女性患者,她有腹痛的症状,肠道特征和便秘的呕吐,经过5天的进化。她还提到了呼吸困难;她去了另一家机构,在那里进行了CAT扫描,发现了GPEH。我们决定通过腹腔镜实现这一过程。我们遵循主要目标,减少疝气,解剖性疝囊切除术,无网眼的风道修复,和Nissen型胃底折叠术,不进行Collis胃成形术。患者停留7天进行监测,当白细胞和LDH达到正常比率时,患者出院。无并发症,肠功能正常,几乎无疼痛。
    结论:我们介绍了一例与上肠梗阻相关的GPEH病例,临床发现提示缺血。治疗方法为腹腔镜手术。
    结论:在择期患者中,腹腔镜检查优于腹部入路。需要比较腹腔镜与开放入路的随机试验才能得出结论,腹腔镜入路优于开放入路,在潜在的GPEH复杂患者中。
    BACKGROUND: A Giant Hiatal Paraesophageal Hernia (GPEH) is a Hiatal Hernia (HH) that includes more than 30% of the stomach in the thorax. The gold standard form of repair today is the laparoscopic abdominal approach in elective scenarios. Laparoscopic HH repair advantages include, less postoperative pain, small incisions, reduced postoperative respiratory complications are reduced, shorter hospital stay. The objective of this paper is to describe a patient undergoing with upper intestinal obstruction and a GPEH Type IV, approached laparoscopically.
    METHODS: We received a female patient 59 years old, she came with symptoms abdominal pain, emesis of intestinal characteristics and obstipation, with an evolution of 5 days. She also referred dyspnea; she went to another institution where made a CAT scan finding a GPEH. We decided to realize the procedure laparoscopically. We follow the principal objectives, reducing the hernia, dissecting al de hernia sac excision, Hiatal reparation with no mesh, and Nissen type fundoplication without Collis Gastroplasty. The patient stayed for seven days for surveillance and when the leukocyte and LDH went to a regular rate patient was discharged. With no complications with normal intestinal function and nearly no pain.
    CONCLUSIONS: We present a GPEH case associated with upper intestinal obstruction, with clinical findings that suggested ischemia. The approach of the treatment was abdominal laparoscopy.
    CONCLUSIONS: In elective patients Laparoscopy is superior than abdominal approach. Randomized trials comparing laparoscopic versus open approach are needed to conclude that laparoscopic approach is superior to open approach, in potentially GPEH complicated patients.
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  • 文章类型: Case Reports
    BACKGROUND: Renal cell carcinoma is the most frequent malignant neoplasia of the kidney accounting for 90 % of all renal solid tumors. Metastases from renal cell carcinoma are rarely located in the small bowel and generally their clinical presentation includes bleeding and obstruction. Intussusception in adults is an extremely rare pathological condition and only 30 to 35 % of small bowel intussusceptions are derived from malignant lesions.
    METHODS: We report here a clinical case of a 75-year-old white man hospitalized for anemia and subocclusion. An abdominal ultrasound and computed tomography showed a small bowel intussusception. During a surgical exploration, a polypoid lesion was found to be the lead point of the intussusception. His small intestine was resected and a functional side-to-side anastomosis was performed. The histological features of the surgical specimen confirmed the diagnosis of metastatic renal cell carcinoma.
    CONCLUSIONS: Small bowel intussusception from renal cell carcinoma metastasis should always be considered in the setting of unexplained intestinal subocclusion in patients with a history of renal cell carcinoma.
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