bowel stenosis

  • 文章类型: Case Reports
    先兆子痫是人类特异性妊娠期高血压疾病。它与胎儿的短期不良反应和新生儿的长期并发症有关,主要是由于在宫内发育的关键时期血流中断。子宫内的缺血事件可以影响胎儿的许多系统,包括小肠受累.我们提出了一个早产的案例,小于胎龄儿有严重宫内生长受限的新生儿,小肠狭窄,和没有旋转不良的扭转,出生于患有严重先兆子痫的母亲。
    Preeclampsia is a human-specific hypertensive disorder of gestation. It is associated with short-term adverse effects in the fetus and long-term complications in the neonate, mainly due to disrupted blood flow during critical periods of intrauterine development. An ischemic event in the uterus can affect many systems of the fetus, including a small bowel involvement. We present a case of a preterm, small for gestational age neonate with severe intrauterine growth restriction, small bowel stenosis, and volvulus without malrotation, born to a mother with severe preeclampsia.
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  • 文章类型: Journal Article
    目的:狭窄是克罗恩病(CD)的常见并发症,可采用保肠手术治疗。我们的研究分析了当手术后留下病变肠时,肠道和全身炎症会发生什么。
    方法:在这项回顾性研究中,我们纳入了42例因狭窄CD而接受狭窄成形术(单独或切除)的连续患者.确定接受完全病变肠切除术的对照患者,并根据性别进行倾向评分匹配,年龄,腹部手术史.在手术后1、6和12个月的随访检查中收集生物体液值。对19例患者进行了狭窄成形术前后的磁共振成像(MRI)。
    结果:在狭窄成形术组中,粪便钙卫蛋白水平在12个月时下降(p=0.03),而在切除组中,它们在6个月时降低(p=0.02)。核磁共振成像,ADC[表观扩散系数](p<0.001),狭窄成形术后,壁厚(p=0.046)和磁共振活动指数(MaRIA)(p<0.001)和克莱蒙(p<0.001)评分均得到改善。狭窄成形术组的手术复发频率高于切除组(p=0.003)。
    结论:我们的回顾性研究表明,即使在手术后留下病变的肠,肠道炎症活性仍下降。然而,患病肠的永久性仍然增加了再次手术的风险,可能是由于狭窄的纤维化性质和CD的多灶性。
    OBJECTIVE: Stricture is a common complication of Crohn\'s disease (CD) and may be treated with bowel-sparing procedures. Our study analyzed what happens in terms of intestinal and systemic inflammation when the diseased bowel is left behind following surgery.
    METHODS: In this retrospective study, we enrolled 42 consecutive patients who underwent strictureplasty (alone or with resection) for stricturing CD. Control patients who underwent complete diseased bowel resection were identified and propensity score-matched for the sex, age, and history of abdominal surgery. Biohumoral values were collected at follow-up examinations at 1, 6, and 12 months after surgery. Magnetic resonance imaging (MRI) was performed before and after strictureplasty in 19 patients.
    RESULTS: In the strictureplasty group, fecal calprotectin levels were decreased at 12 months (p = 0.03), whereas in the resectiongroup, they were decreased at 6 months (p = 0.02). On MRI, the ADC [apparent diffusion coefficient] (p < 0.001), wall thickness (p = 0.046) and Magnetic Resonance Index of Activity (MaRIA) (p < 0.001) and Clermont (p < 0.001) scores were improved after strictureplasty. Surgical recurrence was more frequent in the strictureplasty group than in the resection group (p = 0.003).
    CONCLUSIONS: Our retrospective study showed that even if the diseased bowel was left behind after surgery, the intestinal inflammatory activity still decreased. However, the permanence of the diseased bowel still increased the risk of reoperation, probably because of the fibrotic nature of the stenosis and the multifocality of CD.
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  • 文章类型: Comparative Study
    To assess the prevalence, risk factors, and management of bowel stenosis after surgery for deep infiltrating endometriosis of the rectosigmoid using either disk excision (DE) or segmental resection (SR).
    Retrospective study using data from consecutive cases recorded in the North-West Inter Regional Female Cohort for Patients with Endometriosis database.
    University tertiary referral center.
    Four hundred thirty-one consecutive patients managed for rectosigmoid endometriosis were enrolled in our study.
    Laparoscopic SR or DE.
    One hundred sixty-five patients underwent DE, and 266 patients underwent SR. Large nodules ≥3 cm in diameter were more frequent in the SR group (73.3% vs 66.1%), whereas nodules infiltrating the low rectum were 3 times more frequent in the DE group (35.9% vs 11.3%). The frequency of vaginal excision (67.9% vs 62%) and stoma (46.7% vs 44.4%) were comparable between the DE and SR groups. Twenty-three patients presented with postoperative colorectal stenosis after SR (8.6%) versus none after DE (p <.001). Treatment of colorectal stenosis involved dilatation in 20 (87%) cases and SR in 4 (17.4%) cases. For 1 patient, dilatation resulted in rectosigmoid injury requiring SR, followed by rectovaginal fistula. The logistic regression model identified a diverting stoma as the sole risk factor independently related to the risk of postoperative stenosis after SR.
    Bowel stenosis after surgery for deep infiltrating endometriosis occurred in patients who underwent SR, most of them with a diverting stoma, whereas no cases of stenosis were reported in patients who underwent DE, with or without stoma.
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  • 文章类型: Journal Article
    (1) Objectives: In patients with symptoms suggestive of rectosigmoid endometriosis, imaging techniques are required to confirm the presence and establish the extent of the disease. The objective of the current study was to compare the performance of three-dimensional rectal water contrast transvaginal ultrasonography (3D-RWC-TVS) and computed tomographic colonography (CTC) in predicting the presence and characteristics of rectosigmoid endometriosis. (2) Methods: This prospective study included patients with suspicion of rectosigmoid endometriosis who underwent both 3D-RWC-TVS and CTC and subsequently were surgically treated. The findings of imaging techniques were compared with surgical and histological results. (3) Results: Out of 68 women included in the study, 37 (48.9; 95% C.I. 38.2-59.7%) had rectosigmoid nodules and underwent bowel surgery. There was no significant difference in the accuracy of 3D-RWC-TVS and CTC in diagnosing the presence of rectosigmoid endometriotic nodules (p = 0.118), although CTC was more precise in diagnosing endometriosis located in the sigmoid (p = 0.016). 3D-RWC-TVS and CTC had similar precision in estimating the largest diameter of the main endometriotic nodule (p = 0.099) and, in patients undergoing segmental resection, the degree of the stenosis of the bowel lumen (p = 0.293). CTC was more accurate in estimating the distance between the lower margin of the intestinal nodule and the anal verge (p = 0.030) but was less tolerated than 3D-RWC-TVS (p < 0.001). (4) Conclusion: This was the first study comparing the performance of 3D-RWC-TVS and CTC in the diagnosis of rectosigmoid endometriosis. Both techniques allowed for the evaluation of the profile of the bowel lumen in a pseudoendoscopic fashion and had a similar performance for the diagnosis of rectosigmoid endometriosis, although CTC was more accurate in diagnosing and characterizing sigmoid nodules.
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  • 文章类型: Journal Article
    目的:探讨腹内扩张(IABD)在复杂性胃裂预测中的作用。
    方法:这是一项对174例单胎妊娠合并单胎腹裂的回顾性研究,导致活产和可用的超声图像在20-22和30-32周妊娠。IABD被测量为最扩张的腹内肠段的最大横径,一位对产后结局视而不见的操作员。确定了复杂和简单胃裂的IABD测量值的分布,并使用接收器工作特征(ROC)曲线选择了预测复杂胃裂的最佳临界值。ROC曲线下面积(AUC),检测率(DR),假阳性率(FPR),确定阳性预测值(PPV)和阴性预测值(NPV)。
    结果:研究人群包括39例(22.4%)复杂和135例(77.6%)单纯性腹裂。在复杂腹裂的预测中,妊娠20~22周时的AUC为0.742(95%CI,0.628~0.856),30~32周时的AUC为0.820(95%CI,0.729~0.910).在20-22周时,IABD截止值为7毫米,DR,FPR,复杂腹裂的PPV和NPV分别为61.5%,6.7%,72.7%和89.4%,分别,在30-32周时,IABD截止值为14毫米,分别为64.9%,5.9%,75.0%和90.7%。
    结论:在妊娠20-22或30-32周测量IABD对预测复杂的胃裂是有用的。版权所有©2019ISUOG。由JohnWiley&SonsLtd.发布.
    OBJECTIVE: To investigate intra-abdominal bowel dilation (IABD) in the prediction of complex gastroschisis.
    METHODS: This was a retrospective study of 174 singleton pregnancies with isolated fetal gastroschisis, resulting in live birth and with available ultrasound images from visits at both 20-22 and 30-32 weeks\' gestation. IABD was measured as the greatest transverse diameter of the most dilated intra-abdominal bowel segment, by an operator blinded to postnatal outcome. The distribution of IABD measurements in those with complex and those with simple gastroschisis was determined and the best cut-off value to predict complex gastroschisis was selected using receiver-operating characteristics (ROC) curves. The area under the ROC curve (AUC), detection rate (DR), false-positive rate (FPR), positive predictive value (PPV) and negative predictive value (NPV) were determined.
    RESULTS: The study population included 39 (22.4%) cases of complex and 135 (77.6%) cases of simple gastroschisis. In the prediction of complex gastroschisis, the AUC at 20-22 weeks\' gestation was 0.742 (95% CI, 0.628-0.856) and the respective value for 30-32 weeks was 0.820 (95% CI, 0.729-0.910). At the IABD cut-off of 7 mm at 20-22 weeks, DR, FPR, PPV and NPV for complex gastroschisis were 61.5%, 6.7%, 72.7% and 89.4%, respectively, and at IABD cut-off of 14 mm at 30-32 weeks, the respective values were 64.9%, 5.9%, 75.0% and 90.7%.
    CONCLUSIONS: Measurement of IABD at 20-22 or at 30-32 weeks\' gestation is useful in the prediction of complex gastroschisis. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.
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  • 文章类型: Case Reports
    钝性腹部创伤是一种罕见的肠梗阻病例,世界文献报道的病例很少。闭合性腹部创伤后的狭窄性肠梗阻是非常罕见的并发症。此病例强调了对腹部钝性外伤后出现腹部症状的患者进行临床怀疑系列临床评估和放射学评估的必要性,以及对早期手术的必要性。
    Blunt abdominal trauma is a rare case of intestinal obstruction, and only few cases have been reported in the world literature. Stenotic intestinal obstruction following blunt abdominal trauma is a very rare complication. This case highlights the need for clinical suspicion serial clinical assessment and radiological evaluation and the need for early surgery in patients presenting with abdominal symptoms following blunt abdominal trauma.
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  • 文章类型: Journal Article
    目的:为了研究超声(US)标志物对复杂腹裂(CG)的预测,死亡率,以及腹裂胎儿的发病率。
    方法:这是一项回顾性队列研究,共进行了186例妊娠孤立性胎儿腹裂。分析了八个美国标记。美国标记与CG的预测和关联,死亡率,和发病率进行了评估。研究了预测CG的US标志物的组合。
    结果:腹外肠扩张(EABD),腹内肠扩张(IABD),羊水过多是CG的预测因素。EABD在25至28周之间的敏感性为64%,特异性为89%,阳性预测值(PPV)为56.2%,阴性预测值(NPV)为91.8%。IABD的预测灵敏度为26.7%,特异性=96.7%,PPV=61.5%,净现值=86.8%。在存在1个和2个US标记的情况下,CG的优势比,与没有美国标记相比,分别为18.3(95%CI,3.83-87.64)和73.3(95%CI,6.14-876),分别。
    结论:建立了预测CG的US标志物。这些标记的组合增加了CG的概率。
    OBJECTIVE: To investigate the ultrasound (US) markers predictive of complex gastroschisis (CG), mortality, and morbidity in fetuses with gastroschisis.
    METHODS: This was a retrospective cohort study of 186 pregnancies with isolated fetal gastroschisis. Eight US markers were analyzed. The predictions and associations of US markers with CG, mortality, and morbidity were assessed. Combinations of US markers predictive of CG were investigated.
    RESULTS: Extra-abdominal bowel dilatation (EABD), intra-abdominal bowel dilatation (IABD), and polyhydramnios were predictive of CG. EABD between 25 and 28 weeks had a sensitivity of 64%, a specificity of 89%, a positive predictive value (PPV) of 56.2%, and negative predictive value (NPV) of 91.8%. The predictions of IABD were sensitivity = 26.7%, specificity = 96.7%, PPV = 61.5%, and NPV = 86.8%. The odds ratios for CG in the presence of 1 and 2 US markers, compared with the absence of a US marker, were 18.3 (95% CI, 3.83-87.64) and 73.3 (95% CI, 6.14-876), respectively.
    CONCLUSIONS: US markers predictive of CG were established. The combination of these markers increases the probability of CG.
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