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Rienzo-Madero BD, Kajomovitz-Bialostozky D, Martinez-Munive Á, Pelaez-Luna M, Rivera-García-Granados A, Quijano-Orvañanos F. Eosinophilic enteritis presenting as intestinal obstruction: case report and review of the literature. CIR CIR 2023; 91:709-712. [PMID: 37844898 DOI: 10.24875/ciru.21000723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 10/15/2021] [Indexed: 10/18/2023]
Abstract
Eosinophilic enteritis (EE) is characterized by intense eosinophilic infiltrate of the gastrointestinal tract. Clinical manifestations depend on the affected segment and intestinal layer. First-line treatment is systemic corticosteroids; surgery is reserved for complications. 84-year-old male patient with a history of right hemicolectomy and two episodes of intestinal obstruction presented to the ED with abdominal pain, distension, nausea, and vomiting. CBC showed leukocytosis and no eosinophilia. Contrast-enhanced CT revealed stenosis with thickening of the distal intestinal wall and partial intestinal obstruction. Colonoscopy found aphthous ulcers. Histopathology reported EE. The patient received budesonide and metronidazole, with resolution within 24 h.
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Affiliation(s)
| | | | | | - Mario Pelaez-Luna
- Department of Gastroenterology and Endoscopy. Centro Médico ABC, Mexico City, Mexico
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Valencia-Martínez JG, Reynoso-Saldaña D, Reynoso-González R, Estrada-Hernández D, Ángeles-Santillán M, Aja-Sixto V. Gallstone ileus, a rare cause of intestinal occlusion. A case report. CIR CIR 2023; 91:284-289. [PMID: 37084291 DOI: 10.24875/ciru.21000678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
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.
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Affiliation(s)
- Jesús G Valencia-Martínez
- Servicio de Cirugía General, Hospital Regional Tlalnepantla, Instituto de Seguridad Social del Estado de México y Municipios, Edo. de México, México
| | - Donovan Reynoso-Saldaña
- Servicio de Cirugía General, Hospital Regional Tlalnepantla, Instituto de Seguridad Social del Estado de México y Municipios, Edo. de México, México
| | - Ricardo Reynoso-González
- Servicio de Cirugía General, Hospital Regional Tlalnepantla, Instituto de Seguridad Social del Estado de México y Municipios, Edo. de México, México
| | - David Estrada-Hernández
- Servicio de Cirugía General, Hospital Regional Tlalnepantla, Instituto de Seguridad Social del Estado de México y Municipios, Edo. de México, México
| | - Mariana Ángeles-Santillán
- Servicio de Cirugía General, Hospital Regional Tlalnepantla, Instituto de Seguridad Social del Estado de México y Municipios, Edo. de México, México
| | - Viridiana Aja-Sixto
- Servicio de Cirugía General, Hospital Regional Tlalnepantla, Instituto de Seguridad Social del Estado de México y Municipios, Edo. de México, México
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Requena-López AA, Mata-Samperio BK, Cuadra-Reyes LA, Casillas-Vargas R. Wilkie's syndrome as a cause of bowel obstruction in adults: A case report. CIR CIR 2020; 88:185-188. [PMID: 32116320 DOI: 10.24875/ciru.19001195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background The superior mesenteric artery (SMA) syndrome, also known as Wilkie's syndrome, is one of the rarest causes of small bowel obstruction. Clinical case A 36-year-old female patient, with a medical history of diabetes mellitus type 2, arrived at the emergency department with upper intestinal obstruction; a study protocol is made, integrating the diagnosis of Wilkie's syndrome. We performed a laparoscopic duodenojejunostomy, the patient did well in the post-operative period. Conclusions Laparoscopic duodenojejunostomy is a practical option to treat Wilkie's syndrome. It provides definitive treatment with the advantages and benefits of minimally invasive surgery.
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Affiliation(s)
- Abner A Requena-López
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
| | - Brenda K Mata-Samperio
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
| | - Luis A Cuadra-Reyes
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
| | - Ricardo Casillas-Vargas
- Departamento de Cirugía General, Centro Médico, Instituto de Seguridad Social del Estado de México (ISSEMyM), Ecatepec, Estado de México, México
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Abstract
Exposure and infections by Trypanosoma cruzi are the fourth cause of loss of potential life years between parasitic and infectious diseases. We describe the case of a 11-year-old patient with intestinal occlusion, surgically treated with intestinal volvulus, the surgical specimen is sent to histopathology reporting Chagasic megacolon. The age range of presentation is a challenge in the absence of nonspecific symptoms. There is no pediatric statistical data that define trypanosomiasis in a latent or chronic state and will be diagnosed in adult stages due to the physiopathological alterations that they will present.
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Affiliation(s)
- Víctor H García-Orozco
- Servicio de Cirugía General. Hospital Civil de Tepic Dr. Antonio González Guevara, Servicios de Salud de Nayarit, Tepic, Nayarit, México
| | - Daniel García-Sánchez
- Servicio de Cirugía Pediátrica. Hospital Civil de Tepic Dr. Antonio González Guevara, Servicios de Salud de Nayarit, Tepic, Nayarit, México
| | - Juan F López-Flores
- Banco de Leche Humana. Hospital Civil de Tepic Dr. Antonio González Guevara, Servicios de Salud de Nayarit, Tepic, Nayarit, México
| | - Ricardo Sánchez-Mata
- Servicio de Cirugía General. Hospital Civil de Tepic Dr. Antonio González Guevara, Servicios de Salud de Nayarit, Tepic, Nayarit, México
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Galván-Montaño A, Guzmán-Martínez S, Serrano-Andrade F, García-Moreno S. Postsurgical intestinal occlusion ileum-ileum double intussusception in eleven-month girl. CIR CIR 2020; 88:88-90. [PMID: 31967605 DOI: 10.24875/ciru.19000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Postoperative intussusception is an unusual complication in children; the incidence is 0.01-0.25%. Clinical Case Female of 11 months who underwent colostomy, 48 h later presents abdominal pain, vomiting gastrobiliar and abdominal distension. A laparotomy was performed, finding a double ileo-ileal invagination 60 cm from the ileocecal valve. Discussion The postoperative intestinal invaginations are extremely rare and most of them occur within the first 7 days. The etiology of postoperative intussusception is unknown. Conclusions Postoperative children with intestinal occlusion, intussusception should be suspected and an immediate laparotomy should be performed.
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Affiliation(s)
- Alfonso Galván-Montaño
- Servicio de Cirugía Pediátrica. Hospital General Dr. Manuel Gea González, Ciudad de México, México
| | - Sonia Guzmán-Martínez
- Servicio de Cirugía Pediátrica. Hospital General Dr. Manuel Gea González, Ciudad de México, México
| | | | - Silvia García-Moreno
- Departamento de Investigación. Hospital General Dr. Manuel Gea González, Ciudad de México, México
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Salazar-Jiménez MI, Alvarado-Durán J, Fermín-Contreras MR, Rivero-Yáñez F, Lupian-Angulo AI, Herrera-González A. [Gallstone ileus, surgical management review]. CIR CIR 2019; 86:182-186. [PMID: 29809187 DOI: 10.24875/ciru.m18000032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Gallstone ileus (GI) represents a rare cause of mechanical intestinal occlusion, which is caused by the impaction of a gallstones at the gastrointestinal tract, being most frequently the terminal ileum; its etiology is due to the passage of a calculum through a biliary-enteric fistula. Due to its low incidence, diagnostic suspicion and adequate initial surgical treatment are essential for an adequate clinical evolution. Objective A bibliographic review on the current surgical management of GI was carried out and exemplified by the presentation a clinical case. Clinical case 78-year-old male with bowel obstruction, upon undergoing a CT scan, a gallstone at the level of distal ileum is displayed, therefore, an exploratory laparotomy (ex lap) is performed with enterotomy and extraction of the calculus. The patient bestowed adequate postoperative clinical evolution, and the presence of a cholecystoduodenal fistula is documented by an upper endoscopy. Discussion GI represents an uncommon pathology, however, there is discrepancy in the literature regarding the initial surgical management, especially in whether or not a biliary procedure should be associated with emergency enterolithotomy. Conclusion GI is associated with complications secondary to diagnostic delay and its late surgical resolution, although the initial treatment is aimed at resolving the intestinal obstruction through enterotomy and gallstone extraction, there is controversy regarding the preferred time for cholecystectomy and repair of biliary-enteric fistula, being the two-stage surgery the surgical procedure of choice, especially in patients with a high risk of complications.
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Affiliation(s)
| | - Javier Alvarado-Durán
- Servicio de Cirugía General, Sanatorio Durango. Hospital Central Norte PEMEX, Ciudad de México, México
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Tun-Abraham ME, Martínez-Ordaz JL, Vargas-Rivas A, Sánchez-Fuentes JJ, Pérez-Cerna E, Zaleta-González O. [L-lactate as a serum marker of intestinal ischemia in patients with complicated intestinal obstruction]. CIR CIR 2016; 83:65-9. [PMID: 25982612 DOI: 10.1016/j.circir.2015.04.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2013] [Accepted: 01/21/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND The intestinal obstruction secondary to internal hernia is a diagnostic challenge. The absence of specific symptoms and signs during clinical examination often lead to underestimation of the severity and early surgical treatment. The purpose of this article is to review the clinical presentation of two patients with internal hernia, describe the clinical, biochemical and radiological findings, with emphasis on the L-lactate as an early serum marker of intestinal ischemia. CLINICAL CASES Case 1: female, 44 years history of urolithiasis and 2 cesarean sections. Case 2: female, 86 year old with a history of open cholecystectomy, incisional and bilateral inguinal hernia repair with mesh placement. Both admitted with abdominal pain and intestinal obstruction data. The only significant laboratory finding was elevation of L-lactate. The abdominal films showed air-fluid levels, dilated loops of small intestine and colon. Abdominal contrast tomography showed free abdominal fluid id, internal hernia and torque of mesentery. In both cases, exploratory laparotomy was performed with bowel resection of ischemic segments, with uneventful recovery. CONCLUSIONS Intestinal ischemia secondary to internal hernia is difficult lt to diagnose. In patients with a high suspicion, signs of intestinal obstruction by plain radiography, the elevation of L-lactate, could help in the early diagnosis of intestinal ischemia and immediate surgical treatment.
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Affiliation(s)
- Mauro Enrique Tun-Abraham
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social
| | - José Luis Martínez-Ordaz
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social.
| | - Adriana Vargas-Rivas
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social
| | - José Jesús Sánchez-Fuentes
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social
| | - Edgar Pérez-Cerna
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social
| | - Omar Zaleta-González
- Servicio de Gastrocirugía, Hospital de Especialidades de Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social
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Abstract
BACKGROUND Acute colonic pseudo-obstruction, or Ogilvie syndrome, is a motility abnormality characterised by rapid and progressive dilation of the large intestine. To achieve a diagnosis it is fundamental to exclude mechanical obstruction with imaging studies such as computer axial tomography. The combined incidence of Ogilvie and dysmorphic syndrome has not been described. CLINICAL CASE Female patient of 28 years old with a history of infant cerebral palsy came to emergency room with 4 days of intestinal obstruction. She had hypokalaemia that was reverted, but persisted with obstruction. Later after 72h with recovery of fluids and electrolytes and administration of prokinetics, the obstruction reversed. She was discharged with no complications. CONCLUSIONS Non-invasive medical treatment solves most cases. Promising results have been achieved with neostigmine. In the event of no response to drug therapy, the next step is endoscopic treatment. Even with high recurrence this is preferred due to its lower level of complications in contrast to surgical decompression. Neonatal dysmorphic syndrome is often associated with disorders of the central nervous system. So far, there have been no reports on the incidence of this disease with Ogilvie syndrome, although 9% of cases have been described as associated with neurological events. Conservative management in this disease is the initial approach. Interventions should be reserved for when conservative treatment fails.
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Mussan-Chelminsky G, Vidal-González P, Núñez-García E, Valencia-García LC, Márquez-Ugalde MÁ. [Intestinal carcinoid tumour: Case report]. CIR CIR 2015; 83:438-41. [PMID: 26319938 DOI: 10.1016/j.circir.2015.05.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/05/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Carcinoid of the small intestine, is a well-differentiated neuroendocrine tumor that rarely presents with clinical signs. This tumour can be associated with other conditions, such as inflammatory bowel disease, presenting a wide range of symptoms. In some cases they have an aggressive and highly symptomatic behaviour; thus, clinical suspicion must be high to make an early diagnosis. CLINICAL CASE A 60 year-old male patient with Crohn's disease and gastrointestinal symptoms attributed to this disease within the last year. He presented with intestinal obstruction initially treated with conservative management with no improvement. Exploratory laparotomy was performed finding a mesenteric tumour that caused the bowel obstruction. Bowel resection with primary anastomosis was performed. The pathology report showed an intestinal carcinoid tumour with lymph node metastases. The patient recovered well, and was discharged without complications to continue medical treatment and follow-up by the Oncology department. CONCLUSION In almost 42% of the cases, the most common site of carcinoid tumours is the small intestine, and of these, 41% are presented as locoregional disease. Patients with Crohn's disease present a higher incidence. In these cases, the most common presentation is an acute intestinal obstruction (90%). Surgery is usually curative, and follow up is important as the symptoms of Crohn's disease can hide any recurrence.
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