Acta Gastroenterologica Latinoamericana最新文献

In Argentina there are no multicenter studies evaluating themanagement of patients with acute pancreatitis (AP) nationwide.

Objectives: The main objective of this study is toknow how the patients with AP are treated in Argentina.The secondary objective is to assess whether the results complywith the recommendation of the American College of GastroenterologyGuide.

Material and methods: Twenty threecenter participated in the study. They include in a databasehosted online consecutive patients with acute pancreatitisfrom june 2010 to june 2013.

Results: 854 patients enteredthe study. The average age was 46.6 years and 495(58%) belonged to the female sex. The most common cause(88.2%) of AP was biliary. Some prognostic system wasused in 99 % of patients and the most used was Ranson(74.5%). Were classified as mild 714 (83.6%) patientsand severe 140 (16.4%). Systemic complications occurredin 43 patients and local complications in 21. 86 patientsunderwent dynamic CT scans and 73 patients had pancreaticand / or peripancreatic necrosis. Mortality was1.5%. There was no difference in mortality in relation tothe size, complexity or affiliation of the center. The complyof key recommendations of the American College of Gastroenterology Guide was over 80%.

Conclusions: The diagnosis and treatment of patients with AP in 23 healthcenters located throughout the country was optimal. Themanagement complied with most of the recommendationsof the American College of Gastroenterology Guide.

Introduction: Since the first classic descriptions of surgicalgastrostomies for feeding by supra-umbilical medialincisions, patients were operated under general anesthesia,with prolonged time of surgery; these were patients in poorhealth status, undernourished due to inadequate intake orto neurological or tumor involvement, with prolonged hospitalization,both for the recovery of the intestinal motilityas well as for the recovery of post-surgical wounds. Therefore,we describe a new minimally invasive technique as an alternativeto the percutaneous or endoscopic gastrostomy, inpatients where we are not allowed to place a nasogastric tubeto insufflate the stomach. This is mostly seen in patients withtumors, which cause obstruction.

Material and methods: Between July 2012 and June 2013, 8 patients underwenta single port laparoscopic gastrostomy. Five were females,mean age: 77 years (range: 67-87). In all the patients, itwas impossible to place a nasogastric tube, due to obstructivetumor.

Results: The mean time of the procedure was45 minutes. Seven patients underwent tolerance of dextrose10% through the catheter after 12 hours and one 24 hoursafter the procedures. Enteral feeding was indicated after thedextrose 10% tolerance was performed. No complications relatedto the procedure were observed.

Discussion: Currently,the gold standard technique to perform a gastrostomy is thepercutaneous or endoscopic approach. In patients with headand neck tumors, when it is not possible to insert a nasogastrictube to insufflate the stomach, a laparoscopic gastrostomywould be indicated. We describe a new technique, step bystep, to perform less invasive laparoscopic surgery by a singleport laparoscopic gastrostomy.

Conclusion: The diametercreated is the same as the one performed with an open technique,but in this case, with a minimally invasive approach,that allows us to start feeding the patient with a high qualityof feeding, because of the wider lumen.

In this case we present a patient with chronic abdominalpain of a year of evolution, three months before being admittedto hospital the patient presented melaena and anaemia.Within the surgery antecedents it appears a caesarean 2 yearsbefore and a cholecystectomy a year before. In the endoscopystudy a textiloma was observed coming up from the posterosiorside of the antrum which, after its endoscopic removal,showed a gastro-duodenal fistula with a non-patent pylorus.

The intestinal pneumatosis is a clinical entity that is describedas the presence of gas within the intestinal wall andportomesenteric venous complex as an air cysts without surroundedor no epithelial lining by a granulomatous infiltratewith giant cells multinucleic.1 It is a extremely rareclinical entity that has been characteristically associated withintestinal ischemia and high mortality. We present two casesof intestinal pneumatosis tomographic reports, admittedwith clinical symptoms of intestinal obstruction. Recent advancesin imaging techniques, mainly in multislice computedtomography (MSCT), allow a reliable and accurate earlydiagnosis of these findings.

Neurophysiological studies of anorectal function provide usefulinformation about the integrity of innervation and neuromuscularfunction. This information helps to understand the pathophysiological mechanisms leading to severe anorectaldisorders function, such as fecal incontinence, pelvic floordisorders and dyssynergic defecation. These tests are commonlyperformed in patients referred to third level medicalcenters having negative evaluations or no response to conventionaltherapy. Proper use of these tests may reveal significantnew knowledge of the underlying mechanisms that can leadto better management of these disorders. These techniques arecomplementary to other types of research such as imaging ofthe pelvic floor. In this review, the most accomplished neurophysiologicalstudies, indications and clinical utility areanalyzed. Several techniques are emerging and provide uswith a better understanding of the brain-gut interactions.

One of the greatest achievements in gastroenterology and surgeryof the last 50 years has been the capability to transplantdifferent abdominal organs of the digestive system separatelyor as a whole. The complexity of the intestinal transplantationdemands a multidisciplinary team engaged in the managementof patients with intestinal failure responsible fordefining the need for nutritional support, rehabilitation, orintestinal transplantation. This team should include a basicresearch area to provide answers to unresolved clinical problems.The aim of this work is to update the current status ofintestinal transplantation, and to show the progress and resultsof our center; emphasizing our achievements in the clinicalarea, and the contributions of the translational researchand mucosal immunology studies as part of the integral unitof intestinal failure, rehabilitation and transplantation. Thedata reported here demonstrate that the intestinal transplantationhas been established as a therapeutic option in ourcountry and Latin America, with long term results that haveranked our service at the level of the best centers in the worldpositioning us as referent in the specialty.

Introduction: XSome authors have assessed the link betweenobesity and colon adenoma risk. Moreover, it has been reportedthat obesity could increase the risk of proximal adenomadevelopment. Accordingly, obese patients may have a distinctivepattern of adenoma recurrence. AIM: To determinewhether metachronous adenoma features differ between obeseand non-obese subjects submitted to colonoscopy surveillance.

Materials and methods: We prospectively evaluated all patientsover 18 years old that underwent surveillance colonoscopyat our institution between June 2013 and June 2014.Date of prior colonoscopy was registered. A body mass index≥ 30 was used to define obesity. Analysis looking for variablessignificantly associated with metachronous adenoma was performed.Metachronous adenoma rate was compared betweenobese and non-obese subjects, as well as size, location, morphologicaland histopathological characteristics.

Results: Overall,825 subjects were enrolled. Median time of surveillance colonoscopywas 38.9 months. Obesity was statistically more frequentin those subjects with metachronous adenomas (40% vs25.71%, p < 0.001). On multivariate analysis, obesity [OR1.7 (1.01-2.9)] and age [OR 1.02 (1-1.05)] were independentlyassociated with metachronous adenoma presence. Obesitywas also significantly associated with a higher risk of rightcolon adenomas [OR 2.4 (1.76-3.26)] and advanced adenoma[OR 1.99 (1.29-3.06)]. The risk is significantly higherin men and in those with a family history of colorectal cancer/adenoma.

Conclusion: Obesity was associated with a higherrisk of metachronous adenomas on surveillance colonoscopy. Ahigher risk of right-sided lesions and advanced adenomas wasalso found in this population.

Introduction: The colonic epithelium is a classical aldosteronetarget, but the effect of the hormone on the oxygenconsumption rate (QO2 ) of this tissue is unknown. Objectives.We aimed at assessing, in the rectal epithelium ofrats fed with diets of different sodium content, the effect ofepithelial sodium channel (ENaC) blockade on short-circuitcurrent (ISC ) and QO2 , and the acute effect of aldosteroneincubation on ISC and QO2 .

Methods: Adult male ratswere fed with normal, low or high-sodium diets for 8 days.Plasma sodium and serum aldosterone were measured. Isolatedmucosa preparations from the rectal portion of the colonwere mounted in Ussing chambers modified to measureISC and QO2.

Results: Baseline ISC and QO2 were highestin sodium-deprived rats. Both were proportionally reducedby amiloride (0.1 mM) in this group and in the normalsodium group, but not in sodium-loaded rats. In separateexperiments, incubation with aldosterone (10 nM) for 7 hincreased ISC and QO2 in all groups; increases were larger inthe normal and sodium-loaded groups. Amiloride decreasedboth ISC and QO2 , abolishing the differences between groups.Linear regression of the decrease in QO2 and ISC after amilorideshowed the steepest slope for the sodium-deprived groupand the flattest one for the sodium-loaded group.

Conclusions: Baseline epithelial QO2 of sodium-deprived and controlrats is reduced by ENaC blockade. Aldosterone increasedQO2 proportionally to ISC augmentation in all groups, butthe coupling between aerobic metabolism and electrogenictransport seems more efficient in sodium-deprived animals.

Introduction: The ferric chloride intoxication is frequentlycaused by accident. Its toxicity is generally underrated,which can lead to fatal evolution or irreversible consequences.In this case, the caustic condition of the substance isrelated to the toxic properties of iron.

Case presentation: A 36-year-old male patient arrives by ambulance indicatingsensory deterioration. He presents erosive injuries in thebuccal cavity and in the oropharynx, brownish teeth andmetabolic acidosis. Toxicology tests and ferritin blood dosageare requested, which show a result from 1400 mg/dl. Thesymptoms are interpreted as acute iron intoxication. Due tothe unfavorable evolution of his condition, an abdominaland pelvic CT scan are performed, which show extensivepneumoperitoneum and free fluid in the abdominal cavity.An exploratory laparotomy, a total gastrectomy with esophagostomyand feeding jejunostomy, washing and drainagedue to perforated gastric necrosis caused by caustic ingestionare performed.

Discussion: In our country, there is a highrate of intoxication caused by iron compounds, although itis not statistically measured. Nevertheless, the ferric chlorideintoxication is extremely infrequent. The ingestion of thisproduct leads to complications, which are associated with theiron concentration and its condition as a caustic agent.

Conclusions: The surgical indications in the presence of intoxicationcaused by iron compounds are: stomach evacuationof iron, gastric necrosis, perforation or peritonitis and stenosis.Early or prophylactic gastrectomy is contraindicated.However, if complications that require immediate surgicalintervention arise, there should be no hesitation and the correspondingprocedure should be performed.