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Bolívar-Rodríguez MA, Cortés-Ramos MA, Cázarez-Aguilar MA, Rodolfo Fierro-López RFL, Pámanes-Lozano APL. Análisis clínico-tomográfico en obstrucción de intestino delgado por adherencias según el sitio de obstrucción en la tomografía. Rev Colomb Cir 2021. [DOI: 10.30944/20117582.957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. Las adherencias postoperatorias son la causa más frecuente de obstrucción de intestino delgado. La clínica sugiere el diagnóstico, pero de manera poco precisa la causa y el sitio de la obstrucción. La tomografía computarizada contrastada es el estudio óptimo y permite identificar de manera oportuna a los pacientes que requieren intervención quirúrgica. El objetivo de este estudio fue analizar la correlación entre la clínica y el sitio de obstrucción detectado en la tomografía computarizada contrastada de abdomen, en pacientes con sospecha diagnóstica de obstrucción de intestino delgado por adherencias.
Métodos. Estudio prospectivo, transversal y analítico de pacientes con sospecha clínica de obstrucción de intestino delgado por adherencias y antecedentes quirúrgicos y su correlación con el sitio de obstrucción detectado en la tomografía computarizada de abdomen contrastada, de pacientes atendidos entre marzo de 2016 y febrero de 2019 en un hospital de segundo nivel.
Resultados. Se incluyeron 41 pacientes, la media de edad fue de 59 años y el género masculino el más comprometido (68,3 %, n=28); la ausencia de evacuaciones estuvo presente en 97,5 % (p=0,026). La tomografía computarizada contrastada mostró el sitio de obstrucción en 73 % de los pacientes y la localización de la obstrucción más prevalente fue en íleon distal (31,7 %, n=13). Se asoció a leucocitosis (p=0,041) y a dolor más intenso (p=0,049), sin presentar irritación peritoneal.
Conclusión. La obstrucción localizada en el íleon distal se caracterizó por presentar más dolor y mayor recuento leucocitario, sin correlación como factor de riesgo para requerir tratamiento quirúrgico.
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Bolívar-Rodríguez MA, Magaña-Zavala PA, Pamanes-Lozano A, Fragoza-Sánchez E. Evisceration due to spontaneous rupture of umbilical hernia in adult. Cir Esp 2021; 99:687. [PMID: 34654657 DOI: 10.1016/j.cireng.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Martín Adrián Bolívar-Rodríguez
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Hospital Civil de Culiacán, Culiacán, Sinaloa, Mexico.
| | - Pedro Alejandro Magaña-Zavala
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Hospital Civil de Culiacán, Culiacán, Sinaloa, Mexico
| | - Adrián Pamanes-Lozano
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Hospital Civil de Culiacán, Culiacán, Sinaloa, Mexico
| | - Edgar Fragoza-Sánchez
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Hospital Civil de Culiacán, Culiacán, Sinaloa, Mexico
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Bolívar-Rodríguez MA, Cázarez-Aguilar MA, Fierro-López R. Subcapsular Liver Hematoma Post-ERCP: the Origin. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Bolívar-Rodríguez MA, Magaña-Zavala PA, Pamanes-Lozano A, Fragoza-Sánchez E. Evisceration due to spontaneous rupture of umbilical hernia in adult. Cir Esp 2020; 99:S0009-739X(20)30357-2. [PMID: 33288203 DOI: 10.1016/j.ciresp.2020.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 10/31/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Martín Adrián Bolívar-Rodríguez
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Hospital Civil de Culiacán, Culiacán, Sinaloa, México.
| | - Pedro Alejandro Magaña-Zavala
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Hospital Civil de Culiacán, Culiacán, Sinaloa, México
| | - Adrián Pamanes-Lozano
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Hospital Civil de Culiacán, Culiacán, Sinaloa, México
| | - Edgar Fragoza-Sánchez
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Hospital Civil de Culiacán, Culiacán, Sinaloa, México
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Morgan-Ortiz F, López-de la Torre MA, López-Zepeda MA, Morgan-Ruiz FV, Ortiz-Bojórquez JC, Bolívar-Rodríguez MA. Clinical characteristics and location of lesions in patients with deep infiltrating endometriosis: using the revised Enzian classification. J Turk Ger Gynecol Assoc 2018. [DOI: 10.4274/jtgga.2018.0120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Morgan-Ortiz F, López-de la Torre MA, López-Zepeda MA, Morgan-Ruiz FV, Ortiz-Bojórquez JC, Bolívar-Rodríguez MA. Clinical characteristics and location of lesions in patients with deep infiltrating endometriosis using the revised Enzian classification. J Turk Ger Gynecol Assoc 2018; 20:133-137. [PMID: 30556663 PMCID: PMC6751830 DOI: 10.4274/jtgga.galenos.2018.2018.0120] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objective To describe the clinical characteristics and location of lesions in patients with deeply infiltrating endometriosis using the revised Enzian (rEnzian) classification. Material and Methods The clinical records of 60 patients undergoing laparoscopy for deeply infiltrating endometriosis at Hospital Civil de Culiacán, Sinaloa and Hospital San Javier, Jalisco, Mexico, were reviewed. Age, body mass index (BMI), number of pregnancies, childbearing, previous abortions, laparoscopic suggestion (pelvic pain, bleeding, infertility), and size and location of the lesions were assessed according to the rEnzian classification. Results The mean age of the patients was 30.5 years. The mean BMI was 25.6 kg/m2. Sixty-eight percent were nulliparous and 13% had at least one birth. Eighty-five percent had pelvic pain and 8.3% had infertility. Seventy percent (n=42) of the women had ovarian endometriomas (middle compartment); uterosacral and the torus uterinus ligaments were affected in 23.3%, rectum and sigmoid colon in 35% (posterior compartment), and the appendix and small intestine in 3.3%. According to the rEnzian classification, the most affected compartment was C2 (rectum and sigmoid colon with 1-3 cm lesions). Conclusion Pelvic pain was the main symptom of patients with deeply infiltrating endometriosis, mainly in nulliparous women. According to the rEnzian classification, the C2 compartment was the most affected (rectum and sigmoid colon).
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Affiliation(s)
- Fred Morgan-Ortiz
- Department of Obstetrics and Gynecology, Civil Hospital of Culiacán, Center for Research and Training in Health Sciences, Autonomous University of Sinaloa, Culiacán, Sinaloa, Mexico
| | - Manuel Antonio López-de la Torre
- Department of Obstetrics and Gynecology, Civil Hospital of Culiacán, Center for Research and Training in Health Sciences, Autonomous University of Sinaloa, Culiacán, Sinaloa, Mexico
| | | | - Fred Valentín Morgan-Ruiz
- Department of Obstetrics and Gynecology, Civil Hospital of Culiacán, Center for Research and Training in Health Sciences, Autonomous University of Sinaloa, Culiacán, Sinaloa, Mexico
| | - José Cándido Ortiz-Bojórquez
- Department of General Surgery, Civil Hospital of Culiacán, Center for Research and Training in Health Sciences, Autonomous University of Sinaloa, Culiacán, Sinaloa, Mexico
| | - Martín Adrián Bolívar-Rodríguez
- Department of General Surgery, Civil Hospital of Culiacán, Center for Research and Training in Health Sciences, Autonomous University of Sinaloa, Culiacán, Sinaloa, Mexico
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Bolívar-Rodríguez MA, Fierro-López R, Pamanes-Lozano A, Cazarez-Aguilar MA, Osuna-Wong BA, Ortiz-Bojórquez JC. Surgical outcome of jejunum-jejunum intussusception secondary to Rapunzel syndrome: a case report. J Med Case Rep 2018; 12:362. [PMID: 30522519 PMCID: PMC6284286 DOI: 10.1186/s13256-018-1883-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 10/16/2018] [Indexed: 11/15/2022] Open
Abstract
Background Adult intestinal intussusception is a rare condition caused by the mechanical disruption of bowel motility. A bezoar is defined as indigestible material inside the gastrointestinal tract that develops into a trapped mass; the most frequent bezoar is a trichobezoar. When a trichobezoar extends into the small intestine it is defined as Rapunzel’s syndrome. Literature describing complications related to this pathology remains scarce. Case presentation A 16-year-old Mexican girl presented to our emergency room with acute abdomen and a presumptive diagnosis of intestinal obstruction. Computed tomography was suggestive of intussusception. Surgery confirmed a jejunal-jejunal intussusception with a mass within the gastric cavity extending into her small intestine, corresponding to a trichobezoar. A manual intussusception reduction and a gastrotomy with extraction of the trichobezoar were performed. Conclusions We present a case of a jejunum intussusception as a complication of Rapunzel syndrome. Our patient had a favorable outcome after surgical intervention with a manual intussusception reduction, with retrograde displacement of the trichobezoar into the gastric lumen, and a complete extraction through a gastrostomy. Follow-up included psychiatric evaluation.
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Affiliation(s)
- Martín Adrián Bolívar-Rodríguez
- Departament of General Surgery, Centro de Investigación y Docencia en Ciencias de la Salud de la Universidad Autónoma de Sinaloa en el Hospital Civil de Culiacán, Culiacán, Mexico.
| | - Rodolfo Fierro-López
- Departament of General Surgery, Centro de Investigación y Docencia en Ciencias de la Salud de la Universidad Autónoma de Sinaloa en el Hospital Civil de Culiacán, Culiacán, Mexico
| | - Adrián Pamanes-Lozano
- Departament of General Surgery, Centro de Investigación y Docencia en Ciencias de la Salud de la Universidad Autónoma de Sinaloa en el Hospital Civil de Culiacán, Culiacán, Mexico
| | - Marcel Antonio Cazarez-Aguilar
- Departament of General Surgery, Centro de Investigación y Docencia en Ciencias de la Salud de la Universidad Autónoma de Sinaloa en el Hospital Civil de Culiacán, Culiacán, Mexico
| | - Benny Alonso Osuna-Wong
- Departament of General Surgery, Centro de Investigación y Docencia en Ciencias de la Salud de la Universidad Autónoma de Sinaloa en el Hospital Civil de Culiacán, Culiacán, Mexico
| | - José Cándido Ortiz-Bojórquez
- Departament of General Surgery, Centro de Investigación y Docencia en Ciencias de la Salud de la Universidad Autónoma de Sinaloa en el Hospital Civil de Culiacán, Culiacán, Mexico
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Bolívar-Rodríguez MA, Cazarez-Aguilar MA, Luna-Madrid EE, Morgan-Ortiz F. [Infected jejunal mesenteric pseudocyst: A case report]. CIR CIR 2015; 83:334-8. [PMID: 26123157 DOI: 10.1016/j.circir.2015.05.022] [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] [Received: 07/03/2014] [Accepted: 09/25/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Mesenteric cysts are very rare abdominal growths, generally asymptomatic, and which are usually detected incidentally while performing a physical examination or an imaging test. Complications such as infections, haemorrhage, torsion, rupture, or bowel obstruction, are seldom found in this pathology, but they can be a cause of acute abdomen. The purpose of this report is to describe the characteristics and the clinical outcome of a male patient with an infected mesenteric pseudocyst of the jejunum. CLINICAL CASE A 49 year-old male was admitted to the emergency department with 6-day onset of abdominal pain, bowel obstruction signs, palpable tumour located in the upper hemi-abdomen, systemic inflammatory response syndrome, 36,100/mm(3) white cells, 4.21 ng/ml procalcitonin, abdominal computed tomography scan with evidence of a mesenteric cystic tumour. An exploratory laparotomy was performed, finding the presence of a mesenteric pseudocyst of the jejunum with infection signs, extirpated and sent for histopathological examination. The clinical progress of the patient was satisfactory with the discharge of the patient 7 days after the surgical intervention. CONCLUSION These cysts can debut as an acute abdomen due to haemorrhage, infection, obstruction and/or bowel perforation, complications can be life threatening if not detected and surgically treated at an early stage by performing a resection of the pseudocysts, with or without bowel resection, depending on the location and the size of the cyst.
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Affiliation(s)
- Martín Adrián Bolívar-Rodríguez
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, México.
| | - Marcel Antonio Cazarez-Aguilar
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, México
| | - Eduardo Esaú Luna-Madrid
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, México
| | - Fred Morgan-Ortiz
- Departamento de Cirugía General, Centro de Investigación y Docencia en Ciencias de la Salud, Universidad Autónoma de Sinaloa, Culiacán, Sinaloa, México
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Bolívar-Rodríguez MA, Cazarez-Aguilar MA, Fierro-López R, Romero-Aguilar RE, Lizárraga-González H, Morgan-Ortiz F. [Acute appendicitis during pregnancy: report of 4 cases]. Ginecol Obstet Mex 2014; 82:337-343. [PMID: 24937949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Acute appendicitis is the more frequent no obstetric surgical emergency during pregnancy with an incidence of 1 in 1500 pregnancies. The clinical diagnosis is difficult because of the physiological changes of pregnancy itself. If not treated early increases the risk of maternal and fetal morbidity. OBJECTIVE To describe the diagnosis and treatment of four cases of acute appendicitis during pregnancy. CLINICAL CASE Four cases of acute appendicitis during pregnancy diagnosed in the period of a month. Gestational age at diagnosis of appendicitis was between 8 and 13 week. All patients underwent laparotomy; three cases were appendicitis phase II and one phase III. The preoperative was managed with indomethacin and ceftriaxone. There were no maternal or obstetric complications. CONCLUSIONS An early diagnosis and treatment of acute appendicitis during pregnancy, and a multidisciplinary approach between surgeon, obstetrician and anesthesiologist is the basis for success in the management of these patients.
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