Acute Intestinal Obstruction Due To Gallstone Ileus [abdome Agudo Por Obstrução Por Ileobiliar]

Objective: Small bowel obstruction (SBO) due to gallstones (gallstone ileus) is an uncommon complication of cholelithiasis, for which there is no defined surgical procedure. The objective of this study was to perform a systematic review of the history, available image exams and clinical approach to the diagnosis and treatment of gallstone ileus. Method: We conducted a retrospective study in a university hospital including all cases of SBO treated over a period of 23 years. According to the surgical treatment, the patients were divided into two groups: (1) enterolithotomy with posterior cholecystectomy (two-stage surgery); and (2) enterolithotomy, cholecystectomy and fistula closure (one-stage surgery). Results: Twelve patients were included in the study, including 11 females (91,6%), with a mean age of 72.2 years. All patients presented associated diseases, mainly arterial hypertension (75%). All except one patient had multiple SBO symptoms. Gallstone ileus diagnosis was made before laparotomy in six patients (50%). There were eight patients in group 1 and four in group 2, and the morbidity was, respectively, 33.3% and 8.3%. Overall mortality was 16.6% (one patient in each group). Conclusion: Gallstone ileus should be suspected in the elderly with SBO symptoms. Early diagnosis can reduce post-operative complications. Treatment is urgent laparotomy and the surgical approach must be individualized for each case. The majority of patients in this study were treated with enterolithotomy, with cholecystectomy being performed later in two symptomatic patients.404275280Martin, F., Intestinal obstruction due to gall-stones: With report of three successful cases (1912) Ann Surg., 55 (5), pp. 725-743Reisner, R.M., Cohen, J.R., Gallstone ileus: A review of 1001 reported cases (1994) Am Surg., 60 (6), pp. 441-446Lobo, D.N., Jobling, J.C., Balfour, T.W., Gallstone ileus: Diagnostic pittfalls and therapeutic successes (2000) J Clin Gastroenterol., 30 (1), pp. 72-76Hayes, N., Saha, S., Recurrent gallstone Ileus (2012) Clin Med Res., 10 (4), pp. 236-239Carrascosa, M.F., Riego-Martín, M.D., Salcines Caviedes, J.R., González Gutiérrez, P., Gallstone ileus (2012) BMJ Case Rep., , Feb 21;2012Rojas-Rojas, D.J., Martínez-Ordaz, J.L., Romero-Hernández, T., Biliary ileus: 10-years experience (2012) Cir Cir., 80 (3), pp. 228-232Tucker, A., Garstin, I., A peculiar cause of bowel obstruction (2013) Int J Surg Case Rep., 4 (5), pp. 473-476Halabi, W.J., Kang, C.Y., Ketana, N.K., Lafaro, K.J., Nguyen, V.K., Stamos, M.J., Surgery for gallstone ileus: A nationwide comparison of trends and outcomes (2013) Ann Surg., , jan 4 [Epub ahead of print]Pronio, A., Piroli, S., Caporilli, D., Ciamberlano, B., Coluzzi, M., Castellucci, G., Recurrent gallstone ileus: Case report and literature review (2013) G Chir., 34 (1-2), pp. 35-37McHado, M.A.C., Jukemura, J., Volpe, P., Abdo, E.E., Penteado, S., Bacchella, T., Fístulas biliares internas: Estudo de 13 casos e revisão da literatura (1995) Hos Clin Fac Med S Paulo., 50 (1), pp. 45-48Ayantunde, A.A., Agrawal, A., Gallstone Ileus: Diagnosis and management (2007) World J Surg., 31 (6), pp. 1292-1297Ravikumar, R., Williams, J.G., The operative management of gallstone ileus (2010) Ann R Coll Surg Engl., 92 (4), pp. 279-281Day, E.A., Marks, C., Gallstone ileus: Review of literature and presentation of thirty-four new cases (1975) Am J Surg., 129 (5), pp. 552-558Deitz, D.M., Standage, B.A., Pinson, C.W., McConnell, D.B., Krippaehne, W.W., Improving the outcome in gallstone ileus (1986) Am J Surg., 151 (5), pp. 572-576Bouveret, L., Stenose du pylore, adherent a la vesicule calculeuse (1896) Rev Med., 16, pp. 1-16Gajendran, M., Muniraj, T., Gelrud, A., A challenging case of gastric outlet obstruction (Bouveret's syndrome): A case report (2011) J Med Case Rep., 5, p. 497Costil, V., Jullès, M.C., Zins, M., Loriau, J., Bouveretś syndrome. An unusual localization of gallstone ileus (2012) J Visc Surg., 149 (4), pp. e284-e286Kasahara, Y., Umemura, H., Shiraha, S., Kuyama, T., Sakata, K., Kubota, H., Gallstone ileus. Review of 112 patients in the Japanese literature (1980) Am J Surg., 140 (3), pp. 437-440van Hillo, M., van der Vliet, J.A., Wiggers, T., Obertop, H., Terpstra, O.T., Greep, J.M., Gallstone obstruction of the intestine: An analysis of ten patients and a review of the literature (1987) Surgery., 101 (3), pp. 273-276Nuño-Guzmán, C.M., Arróniz-Jáuregui, J., Moreno-Pérez, P.A., Chávez-Solís, E.A., Esparza-Arias, N., Hernández-González, C.I., Gallstone ileus: One-stage surgery in a patient with intermittent obstruction (2010) World J Gastrointest Surg., 2 (5), pp. 172-176Clavien, P.A., Richon, J., Burgan, S., Rohner, A., Gallstone ileus (1990) Br J Surg., 77 (7), pp. 737-742Murphy, K.P., Kearney, D.E., Mc Laughlin, P.D., Maher, M.M., Complete radiological findings in gallstone ileus (2012) J Neurogastroenterol Motil., 18 (4), pp. 448-449Huang, S.T., Huang, M.Y., Gallstone ileus: A diagnostic challenge by plain radiography (2013) Emerg Med J., 30 (5), p. 370Lasson, A., Lorén, I., Nilsson, A., Nirhov, N., Nilsson, P., Ultrasonography in gallstone ileus: A diagnostic challenge (1995) Eur J Surg., 161 (4), pp. 259-263Mishin, I., Ghidirim, G., Zastavnitsky, G., Non-operative treatment for gall-stone ileus-a case report (2011) Pol Przegl Chir., 83 (4), pp. 223-226Conzo, G., Mauriello, C., Gambardella, C., Napolitano, S., Cavallo, F., Tartaglia, E., Gallstone ileus: One-stage surgery in an elderly patient: One-stage surgery in gallstone ileus (2013) Int J Surg Case Rep., 4 (3), pp. 316-318Mallipeddi, M.K., Pappas, T.N., Shapiro, M.L., Scarborough, J.E., Gallstone ileus: Revisiting surgical outcomes using National Surgical Quality Improvement Program data (2013) J Surg Res., , May 31. [Epub ahead of print]Beriner, S.D., Burson, L.C., One-stage repair for cholecyst-duodenal fistula and gallstone ileus (1965) Arch Surg., 90, pp. 313-316Jones, R., Broman, D., Hawkins, R., Corless, D., Twice recurrent gallstone ileus: A case report (2012) J Med Case Rep., 6 (1), p. 362Paiva-Coronel, G., Martínez-Ramos, D., Cosa-Rodríguez, R., Salvador-Sanchis, J.L., Íleo biliar. Abordaje asistido por laparoscopia (2010) Cir Esp., 87 (4), pp. 255-25

Morphology of Gambierdiscus excentricus (Dinophyceae) with emphasis on sulcal plates

Gambierdiscus excentricus is an epibenthic dinoflagellate able to produce ciguatoxin and maitotoxin-like compounds that are responsible for ciguatera fish poisoning. Morphological descriptions and molecular characterization of two G. excentricus strains isolated from Brazil and maintained in culture were provided. The most complete description of the morphology of the sulcal region of Gambierdiscus based on light and scanning electron microscopy was presented. The sulcal area morphology and nomenclature used by different authors to name the sulcal plates in Gambierdiscus were reviewed. Two small sulcal plates (S.m.a. and S.m.p.) were shown for the first time. Phylogenetic trees based on D1–D3 and D8–D10 large subunits of ribosomal RNA gene sequences showed that the strains of G. excentricus from Brazil clustered with strains of G. excentricus isolated from its type locality, the Canary Islands. Both phylogenetic trees reconstructed the same relationships among all the formally described Gambierdiscus species and Gambierdiscus sp. ribotype 2 and Gambierdiscus sp. type 2.Versión del editor2,080

Caustic ingestion management: world society of emergency surgery preliminary survey of expert opinion

[This corrects the article DOI: 10.1186/s13017-015-0043-4.].sem informação1056sem informaçãosem informaçã

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines

Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury. Endoscopic and percutaneous interventions have increased the ability to non-operatively manage these injuries. Late diagnosis and treatment are both associated to increased morbidity and mortality. Sequelae of late presentations of pancreatic injury and complications of severe pancreatic trauma are also increasingly addressed endoscopically and with interventional radiology procedures. However, for moderate and severe extrahepatic biliary and severe duodeno-pancreatic injuries, immediate operative intervention is preferred as associated injuries are frequent and commonly present with hemodynamic instability or peritonitis. The aim of this paper is to present the World Society of Emergency Surgery (WSES) and American Association for the Surgery of Trauma (AAST) duodenal, pancreatic, and extrahepatic biliary tree trauma management guidelines

Team dynamics in emergency surgery teams: results from a first international survey

Background: Emergency surgery represents a unique context. Trauma teams are often multidisciplinary and need to operate under extreme stress and time constraints, sometimes with no awareness of the trauma\u2019s causes or the patient\u2019s personal and clinical information. In this perspective, the dynamics of how trauma teams function is fundamental to ensuring the best performance and outcomes. Methods: An online survey was conducted among the World Society of Emergency Surgery members in early 2021. 402 fully filled questionnaires on the topics of knowledge translation dynamics and tools, non-technical skills, and difficulties in teamwork were collected. Data were analyzed using the software R, and reported following the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). Results: Findings highlight how several surgeons are still unsure about the meaning and potential of knowledge translation and its mechanisms. Tools like training, clinical guidelines, and non-technical skills are recognized and used in clinical practice. Others, like patients\u2019 and stakeholders\u2019 engagement, are hardly implemented, despite their increasing importance in the modern healthcare scenario. Several difficulties in working as a team are described, including the lack of time, communication, training, trust, and ego. Discussion: Scientific societies should take the lead in offering training and support about the abovementioned topics. Dedicated educational initiatives, practical cases and experiences, workshops and symposia may allow mitigating the difficulties highlighted by the survey\u2019s participants, boosting the performance of emergency teams. Additional investigation of the survey results and its characteristics may lead to more further specific suggestions and potential solutions