Intussuscepção intestinal em gestante pós by-pass gástrico: relato de caso

Worldwide, it is estimated that approximately 634,897 people undergo bariatric procedures each year, with vertical gastrectomy and gastric bypass, representing 53.6% and 30%, respectively. Among operated patients, approximately half are women of reproductive age. In adults, intussusception is typically due to a pathological site in the intestine, which can be malignant in more than half of cases. Intestinal intussusception is rare in adults, representing 1 to 5% of mechanical intestinal obstructions. Intussusception in pregnant women after gastric bypass is a very rare pathology of unknown origin with high power of injury and injury to organs and systems. Its clinical manifestations are like acute obstructive abdomen, but in pregnant women it is difficult to make an early diagnosis.This case report presents a 38-year-old patient, a 22-week pregnant woman, with severe abdominal pain accompanied by vomiting in large quantities for 1 day, a history of gastric bypass for 4 years. The diagnosis of intestinal intussusception was possible after the seventh day of hospitalization with the aid of an image exam - MRI. Surgical treatment is indicated to correct the case. He developed septic shock requiring prolonged hospitalization in an ICUbed, being discharged after 27 days of hospitalization.Em todo o mundo, estima-se que aproximadamente 634.897 pessoas são submetidas a procedimentos bariátricos a cada ano, com gastrectomia vertical e by-pass gástrico, representando 53,6% e 30%, respectivamente. Entre pacientes operados, aproximadamente metade são mulheres em idade reprodutiva. Em adultos, a intussuscepção é tipicamente devida a um local patológico no intestino, que pode ser maligno em mais da metade dos casos. A intussuscepção intestinal é rara em adultos, representando 1 a 5% das obstruções intestinais mecânicas. A intussuscepção em gestantes pós by-pass gástrico é uma patologia muito rara de origem desconhecida com alto poder de lesão e injúria de órgãos e sistemas. Suas manifestações clínicas são como abdômen agudo obstrutivo, porém, na paciente gestante dificulta o diagnóstico precoce. Este relato de caso apresenta uma paciente de 38 anos, gestante de 22 semanas, com quadro de dor abdominal de forte intensidade acompanhada de vômitos em grande quantidade há um dia, antecedente de by-pass gástrico há quatro anos. O diagnóstico do quadro de intussuscepção intestinal foi possível após o sétimo dia de internação com auxílio de exame de imagem - RNM, sendo indicado o tratamento cirúrgico para correção do caso. Evoluiu com choque séptico com necessidade de internação prolongada em leito de CTI, recebendo alta após 27 dias de internação.En todo el mundo, se estimó que aproximadamente 634.897 personas se someten a procedimientos bariátricos cada año, con gastrectomía vertical y bypass gástrico, que representan el 53,6% y el 30%, respectivamente, de todos los procedimientos. Entre los pacientes operados, aproximadamente la mitad son mujeres en edad reproductiva. En adultos, la invaginación intestinal se debe típicamente a un sitio patológico en el intestino, que puede ser maligno en más de la mitad de los casos. La intususcepción intestinal es rara en adultos, representa del 1 al 5% de las obstrucciones intestinales mecánicas. La invaginación intestinal en mujeres embarazadas después de un bypass gástrico es una patología muy rara de origen desconocido con alto poder de lesión y daño a órganos y sistemas. Sus manifestaciones clínicas son altamente específicas con abdomen obstructivo agudo, pero en mujeres embarazadas es difícil hacer un diagnóstico temprano. En este informe de caso, presentamos a una paciente de 38 años, una mujer embarazada de 22 semanas, con dolor abdominal intenso acompañado de vómitos en gran cantidad durante 1 día, antecedentes de derivación gástrica durante 4 años. El diagnóstico de intususcepción intestinal fue posible después del séptimo día de hospitalización con la ayuda de un examen de imagen - MRI. El tratamiento quirúrgico está indicado para corregir el caso. Desarrolló un shock séptico que requirió hospitalización prolongada en una cama de la UCI y fue dado de alta después de 27 días de hospitalización

Transcutaneous Neuromodulation for Constipation and Fecal Incontinence in Children: A Systematic Review and Meta-Analysis

Introduction: Constipation is a disorder with a multifactorial origin. Constipation has a varied clinical presentation, including infrequent defecation of bulky stools and episodes of retentive fecal incontinence. Neuromodulation has been used to treat many health problems, with promising results. Objective: To conduct a systematic review of randomized clinical trials based on the effects of transcutaneous neuromodulation in treating constipation and retentive fecal incontinence in children and adolescents. Methods: A systematic review of randomized clinical trials was performed. Medline (PubMed), PEDro, SciELO, Cochrane (CENTRAL), Embase, and Scopus databases were searched from March 2000 to August 2022. We included clinical trials evaluating transcutaneous neuromodulation in children with constipation and fecal incontinence compared or associated with other types of treatment. Two reviewers independently selected relevant studies, assessed the methodological quality, and extracted the data. Results: Three studies with 164 participants were included in this review. Two meta-analyses were generated based on these studies. These analyses revealed that transcutaneous neuromodulation is an effective adjuvant treatment modality that improves children’s constipation and retentive fecal incontinence. The methodological quality of the included studies was classified as high based on the assessment of the quality of evidence, with a high degree of confidence based on the GRADE system. Conclusions: Transcutaneous neuromodulation is an effective adjuvant treatment modality for children with constipation and retentive fecal incontinence