Factores asociados a tratamiento quirúrgico en pacientes con obstrucción intestinal por adherencias
| Contribuinte(s) |
Isaza-Restrepo, Andres Villaveces, Mariana |
|---|---|
| Data(s) |
10/08/2015
|
| Resumo |
El manejo de la obstrucción intestinal por adherencias es un reto para cualquier especialista en Cirugía debido a que existe controversia sobre el alcance del manejo médico y el momento adecuado para llevar el paciente a cirugía para la resolución del cuadro clínico. En el presente trabajo se pretende, identificar los factores asociados a tratamiento quirúrgico en pacientes con obstrucción intestinal por adherencias. Metodología: Se realizó un estudio de casos y controles en una relación de 1:1, con una recolección de muestra estadística de 48 pacientes en cada grupo, entre mayo 2012 y mayo 2014 en el Hospital Universitario Mayor Mederi y en Barrios Unidos. Se consideraron casos los pacientes intervenidos quirúrgicamente por obstrucción intestinal por bridas y controles los pacientes manejados con tratamiento médico. Se evaluaron factores como edad, antecedentes personales patológicos y quirúrgicos, tiempo de evolución del cuadro clínico, hallazgos en imágenes y laboratorio entre otros. Resultados: Se recolectaron un total de 158 pacientes, (78 casos, 80 controles). Ambas poblaciones fueron comparables (p=0.13). Los factores asociados a tratamiento quirúrgico estadísticamente significativos fueron género masculino, presencia de fiebre al ingreso, el hallazgo de engrosamiento de la pared intestinal y de obstrucción de asa cerrada en imágenes diagnósticas (p<0,05). Discusión: Los principales factores asociados para que un paciente con obstrucción intestinal por bridas requiera de manejo quirúrgico son consistentes con literatura. Se requiere la socialización de los resultados para disminuir la morbimortalidad de nuestros pacientes. The management of intestinal obstruction due to adhesions remains a challenge for any specialist in surgery, because there is controversy over the scope of medical management and the optimal time to consider surgical treatment for the resolution of symptoms. It is intended to identify factors associated to surgical treatment in patients with intestinal obstruction due to adhesions. Methods: A case-control study was performed in a ratio of 1:1, recluting 48 patients per group, over the period between May 2012 and May 2014 at Hospital Universitario Mayor Mederi and Barrios Unidos. There are considered as cases: patients who underwent a to surgical treatment with a diagnosis of intestinal obstruction due to adhesions, and are considered control patients, the ones who were managed with medical treatment. Factors such as age, pathological and surgical medical history, time of evolution of symptoms, laboratory and imaging findings were evaluated. Results: A total of 158 patients were collected (78 cases, 80 controls). The population was parametric (p = 0.13). The statistically significant factors associated for surgical treatment were male gender, presence of fever on admission, the finding of thickening of the intestinal wall and closed-loop obstruction in diagnostic imaging (p <0.05). Discussion : The main factors associated for a patient with intestinal obstruction by adhesions requiring surgical management are consistent with literature. Socialization of results is required to reduce morbidity and mortality of our patients. |
| Formato |
application/pdf |
| Identificador | |
| Idioma(s) |
spa |
| Publicador |
Facultad de Medicina |
| Direitos |
info:eu-repo/semantics/openAccess |
| Fonte |
instname:Universidad del Rosario reponame:Repositorio Institucional EdocUR Cappell MS, Batke M. Mechanical obstruction of the small bowel and colon. Med Clin North Am. 2008;92(3):575-97, viii. Di Saverio S, Coccolini F, Galati M, Smerieri N, Biffl WL, Ansaloni L, et al. Bologna guidelines for diagnosis and management of adhesive small bowel obstruction (ASBO): 2013 update of the evidence-based guidelines from the world society of emergency surgery ASBO working group. World J Emerg Surg. 2013;8(1):42. Margenthaler JA, Longo WE, Virgo KS, Johnson FE, Grossmann EM, Schifftner TL, et al. Risk factors for adverse outcomes following surgery for small bowel obstruction. Ann Surg. 2006;243(4):456-64. Duron JJ, du Montcel ST, Berger A, Muscari F, Hennet H, Veyrieres M, et al. Prevalence and risk factors of mortality and morbidity after operation for adhesive postoperative small bowel obstruction. Am J Surg. 2008;195(6):726-34. Fevang BT, Fevang J, Stangeland L, Soreide O, Svanes K, Viste A. Complications and death after surgical treatment of small bowel obstruction: A 35-year institutional experience. Ann Surg. 2000;231(4):529-37. Menzies D, Ellis H. Intestinal obstruction from adhesions--how big is the problem? Ann R Coll Surg Engl. 1990;72(1):60-3. Barmparas G, Branco BC, Schnüriger B, Lam L, Inaba K, Demetriades D. The incidence and risk factors of post-laparotomy adhesive small bowel obstruction. J Gastrointest Surg. 2010;14(10):1619-28. van Oudheusden TR, Aerts BA, de Hingh IH, Luyer MD. Challenges in diagnosing adhesive small bowel obstruction. World J Gastroenterol. 2013;19(43):7489-93. Zielinski MD, Eiken PW, Bannon MP, Heller SF, Lohse CM, Huebner M, et al. Small bowel obstruction-who needs an operation? A multivariate prediction model. World J Surg. 2010;34(5):910-9. Treves F. Intestinal Obstruction : Its Varieties with their Pathology, Diagnosis and Treatment : the Jacksonian Prize Essay of the Royal College of Surgeons of England 1883. London,1884. 515 s. p. Taylor GW, Jayne DG, Brown SR, Thorpe H, Brown JM, Dewberry SC, et al. Adhesions and incisional hernias following laparoscopic versus open surgery for colorectal cancer in the CLASICC trial. Br J Surg. 2010;97(1):70-8. Dayton MT, Dempsey DT, Larson GM, Posner AR. New paradigms in the treatment of small bowel obstruction. Curr Probl Surg. 2012;49(11):642-717. Ashley SW, Maingot R, Zinner M. Maingot's abdominal operations. 11. ed. New York: McGraw-Hill, Medical Pub. Division; 2007. xvi, 1309 s. p. Boudiaf M, Soyer P, Terem C, Pelage JP, Maissiat E, Rymer R. Ct evaluation of small bowel obstruction. Radiographics. 2001;21(3):613-24. Chang WC, Ko KH, Lin CS, Hsu HH, Tsai SH, Fan HL, et al. Features on MDCT that predict surgery in patients with adhesive-related small bowel obstruction. PLoS One. 2014;9(2):e89804. Fidler JL, Guimaraes L, Einstein DM. MR imaging of the small bowel. Radiographics. 2009;29(6):1811-25. Nagle A, Ujiki M, Denham W, Murayama K. Laparoscopic adhesiolysis for small bowel obstruction. Am J Surg. 2004;187(4):464-70. Wiggins T, Markar SR, Harris A. Laparoscopic adhesiolysis for acute small bowel obstruction: systematic review and pooled analysis. Surg Endosc. 2015. Teixeira PG, Karamanos E, Talving P, Inaba K, Lam L, Demetriades D. Early operation is associated with a survival benefit for patients with adhesive bowel obstruction. Ann Surg. 2013;258(3):459-65. Schraufnagel D, Rajaee S, Millham FH. How many sunsets? Timing of surgery in adhesive small bowel obstruction: a study of the Nationwide Inpatient Sample. J Trauma Acute Care Surg. 2013;74(1):181-7; discussion 7-9. Keenan JE, Turley RS, McCoy CC, Migaly J, Shapiro ML, Scarborough JE. Trials of nonoperative management exceeding 3 days are associated with increased morbidity in patients undergoing surgery for uncomplicated adhesive small bowel obstruction. J Trauma Acute Care Surg. 2014;76(6):1367-72. Chen SC, Lee CC, Hsu CY, Yen ZS, Fang CC, Ma MH, et al. Progressive increase of bowel wall thickness is a reliable indicator for surgery in patients with adhesive small bowel obstruction. Dis Colon Rectum. 2005;48(9):1764-71. Branco BC, Barmparas G, Schnüriger B, Inaba K, Chan LS, Demetriades D. Systematic review and meta-analysis of the diagnostic and therapeutic role of water-soluble contrast agent in adhesive small bowel obstruction. Br J Surg. 2010;97(4):470-8. Abbas SM, Bissett IP, Parry BR. Meta-analysis of oral water-soluble contrast agent in the management of adhesive small bowel obstruction. Br J Surg. 2007;94(4):404-11. Wadani HA, Al Awad NI, Hassan KA, Zakaria HM, Alaqeel FO, A AAM. Role of water soluble contrast agents in assigning patients to a non-operative course in adhesive small bowel obstruction. Oman Med J. 2011;26(6):454-6. Mora López L, Serra-Aracil X, Llaquet Bayo H, Navarro Soto S. [Use of Gastrografin(®) in the management of adhesion intestinal obstruction]. Cir Esp. 2013;91(6):384-8. Zielinski MD, Eiken PW, Heller SF, Lohse CM, Huebner M, Sarr MG, et al. Prospective, observational validation of a multivariate small-bowel obstruction model to predict the need for operative intervention. J Am Coll Surg. 2011;212(6):1068-76. O'Leary EA, Desale SY, Yi WS, Fujita KA, Hynes CF, Chandra SK, et al. Letting the sun set on small bowel obstruction: can a simple risk score tell us when nonoperative care is inappropriate? Am Surg. 2014;80(6):572-9. Baquero D. Propuesta para evaluar la calidad en la atención del paciente de cirugía general de urgencia. Bogotá D.C.: Universidad del Rosario; 2014. RESOLUCION Nº 008430, (1993). Mucha P. Small intestinal obstruction. Surg Clin North Am. 1987;67(3):597-620. Cox MR, Gunn IF, Eastman MC, Hunt RF, Heinz AW. The safety and duration of non-operative treatment for adhesive small bowel obstruction. Aust N Z J Surg. 1993;63(5):367-71. TEME |
| Palavras-Chave | #Cirugía #Enfermedades intestinales #Cirugía abdominal #Enfermedades intestinales - Casos clínicos #617.43 #Adhesions syndrome #Intestinal obstruction |
| Tipo |
info:eu-repo/semantics/bachelorThesis info:eu-repo/semantics/acceptedVersion |
