Divertikuly žalúdka sú veľmi zriedkavou patológiou. Zvyčajne sú asymptomatické a často sa zistia len náhodne, či už ako rádiologický, endoskopický alebo pitevný nález. Ich incidencia je nízka a vyskytujú sa rovnako často u mužov i žien. Bývajú lokalizované najmä na zadnej stene kardie alebo malej kurvatúre žalúdka. Autori predkladajú kazuistiku 58ročnej pacientky s ťažkou sideropenickou anémiou, výraznou stratou hmotnosti a neurčitými dyspeptickými ťažkosťami. Podozrenie na divertikul žalúdka vyjadril gastroenterológ pri gastrofibroskopii a potvrdil ho rádiológ dynamickým CT vyšetrením žalúdka. Divertikul bol lokalizovaný atypicky, tesne pod kardiou zo strany veľkej kurvatúry žalúdka. Pacientka bola operovaná. Pri konvenčnej laparotómii bola urobená resekcia divertikula lineárnym staplerom. Pooperačný priebeh bol bez komplikácií. Histologicky sa potvrdil nepravý divertikul. T. č. sa má pacientka dobre, od operácie pribrala 7 kg a krvný obraz má v norme.
Gastric diverticula represent a rare pathological condition. They are usually asymptomatic and are often found only by accident during radiologic or endoscopic examination, or during autopsy. Their incidence is low and evenly distributed between men and women. Gastric diverticula are most frequently located on the posterior wall of the cardia and on the lesser curvature of the stomach. The authors present a case study of a 58-year-old patient with severe sideropenic anaemia, a marked weight loss and non-specific dyspeptic symptoms. The suspicion of a diverticulum was raised by a gastroenterologist during gastrofibroscopy and confirmed by a radiologist following a dynamic CT examination of the stomach. The diverticulum had an atypical location beneath the cardia on the greater curvature. The patient was indicated for surgery. During conventional laparotomy, resection of the diverticulum was performed using a linear stapler. The postoperative course was uneventful. Histology confirmed a false diverticulum. The patient is doing well, is asymptomatic, has put on 7 kg since the operation and her blood count is normal.
- Keywords
- divertikul žalúdka, odôvodnená indikácia chirurgickej liečby, laparoskopia, laparotómia,
- MeSH
- Diverticulosis, Stomach * diagnosis surgery MeSH
- Laparoscopy * methods MeSH
- Laparotomy * methods MeSH
- Middle Aged MeSH
- Humans MeSH
- Signs and Symptoms, Digestive MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Cholecystitis diagnosis complications MeSH
- Humans MeSH
- Aged, 80 and over MeSH
- Intestinal Fistula diagnosis etiology surgery MeSH
- Gallstones diagnosis surgery complications MeSH
- Check Tag
- Humans MeSH
- Aged, 80 and over MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Biliárny ileus je zriedkavá komplikácia cholecystolitiázy. Vyskytuje sa najmä vo vyššom veku a podľa literálnych údajov jej incidencia kolíše v rozsahu 1–4 %. Najčastejšie vzniká ako komplikácia prekonanej alebo konzervatívne liečenej cholecystitídy alebo ako komplikácia dekubitálnej nekrózy steny žlčníka. Tá vedie k vzniku cholecystoduodenálnej fistuly. V tomto prípade je cholecystolitiáza „nemá“ alebo sa klinicky manifestuje len asi u jednej tretiny pacientov. Na našej klinike sme za ostatných 5 rokov urobili celkom 1 560 cholecystektómií (1345 L-CHE a 215 konvenčných CHE). Pre biliárny ileus sme za sledované obdobie operovali len dvoch pacientov. Diagnózu sme v oboch prípadoch stanovili až pri operácii, i keď pri opakovanom preštudovaní zobrazovacích vyšetrení (NSB postojačky, CT) sme dospeli k názoru, že už nimi sme mohli stanoviť primárnu príčinu črevnej nepriechodnosti.
Biliary ileus is a rare complication of cholecystolithiasis. The condition occurs predominantly in the elderly with incidence rates of 1–4%, according to the literature data. Most commonly, it develops as a complication of cholelithiasis which remained untreated or was managed conservatively, or as a complication of a gallbladder decubitus necrosis. The condition results in a cholecysto- duodenal fistula. In this case, the cholecystolithiasis is latent or is clinically manifested in a third of the patients. A total of 1560 cholecystectomies (1345 L-CHE and 215 conventional CHE) were performed in our clinic during a five- year period. Biliary ileus was an indication for operation only in two subjects, during the studied period. In the both cases, the diagnosis was established intraoperatively, although upon re-examination of the visualization modalities views (upright native abdominal views, CT scans ) the authors concluded that the primary cause of the ileus could have already been identified, based on the above views.
Syndróm krátkeho čreva (short bowel syndrome – SBS) je malabsorpcia vznikajúca ako dôsledok anatomickej alebo funkčnej straty signifikantne dlhého segmentu tenkého čreva. Strata viac ako 80 % dĺžky tenkého čreva sa spája so zvýšenou nevyhnutnosťou podpornej parenterálnej výživy a redukuje celkové prežívanie pacientov. Ak dôjde aj k strate ileocekálnej chlopne (valvula Bauhini), vzniká bakteriálna kontaminácia tenkého čreva, ktorá ovplyvňuje toleranciu orálnej, resp. enterálnej výživy. Autori predkladajú kazuistiku 27ročného pacienta, ktorý mal opakované resekcie tenkého čreva, naposledy aj s Bauhinskou chlopňou, až mu napokon zostalo len 70 cm jejuna.
Short bowel syndrome (SBS) is a malabsorption syndrome resulting from anatomical or functional loss of a significantly long small intestinal segment. A loss over 80% of the small intestinal length is associated with increased urgency for supportive parenteral nutrition and results in reduced overall survival of the patients. The ileocaecal valve (valvula Bauhini) loss results in bacterial contamination of the small intestine, affecting tolerability of the oral, ev. enteral nutrition. The authors present a case review of a 27-year-old patient with repetitive small intestinal resections. The last procedure included the Bauhini valve and, finally, the patient has only 70 cm of the jejunum preserved.
- MeSH
- Adult MeSH
- Ileus complications MeSH
- Humans MeSH
- Intestinal Obstruction etiology MeSH
- Short Bowel Syndrome surgery complications MeSH
- Intestine, Small surgery MeSH
- Tissue Adhesives MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Male MeSH
- Publication type
- Case Reports MeSH
- MeSH
- Humans MeSH
- Thromboembolism surgery complications prevention & control MeSH
- Check Tag
- Humans MeSH
