OPERATIA HARTMANN – SOLUTIE CHIRURGICALA IN DIVERTICULITA SIGMOIDIANA PERFORATA
D.F.Voicu1, Fl.Voicu1, Corina Manole2
Spitalul Judetean de Urgenta BRAILA – ROMANIA
1Sectia Chirurgie II, 2sectia ATI
Boala diverticulara este relativ des intalnita in practica, in ultimul timp. Complicatia sa cea mai frecventa este perforatia, iar segmentul cel mai afectat sigmoidul.
Materialul faptic este reprezentat de 38 bolnavi (20 femei, 18 barbati, varsta 48-72 ani), operati de urgenta in perioada 2000-2009, pentru diverticulita sugmoidiana, cu evolutie paucisimptomatica, neinvestigata si necunoscuta anterior, cu debut clinic prin perforatie. Metodele paraclinice de diagnostic au fost: testele de laborator de rutina, radioscopia abdominala simpla, echografia abdominala si tomografia computerizata.
Toate cazurile au fost rezolvate chirurgical prin colectomie Hartmann, cu extirparea segmentului intestinal afectat. Tehnica a fost usurata de prezenta dolicosigmoidului in 35 cazuri. Evolutia postoperatorie imediata a fost favorabila, cu mortaliate nula.
Se subliniaza frecventa crescuta a bolii diverticulare si necesitatea unui diagnostic precoce, pentru prevenirea complicatiilor majore; utilitatea diagnostica a examenului tomografic; eficienta terapeutica a operatiei Hartmann in chirurgia de urgenta a diverticulitei sigmoidiene perforate.
HARTMANN OPERATION– SURGICAL SOLUTION IN PERFORATED SIGMOIDIAN DIVERTICULITIS
D.F.Voicu1, Fl.Voicu1, Corina Manole2
District Emergency Hospital BRAILA – ROMANIA
1IInd Surgical Unit, 2AIC Unit
Diverticular disease is relatively common in practice lately. Its most frequent complication is perforation and the most affected segment sigmoid.
Factual material is represented by 38 patients (20 women, 18 men, age 48-72 years), operated in emergency during 2000-2009, for sigmoidian diverticulitis with paucisimptomatic evolution, less investigated and previously unknown, with clinical onset through perforation. The diagnostic paraclinical methods were routine laboratory check-up, simple abdominal X-ray, abdominal ultrasonography and CT scan.
All cases were solved by Hartmann colectomy with extirpation of affected intestinal segment. The technique was relieved by the presence of dolicosigmoid in 35 cases. Immediate postoperative evolution was favorable, with nule mortality..
The paper emphasized the high frequence of diverticular disease and the need for early diagnosis to prevent major complications; diagnostic usefullness of tomography examination; therapeutical efficiency of Hartmann operation in emergency surgery for perforated sigmoidian diverticulitis.
TUMORILE RETROPERITONEALE PRIMITIVE – ASPECTE DIAGNOSTICE SI TERAPEUTICE
D.F.Voicu1, Fl.Voicu1, C.Popazu1, Daniela Vasile2, Mioara Mircea3
Spitalul Judetean de Urgenta Braila - Romania
1Sectia Chirugie II, 2Sectia Oncologie, 3Departamentul Anatomie Patologica
Tumorile retroperitoneale primitive sunt tumori dezvoltate in spatiul retroperitoneal, din tesutul adipos, conjunctiv, al fasciilor, al tesutului vascular, nervos, al vaselor limfatice si limfoganglionilor sau din resturi embrionare.
Studiul retrospectiv include 38 cazuri (22 barbati, 16 femei, varsta 38-78 ani) de tumori retroperitoneale considerate primitive (benigne: 7 tumori chistice, 6 mixoame, 6 angiolipoame, 2 leiomioame, 1 hemangiom, 1 schwannom benign; maligne: 7 sarcoame, 3 limfoame, 3 shwannoame maligne, 1 adenocarcinom, 1 carcinom nediferentiat) operate in perioada 1995-2009.
Durerea abdominala (100%) si tumora palpabila (95%) au fost cele mai constante elemente clinice de diagnostic. Investigatiile radiologice clasice (radiografia toraco-abdominala, urografia, tranzitul baritat esogastroduodenal, clisma baritata), echografia si tomografia computerizata au fost mijloacele paraclinice de investigatie.
Laparatomia exploratorie a fost indicata si practicata in toate cazurile, cu scopul de a extirpa macar partial tumora, cu recoltarea de fragmente bioptice (extirpare completa 60%, rezectii partiale 27%, doar biopsie 13%). In 10 cazuri, s-a asociat exereza unor organe invadate: splenectomie, pancreatectomie caudala, colectomie segmentara pe transvers, hemicolectomie dreapta, colecistectomie. Evolutia imediata a fost favorabila in 35 cazuri; s-au inregistrat 3 decese: 2 pancreatite acute necrotice postoperatorii si 1 infarct miocardic acut.
Tumorile retroperitoneale primitive sunt leziuni rare, care ridica serioase probleme de diagnostic si tratament. Se dau detalii si se discuta dificultatile de diagnostic si abord chirurgical.
PRIMITIVE RETROPERITONEAL TUMORS – DIAGNOSTIC AND THERAPEUTIC ASPECTS
Primitive retroperitoneal tumors are developed in the retroperitoneal space from adipose and conective tissue, from fascial, nervous, vascular and lymphatic tissue, or embryonic residue.Studiul retrospectiv include 38 cazuri (22 barbati, 16 femei, varsta 38-78 ani) de tumori retroperitoneale considerate primitive (benigne: 7 tumori chistice, 6 mixoame, 6 angiolipoame, 2 leiomioame, 1 hemangiom, 1 schwannom benign; maligne: 7 sarcoame, 3 limfoame, 3 shwannoame maligne, 1 adenocarcinom, 1 carcinom nediferentiat) operate in perioada 1995-2009. Retrospective study included 38 cases (22 men, 16 women, age 38-78 years) of considered primitive retroperitoneal tumors (benign: 7 cystic tumors, 6 mixomas, 6 angiolipomas, 2 leiomiomas, 1 hemangiomas, 1 benign schwannomas, malignant: 7 sarcomas, 3 lymphomas, 3 malignant shwannomas, 1 adenocarcinoma, 1 undifferentiated carcinoma) operated between 1995-2009.
Durerea abdominala (100%) si tumora palpabila (95%) au fost cele mai constante elemente clinice de diagnostic. Abdominal pain (100%) and palpable tumor (95%) were the most consistent clinical evidence of diagnosis. Investigatiile radiologice lasice (radiografia toraco-abdominala, urografia, tranzitul baritat esogastroduodenal, clisma baritata), echografia si tomografia computerizata au fost mijloacele paraclice de investigatie. Clasic radiological investigations ( toraco-abdominal X-ray, urography, esogastroduodenal barytic transit, barytic clisma), ultrasonography and computered tomography have been the means of paraclinic investigations.
Laparatomia exploratorie a fost indicata si practicata in toate cazurile, cu scopul de a extirpa macar partial tumora, cu recoltarea de fragmente bioptice (extirpare completa 60%, rezectii partiale 27%, doar biopsie 13%).Exploratory laparatomy has been indicated and practiced in all cases, in order to eradicate tumor at least partially, with the collection of biopsy fragments (complete extirpation 60%, partial resections 27%, only biopsy 13%). In 10 cazuri, sa asociat exereza unor organe invadate: splenectomie, pancreatectomie caudala, colectomie segmentara pe transvers, heicolectomie dreapta, colecistectomie. In 10 cases, was associated removal of invaded organs: splenectomy, caudal pancreatectomy, transverse segmental colectomy, right hemicolectomy, cholecystectomy. Evolutia imediata a fost favorabila in 35 cazuri; s-au inregistrat 3 decese: 2 pancreatite acute necrotice postoperatorii si 1 infarct miocardic acut. Immediate evolution was favorable in 35 cases, 3 deaths were registered: acute necrotic postoperative pancreatitis 2 cases and 1 acute myocardial infarction.
Tumorile retroperitoneale primitive sunt leziuni rare, care ridica serioase probleme de diagnostic si tratament. Primitive retroperitoneal tumors are rare lesions that raise serious problems of diagnosis and treatment. Se dau detalii si se discuta dificultatile de diagnostic si abord chirurgical. The paper gives details and discuss the diagnostic difficulties and surgical approaches.
D.F.Voicu1, Fl.Voicu1, C.Popazu1, Daniela Vasile2, Mioara Mircea3
District Emergency Hospital Braila - Romania
1IInd Surgical Unit, 2 Oncology Unit, 3 Pathology Department
