Date post: | 31-May-2015 |
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Diverticulums-Bowel cancerClínicas quirúrgicas
Dr. Héctor Manuel Virgen AyalaDr. Benjamin Robles Mariscal
Ponente: Héctor Eduardo Velázquez Domínguez
Diverticulums
http://www.medicinapratica.com.br/tag/diverticulo/
Congenital
Acquired
Meckel (2%)
Jejunum/Ileum 15%
Colon (50%)
Type
Pathologies
• Diverticular disease (symphtomatic diverticulum)
• Diverticulosis (diverticulum without inflamation)
• Diverticulitis (inflamation and infection)
Meckel diverticulum
http://www.pedsurg.com.pe/El_diverticulo_de_meckel.php
• 2%
• M 3:2 F
• Congenital real diverticulum
• Faulty onfalomesenteric duct obliteration
• Ileum-1m ileocecal valve
http://scielo.sld.cu/img/revistas/rpr/v9n1/f0111105.jpg
Faulty onfalomesenteric duct obliteration
Cells
• Gastric (60%)
• Pancreas
• Brunner glands
• Colon
• Endometrial
• Hepatobiliary
60% heterotopic mucosa
Clinical presentation
• Usually asymptomatic
• 4% complications (50% <10 â)
• Appendicitis like!
http://www.aurorahealthcare.org/yourhealth/healthgate/getcontent.asp?URLhealthgate=%22127569.html%22
Complications• Hemorrhage (50% <18â)
• Diverticulitis (more common in adults)
• Obstruction
• Perforation
• Volvulus
• Intussusception
SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F.MCGRAW‐HILL / INTERAMERICANA DE MEXICO
http://www.revistahnrg.com.ar/pdf_contenidos/con194‐89.pdf
http://www.elsevier.es/sites/default/ciles/elsevier/images/288/288v73n04/grande/288v73n04‐13149799cig1.jpg
Acquired diverticulum
• False diverticulum
• Duodenum near the ampulla
• Jejunum-big and multiple
• Ileum-small and solitary
• Colon (sigmoid)-between tenias/vessels
Jejunum/ileum diverticulum
• 56-76 â
• Traction, muscular weakness and bacteria
• 6-10% symphtomatic
• Intermittent pain, flatulence, diarrhea (10-30%)
• Same complications as Meckel
• Duodenal: compression choledocus or Wirsung
Colon diverticulum
• >50 â (50%)
• Pulsion, low fiber
• most are asymphtomatic
• Left side pain
• Fieber, leukocytosis
• Same complications as Meckel
Dx/Tx• Enteroclysis
• Endoscopy
• Barium enema
• Qx
• Diverticulectomy
• Segmental resection
SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F.MCGRAW‐HILL / INTERAMERICANA DE MEXICO
http://www.youtube.com/watch?v=9S1Xn0Kk4kY
Polyposis
http://mingaonline.uach.cl/scielo.php?pid=s0718‐28642007000100009&script=sci_arttext
Classification
• Neoplasic
• Hamartomatous (youth)
• Inflammatory
• Hyperplastic
• ¡Most of carcinomas evolve from polyps!
SessilePedunculated
Neoplasic
• Villous adenoma (40%)
• Tubulovillous adenoma (22%)
• Tubular adenoma (5%)
http://www.boloncol.com/images/stories/boletin15/colon3.jpg
http://escuela.med.puc.cl/publ/patologiageneral/patol_097.html
Hamartomatous
• Rarely premalignant
• Familiar juvenile polyposis (colon and rectum)
• Peutz-Jeghers syndrome (small intestine, less colon and rectum)
http://www.ngoaikhoathuchanh.info/vn/chitiettintuc.aspx?IDTT=1042011113514&IDLOAI=266201002348
Inherited cancer
• Familiar adenomatous polyposis (100%)
• Lynch syndrome (no polyps)
http://www.elsevier.es/sites/default/ciles/elsevier/images/288/288v74n04/grande/288v74n04‐13147781cig1.jpg
Jejunum and ileum cancer
Statistics
• 1.5% gastrointestinal tract tumor
• 10% symptomatic (75% malign)
• 80% metastasis at diagnosis
• 25% 5 year survival
• 5th-6th decade
• Adenocarcinoma 35-50%
• Carcinoid tumor 20-40%
• Lymphoma 10-15%
• GIST 10-15%
http://www.mdsaude.com/2010/07/polipos‐intestinais.html http://emedicine.medscape.com/article/179284‐overviewhttp://www.gastrointestinalatlas.com/
• Red meat
• Smoked food
• Crohn disease
• Celiac sprue
• Polyps
• FAP
• Lynch syndrome
• Peutz-Jeghers syndrome
Risk factors
http://www.cocinerosonline.com/blog/?page_id=499
Clinical presentation
AsymptomaticParcial or total obstruction
(25%)Palpable mass (25%)
Colicky abdominal painDistension
Nausea and vomitingHemorrhage
http://milennium.net/aikiblog/wp‐content/uploads/2010/09/dolor‐abdomen.jpg
• Enteroclysis
• Endoscopy
• Endoscopy capsule
• 5-HIAA (carcinoid tumor)
Diagnosis
SCHWARTZ PRINCIPIOS DE CIRUGIA (8ª ED.) BRUNICARDI, F.MCGRAW‐HILL / INTERAMERICANA DE MEXICO
Treatment resection
http://www.portalesmedicos.com/publicaciones/articles/889/2/
Colon cancer
Statistics
• Most common GI
• 95% Adenocarcinoma
• 5th-6th decade of life
• PAF and CCHSP (20%)
Location
Risk factors
• Same as jejunum and ileum cancer
• Smoking and alcohol
• Poor fiber intake
• High saturated fat intake
AINEVitamin DExcersise
Symptoms
• Left colon:Changes in bowel habitsBlood in stoolObstructive symptoms
• Right colon:WeaknessAnemiaHidden blood in stoolDispeptic symptomsRight disconfortPalpable mass
Laboratory testsUrinalysis
CBC (biometría hemática)Carcinoembryonic antigen
(ACE)70% colon Cancer
detect recurrences after resection
RadiologyRx
Barium enemaColonoscopy
TACSigmoidoscopy
Endorectal ultrasound
http://hnsebimagenes.blogspot.com/2009/01/cncer‐de‐colon‐derecho.html
Treatment
Resection
PaliativeElectrocoagulation
Fotocoagulation with laserSplints-endoferulas
Adjuvant and neoadjuvant therapyRadio and quimio
Staging: TNM
http://www.youtube.com/watch?v=hycQvTO0C24
Thanks