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Id: biblio-1251523
Autor: Otero-Regino, William; Otero-Parra, Lina; Veitía, Guillermo.
Título: Reservoritis, una complicación del tratamiento quirúrgico de la colitis ulcerativa. Diagnóstico y tratamiento. Revisión / Pouchitis, a complication associated with the surgical treatment of ulcerative colitis. Diagnosis and treatment. Review
Fonte: Rev. colomb. gastroenterol;36(1):65-72, ene.-mar. 2021. tab, graf.
Idioma: es.
Resumo: Resumen Del 20% al 30% de los pacientes con colitis ulcerativa (CU) son sometidos a cirugía, ya sea por intratabilidad, curso fulminante, aparición de displasia o cáncer de colon. La cirugía de elección es la proctocolectomía con reservorio ileoanal. Sin embargo, el 20%-50% de los pacientes presentan reservoritis a 10 años. El diagnóstico se realiza con base en las manifestaciones clínicas, las alteraciones endoscópicas y la histología. Los medicamentos utilizados en el tratamiento de la CU no son tan eficaces en la reservoritis y el tratamiento de primera línea es los antibióticos. Dependiendo de la respuesta inicial y el curso clínico de la entidad, se elegirá el tratamiento posterior. En esta revisión se discuten los aspectos más importantes con respecto a la epidemiología, diagnóstico, patogénesis y tratamiento de la reservoritis.

Abstract Between 20% and 30% of patients with ulcerative colitis (UC) undergo surgery because it is not treatable or because it is associated with a fulminant course, dysplasia, or colon cancer. The surgery of choice is proctocolectomy with ileal-anal pouch. However, 20%-50% of patients present with pouchitis 10 years after surgery. The diagnosis is made based on clinical manifestations, endoscopic alterations, and histology. The drugs used in the treatment of UC are not as effective in pouchitis and the first-line treatment is antibiotics administration. Depending on the initial response and clinical course of the condition, subsequent treatment will be chosen. This review discusses the most important aspects of the epidemiology, diagnosis, pathogenesis, and treatment of pouchitis.
Descritores: Terapêutica
Colite Ulcerativa
Pouchite
Diagnóstico
-Sinais e Sintomas
Proctocolectomia Restauradora
Antibacterianos
Limites: Humanos
Masculino
Feminino
Tipo de Publ: Revisão
Responsável: CO354 - Sociedad Colombiana de Gastroenterología


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Id: lil-517343
Autor: Marin, A; Rocca, A; Sasson, L; Guastavino, E; Dávila, M. T. G de.
Título: Cirugía de la colitis ulcerosa en pediatría / Surgery of ulcerative colitis in children
Fonte: Med. infant;9(2):86-91, jun. 2002. tab.
Idioma: es.
Resumo: El fracaso del tratamiento médico en colitis ulcerosa crónica o la existencia de enfermedad prolongada conducen a la cirugía. Actualmente la técnica de elección es la colectomía total con pouch ileal. Con el objetivo de evaluar sus resultados se revisó la evolución de un grupo de 74 pacientes pediátricos con CU moderada a severa. De ellos, quince requirieron tratamiento quirúrgico. Las indicciones fueron: corticodependencia: (n 8). corticorresistencia: (n 4), megacolon tóxico: (n 3). En trece pacientes se realizó colectomía con pouch ileoanal en J. En 4 de los niños la cirugía se efectuó en dos tiempos y en los 8 restantes se completó en tres tiempos. En una paciente sin compromiso rectal se realizó anatomosis ileorrectal y en un niño se efectuó anastomsis ileoanal sin reservorio. Hasta la actualidad en ocho se recontruyó el tránsito intestinal en un promedio de 9 meses (5 a 12 m) con un media de seguimiento de 3.25 años. Las complicaciones inmediatas fueron: absceso de pouch (n 3), necrosis del pouch (n 1) , hemorragia (n 2), peritonitis (n 1), ileitis (n 1). Las complicaciones alejadas incluyeron: puchitis en 2 pacientes, fístula enterocutánea en 1, oclusión intestinal en 2. Después de la reconstrucción del tránsito los pacientes presentaron deposiciones frecuentes reduciéndose en todos los casos a 3 o 4 por día luego de 3 meses. Ninguno de los niños presentó incontinencia. Se concluye que si bien tiene una elevada morbilidad. la economía total con pouch mejora la calidad de vida de los pacientes, tiene buenos resultados funcionales y evita el riesgo del tratamiento con corticoides y/o inmunosupresores.
Descritores: Colectomia
Colite Ulcerativa/cirurgia
Colite Ulcerativa/complicações
Colite Ulcerativa/terapia
Proctocolectomia Restauradora
Pouchite
Limites: Criança
Tipo de Publ: Estudo de Avaliação
Responsável: AR94.1 - Centro de Información Pediatrica


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Id: biblio-1117863
Autor: Pavez O, Carolina.
Título: Reservoritis/pouchitis: fisiopatología y manejo basado en la evidencia / Reservoirs/pouchitis: physiopathology and evidence-based management
Fonte: Gastroenterol. latinoam;29(supl.1):S58-S62, 2018. tab.
Idioma: es.
Resumo: Pouchitis is a frequent complication following proctocolectomy with ileal pouch-anal anastomosis, mainly in patients with ulcerative colitis. Though etiology is still unknown, evidence shows that there is a relation with host microbiota. Management of chronic refractory pouchitis is challenging, and current evidence showns that the use of biologic agents may have a favourable response.

La reservoritis es una complicación frecuente en pacientes en quienes se ha practicado una proctocolectomía con reservorio ileal, principalmente en pacientes con colitis ulcerosa. La etiología si bien es desconocida, la evidencia actual apunta a que exista una relación con la microbiota del huésped. La reservoritis refractaria crónica es un desafio en el manejo y actualmente ha surgido evidencia que apunta que el uso de biológicos puede tener una respuesta favorable.
Descritores: Pouchite/diagnóstico
Pouchite/tratamento farmacológico
-Complicações Pós-Operatórias/etiologia
Ciprofloxacina/uso terapêutico
Fatores de Risco
Proctocolectomia Restauradora/efeitos adversos
Pouchite/classificação
Pouchite/etiologia
Probióticos/uso terapêutico
Diagnóstico Diferencial
Metronidazol/uso terapêutico
Antibacterianos/uso terapêutico
Limites: Humanos
Tipo de Publ: Revisão
Responsável: CL61.1 - Biblioteca Central Campus Sur


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Texto completo SciELO Brasil
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Id: lil-645440
Autor: Arashiro, Roberta Thiery de Godoy; Teixeira, Magaly Gemio; Rawet, Viviane; Quintanilha, Alina Guimarães; Paula, Henrique Moura de; Silva, Adriano Zanon; Nahas, Sérgio Carlos; Cecconello, Ivan.
Título: Histopathological evaluation and risk factors related to the development of pouchitis in patients with ileal pouches for ulcerative colitis
Fonte: Clinics;67(7):705-710, July 2012. ilus, tab.
Idioma: en.
Resumo: OBJECTIVE: Many changes in mucosal morphology are observed following ileal pouch construction, including colonic metaplasia and dysplasia. Additionally, one rare but potential complication is the development of adenocarcinoma of the reservoir. The aim of this study was to evaluate the most frequently observed histopathological changes in ileal pouches and to correlate these changes with potential risk factors for complications. METHODS: A total of 41 patients were enrolled in the study and divided into the following three groups: a non-pouchitis group (group 1) (n = 20; 8 males; mean age: 47.5 years) demonstrating optimal outcome; a pouchitis without antibiotics group (group 2) (n = 14; 4 males; mean age: 47 years), containing individuals with pouchitis who did not receive treatment with antibiotics; and a pouchitis plus antibiotics group (group 3) (n = 7; 3 males; mean age: 41 years), containing those patients with pouchitis who were administered antibiotics. Ileal pouch endoscopy was performed, and tissue biopsy samples were collected for histopathological analysis. RESULTS: Colonic metaplasia was found in 15 (36.6%) of the 41 patients evaluated; of these, five (25%) were from group 1, eight (57.1%) were from group 2, and two (28.6%) were from group 3. However, no correlation was established between the presence of metaplasia and pouchitis (p = 0.17). and no differences in mucosal atrophy or the degree of chronic or acute inflammation were observed between groups 1, 2, and 3 (p>0.45). Moreover, no dysplasia or neoplastic changes were detected. However, the degree of mucosal atrophy correlated well with the time of postoperative follow-up (p = 0.05). CONCLUSIONS: The degree of mucosal atrophy, the presence of colonic metaplasia, and the degree of acute or chronic inflammation do not appear to constitute risk factors for the development of pouchitis. Moreover, we observed that longer postoperative follow-up times were associated with greater degrees of mucosal atrophy.
Descritores: Colite Ulcerativa/cirurgia
Bolsas Cólicas/patologia
Pouchite/etiologia
-Biópsia
Colite Ulcerativa/patologia
Colo/patologia
Bolsas Cólicas/efeitos adversos
Mucosa Intestinal/patologia
Metaplasia
Pouchite/patologia
Fatores de Risco
Índice de Gravidade de Doença
Limites: Adulto
Idoso
Feminino
Humanos
Masculino
Pessoa de Meia-Idade
Adulto Jovem
Responsável: BR1.1 - BIREME


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Id: lil-640077
Autor: Ibáñez L., Patricio.
Título: Reservoritis / Pouchitis
Fonte: Gastroenterol. latinoam;20(2):113-118, abr.-jun 2009.
Idioma: es.
Conferência: Apresentado em: Curso de Avances en Gastroenterología, 30, Santiago, 1-3 jul. 2009.
Descritores: Pouchite/diagnóstico
Pouchite/terapia
-Doença Aguda
Doença Crônica
Diagnóstico Diferencial
Endoscopia Gastrointestinal
Pouchite/classificação
Pouchite/epidemiologia
Pouchite/etiologia
Índice de Gravidade de Doença
Limites: Humanos
Responsável: CL1.1 - Biblioteca Central


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Id: lil-636168
Autor: Puerta Díaz, Juan Darío; Castaño Llano, Rodrigo; Arismendi, Iván R.
Título: Experiencias clinicoquirúrgicas con 51 bolsas ileales / Clinical and surgical experiences with 51 ileal bags
Fonte: Rev. colomb. gastroenterol;19(2):79-85, jun. 2004. ilus, tab.
Idioma: es.
Resumo: Antecedentes. La proctocolectomía total con reconstrucción con bolsa ileal (BI) se ha convertido en la cirugía para pacientes con colitis ulcerativa (CU) y las diferentes formas de síndromes polipósicos (SP). Propósito. Informar los resultados de ocho años de experiencia con la proctocolectomía total por enfermedad inflamatoria intestinal y SP y la reconstrucción con bolsa ileal. Métodos. Se evaluaron en forma prospectiva 51 pacientes sometidos a BI desde 1994 al 2002. El diagnóstico histopatológico preoperatorio fue CU (n=39), síndromes de poliposis múltiple (n=10), dos enfermos con Crohn y una resección masiva de colon por cáncer. Se obtuvo información referente a los aspectos demográficos, tipo y duración de la enfermedad, cirugías previas e indicación de la cirugía. Se registraron las complicaciones tempranas (30 días después de la cirugía) y las tardías. El seguimiento incluye la funcionalidad de la bolsa al año, el examen físico, y las biopsias de la bolsa y la zona de transición cuando ésta estaba indicada. Resultados. Los 51 pacientes (24 mujeres) tuvieron un seguimiento promedio de 44,5 meses (rango de 12 a 108 meses), el diagnóstico histopatológico se cambió en dos pacientes de CU a EC. La tasa de mortalidad global fue de 2% (un paciente), relacionada con sepsis perianal 45 meses después de realizarle la BI. La morbilidad global es de 65% (73 complicaciones en 33 pacientes; tempranas 39% y tardías en 49%), la estancia promedio fue de 8,9 días (rango de 6 a 25 días). Las complicaciones más frecuentes fueron las obstructivas en 36% (20% tempranas), sépticas en 22% (18% tempranas) y las reintervenciones en 26% (15% tempranas). La complicación tardía, más frecuente fue la "pouchitis" en 29,4%. La bolsa ileal se retiró en un paciente (2%) y en todos los demás es funcional. El índice de satisfacción fue de bueno-excelente en 82%, regular en 16% y malo en 2%. Conclusiones. La proctocolectomía total con reconstrucción con bolsa ileal es un procedimiento seguro, con baja mortalidad pero con una alta morbilidad. Aunque la morbilidad total es apreciable, los resultados funcionales son buenos y la satisfacción del paciente es aceptable.

Background: Restorative proctocolectomy and ileal pouch (IP) has become an established surgery for patients with chronic ulcerative colitis and poliposis syndromes. Purpose: The authors report the results of 8-year experience of restorative proctocolectomy and IP. Methods: Chart review was performed for 51 patients undergoing IP from 1994 through 2002. Preoperative histopathologic diagnoses were ulcerative colitis (n=39), poliposis syndromes (n=10), 2 Crohn disease and 1 patient with colorectal cancer and extended resection. Information was obtained regarding patient demographics, type and duration of diseases, previous operations, and indications for surgery. Early (within 30 days after surgery) and late complications were noted. Follow-up included an annual function, physical examination, and biopsies of the pouch and anal transitional zone when were indicated. Results: Of the 51 patients (24 women) with mean follow-up time of 44,5 months (range 12-108 months), histopathologic diagnoses of ulcerative colitis were changed for Crohn's disease in 2 patients. The overall mortality rate was 2% (1 patient), one death was related to perineal sepsis 45 months after ileal pouch. The overall morbidity rate was 65% (73 complications in 33 patients; early 39%; late 49%) the mean hospitalary stancy was 8,9 days (range 6-25 days). Small bowel obstruction, septic complication and reoperation rates were 36%, 22% and 26%, respectively. The most frecuent late complication was "pouchitis" (31,8%). The ileal pouch was removed in 1 patient, and it is functional in 50 (98%). There was a satisfactory index with 82% with excelent-good results, and 16% and 2% with regular and bad results. Conclusions: Restorative proctocolectomy with an IP is a safe procedure, with low mortality and major morbidity rates. Although total morbidity rate is appreciable, functional results generally are good and patient satisfaction is acceptable.
Descritores: Colite Ulcerativa
Doenças Inflamatórias Intestinais
Pouchite
Proctocolectomia Restauradora
Limites: Humanos
Masculino
Feminino
Adulto
Pessoa de Meia-Idade
Idoso
Tipo de Publ: Ensaio Clínico Controlado Aleatório
Responsável: CO332 - Facultad de Medicina


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Texto completo SciELO Chile
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Id: lil-484922
Autor: Zárate C., Alejandro; Zúñiga D., Álvaro; Pinedo M., George; López K., Francisco; Molina P., María E; Viviani G., Paola.
Título: Reservorio ileal con anastomosis reservorio anal por colitis ulcerosa: Complicaciones y resultados funcionales a largo plazo / Ileal pouch-anal anastomosis for ulcerative colitis: Complications and long term functional results
Fonte: Rev. méd. Chile;136(4):467-474, abr. 2008. tab.
Idioma: es.
Resumo: Background: The ileo anal-pouch-anastomosis (IPAA) is the treatment of choice for patients with ulcerative colitis (UC). Aim To analyze the surgical outcomes, long term evolution and functional results of IPAA. Material and methods: All patients subjected to an IPAA, from 1984 to 2006 were identified from a prospectively constructed inflammatory bowel disease database. Surgical variables, postoperative complications and functional evaluation, using Oresland score were analyzed. Chi square, Fischer exact test, T Student, Mann Whitney and binary logistic regression were included in the statistical analysis. Results: In the study period 107 patients, aged 14 to 62 years (61 females), subjected to an IPAA, were identified in this period. All patients, except 4, had a J pouch. All were protected with a loop ileostomy Thirteen patients (12.1 percent) had specific postoperative complications: pelvic collections in five (4.6 percent), wound infection in four (3.7 percent), fistula of the anastomosis in two (1.8 percent), hemoperitoneum and pouch necrosis in one each. Three (2.7 percent) patients were reoperated. There was no post-operative (30 days) mortality. A complete follow-up was obtained in 106 of 107 patients: four evolved as Crohn disease; four lost their pouch and two died for other causes. One patient required an ileostomy due to a vaginal fistula. Seventy two patients were followed more than 36 months after ileostomy closure and 92 percent have a satisfactory intestinal function. In the univariate analysis, poorest intestinal function was related to age of diagnosis of UC and presence of chronic pouchitis. In the multivariate analyses age of diagnosis was associated with poor function. Conclusions: IPAA has a low rate of complications. The long term intestinal function is satisfactory in most patients. A poorer intestinal function was observed in older patients and those with chronic pouchitis).
Descritores: Canal Anal/cirurgia
Colite Ulcerativa/cirurgia
Bolsas Cólicas/efeitos adversos
Proctocolectomia Restauradora/efeitos adversos
-Anastomose Cirúrgica/efeitos adversos
Doença de Crohn/etiologia
Cuidados Pré-Operatórios
Pouchite/etiologia
Infecção da Ferida Cirúrgica/etiologia
Fatores de Tempo
Resultado do Tratamento
Adulto Jovem
Limites: Adolescente
Adulto
Feminino
Humanos
Masculino
Pessoa de Meia-Idade
Adulto Jovem
Responsável: BR1.1 - BIREME


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Coy, Cláudio Saddy Rodrigues
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Id: lil-442826
Autor: Leal, Raquel Franco; Coy, Cláudio Saddy Rodrigues; Velloso, Lício Augusto; Ayrizono, Maria de Lourdes Setsuko; Fagundes, João José; Milanski, Marciane; Coope, Andressa; Góes, Juvenal Ricardo Navarro.
Título: Atividade inflamatória em mucosa de reservatório ileal na polipose adenomatosa familiar e retocolite ulcerativa inespecífica: avaliação da expressão de TNF-alfa e IL-1beta, e da ativação NF- kapaB / Inflammatory activity in pelvic ileal pouches for familial adenomatous polyposis and ulcerative colitis: expression of TNF-alpha, IL-1beta and the activation of NF- kappaB
Fonte: Rev. bras. colo-proctol;26(4):399-405, out.-dez. 2006. graf.
Idioma: pt.
Resumo: A ileíte do reservatório pós retocolectomia total constitui uma das complicações mais comuns nos doentes com RCUI, apresentando pequena freqüência nos doentes com PAF. OBJETIVO: Avaliar a atividade inflamatória em mucosa de reservatórios ileais endoscopicamente normais, através da expressão de TNF-alfa, NF-kapaB e IL-1beta. CASUíSTICA E MÉTODOS: Selecionaram-se 20 doentes submetidos à retocolectomia total com reservatório ileal em "J" pelo Grupo de Coloproctologia da UNICAMP, sendo 10 doentes com RCUI e 10 com PAF. O grupo controle foi constituído por íleo terminal de intestino normal. Realizadas biópsias da mucosa do reservatório ileal e do íleo terminal normal, e congeladas em nitrogênio líquido. A expressão de TNF-alfa e IL-1beta foi analisada por extrato total e de NF-kB por meio de imunoprecipitado. A separação protéica foi feita por eletroforese em gel de poliacrilamida. RESULTADOS: Expressão de TNF-alfa e IL-1beta apresentaram níveis maiores nos doentes com RCUI, quando comparados àqueles com PAF (p<0.05). Por outro lado, a expressão de NF-kapaB foi maior nos doentes com RCUI, porém sem diferença estatística em relação aos de PAF. O grupo controle apresentou pequena expressão de TNF-alfa (p<0.01) e expressão de NF-kapaB (p>0.1) e IL-1beta (p > 0.05) sem diferença estatística em relação aos demais grupos. CONCLUSÃO: Os doentes com RCUI apresentaram maiores níveis de expressão das citocinas estudadas, mesmo sem evidência clínica e endoscópica de ileíte do reservatório, podendo justificar maior suscetibilidade dos doentes com RCUI a esta complicação.

Pouchitis after total retocolectomy is one of the most common complication of patients with ulcerative colitis (UC), while its frequency is quite rare in familial adenomatous polyposis (FAP). PURPOSE: To evaluate the inflammatory activity in endoscopicaly normal mucosa of the ileal pouch, by determining the expression of TNF-alpha and IL-1beta, and the activation of NF-kappaB. METHODS AND PATIENTS: Twenty patients with "J" pouch after total retocolectomy were studied, being 10 patients with UC and 10 with FAP. The control group was constituted by biopsies from terminal ileum take during normal colonoscopy examination. Biopsies from mucosa of the pouch and from normal ileum were done, and they were snap-frozen in liquid nitrogen. The expression of TNF-alpha and IL-1beta were analyzed by total extract, and NF-kappaB was evaluated by immunoprecipitation and immunoblot. RESULTS: Expression of TNF-alpha and IL-1beta was increased in patients with UC, when it was compared with FAP (p<0.05). Conversely, the expression of NF-kappaB was increased in patients with UC, witch was not different from FAP. The control group had little expression of TNF-alpha (p<0.01). The activation of NF-kappaB (p>0.1) and the expression of IL-1beta (p>0.05) were similar, when comparing UC and FAP with control group. CONCLUSION: The patients with UC presented increased levels of the studied cytokines, even without clinic and endoscope evidence of pouchitis. These findings could be a suggestion of higher susceptibility to this complication among patients with UC.
Descritores: Polipose Adenomatosa do Colo
Citocinas
Pouchite
Proctocolite
-Brasil
Limites: Feminino
Pessoa de Meia-Idade
Humanos
Responsável: BR15.1 - Biblioteca de Ciências Biomédicas


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Id: lil-436576
Autor: Rodríguez, Gerardo Martín; López Peña, Martín Gabriel; Puga, Martín Amilcar; Tomás Roses, Ramiro Javier; Candia, Carlos Francisco; González, José Ismael.
Título: Diagnóstico y tratamiento de pouchitis: presentación de un caso y revisión de la literatura / Diagnostic and treatment of pouchitis: presentation of a case and review of the literature
Fonte: Rev. argent. coloproctología;16(4):299-303, 2005. ilus, tab.
Idioma: es.
Resumo: Introducción: la proctocolectomía total con anastomosis ileo-anal en J es el procedimiento de elección para el tratamiento de la colitis ulcerosa. La inflamación inespecífica del pouch (pouchitis) es la complicación más frecuente del postoperatorio alejado. Se presenta un caso clínico de pouchitis, analizando el manejo diagnóstico y terapéutico de la entidad con revisión de la literatura al respecto. Lugar de Aplicación: Hospital de alta complejidad "Pte. Juan Domingo Perón", Formosa, Argentina. Diseño: presentación de caso clínico y revisión de la literatura. Pacientes y Métodos: mujer de 25 años, intervenida quirúrgicamente en 1995 por colitis ulcerosa, realizándose proctocolectomía total + anastomosis ileo-anal con pouch en J. En marzo de 2005 consulta por dolor abdominal, diarrea, hemoproctorragia, pujo y tenesmo rectal. Se realiza videocolonoscopía, observándose mucosa edematosa, friable y ulceraciones.Se toman muestras de biopsia. Anatomopatológicamente se informa: "mucosa intestinal con foco de ulceración, lámina propia con intenso edema, congestión vascular e infiltrado inflamatorio lifoplasmocitario y polimorfonuclear. Diagnóstico: pouchitis crónica con marcada actividad". Se indica tratamiento con Ciprofloxacina 500 mg. vía oral durante 15 días, evidenciándose mejoría clínica. Se repite videocolonoscopía, observándose remisión del cuadro. Resultados: La incidencia de pouchitis varía entre 10 y 50 por ciento. Los síntomas son inespecíficos: cólicos abdominales, artralgias, incontinencia, diarrea, hemoproctorragia, pujo y tenesmo rectal. La sospecha debe ser confirmada con endoscopía y toma de biopsias del pouch. Se comparó ciprofloxacina oral con metronidazol. La ciprofloxacina resultó más efectiva, con menores efectos colaterales. Conclusiones: La pouchitis es la complicación tardía más común asociada al procedimiento de reservorio pélvico. De etiología poco entendida, el sobrecrecimiento bacteriano puede contribuir al desarrollo de este proceso. La...
Descritores: Pouchite/cirurgia
Pouchite/diagnóstico
Pouchite/epidemiologia
Pouchite/etiologia
Pouchite/tratamento farmacológico
-Anastomose Cirúrgica/métodos
Colonografia Tomográfica Computadorizada
Ciprofloxacina/administração & dosagem
Ciprofloxacina/uso terapêutico
Colectomia/métodos
Colite Ulcerativa/complicações
Diagnóstico Diferencial
Incidência
Metronidazol
Complicações Pós-Operatórias
Limites: Humanos
Adulto
Feminino
Tipo de Publ: Relatos de Casos
Revisão
Responsável: AR1.1 - Biblioteca Rafael Herrera Vegas


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Id: lil-347108
Autor: Teixeira, Magaly Gemio; Ponte, Adauto C. Abreu da; Sousa, Manuela; Almeida, Maristela G. de; Silva Filho, Edésio; Calache, Joäo Elias; Habr-Gama, Angelita; Kiss, Desidério R.
Título: Short- and long-term outcomes of ileal pouch-anal anastomosis for ulcerative colitis
Fonte: Rev. Hosp. Clin. Fac. Med. Univ. Säo Paulo;58(4):193-198, 2003. tab.
Idioma: en.
Resumo: Ileal pouch-anal anastomosis was an important advancement in the treatment of ulcerative colitis. The aim of this study was to determine whether early complications of ileal pouch-anal anastomosis in patients with ulcerative colitis are associated with poor late functional results. PATIENTS AND METHODS: Eighty patients were operated on from 1986 to 2000, 62 patients with ileostomy and 18 without. The early and late complications were recorded. Specific emphasis has been placed on the incidence of pouchitis with prolonged follow-up. RESULTS: The ileostomy was closed an average of 9.2 months after the first operation. Fourteen patients were excluded from the long-term evaluation; 6 patients were lost to regular follow-up, 4 died, and 4 patients still have the ileostomy. Of the 4 patients that died, 1 died from surgical complications. Early complications after operation (41) occurred in 34 patients (42.5 percent). Late complications (29) occurred in 25 patients as follows: 16 had pouchitis, 3 associated with stenosis and 1 with sexual dysfunction; 5 had stenosis; and there was 1 case each of incisional hernia, ileoanal fistula, hepatic cancer, and endometriosis. Pouchitis occurred in 6 patients (9.8 percent) 1 year after ileal pouch-anal anastomosis, 9 (14.8 percent) after 3 years, 13 (21.3 percent) after 5 years, and 16 (26.2 percent) after more than 6 years. The mean daily stool frequency was 12 before and 5.8 after operation. One pouch was removed because of fistulas that appeared 2 years later. CONCLUSIONS: Ileal pouch-anal anastomosis is associated with a considerable number of early complications. There was no correlation between pouchitis and severe disease, operation with or without ileostomy, or early postoperative complications. The incidence of pouchitis was directly proportional to duration of time of follow-up
Descritores: Colite Ulcerativa/cirurgia
Bolsas Cólicas/efeitos adversos
Proctocolite/cirurgia
-Anastomose Cirúrgica/efeitos adversos
Brasil/epidemiologia
Seguimentos
Ileostomia
Incidência
Pouchite/epidemiologia
Pouchite/etiologia
Fatores de Tempo
Resultado do Tratamento
Limites: Adulto
Feminino
Humanos
Masculino
Responsável: BR1.1 - BIREME



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