Patología quirúrgica abdominal en el paciente de edad avanzada

  1. González Rodríguez, F.J. 1
  2. Paredes Cotoré, J.P. 1
  3. Paz Novo, M. 1
  4. Paulos Gómez, A. 1
  5. Sánchez-Wonenburger, M. 1
  6. Domínguez Comesaña, E. 1
  7. Caínzos Fernández, M.A. 1
  1. 1 Departamento de Cirugía. Servicio de Cirugía General. Complejo Hospitalario Universitario de Santiago de Compostela. Universidad de Santiago de Compostela. Santiago de Compostela. A Coruña, España
Journal:
Medicine: Programa de Formación Médica Continuada Acreditado

ISSN: 0304-5412

Year of publication: 2020

Issue Title: Enfermedades del aparato digestivo (X)Patología urgente y quirúrgica abdominal

Series: 13

Issue: 10

Pages: 551-562

Type: Article

DOI: 10.1016/J.MED.2020.06.003 DIALNET GOOGLE SCHOLAR

More publications in: Medicine: Programa de Formación Médica Continuada Acreditado

Sustainable development goals

Abstract

Abdominal surgical pathology in elderly patient is relevant because of two fundamental factors: life expectancy rises and some features of the elderly patients make the diagnosis and treatment a challenge. The prevalence of acute diverticulitis increases with age and usually is located in bowel sigmoid. Diagnosis relies on clinical history and computed tomography (CT). Treatment is conservative (antibiotics), surgery is required only if complications. The diagnosis of acute cholecystitis is based on clinical history and ultrasound; frequently, treatment is surgical with laparoscopic approach. The early diagnosis of acute intestinal ischemia is based on a high level of clinical suspicion and CT angiography is mandatory. Surgical treatment is based on revascularization and non-viable bowel resection. Sigmoid volvulus is the most frequent. Diagnosis is carried out using CT. Initial treatment is endoscopic decompression accompanied by delayed resection of redundant sigma.

Bibliographic References

  • Jacobs DO. Clinical practice. Diverticulitis. N Engl J Med. 2007;357:2057-66.
  • Swanson SM, Strate LL. Acute colonic civerticulitis. Ann Intern Med. 2018;168:Itc65-itc80.
  • Shah SD, Cifu AS. Management of acute diverticulitis. JAMA. 2017;318:291-2.
  • Galgano SJ, McNamara MM, Peterson CM, Kim DH, Fowler KJ, Cama-cho MA, et al. ACR Appropriateness criteria® Left lower quadrant pain-suspected diverticulitis. J Am Coll Radiol. 2019;16:S141-s149.
  • Asaad P, Hajibandeh S, Rahm M, Johnston T, Chowdhury S, Bronder C. Should a colonoscopy be offered routinely to patients with CT proven acute diverticulitis? A retrospective cohort study and meta-analysis of best available evidence. World J Gastrointest Endosc. 2019;11:427-37.
  • Francis NK, Sylla P, Abou-Khalil M, Arolfo S, Berler D, Curtis Nj, et al. EAES and SAGES 2018 consensus conference on acute diverticulitis management: evidence-based recommendations for clinical practice. Surg Endosc. 2019;33:2726-41.
  • Fan YC, Peery AF. Therapeutic management of acute uncomplicated di-verticulitis. Minerva Gastroenterol Dietol. 2017;63:143-51.
  • Sagar AJ. Management of acute diverticulitis. Br J Hosp Med (Lond). 2019;80:146-50.
  • Balayan AZ. Clinical features during the acute cholecystitis in the older age group of patients. Eksp Klin Gastroenterol. 2016;60-64.
  • Schmidt M, Dumot JA, Soreide O, Sondenaa K. Diagnosis and manage-ment of gallbladder calculus disease. Scand J Gastroenterol. 2012;47:1257-65.
  • Lyon C, Clark DC. Diagnosis of acute abdominal pain in older patients. Am Fam Physician. 2006;74:1537-44.
  • Yagi Y, Sasaki S, Terada I, Yoshikawa A, Fukoshima W, Kitagawa H, et al. Massive pneumoretroperitoneum arising from emphysematous cholecys-titis: a case report and the literature review. BMC Gastroenterol. 2015;15: 114.
  • Balmadrid B. Recent advances in management of acalculous cholecystitis. F1000Res. 2018;7. Disponible en: https://dx.doi.org/10.12688/f1000 research.14886.1
  • Flasar MH, Goldberg E. Acute abdominal pain. Med Clin Nor-th Am. 2006;90:481-503.
  • Gurusamy KS, Davidson C, Gluud C, Davidson BR. Early versus delayed laparoscopic cholecystectomy for people with acute chole-cystitis. Cochrane Database Syst Rev. 2013 Jun 30;(6):CD005440.
  • González-Rodríguez FJ, Paredes-Cotore JP, Ponton C Rojo Y, Flores E, Luis-Calo S, et al. Early or delayed laparoscopic cholecystectomy in acu-te cholecystitis? Conclusions of a controlled trial. Hepatogastroenterolo-gy. 2009;56:11-16.
  • Gurusamy KS, Rossi M, Davidson BR. Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis. Cochrane Database Syst Rev. 2013;Cd007088.
  • Prakash VS, Marin M, Faries PL. Acute and chronic ischemic di-sorders of the small bowel. Current Gastroenterol Reports. 2019; 21:27.
  • Clair DG, Beach JM. Mesenteric ischemia. N Engl J Med. 2016;374:959-68.
  • Martínez JP, HoganGJ. Mesenteric ischemia. Emerg Med Clin North Am. 2004;22:909-28.
  • Singh M, Long B, Koyfman A. Mesenteric ischemia. Emerg Med Clin North Am 2017;35:879-88.
  • Ehlert BA. Acute gut ischemia. Surg Clin North Am. 2018;98:995-1004.
  • Sreenarasimhaiah J. Diagnosis and management of intestinal ischaemic disorders. BMJ. 2003;326:1372-6.
  • Renner P, Kienle K, Dahlke MH, Heiss P, Pfister K, Stroszcynski C, et al. Intestinal ischemia: current treatment concepts. Langenbecks Arch Surg. 2011;396:3-11.
  • Debus ES, Müller-Hülsbeck S, Kölbel T, Larena-Avellaneda A. Intestinal ischemia. Int J Colorectal Dis. 2011;26:1087-97.
  • Gingold D, Murrell Z. Management of colonic volvulus. Clin Colon Rec-tal Surg. 2012;25:236-44.
  • Bauman, ZM, Evans CH. Volvulus. Surg Clin North Am. 2018; 98:973-93.
  • Sarr MG, Bulkley GB, Zuidema GD. Preoperative recognition of intesti-nal strangulation obstruction. Prospective evaluation of diagnostic capa-bility. Am J Surg.1983;145:176-82.
  • Catena F, De Simone B, Coccolini F, Di Saverio S, Sartelli M, Ansaloni Ll. Bowel obstruction: a narrative review for all physicians. World J Emerg Surg. 2019;14:20.
  • Kapadia M. Volvulus of the small bowel and colon. Clin Colon Rectal Surg. 2017;30:40-5.
  • Iwuagwu O, Deans GT. Small bowel volvulus: a review. J R Coll Surg Edinb. 1999:44:150-5.
  • Coe TM, Chang DC, Sicklick JK. Small bowel volvulus in the adult po-pulace of the United States: results from a population-based study. Am J Surg. 2015;210:201-10.
  • Ruiz-Tovar J, Morales V, Sanjuanbenito A, Lobo E, Martínez-Molina E. Volvulus of the small bowel in adults. Am Surg. 2009;75:1179-82.
  • Krishnamurthy K, Hussein SE, Omarzai Y. The lethal twist-a story of unspoken pain: small intestinal volvulus in cerebral palsy. Autops Case Report.
  • Huang JC, Shin JS, Huang YT, Chao CJ, Ho SC, Wu MJ, et al. Small bowel volvulos among adults. J Gastroenterol Hepatol. 2005;20:1906-12.
  • Ayane GN, Kadimo K. Diagnosis and surgical management of congenital intestinal malrotation presenting with midgut volvulus in an adult: high index of suspicion (case report). Pan Afr Med J. 2018;29:154.
  • Palomo V, Higuera A, Muñoz R, Sánchez F. Vólvulo de intestino medio: una rara causa de crisis oclusivas en el adulto. Radiología. 2002;44:159-61.
  • Ibáñez Sanz L, Borruel Nacenta S, Cano Alonso R, Diez Maertinez P, Navallas Irujo M. Vólvulos del tracto gastrointestinal. Diagnóstico y co-rrelación entre radiología simple y tomografía computarizada multidetec-tor. Radiología. 2015;57:35-43.
  • Rasih F, Thangarajah T, Mulvey D, Larvin M, Iftikhar SY. A review article on gastric volvulus: a challenge to diagnosis management. Int J Sur. 210;8:18-24.
Data source: Dialnet