Obstrucción del Intestino Grueso

Descripción General

Definición

Una obstrucción del intestino grueso es una interrupción del paso normal del contenido intestinal a través del colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy y el recto.

Epidemiología

• 25% de todas las obstrucciones intestinales
• Presentación inicial del cáncer colorrectal hasta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un 30% de los LOS Neisseria casos
• La edad promedio de presentación a causa de malignidad es de 73 años.
• El retraso promedio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la búsqueda de ayuda médica es de 5 días.
• La obstrucción funcional (pseudoobstrucción) es más frecuente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Hombres
  • Edad > 60 años

Etiología

• Mecánica:
  • Cáncer colorrectal: causa más común
  • Cánceres metastásicos (ovario, páncreas, linfoma)
  • Vólvulo (sigmoide y cecal): causa benigna más frecuente
  • Estenosis producto de:
    • Resección previa de colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy (hasta el 30% de las cirugías con anastomosis colorrectal)
    • Enfermedad inflamatoria ( diverticulitis Diverticulitis Inflammation of a diverticulum or diverticula. Diverticular Disease, colitis Colitis Inflammation of the colon section of the large intestine, usually with symptoms such as diarrhea (often with blood and mucus), abdominal pain, and fever. Pseudomembranous Colitis isquémica, enfermedad inflamatoria intestinal)
  • Adherencias postquirúrgicas
  • Hernias
  • Causas raras:
    • Radioterapia
    • Uso de supositorios
    • Tuberculosis Tuberculosis Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis complex bacteria. The bacteria usually attack the lungs but can also damage other parts of the body. Approximately 30% of people around the world are infected with this pathogen, with the majority harboring a latent infection. Tuberculosis spreads through the air when a person with active pulmonary infection coughs or sneezes. Tuberculosis
    • Endometriosis Endometriosis Endometriosis is a common disease in which patients have endometrial tissue implanted outside of the uterus. Endometrial implants can occur anywhere in the pelvis, including the ovaries, the broad and uterosacral ligaments, the pelvic peritoneum, and the urinary and gastrointestinal tracts. Endometriosis
    • Intususcepción
    • Linfogranuloma venéreo ( Chlamydia trachomatis Chlamydia trachomatis Type species of Chlamydia causing a variety of ocular and urogenital diseases. Chlamydia)
• Funcional (pseudoobstrucción, también conocida como síndrome de Ogilvie):
  • Enfermedad sistémica severa
  • Cirugía (más comúnmente por cesárea o cirugía de cadera)
  • Trauma
  • Anestesia espinal
  • Medicamentos (opiáceos, anticolinérgicos, bloqueadores de los LOS Neisseria canales calcio)

Fisiopatología

Patogénesis

• La dilatación del intestino es el resultado de la acumulación de:
  • Aire deglutido y secreciones intestinales proximales a la obstrucción
  • Gas procedente de la fermentación bacteriana
• ↑ Presión intraluminal → compresión de los LOS Neisseria vasos intramurales → isquemia intestinal → necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage y/o perforación del colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy
• Obstrucción del intestino grueso con asa ASA Anterior Cord Syndrome abierta (10%–20%):
  • La válvula ileocecal incompetente permite el reflujo del contenido hacia el íleon.
  • Se alivia parte de la presión intraluminal en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy.
  • Puede presentarse como una obstrucción del intestino delgado (vómitos, cólicos abdominales)
• Obstrucción del intestino grueso con asa ASA Anterior Cord Syndrome cerrada (80%–90%):
  • Válvula ileocecal competente o vólvulo
  • Resulta en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum oclusión proximal y distal
  • ↑ Riesgo de isquemia o perforación

Fisiopatología para etiologías específicas

• Mecánica:
  • Malignidad:
    • 70% en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum o distal al AL Amyloidosis colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy transverso
    • Distensión progresiva y gradual de los LOS Neisseria segmentos proximales
    • La perforación es una complicación común, probablemente por la inflamación o la invasión tumoral.
  • Vólvulo:
    • Torsión de un segmento colónico → obstrucción de la luz colónica
    • Puede provocar alteración de la irrigación
    • Si no se trata → isquemia y perforación
  • Estenosis: puede ser consecuencia de inflamación recurrente ( diverticulitis Diverticulitis Inflammation of a diverticulum or diverticula. Diverticular Disease, enfermedad de Crohn)
• Obstrucción funcional (pseudoobstrucción):
  • Se desconoce el mecanismo exacto.
  • Se ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia implicado el deterioro de las fibras parasimpáticas S2 S2 Heart Sounds– S4 S4 Heart Sounds.
  • Distensión progresiva ↑ tensión en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la pared del colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy
  • ↑ Riesgo de isquemia y perforación si:
    • Diámetro cecal >10–12 cm (3,9–4,7 in)
    • Distensión presente durante >6 días

Presentación Clínica

Síntomas de obstrucción aguda

• Comunes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum presencia de vólvulos, hernias y pseudoobstrucción
• Dolor Dolor Inflammation abdominal
  • Normalmente por debajo del ombligo
  • Cólicos con paroxismos (cada 20–30 minutos)
  • Dolor Dolor Inflammation focal constante: puede indicar isquemia o necrosis Necrosis The death of cells in an organ or tissue due to disease, injury or failure of the blood supply. Ischemic Cell Damage
  • La peritonitis Peritonitis Inflammation of the peritoneum lining the abdominal cavity as the result of infectious, autoimmune, or chemical processes. Primary peritonitis is due to infection of the peritoneal cavity via hematogenous or lymphatic spread and without intra-abdominal source. Secondary peritonitis arises from the abdominal cavity itself through rupture or abscess of intra-abdominal organs. Penetrating Abdominal Injury difusa sugiere una perforación.
• Distensión abdominal
• Las náuseas y vómitos son más frecuentes en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la obstrucción proximal ( colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy derecho) o en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la obstrucción con asa ASA Anterior Cord Syndrome abierta
• Estreñimiento o constipación (imposibilidad de evacuar o canalizar flatos)

Síndrome de obstrucción crónica

• Común en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cáncer colorrectal
• Cambio gradual en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hábitos intestinales (de semanas a meses):
  • Estreñimiento que empeora progresivamente
  • Aumento del esfuerzo al AL Amyloidosis defecar
  • Cambio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el calibre de las heces (heces “ en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de lápiz”)
• Pérdida de peso
• Melena Melena The black, tarry, foul-smelling feces that contain degraded blood. Gastrointestinal Bleeding o rectorragia
• El tenesmo ( dolor Dolor Inflammation al AL Amyloidosis defecar) sugiere un tumor Tumor Inflammation rectal.
• Síntomas constitucionales sugestivos de cáncer:
  • Pérdida de peso
  • Fatiga
  • Fiebre inexplicable, escalofríos o sudoración nocturna

Examen físico

• General:
  • Signos de desnutrición (emaciación, pérdida de grasa corporal)
  • Deshidratación (mucosas secas, pérdida de turgencia de la piel)
• Abdominal:
  • La distensión se presenta con mayor intensidad en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
    • Obstrucciones distales completas
    • Pseudoobstrucción
    • Vólvulo sigmoide
  • Timpanismo a la percusión
  • Sensibilidad:
    • Focal: irritación peritoneal local por inflamación o isquemia
    • Difusa: sugiere una peritonitis Peritonitis Inflammation of the peritoneum lining the abdominal cavity as the result of infectious, autoimmune, or chemical processes. Primary peritonitis is due to infection of the peritoneal cavity via hematogenous or lymphatic spread and without intra-abdominal source. Secondary peritonitis arises from the abdominal cavity itself through rupture or abscess of intra-abdominal organs. Penetrating Abdominal Injury generalizada (sugestiva de perforación)
  • Masa:
    • Tumor Tumor Inflammation palpable en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes delgados
    • Vólvulo cecal
• Tacto rectal:
  • Los LOS Neisseria tumores rectales bajos pueden ser palpables.
  • Sangre (visible u oculta) es sugestiva de cáncer.

Diagnóstico

Antecedentes relevantes

• Cambio en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum los LOS Neisseria hábitos intestinales
• Fecha y resultado de la última colonoscopia
• Antecedentes de otros tumores malignos (e.g., ovarios, linfomas, otros tumores gastrointestinales)
• Antecedentes familiares de cáncer colorrectal

Estudios de laboratorio

• Hemograma:
  • ↓ Hemoglobina: cáncer o enfermedad crónica
  • ↑ Hemoglobina y hematocrito (hemoconcentración): deshidratación
  • La leucocitosis puede sugerir:
    • Complicaciones: perforación, isquemia
    • Causa subyacente: inflamación, infección
• Química:
  • Deshidratación y pérdida de electrolitos:
    • ↓ Potasio
    • ↓ Sodio
    • ↓ Magnesio
    • ↑ Relación nitrógeno de urea Urea A compound formed in the liver from ammonia produced by the deamination of amino acids. It is the principal end product of protein catabolism and constitutes about one half of the total urinary solids. Urea Cycle en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum sangre (BUN)/creatinina
    • Alcalosis metabólica (temprana) o acidosis Acidosis A pathologic condition of acid accumulation or depletion of base in the body. The two main types are respiratory acidosis and metabolic acidosis, due to metabolic acid build up. Respiratory Acidosis (etapa tardía, sugiere isquemia)
  • ↑ Lactato sugiere isquemia o sepsis Sepsis Systemic inflammatory response syndrome with a proven or suspected infectious etiology. When sepsis is associated with organ dysfunction distant from the site of infection, it is called severe sepsis. When sepsis is accompanied by hypotension despite adequate fluid infusion, it is called septic shock. Sepsis and Septic Shock
  • ↓ Albúmina sugiere desnutrición
• Marcadores tumorales:
  • Antígeno carcinoembrionario ( CEA CEA A glycoprotein that is secreted into the luminal surface of the epithelia in the gastrointestinal tract. It is found in the feces and pancreaticobiliary secretions and is used to monitor the response to colon cancer treatment. Serum Tumor Markers, por sus siglas en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum inglés): fuertemente sugestivo de cáncer colorrectal
  • Antígeno cancerígeno 19-9 ( CA CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) 19-9): puede estar elevado en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cáncer gástrico, pero se asocia más comúnmente con el cáncer de páncreas
  • Antígeno cancerígeno 125 ( CA CA Condylomata acuminata are a clinical manifestation of genital HPV infection. Condylomata acuminata are described as raised, pearly, flesh-colored, papular, cauliflower-like lesions seen in the anogenital region that may cause itching, pain, or bleeding. Condylomata Acuminata (Genital Warts) 125): si se sospecha de un cáncer primario de ovario

Imagenología

• Radiografía de abdomen y tórax:
  • Distensión colónica (>6 cm (2,4 in); ciego >9 cm (3,5 in))
  • Colapso del colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy distal
  • Vólvulo:
    • Un asa ASA Anterior Cord Syndrome de colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy distendida (sigmoide o ciego)
    • Signo de la “exposición del norte”: asa ASA Anterior Cord Syndrome sigmoidea que asciende hacia el colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy transverso
    • Signo del “grano de café”: asa ASA Anterior Cord Syndrome sigmoidea distendida hacia el cuadrante superior derecho
  • Neumoperitoneo (aire bajo el diafragma) si se ha HA Hemolytic anemia (HA) is the term given to a large group of anemias that are caused by the premature destruction/hemolysis of circulating red blood cells (RBCs). Hemolysis can occur within (intravascular hemolysis) or outside the blood vessels (extravascular hemolysis). Hemolytic Anemia producido una perforación
  • Pseudoobstrucción:
    • Distensión colónica desde el ciego hasta la flexura esplénica o el recto
    • El diámetro del ciego >10–12 cm (3,9–4,7 in) es indicador de una perforación inminente.
• Tomografía computarizada:
  • Ayuda a diferenciar entre obstrucción mecánica y pseudoobstrucción
  • Puede ayudar a determinar las causas de la obstrucción
  • Puede distinguir entre vólvulo sigmoide y cecal
  • Perforación: neumoperitoneo
  • Isquemia:
    • Engrosamiento de la pared intestinal
    • Pneumatosis coli (aire en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la pared del colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy)
    • Gas venoso portal
  • Hallazgos de vólvulo:
    • Signo de “la X marca el lugar”: 2 puntos de transición que se entrecruzan
    • Signo de la “pared dividida”: separación de la pared del sigmoide por la grasa mesentérica
    • Signo del “remolino”: giro del mesenterio
    • Signo del “pico de pájaro”: estrechamiento progresivo del colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy hasta el punto de obstrucción
  • Hallazgos de cáncer colorrectal:
    • Punto de transición con dilatación proximal
    • Masa intrínseca (a veces aparece como una lesión en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de “manzana mordida”)
    • Mostrará lesiones sincrónicas y metastásicas si están presentes
  • Pseudoobstrucción:
    • Dilatación difusa sin causa obvia de obstrucción
    • Puede tener una zona de transición intermedia en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la flexura esplénica

• Enema de contraste:
  • No debe utilizarse en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum pacientes con peritonitis Peritonitis Inflammation of the peritoneum lining the abdominal cavity as the result of infectious, autoimmune, or chemical processes. Primary peritonitis is due to infection of the peritoneal cavity via hematogenous or lymphatic spread and without intra-abdominal source. Secondary peritonitis arises from the abdominal cavity itself through rupture or abscess of intra-abdominal organs. Penetrating Abdominal Injury o con alta sospecha de perforación o isquemia
  • Mostrará dilatación del colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy
  • La lesión en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum forma de “manzana mordida” puede estar presente en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum cáncer colorrectal

Colonoscopia o sigmoidoscopia

• Pueden utilizarse para confirmar el diagnóstico de cáncer colorrectal y obtener una biopsia de tejido
• También pueden permitir la descompresión en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum:
  • Vólvulo sigmoide
  • Pseudoobstrucción

Tratamiento

Tratamiento inicial de soporte

• Reanimación intravenosa
  • Hidratación
  • Corrección de electrolitos
• Reposo intestinal: nada por vía oral o líquidos claros
• Descompresión con sonda nasogástrica si hay vómitos o dilatación importante del intestino delgado
• Antibióticos empíricos si se sospecha de isquemia o perforación
  • Piperacilina– tazobactam Tazobactam A penicillanic acid and sulfone derivative and potent beta-lactamase inhibitor that enhances the activity of other anti-bacterial agents against beta-lactamase producing bacteria. Cephalosporins
  • Ciprofloxacina o una cefalosporina de 3ra generación, más metronidazol: Se puede añadir ampicilina o vancomicina para cobertura enterocócica en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de enfermedad severa.
  • Carbapenémicos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum caso de enfermedad severa

Obstrucción mecánica

• Tratamientos endoscópicos:
  • Sigmoidoscopia descompresiva para vólvulos:
    • Reduce (deshace) el vólvulo
    • Permite una resección de colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy sigmoide diferida (electiva), en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum lugar de urgente
    • Si no se realiza una intervención quirúrgica posteriormente, el 50% reaparecerá.
    • Para los LOS Neisseria pacientes con alto riesgo que no toleren la cirugía, esta puede ser la única intervención.
    • No es una opción efectiva para el vólvulo cecal
  • Colocación de stents endoscópicos para la obstrucción por malignidad:
    • Una alternativa menos invasiva a la colostomía derivativa
    • Opción paliativa para pacientes con cáncer colorrectal irresecable o enfermedad metastásica
    • Utilizada mientras se espera por radioterapia, quimioterapia y resección definitiva
• Cirugía:
  • El 75% de las obstrucciones del intestino grueso mecánicas requerirán cirugía.
  • Procedimiento en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un solo tiempo quirúrgico:
    • Resección del segmento de colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy afectado con anastomosis primaria
    • Preferido
    • Indicado para pacientes estables
  • Procedimiento en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum dos tiempos quirúrgicos:
    • Resección del colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy afectado con colostomía terminal o ileostomía en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum asa ASA Anterior Cord Syndrome derivativa
    • Seguido de una reversión de la ostomía en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 3–6 meses, o cuando sea médicamente factible
    • Indicado para aquellos con un alto riesgo de fuga anastomótica y de mortalidad
  • Procedimiento en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum tres tiempos quirúrgicos:
    • Colostomía o ileostomía derivativa
    • Seguido de una resección de colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy
    • Reversión eventual de la ostomía con anastomosis primaria cuando sea factible
    • Indicado para pacientes inestables y delicados con múltiples comorbilidades, o aquellos que necesitarán quimioterapia o radiación antes de la resección definitiva
  • Otros procedimientos para causas menos comunes:
    • Reparación de hernia Hernia Protrusion of tissue, structure, or part of an organ through the bone, muscular tissue, or the membrane by which it is normally contained. Hernia may involve tissues such as the abdominal wall or the respiratory diaphragm. Hernias may be internal, external, congenital, or acquired. Abdominal Hernias
    • Lisis de adherencias
    • Revisión de anastomosis anteriores (por estenosis anastomótica)

Pseudoobstrucción (síndrome de Ogilvie)

• Tratamiento inicial (para pacientes estables sin peritonitis Peritonitis Inflammation of the peritoneum lining the abdominal cavity as the result of infectious, autoimmune, or chemical processes. Primary peritonitis is due to infection of the peritoneal cavity via hematogenous or lymphatic spread and without intra-abdominal source. Secondary peritonitis arises from the abdominal cavity itself through rupture or abscess of intra-abdominal organs. Penetrating Abdominal Injury en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum las 1ras 48–72 horas y un diámetro cecal <12 cm (4,7 in)):
  • De soporte
  • Sonda rectal para la descompresión
  • Suspender los LOS Neisseria medicamentos que pueden provocarla (opiáceos, anticolinérgicos, bloqueadores de los LOS Neisseria canales de calcio).
  • Tratar la enfermedad subyacente.
  • Seguimiento con exámenes físicos y radiografías seriadas cada 12–24 horas.
• Intervenciones farmacológicas:
  • Indicaciones:
    • Falta de mejoría en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum 72 horas
    • Diámetro cecal >12 cm (4,7 in)
  • Neostigmina intravenosa (inhibidor de la acetilcolinesterasa):
    • Dosificación en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum bolo o infusión continua
    • El 89% responde a una sola dosis
    • Los LOS Neisseria pacientes deben estar en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum un entorno monitoreado.
  • Metilnaltrexona: si la obstrucción es precipitada por opiáceos
• Descompresión colonoscópica:
  • Indicaciones:
    • Falta de respuesta a la neostigmina
    • Contraindicaciones para la neostigmina
  • Tiene una tasa de perforación del 3%.
• Cirugía:
  • Indicaciones:
    • Fracaso del tratamiento no quirúrgico
    • Peritonitis Peritonitis Inflammation of the peritoneum lining the abdominal cavity as the result of infectious, autoimmune, or chemical processes. Primary peritonitis is due to infection of the peritoneal cavity via hematogenous or lymphatic spread and without intra-abdominal source. Secondary peritonitis arises from the abdominal cavity itself through rupture or abscess of intra-abdominal organs. Penetrating Abdominal Injury (isquemia o perforación)
  • Anastomosis primaria (pacientes estables)
  • Colectomía abdominal total con ileostomía terminal (isquemia o perforación)

Diagnóstico Diferencial

• Megacolon Megacolon Megacolon is a severe, abnormal dilatation of the colon, and is classified as acute or chronic. There are many etiologies of megacolon, including neuropathic and dysmotility conditions, severe infections, ischemia, and inflammatory bowel disease. Megacolon tóxico: una complicación severa de la colitis Colitis Inflammation of the colon section of the large intestine, usually with symptoms such as diarrhea (often with blood and mucus), abdominal pain, and fever. Pseudomembranous Colitis, frecuentemente asociada a C. difficile, enfermedad inflamatoria intestinal, o colitis Colitis Inflammation of the colon section of the large intestine, usually with symptoms such as diarrhea (often with blood and mucus), abdominal pain, and fever. Pseudomembranous Colitis isquémica. Los LOS Neisseria pacientes presentan distensión y dolor Dolor Inflammation abdominal severos con toxicidad sistémica asociada (fiebre, taquicardia y alteración del estado mental). El diagnóstico se establece con los LOS Neisseria antecedentes, los LOS Neisseria hallazgos físicos y la imagenología (tomografía computarizada). El tratamiento depende de la causa, pero pueden incluir cuidados de soporte y cirugía.
• Obstrucción del intestino delgado: interrupción del contenido intraluminal a través del intestino delgado debido a un problema mecánico o funcional. Los LOS Neisseria pacientes presentan dolor Dolor Inflammation abdominal, distensión, náuseas y vómitos. La imagenología mostrará afectación del intestino delgado, aunque tanto el colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy como el intestino delgado pueden estar distendidos en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum la obstrucción funcional. La mayoría de los LOS Neisseria casos se resuelven con cuidados de soporte.
• Diverticulitis Diverticulitis Inflammation of a diverticulum or diverticula. Diverticular Disease: inflamación de los LOS Neisseria divertículos colónicos. Los LOS Neisseria pacientes presentan cólicos, dolor Dolor Inflammation abdominal bajo y pueden tener estreñimiento. La diverticulitis Diverticulitis Inflammation of a diverticulum or diverticula. Diverticular Disease se asocia frecuentemente con fiebre y leucocitosis. La tomografía computarizada muestra hallazgos característicos. El tratamiento incluye reposo intestinal, antibióticos y, en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum ocasiones, cirugía.
• Apendicitis: inflamación del apéndice. La apendicitis temprana puede presentarse con un dolor Dolor Inflammation tipo cólico difuso, pero el dolor Dolor Inflammation y la sensibilidad eventualmente se localizan en EN Erythema nodosum is an immune-mediated panniculitis (inflammation of the subcutaneous fat) caused by a type IV (delayed-type) hypersensitivity reaction. It commonly manifests in young women as tender, erythematous nodules on the shins. Erythema Nodosum el cuadrante inferior derecho. El diagnóstico se establece mediante una tomografía computarizada. El tratamiento incluye antibióticos y cirugía.
• Megacolon Megacolon Megacolon is a severe, abnormal dilatation of the colon, and is classified as acute or chronic. There are many etiologies of megacolon, including neuropathic and dysmotility conditions, severe infections, ischemia, and inflammatory bowel disease. Megacolon crónico: dilatación del colon Colon The large intestines constitute the last portion of the digestive system. The large intestine consists of the cecum, appendix, colon (with ascending, transverse, descending, and sigmoid segments), rectum, and anal canal. The primary function of the colon is to remove water and compact the stool prior to expulsion from the body via the rectum and anal canal. Colon, Cecum, and Appendix: Anatomy, que puede ser congénita (enfermedad de Hirschsprung) o debida a una enfermedad sistémica (e.g., enfermedad neurológica o autoinmune). Los LOS Neisseria pacientes tendrán un abdomen distendido y timpánico. Se usan los LOS Neisseria antecedentes y la imagenología para el diagnóstico. El tratamiento incluye el tratamiento de cualquier causa subyacente, un régimen intestinal estricto, descompresión y una posible cirugía.