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Biomedical subjects

P Lê

Publications and source records attributed to P Lê.

13 recordsLinked to original sources
PubMed2004

[Right colon diverticulitis].

Diverticulitis involving the right colon is uncommon in the Occident; only one case for every 300 cases of appendicitis occurs in Western countries compared to a ratio of 1/40-1/180 in Asia. The preferential localization of diverticula in the right colon among Asiatics is probably due to genetic factors. In Asia as in the West, a right colon diverticulum is more likely to cause hemorrhage than diverticulitis. The peak age of symptoms is 40-45 years and the sex ratio is 1:1. The patient most commonly presents with symptoms suggestive of acute appendicitis, acute localized peritonitis, or, more rarely, a psoas abscess. Clinical exam reveals an inflammatory mass in the right lower quadrant in 30% of cases; diffuse peritonitis, large abscesses, and fistulae are rare. Helical CT scan is the best tool for establishing the diagnosis and also helps to rule out other possible etiologies in the differential diagnosis-particularly a perforated right colon cancer. In noncomplicated cases with convincing evidence for the diagnosis by CT scan, a conservative (non-surgical) treatment with antibiotics is possible; a later stage colonoscopy will rule out other colonic lesions. More commonly, the correct diagnosis is only made after embarking on an appendectomy via a McBurney incision; the surgical strategy thereafter depends on the level of suspicion regarding the diagnosis and the extent and complexity of the diverticulitis. Therapeutic options may be conservative (appendectomy), limited (diverticulectomy, or extensive (ileocecal resection or right hemicolectomy). For complicated disease (abscess, localized perforation), an aggressive surgical approach is warranted. Surgical strategies need to be validated, particularly in the light of the increasing use of the laparoscopic approach for suspected appendicitis.

Colon↗
PubMed2003

[Situs invertus, a mirror image].

INTRODUCTION: Situs inversus is a rare congenital abnormality often revealed in the childhood. In adults with acute abdomen, it's important to know this organs' inversus for diagnosis and surgery. OBSERVATION: A 36 year-old woman presented with symptoms of appendicitis; she had a complete situs inversus diagnosed in the childhood. Abdominal computed tomography showed signs of diverticulitis but after medical therapy, a colonoscopy revealed a sigmoid tumor. A left colectomy was performed by laparotomy without any particular problems; pathologic examination confirmed a colonic adenocarcinoma T3N0. DISCUSSION: Situs inversus is complete, incomplete or ambiguous. It may be associated with other malformations, especially cardiac abnormalities. When this malformation is unknown in the adulthood, this inversion of organs may be responsible of diagnostic difficulties, especially during the physical examination of an acute abdomen. If the patient underwent surgery, the adaptation to this inversion of organs is relatively easy. In the international literature, the association of this abnormality with colonic tumors seems to be fortuitous.

Abdomen, Acute↗
PubMed2003

[A pneumatosis cystoides coli revealed by a pseudo-obstruction].

Pneumatosis Intestinalis is a rare benign and often asymptomatic disease; we report the case of a 74 year-old woman with a pneumatosis coli revealed by a pseudo-obstruction; the diagnosis was suspected at radiology. The course under medical treatment was uneventfull.

Aged↗
PubMed2002

Should routine spiral computed tomography be performed in adult patients with acute abdominal pain of the right lower quadrant?

BACKGROUND AND AIMS: To determine whether spiral computed tomography (SCT) is helpful in the management of adult patients with acute pain of the right lower quadrant. PATIENTS AND METHODS: The prospective study included 204 patients with acute pain of the right lower quadrant during two periods: 104 before and 100 after the introduction of SCT. A questionnaire was completed for each patient before and after standard clinical and laboratory assessment and SCT, indicating the suspected diagnosis and a provisional therapeutic option. RESULTS: In the pre-SCT period the negative laparotomy rate was 29% vs. only 13% in the SCT period. During the SCT period 10 of the 24 nonoperated patients were discharged on the same day, and 14 were hospitalized 1.6+/-1 days, and only one was readmitted for operation on day 7. The accuracy of SCT assisted by results of clinical and laboratory findings (true positives + true negatives/total of patients) was 86% (vs. 73% for standard clinical and laboratory assessment): 93% in men (vs. 76% for standard clinical and laboratory assessment) but only 63% in women (vs. 60% for standard clinical and laboratory assessment). SCT changed the therapeutic decision guided by standard clinical and laboratory assessment in 18 cases, accurately in 16 cases (90%). CONCLUSION: SCT is helpful in the management of adult patients with acute abdominal pain of the right lower quadrant. In our study it reduced negative laparotomy rate from 29% (guided by standard clinicobiological evaluation) to only 13%.

Abdominal Pain↗
PubMed2002

[Post-operative small bowel obstruction: spiral computed tomography].

INTRODUCTION: The aim of this study was to evaluate prospectively the impact of the routine use of abdominal spiral computed tomography (SCT) in patients with postoperative small bowel obstruction (SBO) for whom initial conservative treatment was proposed. PATIENTS AND METHODS: We have compared the management of SBO in patients with clinical stable condition in two successive periods : from 1989 to 1998, 127 patients (preSCT group) for whom management was based on standard clinical-biological-radiological assessment (CBRA) et from 1999 to 2000, 30 patients (SCT group) for whom management included SCT. The decision of surgical team was correlated with the type of small bowel obstruction at laparotomy : closed-loop obstruction without intestinal necrosis (true-positive), intestinal necrosis as a consequence of delayed diagnosis defined as false-negative, diffuse adhesion defined as false-positive et patient non operated defined as true-negative. RESULTS: Among the 127 patients from the preSCT group, 87 were treated conservatively and 40 were operated : SBO with closed-loop obstruction without intestinal necrosis (n = 29,72%), SBO with diffuse adhesion (n = 4, 10%) and SBO with intestinal necrosis (n = 7, 17%). Among the 30 patients from the SCT group, 16 were treated conservatively and 14 were operated: SBO with closed-loop obstruction without intestinal necrosis (n = 8, 57%), SBO with diffuse adhesion (n = 6,43%) and SBO with intestinal necrosis (n = 0,0%; NS). Both groups were similar for rates of patients with SBO with or without necrosis and rate of patients treated conservatively (NS). In SCT group, there was significantly more patients operated for diffuse adhesions (p < 0,01). Negative predictive value of CBRA + TDM was significantly higher than those of CBRA alone (p = 0,041). CONCLUSION: Due to a very high sensibility, TDM increase probably the rate of early laparotomies, maybe unnecessary, in patients without any sign of SBO due to closed-loop obstruction. Thus, systematic use of TDM in patients with clinical suspicion of SBO remains to be evaluated.

Duodenal Obstruction↗
PubMed2001

[Blunt force rupture of the thoracic aorta and diaphragm: an unusual association].

The aim of this study was to report two cases of rupture of the right hemidiaphragm with intra-thoracic liver hernia, associated with a traumatic aortic disruption. These two lesions followed traffic accidents, and were both treated separately. Both patients had a long-term favourable progression. Association of these two lesions is particularly rare: fewer than 50 cases have been previously described in an extensive review of the literature. CT-scan seems to be particularly efficient in diagnosis, even if less efficient than other more specific explorations. The order of surgical management is guided by the physical examination, and especially by abdominal emergency.

Accidents, Traffic↗
PubMedDate not supplied

[Carcinoma of the transverse colon].

Carcinoma of the transverse colon accounts for 10% of all colorectal cancer. Diagnosis is often delayed and complicated forms (perforation, fistulization, obstruction) occur in 30-50% of cases. The progression of symptoms is often insidious and tumors may be voluminous by the time of diagnosis. Right sided tumors are typically bulky and late-stage; perforation may lead to abdominal wall or retroperitoneal abscess. Tumor can also extend or fistulize into adjacent organs. Distal transverse cancers may be small annular lesions which are prone to obstruction. Cancers present as T4 lesions in 20-40% of cases. Abdominal CT is the best test to evaluate the loco-regional extension of advanced tumors. Their central location and advanced stage at presentation results in an extensive differential diagnosis. This central location also poses difficult surgical choices for lymph node dissection, extent of resection, and re-establishment of intestinal continuity. Surgical series which focus on transverse colon cancer date from the 1970-80's; they show curative resections in only 50% with morbidity/mortality of 20% and a global five year survival of less than 35%; they were considered to have a particularly poor prognosis.

Carcinoma↗