Zusammenfassung. Grundlagen: Die Endometriosis ist eine Erkrankung, die verhältnismäßig häufig bei Frauen im gebärfähigen Alter mit wenigen Kindern vorkommt, die aber selten in Verbindung mit extraperitonealen Beeinträchtigungen auftritt.Hauptziel dieser Arbeit ist es, das Augenmerk bei der Differentialdiagnose von extraperitonealen Geschwülsten auf diese Krankheit zu lenken.Methodik: Es wurde eine retrospektive Analyse der von uns behandelten Fälle von extraperitonealer Endometriosis durchgeführt. Wir stellen sechs Fälle von Patientinnen im Alter von 27 bis 45 Jahren vor, die während der letzten 5 Jahre an der Universitätsklinik Vega Baja (Spanien) behandelt wurden.Ergebnisse: Fünf der sechs Patientinnen konnten durch einen chirurgischen Eingriff geheilt werden. Nur bei zwei der Patientinnen war eine korrekte preoperative Diagnose möglich. Die genaue Ursache der Endometriose ist nicht bekannt und die Diagnose basiert auf klinischen und histologischen Befunden.Schlussfolgerungen: Wir empfehlen eine chirurgische Behandlung der extraperitonealen Endometriosis. Trotzdem ist eine postoperative Kontrolle der Patienten notwendig und eine hormonunterdrückende Therapie kann angezeigt sein. Eine medizinische Behandlung mit Gestagen, Danazol oder Agonisten des Gonadotropin-releasing-Hormon ist bei Endometrien über 2 cm erfolglos.Schlüsselwörter: extraperitoneale Endometriosis, Hernie, perianal.Summary. Background: Endometriosis is a relatively common pathology in women of childbearing age and of low parity, but rarely shows extraperitoneal involvement. The main aim of this paper is to raise the attention of spe-cialists to the necessity of carrying out penetrating diagnosis of nonspecific extraperitoneal masses occurring in women of reproductive age.Methods: We performed a retrospective review of six patients diagnosed with extraperitoneal endometriosis who were treated at the Vega Baja University Hospital (Spain) during the last 5 years.Results: Surgical treatment had positive results in five patients. The preoperative diagnosis was correctly made in only two patients. The accurate aetiology of endometriosis remains unknown and diagnosis is based on clinical and cytopathological findings.Conclusions: Surgical treatment of extraperitoneal endometriosis is recommended. However, postoperative follow-up is obligatory and hormonal suppressive therapy may be necessary. Medical treatment with gestagens, Danazol, or agonists of the gonadotropin-releasing hormone are ineffective in endometriomas which are bigger than 2 cm.
The first description of acute mesenteric ischemia has been attributed to Dr R Virchow in 1852. The most common cause is impaction of an embolus close to the origin of the superior mesenteric artery. This occurs in approximately 40-50% of patients. Other causes include the development of a thrombus on an atheromatous plaque in the superior mesenteric artery, non-occlusive mesenteric ischemia (largely associated with hypotension) and mesenteric venous thrombosis. Almost all patients with acute mesenteric ischemia have abdominal pain and some have additional symptoms such as nausea, vomiting, abdominal distension and gastrointestinal bleeding. Initially, abnormalities on physical examination are relatively minor but signs of peritonitis eventually develop in those with intestinal infarction. In patients with suspected acute mesenteric ischemia, investigations can include plain abdominal radiographs, computed tomography (CT) scans, selective mesenteric angiograms and laparotomy.The images illustrated below were from a 66-year-old man who was admitted to hospital with abdominal pain. He had hypertension and had been previously treated for peripheral vascular disease. Abnormal physical findings included lower abdominal guarding, tenderness, rebound tenderness and diminished bowel sounds. His white cell count was elevated and an abdominal radiograph showed dilated loops of small bowel with air-fluid levels. An enhanced abdominal CT scan showed mild dilatation of loops of small bowel, thickening of the small bowel wall (edema), and gas in the small bowel wall and in the mesentery (Fig. 1). In the liver, gas was noted throughout the portal venous system including the hepatic venous radicals (Fig. 2). The presence of gas in the bowel wall, mesentery and mesenteric vessels (pneumatosis) is a late sign of ischemic injury and indicates bowel infarction and necrosis. In large series, patients with occlusive mesenteric infarction have a high mortality (80-90%) but this is lower (10%) when infarction results from non-occlusive mesenteric ischemia.
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