Obstrução gastrointestinal por fitobezoar na cirurgia bariátrica

Abstract

RESUMO: Objetivo: O objetivo do presente estudo foi avaliar o quadro clínico, a incidência, os fatores predisponentes e a evolução de pacientes com fitobezoar após Gastroplastia Vertical e Y de Roux. Método: No período de Novembro de 1997 à Janeiro de 2004, foram realizadas 512 operações para o tratamento da Obesidade mórbida, seguindo a técnica proposta por Fobi/Capella (Septação gástrica com reconstituição em Y de Roux Proximal). Em dez pacientes foram identificados fitobezoar. Resultados: A incidência de fitobezoar, causando algum tipo de obstrução gastrointestinal, foi de 1,95% (10/512). Todos os casos de fitobezoar estavam relacionados ao fio de sutura inabsorvível do tipo prolene. Sete pacientes apresentaram quadro semioclusivo e de obstrução intestinal e foram tratados com laparotomia exploradora, ressecção da anastomose enteroenteral e confecção de nova enteroenteroanastomose. Nos três pacientes com bezoar situado na anastomose gastrojejunal, a secção do fio e a retirada do corpo estranho foram realizadas por endoscopia digestiva alta. Conclusão: A confecção de anastomose intestinal com fio inabsorvível predispõe a formação de bezoar em pós-operatório de gastroplastia (Rev. Col. Bras. Cir. 2006; 33(1): 35-38). ABSTRACT Background:The aim of this study was to evaluate the relation, incidence, clinical features, predisposing factors and phytobezoar in patients submitted to bariatric surgeries. Methods: During November 1997 and January 2004, 512 bariatric surgeries (Fobi/Capella bypass) were performed to treat morbid obesity. In 10 patients phytobezoar was identified. Results: The incidence of phytobezoar resulting in gastrointestinal obstruction was 1,95% (10/512). All cases of phytobezoar were related to unabsorbed suture stitch (prolene). In seven patients an intestinal semi-occlusive or total intestinal obstruction was treated by laparotomy, resection of the anastomosis and confection of a new enteroanastomosis. In three patients the bezoars were located in the gastrojejunal anastomosis and was successfully treated by upper endoscopic procedure. Conclusion: The use of unabsorbed suture stitch predicted the formation of phytobezoar in the late postoperative period of gastroplasty patients.

Análise radiológica das alterações gastrintestinais após cirurgia de Fobi-Capella

“…Studies in the literature report ulcers occurrence in 1% to 5% of cases, however, no case of ulcer was found in the present study (14)(15)(16)(17) . The present study has found one case of bezoar (2.4%), while the literature reports a 1.9% incidence (19) . Also, one case of enterocutaneous fistula was found, while Capella et al report a low incidence of this complication (20) .…”

Cirurgia bariátrica no Brasil

“…No artigo de Ferraz et al 37 ralizado em 2006, os autores tinham por objetivo avaliar o quadro clínico, a incidência, os fatores predisponentes e a evolução dos pacientes com fitobezoar (tipo de fibra vegetal, geralmente formada por sementes, raízes, Figura 1. A) Fitobezoar fixo ao fio de sutura; B) Imagem aproximada fitobezoar fixo ao fio.…”

Intestinal obstruction by a phytobezoar in a patient with a history of gastroplasty

“…Individuals with a greater propensity to develop phytobezoars include not only vegetarians but also individuals who do not chew their food well, those with impaired gastric motility, and those with hypochlorhydria, as well as those who have undergone gastrectomy. A history of gastric surgery is a risk factor because it reduces the surface area of the stomach and acid secretions, causing inadequate digestion and allowing larger masses of agglomerated material to pass into the small intestine ( 1 - 3 ) . Phytobezoars can also occur in patients who have had bariatric surgery.…”