{"id":4695,"date":"2020-05-12T09:28:00","date_gmt":"2020-05-12T09:28:00","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/uncategorized\/terapia-a-vacuo-transgastrica-para-tratamento-de-fistula-pancreatocutanea\/"},"modified":"2022-07-11T07:50:01","modified_gmt":"2022-07-11T07:50:01","slug":"terapia-a-vacuo-transgastrica-para-tratamento-de-fistula-pancreatocutanea","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/terapia-a-vacuo-transgastrica-para-tratamento-de-fistula-pancreatocutanea\/","title":{"rendered":"Terapia a v\u00e1cuo transg\u00e1strica para tratamento de f\u00edstula pancreatocut\u00e2nea ap\u00f3s necrosectomia endosc\u00f3pica utilizando um sistema de drenagem t\u00fabulo-laminar fechado"},"content":{"rendered":"<p>A pancreatite aguda necrotizante est\u00e1 associada a cole\u00e7\u00f5es necr\u00f3ticas organizadas em mais de 50% dos casos, e cerca de 25% desses casos necessitam interven\u00e7\u00e3o. A necrosectomia endosc\u00f3pica transg\u00e1strica (NET) \u00e9 uma op\u00e7\u00e3o menos invasiva para tratamento de cole\u00e7\u00e3o necr\u00f3tica organizada, e deve ser priorizada sempre que poss\u00edvel antes de uma abordagem cir\u00fargica. A terapia a v\u00e1cuo transg\u00e1strica tem sido descrita para tratamento de cole\u00e7\u00e3o necr\u00f3tica organizada pancre\u00e1tica. N\u00f3s descreveremos a seguir um m\u00e9todo de drenagem a v\u00e1cuo utilizando um sistema de drenagem t\u00fabulo-laminar fechado para tratamento de f\u00edstula pancreaticocut\u00e2nea de alto d\u00e9bito associado a pancreatite necrotizante.<\/p>\n<p>Um paciente masculino de 36 anos foi hopsitalizado em Junho de 2018 com sintomas de dor abdominal por pancreatite aguda necrotizante associada a etilismo e tabagismo. Ele n\u00e3o apresentava comorbidades. O paciente evoluiu com s\u00edndrome de resposta inflamat\u00f3ria sist\u00eamica e fal\u00eancia de m\u00faltiplos \u00f3rg\u00e3os, e uma tomografia computadorizada de abdomem revelou uma cole\u00e7\u00e3o necr\u00f3tica organizada massiva. O paciente desenvolveu quadro s\u00e9ptico e sangramento digestivo varicoso,\u00a0necessitando tamponamento com passagem de bal\u00e3o esof\u00e1gico.\u00a0Em seguida, houve drenagem espont\u00e2nea de secre\u00e7\u00e3o pancre\u00e1tica em regi\u00e3o inguinal esquerda.<\/p>\n<div id=\"attachment_10653\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2019\/12\/artigo-transgastric-sump-type-drainage.001.jpg\" data-rel=\"penci-gallery-image-content\" ><img fetchpriority=\"high\" decoding=\"async\" aria-describedby=\"caption-attachment-10653\" class=\"wp-image-10653 size-medium\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/artigo-transgastric-sump-type-drainage.001.jpg\" alt=\"Cole\u00e7\u00e3o necr\u00f3tica organizada massiva estendendo-se atrav\u00e9s do espa\u00e7o retroperitonial (setas vermelhas) at\u00e9 a regi\u00e3o inguinal esquerda (seta amarela).\" width=\"300\" height=\"225\" \/><\/a><p id=\"caption-attachment-10653\" class=\"wp-caption-text\">FIGURA 1 &#8211; Cole\u00e7\u00e3o necr\u00f3tica organizada massiva estendendo-se atrav\u00e9s do espa\u00e7o retroperitonial (setas vermelhas) at\u00e9 a regi\u00e3o inguinal esquerda (seta amarela).<\/p><\/div>\n<p>&nbsp;<\/p>\n<div id=\"attachment_10654\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2019\/12\/artigo-transgastric-sump-type-drainage.002.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" aria-describedby=\"caption-attachment-10654\" class=\"wp-image-10654 size-medium\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/artigo-transgastric-sump-type-drainage.002.jpg\" alt=\"\" width=\"300\" height=\"225\" \/><\/a><p id=\"caption-attachment-10654\" class=\"wp-caption-text\">FIGURA 2 \u2013 Varizes g\u00e1stricas devido a trombose de veia espl\u00eanica (setas). Essa complica\u00e7\u00e3o imp\u00f4s um desafio \u00e0 drenagem transg\u00e1strica.<\/p><\/div>\n<p>&nbsp;<\/p>\n<p>Nessa ocasi\u00e3o o paciente foi ent\u00e3o transferido de hospital para o nosso setor de endoscopia para NET com uso de pr\u00f3tese met\u00e1lica autoexpans\u00edvel para aposi\u00e7\u00e3o luminal.<\/p>\n<div id=\"attachment_10655\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2019\/12\/artigo-transgastric-sump-type-drainage.003.jpg\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" aria-describedby=\"caption-attachment-10655\" class=\"wp-image-10655 size-medium\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/artigo-transgastric-sump-type-drainage.003.jpg\" alt=\"\" width=\"300\" height=\"225\" \/><\/a><p id=\"caption-attachment-10655\" class=\"wp-caption-text\">Figura 3 \u2013 Drenagem transg\u00e1strica de cole\u00e7\u00e3o pancre\u00e1tica organizada utilizando pr\u00f3tese met\u00e1lica por aposi\u00e7\u00e3o luminal (setas) (Hanaro BCF 12mm\/30mm stent, MItech, Gyeonggi-do, Rep. of Korea).<\/p><\/div>\n<p>&nbsp;<\/p>\n<p>Ap\u00f3s tr\u00eas sess\u00f5es semanais de NET, houve limpeza efetiva do material necr\u00f3tico pancre\u00e1tico, por\u00e9m o paciente desenvolveu uma f\u00edstula pancreaticocut\u00e2nea de alto d\u00e9bito em regi\u00e3o inguinal (acima de 1000mL). Foi decidido por terapia a v\u00e1cuo com dreno t\u00fabulo-laminar.<\/p>\n<div id=\"attachment_10656\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2019\/12\/artigo-transgastric-sump-type-drainage.004.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-10656\" class=\"wp-image-10656 size-medium\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/artigo-transgastric-sump-type-drainage.004.jpg\" alt=\"\" width=\"300\" height=\"225\" \/><\/a><p id=\"caption-attachment-10656\" class=\"wp-caption-text\">Figura 4 \u2013 Terapia a v\u00e1cuo transg\u00e1strica utilizando drenagem fechada t\u00fabulo-laminar (dreno de Waterman). a. O dreno foi constru\u00eddo a partir de uma sonda nasog\u00e1strica de polietileno tipo Levine 14F envolta por um dreno de latex tipo Penrose N3. b. um fio-guia foi inserido endoscopicamente at\u00e9 sua exterioriza\u00e7\u00e3o no orif\u00edcio inguinal. O fio-guia foi ent\u00e3o transferido da boca para a narina esquerda. c. o dreno t\u00fabulo-laminar foi ent\u00e3o inserido at\u00e9 atingir a cavidade abdominal auxiliando por um endosc\u00f3pio. d. Extremidade g\u00e1strica do dreno t\u00fabulo-laminar.<\/p><\/div>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>Uma primeira tentativa de passagem do dreno atrav\u00e9s da pr\u00f3tese resultou em mal posicionamento da mesma, com persist\u00eancia da f\u00edstula. Uma semana ap\u00f3s, foi optado por remo\u00e7\u00e3o da pr\u00f3tese e passagem atrav\u00e9s do orif\u00edcio g\u00e1strico e dentro da retrocavidade abdominal.<\/p>\n<div id=\"attachment_10657\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2019\/12\/artigo-transgastric-sump-type-drainage.005.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-10657\" class=\"wp-image-10657 size-medium\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/artigo-transgastric-sump-type-drainage.005.jpg\" alt=\"\" width=\"300\" height=\"225\" \/><\/a><p id=\"caption-attachment-10657\" class=\"wp-caption-text\">Figura 5 \u2013 Dreno tubulo-laminar situado no espa\u00e7o retroperitonial (setas). A pr\u00f3tese met\u00e1lica pr\u00e9-existente foi removida.<\/p><\/div>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p>A terapia a v\u00e1cuo (press\u00e3o de 200 mmhg) foi ent\u00e3o reiniciada, resultando em redu\u00e7\u00e3o significativa do d\u00e9bito da f\u00edstula (de acima de 1000mL para 30mL em 24 horas). Cinco dias ap\u00f3s controle efetivo do d\u00e9bito da fistula, o dreno foi removido e 2 pr\u00f3teses pl\u00e1sticas duplo-espiraladas 7F\/7cm (Cook endoscopy, Winstom-Salem, NC, USA) foram posicionadas atrav\u00e9s do pertuito g\u00e1strico.<\/p>\n<div id=\"attachment_10658\" style=\"width: 310px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2019\/12\/artigo-transgastric-sump-type-drainage.006.jpg\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-10658\" class=\"wp-image-10658 size-medium\" src=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/artigo-transgastric-sump-type-drainage.006.jpg\" alt=\"\" width=\"300\" height=\"225\" \/><\/a><p id=\"caption-attachment-10658\" class=\"wp-caption-text\">Figura 6 \u2013 Resolu\u00e7\u00e3o completa da cavita\u00e7\u00e3o necrosada e da fistula pancreaticocut\u00e2nea. Duas pr\u00f3teses pl\u00e1sticas duplo-espiraladas foram inseridas para manuten\u00e7\u00e3o do pertuito gastrico. A seta amarela mostra a extremidade distal\/interna da pr\u00f3tese.<\/p><\/div>\n<p>&nbsp;<\/p>\n<p>O paciente restaurou a dieta via oral e recebeu alta 2 semanas ap\u00f3s este procedimento. Ap\u00f3s 18 semanas de seguimento o paciente restaurou o peso original e encontra-se sem sintomas digestivos. As pr\u00f3teses pancre\u00e1ticas transg\u00e1stricas devem permanecer indefinidamente devido ao desenvolvimento de s\u00edndrome de desconex\u00e3o pancre\u00e1tica.<\/p>\n<p>&nbsp;<\/p>\n<p>&nbsp;<\/p>\n<p><strong>AUTORES<\/strong><\/p>\n<p>Eduardo Aimore Bonin, Andre Marussi Morsoletto, Eduardo Silva Carboni, Eduardo Brommelstroet Ramos, Julio Cesar Wiederkher, Micheli Fortunato Domingos, Guilherme Francisco Gomes.<\/p>\n<p>Hospital Nossa Senhora das Gra\u00e7as, Curitiba, Brasil<\/p>\n<p>&nbsp;<\/p>\n<p>REFER\u00caNCIAS<\/p>\n<p>1 \u00a0Manrai M, Kochhar R, Gupta V, Yadav TD, Dhaka N, Kalra N, Sinha SK, Khandelwal N. Outcome of Acute Pancreatic and Peripancreatic Collections Occurring in Patients With Acute Pancreatitis. Ann Surg. 2018 Feb;267(2):357-363.<\/p>\n<p>2 Sarathi Patra P, Das K, Bhattacharyya A, Ray S, Hembram J, Sanyal S, Dhali GK. Natural resolution or intervention for fluid collections in acute severe pancreatitis. Br J Surg. 2014 Dec;101(13):1721-8.<\/p>\n<p>3 Bakker OJ, van Santvoort HC, van Brunschot S, Geskus RB, Besselink MG, Bollen TL, van Eijck CH, Fockens P, Hazebroek EJ, Nijmeijer RM, Poley JW, van Ramshorst B, Vleggaar FP, Boermeester MA, Gooszen HG, Weusten BL, Timmer R; Dutch Pancreatitis Study Group. Endoscopic transgastric vs surgical necrosectomy for infected necrotizing pancreatitis: a randomized trial. JAMA. 2012 Mar 14;307(10):1053-61.<\/p>\n<p>4 Loske G, Schorsch T, Gobrecht O, Martens E, Ruckt\u00e4schel F.Transgastric endoscopic vacuum therapy with a new open-pore film drainage device in a case of infective pancreatic necrosis. Endoscopy. 2016;48 Suppl 1:E148-9.<\/p>\n<p>5 Wedemeyer J, Kubicka S, Lankisch TO, Wirth T, Patecki M, Hiss M, Manns MP, Schneider AS. Transgastrically placed endoscopic vacuum-assisted closure system as an addition to transgastric necrosectomy in necrotizing pancreatitis (with video).Gastrointest Endosc. 2012 Dec;76(6):1238-41.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A pancreatite aguda necrotizante est\u00e1 associada a cole\u00e7\u00f5es necr\u00f3ticas organizadas em mais de 50%&hellip;<\/p>\n","protected":false},"author":1513,"featured_media":4689,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[],"ano":[146],"tipo":[154],"volume":[263],"class_list":["post-4695","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","ano-146","tipo-ecoendoscopia","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.2) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Terapia a v\u00e1cuo transg\u00e1strica para tratamento de f\u00edstula pancreatocut\u00e2nea ap\u00f3s necrosectomia endosc\u00f3pica utilizando um sistema de drenagem t\u00fabulo-laminar fechado &#8226; Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/terapia-a-vacuo-transgastrica-para-tratamento-de-fistula-pancreatocutanea\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Terapia a v\u00e1cuo transg\u00e1strica para tratamento de f\u00edstula pancreatocut\u00e2nea ap\u00f3s necrosectomia endosc\u00f3pica utilizando um sistema de drenagem t\u00fabulo-laminar fechado\" \/>\n<meta property=\"og:description\" content=\"A pancreatite aguda necrotizante est\u00e1 associada a cole\u00e7\u00f5es necr\u00f3ticas organizadas em mais de 50% dos casos, e cerca de 25% desses casos necessitam\" \/>\n<meta property=\"og:url\" content=\"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/terapia-a-vacuo-transgastrica-para-tratamento-de-fistula-pancreatocutanea\/\" \/>\n<meta property=\"og:site_name\" content=\"Endoscopia Terapeutica\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/endoscopiaterapeutica\" \/>\n<meta property=\"article:published_time\" content=\"2020-05-12T09:28:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2022-07-11T07:50:01+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/endoscopiaterapeutica.net\/pt\/wp-content\/uploads\/2021\/08\/artigo-transgastric-sump-type-drainage.001.jpg?v=1628201156\" \/>\n\t<meta property=\"og:image:width\" content=\"1024\" \/>\n\t<meta property=\"og:image:height\" content=\"768\" \/>\n\t<meta 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