LUCAS FARACO SOBRADO
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
8 resultados
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- Fournier’s Gangrene During Pregnancy in a Patient with Crohn’s Disease(2022) SOBRADO, L. F.; AVERBACH, P.; JAYME, V. R.; CAMARGO, M. G. M. de; SOBRADO, C. W.; NAHAS, S. C.Patient: Female, 29-year-old Final Diagnosis: Crohn’s associated Perianal and perirectal abscess • Fournier’s gangrene Symptoms: Anal pain Medication: — Clinical Procedure: — Specialty: Surgery Objective: Background: Case Report: Conclusions: Unusual clinical course Fournier’s gangrene (FG) is a rapidly progressive necrotizing infection of the perineum. Risk factors include male sex and immunosuppression. Inflammatory bowel disease and pregnancy may alter immune response by complex mechanisms but have rarely been associated with necrotizing infections of the perineum. To the best of our knowledge, only 5 cases of FG in association with IBD have been reported in the literature, and none of them occurred during pregnancy. We report the case of a young woman with long-standing Crohn’s disease in clinical remission with Infliximab monotherapy who developed FG in the third trimester of pregnancy. A cesarean section was undertaken at 35 weeks due to fetal distress, followed by debridement, diverting stoma, and vacuum-assisted therapy. The perineal defect was closed following 4 debridements and vacuum-therapy exchanges with a unilateral medial thigh advancement flap, and a draining seton was placed in the suprasphincteric fistula. The patient was dis-charged after 28 days and her recovery was unremarkable. The neonate also recovered well. The treatment of FG is multidisciplinary and includes early debridement and intestinal diversion. Perianal pain should not be disregarded, as it may be the initial symptom of severe perianal sepsis in the immunosuppressed. To the best of our knowledge, this is the first case report of FG during pregnancy in a patient with Crohn’s disease. © Am J Case Rep, 2022.
- Gastric and Duodenal Fistulas in Crohn's Disease, a Surgical Challenge: Report of 5 Cases and a Review of the Literature(2023) SOBRADO JUNIOR, Carlos Walter; VILLELA JUNIOR, Helder de Moura; FACANALI, Carolina Bortolozzo Graciolli; SOBRADO, Lucas Faraco; CAMARGO, Mariane Gouvea Monteiro de; NAHAS, Sergio CarlosObjective: Rare diseaseBackground: Fistulas involving the stomach and duodenum in Crohn's disease are rare (occurring in less than 1% of patients). Here, we reviewed registers from 855 patients with Crohn's disease treated in our service from January 2007 to December 2020 and found 4 cases of duodenal fistula and 1 case of gastric fistula.Case Reports: The fistula origin was in the ileocolic segment in all cases, and all of the patients underwent preoperative optimization with improvement of nutritional status and infection control. They then underwent surgical treatment with resection of the affected segment and duodenal or gastric closure with covering by an omental patch. One case of a duodenal fistula was complicated by duodenal dehiscence. This was treated surgically with duodenojejunostomy. Each of the other patients had an uneventful postoperative course. All patients were successfully cured of their gastroduodenal fistulas, and at the time of this publication, none of them died or had fistula recurrence.Conclusions: Fistulas with the involvement of the stomach and duodenum in patients with Crohn's disease are almost always due to inflammation in the ileum, colon, or previous ileocolic anastomosis. Management of this situation is complex and often requires clinical and surgical assistance; preoperative optimization of the patient's general condition can improve the surgical results. The surgical approach is based on resection of the affected segment and gastric or duodenal closure with covering by an omental patch. Gastrojejunostomy or duodenojejunostomy can be performed in selected patients with larger defects and minor jejunal disease. To prevent recurrence, prophylactic therapy with anti-TNF agents and early endoscopic surveillance are also essential for successful treatment.
- The relationship of major depressive disorder with Crohn?s disease activity(2023) FACANALI, Carolina Bortolozzo Graciolli; SOBRADO JUNIOR, Carlos Walter; FRAGUAS JUNIOR, Renerio; FACANALI JUNIOR, Marcio Roberto; BOARINI, Lucas Rodrigues; SOBRADO, Lucas Faraco; CECCONELLO, IvanIntroduction: Crohn's disease (CD) has been related to an increased prevalence of psychiatric disorders and suicide risk (SR). However, the nature of their relationship still deserves clarification. The aim of this study is to assess the prevalence of major depressive disorder (MDD) in patients with CD, and to investigate the relationship between MDD and CD outcomes.Methods: A cross-sectional study involving CD patients was performed. CD activity was evaluated by the Harvey -Bradshaw index and CD phenotype by the Montreal classification. The presence of MDD was assessed by the Patient Health Questionnaire score-9 (PHQ-9). Sociodemographic data and other characteristics were retrieved from electronic medical records.Results: 283 patients with CD were included. The prevalence of MDD was 41.7%. Females had a risk of MDD 5.3 times greater than males. CD disease duration was inversely correlated with MDD severity. Individuals with active CD were more likely to have MDD (OR = 796.0; 95% CI 133.7-4738.8) than individuals with CD remis-sion. MDD was more prevalent in inflammatory behavior (45.5%) and there were no statistical differences regard-ing the disease location. 19.8% of the sample scored positive for SR.Conclusion: The present results support data showing an increased prevalence of MDD in individuals with CD. Additionally, it indicates that MDD in CD might be related to the activity of CD. Prospective studies are warranted to confirm these results and to address whether MDD leads to CD activity, CD activity leads to MDD or both ways are existent.
- Case Series of Right Colon Diverticulitis in the West: A Neglected Disease?(2022) SOBRADO, L. F.; CALDAS, T. G.; FACANALI, C. G.; BUSTAMENTE-LOPEZ, L.; SOBRADO, C. W.Introduction Right colon diverticulitis (RCD) is an uncommon condition in Western populations, but its incidence has increased over the last decades. Due to its rarity, many surgeons are unfamiliar with this disease, which is often mistakenly diagnosed as acute appendicitis. The lack of data about the diagnosis and management of RCD in Western populations makes it difficult to establish the optimal therapeutic strategy. Objective To evaluate the outcomes of patients treated for acute RCD and to propose a therapeutic algorithm for the diagnosis and treatment. Methods A retrospective analysis of the medical records of patients treated for acute RCD between 2008 and 2020 by a single experienced colorectal surgeon was performed. Results In total, 12 patients were identified, 8 male and 4 female subjects, with a mean age of 49.6 years; 9 of these patients were of Western origin. The median follow-up time was of 49 months (range: 12 to 144 months). The most frequent symptoms were abdominal pain (100%) and fever (66%). Diagnostic errors in imaging exams occurred in four patients. A total of 6 patients were managed clinically, and the other 6 underwent surgical treatment with right colectomy (n = 5) and total colectomy (n = 1), 2 via laparoscopy and 4 through a laparotomy. The anatomopathological examination confirmed RCD in all operated patients. There was no incidental finding of neoplasia and there were no deaths during the study period. Conclusion Uncomplicated RCD can be treated conservatively with a high success rate. Recurrent cases that impact quality of life or complicated forms of RCD should undergo surgical treatment, preferably through a right laparoscopic colectomy. The authors present a diagnostic and therapeutic algorithm to facilitate the diagnosis and to guide the management of this uncommon disease. © 2022. Sociedade Brasileira de Coloproctologia. All rights reserved.
- Laparoscopic Frykman-Goldberg procedure for internal rectal prolapse and chronic constipation - A video vignette(2023) SOBRADO, Lucas Faraco; PINTO, Rodrigo Ambar; SOBRADO, Carlos Walter
- RISK FACTORS FOR EARLY POSTOPERATIVE COMPLICATIONS IN ACUTE ESFAGOGÁSTRICE ESPLENECTOMIA INFL COLITIS IN THE ERA OF BIOLOGIC THERAPY(2023) SOBRADO, Lucas Faraco; MORI, Fernando Noboru Cabral; FACANALI, Carolina Bortolozzo Graciolli; CAMARGO, Mariane Gouvea Monteiro; NAHAS, Sergio Carlos; SOBRADO, Carlos WalterBackground: Despite major advances in the clinical treatment of inflammatory bowel disease, some patients still present with acute colitis and require emergency surgery. Aims: To evaluate the risk factors for early postoperative complications in patients undergoing surgery for acute colitis in the era of biologic therapy. Methods: Patients with inflammatory bowel disease admitted for acute colitis who underwent total colectomy at a single tertiary hospital from 2012 to 2022 were evaluated. Postoperative complications were graded according to Clavien-Dindo classification (CDC). Patients with more severe complications (CDC >= 2) were compared with those with less severe complications (CDC<2). Results: A total of 46 patients underwent surgery. The indications were: failure of clinical treatment (n=34), patients' or surgeon's preference (n=5), hemorrhage (n=3), toxic megacolon (n=2), and bowel perforation (n=2). There were eight reoperations, 60.9% of postoperative complications classified as CDC >= 2, and three deaths. In univariate analyses, preoperative antibiotics use, ulcerative colitis diagnosis, lower albumin levels at admission, and preoperative hospital stay longer than seven days were associated with more severe postoperative complications. Conclusions: Emergency surgery for acute colitis was associated with a high incidence of postoperative complications. Preoperative use of antibiotics, ulcerative colitis, lower albumin levels at admission, and delaying surgery for more than seven days were associated with more severe early postoperative complications. The use of biologics was not associated with worse outcomes.
- Laparoscopic mesh removal due to chronic pelvic pain following ventral rectopexy-a video vignette(2023) SOBRADO, Lucas Faraco; MORI, Fernando Noboru Cabral; SOBRADO, Carlos Walter
- Laparoscopic Enterectomy With Intracorporeal Anastomosis for Stricturing Crohn's Disease of the Small Bowel(2023) SOBRADO, Lucas Faraco; FRUGIS, Marcos Onofre; SOBRADO, Carlos Walter