{"id":2308,"date":"2019-12-31T19:32:10","date_gmt":"2019-12-31T18:32:10","guid":{"rendered":"https:\/\/angh.net\/abstracts\/perforation-rectale-de-diagnostic-difficile\/"},"modified":"2019-12-31T19:32:10","modified_gmt":"2019-12-31T18:32:10","slug":"perforation-rectale-de-diagnostic-difficile","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/perforation-rectale-de-diagnostic-difficile\/","title":{"rendered":"perforation rectale de diagnostic difficile"},"content":{"rendered":"

2019<\/strong><\/p>\n

Pierre Claud\u00e9, Faly Ralaizanaka, Eloise Bolot<\/em><\/p>\n

Gastroent\u00e9rologie <\/strong>– \u00a02019-05-25 –\u00a0NULL –<\/p>\n

________________________________<\/p>\n

patient de 74 ans, diab\u00e9tique type 2, hypertendu, admis aux urgences dans un tableau de douleurs abdominales et de rectorragies dans la soir\u00e9e du 28\/11\/18
\nlaparotomie en urgence car pr\u00e9sence d’air extradigestif au scanner, pas de perforation identifi\u00e9e, r\u00e9alisation d’une colostomie
\ns\u00e9jour en r\u00e9animation marqu\u00e9 par l’apparition d’un saignement gastrique, mise en \u00e9vidence de l\u00e9sions fundiques atypiques ulc\u00e9r\u00e9es \u00e0 la gastroscopie du 14\/12\/18; pr\u00e9sence de filaments \u00e0 l’histologie, une mycose est \u00e9voqu\u00e9e, il ne s’agit pas de l’aspect d’une candidose
\nstabilit\u00e9 clinique, sortie de r\u00e9animation
\npersistance de l\u00e9sions ulc\u00e9r\u00e9es \u00e0 la gastroscopie du 27\/12\/18
\npr\u00e9l\u00e8vements fundiques envoy\u00e9s en microbio pour recherche de mucormycose
\nd\u00e9veloppement rapide de Rhizopus sp (4 points sur 4 inocul\u00e9s)<\/p>\n

traitement probabiliste par Ambisome
\nantifongigramme: r\u00e9sistance au posaconazole, sensibilit\u00e9 \u00e0 l’amphot\u00e9ricine B<\/p>\n

am\u00e9lioration clinique<\/p>\n

rectosigmoidoscopie le 11\/1\/19: pr\u00e9sence d’un orifice fistuleux du rectum \u00e0 7-8 cm, sur la face ant\u00e9rieure, \u00e9coulement de filaments blanch\u00e2tres <\/p>\n

cicatrisation des l\u00e9sions gastriques le 5\/2\/19
\nsouche identifi\u00e9e: Rhizopus microsporus<\/p>\n

retour au domicile<\/p>\n

donc tableau de perforation rectale avec rectorragies r\u00e9v\u00e9lant une mucormycose digestive chez un patient non immunod\u00e9prim\u00e9, il s’agit d’une situation rare
\nnous pensons que la localisation gastrique \u00e9tait le premier stade et la localisation rectale, r\u00e9v\u00e9latrice de la maladie, secondaire<\/p>\n","protected":false},"excerpt":{"rendered":"

2019 Pierre Claud\u00e9, Faly Ralaizanaka, Eloise Bolot Gastroent\u00e9rologie – \u00a02019-05-25 –\u00a0NULL – ________________________________ patient de 74 ans, diab\u00e9tique type 2, hypertendu, admis aux urgences dans un tableau de douleurs abdominales et de rectorragies dans la soir\u00e9e du 28\/11\/18 laparotomie en urgence car pr\u00e9sence d’air extradigestif au scanner, pas de perforation identifi\u00e9e, r\u00e9alisation d’une colostomie s\u00e9jour […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[30],"class_list":["post-2308","post","type-post","status-publish","format-standard","hentry","category-gastroenterologie","tag-30"],"yoast_head":"\nperforation rectale de diagnostic difficile - 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