La otorragia. Una complicación de la hemicolectomía laparoscópica / Otorrhagia. A complication of laparoscopic hemicolectomy

El creciente y rápido avance de la tecnología quirúrgica en las últimas décadas ha permitido el desarrollo de la cirugía laparoscópica. La cirugía «mínimamente invasiva» se ha popularizado en los últimos años, y sus fronteras no solo se limitan a los procedimientos ginecológicos, sino que se ha extendido al campo de la cirugía general, la ortopedia, el tórax y la urología. La insuflación de gas en la cavidad peritoneal y la posición del paciente se acompañan de cambios fisiológicos y complicaciones que no se presentan en la cirugía abierta. Presentamos el caso de una paciente que tras hemicolectomía izquierda laparoscópica presentó otorragia bilateral postoperatoria. El neumoperitoneo y la posición de Trendelenburg a más de 35° provocan alteraciones hemodinámicas que condicionan un aumento de la presión arterial y de la presión venosa central. La vascularización del conducto auditivo externo sufre directamente estas modificaciones, pudiendo aparecer otorragia postoperatoria después de una cirugía laparoscópica prolongada (AU)

The fast and increasing advance in surgical technology during the last decades has led to a remarkable development in laparoscopic surgery. «Minimally invasive» surgery has become very popular in the last few years, not only in gynecological procedures but also in general surgery, orthopedics, thoracic and urological procedures. Gas inflation into the abdominal cavity and patient position provokes physiological changes, as well as complications that are not seen in open surgery. Pneumoperitoneum and the Trendelenburg position beyond 35° cause hemodynamic changes, resulting in an increase in arterial and central venous pressure. The external auditory canal vessels are directly affected by these changes, and postoperative otorrhagia after a prolonged laparoscopic surgery may be present. A case is presented of postoperative bilateral otorrhagia after laparoscopic left hemicolectomy (AU)

Anatomical comparison of a defect in the hepatic segment of the inferior vena cava with the normal azygos system

During anatomical practice between 2001-2002 at the Tokyo Women's Medical University, a defect in the hepatic segment of the inferior vena cava was encountered in a 94-year-old male cadaver. Although this type of defect has often been observed clinically using imaging diagnosis, the topological changes in the small vessels and surrounding structures have not been described previously. Here, the topological changes in small vessels and surrounding structures, in addition to the morphology of a defect in the hepatic segment of the inferior vena cava, are described in detail. Normal variations in the venous system were also examined using 26 human cadavers for comparison. The following results and interpretations were obtained: The thoracic portion of the anomalous vein originated from the azygos system, judging from the topological relationships among the main venous trunk, small vessels, and the autonomic nerves. Although a close relationship between the inferior vena cava and the azygos system was recognized, the development of each venous system should be regarded as independent, based on the normal variations observed in 26 human cadavers and the currently available medical literature. The boundary between the cardinal vein (inferior vena cava) and the azygos system might be the lower border of the renal vein, since the renal vein drained into the ventral aspect of the inferior vena cava and the left renal artery ran superficially across the abdominal portion of the anomalous vein. Examination of topological changes in the surrounding structures may provide important clues regarding the morphogenesis of defects in the hepatic segment of the inferior vena cava and normal venous systems (AU)

No disponible