RESUMO
UNLABELLED: Lower gastrointestinal bleeding is defined as any bleeding localized distally to Treitz's ligament. The massive bleeding from the appendix is extremely rare and only 21 cases described in the English literature. CASE PRESENTATION: We present a 61-years-old patient with decompensated liver cirrhosis and bleeding from esophageal varices. He underwent band ligation by Six Shooter (Cook Medical, USA). Due to a massive bleeding from the lower gastrointestinal tract and a rapid decline of hemoglobin level to 3 g/dL, angiography was performed. It revealed a bleeding from distal branches of ileocolic artery, confirmed by the followed computed tomography angiography. The patient underwent appendectomy and was discharged in a good condition on the 6th postoperative day. CONCLUSION: The synchronous bleeding from upper and lower GIT should be considered, especially in the cases with portal hypertension. The angiography and computed tomography angiography are valuable diagnostic methods, able to localize the bleeding a thus to reduce the morbidity and mortality.
Assuntos
Apendicectomia , Apêndice/cirurgia , Varizes Esofágicas e Gástricas/cirurgia , Hemorragia Gastrointestinal/cirurgia , Cirrose Hepática/complicações , Angiografia , Apendicectomia/métodos , Varizes Esofágicas e Gástricas/complicações , Hemorragia Gastrointestinal/complicações , Humanos , Hipertensão Portal/complicações , Hipertensão Portal/diagnóstico , Ligadura/métodos , Masculino , Pessoa de Meia-IdadeRESUMO
Morgagni-Larey diaphragmatic hernias are very rare. The defect of diaphragm is usually small and the disease passes asymptomatically. If complaints are present and surgical treatment is needed, two types of operative access could be performed--thoracic and abdominal. A 18 years old man with asymptomatic flow of the disease is presented. The laparoscopic treatment was successful. The possible aspects of operative technique are discussed.