RESUMEN
The current global COVID-19 pandemic is caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, acquired tracheoesophageal fistulas are mainly iatrogenic lesions produced by prolonged tracheal intubation. We present a case of tracheoesophageal fistula with severe tracheal stenosis following tracheal intubation in a patient with SARS-CoV-2 infection.
Asunto(s)
COVID-19/terapia , Intubación Intratraqueal/efectos adversos , Procedimientos Quirúrgicos Otorrinolaringológicos/métodos , Síndrome de Dificultad Respiratoria/terapia , Estenosis Traqueal/cirugía , Fístula Traqueoesofágica/cirugía , Adulto , Anastomosis Quirúrgica/métodos , Broncoscopía/métodos , COVID-19/complicaciones , Humanos , Masculino , Quirófanos , Aisladores de Pacientes , Respiración Artificial , Síndrome de Dificultad Respiratoria/etiología , SARS-CoV-2 , Tomografía Computarizada por Rayos X , Estenosis Traqueal/etiología , Fístula Traqueoesofágica/etiologíaRESUMEN
INTRODUCTION: Internal hernias (IH) are late complications of bariatric surgery, specifically gastric bypass and manifest with diffuse abdominal pain and/or intestinal obstruction. They have a low incidence, however, are increasingly common in patients undergoing laparoscopic gastric bypass (LGBP). Petersen's internal hernia is one of the most frequent internal hernias following Bariatric surgery. METHODS: We describe our experience at a third-level surgical center using a prophylactic Petersen's space herniorrhaphy immediately following LGBP as a preventative strategy for post-bariatric internal hernias. In addition, we perform a retrospective descriptive study with 667 patients undergoing LGBP under which we divided into two groups. In the first group, the Petersen's space was not closed, and in the second group, the Petersen´s space closure was performed using non-absorbable polypropylene non-interrupted sutures. RESULTS AND CONCLUSIONS: 667 patients were taken to LGBP, and of which 5 presented internal hernias. From the 346 patients who had Petersen´s herniorrhaphy performed, one developed signs of an internal hernia at 22 months follow-up and was subsequently confirmed later with laparoscopy (0.02%). Of the 321 patients not having had Petersen's space closure, 4 developed Petersen's internal hernia at an average of 22-month post-op, incidence of 0.1%. We analyzed and compared our results with those reported in the literature. Petersen's space closure immediately after a LGBP with an alimentary loop in the anterior colic position (prophylactic herniorrhaphy) with non-interrupted non-absorbable suture is a useful, safe, and effective technique to prevent the development of Petersen's IH during the post-operative period following LGBP.
Asunto(s)
Derivación Gástrica/efectos adversos , Derivación Gástrica/métodos , Hernia Abdominal/prevención & control , Herniorrafia/métodos , Cirugía Bariátrica/efectos adversos , Cirugía Bariátrica/métodos , Hernia Abdominal/etiología , Humanos , Incidencia , Laparoscopía/efectos adversos , Mesenterio/cirugía , Estudios Retrospectivos , Técnicas de SuturaRESUMEN
INTRODUCTION: A tension hydrothorax is defined as a massive pleural effusion presenting with hemodynamic abnormalities secondary to mediastinal compression. In these patients pleural volume increases intrathoracic pressure to the point of compromising diastolic filling and cardiac output simulating a cardiac tamponade physiology. This is an uncommon yet potentially fatal medical emergency that if left untreated may progress to cardiac arrest. Early detection and rapid intervention of these patients prevents cardiorespiratory collapse. CASE PRESENTATION: We present a two-case report of patients presenting with malignant tension hydrothoraxes decompressed with ultrasound-guided thoracentesis and tube thoracostomy in the ED. CONCLUSION: Although these life-saving decompressive interventions appear simple, not having proper training is an independent factor for chest tube and thoracentesis complications. Courses and simulation training can benefit physicians to minimize potential complications when managing emergency conditions such as tension hydrothoraxes which continue to be a medical challenge. Whether thoracentesis or thoracostomy is superior in managing this condition remains in debate and a clinical dilemma.