RESUMEN
BACKGROUND: Obturator hernia is an uncommon but important cause of intestinal obstruction. METHODS: Retrospective study of 16 patients undergoing surgery for obturator hernia in a 20-year period. RESULTS: All patients were elderly women. Low body mass index and multiparity were predisposing factors. Mean time from onset of symptoms to consultation was 4.1 days. The preoperative diagnosis was intestinal obstruction of unknown etiology in 13 cases and intestinal obstruction due to obturator hernia in three (diagnosis by CT). The rate of strangulated hernias was 75% and the perforation rate was 56.3%. Intestinal resection was required in 12 cases. Hernia repair was performed using polypropylene mesh in 11 cases and by means of simple suture and apposition of the peritoneum in five. Morbidity was 75% and mortality was 18.8%. CONCLUSIONS: Early diagnosis--we recommend CT in thin, elderly, multiparous women with intestinal obstruction--and early treatment can reduce complications and mortality.
Asunto(s)
Algoritmos , Hernia Obturadora/diagnóstico , Hernia Obturadora/cirugía , Anciano , Anciano de 80 o más Años , Distribución de Chi-Cuadrado , Femenino , Hernia Obturadora/complicaciones , Historia del Siglo XVII , Humanos , Obstrucción Intestinal/etiología , Estudios Retrospectivos , Factores de Riesgo , Tomografía Computarizada por Rayos XRESUMEN
We report a suicide attempt with lithium, chlorpromazine and flunitrazepam. In case of intoxication, renal excretion of lithium can be facilitated with forced diuresis by the administration of large volumes of saline solution, peritoneal dialysis or hemodialysis. In the case of our patient, treatment with saline solution was not effective, so continuous arteriovenous hemofiltration (CAVH) was performed achieving a decrease in serum lithium and obtaining a prompt clinical improvement. No secondary effects or serum lithium rebound effect were observed. We have not found any previous record of the use of CAVH in the treatment of acute lithium intoxication.