RESUMO
A 42-year-old man was brought into the Accident and Emergency Department with epigastric discomfort and severe bradycardia. Computerized tomography of the chest revealed spontaneous rupture of the left hemidiaphragm with herniation of small bowel loops.
Assuntos
Hérnia Diafragmática/diagnóstico por imagem , Hérnia Diafragmática/cirurgia , Doenças Musculares/diagnóstico , Doenças Musculares/cirurgia , Adulto , Bradicardia/etiologia , Medicina de Emergência/métodos , Hérnia Diafragmática/complicações , Humanos , Masculino , Doenças Musculares/complicações , Radiografia , Ruptura Espontânea/complicações , Ruptura Espontânea/diagnóstico , Ruptura Espontânea/cirurgia , Resultado do TratamentoRESUMO
Most knife assault victims attending hospital have slash-type wounds, mainly to the face, with fewer over the upper limb and trunk. Only 11% have multiple wounds. Sixty seven male soldiers were asked to slash a vertical human-sized target with a blade. The method of slashing was recorded for each. Approximately, half used multiple strikes, most attacked at the height of the upper torso. This differs from patterns of knife injury seen in clinical practice. The mechanics of fighting in which the victims fend off strikes or disengage is the likely explanation for these differences.
RESUMO
Acute abdominal pain is a common presentation to the ED. Most patients undergo a chest radiograph as part of their initial investigations, which occasionally reveals pneumoperitoneum. Pneumoperitoneum on imaging suggests a perforated hollow abdominal viscus and therefore often constitutes a surgical emergency. However, if the patient is neither peritonitic nor septic a management dilemma is faced. Some cases of pneumoperitoneum might be managed conservatively thus avoiding unnecessary laparotomy. We present a case of recurrent spontaneous pneumoperitoneum with abdominal pain that was managed conservatively and discuss the possible aetiologies and management issues of spontaneous pneumoperitoneum.