RESUMEN
The Pfannenstiel incision is commonly utilized for Cesarean section. Long-term complications of this incision are rare. This retrospective charts review from a community teaching hospital over a 3-year period describes seven cases of scar endometriosis in a Pfannenstiel incision after Cesarean section. In two other instances, hernias were found. Patients presented with pain and/or a mass at the incision site. Although extensive diagnostic workup including ultrasonography, computerized tomographic scan, and needle biopsy have been suggested by other authors, surgical exploration was both diagnostic and therapeutic in our experience.
Asunto(s)
Cesárea/efectos adversos , Endometriosis/etiología , Hernia Inguinal/etiología , Neoplasias Cutáneas/etiología , Adulto , Cesárea/métodos , Cicatriz , Endometriosis/diagnóstico , Endometriosis/cirugía , Femenino , Humanos , Embarazo , Estudios Retrospectivos , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/cirugía , SíndromeRESUMEN
Rupture of a splenic artery aneurysm during pregnancy or delivery is an unusual event. Only 98 previous cases have been reported. The survival of both mother and fetus is even more uncommon. This paper describes the tenth case of maternal-fetal survival after splenic artery aneurysm rupture. The literature is reviewed in detail with emphasis on the epidemiology, etiology, clinical presentation, and treatment of this problem. A high index of suspicion and an awareness of the management options are necessary to achieve a successful outcome.
Asunto(s)
Aneurisma Roto/diagnóstico , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Arteria Esplénica , Adulto , Aneurisma Roto/cirugía , Femenino , Humanos , Recién Nacido , Complicaciones del Trabajo de Parto/diagnóstico , Complicaciones del Trabajo de Parto/cirugía , Embarazo , Complicaciones Cardiovasculares del Embarazo/cirugía , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/cirugía , Rotura Espontánea , Arteria Esplénica/cirugíaRESUMEN
Between July 1, 1970 and December 31, 1988, 453 patients underwent hepatic resection by the senior author. Ninety of these patients were more than 64 years old and are the subject of this review. The 30-day operative mortality rate for all patients undergoing hepatic resection was 3.3%: major hepatic resection was 4.4% and subsegmental resection was 1.4%. The operative mortality rate for patients undergoing major hepatic resection increased incrementally with age: for patients up to age 55 years it was 0.70%, for those between 55 and 64 years it was 3.6%, and for patients older than 64 years it increased to 11.1%. This higher operative mortality rate in the elderly reflects the mortality rate for extended right hepatic lobectomy in this age group of 30.7%. If this procedure is excluded, the operative mortality rate for patients older than age 64 was 7.6%. Sixty per cent of the operative deaths were due to hepatic insufficiency. The data presented demonstrate that major hepatic resection can be performed in the elderly with a low but somewhat increased mortality risk. However, because of its markedly increased operative risk, extended right hepatic lobectomy should be performed in elderly patients only in selected cases until better methods of estimating hepatic reserve are available.