Asunto(s)
Medicina de Emergencia , Priapismo , Urología , Niño , Hospitales de Enseñanza , Humanos , Masculino , Nigeria , Priapismo/etiología , Priapismo/terapia , UniversidadesRESUMEN
BACKGROUND: The traumatic diaphragmatic hernia (TDH) may appear acutely after a blunt or penetrating trauma, or it can remain missed also for many years. The discussion about the utility of a laparoscopic repair in acute and chronic TDH is controversial. METHODS: In this paper, we present two cases of chronic TDH that were successfully treated with laparoscopy. The first patient was treated 1 year after a stab wound and the second one 10 years after a firearm injury. RESULTS: In both cases, the diaphragmatic defects were easily laparoscopically detected and treated. The defects were repaired with a direct running suture owing to the acceptable dimensions of the tears. The mean operative time was 135 minutes (range, 75-195). The blood loss during the operations was unremarkable. No intraoperative complications occurred, and the conversion rate was null. The postoperative course was uneventful in the first patient, whereas the second patient, owing to the intraoperative respiratory problems, needed an accurate respiratory monitoring in the Intensive Care Unit. The mean length of stay after the operation was 7 days (range, 6-8). At follow-up, the clinical examination and the chest X-rays documented no recurrence. CONCLUSIONS: We recommend the use of laparoscopy in left chronic TDH repair, performing a direct suture of the diaphragm when possible.
Asunto(s)
Hernia Diafragmática/diagnóstico , Laparoscopía/métodos , Traumatismos Torácicos/complicaciones , Heridas Penetrantes/complicaciones , Adulto , Enfermedad Crónica , Estudios de Seguimiento , Hernia Diafragmática/etiología , Hernia Diafragmática/cirugía , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Atelectasia Pulmonar/terapia , Técnicas de Sutura , Tomografía Computarizada por Rayos X , Heridas por Arma de Fuego/complicaciones , Heridas Punzantes/complicacionesRESUMEN
This is the unusual case of a 17-year-old girl affected by Rett Syndrome (RS) who suffered acute abdominal distension and constipation for a week. Laparotomy showed massive gastric dilatation, with total necrosis and perforation. Total gastrectomy and Y-Roux esophagojejunostomy were performed. We believe the clinical status was caused by the mechanism of air swallowing, present in our patient and typical in RS. In fact, as reported, massive air bloat may result in a decrease of the intramural blood flow with consequential ischemia of the gastric wall. We stress the importance of early detection of the gastroenterological symptoms in these patients, with timely positioning of nasogastric tube and gastrostomy, to prevent serious complications potentially life-threatening as massive gastric necrosis.
