Staphylococcus aureus brainstem abscess in a Brazilian Amazon man. Case report.

The brainstem is an uncommon site for a brain abscess. It accounts for less than 4% of all posterior cranial fossa abscesses, and less than 1% of all intracranial abscesses. The pons is the most common site for these abscesses. The aim of the present report was to describe the case of a Brazilian Amazon man with a brainstem abscess (BSA) managed with combined surgical drainage and systemic antibiotic therapy. This case reinforces the importance of an early suspicion of BSA in patients with unexplained fever and neurologic deficits, especially sixth and seventh cranial nerve lesions, to minimize permanent damage.

Pneumoperitoneum in association with perforated appendicitis in a Brazilian Amazon woman. Case report.

Radiographic findings of free air in the peritoneal cavity secondary to perforation of a acutely inflamed appendix are extremely rare. It accounts for about 0-7% of all patients with pneumoperitoneum. We report on a 58-years-old Brazilian Amazon woman presenting a 1- week history of abdominal pain, tenderness and distension associated with asthenia and without passage of stool or gas. Abdominal percussion revealed a tympanic sound located on the right hypocondrium. Plain chest radiography revealed a large amount of free air beneath the right leaf of the diaphram. The patient was taken immediately to the operation room and, during surgery, a gangrenous appendix with an apex perforation was verified. Appendectomy was performed as routinely. The patient evolved with pneumonia and septic shock that responded well to intravenous antibiotics and vasoactive drugs. She was discharged to home on the twenty-first post-operative day in good clinical conditions. This case highlights that perforated acute appendicitis is rarely associated with pneumoperitoneum, but it must be considered in the differential diagnosis of patients presenting right abdominal pain and free intraperitoneal air.

Spontaneous rupture of giant hepatic hemangioma: a rare source of hemoperitoneum. Case report.

BACKGROUND: Hemoperitoneum due to spontaneous rupture of a hepatic hemangioma is a rare and serious clinical event with a high mortality rate. CASE REPORT: 25-year-old woman under hormonal treatment for pregnancy with abdominal pain with distension followed by vomits, palpable epigastric mass and paleness of the skin and mucosas. Computed tomography of the abdomen without oral and venous contrast showed a heterogeneous and capsulated tumor of the liver. Exploratory laparotomy was carried out that revealed a large tumor occupying the gastro-hepatic site with partial rupture of the tumor's capsule with bleeding. Because of the close relationship between the tumor and the retro-hepatic inferior vena cava, the partial resection of the tumor was realized. The patient had a good post-operative evolution. The study of the tumor revealed hepatic hemangioma. CONCLUSION: Hepatic Hemangiomas may evolve to spontaneous rupture leading to hemorrhagic acute abdomen. Surgery is mandatory and the resection of the Hemangioma will depend on the clinical condition of the patient and on the relationship of the tumor with the vascular structures of the liver. Partial resection is a safe choice that saves lives in urgency situations, as the one described herein.

Subcapsular hematoma of the liver due to intercostal anesthesic blockage after cholecystectomy: case report.

The subcapsular hematoma of the liver (SHL) are the results of injuries such as liver needle biopsy, liver trauma, pregnancy illnesses, parasitic diseases and others. The approach of these lesions depends on the various clinical presentations of subcapsular hematoma of the liver because it may be small with minimal clinical repercussion, managed only by ultrasound observation. In some situations the SHL may present large dimensions with hemodinamic instability. A case of subcapsular hematoma of the liver secondary to anesthetic intercostal blockade to control the postoperative pain after cholecystectomy is reported. A 34-year-old woman was submitted to intercostal anesthetic blockade after cholecystectomy for treatment of cholelithiasis. The blockade evolved with pain in right flank followed of mucocutaneous pallor and fall of the haematocrit and hemoglobin levels. At relaparotomy, subcapsular hematoma of the liver was proven and tamponed with compresses. The patient had good postoperative evolution being discharged from hospital, after removing the compresses. In conclusion, the intercostal anesthesic blockade, as any other medical procedure, is not exempt of complications. Therefore, it must be carried through in well selected cases; Anyway nowadays, there are efficient drugs for the control of postoperative pain.