Trombosis aguda carotídea en el traumatismo penetrante: es necesaria la revascularización en el paciente sin déficit neurológico central? / Acute carotid thrombosis in penetrating traumatism: is revascularization necessary in the patient without central neurological deficit?

INTRODUCTION: Carotid lesions require priority in both evaluation and treatment due to their high morbidity and mortality. Controversy about therapeutic behavior in these patients with or without central neurological deficit is still under in discussion. OBJECTIVES: To present a patient with acute carotid thrombosis due to a shotgun wound and discuss its therapeutic behavior. SETTING: Hospital de Urgencias in Córdoba city. MATERIAL AND METHODS: A 15-year-old male patient is presented with a point-blank shotgun wound in the soft parts of the left cervical region, and a left carotid thrombosis with no central neurological deficit. RESULTS: Wound toilette and carotid revascularization by means of resection and venous by-pass with external carotid ligature was performed. The procedure was finished by delaging for plastic reconstruction of the cervical injury. Carotid postoperative angiographic control showed good permeability with no carotid flow alteration. CONCLUSION: Penetrating carotid injuries should be resolved, if technically possible, with revascularization of the carotid sector. This procedure has to be aborted if the patient is in coma or the lesion is difficult to repair, in such a case ligature should be carried out.

Trombosis aguda carotídea en el traumatismo penetrante: es necesaria la revascularización en el paciente sin déficit neurológico central? / Acute carotid thrombosis in penetrating traumatism: is revascularization necessary in the patient without central neurological deficit?

INTRODUCTION: Carotid lesions require priority in both evaluation and treatment due to their high morbidity and mortality. Controversy about therapeutic behavior in these patients with or without central neurological deficit is still under in discussion. OBJECTIVES: To present a patient with acute carotid thrombosis due to a shotgun wound and discuss its therapeutic behavior. SETTING: Hospital de Urgencias in Córdoba city. MATERIAL AND METHODS: A 15-year-old male patient is presented with a point-blank shotgun wound in the soft parts of the left cervical region, and a left carotid thrombosis with no central neurological deficit. RESULTS: Wound toilette and carotid revascularization by means of resection and venous by-pass with external carotid ligature was performed. The procedure was finished by delaging for plastic reconstruction of the cervical injury. Carotid postoperative angiographic control showed good permeability with no carotid flow alteration. CONCLUSION: Penetrating carotid injuries should be resolved, if technically possible, with revascularization of the carotid sector. This procedure has to be aborted if the patient is in coma or the lesion is difficult to repair, in such a case ligature should be carried out. (AU)

[Zenker diverticulum: therapeutic approach]. / Diverticulo de Zenker: conducta terapéutica.

BACKGROUND: Pharyngoesophageal or Zenker diverticula are a few frequent pathology that could represent between 1 and 3% of the patients with dysphagia and their physiopathology even at present is scarcity clear. OBJECTIVE: Therapeutic procedures results about this pathology were analyzed. SETTING: Caraffa and Sucre Clinic. DESIGN: Retrospective observational study. METHOD: It analyzed 13 patients operated by Zenker diverticula 9 of which were male and 4 were female sex with an average age of 55.6 years. Dysphagia occurred in 100% of the cases. Besides clinical finding the diagnosis was made evident by esophageal X-ray with contrast medium and endoscopy. Diverticulectomy by one stage through a left cervicotomy was the surgical procedure of choice. RESULTS: There was no surgical mortality. Related with morbility 2 patients presented fistulas managed medically and in other 2 patients abscesses of surgical wound occurred. The follow-up was carried on 6 months, 4 and 7 years respectively without relapses and with a good posterior evolution. CONCLUSIONS: Based on our short experience and the results attained we think the treatment of Zenker or pharyngoesophageal diverticulum by diverticulectomy through a left cervicotomy is safe and effective procedure to control this pathology.

Diverticulo de Zenker: conducta terapéutica. / [Zenker diverticulum: therapeutic approach]

BACKGROUND: Pharyngoesophageal or Zenker diverticula are a few frequent pathology that could represent between 1 and 3

of the patients with dysphagia and their physiopathology even at present is scarcity clear. OBJECTIVE: Therapeutic procedures results about this pathology were analyzed. SETTING: Caraffa and Sucre Clinic. DESIGN: Retrospective observational study. METHOD: It analyzed 13 patients operated by Zenker diverticula 9 of which were male and 4 were female sex with an average age of 55.6 years. Dysphagia occurred in 100

of the cases. Besides clinical finding the diagnosis was made evident by esophageal X-ray with contrast medium and endoscopy. Diverticulectomy by one stage through a left cervicotomy was the surgical procedure of choice. RESULTS: There was no surgical mortality. Related with morbility 2 patients presented fistulas managed medically and in other 2 patients abscesses of surgical wound occurred. The follow-up was carried on 6 months, 4 and 7 years respectively without relapses and with a good posterior evolution. CONCLUSIONS: Based on our short experience and the results attained we think the treatment of Zenker or pharyngoesophageal diverticulum by diverticulectomy through a left cervicotomy is safe and effective procedure to control this pathology.