RESUMO
The haemocholecyst is a rare disease with a low index of suspiction, which is even lower if the patient does not present risk factors. Likewise, the course of this pathology with a haemoperitoneum without vesicular perforation is equally infrequent. We present an unusual case in which the diagnosis of the patient was carried out intraoperatively. We consider that communicating these unusual cases in clinical practice helps to increase clinical suspiction and prompt diagnosis.
El hemocolecisto es una patología poco frecuente y con un índice bajo de sospecha, que todavía es menor si el paciente no presenta factores de riesgo. Asimismo, su curso con clínica de hemoperitoneo sin perforación vesicular es igualmente infrecuente. Presentamos un caso poco habitual en el cual el diagnóstico de la paciente se llevó a cabo intraoperatoriamente. Consideramos que comunicar estos casos poco habituales en la práctica clínica colabora a aumentar la sospecha clínica y el diagnóstico precoz.
Assuntos
Colecistite Aguda , Doenças da Vesícula Biliar , Colecistite Aguda/complicações , Hemoperitônio/etiologia , Humanos , Doenças RarasRESUMO
The preoperative use of progressive pneumoperitoneum has been demonstrated to be safe and effective in the treatment of large hernias. The indications for this technique include massive hernias, hernias in patients with high surgical risk, and large recurrent hernias. We describe four patients in whom progressive pneumoperitoneum was carried out under local anesthesia and sedation between 1 and 3 weeks before surgery. All four hernias were closed with a preperitoneal mesh. Insufflation was performed on an inpatient basis in two patients and in the ambulatory setting in one. No postoperative complications were detected. No evidence of recurrence was found during follow-up (10 months-11 years).
Assuntos
Hérnia Abdominal/cirurgia , Pneumoperitônio Artificial/métodos , Idoso , Feminino , Hérnia Abdominal/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Pneumoperitônio Artificial/efeitos adversos , Complicações Pós-Operatórias , Cuidados Pré-Operatórios , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
El uso del neumoperitoneo preoperatorio progresivo ha demostrado ser una técnica útil y eficaz para el tratamiento de grandes defectos de la pared abdominal. Está indicado en hernias gigantes, pacientes de alto riesgo quirúrgico y grandes defectos recidivados. Se describe a 4 pacientes en los que se empleó neumoperitoneo progresivo realizado bajo anestesia local y sedación entre 1 y 3 semanas antes de la cirugía, seguido del tratamiento del defecto herniario con malla preperitoneal. Dos pacientes en régimen ambulatorio y 2 hospitalizados. No se detectaron complicaciones postoperatorias. Durante el seguimiento (10 meses-11 años) no hubo evidencias de recidiva (AU)
The preoperative use of progressive pneumoperitoneum has been demonstrated to be safe and effective in the treatment of large hernias. The indications for this technique include massive hernias, hernias in patients with high surgical risk, and large recurrent hernias. We describe four patients in whom progressive pneumoperitoneum was carried out under local anesthesia and sedation between 1 and 3 weeks before surgery. All four hernias were closed with a preperitoneal mesh. Insufflation was performed on an inpatient basis in two patients and in the ambulatory setting in one. No postoperative complications were detected. No evidence of recurrence was found during follow-up (10 months-11 years) (AU)
