RESUMO
The most common causes of acute gastric outlet obstruction (GOO) are duodenal and type 3 gastric ulcers. However, mechanical or functional causes may also lead to this pathology. Acute GOO is characterized by delayed gastric emptying, anorexia, or nausea accompanied by vomiting. Herein we report a 56-year-old man diagnosed with GOO secondary to paraesophageal hiatal herniation of gastric antrum after laparoscopic fundoplication. Because of the rarity of this disease, common gastrointestinal complaints may mislead the emergency physician to diagnose a nonsurgical gastrointestinal disease if a detailed history and physical examinations are not obtained.
Assuntos
Fundoplicatura , Obstrução da Saída Gástrica/etiologia , Hérnia Hiatal/etiologia , Laparoscopia , Complicações Pós-Operatórias , Fundoplicatura/métodos , Obstrução da Saída Gástrica/diagnóstico , Hérnia Hiatal/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Antro PilóricoRESUMO
Air contained within the spinal canal is termed pneumorrhachis, and very rarely, traumatic pneumocephalus can cause pneumorrhachis. Pneumorrhachis can be classified as epidural or subarachnoid space pneumorrhachis.
Assuntos
Enfisema/etiologia , Traumatismos Cranianos Fechados/complicações , Canal Medular , Acidentes de Trânsito , Vértebras Cervicais , Enfisema/diagnóstico por imagem , Enfisema/terapia , Traumatismos Cranianos Fechados/diagnóstico por imagem , Humanos , Vértebras Lombares , Masculino , Pessoa de Meia-Idade , Pneumocefalia , Canal Medular/diagnóstico por imagem , Espaço Subaracnóideo , Vértebras Torácicas , Tomografia Computadorizada por Raios XRESUMO
This study was undertaken to evaluate the use of computed tomography pulmonary angiography (CTPA) in patients with pulmonary embolism (PE) who were followed in the emergency department (ED). The files and computer records of 850 patients older than 16 years of age who were seen in the Hacettepe University Hospital ED between April 10, 2001, and December 1, 2005, and who required CTPA for PE prediagnosis and/or another diagnosis, were studied retrospectively. PE was identified by CTPA in 9.4% of 416 women and in 5.8% of 434 men. A significant difference (P<.05) was noted in the women and men in whom PE was detected. The mean age of the patients was 58.13+/-17.88 y (range, 16-100 y). Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for clinical susceptibility to PE among patients who underwent CTPA were assessed at 95.3%, 48.2%, 13%, and 99.2%, respectively. CTPA was done for different reasons: aortic aneurysm dissection (n=1), cough distinctive diagnosis (n=1), dyspnea distinctive diagnosis (n=6), chest pain distinctive diagnosis (n=3), PE prediagnosis (n=51), and other reasons (n=2). Also, sensitivity, specificity, PPV, and NPV were found to be 95.4%, 16.2%, 14.4%, and 96%, respectively, for D-dimer. CTPA, which is accessible on a 24-h basis in the ED, is a valuable tool for the diagnosis of PE.
