RESUMO
BACKGROUND: The intestinal obstruction secondary to internal hernia is a diagnostic challenge. The absence of specific symptoms and signs during clinical examination often lead to underestimation of the severity and early surgical treatment. The purpose of this article is to review the clinical presentation of two patients with internal hernia, describe the clinical, biochemical and radiological findings, with emphasis on the L-lactate as an early serum marker of intestinal ischemia. CLINICAL CASES: Case 1: female, 44 years history of urolithiasis and 2 cesarean sections. Case 2: female, 86 year old with a history of open cholecystectomy, incisional and bilateral inguinal hernia repair with mesh placement. Both admitted with abdominal pain and intestinal obstruction data. The only significant laboratory finding was elevation of L-lactate. The abdominal films showed air-fluid levels, dilated loops of small intestine and colon. Abdominal contrast tomography showed free abdominal fluid id, internal hernia and torque of mesentery. In both cases, exploratory laparotomy was performed with bowel resection of ischemic segments, with uneventful recovery. CONCLUSIONS: Intestinal ischemia secondary to internal hernia is difficult lt to diagnose. In patients with a high suspicion, signs of intestinal obstruction by plain radiography, the elevation of L-lactate, could help in the early diagnosis of intestinal ischemia and immediate surgical treatment.
Assuntos
Doenças do Colo/complicações , Hérnia Abdominal/complicações , Hérnia/complicações , Doenças do Íleo/complicações , Obstrução Intestinal/sangue , Intestinos/irrigação sanguínea , Lactatos/sangue , Isquemia Mesentérica/etiologia , Anormalidade Torcional/sangue , Dor Abdominal/etiologia , Adulto , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Biomarcadores , Doenças do Colo/cirurgia , Colostomia , Feminino , Hérnia Inguinal/cirurgia , Herniorrafia , Humanos , Doenças do Íleo/cirurgia , Obstrução Intestinal/etiologia , Intestinos/cirurgia , Laparotomia , Leucocitose/etiologia , Mesentério , Pneumatose Cistoide Intestinal/etiologia , Complicações Pós-Operatórias/sangue , Complicações Pós-Operatórias/etiologia , Telas Cirúrgicas , Anormalidade Torcional/etiologiaRESUMO
BACKGROUND: Bochdalek's hernia is a congenital defect of the posterolateral region of the diaphragm, usually on the left side. It appears frequently in infants and is rare in adults. Diagnosis is incidental or when it becomes symptomatic. Our objective was to offer the general surgeon a differential diagnosis for presence of noncardiac thoracic pain in the adult. CLINICAL CASE: We present the case of a 78-year-old female with cardiorespiratory and digestive symptoms of slight intensity and managed for many years as hypertensive cardiopathy and dyspeptic syndrome until she was admitted to our service with severe epigastric pain. Postero-anterior x-ray of the thorax demonstrated the presence of the stomach in the thoracic cavity. This was confirmed by barium esophagogram, upper gastrointestinal endoscopy and abdominal CT scan where porcelain gallbladder was also detected. The patient underwent abdominal surgery where a large diaphragmatic hernia was found with the complete stomach and small bowel inside. Primary repair of the diaphragm and cholecystectomy were performed, confirming gallbladder cancer. DISCUSSION: It is frequent that thoracic pain in patients of advanced age is interpreted as cardiac and/or digestive pathology and that more diagnostic investigation is not pursued due to patient age and invasive nature of the studies. Therefore, patients are treated according to their symptoms. It is important that the surgeon establishes an etiological diagnosis in order to offer appropriate treatment. CONCLUSIONS: Congenital diaphragmatic hernia in the adult is rarely suspected in the differential diagnosis of noncardiac thoracic pain. The surgeon must keep this in mind, especially in patients of advanced age, even when cardiac and/or gastrointestinal diagnosis is confirmed.
Assuntos
Dor no Peito/etiologia , Hérnias Diafragmáticas Congênitas , Idade de Início , Idoso , Carcinoma Adenoescamoso/complicações , Carcinoma Adenoescamoso/diagnóstico por imagem , Carcinoma Adenoescamoso/cirurgia , Colecistectomia , Colelitíase/complicações , Colelitíase/cirurgia , Tosse/etiologia , Erros de Diagnóstico , Dispepsia/diagnóstico , Feminino , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/cirurgia , Refluxo Gastroesofágico/etiologia , Cardiopatias/diagnóstico , Hérnia Diafragmática/complicações , Hérnia Diafragmática/diagnóstico , Hérnia Diafragmática/epidemiologia , Humanos , Achados Incidentais , Pneumopatias/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Bochdalek's hernia is a congenital defect of the posterolateral region of the diaphragm, usually on the left side. It appears frequently in infants and is rare in adults. Diagnosis is incidental or when it becomes symptomatic. Our objective was to offer the general surgeon a differential diagnosis for presence of noncardiac thoracic pain in the adult. CLINICAL CASE: We present the case of a 78-year-old female with cardiorespiratory and digestive symptoms of slight intensity and managed for many years as hypertensive cardiopathy and dyspeptic syndrome until she was admitted to our service with severe epigastric pain. Postero-anterior x-ray of the thorax demonstrated the presence of the stomach in the thoracic cavity. This was confirmed by barium esophagogram, upper gastrointestinal endoscopy and abdominal CT scan where porcelain gallbladder was also detected. The patient underwent abdominal surgery where a large diaphragmatic hernia was found with the complete stomach and small bowel inside. Primary repair of the diaphragm and cholecystectomy were performed, confirming gallbladder cancer. DISCUSSION: It is frequent that thoracic pain in patients of advanced age is interpreted as cardiac and/or digestive pathology and that more diagnostic investigation is not pursued due to patient age and invasive nature of the studies. Therefore, patients are treated according to their symptoms. It is important that the surgeon establishes an etiological diagnosis in order to offer appropriate treatment. CONCLUSIONS: Congenital diaphragmatic hernia in the adult is rarely suspected in the differential diagnosis of noncardiac thoracic pain. The surgeon must keep this in mind, especially in patients of advanced age, even when cardiac and/or gastrointestinal diagnosis is confirmed.
Assuntos
Humanos , Feminino , Idoso , Dor no Peito/etiologia , Hérnia Diafragmática/congênito , Idade de Início , Carcinoma Adenoescamoso , Colecistectomia , Colelitíase , Cardiopatias/diagnóstico , Erros de Diagnóstico , Dispepsia/diagnóstico , Neoplasias da Vesícula Biliar , Hérnia Diafragmática , Achados Incidentais , Pneumopatias/diagnóstico , Refluxo Gastroesofágico/etiologia , Tomografia Computadorizada por Raios X , Tosse/etiologiaRESUMO
Surgical site infection is one of the most important health problems representing an increase in morbi-mortality and economical devastation for the patient. There have been a variety of procedures that surgeons have employed to control this situation, from very refined surgical procedures, advanced antimicrobial therapy to local therapy with alginates, hydrocolloid dressings and many others with active topical substances. One of the newest treatments is the VAC (Vacuum-Assisted Closure). This therapy has been proven to be useful in wound infection control and we used it to carry out this study in 38 patients with wound infections. We present the results with this therapy in our institution.
Assuntos
Infecção da Ferida Cirúrgica/terapia , Vácuo , Desbridamento , Feminino , Humanos , Masculino , Curativos Oclusivos , Sucção/métodos , Técnicas de Sutura , Resultado do Tratamento , CicatrizaçãoRESUMO
Acute appendicitis is still the first cause of abdominal surgery worldwide, with 1.4 cases/1000 in the general population. As frequent as this is, appendiceal stump appendicitis is a very rare surgical event, due to an incomplete appendix resection and misleading cecum base identification due to cecum edema, abscesses, abnormal anatomy position of the appendix or multiple adhesions. The incidence of appendiceal stump appendicitis is not well known; however, there are some reports that suggest a slight increase in this pathology possibly due to laparoscopic surgical techniques. This report attempts to point out this diagnostic possibility to be considered by the surgeon when presented with a patient with acute abdominal pain and a past appendectomy.
Assuntos
Apendicectomia/efeitos adversos , Apendicite/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Idoso de 80 Anos ou mais , Feminino , HumanosRESUMO
Adrenal gland lymphangiomas are benign, non-functional, and uncommon tumors of lymphatic tissue and with a cyst component. The majority of these are asymptomatic and are discovered incidentally. We present the case of an adrenal gland lymphangioma in a 24-year-old female with a history of high blood pressure, headaches, and anxiety of nearly 2 years in whom a routine ultrasound exam revealed a cyst tumor of right adrenal gland confirmed by computer tomography (CT) scan. Surgery was performed and lymphangioma of adrenal gland was the pathologist's report. The patient's clinical symptoms disappeared.