RESUMO
BACKGROUND: Intended open abdomen is an option in cases of trauma and non-trauma patients. Nevertheless, after primary closure, incisional hernia rate is high. We describe a novel method, called COmbined and MOdified Definitive Abdominal closure (COMODA), a delayed primary closure which prevents incisional hernia. METHODS: A negative pressure wound therapy system is combined with a condensed polytetrafluoroethylene (cPTFE) mesh. TRIAL REGISTRATION: ISRCTN72678033. RESULTS: Ten male patients with a median age of 68.8 (43-87) years were included. Primary closure rate was 100% per protocol. The median number of procedures per patient was 5.7 (5-9). Primary closure was obtained in 20.8 (10-32) days and median hospital stay was 36.3 (18-52) days. Only one patient developed incisional hernia during a median follow-up of 27 (8-60) months. CONCLUSION: COMODA method allows for a high rate of delayed primary closure. It is safe and decreases the risk for developing an incisional hernia. However, a large number of patients are needed to support this conclusion.
Assuntos
Hérnia Ventral/prevenção & controle , Hérnia Incisional/prevenção & controle , Tratamento de Ferimentos com Pressão Negativa , Técnicas de Abdome Aberto/métodos , Telas Cirúrgicas , Parede Abdominal/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Hérnia Ventral/etiologia , Humanos , Hérnia Incisional/etiologia , Masculino , Metilmetacrilatos/administração & dosagem , Pessoa de Meia-Idade , Técnicas de Abdome Aberto/efeitos adversos , Politetrafluoretileno/administração & dosagem , Povidona/administração & dosagemRESUMO
OBJECTIVE: To describe two cases of adrenal pseudocyst that presented as acute abdomen and shock. METHODS: Two cases of adrenal pseudocyst are presented: one patient was a 69-year-old woman who presented with shock and pain in the left hypochondrium and the other was a 23-year-old woman who complained of dizziness and pain in the left hypochondrium. RESULTS: US and CT evaluation showed a heterogeneous cystic mass. Blood analysis showed low hematocrit and hemoglobin levels. Surgical resection of the retroperitoneal cystic mass was performed. The pathological analysis disclosed an adrenal pseudocyst. CONCLUSIONS: Adrenal pseudocyst is an uncommon lesion that infrequently causes symptoms and rarely presents as acute abdomen. Ultrasound and CT are the most useful diagnostic imaging methods. Treatment is by surgery if the lesion is large and symptomatic, if it cannot be clearly distinguished from a tumor, and if massive hemorrhage occurs.
