RESUMO
INTRODUCTION: Vascular trauma is a low frequency event and is related to a high burden of morbidity and mortality. Vascular trauma of the upper limb is of different etiology. More frequent, secondary to closed trauma. It is usually associated with other lesions, soft tissue and nerves. OBJECTIVES: To present a case of complex vascular trauma of the upper limb and its multidisciplinary management. METHOD: Description of the clinical case and literature review. The information was obtained from the patient's clinical record, review and analysis of the published literature was performed using search engines. CASE REPORT: Young man, fall with upper limb in extension, results in elbow dislocation associated with acute ischemia. AngioTAC confirms stop in brachial. Emergency surgery: brachio-radial saphenous bridge. It evolves with absence of pulses. It is reexplored finding incomplete fasciotomy, brachial artery bridge to cephalic vein with inverted saphenous. Elbow dislocated, unstable. Arterial bridge, external fixation and fasciotomy is completed. Coming out with radial pulse. He undergoes multiple surgeries and surgical toilets, achieving skin closure at 45 days. Then traumatology removes external tutors. Electromyography confirms incomplete lesion of median, radial and ulnar. Currently in the process of rehabilitation. DISCUSSION AND CONCLUSION: Vascular trauma of the upper limb is of low incidence. However, they are associated with a high burden of morbidity and mortality, generally occurring in young men. The diagnostic pillar is through the medical history and physical examination. its surgical management.
Assuntos
Humanos , Masculino , Artérias/cirurgia , Extremidade Superior/cirurgia , Lesões do Sistema Vascular/cirurgia , Artéria Braquial , Registros Médicos , Veias Braquiocefálicas , Resultado do Tratamento , FasciotomiaRESUMO
INTRODUCTION: Femoral hernias have a high risk of strangulation or obstruction, and their acute presentations are associated with a high risk of mortality, occurring in up to 60% of cases with complications. The presence of the appendix within the femoral sac has been described in a maximum of 1% of cases, which has been called Garengeot hernia, but only 0.08% with concomitant appendicitis. CASE REPORT: Woman 56 years old, cholecystectomized, with no other relevant history, 5 months of evolution, right femoral region volume increase, consultation for 24 hours of evolution of habitual pain exacerbation, CT scan showing complicated hernia, with appendix inside of the hernial sac. The right inguinal approach is performed, the cecal appendix is the only content within the hernial sac, with signs of acute appendicitis, appendectomy and hernia repair with Prolene mesh. Diagnosis is confirmed with biopsy. DISCUSSION AND CONCLUSION: Acute appendicitis within De Garengeot's hernia is extremely rare and often difficult to diagnose. The diagnosis of a femoral hernia appendicitis is often obscured by nonspecific clinical findings that indicate a complicated hernia. Computed tomography may be useful to definitively diagnose acute appendicitis contained within a femoral hernia. It is important to always consider De Garengeot hernia as a differential diagnosis in patients with inguinal mass of acute pain, so as not to delay its detection and management.
