Rotura vesical intraperitoneal y reparación laparoscópica: ¿es éste el nuevo gold standard? / Intraperitoneal bladder rupture and laparoscopic repair: is this the new gold standard?

Introduction: Nowadays laparoscopy is the new paradigm in many surgical treatments; however, its role in urological trauma is barely emerging. The aim of this article is to show a laparoscopic repair technique of an intraperitoneal bladder rupture secondary to a blunt abdominal trauma, its feasibility and safety. Case: We present a 28 year old man who consulted with 6 hours of hypogastric pain, absence of micturition and vesical globe, after alcoholic consumption. He presented high blood both creatini-ne and inflammatory parameters. A Foley catheter was installed, the pain increased progressively, with Blumberg sign and tachycardia. Looking back again, he told about a blow in the hypogastric region with full bladder. A non-contrasted CT of the pelvis showed the catheter's end into peritoneal cavity. A successfully three port laparoscopic repair was made using intracorporeal double layer suturing technique with poliglactin, an intraoperative cystoscopic check was performed. The patient was discharged at sixth day without complications. Discussion: Classically surgical treatment for intraperitoneal bladder rupture has been laparotomy with double layer closure of the lesion. However, there are no randomized control trials comparing this technique with other methods. Also, there is a lack of laparoscopic repair reports, probably due to most bladder ruptures are extraperitoneal (managed with non-surgical treatment) or associated with other organs injury (needing laparotomy). Although more evidence is needed, we believe that laparoscopic repair of intraperitoneal bladder rupture could be considered as an option in stable patients and without important associated injuries, achieving better cosmetic outcomes and faster recovering.

Introducción: Actualmente la laparoscopia es el nuevo paradigma en muchos tratamientos quirúrgicos, pero su rol en trauma urológico es incipiente. Nuestro objetivo es mostrar una técnica factible y segura de cistorrafia laparoscópica por ruptura vesical intraperitoneal contusa. Caso: Un hombre de 28 años consulta por 6 horas de dolor hipogástrico, retención y globo vesical, después de una transgresión alcohólica. Ingresa con creatininemia y parámetros inflamatorios elevados. A pesar de un sondeo vesical exitoso, evoluciona con más dolor, Blumberg y taquicardia. Revisando la anamnesis, refiere un golpe en hipogastrio, con vejiga llena. En pieloTAC se observa el extremo de la sonda en cavidad peritoneal. En pabellón, se realiza una reparación laparoscópica mediante tres trócares, usando sutura de poliglactina en doble capa, con revisión cistoscópica intraoperatoria. El paciente se da de alta al sexto día postoperatorio, sin complicaciones. Discusión: Clásicamente, el tratamiento quirúrgico de la ruptura vesical intraperitoneal, ha sido la laparotomía exploradora con cierre de la lesión en doble capa. Sin embargo, esta técnica no ha sido comparada en estudios randomizados con otras modalidades. Además, hay escasos reportes de la técnica laparoscópica, probablemente porque la mayoría de las lesiones son extraperitoneales (con manejo conservador) o con lesión de otros órganos (requiriendo laparotomía). Se necesita más evidencia, pero creemos que la cistorrafia laparoscópica de lesiones intraperitoneales, es una buena conducta en pacientes estables sin otros daños asociados, alcanzando mejores resultados estéticos y una recuperación más rápida.

[Spontaneous pneumomediastinum. Review of eight cases]. / Neumomediastino espontáneo (síndrome de Hamman): una enfermedad benigna mal diagnosticada.

BACKGROUND: Hamman syndrome or spontaneous pneumomediastinum is uncommon and its clinical manifestations are chest pain, dyspnea and subcutaneous emphysema. AIM: To report a series of patients with spontaneous pneumomediastinum. MATERIAL AND METHODS: Medical records of patients with the diagnosis of pneumomediastinum, managed between 2002 and 2007 in a public hospital, were retrieved and reviewed. RESULTS: Eight patients aged between 16 and 41 years (five males) were identified. The most common symptom was chest pain and the most common sign was subcutaneous emphysema. A chest X ray was performed in all and a chest CT scan in seven. AH were managed conservatively with oxygen, analgesia and rest. No patient required surgery and the evolution was favorable. CONCLUSIONS: The most common presenting complaint of spontaneous pneumomediastinum is chest pain and its management does not require surgery.

Neumomediastino espontáneo (síndrome de Hamman): Una enfermedad benigna mal diagnosticada / Spontaneous pneumomediastinum: Review of eight cases

Background: Hamman syndrome or spontaneous pneumomediastinum is uncommon and its clinical manifestations are chest pain, dyspnea and subcutaneous emphysema. Aim: To report a series of patients with spontaneous pneumomediastinum. Material and methods: Medical records of patients with the diagnosis of pneumomediastinum, managed between 2002 and 2007 in a public hospital, were retrieved and reviewed. Results: Eight patients aged between 16 and 41 years (five males) were identified. The most common symptom was chest pain and the most common sign was subcutaneous emphysema. A chest X ray was performed in all and a chest CT scan in seven. AH were managed conservatively with oxygen, analgesia and rest. No patient required surgery and the evolution was favorable. Conclusions: The most common presenting complaint of spontaneous pneumomediastinum is chest pain and its management does not require surgery.

[Spontaneous retroperitoneal hematoma. Report of one case]. / Hematoma retroperitoneal espontáneo. Caso clínico.

Spontaneous retroperitoneal hematoma is a rare condition. We report a 78 year-old man with progressive pain in his right thigh and hip lasting one week. The pain subsequently was associated with abdominal pain in the right lower quadrant. Physical examination revealed pain to deep palpation of the area, associated with a diffuse positive rebound pain. An abdominal and pelvis CT scan showed an extensive mesenteric hematoma. During surgery, a large retroperitoneal encapsulated hematoma, without evidence of active bleeding, was found and drained. Pathology confirmed the diagnosis and was negative for cancer.

Hematoma retroperitoneal espontáneo: Caso clínico / Spontaneous retroperitoneal hematoma: Report of one case

Spontaneous retroperitoneal hematoma is a rare condition. We report a 78 year-old man with progressive pain in his right thigh and hip lasting one week. The pain subsequently was associated with abdominal pain in the right lower quadrant. Physical examination revealed pain to deep palpation of the area, associated with a diffuse positive rebound pain. An abdominal and pelvis CT scan showed an extensive mesenteric hematoma. During surgery, a large retroperitoneal encapsulated hematoma, without evidence of active bleeding, was found and drained. Pathology confirmed the diagnosis and was negative for cancer.