Passing Through a Hole: Delayed Diaphragmatic Hernia After Cytoreductive Surgery.

A diaphragmatic hernia is a protrusion of abdominal contents into the thoracic cavity. Although it is commonly congenital, diaphragmatic hernias can also be acquired. Blunt or penetrating trauma are among the most frequent causes, although spontaneous or iatrogenic cases have been reported. Recently, some case reports related to diaphragmatic hernia after debulking surgery for advanced ovarian cancer have been described. This is an exceedingly rare but life-threatening complication, being prompt recognition and surgical correction critical. We report a case of a delayed diaphragmatic hernia in a 19-year-old female resulting from cytoreductive surgery for advanced ovarian cancer. Rapid evolution from gastrointestinal symptoms to hypovolemic shock occurred, and intensive care admission was required. Immediate surgery was critical to improving the patient outcome. This case highlights this uncommon but life-threatening complication, the challenges of diagnosing and managing those patients, and the need for early recognition, support, and surgical correction.

[Subcutaneous Emphysema and Pneumomediastinum During a Tooth Extraction].

Subcutaneous emphysema is a possible but rare complication after dental procedures. The condition should be distinguished from other situations, such as hematoma, allergic reaction or angioedema, and infection. We describe the case of a 20-year-old puerperal woman, with multiple dental caries, who developed cervicofacial subcutaneous emphysema complicated by pneumomediastinum, following an incomplete extraction of the lower right second molar. This was diagnosed clinically and through imaging tests, and the situation resolved after hospital admission, with antibiotics and close monitoring. The case underlines the need to diagnose and treat this complication early, because of the risk of airway compromise, air embolism, infection, sepsis and death.

O enfisema subcutâneo cervicofacial e mediastínico é uma possível complicação, rara, após procedimentos dentários. Deve-se distinguir de outras situações como o hematoma, reação alérgica ou angioedema e infeção. Descreve-se o caso de uma puérpera de 20 anos com múltiplas cáries dentárias, que desenvolveu enfisema subcutâneo cervicofacial, complicado de pneumomediastino, após extração incompleta do segundo molar inferior direito. O diagnóstico da complicação foi clínico e imagiológico e a situação resolveu sob vigilância, com antibioterapia, em internamento. O caso pretende chamar a atenção para a necessidade de se diagnosticar e tratar precocemente esta complicação, devido ao risco de compromisso da via aérea, embolia gasosa, infeção, sépsis e morte.