RESUMEN
RESUMEN Los cuerpos extraños en el esófago son un problema frecuente en urgencias, debido la mayoría de las veces a ingestión accidental. Presentamos el caso de una paciente femenina de 50 años, sin antecedentes patológicos, que consulta por presentar la ingesta de prótesis dental mientras almorzaba, con posterior disfagia, odinofagia y dolor cervical. Se le realizan radiografías y tomografía computarizada (TC) donde se evidencia imagen radiopaca en esófago cervical. Se interconsulta con el Servicio de Gastroenterología, dada la imposibilidad de extracción de la prótesis por vía endoscópica. Se realiza luego cervicotomía lateral izquierda de emergencia, con esofagotomía, extracción del cuerpo extraño y cierre primario del esófago. La obstrucción del esófago por cuerpos extraños puede ocasionar muchas complicaciones. La consecuente demora en el tratamiento puede llevar a un marcado aumento de la mortalidad. Por eso, en este caso, se prioriza la cirugía ante un riesgo elevado de perforación y hemorragia.
ABSTRACT Esophageal foreign bodies are a common problem in the emergency department, usually due to accidental ingestion. We report the case of a 50-year-old otherwise healthy female patient who sought medical care due to dysphagia, odynophagia and cervical pain after swallowing a partial denture while having lunch. The patient underwent X-rays and a computed tomography (CT) scan which showed a radiopaque image in the upper esophagus. After a failed attempt to remove the denture through endoscopy, surgery was decided via a left lateral emergency cervicotomy with esophagotomy, foreign body removal and primary closure of the esophagus. Esophageal obstruction due to foreign bodies may cause many complications. Treatment delays may result in increased mortality. Thus, in this case we prioritized surgery due to high risk of perforation and bleeding.
Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Esofagostomía , Esófago , Cuerpos Extraños , Dentadura Parcial , EndoscopíaRESUMEN
A contained open abdomen is commonly used during damage control laparotomy and consists of the temporary coverage of the abdomen for protection of the viscera and reduction of intra-abdominal pressure. Definitive closure of a contained open abdomen is technically difficult due to the inability to obtain primary fascial suture. The insertion of a prosthetic mesh can be complicated with enterocutaneous fistula, and other definitive closure techniques need several surgical procedures. We describe a low cost technique that allows definitive closure of large abdominal wall defects avoiding the risk of intestinal fistula.
Asunto(s)
Traumatismos Abdominales/cirugía , Fístula Intestinal/prevención & control , Laparotomía/métodos , Recto del Abdomen/trasplante , Colgajos Quirúrgicos/irrigación sanguínea , Traumatismos Abdominales/diagnóstico , Adolescente , Adulto , Anciano , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Humanos , Cuidados Intraoperatorios/métodos , Laparotomía/efectos adversos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Recto del Abdomen/cirugía , Medición de Riesgo , Mallas Quirúrgicas , Dehiscencia de la Herida Operatoria/prevención & control , Técnicas de Sutura , Factores de Tiempo , Resultado del Tratamiento , Cicatrización de Heridas/fisiología , Adulto JovenRESUMEN
A 38-year-old woman with neurofibromatosis type 1 was referred for massive swelling of the left thigh, pain, and anemia. Angiography demonstrated three saccular aneurysms of the femoropopliteal artery. The largest measured 3 cm in diameter. Resection of the aneurysms and femoropopliteal interposition grafting using reversed saphenous vein was performed through a medial surgical approach. Arterial involvement in neurofibromatosis is a well known but infrequent occurrence. Stenotic lesions predominate. Aneurysmal defects are less common, and rupture of peripheral arteries is exceptional. Neurofibromatous invasion and dysplasia of the tunica media of the femoropopliteal vessel were confirmed by means of pathologic study. We think this is the second reported case of a femoropopliteal artery aneurysm and rupture associated with neurofibromatosis.