RESUMEN
Accidental ingestion of foreign bodies is fairly common in the general population. However, recurrent, deliberate ingestion of foreign bodies associated with continual abdominal self-mutilation with blunt objects is extremely unusual. We present the case of a young woman with an underlying psychiatric disorder who repeatedly presented to the emergency department of our hospital for attempted suicide. The most frequent reason for presenting to the emergency department was ingestion of multiple objects, usually sharp metal objects, frequently associated with abdominal self-mutilation using a sharp instrument. Treatment consisted of extraction of the foreign bodies through upper gastrointestinal endoscopy or abdominal surgery. The patient has survived all these attempts with minimal morbidity.
Asunto(s)
Traumatismos Abdominales/etiología , Cuerpos Extraños/complicaciones , Trastornos Mentales/complicaciones , Intento de Suicidio , Traumatismos Abdominales/diagnóstico por imagen , Traumatismos Abdominales/cirugía , Adulto , Femenino , Cuerpos Extraños/diagnóstico por imagen , Gastroscopía , Humanos , Laparotomía , Radiografía Abdominal , Automutilación/complicaciones , Automutilación/diagnóstico por imagen , Resultado del TratamientoRESUMEN
Congenital diaphragmatic hernia of Morgagni-Larrey is a rare entity that usually presents on the right side. These hernias, occurring in the anterior midline through the sternocostal hiatus of the diaphragm, are usually discovered incidentally when the patient has reached adulthood, or when they become symptomatic due to intestinal involvement (occlusive symptoms) or when respiratory dysfunction occurs. We present 10 patients (mean age: 69 years) with symptomatic sternocostal hernia and intestinal occlusion. In 7 patients, the hernia was located on the right (Morgagni's hernia) and in three it was located on the left (Larrey's hernia). Most of the patients presented important associated comorbidity, mainly cardiovascular and neoplastic. Surgical treatment consisted of reduction of the contents of the herniated sac and hernia repair through simple suture with or without mesh for reinforcement, mainly through the abdominal approach. Mortality in this series was nil. The infrequency of this entity and its diagnosis mainly in adults, with a high prevalence of circumstances favoring abdominal hernias, suggest that an embryological defect of the sternocostal foramina of Morgagni or Larrey are an essential element in the physiopathology of these processes.
Asunto(s)
Hernia Diafragmática , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hernia Diafragmática/diagnóstico , Hernia Diafragmática/cirugía , Humanos , Masculino , Estudios RetrospectivosRESUMEN
Gallstone ileus is an infrequent surgical emergency that nevertheless represents a not insignificant percentage of occlusions of the small intestine without strangulation. We present a retrospective study of 21 years (1980-2000) in 40 patients. Mean age was 76 years and most of the patients (85%) were women. Mean age and associated disease increased throughout the study period. Cases of gallstone ileus decreased in the second and third 5-year periods and clearly increased in the fourth (1996-2000). Localization of gallstones was ileum in 25 patients, jejunum in 9, duodenum in 3, colon in 1 and feces in 2. Only 12 patients (30%) received a correct preoperative diagnosis. Treatment was surgical in 38 patients with 7.5% mortality and 57.5% morbidity. Enterolithotomy was the technique of choice. A high degree of suspicion for gallstone ileus and early treatment may be the factors required to improve prognosis. The increase in life expectancy and associated comorbidity, which contraindicate elective surgery for cholelithiasis, may be contributing towards an increase in the population prone to developing gallstone ileus.