RESUMEN
A very large incisional hernia measuring 59 x 35 cm was repaired in four stages after preoperative creation of a pneumoperitoneum using a Tenckoff catheter to facilitate reduction of the contents of the sac into the peritoneal cavity. Initially, three large sheets of 2-mm-thick expanded polytetrafluoroethylene (ePTFE, GORE-TEX Soft Tissue Patch) were used to bridge the defect. Two subsequent procedures further tightened the abdominal wall by excising several inches of the central part of the patch. During the fourth operation, the remaining ePTFE was explanted and replaced with two 15 x 19 pieces of macroporous ePTFE sheet (GORE-TEX Mycro Mesh), overlapping the lateral edges of healthy fascia to prevent herniation from the sides. Postoperative complications included a small draining sinus that cleared after the final operation and a seroma that resolved in several weeks. The patient has recovered and walks normally, which she was unable to do earlier.
Asunto(s)
Hernia Ventral/cirugía , Neumoperitoneo Artificial , Politetrafluoroetileno/uso terapéutico , Anciano , Femenino , Humanos , Prótesis e Implantes , Recurrencia , Procedimientos Quirúrgicos Operativos/métodos , Técnicas de SuturaRESUMEN
Massive gastrointestinal hemorrhage secondary to benign cecal ulceration is a rare occurrence. The diagnosis of bleeding from this benign condition is rarely entertained and is often a finding on a pathologic examination. A case of massive hemorrhage from a cecal ulcer is presented, and the literature is reviewed. The role of angiographic demonstration of the lesion, if angiography is readily available, is emphasized, but surgery is the definitive therapy.