RESUMO
BACKGROUND: Intramural duodenal haematoma is a rare entity that usually occurs in the context of patients with coagulation disorders. A minimum percentage is related to processes such as pancreatitis and pancreatic tumours. CLINICAL CASE: The case is presented of a 45 year-old male with a history of chronic pancreatitis secondary to alcoholism. He was seen in the emergency room due to abdominal pain, accompanied by toxic syndrome. The abdominal computed tomography reported increased concentric duodenal wall thickness, in the second and third portion. After oesophageal-gastro-duodenoscopy, he presented with haemorrhagic shock. He had emergency surgery, finding a hemoperitoneum, duodenopancreatic tumour with intense inflammatory component, as well a small bowel perforation of third duodenal portion. A cephalic duodenopancreatectomy was performed with pyloric preservation and reconstruction with Roux-Y. DISCUSSION: Treatment of a duodenal haematoma is nasogastric decompression, blood transfusion and correction of coagulation abnormalities. Surgery is indicated in the cases in which there is no improvement after 2 weeks of treatment, or there is suspicion of malignancy or major complications arise. CONCLUSIONS: Duodenal intramural haematoma secondary to chronic pancreatitis is rare, although the diagnosis should be made with imaging and, if suspected, start conservative treatment and surgery only in complicated cases.
Assuntos
Abdome Agudo/etiologia , Duodenopatias/complicações , Hematoma/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Introducción: el objetivo de este trabajo es presentar un caso de empalamiento a través de la región inguinal. Las heridas por empalamiento son infrecuentes y, en ocasiones, de extrema gravedad, necesitan de una actuación rápida del personal médico de urgencias y del cirujano. Caso clínico: se presenta el caso de un varón de 40 años que sufrió un accidente laboral con empalamiento de un hierro de ferralla a través de la región inguinal derecha, el cuerpo extraño penetró en la cavidad abdominal. Se expone ampliamente el caso clínico, así como los procedimientos realizados en el diagnóstico y el tratamiento de este tipo de lesiones. Conclusiones: las heridas por empalamiento son infrecuentes y suponen un reto para el personal médico que atiende al afectado desde el primer momento, tanto por lo complejas que pueden ser, como por la necesidad de una actuación rápida, sin poder conocer a priori, en muchas de las situaciones, la extensión verdadera de las lesiones, que se evidenciará durante el posible acto operatorio(AU)
Introduction: the objective of this paper was to present a case of impalement through the inguinal region. The impalement injuries are infrequent and sometimes extremely serious. These injuries require prompt action of the emergency medical personnel and surgeon. Clinical case: a forty-year old man, who had an occupational accident resulting in impalement of an iron rebar through the right inguinal region and penetrating abdominal cavity. The clinical case and the procedures performed in the diagnosis and treatment of these injuries were presented in detail. Conclusions: The impalement injuries are rare and represent a challenge to the medical staff that treat the patient from the very beginning, because they can be very complex and require fast action and treatment. In many cases, the real dimension and severity of lesions at first is unknown and can only be assessed during surgery(AU)