RESUMO
Introducción: la endometriosis es una de las patologías ginecológicas más frecuentes, que se entiende como la implantación intrapélvica de tejido endometrial, sensible, en la gran mayoría de casos, al influjo hormonal. Extrauterinamente, se caracteriza por la presencia de glándulas y estroma endometrial en órganos o tejidos no ginecológicos. Sin embargo, la piel corresponde a uno de los sitios con menor fre-cuencia de implantación, ya sea de forma primaria o secundaria. Se calcula la incidencia de endometrio-sis cutánea en la zona umbilical en menos del 1 % de los casos. Presentación del caso: mujer de 36 años de edad, quien consulta con Cirugía General por un cuadro clínico de dos años de evolución, consistente en lesiones sobrelevantadas de la piel en la región umbilical, de color café oscuro, las cuales describe como dolorosas y sangrantes en el momento del ciclo menstrual. A pesar de haber sido resecadas en dos ocasiones, se encontró persistencia del cuadro. Discusión: la endometriosis cutánea primaria umbilical representa del 0.5 al 1.0 % de todas las pacientes con endometriosis ectópica, y el ombligo es uno de los sitios menos comunes de implantación. Esta condición afecta alrededor del 5 al 15 % de mujeres en edad fértil, y del 3 al 5 % de mujeres en edad menopaúsica. La presentación clínica más común se basa en una masa palpable, sangrado umbilical y dolor regular o irregular abdominal. Al asociar la endometriosis extrapélvica con la presencia de endometriosis pélvica, solamente alrededor del 20 % de las pacientes presentará esta última
Introduction: Endometriosis is one of the most frequent gynecological pathologies, understood as an intrapelvic implantation of endometrial tissue, sensitive to hormonal influence in most cases. At the extrauterine level, it is characterized by the presence of endometrial glands and stroma in the non-gy-necological organs or tissues. However, the skin corresponds to one of the sites with the least frequency of implantation, either primary or secondary, with the incidence of cutaneous endometriosis being calculated at the umbilical level in <1% of the cases. Case presentation: A 36-year-old female patient presented to the General Surgery department with a two-year history of dark brown, raised skin lesions in the umbilical region, which she described as painful, and bleeding at the time of the menstrual cycle. Despite having been resected twice, the condition still persisted. Discussion: Umbilical primary cutane-ous endometriosis represents 0.5%1.0% of all patients with ectopic endometriosis, with the navel being one of the least common implantation sites. This condition affects about 5%−15% of women of childbear-ing age, and 3%−5% women of menopausal age. The most common clinical presentation is based on the palpable mass, umbilical bleeding, regular or irregular abdominal pain. Associating extrapelvic endo-metriosis with the presence of pelvic endometriosis, only about 20% of the patients will have the latter
Introdução: a endometriose é uma das patologias ginecológicas mais frequentes, entendida como o implante intrapélvico de tecido endometrial, sensível na grande maioria dos casos à influência hor-monal. No nível extrauterino, é caracterizada pela presença de glândulas e estroma endometriais em órgãos ou tecidos não ginecológicos. Porém, a pele corresponde a um dos locais com menor frequência de implantação, seja ela primária ou secundária, calculando-se a incidência de endometriose cutânea ao nível umbilical em menos de 1% dos casos. Apresentação do caso: paciente do sexo feminino, com 36 anos de idade, que consulta para Cirurgia Geral devido a quadro clínico de 2 anos de evolução, cons-tituído por lesões cutâneas elevadas na região umbilical, de coloração marrom-escura, que descreve como dolorosas e com sangramento no momento do ciclo menstrual. Apesar de ter sido ressecado em 2 ocasiões, o quadro era persistente. Discussão: a endometriose cutânea primária umbilical representa 0.5%-1.0% de todas as pacientes com endometriose ectópica, sendo o umbigo um dos locais de implan-tação menos comuns. Essa condição afeta cerca de 5% a 15% das mulheres em idade reprodutiva e 3% a 5% das mulheres em menopausa. A apresentação clínica mais comum baseia-se em massa palpável, sangramento umbilical, dor abdominal regular ou irregular. Ao associar a endometriose extrapélvica à presença de endometriose pélvica, apenas cerca de 20% das pacientes a apresentarão
Assuntos
Humanos , Feminino , Adulto , Endometriose , Pele , Cirurgia Geral , Umbigo , IncidênciaRESUMO
INTRODUCTION AND IMPORTANCE: Congenital hernias occur 70% on the right side, 25% on the left side, and approximately 5% bilaterally. The finding of a congenital Amyand's hernia is of interest, especially in patients who do not present risk factors associated with connective tissue disorders, ascitic conditions, fetal developmental disorders or any condition that increases abdominal pressure. CASE PRESENTATION: Male patient, 6 months old, was brought to the pediatric surgery department due to a visible mass in the bilateral inguinal region, which protruded with crying. The parents report that he was a 36-week preterm, low birth weight, monochorionic monoamniotic twin with bilateral congenital inguinal hernia. An open herniorrhaphy was performed, showing a left communicating hydrocele with an indirect left inguinal hernia and right communicating hydrocele with indirect inguinal hernia containing cecal appendix with no signs of inflammation. CLINICAL DISCUSSION: The most common clinical presentation is the presence of a reducible or irreducible mass, erythema and/or inguino-scrotal edema, irritability manifested by crying and recurrent pain in older infants. This condition may be associated with cryptorchidism, intrauterine structural developmental disorder, and the presence of fistulas. Appendectomy and traditional hernia reduction are the most common surgical approach. The evolution of this condition is favorable with extremely low complication rates. CONCLUSION: Amyand's hernia in the neonate is a rare presenting condition, which frequently involves nearby structures with risk of inflammation, incarceration and perforation, so repair should be performed early.
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El empalamiento es una causa grave y rara de lesión anorrectal, pudiendo darse en multitud de contextos, ya sea de índole accidental, psiquiátrica o por prácticas sexuales o criminales. El objetivo de este manuscrito es mostrar al autoempalamiento como agente causante de lesión anorrectal, de presentación extraordinaria. Se presenta un caso de empalamiento autoinfligido con perforación intestinal en un hombre de 44 años, que acudió al servicio de urgencias sin el objeto causante de la lesión y con un cuadro de abdomen agudo, debido a hemoperitoneo, peritonitis fecal y perforación en la unión rectosigmoidea.The impalement is a severe and rare cause of the anorectal lesion and can occur in a multitude of contexts, whether accidental, psychiatric or due to sexual or criminal practices. The objective of this manuscript is to show self-packing as the causative agent of anorectal lesion, being of extraordinary presentation. We present the case of self-inflicted impalement with intestinal perforation in a 44-year-old man, who attends the emergency department without the cause of the injury and with an acute abdomen, due to hemoperitoneum, fecal peritonitis and a perforation in the rectosigmoid junction.
Assuntos
Perfuração Intestinal , Adulto , Colo , Serviço Hospitalar de Emergência , Humanos , Perfuração Intestinal/etiologia , MasculinoRESUMO
Se presenta un caso de perforación de íleon distal, posterior a la ingesta de una espina de pescado. Se realiza la presentación del caso, en relación a la sintomatología clínica, estudios realizados para el diagnóstico conciso, ecografía abdominal. Se describe técnica operatoria y se realiza una discusión del asunto y de la información obtenida en la bibliografía.
Distal ileum perforation caused by a fish bone: a case reportABSTRACT We present a case of distal ileum perforation after the ingestion of a fish bone. This case report includes the symptomatology, studies conducted for reaching a concise diagnosis, abdominal ultrasound results, and description of the operative technique. In addition, a discussion of the topic and information gathered from the literature is carried out.