RESUMO
INTRODUCTION: Bouveret's syndrome is characterized by piloro-duodenal obstruction following the implant of a giant gallstone with gallstone ileus origin. It constitutes the less common variety of gallstone ileus (1-3%), mainly affecting elderly patients with chronic degenerative illnesses, possibly with high mortality. OBJECTIVE: We report the case of a patient with a less common variety of gallstone ileus. The patient was treated at a third-level care hospital. CLINIC CASE: Patient is a 52-year-old male with gastric obstruction and secondary dehydration. Studies were supported by a series of esophagus-gastric-duodenal and broad endoscopy. Piloro-duodenal obstruction by a giant gallstone was reported which could not be extracted by endoscopy. The patient was taken to surgery where a giant gallstone lying in the duodenal site was found and biliary vesicular scleroatrophic. Gastrotomy is effected with the extraction of the gallstone and gastrography. Gallstone duodenal fistula is then identified with support analysis. CONCLUSIONS: Bouveret's syndrome is a rare entity whose diagnosis has a high sensitivity and specificity with a supported radiographic diagnosis. Endoscopy is difficult in the case of a giant impacted gallstone, making surgery the best therapeutic choice.
Assuntos
Obstrução Duodenal/etiologia , Cálculos Biliares/complicações , Piloro , Obstrução Duodenal/diagnóstico , Obstrução Duodenal/cirurgia , Cálculos Biliares/diagnóstico , Cálculos Biliares/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , SíndromeRESUMO
OBJECTIVE: To know the current state of surgical management of patients with abdominal trauma. MATERIAL AND METHODS: We carried out a retrospective, observational, transversal study involving patients with abdominal trauma with clinical files wtih trauma who required surgery during the period of April 1, 1998 through March 30, 2003. RESULTS: There were 72 cases including nine male and 33 female patients. Mechanism of lesion was divided into closed and penetrating trauma, the latter group of patients divided into individuals with blunt wounds or with gunshot wounds. Most frequent early postoperative complication was hemorrhage, while most frequent late postoperative complication was acute renal failure. Causes of death were hypovolemic shock in four patients followed by two cases each with the following pathologies: acute respiratory insufficiency syndrome; myocardial infarct, and septic shock. CONCLUSIONS: Abdominal trauma is a frequent pathology in our environment, males the most affected patients, with penetrating trauma main lesion cause. Prolonged surgical time required hemotransfusions, and infectious processes together with processes related with tissular hypoxia are the most common cause of complications and death.