RESUMO
OBJECTIVE: To present a case of esophagic perforation due to a pneumatic dilatations of the cardias in a patient with achalasia. BACKGROUND: Achalasia of the esophagus is a primary motor alteration with an unknown cause. The principal characteristics are the lower or absent peristaltic waves in the esophagic body and the impared lower esophagic sphincter relaxation during deglution. The management is palliative with pneumatic dilatations, pharmacologic therapy or with surgery. When a esophagic perforation occurs, it must be diagnosed and treated as soon as possible because a delay in diagnosis and management affect directly the patient prognosis. METHOD: To present a case of esophagic perforation due to pneumatic dilatations of the cardias in a patient with achalasia. CONCLUSIONS: An useful palliative management for achalasia is the pneumatic forceful dilatation, however it carries some risk of perforation; in every patient who was treated with dilatations is mandatory to think in perforation when the clinical condition is different after the procedure. The success of surgical management of the perforated esophagus and the control of sepsis and mediastinitis depends directly of the clinical condition of the patient and the time within perforation and surgical therapy.
Assuntos
Cateterismo/efeitos adversos , Acalasia Esofágica/terapia , Perfuração Esofágica/etiologia , Idoso , Humanos , MasculinoRESUMO
OBJECTIVE: To describe the clinical presentation and treatment of one patient with a neuroendocrine pancreatic neoplasm and gastrointestinal hemorrhage. BACKGROUND: Neuroendocrine pancreatic tumors are relatively rare neoplasms. When the tumor does not have endocrine function, clinical manifestations are non-specific and show symptoms when the tumor is quite large. Massive upper gastrointestinal hemorrhage is an infrequent clinical manifestation of these tumors. METHOD: A case of gastrointestinal hemorrhage, which required a pancreaticoduodenectomy to control bleeding of an ulcerated pancreatic head neoplasm, is presented. CONCLUSION: Pancreaticoduodenectomy is the procedure of choice to control duodenal massive bleeding secondary to an ulcerated neuroendocrine tumor of the pancreas.
Assuntos
Hemorragia Gastrointestinal/cirurgia , Pancreaticoduodenectomia , Adulto , Feminino , Hemorragia Gastrointestinal/patologia , HumanosRESUMO
OBJECTIVE: To describe the clinical presentation and treatment of two patients with the Klippel-Trenaunay syndrome referred to our hospital because of rectal bleeding and to review the literature concerning the diagnosis and treatment of this complication. CASE 1: Fifteen year old male with the Klippel-Trenaunay syndrome and chronic anemia who presented with severe rectal bleeding. CASE 2: Nineteen year old female with the same syndrome and a two year history of intermittent rectal bleeding, anemia and thrombocytopenia. In both cases the study protocol revealed varicose lesions in the colon as the cause of bleeding and other vascular malformations related to their syndrome. TREATMENT: The first patient was treated with partial colectomy and colorectal anastomosis. Four years after surgery he presented with new episodes of bleeding and was treated with sclerosis of the residual rectal varices using formaldehyde. The second patient was treated with partial colectomy and colostomy. She has received to sessions of sclerosis with absolute alcohol of the residual varices in the rectal stump. Colostomy closure is soon to be performed. CONCLUSION: Klippel-Trenaunay syndrome is a rare clinical entity with vascular alterations at different levels. A small percentage of cases may present rectal bleeding due to colonic varices and can lead to chronic anemia or severe hemorrhage with hemodynamic implications. Treatment of this complication involves resection of the affected colonic segment combined with a secondary procedure to control bleeding of the residual rectal varices.