RESUMO
Introducción: La ruptura diafragmática es un reto diagnóstico y terapéutico para los médicos que se enfrentan al manejo de pacientes politraumatizados; debe sospecharse siempre en lesiones traumáticas de localización torácica o abdominal. Objetivo: Informar los elementos diagnósticos y terapéuticos seguidos ante ruptura diafragmática y esplénica de origen traumático. Presentación del caso: Se presenta el caso de un adolescente de 14 años que ingresa por presentar herida punzante por arma blanca de localización abdominal y manifestaciones clínicas que permiten hacer el diagnóstico de la afección tratada. Durante el acto quirúrgico se comprobó la ruptura del diafragma, hernia diafragmática y ruptura esplénica con salida de sangre hacia la cavidad abdominal. Se realizó reducción de la hernia, sutura del diafragma y extirpación del bazo por el estado del órgano en el momento de la cirugía. Conclusiones: La ruptura diafragmática postraumática es una entidad que cada vez se observa con mayor frecuencia en pacientes pediátricos. El examen clínico auxiliado por estudios imagenológicos resulta vital para su diagnóstico, tratamiento precoz y evitar complicaciones. Es importante mantener un alto índice de sospecha ante esta entidad poco frecuente, pero no rara en la edad pediátrica. El paciente tuvo una evolución favorable y fue egresado del servicio de cirugía luego de 10 días de hospitalización(AU)
Introduction: The diaphragmatic rupture is a diagnostic and a therapeutic challenge for physicians who have to face the management of polytraumatized patients; there must always be suspicion on traumatic injuries of thoracic or abdominal location. Objective: To inform the diagnostic and therapeutic elements followed in case of diaphragmatic and splenic rupture of traumatic origin. Presentation of the case: 14-year-old male teenager that was admitted for presenting stabbing wound by sharp weapon, with abdominal location and clinical manifestations that allow making the diagnosis of the condition being treated. During surgery, it was found the rupture of the diaphragm, a diaphragmatic hernia and splenic rupture with output of blood into the abdominal cavity. It was conducted the reduction of the hernia, the suture of the diaphragm and the removal of the spleen due to the state of the organ during the surgery. Conclusions: Post-traumatic diaphragmatic rupture is an entity that it is most often seen in pediatric patients. The clinical examination aided by imaging studies is vital for its diagnosis, early treatment and to avoid complications. It is important to maintain a high index of suspicion to face this rare entity, but not so rare in the pediatric age group. The patient had a favourable evolution and he was discharged of the surgery service after 10 days of hospitalization(AU)
Assuntos
Humanos , Masculino , Adolescente , Baço/lesões , Ruptura Esplênica/cirurgia , Diafragma/lesões , Hérnia Diafragmática Traumática/cirurgiaRESUMO
Se hizo un estudio descriptivo y transversal de 128 pacientes ingresados con fractura de cadera en el Servicio de Ortopedia y Traumatología del Hospital Clinicoquirúrgico Docente "Dr. Ambrosio Grillo" de Santiago de Cuba, desde junio del 2008 hasta mayo del 2009, con vistas a caracterizarles según determinadas variables clinicoepidemiológicas. Dichas lesiones resultaron más frecuentes en el grupo etario de 80-89 años y el sexo femenino, con predominio de las fracturas traumáticas extracapsulares, tratadas quirúrgicamente con reducción y osteosíntesis en 45,3 % de los afectados durante las primeras 24 horas de hospitalización. En 61,4 % del total se presentó alguna complicación como la anemia aguda e infección de la herida; no obstante, la mayoría de los integrantes de la casuística (96,9 %) egresó con vida.
A descriptive and cross-sectional study was carried out in 128 patients with hip fractures admitted to the Orthopedics and Traumatology Department at "Dr. Ambrosio Grillo" Teaching Clinical Surgical Hospital in Santiago de Cuba from June 2008 to May 2009, in order to characterize them according to certain clinical epidemiological variates. These injuries were more frequent in the age group of 80-89 years and in female sex, with a predominance of extracapsular traumatic fractures, treated surgically with reduction and osteosynthesis in 45,3 % of patients during the first 24 hours of hospitalization. There were some complications as acute anemia and wound infection in 61,4 % of the total; however, most cases (96,9 %) were discharged alive.
RESUMO
Um episódio de delirium após sangramento intestinal agudo é relatado em paciente masculino com 90 anos de idade. O local de sangramento, um pólipo adenomatoso no colon direito, foi identificado por de cintilografia com eritrócitos marcados com tecnécio. O paciente recebeu hemotransfusões e haloperidol, com rápida melhora antes daressecção endoscópica do pólipo. Este relato visa a aumentar o alerta dos clínicos gerais acerca do delirium, uma condição comum entre idosos, que pode representar alta morbidade e mortalidade. A anemia deve ser incluída entre os principais fatores de risco de alterações cognitivas em idosos.
An episode of delirium after an acute intestinal bleeding is reported in a 90-year-old male. The site of bleeding was detected by technetium-labeled erythrocyte scintigraphy, and was an adenomatous polyp of the right colon. The patient received blood transfusions and haloperidol, with rapid improvement before the endoscopic resection of the polyp. This report aims is to increase the awareness of general physicians about delirium, a common condition among the oldest old that may cause high morbidity and mortality. Anemia should be included among the main riskfactors of cognitive decline in elderly.