ABSTRACT
Bile ileus represents 1-4% of mechanical intestinal obstructions with greater incidence in people over 65 (25%), predominantly in women (ratio 3.5: 1) (1,2), it is characterized by the impact of a Large gallstone (≥3cm) in the intestinal lumen through a fistula (1,2). This is a 77-year-old female patient with high blood pressure controlled, which comes from diffuse abdominal pain type 24 colic hours of evolution On physical examination the distended, painful abdomen at deep palpation, without peritonism, absent hydro sounds. The abdomen x-ray with uneven levels. It was initially handled by conservative way. Tests revealed leukocytosis, and ultrasound Abdominal showed an intestinal loop occupied by hyperechogenic imaging with posterior acoustic shadow (Figure 1); it is decided to perform tomography contrasted abdominal-pelvic, evidencing lobe pneumobilia left hepatic, dilated bile duct (11 mm), duodenal distention, jejunal and transition zone with 3.2cm calcified intraluminal image (Figure 2). With these findings the behavior was surgical exploration, finding jejunal mass, located 40cm from the angle of Treitz. In the enterotomy was removed large litho causing complete obstruction (Figure 3). Next, enterorrafa was performed and the procedure concluded without complications. The patient evolved favorably and She was discharged on the third day.
Subject(s)
Bile Ducts , Gallstones , Ileum , Intestinal DiseasesABSTRACT
El hematoma subcapsular hepático accidentado secundario a síndrome HELLP es una entidad infrecuente, relacionada a potenciales consecuencias fatales sobre la madre y el feto. Ocasionalmente el diagnóstico clínico puede verse dificultado por la presentación de síntomas y signos poco específicos, por lo cual los métodos de imagen adquieren particular importancia, en especial la tomografía axial computarizada. El manejo conservador o quirúrgico depende directamente del cuadro presentado por cada paciente. Se presenta el caso de una mujer de 43 años de edad que cursaba la semana 25.5 de gestación, quien fue hospitalizada con la impresión diagnóstica inicial de colelitiasis sintomática e hipertensión gestacional. Durante la laparoscopía se encontró un hematoma subcapsular hepático accidentado, que fue resuelto mediante laparotomía; posteriormente la paciente presentó una evolución favorable.
Accidental liver subcapsular hematoma secondary to HELLP syndrome is an infrequent entity, related to potential fatal consequences on the mother and fetus. Occasionally, clinical diagnosis can be hampered by the presentation of unspecific symptoms and signs, making imaging methods particularly important, especially computed tomography. Conservative or surgical management depends directly on the picture presented by each patient. We present the case of a 43-year-old woman who was in week 25.5 of gestation, who was hospitalized with the initial diagnostic impression of symptomatic cholelithiasis and gestational hypertension. During laparoscopy, an injured hepatic subcapsular hematoma was found, which was resolved by laparotomy; subsequently the patient presented a favorable evolution.
Subject(s)
Humans , Female , Pregnancy , Pre-Eclampsia , HELLP Syndrome , Hypertension , Hematoma , Liver AbscessABSTRACT
En vista del incremento de la incidencia del trauma abdominal en el servicio de cirugía, hemos decidido evaluar nuestro trabajo quirúrgico en los últimos años, determinar la incidencia, tipo de lesión, lesiones asociadas, morbilidad y tipo de tratamiento. Es un estudio, retrospectivo, comparativo y analítico. Se analizaron los expedientes de pacientes con diagnóstico de trauma abdominal quienes ingresaron a la institución entre enero de 1999 a mayo del 2004, se revisaron 103 expedientes de pacientes, de los cuales 77 (75%) fueron del sexo masculino, 26 (25%) fueron del sexo femenino. Se realizaron 17 procedimientos laparoscópicos (16.5%) y 86 laparotomías (83.5%). Se evidenciaron 39 heridas por arma de fuego (38%), 9 heridas por arma blanca (8.5%), 51 traumas abdominales contusos (49.5%) y 4 caídas de altura (5%). La mortalidad es del 6.79%.
In view of the increased incidence of abdominal trauma in the surgery department, we have decided to evaluate our surgical work in recent years, to determine the incidence, type of injury, associated injuries, morbidity and type of treatment. It is a retrospective, comparative and analytical study. The records of patients diagnosed with abdominal trauma who entered the institution between January 1999 to May 2004 were analyzed, 103 patient records were reviewed, of which 77 (75%) were male, 26 (25%) were female. 17 laparoscopic procedures were performed (16.5%) and 86 laparotomies (83.5%). There were 39 firearm injuries (38%), 9 stab wounds (8.5%), 51 blunt abdominal trauma (49.5%) and 4 falls from height (5%). Mortality is 6.79%.
Subject(s)
Humans , Male , Female , Surgical Procedures, Operative , Wounds and Injuries , Abdomen , Surgicenters , Clinical ProtocolsABSTRACT
Presentamos el caso de un paciente de 11 años, quién acude al hospital 24 horas después de haber sufrido caída de altura (4 metros), con impacto directo en el hemicuerpo derecho, luego de lo cual evidencia dolor abdominal sobre todo en el cuadrante superior derecho y náusea al examen físico, es un paciente álgido, hemodinámicamente estable, el abdomen algo distendido, doloroso a nivel de hipocondrio derecho y flanco derecho, sin reacción peritoneal. Se realiza TAC abdominal la cual evidencia trauma hepático grado II-III. El paciente es ingresado a la Unidad de Cuidados Intermedios, para observación estrecha y monitorización. Nos centramos fundamental me en el traumatismo abdominal contuso o cerrado por ser el más frecuente en nuestro medio, sobretodo en relación con los accidentes de tráfico y por la aparición de nuevos enfoques terapéuticos para su tratamiento en forma conservadora.
We present the case of an 11-year-old patient, who goes to the hospital 24 hours after suffering a fall from height (4 meters), with a direct impact on the right body, after which he evidences abdominal pain, especially in the right upper quadrant. and nausea on physical examination, he is an acute patient, hemodynamically stable, the abdomen somewhat distended, painful at the level of the right hypochondrium and right flank, without peritoneal reaction. An abdominal CAT scan is performed, which shows grade II-III liver trauma. The patient is admitted to the Intermediate Care Unit, for close observation and monitoring. We focus fundamentally on blunt or blunt abdominal trauma as it is the most frequent in our environment, especially in relation to traffic accidents and the appearance of new therapeutic approaches for its conservative treatment.
Subject(s)
Humans , Male , Female , Child , Wounds and Injuries , Conservative Treatment , LiverABSTRACT
La colecistectomía constituye uno de los procedimientos quirúrgicos más ampliamente aceptados y practicados, con el advenimiento de la laparoscopía el manejo del paciente y la morbimortalidad han variado notablemente. Hacemos una revisión de los procedimientos, convencional y laparoscópico en los últimos 5 años en el Servicio de Cirugía del Hospital Vozandes Quito. Se analizaron 2003 expedientes de pacientes sometidos a colecistectomía en el periodo comprendido entre enero de 1999 a mayo del 2004, obteniéndose datos demográficos, índices de morbimortalidad y complicaciones que fueron similares a estadísticas mundiales y en algunos casos aún menores a los reportes internacionales.
Cholecystectomy constitutes one of the most widely accepted and practiced surgical procedures, with the advent of laparoscopy, patient management and morbidity and mortality have varied markedly. We review the procedures, conventional and laparoscopic in the last 5 years in the Surgery Service of the Hospital Vozandes Quito. 2003 records of patients undergoing cholecystectomy in the period from January 1999 to May 2004 were analyzed, obtaining demographic data, morbidity and mortality rates and complications that were similar to world statistics and in some cases even lower than international reports.