Un cuerpo extraño inusual de cianoacrilato en el oído. Presentación de un caso clínico y revisión de la literatura / An unusual cyanoacrylate foreign body in the ear. Presentation of a clinical case and literature review

El pegamento basado en cianoacrilato posee una gran capacidad de adherencia a los tejidos, representando un problema cuando se encuentra en el oído externo debido a sus características anatómicas particulares. Se presenta un caso clínico de cuerpo extraño de cianoacrilato que ocluye el conducto auditivo externo y el tímpano, alterando la audición. Se describen los hallazgos y los intentos de extracción utilizando las alternativas terapéuticas descritas en la literatura, sin obtener resultados positivos, debiendo recurrir a la extracción quirúrgica. Además, se presentan detalles del procedimiento y los resultados. El paciente recupera la audición y la normalidad anatómica.

Cyanoacrylate-based glue has a great capacity for adhering to tissue, which is a problem when it is placed in the ear canal due to the anatomy of this structure. A clinical case of a cyanoacrylate foreign body occluding the external auditory canal and the tympanic membrane is presented. The therapeutics alternatives described in the literature used in the case failed, so, it was surgically removed by drilling the glue. Details of the procedure and results are presented. The patient recovers the hearing and anatomical normality.

Surgical management of an abdominal impalement injury: a case report / Manejo quirúrgico de una lesion por empalamiento abdominal: reporte de caso

Impalement injuries are a complex and rare type of penetrating abdominal trauma that happens when an object such as a post or a pole penetrates a person injuring several organs, making it a life-threatening situation in which time and correct management play an important part in the survival of the patient. A 37-year-old man suffered abdominal impalement injury with a metal signal post, penetrating the left flank of the abdomen. On examination, there is a hypoventilated left hemithorax with intercostal retractions, increased heart rate, weak distal pulses, delayed capillary refill, and pale skin. A 1-meter-long metal post (approximately 7cm diameter) penetrates the left flank with the entry in the posterior lumbar region. Abdominal viscera, omentum, intestinal content, and ischemic loops of the small intestine are visible. An exploratory laparotomy was performed; left hemicolectomy, end colostomy and Hartmann procedure, resection of the affected jejunum, and end-to-end anastomosis were performed. On the ninth postoperative day, an abdominal tomography was performed due to the presence of fever peaks, which reported thrombosis of the left renal artery and emphysematous pyelonephritis, with the presence of a left pararenal collection. A simple left nephrectomy was performed. Postoperative surveillance was satisfactory during the following 5 days. The patient was discharged. An impaled injury is a complex lesion that needs special attention from the medical field for correct management. Although there is some literature about it, we encourage more research to be done about impalement injuries.

Las lesiones por empalamiento son un tipo de traumatismo abdominal penetrante complejo y raro de que se produce cuando un objeto, como un poste o una vara, penetra a una persona lesionando varios órganos, lo que la convierte en una situación potencialmente mortal en la que el tiempo y el manejo correcto juegan un papel importante en la supervivencia del paciente. Un hombre de 37 años sufrió una herida por empalamiento abdominal con un poste de señales de metal, penetrando el flanco izquierdo del abdomen. A la exploración física, hay un hemitórax izquierdo hipoventilado con retracciones intercostales, aumento de la frecuencia cardíaca, pulsos distales débiles, relleno capilar retrasado y piel pálida. Un poste metálico de 1 metro de largo (aproximadamente 7 cm de diámetro) penetra el flanco izquierdo con entrada en la región lumbar posterior. Son visibles las vísceras abdominales, el epiplón, el contenido intestinal y las asas isquémicas del intestino delgado. Se realizó una laparotomía exploradora; Se realizó hemicolectomía izquierda, colostomía terminal y procedimiento de Hartmann, resección del yeyuno afectado y anastomosis terminoterminal. Al noveno día postoperatorio se realiza tomografía abdominal por presencia de picos febriles, que reporta trombosis de arteria renal izquierda y pielonefritis enfisematosa, con presencia de colección pararrenal izquierda. Se realizó nefrectomía izquierda simple. La vigilancia postoperatoria fue satisfactoria durante los siguientes 5 días. El paciente fue dado de alta. Una lesión por empalamiento es una lesión compleja que necesita una atención especial desde el ámbito médico para su correcto manejo. Aunque existe cierta literatura al respecto, alentamos a que se realicen más investigaciones sobre estas lesiones.

Extracción de proyectil acetabular por artroscopía de cadera / Acetabular bullet removal for hip arthroscopy

La extracción artroscópica de un proyectil articular de cadera por herida de bala se introdujo por primera vez por Cory y cols. en 1998. El misil puede ubicarse flotando libremente dentro de la articulación, ubicado cercano a esta o alojado dentro del hueso del acetábulo o de la cabeza femoral. Se presenta el caso de un paciente de treinta y dos años, quien fue asaltado. El proyectil se alojaba en el trasfondo del acetábulo luego de un trayecto abdominal.La artroscopía de cadera es un procedimiento mínimamente invasivo que resultó efectivo para el retiro de un proyectil articular, resultando menos cruento que una artrotomía. No se encontraron complicaciones. Nivel de Evidencia: III

Arthroscopic removal of a bullet from the hip joint was introduced first by Cory et al. in 1998. The missile can be located freely floating within the joint, located close to the joint, or lodged within the acetabulum bone or the femoral head. A case is presented in a thirty-two-year-old patient, who was assaulted. The projectile lodged in the background of acetabula fossa after an abdominal trajectory.Hip arthroscopy is a minimally invasive procedure that was effective for the removal of a joint projectile resulting in less morbidity than an arthrotomy. No complications were found. Level of Evidence: III

Mysterious ureteral migration of a wooden toothpick from the digestive tract: case report and diagnostic considerations

ABSTRACT Migration of foreign bodies into the urinary tract is a rare event. In certain instances, to unravel the way that objects arrived in the urinary tract is not easy. We report the case of an accidentally swallowed wooden toothpick that migrated and was found in the left ureterovesical junction, protruding into the bladder. Even though the computed tomography scan is widely employed to evaluate the urinary tract, this resource does not have a good sensitivity for detecting foreign bodies. Our report presents an insight into the best imaging approach if wooden toothpicks are suspected. In the present case, the endoscopic treatment was possible with an uneventful outcome and a complete resolution of symptoms.

A case of chronic refractory wound in the abdomen caused by residual foreign body / 中华烧伤杂志

A 59-year-old male patient with local sinus tract formation due to residual foreign body was admitted to the Second Affiliated Hospital of Zhejiang University College of Medicine on December 17, 2018. The examination showed that the residual foreign body was the component of a sticky cloth implanted when the patient underwent appendectomy 27 years ago. Hypertrophic scar developed at the right-lower abdominal incision for appendectomy 23 years ago and the secondary infection after cicatrectomy resulted in non-healing of the wound. The chronic refractory wound healed completely after surgical treatment in our hospital after this admission. The postoperative pathological examination revealed local inflammatory granuloma. This case suggests that chronic refractory wound is likely to form when secondary infection occurs following the surgical procedure near the implant, and aggressive surgery is an effective way to solve this problem.

Una nueva alternativa para la localización y la recuperación de agujas fracturadas durante la anestesia odontológica. Presentación de técnica y caso clínico / A new alternative for locating and removing a needle fractured during dental anesthesia. Technique and case report

Objetivo: Describir en un caso clínico una nueva técni- ca para la localización y la remoción de agujas fracturadas du- rante la anestesia odontológica mediante planificación virtual. Caso clínico: Una paciente de género femenino de 52 años de edad concurre a la Cátedra de Cirugía y Traumatolo- gía Bucomaxilofacial I de la Facultad de Odontología de la Universidad de Buenos Aires y relata que dos meses atrás, durante la atención odontológica, se produjo la fractura de la aguja durante la anestesia troncular mandibular. Se realiza diagnóstico y planificación virtual para conocer la ubicación exacta de la aguja y se confecciona un modelo estereolito- gráfico y una guía quirúrgica individualizada para removerla. El uso de una guía quirúrgica individualizada y confeccio- nada mediante planificación virtual permitió ubicar la aguja tridimensionalmente y con mayor precisión en espacios pro- fundos y disminuir tiempos operatorios (AU)

Aim: To describe in a clinical case a new virtual plan- ning technique for locating and removing a fractured dental anesthetic needle. Clinical case: A 52-year-old patient visited the De- partment of Oral and Maxillofacial Surgery I (School of Dentistry, University of Buenos Aires) with a retained den- tal needle in the pterygomandibular space. The needle had fractured during inferior alveolar nerve block two months previously. Virtual diagnosis and planning were performed to locate the needle and a stereolithographic model and a customized surgical guide were prepared. The use of cus- tomized surgical guides prepared by virtual planning ena- bled precise location of the dental needle in deep spaces and reduced operating times (AU)

Arritmia ventricular maligna asociada a un gossypiboma: reporte de un caso / Malignant ventricular arrhythmia associated to gossypiboma: clinical case report / Arritmia ventricular maligna vinculada a gossypiboma: reporte de um caso clínico

Un gossypiboma, oblitoma o textiloma se define como todo cuerpo extraño olvidado en el interior de un paciente durante una intervención quirúrgica. Representa una complicación posquirúrgica poco frecuente pero de consecuencias potencialmente graves. En general, se manifiesta con cuadros clínicos variables: una masa o pseudotumor, sangrados, fiebre, dolor, varios meses o años después de la cirugía original. También puede ser un hallazgo accidental. Describimos el caso clínico de una paciente con un gossypiboma vinculado a una cirugía cardíaca que se realizó 40 años antes al cuadro clínico actual, que se presenta con arritmia ventricular maligna.

A gossypiboma, oblitoma or textiloma is defined as a surgical object left in the interior of the body after surgery. It represents an uncommon but potentially life threatening post-surgery complication. Clinical manifestations are variable and depend on location, relations and size, from pseudo-tumoral masses, bleeding, fever, pain and other nonspecific presentations. The onset of symptoms is unpredictable, occurring from months or years after surgery. Patients may course asymptomatically and be diagnosed incidentally as an imaging finding. We describe a case of a patient with gossypiboma diagnosed 40 years after undergoing cardiac surgery, who presented with a malignant ventricular arrhythmia.

Um gossypiboma, oblitoma ou textiloma está definido como todo corpo estranho esquecido no interior de um paciente durante um procedimento cirúrgico, representando uma complicação pos cirúrgica pouco frequente, mas com consequências potencialmente graves. Geralmente, se manifesta com quadros clínicos variáveis: uma massa ou pseudotumor, sangramentos, febre, dor, varios meses ou anos após a cirurgia original ou ser um hachado acidental. Descrevemos o caso clínico de uma paciente com um gossypiboma vinculado a uma cirurgia cardíaca realizada 40 anos antes do quadro clínico atual, que se apresenta com arritmia ventricular maligna.

Resultados del tratamiento quirúrgico de la perforación intestinal causada por ingestión de mondadientes: aportación de 3 casos / Results of surgical treatment of intestinal perforation caused by toothpick ingestion: contribution of 3 cases

RESUMEN: La ingestión de mondadientes (IM) constituye un evento poco frecuente (se han publicado alrededor de 157 casos a nivel mundial), pero puede causar perforaciones intestinales (PI), con peritonitis, sepsis e incluso muerte. Este hecho, determina la necesidad de intervenir quirúrgicamente a la mayoría de estos pacientes. El objetivo de este manuscrito fue informar resultados del tratamiento quirúrgico de 3 casos de PI por IM. Caso 1: hombre de 52 años, con perforación duodenal y de la vesícula biliar. Caso 2: Mujer de 54 años con perforación cecal. Caso 3: hombre de 72 años, con perforación de colon izquierdo y lesión esplénica. Todos fueron hospitalizados por dolor abdominal y fiebre. En dos casos el diagnóstico se verificó por tomografía y en uno por ecotomografía. Los tres casos fueron intervenidos quirúrgicamente a través de laparotomía. Intervenciones: Caso 1: se realizó colecistectomía y sutura duodenal. Caso 2: se realizó hemicolectomía derecha e ileotransverso anastomosis. Caso 3: se realizó hemicolectomía izquierda y esplenectomía. En todos los casos se encontró el mondadientes. Todos los pacientes evolucionaron de forma satisfactoria, sin complicaciones postoperatorias. La IPD es una emergencia quirúrgica. Las PI son comunes y la peritonitis asociada es frecuente. El pronóstico depende de un diagnóstico precoz y un tratamiento oportuno.

SUMMARY: Toothpick ingestion (TPI) is a rare event, but can cause intestinal perforation (IP), peritonitis, sepsis, and even death (approximately 157 cases have been published worldwide). This fact determines the need for surgical intervention in most of these patients. The aim of this manuscript was to report the results of the surgical treatment in 3 cases of IP by TPI. The report involves the following: Case 1: A 52-year-old man, with duodenal and gallbladder perforation. Case 2: A 54-year-old woman with cecal perforation. Case 3: A 72-year-old man, with perforation of the left colon and splenic rupture. All were hospitalized for abdominal pain and fever. In two of the cases the diagnosis was verified by tomography and in one by ultrasound. All three patients underwent laparotomy. In the first case (1), cholecystectomy and duodenal suture were performed; in the second case (2) right hemicolectomy and ileo-transverse anastomosis were performed, and in the third case (3), Left hemicolectomy and splenectomy were performed. Toothpick was found in all cases. The patients in this report all evolved satisfactorily without postoperative complications. In conclusion, TPI is a surgical emergency. IP are common and the associated peritonitis is high. Prognosis depends on early diagnosis and timely treatment.

Espina de pescado alojada en la glándula tiroides / Fishbone lodged in the thyroid gland

Los cuerpos extraños alojados en la vía aéreodigestiva superior son un motivo de consulta frecuente para el otorrinolaringólogo. Uno de los más frecuentes son las espinas de pescado. En raras ocasiones, éstas migran hacia tejidos adyacentes y generan complicaciones importantes. Presentamos el caso de una paciente que tras la ingesta de pescado manifiesta sensación de cuerpo extraño faríngeo, odinofagia y dolor látero cervical derecho. Dada la ausencia de hallazgos a la exploración física y laringoscópica se realiza una tomografia computarizada cervical, visualizando un cuerpo extraño alojado en la glándula tiroidea. Se interviene mediante cervicotomía media, realizando la extracción de la espina sin complicaciones. El diagnóstico precoz y manejo adecuado es determinante para prevenir complicaciones en estos casos.

Foreign bodies in the aerodigestive tract are commonly confronted in otolaryngology practice. The most frequent are the fish bones. In rare cases they can move and cause numerous complications. We report the case of a patient that manifest the sensation of pharyngeal foreign body, after fish ingestion. She also referred odynophagia and right cervical pain. Physical and laryngoscopic examination were normal. A cervical CT was performed, where a foreign body lodged in the thyroid gland was visualized, median cervicotomy was done and the foreign body was extracted. Early diagnosis and adequate management are crucial to prevent complications in these cases.

Fractura intravascular de un catéter arterial: una complicación poco común pero real / Intravascular fracture of an arterial catheter: an uncommon nevertheless real complication

Arterial catheterization is a common procedure performed for invasive blood pressure as well as cardiac output monitoring and blood sampling for analysis. The fracture or embolization of arterial catheters are rare but serious complications, and may cause vascular thrombosis or occlusion. Ultrasound can be used to identify the intravascular fragment, however their removal may be complex. The authors report a case of intra-arterial catheter fracture in the radial artery, confirmed by ultrasound and surgically removed. This case may alert to be aware of this complication when using this invasive method, helping to prevent future complications for patients.

La introducción de un catéter arterial es un procedimiento realizado regularmente para evaluar la presión arterial invasiva, el gasto cardíaco y tomar muestras de sangre para su análisis. La fractura y la embolización de los catéteres arteriales son complicaciones poco frecuentes pero graves y pueden causar trombosis u oclusión de la arteria. La ecografía puede usarse para identificar el fragmento intravascular, pero la extracción puede ser compleja. Presentamos un caso de fractura intravascular del catéter de la arteria radial confirmada por ecografía y extirpada quirúrgicamente. Este caso señala la necesidad de prestar atención a esta complicación cuando se usa el monitoreo invasivo, para evitar complicaciones futuras para los enfermos.

Cuerpo extraño intraarticular en rodilla de paciente pediátrico: Resolución artroscópica / Intraarticular knee foreign body in pediatric patient. Arthroscopic resolution

Los cuerpos extraños intraarticulares son entidades poco frecuentes de encontrar en una consulta médica, muchas veces pueden imitar una lesión meniscal o condral y provocar episodios de dolor intenso y bloqueo articular, sobre todo en pacientes deportistas.Se presenta el caso de una niña de diez años, quien consulta por gonalgia derecha de cuatro meses de evolución. En la anamnesis la paciente refiere exacerbación del dolor en flexión y episodios de bloqueo articular. Niega trauma reciente. Como dato adicional, relata un accidente doméstico seis meses antes del inicio de los síntomas: atravesó una puerta ventana de vidrio, lo que le provocó heridas cortantes superficiales en la rodilla. En la consulta actual, la radiografía anteroposterior mostró una imagen radiopaca a nivel del intercóndilo y la espina tibial que hizo sospechar una avulsión de esta última. Se solicitó una RM de rodilla que evidenció una espina tibial continua y ninguna lesión evidente en la articulación. Se completó el estudio con una TAC, donde se visualizaron dos cuerpos intraarticulares compatibles con vidrio, tanto en la región anterior como posterior del compartimento lateral. Se programó una artroscopía para realizar su exéresis. En nuestro reporte de caso intentaremos demostrar la importancia de la anamnesis y el examen clínico cuando se sospecha una patología, de lo difícil que puede ser el diagnóstico aun con el soporte de los exámenes complementarios y de lo demandante quirúrgicamente que puede tornarse encontrar y sacar un cuerpo extraño de estas características en una articulación

Intraarticular foreign bodies are unusual entities that can be found in a medical consultation. They can often mimic a meniscal or condral injury by triggering episodes of intense pain and articular locking, most frequently in athletes. We present a case of a ten year old girl, who consults with knee pain of four months of evolution. In the anamnesis the patient refers intensification of the pain with knee flexion and episodes of articular locking. She denies recent trauma, but as a remarcable fact she refers that six months before the symptoms appear, she had a domestic accident where she broke through a glass window, getting superficial wounds in her knee.The anterior-posterior X-Ray showed a radiopaque image in the intercondylar level and the tibial spine that made us suspect an avulsion of it, that's why a knee MRI was requested but not showing any lesion of the tibial spine or joint. We completed the study with a CT scan that enhanced two intraarticular bodies, glass compatible, in the anterior as well as the posterior area of the lateral compartment. We schedule an arthroscopy to remove both pieces.In this case report we try to demonstrate the importance of the anamnesis and physical exam when you suspect a pathology, the difficult it can be the diagnosis even counting with complementary imaging, and the surgically demanding that can become finding and removing a glass foreign body in a joint

Iatrogenic foreign body in urinary bladder: Holmium laser vs. Ceramic, and the winner is

ABSTRACT Introduction Urological surgery is estimated to be the third most common cause of iatrogenic-retained foreign bodies 1. Presentation A 76-year old man was undergoing a transurethral resection of bladder tumor with a 26-Ch continuous flow resectoscope (Karl Storz, Germany). Before starting resection, a detachment of resectoscope sheath tip was noted. The ceramic tip was free-floating in the bladder lumen, and it would not fit within the sheath, making direct extraction using the loop impossible. An attempt was made to break it with a stone punch, but it was unsuccessful due to impossibility of closing it in the branches. Therefore, we decided to fragment the tip with holmium laser (RevoLix®, LISA Laser products, Germany), using an 800-micron, front-firing fiber. Laser device was settled at with 2.5 J energy and 5 Hz frequency. Ceramic appeared very hard, but it was difficult to carry on breaking with this setting because of tip retropulsion. Then, laser setting was switched to lower energy and higher frequency (1 J and 13 Hz). This setting guaranteed the same power of 13 W, but with minimal retropulsion. Results Tip was fragmented against the posterior bladder wall in seven pieces, which were retrieved trough the outer sheath. A total 5.62 kJ were used to fragment it. At the end, superficial lesions of the posterior bladder wall were highlighted. Surgical time was 55 minutes. Patient was discharged home next day without problems. Conclusions Holmium laser fragmentation is a safe and effective approach to remove foreign bodies from the bladder.

Cuerpo extraño en intestino delgado / Foreign Body in the Small Intestine

RESUMEN Se presenta el caso de un paciente masculino de 39 años de edad, que acude al cuerpo de guardia del Hospital General Docente Abel Santamaría Cuadrado por presentar un cuadro de dolor abdominal de tres días de evolución. Se interviene quirúrgicamente con el diagnóstico presuntivo de apendicitis aguda complicada. En el acto quirúrgico se comprobó que el apéndice cecal era normal y al examinar el íleon terminal, a una distancia aproximada de 50 cm se encontró un divertículo de Meckel, y a 5 cm de este, una espina de pescado adherida a la pared intestinal, la cual parecía ser la causante del cuadro, ya que el divertículo también era normal. El tratamiento consistió en trasladar la espina hacia el divertículo y realizar resección intestinal de ese tramo con anastomosis término-terminal. La evolución posoperatoria fue satisfactoria y el paciente fue dado de alta a los 8 días de la operación(AU)

ABSTRACT We present the case of a male patient, 39 years of age, who presents to the emergency room of Abel Santamaría Cuadrado General Teaching Hospital with a clinical picture of abdominal pain of three days of natural history. He is surgically intervened with the presumptive diagnosis of complicated acute appendicitis. In the surgical act, the cecal appendix was verified to be normal and, when examining the terminal ileum, at a distance of approximately 50 cm, a Meckel's diverticulum was found, and, at 5 cm from this, a fish spine adhered to the intestinal wall, which seemed to be the cause of the clinical picture, since the diverticulum was also normal. The treatment consisted of transferring the spine to the diverticulum and performing intestinal resection of that section with end-to-end anastomosis. The postoperative evolution was satisfactory and the patient was discharged 8 days after the operation(AU)

Smartphone-based stent tracking application for prevention of forgotten ureteral double-J stents: a prospective study

ABSTRACT Purpose: Retained or forgotten ureteral stents (FUS) have a potential to cause significant morbidity as well as medico-legal issues and increased cost. We aimed to evaluate the efficacy and usefulness of smartphone-based Ureteral Stent Tracker (UST) application and compare the results with basic appointment card system to prevent FUS, prospectively. Materials and Methods: A total of 90 patients who underwent ureteroscopic stone treatment procedure with indwelling DJ stents were equally distributed into two groups. In group-1, patients were followed using UST application. In group-2, only appointment cards were given to the patients. Two groups were compared in terms of stent overdue times and complete lost to follow up rates. Results: Forty-four patients in group-1 and 43 patients in group-2 completed the study. Among patients, 22.7% in group-1 and 27.9% in group-2 did not return for the stent removal on the scheduled day. In group-1, these patients were identified using the UST and called for the stent removal on the same day. After 6 weeks of maximal waiting period, mean overdue times in group-1 and group-2 were 3.5 days and 20 days, respectively (p = 0.001). In group-2, 3 patients (6.9%) were lost to follow up, while in group-1, it was none (p = 0.001). Conclusions: We found that the patients who were followed by the smartphone-based UST application has less overdue times and lost to follow up cases compared to the basic appointment card system. The UST application easily follows patients with indwelling ureteral stents and can identify patients when overdue.

Enfrentamiento de la ingesta de cuerpo extraño en un Hospital Regional del sur de Chile / Management of foreign body ingestion at a Regional Hospital in southern Chile

Introducción: La ingesta de cuerpos extraños (ICE) es frecuente en pediatría y puede llevar a complicaciones. Nuestro objetivo es revisar la experiencia de nuestro centro en el manejo de estos pacientes y proponer un protocolo de tratamiento. Material y Método: Estudio transversal retrospectivo, observacional y descriptivo, en el cual se revisaron los informes endoscópicos y fichas de pacientes con diagnóstico de ICE manejados por la Unidad de Endoscopia Pediátrica del Hospital Clínico Regional de Concepción entre enero de 2013 y junio de 2017 (53 meses), totalizando 40 casos. El registro y análisis de los datos se realizó con Microsoft® Excel 2016® para MacOS®. Resultados: El promedio de edad fue de 3,96 ± 3,24 años. La moda estadística fue de 2 años. A todos los pacientes se les realizó una endoscopia digestiva alta. El CE más frecuente fue la moneda (61,9%). En 6 casos (14,2%) fue una pila de botón. La retención de CE fue en tercio proximal del esófago (30,9%), el cuerpo gástrico (26,2%) y el tercio distal del esófago (14,2%), extrayéndose principalmente con pinza de cuerpo extraño (90,4%). El 57,5% evidenció alguna lesión relacionada a la ubicación del CE, siendo la más grave la producida por pila de botón. Conclusión: La ICE en niños es una entidad potencialmente peligrosa, por lo que se hace necesario disponer de una unidad de endoscopia pediátrica y protocolos de manejo para evitar complicaciones, sobre todo con objetos de alto riesgo.

Introduction: Foreign body ingestion (FBI) is common in pediatrics and can lead to complications. The aim of the present study is to review the experience of our center in the management of these patients and to propose a treatment protocol. Material and Method: Retrospective, observational and descriptive cross-sectional study, in which the endoscopic reports and records of patients diagnosed with IFB managed by the Pediatric Endoscopy Unit of the Regional Clinical Hospital of Concepción between January 2013 and June 2017 (53 months) were reviewed, with a total of 40 cases. Data recording and analysis was performed with Microsoft® Excel 2016® for MacOS®. Results: The average age was 3,96 ± 3,24 years. The statistical fashion was 2 years. All patients underwent a upper gastrointestinal endoscopy. The most frequent FB was the coin (61,9%). In 6 opportunities (14,2%) was a button batery. FB retention was in the proximal third of the esophagus (30,9%), the gastric body (26,2%) and the distal third of the esophagus (14,2%), being extracted mainly with foreign body clamp (90,4%). The 57,5% showed some injury related to the location of the FB, being the most serious the produced by button batery. Conclusion: FBI in children is a potentially dangerous entity, so it becomes necessary to have a pediatric endoscopy unit and treatment protocols to avoid complications, especially with high-risk objects.

Heart injury with projectile lodged inside the heart

Abstract Penetrating heart injuries present high mortality rates. Increasing rates of urban violence have contributed to a significant rise in the number of heart injuries by firearm projectiles. Such injuries are associated with the highest mortality rates among penetrating cardiac injuries and may involve one or more cardiac chambers. We present the case of a police officer who, in an approach to five robbers, suffered a transfixed cardiac injury by firearm with the projectile having been lodged inside the right ventricle. This patient was successfully operated, 65 days after the injury, at our institution.

Oblitos en Cirugía: análisis de casuística y estrategias para su prevención / Foreign body: case analysis and prevention strategies / Oblitos em Cirurgia: análise de caso e estratégias de prevenção

Introducción: El oblito es un evento de muy baja frecuencia pero que puede generar morbilidad grave. Si bien se han reconocido algunos factores de riesgo y desarrollado sistemas complementarios de detección, continua siendo un gran problema desde el punto de vista sanitario y médico legal. Objetivos: Analizar una casuística del Hospital Maciel, su forma de presentación y complicaciones. Pacientes y métodos: Se presentan 7 pacientes asistidos en los Servicios de Cirugía General y Urología del Hospital Maciel, en el período comprendido del 2013 - 2016. Las principales variables que se analizan son la forma de presentación y complicaciones, así como presencia de factores de riesgo. Resultados: El hallazgo fue de compresas en todos los pacientes. En 2 casos el oblito fue asintomático y en otros 4 sintomático. En los últimos, 2 tuvieron una presentación temprana y 2 tardía. El recuento de material fue incorrecto solamente en un caso. Ningún paciente falleció por las complicaciones resultantes. Discusión: El oblito en cirugía es un problema que seguirá existiendo en tanto existan los procedimientos quirúrgicos, por lo que es necesario hacer énfasis en el abordaje sistemático, existiendo también métodos auxiliares de diagnóstico que podrían comenzar a implementarse. Conclusiones: Encontramos casi sin excepción la presencia de factores de riesgo conocidos en nuestra serie, si bien el número de casos es reducido. También la incidencia impresiona ser algo más elevada de la señalada en la literatura.

Introduction: Retained foreign items are infrequent but can generate serious morbidity. Although some risk factors have been recognized and complementary detection systems developed, it continues to be a major problem from a health and medical legal point of view. Objectives: to examine a case study at Hospital Maciel, focusing on clinical presentation and complications. Patients and methods: 7 patients treated at the General Surgery and Urology Departments in Hospital Maciel, between 2013-2016. The main results analized are clinical presentation and complications, as well as the presence of recongnized risk factors. Results: In all patients, the foreign bodies were compresses. In 2 cases the foreign body did not elicit symptoms whereas in 4 cases it did. In the latter, 2 had an early and a late presentation. The material count was incorrect in only one case. No patient died from the resulting complications Discussion: Because retained surgical ítems will be a problem as long as surgical procedures are performed, it is necessary to emphasize on a systematic approach accompanied by complementary diagnostic tools that are also available in cases of item miscount. Conclusions: Risk factors were present almost without exception in our casuistry. Also, the incidence seems to be higher than that reported in the literature.

Introdução: Oblito é um evento de baixa freqüência, mas que pode gerar uma grave morbidade. Embora alguns fatores de risco tenham sido reconhecidos e desenvolvidos sistemas de detecção complementares, continua a ser um grande problema do ponto de vista da saúde e do direito médico legal. Objetivos: Analisar uma casuística do Hospital Maciel, sua apresentação e complicações. Pacientes e métodos: sete pacientes foram atendidos nos Serviços de Cirurgia Geral e Urologia do Hospital Maciel, no período entre 2013 e 2016. As principais variáveis analisadas são a apresentação e complicações, bem como a presença de fatores risco. Resultados: a descoberta foi de compressas em todos os pacientes. Em 2 casos, o oblito foi assintomático e em 4 casos foi sintomático. No segundo, em 2 a apresentação foi temprana e em 2 foi tardia. A contagem de materiais estava incorreta em apenas um caso. Nenhum paciente morreu pelas complicações resultantes. Discussão: o oblito em cirurgia é um problema que continuará a existir enquanto houver procedimentos cirúrgicos, por isso é necessário enfatizar a abordagem sistemática, e também há métodos de diagnóstico que podem ser implementados. Conclusões: encontramos quase sem exceção a presença de fatores de risco conhecidos em nossa série, embora o número de casos seja pequeno. A incidência também parece ser um pouco maior do que a relatada na literatura.