An innovative proposal for anophthalmic cavity reconstruction surgery with bone cement: a case report / Proposta inovadora para reconstrução de cavidades anoftálmicas utilizando cimento ósseo: um relato de caso

ABSTRACT We present a patient who underwent evisceration surgery after spontaneous rupture of the ocular globe due to long-data uncontrolled glaucoma, with posterior placement of an orbital implant made of a bone cement compound based on polymethylmethacrylate as alternative materials were not available. Such a compound is characterized by excellent biocompatibility and low cost, which makes it an interesting alternative for treatment. The anophthalmic socket was successfully filled, providing proper esthetic results and favorable conditions for the posterior scleral prosthesis implantation. No complications were observed during 10 months of follow-up. We believe that, in the absence of alternative materials, low-cost materials may be used in emergency settings to repair anophthalmic cavities and provide satisfactory functional and esthetic outcomes.

RESUMO Apresentamos um paciente que foi submetido à cirurgia de evisceração após ruptura espontânea do globo ocular devido a glaucoma não controlado de longa data, com posterior colocação de implante orbital feito de cimento ósseo, composto à base de polimetilmetacrilato, diante da indisponibilidade de materiais alternativos. Tal composto se caracteriza pela excelente biocompatibilidade e baixo custo, o que o torna uma alternativa interessante para o tratamento. A cavidade anoftálmica foi preenchida com sucesso, fornecendo resultados estéticos adequados e condições favoráveis para o implante posterior de prótese escleral. Nenhuma complicação foi observada durante os 10 meses de seguimento. Acredi­tamos que, na ausência de materiais alternativos, materiais de baixo custo podem ser usados em situações emergenciais para preencher cavidades anoftálmicas e prover resultados funcionais e estéticos satisfatórios.

Hematoma subcapsular hepático roto en síndrome HELLP / Ruptured subscapular liver hematoma in context of HELLP syndrome

Background: Ruptured subscapular liver hematoma in context of HELLP syndrome is a rare complication with high mortality. Clinical presentation is nonspecific: epigastric pain, right upper quadrant pain and shoulder pain, should however provide high index of suspicion. Termination of pregnancy is the only definitive treatment with a beneficial effect on the mother and the fetus. According to the hemodynamic status of the patient, treatment can be conservative through hepatic artery embolization, or surgical management, via contained packing of the bleeding area. Aim: To report seven cases of ruptured subscapular liver hematomas treated in a period of 13 years. Material and Methods: Review of medical records of patients discharged with the diagnosis from 2002 to 2015. Results: We identified seven women aged 30 to 44 years, for a total of 86,858 live births. At presentation, mean gestational age was 36 weeks. Five patients reported epigastric pain and three shoulder pain. All patients met the criteria for HELPP syndrome. All patients were operated on, and packing of the bleeding zone was carried out in six. One patient died. Two newborns died. Conclusions: The features of these patients may help in the management of this uncommon but severe condition.

Ruptura esplênica secundária à infeção por Plasmodium falciparum / Splenic rupture secondary to Plasmodium falciparum infection

A ruptura esplênica é uma complicação possível da malária. É importante pela dificuldade diagnóstica, pois um elevado índice de suspeição é necessário para um diagnóstico atempado. Pode condicionar uma hemorragia intraperitoneal e deve ser considerada no diagnóstico diferencial de quadros de dor abdominal, hipotensão e diminuição do hematócrito. Os autores descrevem o caso de um homem de 59 anos, com ruptura esplênica secundária à malária por Plasmodium falciparum, tendo realizado esplenectomia urgente. Com a apresentação do caso, os autores pretendem chamar a atenção para a necessidade de incluir esta afecção no diagnóstico diferencial dos doentes com malária e hipotensão refractária.

Splenic rupture is a possible complication of malaria. Due to its difficult diagnosis, it is important, because a high level of suspicion is needed for a timely diagnosis. It results in intraperitoneal bleeding and should be considered in the differential diagnosis of abdominal pain, hypotension and low hematocrit. The authors report the case of a 59-year old man with splenic rupture secondary to malarial infection by Plasmodium Falciparum, who was treated with urgent splenectomy. This case is presented to remind the clinicians of include this entity in the differential diagnosis of patients with malaria and refractory hypotension.

Rotura espontánea de válvula tricúspide en un paciente con hipertensión pulmonar secundaria a VIH / Spontaneous rupture of tricuspid valve papillary muscle in pulmonary hypertension secondary to HIV infection.Report of one case

Acute primary tricuspid regurgitation (TR) secondary to papillary muscle rupture is an extremely rare clinical situation. We report a 42-year-old male with pulmonary artery hypertension (PAH) secondary to HIV infection, who presented with an acute TR due to spontaneous papillary muscle rupture. He remained in cardiogenic shock despite therapy with inotropic drugs and pulmonary vasodilator therapy. He was subjected to a tricuspid valve replacement. In the postoperative period the patient had severe PAH, which was successfully controlled with inhaled nitric oxide. Tricuspid valve replacement and adjunctive use of pulmonary vasodilator therapy can be a life saving and useful approach in this condition.

Boerhaave's syndrome: a differential diagnosis of acute chest pain following a vomiting illness / Síndrome de Boerhaave: un diagnóstico diferencial de dolor torácico, agudo tras enfermedad acompañada de vómitos

Spontaneous oesophageal rupture (Boerhaave's syndrome) is extremely rare in children. Presentation is usually in middle aged men as a result of vomiting following heavy food or alcohol consumption. We describe an unusual case of a 12-year old boy without significant past medical history presenting with acute chest pain following gastroenteritis.

La ruptura esofágica espontánea (síndrome de Boerhaave) es extremadamente rara en niños. Por lo general se presenta en hombres de mediana edad como resultado vómitos tras la ingestión de alcohol o alimentos pesados. Describimos un caso inusual de un niño de 12 años de edad sin antecedentes clínicos significativos, que acudió con dolor torácico agudo tras una gastroenteritis.

A Case of Hepaticoduodenal Fistula Development after Transarterial Chemoembolization in Patient with Hepatocellular Carcinoma / 대한소화기학회지

Transarterial chemoembolization (TACE) is recommended as one of the first line therapy for unresectable hepatocellular carcinoma (HCC). Rupture of HCC following TACE is a rare and potentially fatal complication. We report a case of hepaticoduodenal fistula with ruptured HCC and liver abscess complicated by TACE. A 52-year-old male was treated by TACE three times, followed by radiation therapy and systemic chemotherapy. 30 days after the last TACE, right upper quadrant pain of abdomen was developed. About 1 month later, computed tomography of abdomen showed ruptured HCC with debris containing liver abscess and hepaticoduodenal fistula. Esophagogastroduodenoscopy revealed hepaticoduodenal fistula and hepatic parenchyme covered with exudate. The patient was managed with supportive care, but the hepaticoduodenal fistula persisted.

Ruptura espontánea de metástasis hepática de cáncer anal espinocelular y hemoperitoneo masivo: reporte de un caso / Spotanous rupture of hepatic metastasis of spinocelular anal cancer and masive hemoperitoneum: case report

Presentamos el caso de un hombre de 61años ingresado al servicio de urgencia por hematemesis y síncope. Previamente había sido tratado por cáncer anal espinocelular sin evidenciade recidiva. Al examen físico destacaba palidez, taquicardia y sudoración. Se realizó endoscopia alta que evidenció lesiones no significativas. El paciente evolucionó con shock hipovolémico y coagulación intravascular diseminada.La tomografía computarizada de abdomen demostró líquido libre intrabdominal y tumor hepático con signos de ruptura. Se realizó laparotomía de urgencia, posteriormente se efectuó embolización selectiva de arteria hepática derecha con buen resultado clínico. La biopsia del tumor hepático resultó compatible con metástasis de cáncer anal espinocelular.

A 61 years old man was admitted in emergency room by syncope and hematemesis. He has been treated by spinocellular carcinoma of the anus without evidence of relapse. At physical examination pallor, sweet and tachycardia, were observed. Upper endoscopy showed no significant lesions. The patient progressed to a hypovolemic shock and intravascular disseminated coagulation. The Abdominal CT revealed massive hemoperitoneum and a single hepatic mass with signs of rupture. The initial treatment was emergency surgery. In a second time selective hepatic artery embolization was done with successful clinical outcome. Biopsy o the liver tumor revealed hepatic metastasis of anal cancer.

Post hysterectomy spontaneous rupture of spleen

Spontaneous rupture of spleen is a rare entity in the world of obstetrics and gynaecology. The obstetricians-gynaecologist has to confront with ruptured spleen sometimes in their practice. Ruptured spleen is not uncommon in trauma and some surgical procedures in upper abdomen. Splenic rupture after hysterectomy is exceedingly rare occurrence. However it should be considered as part of diagnostic workup in any unstable post hysterectomy subject with high degree of suspicion along with other differential diagnosis. Early reorganization of this potentially life-threatening complication is very important for the wellbeing of patient and carries medico legal significance as well. We are reporting fourth case of spontaneous rupture spleen after abdominal hysterectomy found in the literature along with literature review and update on the topic regarding its diagnostic criteria

Spontaneous splenic rupture due to dengue fever: report of two cases

Dengue is a febrile illness caused by Flavivírus and mainly transmitted by the mosquito Aedes aegypiti which have been a serious epidemic in Rio de Janeiro. In most of cases it was a self limited disease. We report two cases of a serious and rare complication of this viral infection.

Angiosarcoma intracardíaco: presentación de un caso / Intracardiac sarcoma: a case report

Objetivo: Revisión y presentación de un caso de angiosarcoma cardíaco. Introducción: Los tumores malignos cardíacos primarios aparecen con una frecuencia de 0,0017-0,33 por ciento (sarcoma 16 por ciento y angiosarcoma 26 por ciento); predominan los metastáticos. Alta malignidad; relación hombres-mujeres, 2:1; edad, entre los 20 y los 60 años. La clínica depende de la localización, el tamaño y la histología. Predominan en la aurícula derecha. Trombogénicos; destruyen la estructura; producen derrame, isquemia; arritmias; muerte súbita. Invaden contiguamente; metastatizan a distancia. Escasa respuesta a radioterapia y quimioterapia. Pronóstico ominoso. Presentación del caso: Mujer de 72 años; antecedente de disnea CF II, 2 síncopes. Masa en la aurícula derecha, heterogénea, sin pedículo y otra en el ventrículo derecho, infiltración pericárdica. Pericardiocentesis diagnóstica y terapéutica. Estudios negativos de lesión extracardíaca. ASA IV. Estimación del riesgo perioperatorio: bloqueo A-V, SIRS, embolizaciones. Anestesia general balanceada, infusión de ípsilon y solución GIK. Derivación cardiopulmonar (CPB) 71' y clampeo aórtico 49'. Cirugía: resección de masa en la aurícula, el pericardio y la pleura adyacente. Destete de CPB con marca paso transitorio, apoyo inotrópico. Postoperatorio: hipoperfusión tisular, acidemia, hiperglucemia, hipopotasemia, sin respuesta terapéutica. Óbito a las 4 horas, con diagnóstico presuntivo de respuesta inflamatoria sistémica.

Objective: Review and presentation of a case of cardiac angiosarcoma. Introduction: Primary cardiac malignant tumors have frequency between 0,0017-0,33 per cent (sarcoma 16 per cent and angiosarcoma 26 per cent), predominantly metastatic. High malignancy; male-female ratio: 2:1; appears between ages 20 to 60. Symptoms depend on location, size and histology. Predominate in right atrium. Thrombogenic, they destroy the structure; cause spills, ischemia, arrhythmia, sudden death. Invade contiguously; metastasize at a distance. Poor response to radiotherapy and chemotherapy. Ominous prognosis. Case report: 72 year old female. Dyspnoea CF II, two syncopes. Heterogeneous mass in right atrium (RA) and another one in right ventricle with pericardial infiltration. Diagnosis and treatment by puncture of the pericardium. Studies negative for primary extracardiac injury. ASA IV. Perioperative risk estimation: AV Block, SIRS, embolizations. Balanced general anesthesia, infusion of GIK solution and Ipsilon. Cardiopulmonary by-pass 71' and cross aortic clamp 49'. Surgery: resection mass in RA and adjacent pericardium and pleura. Weaning from CPB: transitory pacemaker and inotropic support. Surgery: resection mass in RA and adjacent pericardium and pleura. Postoperative period: tissue hypoperfusion, lactacidemia, hyperglycemia resistant to insulin, hypopotassemia. No response to treatment. Cardiac arrest at the 4th hour with a presumptive diagnosis of systemic inflammatory response. Death.

Objetivo: Revisao e apresentaçao de um caso de angiosarcoma cardíaco. Introduçao: A ocorrência de tumores cardíacos malignos primários está na faixa de 0,0017-0,33 por cento (sarcoma 16 por cento e angiosarcoma 26 por cento); predominam os metastáticos. Alta malignidade; relaçao homens-mulheres, 2:1; faixa etária: 20 a 60 anos. A clínica depende da localizaçao, do tamanho e da histologia. Predominam na aurícula direita. Trombogénicos; destroem a estrutura; causam derrame, isquemia; arritmias; morte súbita. Invadem estruturas vizinhas; produzem metástase a distancia. Fraca resposta a radioterapia e quimioterapia. Prognóstico nefasto.Apresentaçao do caso: Mulher de 72 anos; antecedente de dispnéia CF 11,2 síncopes. Massa na aurícula direita, heterogênea, sem pedículo e outra no ventrículo direito, infiltraçao pericárdica. Pericardiocentese diagnóstica e terapêutica. Estudos negativos de lesao extracardíaca. ASA IV. Estimaçao do risco perioperatório: bloqueio A-V, SIRS, embolizaçoês. Anestesia geral balanceada, infusao de Ipsílon e soluçao GIK. By-pass cardiopulmonar (CPB) 71' e clampeamento da aorta 49'. Cirurgia: ressecçao de massa na aurícula, no pericárdio e na pleura adjacente. Retiro gradual do CPB com marca-passo transitório, apoio inotrópico. Pósoperatório: hipoperfusao tissular, acidemia, hiperglicemia, hipopotassemia, sem resposta terapêutica. Óbito 4 horas depois, com diagnóstico presuntivo de resposta inflamatória sistêmica.

Spontaneous rupture of malarial spleen.

Spontaneous rupture of malarial spleen is uncommon even in highly endemic areas of malaria. We report an eight year old girl who presented with spontaneous splenic rupture following malaria. She recovered with conservative management.

Spontaneous rupture of the lateral thoracic artery in patients with liver cirrhosis

Bleeding in patients with liver cirrhosis is primarily caused by gastroesophageal varix in association with extensive collateral circulation, portal hypertensive gastropathy, a Mallory-Weiss tear and peptic ulcer disease. The spontaneous rupture of an artery, as a result of coagulopathy, is extremely rare in patients with liver cirrhosis; however, we recently observed a case of a spontaneous rupture of the lateral thoracic artery in a 47 year-old male patient with alcoholic liver cirrhosis. The patient expired despite repeated transcatheter arterial embolization of the lateral thoracic artery and best supportive care. This is, to our knowledge, the first documented case of the spontaneous rupture of the lateral thoracic artery in a patient with liver cirrhosis.

Ruptura pós-emética do esôfago: a síndrome de Boerhaave / Postemetic rupture of the esophagus: Boerhaave's syndrome

A ruptura pós-emética do esôfago, também chamada ruptura espontânea ou síndrome de Boerhaave, foi descrita pela primeira vez em 1724 por Herman Boerhaave. Trata-se de uma doença grave, de alta mortalidade e de difícil diagnóstico, tanto por ser rara como por ser freqüentemente confundida com quadros graves mais comuns, como o infarto agudo do miocárdio, a úlcera péptica perfurada e a pancreatite aguda. Descrevemos, a seguir, três casos de pacientes com esta síndrome. Dois foram submetidos ao reparo primário da lesão e um foi submetido à esofagectomia com posterior reconstrução. Houve um óbito por choque séptico no pós-operatório imediato. Os outros dois casos tiveram boa evolução a longo prazo.

Postemetic rupture of the esophagus, also known as spontaneous rupture or Boerhaave's syndrome, was first described by Herman Boerhaave in 1724. This is a severe disease that causes high mortality rates and is difficult to diagnose not only because it is rare but also because it is frequently confused with other severe clinical conditions, such as acute myocardial infarction, perforated peptic ulcer, and acute pancreatitis. Herein, we describe three cases of patients with this syndrome. Two underwent primary repair of the rupture, and one underwent esophagectomy followed by reconstruction. There was one death due to septic shock in the immediate postoperative period. The other two patients presented favorable long-term evolution.

Benign cystic teratoma of ovary perforating into small intestine with co-existent typhoid fever.

Intra-peritoneal rupture or perforation into adjacent abdominal viscera is a rare complication of benign cystic teratoma (dermoid cyst) of the ovary. We report a 48-year-old woman in whom an ovarian dermoid cyst perforated into a loop of the small bowel. The patient had co-existing typhoid fever, which probably predisposed to this complication. She recovered on antibiotic therapy and after surgical excision.

Ruptura esplénica espontanea secundaria a amiloidosis / Spontaneous splenic rupture due to amyloidosis

La ruptura esplénica se produce frecuentemente por mecanismos traumáticos. Se la denomina espontánea o patológica cuando no existe tal antecedente o hay alguna patología esplênica predisponente. La ruptura esplénica espontánea por infiltración amiloide es una causa muy infrecuente de abdômen agudo quirúrgico. Se presenta el caso de una mujer internada por abdomen agudo secundario a ruptura esplénica espontánea, cuyo diagnóstico final fue amiloidosis primaria.

Empaquetamiento hepático permanente con malla de poliglactina en estallido hepático secundario a síndrome de Hellp / Permanent hepatic packing with polyglactin mesh in secondary ruptured liver to Hellp syndrome

El estallido hepático constituye una de las más graves complicaciones del síndrome de Hellp y es una de sus principales causas de muerte. Dada la presencia de falla hepática y trombocitopenia que constituyen la esencia del síndrome de Hellp, la hemostasia quirúrgica del hígado estallado es extremadamente difícil. Presentamos nuestra experiencia con dos casos de embarazos con síndrome de Hellp y complicados con estallido hepático, que debieron ser operados en nuestro servicio y que pudieron ser controlados mediante el empleo de un empaquetamiento hepático con malla de poliglactina. Los objetivos son discutir las alternativas técnicas para la resolución quirúrgica de esta grave complicación y mostrar los detalles de esta forma de empaquetamiento hepático permanente por nosotros empleado.

Rotura hepática asociada a preeclampsia severa y síndrome HELLP: manejo y tratamiento con taponamiento intraabdominal temporal de compresas / Hepatic rupture associated to severe preeclampsia and HELLP syndrome: management and treatment with intraabdominal temporary packingg

Damos a conocer una serie de 4 pacientes con rotura hepática, preeclampsia severa y síndrome de HELLP, resuelto su parto y tratada su complicación hepática con taponamiento temporal de compresas, lo que permitió la sobrevida de todas ellas.