RESUMO
Esophageal perforation secondary to blunt trauma carries a high morbidity and mortality rates. It is a rare disease. Cervical esophagus is the commonest site of perforation. Numerous options are available for the management of esophageal injuries. The conservative medical management is allowed in well defined cases. We report a rare clinical case of a 40-year- old patient who was injured in a car accident with an impact to the anterior chest. At the time of admission, the patient was alert and complained of chest pain. Clinical findings showed of subacute ischemia in the right upper limb. Chest computed tomography [CT] with intraveinous contrast showed thrombosis of the brachiocephalic artery [a few air bubbles, in the upper mediastinum and a bilateral pneumothorax]. The diagnosis of esophageal perforation was confirmed by a second CT with ingestion of a water-soluble contrast agent. Outcome was favourable on antibiotics and parenteral nutrition. Provided that no clinical signs of sepsis are present and that the patient rapidly improves the conservative management of traumatic perforation of the thoracic oesophagus is a sounded option
RESUMO
Anal stenosis represents a rare post hemorroidectomy complication which is difficult to manage. We report a series of eight cases, five male and three female, aged 29 to 67 years old, through a period of 12 years, in whom anal stenosis occurred 2 to 16 months after hemorroidectomy, which was of pedicular type in 5 cases, circular in one case and of a non precise type in 2 cases. We performed three sphincterotomy with anoplasty, two dilatations associated with lateral sphincterotomy, one Bellan's anoplasty and an Y-V flap's anoplasty. All our patients regained their proper anal diameter, with amelioration of the discriminatory sensibility, the medium recurrence time was three years and half [maximum 9 month and 7 years]. The anoplasties provide good results. The best treatment is prophylaxis done by choosing the safety technic and respecting the rules of hemorroidectomy