RESUMO
Diverticular bleeding of the small bowel is rare and occurs primarily in adults aged more than 60 years. In younger adults, Meckel's diverticulum, a true diverticulum that congenitally occurs in the distal ileum, is the most common cause of diverticular bleeding of the small bowel. Unlike Meckel's diverticula, other kinds of small bowel diverticula are not congenital and their incidence is related to age. Furthermore, congenital true diverticular bleeding of the jejunum in adults is very rare. We report the case of a 24-year-old man with subepithelial tumor-like lesion accompanied with obscure overt gastrointestinal bleeding. This lesion was initially suspected to be a subepithelial tumor based on radiologic tests and capsule endoscopy. He was finally diagnosed with a congenital true diverticulum in the jejunum with the appearance of a Meckel's diverticulum after surgical resection.
Assuntos
Adulto , Humanos , Adulto Jovem , Endoscopia por Cápsula , Divertículo , Hemorragia Gastrointestinal , Hemorragia , Íleo , Incidência , Jejuno , Divertículo Ileal , Neoplasias Epiteliais e GlandularesRESUMO
Esophageal foreign bodies are a common clinical problem; they can be removed via endoscopic intervention. However, sharp foreign bodies, such as fish bones, stuck in a physiological or pathological stenosis of the esophagus can sometimes lead to esophageal perforation. This can even lead to fatal complications, such as empyema, mediastinitis, esophago-tracheal fistula, and peritonitis. Consequently, during an endoscopic procedure, special precautions and protective devices are required. Here, we report the case of a 56-year-old woman who presented with an esophageal impacted fish bone with iatrogenic esophageal perforation caused by the gag reflex during endoscopic removal. She was treated successfully with surgery and antibiotics. The case highlights the need for sufficient sedation of the patient and attention by clinicians to achieve successful treatment without complications.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Antibacterianos , Constrição Patológica , Empiema , Perfuração Esofágica , Esôfago , Fístula , Corpos Estranhos , Mediastinite , Métodos , Peritonite , Equipamentos de Proteção , ReflexoRESUMO
No abstract available.
RESUMO
End-tidal PCO2 measurements are less accurate in neonates, infants, and small children than in adults. These in accuracies may by attributed in part to the dilution of end-tidal gas with fresh gas as a result of placing the sampling catheter between the endotracheal tube and a partial rebreathing circuit. To determine the most accurate catheter position for measurements of end-tidal gas tensions, end-tidal PCO2 was measured continuously from the distal and proximal end of the endotracheal tube and these data were compared with simultaneous arterial PCO2 The results were as follows: 1) In children weigthing above 15 kg ventilated with partial rebreathing circuit, both distal and proximal end-tidal PCO2 values approximated arterial PCO2 (p<0.05). 2) In infants and children weigthing below 15 kg ventilated with Ayre's T-piece breathing circuit(Jackson-Rees modification), only distal end-tidal PCO2 approximated arterial PCO2.