Perfuração de intestino delgado por doença diverticular jejunal / Intestinal perforation in consequence of small intestine's diverticulitis

Small Intestine's diverticulosis is an uncommon pathology of intestine. It's more evident at jejune and can be complicated by intestinal perforation, obstruction or diverticulitis, increasing the mortality. We describe a forty years old female patient that arrived at emergency service complained of diffuse abdominal pain. There aren't signals of peritonitis and the radiological evaluation showed small intestine's distension. Surgical intervention was performed revealing multiples diverticulums at jejune and intestinal perforation. The aim of this article is present a case of Small Intestine's diverticulosis and its complications that had precise intervention resulting in a favorable resolution.

Perfuração de esôfago: análise de 11 casos / Esophageal perforation: analysis of 11 cases

OBJETIVO: Avaliar o tratamento de 11 pacientes com perfuração de esôfago. MÉTODO: Foram avaliados 11 casos de perfuração esofágica tratados pelo autor no Hospital Getúlio Vargas, no período de setembro de 2001 a março de 2008. RESULTADOS: Em seis pacientes (54,5 por cento), a perfuração era no esôfago cervical, quatro (36,4 por cento) no torácico e um (9,1 por cento) no abdominal. A etiologia da lesão foi corpo estranho em cinco casos, arma branca em dois e os outros foram por arma de fogo, dilatação endoscópica, ingestão de substância cáustica e trauma contuso. Diagnóstico e tratamento nas primeiras 24 horas ocorreu em três (27,3 por cento) pacientes e após 24 horas em oito casos (72,7 por cento). O tratamento conservador foi instituído para dois (18,2 por cento), que evoluíram bem e o cirúrgico para nove (81,9 por cento), dentre os quais houve dois óbitos. CONCLUSÃO: a perfuração esofágica é grave, mas um tratamento precoce e adequado pode resultar na sobrevida da maioria dos pacientes.

BACKGROUND: We evaluated the treatment of 11 patients with esophageal perforation. METHODS: A retrospective clinical review was undertaken of 11 cases of esophageal perforation treated by the author in the Getúlio Vargas Hospital, between September/2001 and March/2008. RESULTS: In six patients (54.5 percent), the site of the esophageal perforation was cervical esophagus, four (36.4 percent) at the thoracic portion and one (9.1 percent) at the abdominal segment. The lesion was induced by foreign bodies in five cases, stab wound in two and the others were gunshot wound, endoscopic instrumentation, ingestion of caustic substance and blunt abdominal trauma. Diagnosis and treatment were performed within the first 24 hours in three (27.3 percent) patients and after 24 hours in eight patient (72.7 percent). Conservative treatment was employed in two (18.2 percent) patients, with good outcome. Surgical treatment was performed in nine (81.9 percent) patients, with two deaths. CONCLUSIONS: Esophageal perforation is a serious condition, but an early and appropriate treatment can result in the survival for the majority of the patients.