Obstructive acute abdomen due to Meckel's diverticulum in adult: Case report.

INTRODUCTION: Meckel's diverticulum is anatomically considered as a true diverticulum, with its embryological origins arising from a persistent omphalomesenteric duct. In adults, the disease is usually asymptomatic, often being accidentally diagnosed during imaging tests or surgery to treat other diseases, or due to further complications. PRESENTATION OF THE CASE: We report the case of a 26-year-old female patient was admitted to the emergency room complaining of pain and abdominal distension for 3 days, progressing to cessation of the elimination of gas for 1 day together with nausea and vomiting. Since the cause of the obstruction was not clearly identified, the patient's clinical status did not improve with non-operative measures and laparoscopy was not available, an exploratory laparotomy was conducted. In the cavity inventory, an approximately 20 cm wide MD was found in the terminal ileum adhered to the distal portion of the anterior abdominal wall. DISCUSSION: MD is the most common congenital anomaly of the gastrointestinal tract, with an estimated prevalence of between 0.3 % and 2.9 % in the general population. The clinical picture is usually asymptomatic, with the diagnosis made either via imaging tests performed to investigate other diseases, or during surgery to treat complications. CONCLUSION: MD is the most common anomaly of the digestive tract, despite its low prevalence. It presents even rarer complications, including obstruction, digestive bleeding, or diverticulitis. It is important to consider the diverticulum as a diagnostic hypothesis in cases of obstruction without apparent causes, but it does not alter the initial management of the patient.

Renovascular hypertension secondary to Takayasu's arteritis in a child: Case report.

Introduction: Takayasu arteritis (TA) is a chronic inflammatory arteriopathy of unknown etiology that affects the aorta and its branches. Inflammation leads to arterial stenosis, thrombosis, and aneurysm formation. Management strategies for TA include medical therapy and revascularization procedures after inflammation is controlled. Presentation of the case: We report the case of a 12-year-old female patient, who presented with dyspnea and growth retardation. Initial clinical and radiological evaluations revealed hypertension and congestive heart failure. After controlling the inflammatory phase of the disease and blood pressure partially (with three antihypertensive agents), the patient underwent percutaneous balloon angioplasty of both renal arteries, with angiographic and clinical success. At the 2-year follow-up, she presented with re-stenosis of the right renal artery and progression of the supra-renal aortic stenosis. She was subjected to a second balloon angioplasty of the right renal artery and aortic balloon angioplasty. Discussion: After controlling the inflammatory phase of the disease, stenotic and/or aneurysmal lesions can be addressed. Percutaneous revascularization of renal arteries is reasonable for patients with hemodynamically significant renal artery stenosis. Conclusion: TA with renal involvement must be considered as an etiologic factor for secondary hypertension in young patients, even if there is no blood pressure difference between the upper extremities. In this case, renal and aortic stenosis were performed with low perioperative morbidity.

Forgotten guidewire: A case report.

Introduction: The Seldinger technique for implanting central venous catheters is the most used in the world. A metallic guidewire is employed in it, introduced through the lumen of a venipuncture needle, which serves as a path for the introduction of the central venous catheter. Complications directly related to this technique are of several types, such an insertion of a long-winded segment of the guidewire, which can lead to venous perforation, cardiac perforation, arrhythmias or even guidewire retention/embolization. Presentation of the case: We report the case of a patient with a late diagnosis of a guidewire retained in her venous system. The distal end of the guidewire pierced the pulmonary artery, crossed the chest wall and remained in the left breast tissue. It was removed by laparotomy, through an extra-peritoneal access to the right common iliac vein. Discussion: Different factors have been identified as responsible for the increase in the number of guidewires retained after central venous catheterizations. Lack of supervision, in procedures performed by training physicians, has been identified as one of the most important risk factor in the cases reported in the literature. Conclusion: The present report demonstrates that central venous catheterization, despite being a relatively straight forward procedure, should not be underestimated and should be performed by properly trained physicians or by training physicians under supervision.

Pott's disease associated with psoas abscess: Case report.

INTRODUCTION: Extrapulmonary tuberculosis may develop in any organ system, including the spine. The affection of spinal cord is called Pott's disease and it is the most frequent set. Pott's disease can present as back pain and be related to complications such psoas muscle abscess. CASE PRESENTATION: We report a case of 23-year-old Brazilian woman, natural from Amazonas, presenting with psoas abscess associated to Pott's disease treated with surgical debridement and drainage and extended tuberculosis scheme. DISCUSSION: Psoas abscess is rare and the main agents related to psoas abscess are Staphylococcus aureus, followed by Streptococcus and Escherichia coli. Retrofascial abscesses usually originate from bone lesions, including spine tuberculosis as our case, or due to contiguity of the retroperitoneal space. CONCLUSION: Psoas abscess related to Pott's disease is a difficult diagnosis, requiring high suspicious and proper investigation through good anamnesis, CT scan and culture.

Diaphragmatic herniation after 3 years of penetrating trauma managed through laparotomy: A case report.

INTRODUCTION: Diaphragmatic rupture is an uncommon trauma complication and it is associated with chronic diaphragmatic herniation, especially in the left side. Chronic diaphragmatic herniation is usually due to white weapon injury and as consequence of low suspicious and absence of proper investigation. CASE REPORT: We report a chronic diaphragmatic herniation after three years of a stab in the left thoracoabdominal transition, managed through laparotomy. DISCUSSION: Traumatic diaphragmatic rupture is a rare trauma consequence, most common in the left side. The herniation occurs gradually because of negative pressure of the thoracic cavity that works as a suction of the abdominal organs. CONCLUSION: Traumatic diaphragmatic ruptures diagnosis is difficult and might go unnoticed without high suspicious and proper investigation. Chronic herniation is associated with higher morbimortality.