ABSTRACT
The authors present a case of penetrating injury of the extraperitoneal rectum, in a worker of 41. The treatment required a simple suture, because the conditions were favourable, such as simple lesions, without peritoneum contamination. Moreover, the authors propose a review of the literature, to single out the factors which influence mortality and mobility, as well as the most recent pathogenetic and therapeutic findings. Lesions caused by impalement are usually a difficult surgical problem. The mechanism of the injury, is usually a direct one, commonly diffused among workers. The entity of these lesions depends on the fall height, the penetrating object dimensions and the patient's weight. The diagnosis is based on anamnestic, clinical, radiological and endoscopic observations. The prognosis depends on several factors, such as: 1) the trauma extension and the presence of associated lesions; 2) the time elapsed between the trauma and the treatment influences the degree of bacterial contamination; 3) the patient's age and his physical conditions; 4) the assistance quality at the moment of the occurrence. The mortality, as far as complex lesions are concerned, is nowadays very high (50-75%).
Subject(s)
Anal Canal/injuries , Wounds, Penetrating , Adult , Humans , Male , Perineum/injuries , Wounds, Penetrating/complicationsABSTRACT
The authors' aim is to review the medical literature dealing with diagnostic and therapeutical problems, after observations in pregnancy because of acute appendicitis in 9 cases. Diagnosis is difficult because of the aspecificity and the alterations both of the site of symptoms and clinical manifestations, particularly during the last period of gestation. As there is an upward displacement of the viscus by the pregnant uterine. Notwithstanding the use of some not invasive methods, such as graded-compression sonography, the diagnosis is always effected by the clinical examination. Surgical treatment is always possible in the presence of acute appendicitis, as pregnancy isn't a reason for delay. The maternal mortality is at a zero level, the fetal one varies from 2% to 43% in cases of perforated appendicitis.
Subject(s)
Appendicitis/diagnosis , Pregnancy Complications, Infectious/diagnosis , Acute Disease , Adult , Diagnosis, Differential , Female , Humans , Pregnancy , Pregnancy OutcomeABSTRACT
The authors present their own experience of emergency in strangulated laparoceles. Between January 1984 and June 1992 they treated at the Division of Emergency Surgery of the Hospital "A. Cardarelli" in Naples 133 cases of laparocele, 63 of which were strangulated. 48 of the 63 cases were treated by simply vertical or transversal laparoplasty ("waistcoat"); in 4 cases a direct plastic surgery; was executed in 11 cases a synthetic patch was used: in 2 cases a Teflon prosthesis was used; in one case a double prosthesis: a reabsorbable Vicryl patch internally and an external Marlex reticulated; in 8 cases a Marlex prosthesis. Moreover in most cases, before the laparoplasty of the abdominal wall operations of viscerolysis, were carried out intestinal and/or epiploon resection because of ischemia, colostomy, a Hartmann (one case). Of the 11 patients treated with synthetic patches, only 4 presented local complications: a seroma, two suppurations of the wound and a skin necrosis. These complications were treated with a medical therapy. In no case it was necessary to remove the prosthesis, as there were no general complications or deaths. We have to underline that notwithstanding the great advances both in surgery and in prosthesis' materials, the problem of the strangulated laparocele still represent a great engagement for the surgeon. The main reasons are: concomitant pathologies ("eventration disease"') and complications. The complications may be local (infection of the wound) or general (cardiocirculatory and respiratory problems due the viscus reduction in the original abdominal cavity).(ABSTRACT TRUNCATED AT 250 WORDS)
