Thoracic foreign body management after penetrating chest trauma by chainsaw in the Amazon countryside: A case report.

INTRODUCTION: Accidents involving chainsaws are not uncommon in trauma care and may present as penetrating injuries with retention of a foreign object in the patient's chest. The current literature, however, does not present a consensus on the best way to approach these cases. PRESENTATION OF CASE: Male patient, 46-year-old man, born in Amazonas countryside, brought to the city of Manaus with a penetrating injury resulting from an accident with a chainsaw and retaining a 2cm sawtooth in his chest, six days after the event. After laboratory and imaging tests, as well as pre-operative preparation, an open thoracotomy was realized, the object was removed, and the patient was placed under a thoracostomy tube. DISCUSSION: The diagnosis of chainsaw incidents is generally described in the literature as post-mortem, mainly due to the inappropriate use of the equipment. Surgical removal of a foreign body is indicated in most cases, except when it is peripheral or when there is some impossibility. Early surgical treatment benefits the patient, with lower mortality and morbidity. CONCLUSION: In view of the absence of consensus and guidelines to the approach of thoracic injury with foreign body retention, it is up to the surgeon to evaluate the best conduct in each case and according to the available resources.

A differential diagnosis in chronic lower abdominal pain.

INTRODUCTION: Spigelian hernias represent 0.12-2.4% of all abdominal wall hernias. Its diagnosis is elusive and requires a high level of conjecture given the disease rarity, vague associated abdominal complaints and frequent lack of consistent physical findings. PRESENTATION OF CASE: A 60-year-old woman presented with a history of chronic pain in the left lower side of the abdomen. The patient was treated for several diseases with no relief of symptoms. Abdominal ultrasound showed a Spigelian hernia in the lower left abdomen and surgery was scheduled for treatment. DISCUSSION: A SH is generally an inter-parietal hernia, meaning that the pre-peritoneal fat and the hernia sac penetrate the trasnversus abdominis and internal oblique muscles but remain behind the external oblique aponeurosis. In most of the patients the lack of clinical signs demands radiological investigation. That's the importance of the high grade of suspicious of the disease during the physical exam. The surgical repair is necessary due to the high risk of incarceration-related complications which can occur in up to 21% of cases. CONCLUSION: It's important to think in the Spigelian hernia as cause of lower abdominal pain to prompt indicate surgical repair and provide the patient's symptom relief. Also the type of repair is dependent on the surgeon's choice and also the means available in each center.