RESUMEN
The VenaSeal (Medtronic, Minneapolis, Minn) cyanoacrylate closure system is a nonthermal technique for ablating saphenous veins using a proprietary n-butyl cyanoacrylate. One possible side effect is an allergic reaction to cyanoacrylate. We report the case of a 49-year-old woman treated with cyanoacrylate closure who developed a persistent type IV hypersensitivity reaction. The patient elected to have the vein excised, and the histologic features were consistent with a type IV hypersensitivity reaction.
RESUMEN
Pylephlebitis is thrombophlebitis of the portal vein or its tributaries. It is a rare diagnosis that carries a high mortality if not diagnosed and treated before the onset of sepsis. The authors describe a case of pylephlebitis in a patient who represented with sepsis after surgical treatment of perforated appendicitis.
Asunto(s)
Vena Porta , Tromboflebitis/diagnóstico , Adulto , Apendicectomía/efectos adversos , Diagnóstico Diferencial , Humanos , Masculino , Vena Porta/diagnóstico por imagen , Tromboflebitis/diagnóstico por imagen , Tromboflebitis/terapia , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: There are minimal data comparing laparoscopic appendectomy (LA) with open appendectomy (OA) in obese patients. METHODS: We reviewed consecutive adult patients from 2003 to 2005 who underwent an appendectomy at a University-affiliated teaching hospital. Obesity was defined as a body mass index of 30 or greater. Outcome measures included length of stay, surgical times, intra-abdominal abscesses, wound infections, and hospital charges. RESULTS: There were 116 patients with a mean body mass index of 35. Eighty-five patients underwent LA, 12 were converted to open, 4 of 12 (31%) were perforated. Thirty-one patients underwent OA. Overall, 21 (18%) were perforated. Length of stay for LA was better, 3.4 days versus 5.5 days for OA (P = .02), and wound closure rate was better, 90% for LA versus 68% for OA (P < .01). Other outcome measures were equivalent. CONCLUSIONS: LA is associated with shorter lengths of stay, fewer open wounds, and equivalent hospital charges and intra-abdominal abscess rates; and should be considered the procedure of choice for obese patients with appendicitis.
