Continuous negative pressure wound therapy in the treatment of a gigantic trophic leg ulcer.

AIM: to present a therapeutic algorithm for chronic venous insufficiency complicated with ulceration, using etiologic treatment combined with local treatment by negative pressure wound therapy (NPWT) before and after skin grafting. MATERIAL AND METHOD: we are discussing a 59 years-old patient with a lower leg gigantic, circumferential trophic lesion. The aetiology was combined, post-traumatic and chronic venous insufficiency, with 30 years of evolution. RESULTS: the treatment was applied in two surgical steps. Initially the pathological refluxes were interrupted; secondarily a skin graft was applied, preceded and followed by NPWT until graft intake. The wound healed completely; patient developed secondary foot lymphoedema. CONCLUSIONS: 1. Case treatment particularity consists in using a combination of etiologic and local treatment, combined with adjuvant NPWT. 2. Secondary lymphoedema developed due to circumferential location of the lesion. 3. Continuous NPWT has proven its efficiency in chronic ulcer before and after skin grafting, reducing costs and duration of treatment.

[Intramural intestinal hematoma--a complication of the oral anticoagulant therapy]. / Hematom intestinal intramural, complicatie a tratamentului anticoagulant oral.

AIM: The presentation of a rare complication of oral anticoagulant treatment involving abdominal surgery. MATERIAL AND METHOD: A 59 years old patient who received oral anticoagulant treatment with Warfarine for repeated episodes of thrombosis of the lower limbs, suddenly develops an occlusive abdominal simptoms, which did not submit under conservative treatment. Biologically the clotting times were modified and the abdominal CT showed lesions of the first jejunal loop. RESULTS: During surgery an amount of blood was found in abdominal cavity and a large haematoma of the first jejunal loop which required resection. The postoperative evolution was simple with discharge in the 12th day, surgically cured. CONCLUSIONS: 1. Intramural intestinal haematoma is a rare, but possible complication of the oral anticoagulant treatment. 2. Precise diagnosis is possible, avoiding unnecessary surgical intervention because the complication is treatable using conservative therapy. 3. Surgical intervention is required in case of a sudden onset, imprecise diagnosis and unfavorable evolution which could point associated intraabdominal lesions.

[Intestinal stromal tumors, rare cause of lower gastrointestinal bleeding. Case report]. / Tumora intestinala stromala, cauza rara de hemoragie digestiva inferioara. Caz clinic.

Gastrointestinal stromal tumors represent a heterogeneous group of mesenchymal tumors that can develop throughout the gastrointestinal tract. We present the clinical case of a patient with such malignancies occurred in the proximal jejunum and clinically manifested by a severe digestive hemorrhage with hemorrhagic shock and severe posthemorrhagic anemia. Pre-operative diagnosis was possible only through the Entero-MRI. The evolution was favorable after surgical extirpation. It's being discussed particular aspects of this lesion's entity and post-operative optimal attitude in this case.