RESUMO
We present the case of a 16-year-old girl who was sexually assaulted with transanal forearm penetration resulting in rectal perforation. She required a sigmoid colostomy that was later reversed. The patient's history and physical examination was complicated by multiple factors: she was intoxicated at the time of presentation as well as during the assault; her presentation fluctuated over time, she was obese, and she carried a psychiatric diagnosis. This case report documents a rare injury caused by sexual assault in the adolescent population and also serves as a platform to discuss the evaluation and management of pediatric victims of sexual assault. We support a collaborative model of care including qualified sexual assault pediatricians, sexual assault nurse (or forensic) examiners, medical specialists, and the criminal justice system. The importance of developing updated sexual assault protocols, ensuring their implementation, and maintaining continuous quality assurance cannot be overemphasized.
Assuntos
Perfuração Intestinal/cirurgia , Estupro/diagnóstico , Reto/lesões , Reto/cirurgia , Adolescente , Intoxicação Alcoólica/complicações , Braço , Colonoscopia/métodos , Colostomia/métodos , Serviço Hospitalar de Emergência , Feminino , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Perfuração Intestinal/etiologia , Laparotomia/métodos , Notificação de Abuso , Transtornos Mentais/complicações , Cidade de Nova Iorque , Obesidade/complicações , Cuidados Pós-Operatórios/reabilitação , Reoperação/métodos , Medição de Risco , Delitos Sexuais , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
Controversy exists as to the role of minimally invasive techniques in the management of early gallbladder cancer. The majority of early gallbladder cancers are diagnosed upon final pathology after laparoscopic cholecystectomy. For stage pT1a tumors, no further surgery is warranted; however, for pT1b or greater lesions, patients usually undergo port-site excisions and completion of open radical cholecystectomy involving a partial hepatectomy of segments IV and V and a lymphadenectomy of the hepatoduodenal ligament. Presented in this paper is a totally laparoscopic radical cholecystectomy performed for suspected early gallbladder cancer. Despite the fact that a preoperative serum IgG4 level was within normal limits, final pathology was consistent with autoimmune cholecystitis. As a result, the laparoscopic radical cholecystectomy may be useful in select patients with a preoperative suspicion of early-stage gallbladder cancer by sparing them the necessity of a second-stage open procedure.
