RESUMO
Cervical necrotizing fasciitis represents an aggressive form of deep neck space infection with a high mortality rate. The origin is generally odontogenic, in most cases, resulting from a dental abscess. A series of three cases developed after local application of herbal medicine in patients with no co-morbidities and with a history of a toothache in the lower quadrants for >2 weeks is presented. All patients were managed with antibiotics, extraction of offending tooth and serial wound debridement. Two patients recovered with a resultant skin defect on the neck and one died due to multiple organ failure. This case series demonstrated that early diagnosis, prompt surgical intervention and appropriate medical treatment are very important to increase patient survival. Late report to hospital because of financial constraints and over-reliance on herbal preparation could lead to the development of serious complication in patients with dental infections and could even lead to death of the patient.
RESUMO
Acute traumatic abdominal wall hernia (TAWH) is a rare type of hernia that occurs after a low or high velocity impact of the abdominal wall against a blunt object with few cases reported. Perforations of the hollow viscera commonly follow abdominal trauma and likely require surgery for hemorrhage and sepsis source control. We report a case where a high velocity impact of the abdominal wall against the stump of a felled tree caused a TAWH with concomitant gastric perforation in a 20-year-old male patient who required exploratory laparotomy with primary repair of the stomach and fascia. The physical examination findings without previous history of abdominal hernia and pneumoperitoneum in the chest X-ray made suspect our diagnosis and it was confirmed intraoperatively. At 3 months postoperatively the patient has a strong abdominal wall. It is imperative to emphasize the importance of the physical examination goal of not losing diagnosis of TAWH.
RESUMO
Se presenta el caso de paciente femenina de 33 años, cesareada hace 6 meses, con dolor abdominal, vómitos y no expulsión de heces ni gases, con abdomen distendido y ruidos hidroaéreos aumentados. El ultrasonido abdominal informa asas dilatadas, con líquido interasa, sin signos de lucha. En la radiografía de abdomen simple se observan niveles hidroaéreos de forma escalonada. Durante el acto quirúrgico se observa apelotonamiento de asas yeyunales e iliales con fístulas complejas y múltiples que obligan a realizar resección intestinal doble con anastomosis término terminal en dos planos, lavado y drenaje. En anatomía patológica se concluye como resección de intestino delgado a cuerpo extraño (compresa de 30.5 X 49.2) no tumor. Evolución ulterior satisfactoria. Se revisan aspectos clínicos y quirúrgicos de interés práctico en la prevención y tratamiento de esta patología (AU)
