RESUMO
We present a case of a 66-year-old man, who was admitted with a 6-hour history of severe diffuse abdominal pain of acute onset, accompanied by nausea and flatulence. The patient underwent an exploratory laparotomy, which revealed the presence of multiple diverticules of the jejeunum, one of which was ruptured. The patient was treated with segmental resection of the jejunum carrying the ruptured diverticle. Perforation of a jejunal diverticulum has to be considered in the differential diagnosis of acute abdomen.
Assuntos
Abdome Agudo/etiologia , Divertículo/complicações , Perfuração Intestinal/etiologia , Doenças do Jejuno/complicações , Abdome Agudo/diagnóstico , Abdome Agudo/cirurgia , Dor Abdominal/etiologia , Idoso , Diagnóstico Diferencial , Divertículo/diagnóstico , Divertículo/cirurgia , Humanos , Perfuração Intestinal/diagnóstico , Perfuração Intestinal/cirurgia , Doenças do Jejuno/diagnóstico , Doenças do Jejuno/cirurgia , Masculino , Ruptura Espontânea , Resultado do TratamentoRESUMO
BACKGROUND: To compare tension-free hernia repair to a modified Bassini technique (Andrew's technique) used to treat complicated inguinal hernia. METHODS: In the period 1990-2004, 75 patients were submitted to emergency operation because of strangulated inguinal hernia. 33 patients underwent tension-free repair utilizing a polypropylene mesh (group A), whereas the remaining 42 patients underwent a modified Bassini technique (group B). RESULTS: Mean operative time was significantly longer for group B (91.5+/-9.3 min vs 75.7+/-10.5 min, p<0.05). Postoperative hospital stay was also significantly longer in group B compared to group A (10.3+/-3.4 days vs 4.5+/-2.1 days, p<0.01). Postoperative complication rate did not differ significantly between the two groups (5/33, 15.1% vs 5/42, 11.9%, p=n.s.). No mesh had to be removed. At follow-up (mean 9+/-4.2 years), there was one recurrence in group A (1/33, 3%) and two recurrences in group B (2/42, 4.7%) (p=n.s.). CONCLUSION: The presence of a strangulated inguinal hernia cannot be considered a contraindication for the use of a prosthetic mesh.
Assuntos
Hérnia Inguinal/diagnóstico , Hérnia Inguinal/cirurgia , Laparoscopia/métodos , Laparotomia/métodos , Polipropilenos , Telas Cirúrgicas , Idoso , Estudos de Coortes , Emergências , Feminino , Seguimentos , Humanos , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Probabilidade , Recidiva , Estudos Retrospectivos , Medição de Risco , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Anormalidade Torcional , Resultado do TratamentoRESUMO
We report on a case of a retroperitoneal accessory spleen with vascular supply directly from the aorta. A 47-year old woman presented with a six-month history of epigastric pain, intermittent nausea and vomiting. The CT scan of the abdomen revealed the presence of a retroperitoneal tumor between the spleen, left kidney and pancreas. The MR-tomography confirmed the presence of a solid tumor, with vascular supply directly from the aorta. The exploratory laparotomy showed the presence of a well-shaped accessory spleen, which was confirmed by the histological examination of the specimen. The surgeon should be aware of the possible existence of accessory spleens for the differential diagnosis of retroperitoneal tumors.
