Right hepatic vein bullet embolism: A case report.

Penetrating trauma is usually divided into stab and gunshot wounds (GSW). When considering GSW, the initial assessment involves the identification of all the wounds, to understand the projectile's trajectory as well as to determine which anatomic structures might have been damaged [1]. Rarely, the projectile might not leave the victim's body and embolize to a different region through large blood vessels. Known as Missile Embolism (ME), this uncommon complication can compromise multiple body segments, resulting in severe injuries, whether it occurs through an artery or a vein, such as pulmonary embolism, cardiac-valve incompetence, limb-threatening ischemia, coronary infarct, and stroke [2,3]. This is a case report of an 18-year-old male patient who suffered a gunshot wound and was submitted to an exploratory laparotomy which identified a laceration of the inferior vena cava. Further exams concluded that the bullet was embolized to the right hepatic vein. ME treatment will depend mostly on the bullet's placement; if located in the left circulation or arterial vessels, retrieval is the preferred treatment. It can be executed through surgical exploration or endovascular procedure [3,4,8] Venous ME has several treatment options, including conservative management if the patient remains asymptomatic [[3], [4], [5], [6], [7]]. Cases of paradoxical embolization might be managed as arterial ME [3,4].

Avaliaçäo manométrica do esôfago distal de coelhos submetidos a fundoplicatura total laparotômica e laparoscópica / Manometric evaluation of distal esophagus of rabbits submitted to open and laparoscopic fundoplication

Racional - A fundoplicatura total, procedimento empregado no tratamento da doença do refluxo gastroesofágico, pode ser realizada segundo duas técnicas de abordagem: laparotômica e laparoscópica. Objetivo - Analisar o esfíncter inferior do esôfago de coelhos submetidos a fundoplicatura total laparotômica e laparoscópica. Material e Métodos - Em 40 coelhos machos foram realizados estudos eletromanométricos do esôfago segundo a técnica de puxada intermitente da sonda e infusäo contínua dos cateteres com água destilada. Estes estudos permitiram a análise de dois parâmetros: amplitude da pressäo no esfíncter inferior do esôfago (mm Hg) e comprimento do esfíncter inferior do esôfago em condiçöes basais (momento 1). Os 40 animais foram divididos em quatro grupos de 10, na dependência do procedimento cirúrgico realizado: grupo 1: fundoplicatura total laparotômica; grupo 2: laparotomia mediana e dissecçäo da transiçäo gastroesofágica; grupo 3: fundoplicatura total laparoscópica; grupo 4: pneumoperitônio e dissecçäo da transiçäo gastroesofágica. No momento 2 (1 semana após os procedimento cirúrgicos) foram realizados estudos eletromanométricos do esôfago em todos os animais. Resultados - Nos animais do grupo 1 (fundoplicatura laparotômica) e do grupo 3, foi observado aumento da amplitude da pressäo e do comprimento do esfíncter inferior do esôfago. Naqueles dos grupos 2 e 4, näo foi observada alteraçäo da amplitude e do comprimento do esfíncter inferior do esôfago. Conclusöes - A fundoplicatura interfere na barreira anti-refluxo gastroesofágica, tornando-a mais eficiente, uma vez que a pressäo e o comprimento do esfíncter inferior do esôfago elevam-se no pós-operatório desta intervençäo. Este efeito foi observado nas duas técnicas de abordagem estudadas, laparotômica e laparoscópica

[Manometric evaluation of distal esophagus of rabbits submitted to open and laparoscopic fundoplication]. / Avaliação manométrica do esôfago distal de coelhos submetidos a fundoplicatura total laparotômica e laparoscópica.

BACKGROUND: Total fundoplication used in gastroesophageal reflux treatment, may be performed according to two techniques: laparotomy and laparoscopy. AIM: To study the lower esophageal sphincter in rabbits submitted to open and laparoscopic fundoplication. MATERIAL AND METHODS: Electromanometry studies of esophagus were carried out in 40 male rabbits, through the pull trough technique and infusion of the catheters with distilled water. The pressure width (mm Hg) and the length (cm) of the lower esophageal sphincter were measured in basal conditions (moment 1). The 40 animals were divided into four groups of 10 animals, according to the following surgical procedure: group 1: open total fundoplication; group 2: median laparotomy and dissection of gastroesophageal junction; group 3: laparoscopy total fundoplication; group 4: pneumoperitonium and dissection of the gastroesophageal junction. In moment 2 (1 week after the surgery) the manometry of the esophagus was performed in every animals. RESULTS: In groups 1 (open fundoplication) and 3, an increase of pressure width and length of the lower esophageal sphincter was observed. In groups 2 and 4, the pressure width and length of the lower esophageal sphincter presented no significant alteration. CONCLUSIONS: The fundoplication affects the antireflux gastroesophagic barrier and it becomes more efficient, because the pressure and the length of the lower esophageal sphincter increased after the pos-operated step of the surgery. This effect was observed in the two studied techniques, the laparotomy and the laparoscopy.