RESUMO
Since the first successful use of mesh in hernia surgery, the development and progress in materials, techniques, and procedures have increased exponentially; consequently, surgeons started to use meshes for hiatal hernia repair to prevent postoperative hernia recurrences and complications. Nonetheless, there are alarming reports in literature concerning cardiac tamponade as an apparently rare complication of hiatal mesh placement, especially when fixation is performed with tacks. A 50-year-old female diagnosed with gastroesophageal reflux disease undergoes an elective laparoscopic Nissen fundoplication and hiatal hernia repair with tack fixation of the mesh; on the fourth postoperative day she was readmitted with cardiac tamponade diagnosed via echocardiography, and CT scan showed proximity of the tacks to the pericardium. She underwent a failed attempt of ultrasound guided pericardiocentesis (PC), therefore, a pericardial window was performed. The ideal method for diaphragmatic mesh fixation is still controversial. Some recent articles alert of this potential risk; although the manufacturers contraindicate the use of tacks in the diaphragm, one-third of surgeons prefer this method.
RESUMO
Cecal volvulus is a rare cause of intestinal obstruction, with multifactorial etiologies. This is a case report describing a 52-year-old female with a cecal volvulus diagnosis made during the laparotomy procedure, which was treated with a right hemicolectomy with a side-to-side ileotransverse anastomosis. The aim of this report is to emphasize the importance of a diagnosis and appropriate treatment in this rare pathology in abdominal procedures. In this particular case, the patient benefited from an early surgical intervention without further complications, as well as an adequate postoperative evolution; it is important to acknowledge and consider this pathology during differential diagnosis, and not delay the treatment in patients with cecal volvulus. A critical review of the literature is included and discussed.
RESUMO
INTRODUCCIÓN Y OBJETIVO: El término mano diabética describe las infecciones de mano graves resultantes de trauma, mordedura humana o de perro y abuso de drogas, en pacientes que padecen diabetes mellitus. Las manifestaciones clínicas más frecuentes son celulitis, paroniquia, tenosinovitis, absceso profundo, artritis séptica y osteomielitis. Nuestra finalidad es presentar nuestra experiencia en la atención de pacientes con mano diabética, debido a que el retraso del diagnóstico de esta patología dificulta su tratamiento y predispone a mayores complicaciones. MATERIAL Y MÉTODO: Realizamos un estudio retrospectivo sobre los casos de mano diabética atendidos en el Servicio de Cirugía Plástica y Reconstructiva del Hospital General "Eduardo Liceaga" de la Ciudad de México (México) entre marzo de 2013 y marzo de 2018. RESULTADOS: El intervalo de edad de los pacientes fue de 19 a 87 años, con un número total de 42 pacientes atendidos, 23 mujeres (55%) y 19 varones (45%). Veinticinco pacientes (60%) no referían antecedentes de cirugías previas en mano y 17 (40%) presentaban antecedentes quirúrgicos tales como: amputación supracondílea en 4 pacientes (10%), amputación infracondílea en 1 paciente (2%) y remodelación de dedos en el 7%. El diagnóstico más frecuente fue tenosinovitis infecciosa de 3er dedo. El patógeno más frecuentemente encontrando fue Enterobacter cloacae (14%). Al analizar los tipos de tratamiento quirúrgico utilizados, específicamente la amputación, hubo diferencias sobresalientes al realizar el contraste por género y valorar la presencia de obesidad en los pacientes. El 52% de las mujeres sufrió amputación frente al 21% de varones (p = .029 a través de X2 de Pearson). El 43% de los pacientes con obesidad fueron amputados en comparación con el 36% que no la padecían (p = .061 a través de X2 de Pearson). CONCLUSIONES: En nuestra experiencia, se trata de una patología con una alta incidencia; sin embargo, no contamos en general con literatura suficiente para determinar un diagnóstico oportuno y un tratamiento eficaz, al igual que tampoco disponemos de un algoritmo o clasificación que ayude al control y seguimiento de los pacientes
BACKGROUND AND OBJECTIVE: The term diabetic hand describes serious hand infections resulting from trauma, human or dog bite and drug abuse, in patients suffering from diabetes mellitus. The most frequent clinical manifestations are cellulitis, paronychia, tenosynovitis, Deep abscess, septic arthritis and osteomyelitis. We present our experience in the care of patients with diabetic hand, as the delay of diagnosis makes the treatment difficult and predisposes to greater complications. METHODS: A retrospective study was conducted on cases of diabetic hand in Plastic and Reconstructive Surgery Department at Hospital General "Dr. Eduardo Liceaga" in Mexico City (Mexico) from March 2013 to March 2018. RESULTS: The age range of the patients was from 19 to 87 years, having a total number of 42 patients, 23 female (55%) and 19 male (45%). Twenty-five patients (60%) did not report a history of surgery, meanwhile 17 (40%) had a surgical history: supracondylar amputation was found in 4 patients (10%) and infracondylar amputation in 1 patient (2%); remodelation of the finger was equivalent to 7%. The most frequent diagnosis was infectious tenosynovitis of 3rd finger. The pathogen most frequently found was Enterobacter cloacae (14%). When analyzing the types of surgical treatment used, specifically amputation, there were outstanding differences when contrasting by gender and the presence of obesity in the patients: 52% of the female gender were amputated against 21% of the male group (p = .029 through Pearson's X2); 43% of patients with obesity were amputed compared to 36% who did not have it (p = .061 through Pearson's X2). CONCLUSIONS: This pathology has a high incidence, however there is not enough literature to determine timely diagnosis and effective treatment, as there is yet no algorithm or some classification that helps the control and monitoring of patients
