RESUMO
A 54-year old male patient was admitted with a tentative diagnosis of biliary pancreatitis. After 3 days, he developed an acute abdomen with a pneumoperitoneum. A laparotomy was performed: multiple perforations of the terminal ileum and a necrotic gallbladder were found. A right hemicolectomy with 30 cm of the terminal ileum and a cholecystectomy were carried out. At the same time, positive blood cultures for Salmonella typhi were obtained and this confirmed the diagnosis of ileal perforation due to salmonella typhi infection. This case illustrates that Salmonella typhi infection can be a surgical problem in the western countries.
Assuntos
Doenças do Íleo/etiologia , Perfuração Intestinal/etiologia , Febre Tifoide/complicações , Humanos , Doenças do Íleo/cirurgia , Perfuração Intestinal/cirurgia , Masculino , Pessoa de Meia-Idade , Febre Tifoide/cirurgiaRESUMO
Hemobilia, although not uncommon, is usually inconsequential and most of the times not even diagnosed. It is known that hemobilia is a rare complication of cholecystitis and cholecystolithiasis. We report the case of a patient who presented with a life-threatening upper gastro-intestinal bleeding due to erosion of the cystic artery by cholecystolithiasis and cholecystitis.
Assuntos
Abdome Agudo/etiologia , Colecistite/complicações , Colelitíase/complicações , Hemobilia/etiologia , Idoso , Colecistite/diagnóstico por imagem , Colecistite/cirurgia , Colelitíase/diagnóstico por imagem , Colelitíase/cirurgia , Feminino , Hematemese/etiologia , Humanos , Tomografia Computadorizada por Raios XRESUMO
The long-stem, long-neck endoprosthesis is used in the treatment of pertrochanteric hip fractures in the elderly. Between 1978 and 1984, 157 patients 70 years of age and over were treated at our clinic for fresh unstable pertrochanteric hip fractures. Fifty-five patients had internal fixation. Because of the high incidence of mechanical complications, the long spherostem endoprosthesis became the treatment of choice between 1980 and 1984. Thus, 102 patients were treated with this type of arthroplasty. They were compared with the 55 patients treated with osteosynthesis, and we concluded that: (1) in comparison with osteosynthesis, the procedure of endoprosthetic replacement is no more extensive and the mortality is no higher; (2) the incidence of mechanical complications is significantly lower in the endoprosthesis group; (3) even if the dynamic hip screw is now the treatment of choice for pertrochanteric fractures, the long spherostem endoprosthesis is still indicated in arthrotic hip fractures or in the case of reintervention after implant failure.
