Limb salvage versus amputation: Experience of a young patient at a university hospital.

Decision-making regarding limb amputation represents a significant clinical challenge, especially when the initial evaluation does not coincide with the criteria established in scales used worldwide, as is the case of the MESS scale. This article presents the case of a 24-year-old female patient who was transferred to a university hospital after a road traffic accident with severe and large lesions in the left lower limb. Despite a poor initial prognosis and in-hospital complications, including multiple surgical procedures and foot drop, a favorable recovery was achieved with complete anatomical salvage of the limb at risk. The multidisciplinary approach and intensive rehabilitation were instrumental in achieving a satisfactory functional recovery. This case highlights the importance of considering factors beyond amputation scale scores, as well as the need for comprehensive care to improve outcomes in patients with complex extremity injuries.

Endoscopic negative pressure therapy for the closure of an esophagojejunal anastomosis fistula. Case report / Terapia endoscópica de presión negativa para cierre de fístula de la anastomosis esófago-yeyunal. Reporte de caso

Abstract Introduction: Post-surgical esophagojejunal anastomosis fistulas can be life-threatening. Currently, there are several treatment alternatives. In recent years, endoscopic negative pressure therapy has emerged as an innovative treatment for these fistulas, offering numerous benefits. Case presentation: A 72-year-old man diagnosed with gastric adenocarcinoma of the body and fundus underwent total gastrectomy with D2 lymphadenectomy and Roux-en-Y anastomosis with curative intent in a quaternary care hospital in Popayán, Colombia. However, in the postoperative period, he presented systemic inflammatory response syndrome and acute abdomen due to an esophagojejunal fistula. Initial management included a laparotomy, two peritoneal washings, and an abdominal drainage. Then the patient developed frozen abdomen, so it was not possible to access the esophagojejunal anastomosis. Fistula closure was attempted by inserting a self-expandable metallic stent, yet the procedure was not successful. Salvage therapy was started using an endoscopic vacuum-assisted closure (VAC) system. After 5 replacements of the VAC system, complete drainage of the intra-abdominal collection, complete closure of the peritoneal cavity, and closure of the esophagojejunal leak, with a small residual diverticular formation, were achieved. The patient's condition improved progressively, resuming oral intake 20 days after initiation of VAC therapy. In addition, no new abdominal complications were reported during the follow-up period (17 months). Conclusions: Endoscopic VAC therapy is a new safe and effective alternative to treat complex post-surgical fistulas caused by esophagojejunal anastomosis.

Resumen Introducción. Las fístulas de las anastomosis esófago-yeyunales postquirúrgicas pueden llegar a ser mortales. En la actualidad, existen varias alternativas de tratamiento, y en los últimos años la terapia endoscópica de presión negativa se ha convertido en un método innovador y con grandes ventajas para el manejo de estas fístulas. Presentación del caso. Hombre de 72 años diagnosticado con adenocarcinoma gástrico de cuerpo y fondo a quien se le realizó una gastrectomía total con linfadenectomía D2 y una anastomosis en Y de Roux con intención curativa en un hospital de cuarto nivel en Popayán, Colombia. Sin embargo, en el posoperatorio presentó síndrome de respuesta inflamatoria sistémica y abdomen agudo producto de fístula esófago-yeyunal. Se realizó manejo inicial con laparotomía, dos lavados de cavidad peritoneal y drenaje abdominal. Posteriormente, el paciente desarrolló abdomen congelado, por lo que no fue posible acceder a la anastomosis esófago-yeyunal. Se intentó cierre de fístula mediante la inserción de prótesis metálica autoexpandible, pero el procedimiento no fue exitoso. Se inició terapia de rescate mediante sistema de cierre asistido por vacío (VAC) por vía endoscópica. Luego de 5 recambios del sistema VAC, se logró el drenaje completo de la colección intraabdominal encontrada, el cierre completo de la cavidad peritoneal y el cierre de la fuga esófago-yeyunal, con una pequeña formación diverticular residual. La condición del paciente mejoró progresivamente, con reinicio de la vía oral a los 20 días del inicio de la terapia VAC. Además, no se reportaron nuevas complicaciones abdominales en el periodo de seguimiento (17 meses). Conclusión. La terapia endoscópica de VAC es una nueva alternativa segura y efectiva para el tratamiento de fístulas postquirúrgicas complejas producto de anastomosis esófago-yeyunales.

Rehabilitación estética con coronas de resina personalizadas utilizando encerado digital en paciente pediátrico: informe de caso / Aesthetic rehabilitation with customized resin crowns using digital wax-up in pediatric patient: a case report

Resumen Introducción: El presente informe de caso clínico se enfoca en el diagnóstico y tratamiento para la rehabilitación de la dentición temporal en el sector anterosuperior utilizando tecnología CAD-CAM. Objetivo: Proponer una alternativa para mitigar el margen de error y tiempo de trabajo en el paciente pediátrico, reintegrando la estética y funcionalidad en la cavidad oral. Métodos: Se describe el caso de un paciente de sexo masculino de 6 años que acudió a la clínica universitaria de la Universidad UTE con lesiones cariosas extensas en sus dientes anterosuperiores y su rehabilitación a través de la utilización de coronas personalizadas de resina mediante un encerado digital realizado en CAD-CAM. Resultados: El tratamiento efectuado en el niño fue satisfactorio, se evidenció una mejoría en la dimensión vertical e incremento en la estética dental y facial, mejorando su aspecto y autoestima después de la rehabilitación. Conclusión: La utilización del encerado digital en pacientes pediátricos podría ser una alternativa que permita reducir el tiempo de trabajo del tratamiento en una rehabilitación estética dental.

Abstract Introduction: This case report focuses on the diagnosis and treatment for the rehabilitation of the primary dentition in the anterosuperior sector using CADCAM technology. Objective: To propose an alternative to mitigate the margin of error and working time in pediatric patients, reintegrating esthetics, and functionality in the oral cavity. Methods: We describe the case of a 6-year-old male patient who came to the clinic of Universidad UTE with extensive carious lesions in his anterosuperior teeth and his rehabilitation using personalized resin crowns by means of a digital waxup performed in CAD-CAM. Results: The treatment performed on the child was satisfactory, there was an improvement in the vertical dimension and an increase in dental and facial esthetics, improving his appearance and self-esteem after the rehabilitation. Conclusión: The use of digital wax-up in pediatric patients could be an alternative that allows the treatment time to be reduced in esthetic dental rehabilitation.

Spontaneous enterocutaneous fistula in a patient with femoral hernia: a case report.

BACKGROUND: Enterocutaneous fistula commonly occurs in the post-operative setting. However, a handful of cases have been reported to occur secondary to strangulation of hernia, mostly femoral due to the narrow femoral ring through which this type of hernia passes through. CASE PRESENTATION: We encountered a case of spontaneous fecal fistula, which occurred in the setting of an incarcerated femoral hernia. The patient did not develop peritonism, or obstruction, throughout the course of the disease. The hernia ruptured on day 7 of incarceration. Exploratory laparotomy under epidural anesthesia revealed a femoral hernia with ileum as content, arising approximately 20 cm from the ileocecal junction. Reduction of the contents was done, and a resection performed along with repair of the hernia. CONCLUSION: As very few literature describe the formation of spontaneous fecal fistula, we discuss the presentation in this report.