Introduction and importance
Duodenal trauma is rare, however, it has high morbidity and mortality rates. Surgical treatment modalities are employed depending on severity, ranging from simple sutures to complex pancreaticoduodenectomy cases.
Case presentation
A male patient had a circular saw accident, leading to evisceration in an extensive wound from the thoracoabdominal transition to the inguinal region, with 75% laceration of the second duodenal portion circumference, laceration in hepatic segments, section from right mesocolon to transverse colon, and multiple perforations in small bowel loops between 70 and 90 cm from the angle of Treitz. Laterolateral duodenum enteroanastomosis was performed with proximal jejunum and gastroenteroanastomosis with the distal loop of the small intestine at 90 cm from the Treitz angle, and a termino lateral enteroanastomosis between food and the biliary loop at 20 cm from the gastroenteroanastomosis.
Clinical discussion
This report presents a new surgical technique for patients with penetrating duodenal trauma associated with liver and intestinal injuries, to avoid the need for more complex procedures. In addition, it demonstrates postoperative management of complications, including confection of the enteroatmospheric fistula for feeding.
Conclusion
The technique described in this article proved to be a good option for treating these lesions, as evidenced by optimal postoperative results.
Nonoperative tratment (NOT) of blunt liver injury is a widespread practice that has a high sucess rate (82- 100%). Because of this, NOT has been used in cases of penetrating liver injury. However, despite the positive outcomes, the indication of NOT in these cases is controversial. Due to high incidence of associated thoracoabdominal injuries, this treatment modality requires a careful selection of the patient. This report presents a case of a victim of a firearm injury whose projectile was lodged in segment II of the liver, and this injury was managed with NOT, without any liver complications. However, due to its thoracic path to the abdominal cavity, it was necessary to approach the pleural empyema condition, with good evolution, without other associated complications.
Introdução: A ocorrência de metástase de carcinoma espinocelular (CEC) de colo de útero envolvendo trato gastrointestinal, corresponde a aproximadamente 8% dos casos, sendo que o segmento anatômico mais afetado é a porção retossigmoideana, especialmente devido a sua topografia. O acometimento isolado do intestino delgado é extremamente raro. Relato do caso: Nesse artigo, relatamos o caso de uma paciente de 67 anos, com história de carcinoma cervical tratado há dois anos, apresentando quadro de abdome agudo obstrutivo, com necessidade de tratamento cirúrgico. No intra operatório, apresentou evidência de metástase em intestino delgado com invasão de raiz de mesentério, confirmada através da análise histopatológica. Devido a irressecabilidade da lesão e estágio avançado da doença, paciente evoluiu para óbito durante internação hospitalar. Conclusão: A despeito de metástases para o intestino delgado serem raras, essa hipótese deve fazer parte dos diagnósticos diferenciais a fim de auxiliar nas decisões terapêuticas.
A intussuscepção no adulto é rara, sendo somente 10% de causas idiopáticas. A ocorrência transitória dela é mais rara e normalmente relacionada a doença celíaca, doença de Crohn ou aderências. Nesse artigo, relatamos o caso de um paciente, 66 anos, que apresentou uma intussuscepção idiopática transitória. Ele procurou atendimento
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