We describe the surgical management of a patient who had gallbladder stones and hemolytic anemia by spherocytosis. On this patient we performed cholecystectomy and splenectomy by laparoscopic approach without any complications and a succesfully post operative period.
Philosophic medical and legal principles are stated introducing the name oblito, explaining its linguistic root.the definition of foreing body accidentally forgotten during an operation and with no therapeutic value, is proposed. The characteristics of the foreing body left in the abdomen during surgery from the nosographic and nosologic point of view, give this process an individuality, that allows to speak about its clinics. The symptomatology is clear and connected to the clinical forms analyzed.diagnosis is reached specially by radiology. In orden to complete the oblito's pathological similitude with other abdominal processes, it is necessary to point out that it has a regulated prophilaxis, in nearly every surgical center.
SUMMARYThe abdominal oblito that can be formed in an involuntary way after making an invasive procedure abdominal constitutes a serious problem that is not very analyzed in the medical literature. The purpose in the presentation of this case of intestinal obstruction by oblito is to aid the support of the concept that all has not still been said about the ways of presentation of the abdominal oblito. Also to insist in the importance of the prevention and the inform of the personnel of the surgical room. The daily chore confirms that this topic is a taboo issue and that it generates dilemmas in diverse planes which magnitude is as enough as to be discussed. INTRODUCCIÓNSegún el Diccionario de la Real Academia de la Lengua Española, en su 21 ava edición (1992). El oblito abdominal es un cuerpo extraño dejado accidentalmente en el abdomen durante una intervención quirúrgica y sin efecto terapéutico: gasas, compresas de distinta variedad y tamaño, tubo de drenaje o aspiración, instrumentos,etc.(1,2,3), quedan excluídos todos aquellos elementos que se hallan en el organismo cumpliendo un propósito terapéutico o estético tales como prótesis, suturas metálicas, parches mallas entre, otros. La calificación de "quirúrgico" resulta redundante. Comprende, por extensión, hechos similares acontecidos en el curso de cualquier maniobra invasiva.La incidencia del oblito se desconoce. En la búsqueda bibliográfica se encontraron 3 trabajos nacionales y 91 extranjeros durante el período 1990-2001(3,4).Cabe destacar que existe un sub registro de su ocurrencia, ya que se desconoce la cantidad de casos con resolución espontánea y cuando acontece, se niega o no se publica su hallazgo, no existen estudios necrópsicos sistemáticos y la aceptación del oblito se constituye en origen potencial de demandas.El objetivo de esta presentación es hacer conocer otra forma de presentación del oblito abdominal y abordar también algunos aspectos clínicos, metas terapéuticas, prevención y consideraciones medico legales. Caso clínicoPaciente de 42 años, casada, mestiza, con antecedente de haber sido colecistectomizada en Ayacucho en junio del 2001 y reintervenida 48 horas después por peritonitis biliar.A los pocos días de la reoperación y desde hace aproximadamente 8 meses presenta dispepsia y flatulencia en forma intermitente, que con el tiempo se acompaña de llenura precoz y vómitos de contenido alimenticio. Ante la persistencia de esta sintomatología acudió al Hospital Nacional Cayetano Heredia donde se encuentra una paciente en REG, REN, REH, peso 52
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