Introducere: Leziunile diafragmatice sunt produse prin traumatisme toraco-abdominale închise sau deschise. Acestea sunt leziuni potenţial letale prin hernierea organelor abdominale în cavităţile pleurale şi prin severitatea leziunilor asociate. Scopul acestui studiu a fost analizarea manifestărilor clinice şi a managementului pacienţilor internaţi în clinica noastră cu diagnosticul de ruptura traumatică a diafragmului. Material şi metodă: Am efectuat un studiu retrospectiv pe o perioadă de 5 ani, în care am inclus pacienţii internaţi cu leziuni diafragmatice acute, internaţi în Clinica de Chirurgie Generală a Spitalului de Urgenţă "Bagdasar-Arseni". Am analizat repartiţia pe sexe şi vârstă, mecanismul traumei, localizarea, timpul până la diagnostic, leziunile concomitente, tratamentul chirurgical şi rezultatele. Rezultate: Au fost incluşi în studiu 15 pacienţi (8 bărbaţi, 7 femei, vârstă medie de 42 ani) cu rupturi diafragmatice (13 ale hemidiafragmului stâng, 2 ale celui drept), produse prin traumatisme închise (8 cazuri) sau deschise (7 cazuri). Leziunile diafragmatice închise au avut dimensiuni mai mari, producând hernierea viscerelor abdominale la 6 bolnavi. Sutura directă a fost efectuată la toţi cei 15 pacienţi, abordul prin laparotomie mediană fiind preferat de cele mai multe ori. Rata mortalităţii a fost de 20%, cauza principală fiind leziunile concomitente foarte grave. Concluzii: Deşi rupturile traumatice diafragmatice se asociază
Chirurgia, 113 (3), 2018 www.revistachirurgia.ro 353 RezumatFrecvent apărute că şi complicaţii ale pancreatitei, pseudochistele pancreatice sunt entităţi rare, pentru tratamentul cărora s-au dezvoltat de-a lungul timpului multiple tehnici terapeutice, variind de la metode minim invazive la tehnici complexe de chirurgie clasică. Pseudochistele simptomatice, cele de mari dimensiuni precum şi cele ce suferă complicaţii evolutive de timpul hemoragiei, suprainfectiei şi rupturii au indicaţie de drenaj. Alegerea metodei optime de drenaj este deseori o provocare, multiplii factori trebuind să fie luaţi în considerare, incluzând locaţia pseudochistului, dimensiunea precum şi starea generală a pacientului şi comorbidităţile acestuia. Astfel, elaborarea unui algoritm terapeutic ar fi de o utilitate incontestabilă, conferind posibilitatea alegerii unei tehnici fezabile leziunii însă adaptată pacientului.Cuvinte cheie: pancreas, pseudochist, tratament, drenaj AbstractFrequently appearing as a complication of pancreatitis, pancreatic pseudocysts are rare appearances in current medical practice. Multiple therapeutical options are available, from minimum invasive methods to complex open surgical techniques. The indications of drainage include symptomatic pseudocysts, large pseudocysts along with the development of complications such as hemorrhage, secondary infection, and rupture. Choosing the best drainage technique is often a challenge. Multiple factors need to be considered in managing a pseudoocyst, including its location, dimension and the patient's
This is a video submission for an interesting caseA 66 year-old lady was previously repeated admitted for vomiting and aspiration pneumonia. EGD showed a suspected hiatal hernia with gastric volvus. Endoscopic reduction was performed and the patient was scheduled for operation. Intra-operatively, it was noted that there were no hiatal hernia but a left diaphragmatic hernia was present. The hernial contents were reduced and the sac excised. The diaphragmatic defect was then closed primarily and reinforced with a 10 x 10cm biological mesh. An anterior partial fundoplication was also performed and the hiatus was closed.
This is a video submission for an interesting caseA 66 year-old lady was previously repeated admitted for vomiting and aspiration pneumonia. EGD showed a suspected hiatal hernia with gastric volvus. Endoscopic reduction was performed and the patient was scheduled for operation. Intra-operatively, it was noted that there were no hiatal hernia but a left diaphragmatic hernia was present. The hernial contents were reduced and the sac excised. The diaphragmatic defect was then closed primarily and reinforced with a 10 x 10cm biological mesh. An anterior partial fundoplication was also performed and the hiatus was closed.
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