Necrose da mucosa esofágica como complicação da cardiomiotomia à heller para tratamento de megaesôfago chagásico

This article presents a complication of the laparoscopic technique for Heller cardiomyotomy and anterior fundoplication. This procedure is safe and provides excellent relief of disphagia in esophageal achalasia. Nevertheless, there are rare but dangerous complications, such as late active digestive bleeding, presented in this paper which was resistant to conservative treatment and led to hypovolemic shock. Urgent laparotomy performed to identify and control bleeding, revealed necrosis of esophageal mucosa with a bleeding gastric vessel. Inadequate exposure of the gastroesophageal junction and an incision very close to the lesser curvature might have damaged the esophageal branches of the left gastric artery, leading to ischemic necrosis of the mucosa and exposure of the gastric wall and its vessels.

Drenagem endoscópica de abscesso pancreático

Surgical drainage is still considered the gold standard treatment of pancreatic abscess. Patients with high surgical risk, however, require alternative therapy. The authors report three cases of pancreatic abscess that were treated endoscopically. In patients who met endoscopic drainage criteria, treatment was effective, though one case did require surgical intervention as a result of gastric puncture point bleeding. After this initial experience, we believe that endoscopic drainage should be considered in selected cases.

Arma branca retida em aorta abdominal superior

Abdominal aorta wounds carries a high immediate mortality. Few patients reach hospital care alive. There are no reports on Medline (1969-2002) about aortic wounds of foreign body with retention. A case with upper abdominal aortic wound with an inlaid blade is reported. The retained blade fixed the stomach to the surgical field, difficulting the vascular control, leading to an unconventional approach and allowing extensive contamination. The patient developed multiple organ dysfunction and died at fifth postoperative day. Singularities of an inlaid knife in upper abdominal aorta and changes in traditional approach are discussed. The authors assumed that the inlaid knife decreased the bleeding, allowing the patient arrival to the hospital, but worsened the approach to the aorta wound.

Sling transobturatório: resultados de um centro de uroginecologia em Curitiba no ano de 2004

OBJETIVO: Avaliar o resultado da colocação de sling transobturatório sintético utilizado para a correção de incontinência urinária. MÉTODO: Foram relatados os casos de sling transobturatório sintético realizados no Hospital Universitário Evangélico de Curitiba no ano de 2004. A cirurgia consiste na colocação de uma faixa de polipropileno de 20X1,5cm, sob uretra média, confeccionada manualmente a partir de uma tela de 20X20cm, por via transobturatória. RESULTADOS: A média de idade das pacientes foi de 51,4 anos. Não houve complicações no intra-operatório. Noventa e um por cento das pacientes apresentaram cura e 9% apresentaram recidiva da incontinência urinária após seis meses. Duas (4,25%) pacientes apresentaram exposição da tela para a vagina. 4/47 pacientes apresentaram infecção do trato urinário e 1/47 apresentou hematoma de sitio cirúrgico na parede vaginal posterior. CONCLUSÃO: O Sling transobturatório sintético é um procedimento efetivo para a correção de incontinência urinária de esforço após seis meses de acompanhamento. A técnica utilizada na confecção do sling mostrou-se biocompatível, com níveis de complicação e recidiva aceitáveis e comparáveis aos slings transobturatórios industrializados. Avaliações com período de acompanhamento maior se fazem necessárias para a validação dessa técnica.

Cirurgia para controle do dano: uma revisão

Damage control surgery is one of the major advances in surgical practice in the last 20 years. The indications for damage control surgery are: the need to terminate a laparotomy rapidly in an exsanguinating, hypothermic patient who had developed a coagulopathy and who is about to die on the operating table; inability to control bleeding by direct hemostasis; and inability to close the abdomen without tension because of massive visceral edema and a tense abdominal wall. Damage control surgery has three phases: 1) laparotomy to control hemorrhage by packing, shunting, or balloon tamponade, or both; control of intestinal spillage by resection or ligation of damaged bowel, or both; 2) physiological resuscitation to correct hypothermia, metabolic acidosis, and coagulopathy. 3) planned reoperation for definitive repair. Damage control surgery is appropriate in a small number of critically ill patients who are likely to require substantial hospital resources. However, there are many questions that need to be answered. Who is the patient elected for this surgery? When is the ideal time to make the decision? Which are the parameters that indicate to the surgeons the moment to re-operate the patient? How to treat the long-term complications? In the present review we described some historical aspects, indications, technical aspects, advantages and disadvantages of this procedure, as well as its physiological consequences and morbidity and mortality rates of damage control surgery. Damage control surgery offers a simple effective alternative to the traditional surgical management of complex or multiple injuries in critically injured patients.