ANGELESCU TRATAT DE PATOLOGIE CHIRURGICALA PDF
acute chirurgicale, complicate cu peritonită, în majoritatea cazurilor spitalizaţi după .. In: Angelescu N, editor. Tratat de. Patologie Chirurgicală. Bucureşti: Ed. Sign in. Main menu. Tratat de patologie chirurgicala. N. Angelescu; Editura Medicala, Bucureşti,; . 1 Excerpt. Computer-aided detection in mammography: an assessment of.
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A year-old man with a large paraesophageal hiatus hernia, treated in a foreign clinic with a Nissen fundoplication when a lesion of the pagologie fornix during laparoscopic dissection has determined conversion to open technique is admited 3 weeks after surgery, being diagnosed with an esophageal leekage witch maintains a large subphrenic abscess with sepsis.
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Hratat patient VLP, male, aged 56, was known to have a giant paraesophageal hiatus hernia for almost 20 years see fig. He did not present neither gastro-esophageal reflux nor esophagitis. On the 11th of Januarythe patient underwent surgery in a private clinic abroad.
Initially, laparoscopy was applied, then converted into open surgery and Nissen fundoplication was performed. The immediate outlook was favourable.
After surgery, a moderate and persistent dysphagia for solid substances was present. The following investigations chiruegicala made in Floreasca Emergency Hospital: The surgeon was contacted by phone and he confirmed an intraoperative lesion of the gastric fornix during the laparoscopy dissection, sutured after conversion; there were no other lesions.
Therefore, the esophageal leakage, with its subsequent subphrenic abscess had no apparent aetiology. In our clinic we practiced an esophageal-gastrofibroscopy in the surgery room, just before the surgical intervention, with the intubated patient, which confirmed an esophageal leakage at 36 cm away from the dental arcade, with a diameter of mm, through which pus flowed spontaneously and at extrinsic compression of the abdomen fig.
Surgery continued the same day. A large subphrenic abscess was evacuated tratzt. After surgery, the outlook was simple. Oral feeding was stopped; feeding through the jejunostomy tube was initiated very early, starting with the 2nd day, with Nutren and Freshubin. The control barium passage, with hydro soluble radio opaque substance, done in the 8th day after surgery, showed a normal esophageal passage, without any leaks fig.
The patient was discharged in the 11th tratah 11 days after the surgery. A new radiology control examination made on the 14th day confirmed the healing of the leakage. Thereafter, oral feeding was introduced again; after another 7 days the jejunostomy tube was pulled out.
In the case of a large and old hiatus hernia, a difficult dissection is expected due chirrugicala filamentous adherents. One can try the laparoscopic approach, but the conversion must be very early, before the occurrence of severe lesions.
The option of surgery can be the indication of choice. There are possible iatrogenic complex lesions. The treatment of these serious complications did not tempt the primary approach of the esophageal leakage — an illusory goal — technical and tactical.
The surgical strategy pursued two objectives, after angeelscu evacuation of the abscess: This way we obtained the secondary healing patokogie the leakage, with a very good result, including a functional one.
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Ion Mihalachesector 1, Bucharest, Romania. This article is distributed under the terms of the Creative Commons Attribution License http: Abstract A year-old man with a large paraesophageal hiatus hernia, treated in a foreign clinic with a Nissen fundoplication when a lesion of the gastric fornix during laparoscopic dissection has determined conversion to open technique is admited 3 weeks after surgery, being diagnosed with an esophageal leekage witch maintains a large subphrenic abscess with sepsis.
Open in a separate window. CT — collection with air-fluid level on the little gastric curve. Discussions Chirufgicala the case of a large and old hiatus hernia, a difficult dissection is expected due to filamentous adherents. Le BlancJ-M. Elsevier Masson SAS; Herniile Hiatale, in Tratat de Patologie Chirurgicala, vol.