Caso clínico 1: trauma penetrante cardiaco manejado mediante ventana pericárdica subxifoidea. Caso clínico 2: vólvulo de colon transverso

Abstract

Abstract 1 Penetrating cardiac trauma is a type of injury that presents a high mortality rate, even conditioning the victim not to reach an emergency department for management. Depending on the hemodynamic status of the patient, it has been observed the different management that could be provided in a hospital center, from the need for thoracotomy in severe patients or the practice of pericardial window for confirmation and treatment of cardiac trauma in a clinically stable patient, without neglecting the importance of complementary examinations that we have today. We present a single case of a 43-year-old male patient who was admitted with a diagnosis of cardiac tamponade following penetrating chest trauma with a stab wound. The patient presented with lesion in the anterior precordial face, with tendency to hypotension and tachycardia; in addition to psychomotor agitation. A subxiphoid pericardial window was performed where a hemopericardium of approximately 200cc of blood plus clots was found. It was also necessary to perform pleural drainage for presenting grade II pneumothorax. The patient remained hospitalized for 5 days, and due to his favorable evolution and the absence of complications, he was discharged from hospital. The management and treatment of patients with penetrating cardiac trauma depends on their hemodynamic status and the anatomical site of injury. It has been observed that starting with aggressive surgical treatment such as a thoracotomy may not always be necessary, thus committing the patient to greater comorbidity and hospital stay. The new diagnostic methods that we have in the emergency rooms of the hospital centers, help us a lot nowadays to take a more effective course of action. According to these results, the surgeon could choose the pericardial window as a good first option for this type of management. Abstract 2 Introduction: Volvulus of the gastrointestinal tract are an important cause of acute abdomen, both because of their frequency and the severity of their potential complications. (1) They are difficult to diagnose clinical entities that can occur in any tract of the gastrointestinal tract and with high complication value (1). Volvulus occurs when parts of the intestine become entangled in a mesenteric axis, which can lead to impairment of the blood supply or can cause total or partial obstruction of the intestinal lumen (2). We present the clinical case of a 17-year-old male patient with acute obstructive abdomen due to volvulus of the transverse colon, where exploratory laparotomy was performed plus intestinal resection plus end terminal anastomosis of the transverse colon, who was also diagnosed with a malformation in the form of sequential dilatation of the middle third of the transverse colon (intestinal duplication), including malformation of the mesentery (lax tissue). Patient presented favorable evolution and after 5 days of hospitalization was discharged. Volvulus of the gastrointestinal tract is an important cause of acute abdomen, its late diagnosis can lead to complications even compromising the patient's life. There are several anatomical sites of the colon that could be affected by this pathology, being the transverse colon the one with the lowest incidence with 1-4%. At present, depending on the clinical condition of the patient, less invasive management such as decompression by colonoscopy is decided in the absence of peritoneal signs, but in the presence of findings such as suspected intestinal necrosis, perforation and shock, surgical treatment is the first choice.