Ciencias de la Salud

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Subject: search.filters.subject.COLECCIÓN_HEPÁTICA

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    “Absceso retroperitoneal como complicación de apendicitis aguda”
    (Medicina, 2018-10-01) Chaglla Alomoto, Alexandra Pamela; Viteri Llerena, Wilian Geovanni.Dr. Esp.
    Acute appendicitis is the most frequent cause of acute abdomen and represents one of the most common emergencies that a surgeon faces. It occurs, generally, in patients between the second and third decades of life, being less frequent in the extremes of life. The estimated risk to present this pathology is between 7 and 8%. According to the INEC, in 2017, 38,533 cases5 of acute appendicitis were recorded in Ecuador, representing a rate of 22.97 cases5 per 10,000 inhabitants, thus being the first cause of morbidity in the country. Currently the treatment of choice is surgical, there is a high risk of perforation and peritonitis especially in cases of delay in diagnosis and appropriate treatment; there is controversy about the correct treatment for an acute appendicitis that develops abscess or phlegmon. The following, a male patient of 51 years of age, presented with abdominal pain, 8 days prior to admission of moderate intensity, 7/10 on the visual analog scale, that start in the epigastrium accompanied by nausea, fever, does not decrease with the intake of food, vomiting, deposition, urination and decubitus, self-medicated scopolamine butylbromide, without decreased the syntomatology on the third day goes to a private doctor,administring intravenous ceftriaxone 1g (IV), gentamicin 160 mg IV, single dose, ciprofloxacin 750 mg BID; until the day of admission without yielding pain. Until the day of admission present a pain that is located in the right iliac fossa, so he goes to this health house where he performs ecosonography (09/26/2017) which reports: biliary mud in a small amount, suggestive of appendicular plastron, TAC simple and contrasted abdomen and pelvis (09/26/2017) that reports: intraperitoneal abscess located in the right iliac fossa with extension to the flank and hypochondrium on the same side, volume approximately 300, with an increase in the density of mesentery fatty tissue suggestive picture of perforated appendix. Pathology that was resolved with three surgical interventions
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    “Absceso hepático y esplénico secundario a apendicitis aguda”
    (Universidad Técnica de Ambato - Facultad de Ciencias de la Salud - Carrera de Medicina, 2018-05-01) Reinoso Torres, Lizeth Carolina; Guanuchi Quito, Franklin Hernan Dr. Esp
    We present the case of a male patient of 15 years of age, with a surgical history of grade II appendicitis resolved 1 month ago on the day of admission, go to the emergency service, presenting abdominal pain of 7 days of evolution, add boost non-quantifiable thermal, cough that does not mobilize secretions, chills, went to a private doctor 4 days ago who prescribes antipyretic treatment and discharge with medication, improvement picture however 2 days ago it presents thermal rise not quantified, yellow skin, upper abdominal pain so they go to this health house. Physical examination at admission: TA: 91/49; FC: 120; FR: 28; SO2: 92%, temperature 36.8 ° C; General Appearance: Algico, jaundiced, conscious, oriented patient, Glasgow scale15 / 15. Mouth: dry oral mucosa; skin: icteric dye; heart: hyperphonic noises, no murmurs; lungs: diminished vesicular murmur in right lung base; abdomen: soft, depressible, painful on palpation, positive blumberg, liver palpation 2 cm under the costal margin; lower extremities: multiple petechiae, patient is operated on the following day approaching an exploratory laparotomy evidencing yellow inflammatory fluid approximately 600cc in suprahepatic and perihepatic space and 300 cc in perisplenic space, placing drainages; due to the septic and hemodynamic condition, patient enters the Intensive Care Unit, 17 days after admission, hepatic abscess is seen in segment VI on Computed Tomography, performing percutaneous drainage; on the second day after drainage, new abscess is evidenced in segment VII of 14cc , total of 6 percutaneous drainages, plus abscess culture reports Pseudomonas aeruginosa, presents complications of a subconjunctival hemorrhage, hypoacusis due to possible drug ototoxicity, patient is transferred to the surgery service where it ends with antibiotic scheme, presenting favorable clinical evolution is discharged to the month 4 days and control with treating doctor in outpatient clinic.