RESUMO
We report the case of a 37-year-old woman with no relevant medical history. She was admitted to the hospital for epigastric pain related with food intake for 4 days; the pain did not improve with symptomatic management. A laparoscopic cholecystectomy due to acute lithiasic cholecystitis was performed. However, after 4 days, postoperative painless jaundice was evident; thus, endoscopic retrograde cholangiopancreatography was performed, which revealed an amputation of intrapancreatic common bile duct, as well as secondary intra- and extrahepatic bile duct dilatation. Brushing of the distal portion of the common bile duct revealed a well-differentiated adenocarcinoma. Therefore, a Whipple procedure with pylorus preservation was performed. Pathologic diagnosis of a papillary in situ adenocarcinoma with two microscopic foci of microinvasion was established. The pathologic Tumor-Node-Metastasis (TNM) stage was pT1, pN0, pM0, R0. The patient is asymptomatic and disease-free 24 months after surgery. In general, adenocarcinomas of the extrahepatic bile ducts are uncommon and have a poor prognosis. However, symptomatic patients with early disease stages are even rarer and can be cured surgically.
Assuntos
Adenocarcinoma Papilar/diagnóstico , Neoplasias dos Ductos Biliares/diagnóstico , Carcinoma in Situ/diagnóstico , Colangiopancreatografia Retrógrada Endoscópica/métodos , Colecistectomia Laparoscópica/métodos , Ducto Colédoco , Adenocarcinoma Papilar/cirurgia , Adulto , Neoplasias dos Ductos Biliares/cirurgia , Carcinoma in Situ/cirurgia , Feminino , HumanosRESUMO
La hernia diafragmática traumática (HDT) es una complicación poco común en el trauma abdominal cerrado y puede no ser diagnosticada a menos de que se tenga un alto índice de sospecha. El mecanismo fisiopatológico consiste en un impacto de alta energía con aceleración y desaceleración que condiciona incremento súbito de la presión intraabdominal. El hemidiafragma izquierdo es afectado más comúnmente. El diagnóstico temprano y oportuno es fundamental debido a la elevada incidencia con la que se asocia a lesión a otros órganos y complicaciones. El objetivo de este artículo es presentar el caso de un paciente de 62 años que desarrolló hernia diafragmática secundaria a trauma abdominal cerrado y revisar la literatura relacionada a esta entidad.
Traumatic diaphragmatic hernia is an uncommon complication of abdominal blunt trauma and is easily overlooked unless high index of suspicion is maintained. The underlying mechanism for diaphragmatic rupture is due to a high-energy acceleration-deceleration impact that results in a sudden increase in the intra-abdominal pressure. The left diaphragm is more commonly involved. The diagnosis is important because of the high incidence of associated organ damage and complications. The aim of this paper is to present the case of 62 years old patient who developed traumatic diaphragmatic hernia and review the literature related to this entity.