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Abstract
AIMS: To report the case of a patient with acute intestinal obstruction by internal hernia, that presented a challenging diagnosis due to previous procedures and individual profile, and to perform a brief review of the literature on the types of hernia. CASE DESCRIPTION: A 44 year-old man, alcoholic, crack user, with prior surgery for reduction of prolapsed colostomy, returns to the emergency room two days after the procedure, with epigastric pain, nausea, vomiting and without bowel movement. There was progression of the disease to acute abdomen in 24 hours. An exploratory laparotomy revealed an inflammatory mass adhering to the left colon stoma and abdominal wall, with herniation of a segment of small intestine. CONCLUSIONS: Acute abdomen may be a condition of difficult clinical management in some cases, as the one herein reported, where initial clinical signs and symptoms did not portray the severity of the disease. Cases as this one may be used as examples for decision-making in difficult situations.
Highlights
An exploratory laparotomy revealed an inflammatory mass adhering to the left colon stoma and abdominal wall, with herniation of a segment of small intestine
Acute abdomen may be a condition of difficult clinical management in some cases, as the one reported, where initial clinical signs and symptoms did not portray the severity of the disease
Cases as this one may be used as examples for decision-making in difficult situations
Summary
Eduardo Paglioli, realizada em junho de 2013 no Hospital São Lucas da PUCRS, Porto Alegre, Rio Grande do Sul. RESUMO Objetivos: Relatar o caso de um paciente com quadro de abdome agudo obstrutivo por hérnia interna, que apresentou diagnóstico desafiador, devido a procedimentos anteriores e ao perfil individual, e realizar uma breve revisão da literatura sobre os tipos de hérnia. Conclusões: Abdome agudo pode ser um quadro clínico de manejo difícil em alguns episódios, como o relatado, em que os sintomas e sinais clínicos iniciais não evidenciam a magnitude e a gravidade do caso.
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