%0 Journal Article
%T F¨ªstula de alto gasto High output fistula
%A Ricardo Almeida Varela
%A Oscar Su¨¢rez Echeverr¨ªa
%A Oscar P¨¦rez Guti¨¦rrez
%A Eugenio Selman Houssein
%J Revista Cubana de Cirug¨ªa
%D 2012
%I Editorial Ciencias M¨¦dicas
%X Se presenta a un paciente de 37 a os de edad que acude a nuestro Cuerpo de Guardia politraumatizado, con lesiones tor¨¢cicas y abdominales, con s¨ªntomas y signos sugestivos de fracturas costales m¨²ltiples, con hemot¨®rax derecho y hemoperitoneo, corroborado imaginol¨®gicamente y en la punci¨®n abdominal. Se realiza pleurostom¨ªa m¨ªnima intermedia y laparotom¨ªa exploratoria. Se le encuentran lesiones hep¨¢ticas de los segmentos VI, V, VIII y IV, con una profundidad mayor de 3 cm, adem¨¢s, deserosamientos en las asas delgadas intestinales y colon. Se realiza hepatorrafia y empaquetamiento hep¨¢tico. Posteriormente van apareciendo complicaciones, por lo que tiene que ser reintervenido en m¨¢s de 60 ocasiones. Entre ellas, la aparici¨®n de una f¨ªstula de alto gasto, que lo llev¨® a la desnutrici¨®n y a la permanencia con el abdomen expuesto durante 7 meses hasta el egreso. Se revisa la literatura correspondiente a estas entidades. A 37 years-old multi-traumatized male patient went to our emergency service. He had many injures in the thorax and the abdomen, together with symptoms and signs suggestive of multiple costal fractures, with right hemothorax and hemoperitoneum, all of which was confirmed by imaging techniques and by abdominal puncture. Minimal intermediate pleurostomy and exploratory laparoscopy were performed. We found hepatic lesions in the 6th, 5th, 8th and 4th segments, over 3 cm deep; additionally, the loss of serosa from the intestinal ansae and from the colon. Hepatorrhaphy and hepatic packing were also performed. Later on, more complications appeared, so he had to be re-operated more than 60 times. The occurrence of a high output fistula led him to malnutrition and his abdomen remained exposed for 7 months until he was finally discharged from hospital. This paper also presented a literature review on this topic.
%K politrauma
%K trauma hep¨¢tico
%K empaquetamiento
%K abdomen expuesto
%K bolsa de Bogot¨¢
%K f¨ªstula intestinal
%K multitrauma
%K hepatic trauma
%K packing
%K exposed abdomen
%K Bogota's bag
%K intestinal fistula
%U http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0034-74932012000200008