Browsing by Autor "Andrea Fargier Paoli"

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    Cierre temprano de colostomía temporal
    (Universidad Internacional de La Rioja, 2012) Estrella Celeste Uzcátegui Paz; Yorvin Niño; Jose L. Plata Patiño; Andrea Fargier Paoli; Carlos González Torres
    Colostomy is a surgical procedure to diverse colonic transit, which is performed in inflammatory diseases, traumatic wounds or neoplasic causes to inmediatly solve the problem. However, colostomies cause morbidities, social rejection, delay in labor reinsertion and psychologically affects to the patients; due to this we proposed to evaluate results of colostomy early closure in a prospective observational study including 67 patients in the Instituto Autonomo Hospital Universitario de Los Andes, from January 2009 to October 2011.Patients were gathered in Controls (patients with late closure, after a month) and cases (early closure, prior to 30 days). Our results show that of 67 patients in 31 patients an early closure of temporary diversion colostomy was performed, most of them of masculine gender with average age of 37 years and most frequent cause of performing this procedure was abdominal trauma. There were no statically significant difference concerning to postoperative complications as suture leaks and fistulae development among the groups. Nevertheless, abdominal wall abscess was greater and statistic significant in the early closure cases group compared than late closure group, with 31 vs 2 patients, like hospital stay and work reintegration with 71% for early closure group and 27,7% for late closure group. We can conclude that early closure of a temporary diversion colostomy is a safe and feasible surgical procedure, without increase of morbidities and obvious advantages to rehabilitation, less hospital stay labor reinsertion and psychological affection.
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    Fascitis necrotizante de punto de partida abdominal: a propósito de un caso
    (Universidad Internacional de La Rioja, 2012) Dayyorsem Canelón; Andrea Fargier Paoli; Gustavo León; Maria João Silva; Estrella Celeste Uzcátegui Paz
    La fascitis necrotizante es una infeccion de etiologia tipicamente polibacteriana, cuyas toxinas afectan los tejidos blandos\n(fascias, subcutaneo, vasos y nervios). Caso Clinico: masculino de 47 anos de edad, hipertenso cronico no controlado, quien\ningresa en shock hipovolemico secundario a abdomen agudo quirurgico traumatico por herida de arma de fuego en region\nlumbar sin orificio de salida. Se aplica ABC para paciente politraumatizado incluyendo profilaxis antimicrobiana a base de\nAmpicilina-Sulbactam-Metronidazol. Es llevado a quirofano teniendo como hallazgos operatorios: 1400 cc de\nhemoperitoneo y contenido intestinal (materia fecal) libre en cavidad, desvascularizacion de mesocolon ascendente, lesion\nde arteria ileocolica y colon, por lo que se procede a realizar hemicolectomia derecha ampliada. En el postoperatorio\ninmediato y de evolucion rapida presenta lesiones cutaneas dadas por eritema, edema, vesiculas, flictenas en flanco\nderecho, a las 36 hrs cursa con necrosis que se extiende hasta tercio medio y lateral de muslo, se toma cultivo que reporta\nStreptococcus sp. �À hemoliticos, Escherichia coli, Citrobacter perfringens. Decidiendose realizar fasciotomia, ampliar la\nantibioticoterapia de amplio espectro con (Tigeciclina) y dar soporte ventilatorio mecanico teniendo a pesar de ello, una\nevolucion torpida que conduce a falla multiorganica y deceso. Consideramos que si bien es una patologia poco frecuente\ndebe tenerse presente para garantizar el tratamiento precoz y de esta manera disminuir su alta mortalidad.