Caso clínico 1: hernia lumbar bilateral una entidad rara; reporte de caso clínico. Caso clínico 2: manejo conservador de lesiones miocárdicas secundarias a trauma precordial penetrante estable con ventana pericárdica positiva por toracoscopia, reporte de caso clínico

Abstract

Lumbar hernia is rare, and its bilateral presentation is seen less frequently. Most lumbar hernias are secondary to trauma or previous surgery. They originate primarily from Grynfelt's triangle, are unilateral, and occur between the 5th and 6th decade of life. The study’s objective is to describe a rare case of bilateral lumbar Grynfelt hernia, at the Teófilo Dávila General Hospital in the city of Machala-El Oro. Clinical case, 83-year-old female patient who attended the General Surgery outpatient clinic with a clinical picture of pain in the bilateral lumbar region of moderate intensity related to physical exertion and tasks of daily living, accompanied by the presence of a mass in the lower back that increases in size with increased intra-abdominal pressure, causing discomfort; Therefore, imaging studies and subsequent open surgical resolution are indicated. Conclusions: Lumbar hernias are infrequent, and are a real diagnostic challenge for the surgeon, due to their complex and rare anatomical situation and the way of bilateral presentation, for which the presentation of this clinical case concluded that the patient would benefit from an open surgical approach, obtaining good results, medical discharge with a favorable evolution. Penetrating precordial injuries are becoming more frequent. Of every 100 patients with these injuries and hemodynamically stable, 15%-20% have an occult heart injury. If the pleura has been violated, the pericardial window can be performed substrates diaphragmaticic with a transdiaphragmatic window or thoracoscopic. The study’s objective is to describe the case of a patient with conservative management of myocardial injury secondary to penetrating precordial trauma by a sharp weapon, with a positive pericardial window by thoracoscopy. Clinical case: A 36-year-old male patient, with no pathological history, was admitted to the Teófilo Dávila Machala-Ecuador General Hospital, with a diagnosis of penetrating chest trauma plus penetrating precordial wound, hemodynamically stable. Evolution: Conservative management of the myocardial lesion was performed, after a positive pericardial window by thoracoscopy plus thoracostomy, after four days of hospitalization, he was discharged with favorable evolution. There were no complications or readmission after 3 months of follow-up and control by external consultation. Conclusion: In hemodynamically stable patients with penetrating precordial wounds and a positive pericardial window who present cardiac injury without active bleeding, they are susceptible to conservative management. This minimally invasive alternative is less morbid and as safe as open techniques.