Caso clínico 1: cirugía de control de daños + gastrectomía en manga por cuadro de vólvulo secundario a hernia diafragmática: reporte de caso clínico; y, Caso clínico 2: tumor de Buschke Lowenstein en paciente embarazada, reporte de caso clínico

Abstract

Diaphragmatic hernias occur when abdominal viscera displace into the thoracic cavity. In adults, most hernias are acquired and are treated with elective surgery. However, in cases of gastric volvulus, they become an emergency where aggressive management and resolution of the defect is necessary to avoid organ necrosis. These cases are rare and difficult to diagnose, but are usually performed by radiology and treatment varies according to the extent of gastric necrosis and the skill of the medical team. We describe a 41-year-old woman with no past history who is admitted to the hospital for severe abdominal pain and nausea. Clinical findings include a distended and painful abdomen, with no signs of peritoneal reaction. After progressive hemodynamic deterioration, she is admitted to the operating room, where a grade III diaphragmatic hernia with organoaxialgastric volvulus with extensive necrosis is evidenced. The patient underwent damage control surgery and after initial resuscitation in the intensive care unit, a gastric sleeve and abdominal cavity closure were performed due to 60% gastric necrosis. This case highlights the importance of considering diaphragmatic hernia as a possible diagnosis in patients with severe abdominal pain and the need for an adequate therapeutic approach to prevent serious complications. It also shows the importance of an integral management of the patient for a successful recovery, working hand in hand with the intensive care unit, anesthesiology, physical therapy, nutrition. Abstract case 2 Buschke-Lowenstein tumor (BLT) is a rare, fast-growing, locally invasive type of tumorigenesis in the anogenital region caused by papillomavirus. Immunosuppression, chronic inflammation, poor hygiene and HIV infection have been identified as risk factors for this disease. We present the case of a 38-year-old female patient in her second trimester of pregnancy, who is admitted for the presence of giant condylomatous lesions in the perianal region, which appeared suddenly and presented an accelerated growth, causing multiple discomforts. The patient underwent a surgical resection showing great infiltration to neighboring tissues including the vaginal vertex. Histopathological examination confirms the diagnosis of BLT. The evolution is favorable. The importance of early detection of giant condylomatous lesions in the perianal region and timely treatment to prevent complications in the patient's health and possible complications is emphasized, as well as the rarity of this pathology due to the lack of case reports, as well as insisting on the importance of the fight against sexually transmitted diseases and the increased use of vaccination against HPV in the future.