Abstract Accidental fish bone ingestion is a common complaint at emergency departments. The majority of cases have a benign course. However, serious complications such as esophagus perforation, cervical vessel injury and cervical abscess can occur in 7.4% of cases. Mortality rates can be as high as 50% when mediastinitis occurs. We report a case of an esophageal perforation caused by a fish bone with a lesion to the right common carotid artery after 20 days of evolution. Surgical exploration occurred with corrections of the lesion in the right common carotid and esophagus. Early identification of this kind of injury is paramount to prevent potentially fatal complications.

Abstract Accidental fish bone ingestion is a common complaint at emergency departments. The majority of cases have a benign course. However, serious complications such as esophagus perforation, cervical vessel injury and cervical abscess can occur in 7.4% of cases. Mortality rates can be as high as 50% when mediastinitis occurs. We report a case of an esophageal perforation caused by a fish bone with a lesion to the right common carotid artery after 20 days of evolution. Surgical exploration occurred with corrections of the lesion in the right common carotid and esophagus. Early identification of this kind of injury is paramount to prevent potentially fatal complications.

Resumo Policial masculino de 47 anos foi atendido em consultório com queixa de dispneia aos esforços, edema e dor importantes em braço direito. Relatou ferimento por arma de fogo infraclavicular direito 7 meses antes. Tomografia de tórax mostrou grande dilatação de veia subclávia, veias cervicais e de membro superior direito sem identificação da comunicação arteriovenosa. O paciente foi internado antes da data prevista para tratamento por piora clínica e foi submetido a implante de stent revestido Fluency 8x100 mm em artéria subclávia direita por técnica do varal. Angiografia de controle mostrou artéria subclávia pérvia e fechamento da fístula. Houve melhora dos sintomas em braço direito no primeiro dia após o procedimento. As lesões traumáticas da artéria subclávia são incomuns, porém podem evoluir com alto índice de morbimortalidade O trauma penetrante é o principal agente etiológico, e fístulas arteriovenosas devem ser pesquisadas durante o atendimento do paciente com lesões penetrantes em trajeto vascular.

Abstract A 47-year-old male police officer presented at an outpatients consulting room complaining of exertional dyspnea and swelling and pain in the right arm. He had suffered a perforating gunshot wound of the right infraclavicular region 7 months previously. A chest tomography showed considerable dilatation of the subclavian and cervical veins and veins of the right upper limb, with no clear point of arteriovenous communication. His symptoms exacerbated and he was admitted to hospital before the date scheduled for treatment. He underwent endovascular treatment with an 8x100 mm Fluency covered stent that was placed in the right subclavian artery using the through-and-through technique. Control angiography showed that the fistulous defect had been completely sealed. There was significant relief of the symptoms on the first day after the operation. Traumatic lesions of the subclavian artery are rare, but can be associated with high morbidity and mortality rates. Penetrating trauma is the main cause and arteriovenous fistulas should be ruled out when evaluating penetrating injuries in vascular territories.

CONTEXTO: O câncer colorretal é causa de morte frequente e sua prevenção deve fazer parte dos programas de rastreamento em indivíduos assintomáticos. OBJETIVO: Avaliar os achados colonoscópicos de pessoas assintomáticas submetidas a colonoscopia. MÉTODO: Foram estudados 153 pessoas assintomáticas submetidas a colonoscopia. Sexo, idade, história pregressa e familiar, tabagismo e etilismo foram avaliados. Indivíduos com hematoquesia macro ou microscópica e os com doença colorretal foram excluídos. Preparo intestinal, presença de pólipos, angioectasias, doença diverticular, processo inflamatório e neoplasia foram investigados. Os pólipos foram classificados de acordo com seu tamanho, número e localização. RESULTADOS: A idade média foi de 52,47 ± 11,64 anos. História familiar de câncer colorretal foi verificada em 20,2% dos indivíduos. Alterações colonoscópicas foram verificadas em 99 indivíduos: pólipos em 64,28%, doença diverticular em 27,92%, alterações inflamatórias em 9,74%, melanose colônica em 2,6% e angioectasias em 7,8%. Houve incidência maior de pólipos em indivíduos acima de 50 anos. A análise de regressão logística mostrou a idade e sexo como fatores preditores para a presença de pólipos (RR = 1,69; 1,23 <RR <2,51). CONCLUSÃO: Existe significativa incidência de alterações colonoscópicas em pessoas assintomáticas submetidas a colonoscopia para rastreamento de câncer colorretal.

CONTEXT: Colorectal cancer is the second leading cause of cancer-related death. Prevention of colorectal cancer should be achievable by screening programs in asymptomatic patients. OBJECTIVE: To assess the colonoscopic findings in asymptomatic people submitted to screening. METHODS: A prospective study was undertaken on 153 consecutive asymptomatic people submitted to colonoscopy. Sex, age, previous diseases and familial cases of cancer, as well as tobacco and alcohol ingestion were assessed. Patients with rectal macro- or microscopic bleeding and colorectal diseases were excluded. Bowel preparation, polyps, angioectasias, diverticular disease, inflammation and neoplasm were also verified. Polyps were classified according to their size, number and location. RESULTS: Mean age was 52.5 ± 11.7 years. Family history for colorectal cancer occurred in 79.8% of individuals. Colonoscopic alterations were detected in 99 individuals: polyps in 64.3%, diverticular disease in 27.9%, inflammatory mucosal alterations in 9.7%, melanosi coli in 2.6% and angioectasias in 7.8%. There were an increasing incidence of polyps in patients older than 50 year. Multivariate logistic regression showed age and sex as predictive factors for polyps (OR = 1.43; 1.19 <OR <2.67). CONCLUSION: There is a significant incidence of colonoscopic alterations in asymptomatic people submitted to colonoscopy for colorectal cancer screening.