The case addresses a patient who suffered a penetrating wound by a knife in right anterior cervical region (zone I) and left thoracic region that was admitted with signs of hemorrhagic hypovolemic shock (class III). The emergency surgical approach in patients with cervical trauma is indicated in cases of shock that is refractory to volume replacement, murmurs in the cervical region, and intense active bleeding. It is also suggested to avoid approaching non-expandable hematomas due to the risk of rebleeding. In this case, the patient had bleeding in the orifice of the cervical region and signs of shock. First, bleeding control was performed with Foley catheter placed in the wound and a massive transfusion protocol was initiated in the emergency room. Then, the patient was referred to the operating room. The management of penetrating neck injuries is based on anatomical division of the cervical region into zones I, II and III. Zone II is the area where most lesions are observed, followed by zones I and III.

Introduction: Situs Inversus (SI) is a rare congenital anomaly that affects 1:10,000 to 1:20,000 people. It is characterized by the mirror image of the abdominal and thoracic viscera. Situs Inversus Incompletus (SII) is an abdominal heterotaxis associated with levocardia. It is a much rarer condition and accounts for 1 in 2,000,000 of the general population. Small bowel diverticulum is a rare condition, in which most patients are asymptomatic. In this report, we present a patient with IBS with an acute abdomen due to a perforated jejunal diverticulum, treated at the Hospital de Base of São José do Rio Preto, Brazil.

The ingestion of caustic substances is an important cause of emergency care, with children under 5 years of age being the highest risk age group. Tracheoesophageal fistula is an uncommon complication, but with high severity, being associated with mortality of up to 40% when combined with mediastinitis. The objective of this report is to present the case of ingestion of a caustic substance by a 9-month-old infant, describing the clinical and operative management, as well as a brief literature review.

Trauma is the third leading cause of death in Brazil and has a huge impact on the potential years of life lost. Most of the lesions identified are mild and, when treated in time have an excellent prognosis. Air embolism (AE) is a rare but potentially fatal condition, especially after blunt chest trauma, when diagnosis is challenging. A 39-year-old male victim of a motorcycle fall at 60 km/h with moderate traumatic brain injury and chest trauma. There was no change in the primary assessment. In the secondary evaluation, he presented pain on palpation of the anterior chest, and pain in the epigastrium, without peritonitis. The computed tomography (CT) demonstrated the presence of a gaseous focus in the left ventricle (LV); small bilateral pneumothorax foci; areas of lung contusion bilaterally; left kidney and pancreas with signs of ischemia and gaseous foci inside. He was followed in the Intensive Care Unit (ICU) with acute renal failure and pancreatitis, treated conservatively. Then, he was undergone to a cardiac catheterization: absence of significant obstructive coronary artery disease and mild LV systolic dysfunction. He was maintained on 100% O2 until discharge from the ICU and discharged from hospital after 12 days of hospitalization. When the lung parenchyma is injured by a blunt trauma of high kinetics, the pulmonary vessels (PV) and the bronchial tree come into contact and air, under high pressure, enters the PV causing AE. AE is difficult to diagnose in the acute phase as the embolus disappears in about 0.5-30h. [1] Diagnosis is usually made with imaging tests. The treatment of air embolism is eminently supportive. 100% O2 therapy decreases bubble size by forcing nitrogen out of the plunger. The use of a hyperbaric chamber is described and, in more severe cases, it is possible to perform aspiration of the ventricle.

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