Estrangulated obturatory hernia. Case report of a challenging diagnosis of obstructive syndrome.

INTRODUCTION AND IMPORTANCE: Obturator hernia accounts for less than 1 % of all documented cases of pelvic hernias. It most commonly presents as an obstructive syndrome in elderly, multiparous, slim women, characterized by a wider pelvis that facilitates the passage of the hernia sac through the obturator foramen alongside the obturator nerve. In this case, adhering to the SCARE (Updating Consensus Surgical CAse REport) checklist criteria, we present a typical scenario involving an elderly woman who was initially misdiagnosed with a fecaloma, concealing an obturator hernia. CASE REPORT: An 85-year-old patient, displaying prodromal signs of senile disease, presented for medical attention with incapacitating abdominal pain in the right iliac fossa, accompanied by nausea and vomiting. Rectal examination revealed the presence of a fecaloma, and glycerin administration was performed rectally. The patient's condition worsened with the development of mental confusion and hyperactive delirium. Abdominal Computer tomography scan (CT scan) revealed right obturator hernia with enteral segment insinuation and dilation of the proximal bowel. An infraumbilical laparotomy was performed. The herniation of an ileal segment and the right ovary through the obturator foramen was identified. The content proved irreducible to manual maneuvers, leading to obturator muscle section following the dissection of the Retzius space. The right round ligament of the uterus was sectioned, and we manage to preserve the Obturatory branch of the lumbar plexus throughout dissection. A polypropylene mesh was positioned and secured with non-absorbable sutures on the Cooper's ligament, iliac crest, and obturator muscle and segmental enterectomy with primary anastomosis using a linear stapler was performed. CLINICAL DISCUSSION: This demanding case brings to the spotlight the importance of reevaluating even the usual cases. We provide our experience bringing together an unusual diagnosis after the conduction of a once diagnosed fecaloma that almost went down to a perforated acute abdomen. Hence the importance of suspect obturator hernia in unknown obstructive abdomen in elderly women. CONCLUSION: With this report we aim to raise awareness of careful propaedeutic inquiry of acute abdomen. We provide our experience bringing together the diagnosis that agrees with our literature review. Elderly patients commonly challenge the clinical evaluation, especially those with signs of senile disease. Thereby, inkling hidden diagnosis in typical scenarios can improve the patient's care in emergency settings.

[Ectopic cutaneous schistosomiasis caused by Schistosoma mansoni]. / Esquistossomose cutânea ectópica por Schistosoma mansoni.

A case of cutaneous schistosomiasis with lesions on the trunk caused by eggs of Schistosoma mansoni is described. A brief review of the reported cases of cutaneous ectopic schistosomiasis by S. mansoni in made. The different forms of cutaneous lesions caused by schistosoma are considered.

[Advances and perspectives in American cutaneous leishmaniasis]. / Progressos e perspectivas na leishmaniose tegumentar americana.

The advances and perspectives in American (mucocutaneous) leishmaniasis are presented under the following topics: 1. Epidemiology in Latin America, particularly in Brazil. 2. Parameters for taxonomic identification of species and subspecies of the genus leishmania, which belong to L. mexicana and L. braziliensis complexes: biologic behaviour in hamster, in culture, in animal reservoir, clinical aspects, vectors, electronic microscopy, electrophoretic mobility of isoenzymes, radiorespirometry, DNA characterization, monoclonal antibodies, other immunological aspects and genetics. 3. Diagnosis by intradermal test, indirect immunofluorescence, ELISA, culture and animal inoculation. 4. Therapeutics and prevention by vaccination.

[Giant granulo-cellular Abrikosov's tumor]. / Tumor gránulo-celular de Abrikossoff gigante.

A case of Abrikossoff's granular-cell tumor is reported because of its unusually large dimensions (12.5 X 10.5 X 8.0 cm.), weight (700 g.) and supra-umbilical localization. Ample surgical excision of the tumor and reconstruction of the abdominal wall with silastic and skin graft were performed. Comments are made about the clinical, histopathological and histogenetic aspects of the neoplasia.

[Occupational and familial sporotrichosis]. / Esporotricose ocupacional e familial.

The incidence of occupational mycoses and the main criteria to make a correct diagnosis are commented. The sources of infection of the superficial and deep professional mycotic infections are analysed. The occurrence of an epidemic outbreak of sporotrichosis in 13 members of one family is reported. The parents and 11 sibling were infected with the grass utilized for the filling of mattress, in a small domestic craftsmanship.

Elastose perfurante serpiginosa - relato de quatro casos. / Elastosis perforans serpiginosa - report of 4 cases

Sao relatados quatro casos de elastose perfurante serpiginosa, ocorridos em jovens brancos, de 12 a 16 anos. Dois pacientes eram do sexo masculino e dois do feminino.O inicio da molestia ocorreu nas idades de tres a 12 anos A evolucao variou de dois a 13 anos. As lesoes eram eritemato-papulosas, ceratosicas e tinham disposicoes arciforme e serpiginosa.Raramente eram isoladas. Em todos os casos as lesoes se localizaram nos membros superiores.Um dos pacientes apresentava tambem lesoes nos joelhos e coxas.Em um caso havia associacao com alopecia ofiasica e monogolismo ou sindrome de Down e em outro com nevo pigmentado congenito gigante da regiao peitoral direta. Foram abordados alguns aspectos histopatologicos e patogeneticos da afeccao

Infection versus disease in South American blastomycosis.

The mechanism of infection in South American blastomycosis is discussed, and the probability of a mild or asymptomatic form of the disease, regressing spontaneously with subsequent immunity, in persons living in endemic areas. Primary lesions in the oral mucosa or in the skin have not been convincingly shown to occur in paracoccidioidomycosis. Several reports of systemic involvement of many organs with no evidence of skin and mucosal lesions support the theory of pulmonary entry.