Herniation through the foramen of Winslow: a laparoscopic approach.

We describe a case of a young woman with acute epigastric pain. Extensive diagnostic workup suggested a hernia through the foramen of Winslow. A laparoscopic exploration of the abdomen revealed an internal herniation of the cecum and ascending colon behind the hepatoduodenal ligament into the lesser sac. Successful management requires prompt diagnosis and surgical treatment. In our case the internal herniation was uncomplicated and could be reduced laparoscopically. To our knowledge, this is the first documented case of a laparoscopically treated Winslow hernia.

Classification of primary and incisional abdominal wall hernias.

PURPOSE: A classification for primary and incisional abdominal wall hernias is needed to allow comparison of publications and future studies on these hernias. It is important to know whether the populations described in different studies are comparable. METHODS: Several members of the EHS board and some invitees gathered for 2 days to discuss the development of an EHS classification for primary and incisional abdominal wall hernias. RESULTS: To distinguish primary and incisional abdominal wall hernias, a separate classification based on localisation and size as the major risk factors was proposed. Further data are needed to define the optimal size variable for classification of incisional hernias in order to distinguish subgroups with differences in outcome. CONCLUSIONS: A classification for primary abdominal wall hernias and a division into subgroups for incisional abdominal wall hernias, concerning the localisation of the hernia, was formulated.

Open, preperitoneal hernia repair with the Kugel patch: a prospective, multicentre study of 450 repairs.

BACKGROUND: The Kugel patch inguinal hernia repair is a relatively new, open, minimally invasive procedure using a preperitoneal approach. METHOD: Prospective multicentre case series of 450 consecutive Kugel patch repairs. Recurrence rates and persistent inguinal pain after at least 1 year as well as short-term outcomes were studied. RESULTS: After a follow-up of 18 months, eight recurrences (1.9%) were found, and persisting inguinal pain was reported in 15 patients (3.5%). The mean operation time and hospital stay were 20 +/- 9 min and 19 +/- 1.3 h respectively. Less than 1% of patients planned for an ambulatory treatment needed prolonged hospitalisation. Analgesics were used for 3 +/- 2 days. Paracetamol was the only painkiller used in 69% of patients, and 13% did not take any painkiller at all. Half of all patients returned to their daily activities after 9 days and half of the employed patients returned to work after 14 days. CONCLUSION: The Kugel patch repair is a quick technique with a low recurrence rate and good patient comfort. It offers the advantages of a preperitoneal inguinal hernia repair without the need for general anaesthesia or expensive laparoscopic equipment.

Early Belgian experience with the Kugel patch inguinal hernia repair.

The Kugel hernia repair is an open but minimally invasive, tension free repair, offering the advantages of a preperitoneal repair without the need for general anaesthesia. We report our initial experience with this technique in 25 inguinal hernia repairs. Operating time averaged 40 +/- 16 min, and one complication, a bladder tear, occurred intra-operatively. Patients were discharged after a median of 2 days and were then seen after 3 weeks and after at least one year. Three weeks postoperatively, there were two superficial skin inflammations and one haematoma. One year post-operatively no recurrences occurred but two patients complained of persistent inguinodynia. The Kugel hernia repair is a relatively new technique with a short operating time and minimal postoperative pain, but a learning curve, comparable to that of TEP has to be overcome in order to reproduce the results of its inventor.

Pneumoperitoneum in repair of giant hernias and eventrations.

The common use of laparoscopy has made many surgeons familiar with the use of pneumoperitoneum. It is important to know the therapeutic advantage of this technique in the repair of giant hernias and eventrations where the viscera are forced out of the abdominal cavity.

Vitamin status in patients with acute pancreatitis.

The serum levels of 6 vitamins were prospectively evaluated in 20 patients with acute biliary pancreatitis and in 20 patients with acute alcoholic pancreatitis. Twenty healthy subjects acted as controls. There were no statistically significant differences in the levels of vitamin B12 and D among the groups. Patients with alcoholic pancreatitis had significantly lower levels of vitamins A, E (p < 0.01) and C (p < 0.001) than those of the control group. Plasma levels of vitamin K were decreased or undetectable in 6 patients with biliary and 3 with alcoholic pancreatitis. The pathophysiological and clinical implications of this abnormal vitamin status in patients with acute pancreatitis are unknown. Nevertheless, multi-vitamin supplementation seems justified, especially in patients affected by alcoholic pancreatitis. Vitamin K should be administered in both types of pancreatitis when blood coagulation tests are disturbed.

Peroperative ultrasonography in the diagnosis of splenic vein thrombosis.

A case of recurrent bleeding from gastric varices due to isolated splenic vein thrombosis is reported. There was no evidence of pancreatic, retroperitoneal or infectious disease. The final diagnosis was made by intraoperative ultrasonography during an emergency laparotomy for massive bleeding from a ruptured gastric vein. Splenectomy is the treatment of choice in this case. The patient was cured after splenectomy.

Aortocolic fistula caused by an ingested chicken bone.

Primary aortocolic fistulas are a rare but lethal complication of aortic or iliac aneurysms. A case of fistula between a nonaneurysmal aortic bifurcation and sigmoid colon caused by an ingested chicken bone is presented. This cause of rectal bleeding, which has never been described, might have been suspected after careful examination of abdominal x-ray films. Surgical management included removal of the foreign body and primary repair of the colonic and aortic rent and appeared to be adequate.

Comparison of auscultation, continuous wave Doppler imaging, intravenous digital subtraction angiography and conventional angiography in diagnosis of carotid artery disease.

The reliability of auscultation, continuous wave (CW) Doppler imaging, and intravenous digital subtraction angiography (IV DSA) in the assessment of carotid artery disease has been evaluated in comparison with conventional angiography in 30 patients. With auscultation, specificity and sensitivity for internal carotid artery (ICA) stenosis of 50% or more were 81% and 67% respectively. CW Doppler imaging detected ICA stenosis of 50% or more with a sensitivity of 83% and a specificity of 92% and ICA occlusion with a sensitivity of 60%. The specificity of IV DSA was 95% and the sensitivity for ICA stenosis of 50% or more and ICA occlusion were 75% and 100% respectively. Combining CW Doppler and IV DSA findings raised sensitivity for ICA stenosis of 50% or more and ICA occlusion to 89% and 100% respectively and specificity to 95%. The combination of CW Doppler and IV DSA is a safe and accurate test battery in the detection and categorization of carotid disease.

Vascular leiomyoma in the hand.

Two patients with vascular leiomyomas of the hand are reported. These lesions are probably not as rare as the literature suggests. There are three pathologic types--solid, cavernous, and venous type tumors. All are composed of smooth muscle bundles surrounding vascular channels.

Left ventricular right atrial communication. A case report.

Left ventricular-right atrial communication is a relatively rare surgically corrigible congenital heart defect. We report a case with review of the literature.

Histochemical and proliferative changes preceding the onset of spontaneous gastric adenocarcinoma in Mastomys natalensis.

The histochemical and proliferative changes preceding spontaneously developing gastric adenocarcinoma were examined in Mastomys natalensis. The stomachs of 86 inbred animals from the DWZ strain were examined between 1 and 24 months of age. Two thirds of the animals had a small solitary ulcer in the middle of the lesser curvature which was observed by the first month of age. With increasing age, more and more dysplastic glands invading the submucosa were seen around the ulcer and eventually adenocarcinoma was observed after 12 month. Histochemical alterations included increased intracellular peanut lectin and Concanavalin A binding sites in the gastric pits and the development of lectin binding sites and of acid glycoproteins in the surface epithelium. Using 3H thymidine and autoradiography increased labelling and mitotic indices with extension of the progenitor area to the mucosal surface were observed around the ulcer. The coexistence of these histochemical and histokinetic alterations may represent an early sign of malignant potential in the gastric mucosa.