An internal hernia caused by Meckel's diverticulum: a case report.

BACKGROUND: Meckel's diverticulum is a remnant of the omphalomesenteric duct. It can lead to intestinal perforation, obstruction and gastrointestinal bleeding. While the internal hernia caused by Meckel's diverticulum is rarely reported. CASE PRESENTATION: We report a case of a 45-year old female patient who presented with intestinal obstruction and on laparotomy was found to have Meckel's diverticulum with internal hernia causing intestinal gangrene. Segmental bowel resection was performed and the patient had uneventful recovery. CONCLUSIONS: In patients with acute intestinal obstruction without previous abdominal surgery, Meckel's diverticulum and its complications should be suspected.

Failure of abdominal wall closure after intestinal transplantation: Identifying high-risk recipients.

Open abdomen and fascial dehiscence after intestinal transplantation increase morbidity. This study aims to identify recipient and donor factors associated with failure to achieve sustained primary closure (failed-SPC) of the abdomen after intestinal transplant. We conducted a single-center retrospective study of 96 intestinal transplants between 2013 and 2018. Thirty-eight (40%) were adult patients, and 58 were pediatric patients. Median age at transplantation was 36.0 and 5.8 years, respectively. Failed-SPC occurred in 31 (32%) patients. Identified risk factors of failed-SPC included preexisting enterocutaneous fistula (OR: 6.8, CI: 2.4-19.6, P = .0003), isolated intestinal graft (OR: 3.4, CI: 1.24-9.47, P = .02), male sex in adults (OR: 3.93, CI: 1.43-10.8, P = .009), and age over four years (OR: 6.22, CI: 1.7-22.7, P = .004). There was no association with primary diagnosis and prior transplant with failed-SPC. Donor-to-recipient size ratios did not predict failed-SPC. There was an association between failed-SPC and extended median hospital stay (100 vs 57 days, P = .007) and increased time to enteral autonomy in pediatric patients. There is a relationship between failed-SPC and a higher rate of laparotomy (OR: 21.4, CI: 2.78-178.2, P = .0003) and fistula formation posttransplant (OR: 11.4, CI: 2.83-45.84, P = .0005) in pediatric patients. Given inferior outcomes with failed-SPC, high-risk recipients require careful evaluation.

Lethal small intestinal herniation through a congenital mesenteric defect.

A three-year-old boy with mild symptoms of an upper respiratory tract infection and recent onset vomiting collapsed at home. Resuscitative attempts in hospital were eventually unsuccessful. At autopsy an obstruction of the small intestine, with ischemia, was identified. It had been caused by strangulation of the small intestine through a congenital mesenteric defect. Moderate mesenteric lymphadenopathy, with enlarged lymph nodes in the region of the herniated small intestine, were associated with positive testing for human metapneumovirus and enterovirus. Transmesenteric hernias are a very rare form of internal herniation that have the highest risk of strangulation. Unfortunately in children the presentation may be relatively nonspecific with a precipitate decline towards the end. In the reported case it is possible that mesenteric lymphadenopathy may have contributed to intestinal entrapment by preventing spontaneous reduction.

Early morphological changes in tissues when replacing abdominal wall defects by bacterial nanocellulose in experimental trials.

Experimental trials were done on five dogs to explore if an anterior abdominal wall defect could be repaired using wet (99.9%), compact BNC membranes produced by the Мedusomyces gisevii Sa-12 symbiotic culture. The abdominal wall defect was simulated by middle-midline laparotomy, and a BNC membrane was then fixed to open aponeurotic edges with blanket suture (Prolene 4-0, Ethicon). A comparative study was also done to reinforce the aponeurotic defect with both the BNC membrane and polypropylene mesh (PPM) (Ultrapro, Ethicon). The materials were harvested at 14 and 60 days postoperative to visually evaluate their location in the abdominal tissues and evaluate the presence of BNC and PPM adhesions to the intestinal loops, followed by histologic examination of the tissue response to these prosthetics. The BNC exhibited good fixation to the anterior abdominal wall to form on the 14th day a capsule of loose fibrin around the BNC. Active reparative processes were observed at the BNC site at 60 days post-surgery to generate new, stable connective-tissue elements (macrophages, giant cells, fibroblasts, fibrin) and neocapillaries. Negligible intraperitoneal adhesions were detected between the BNC and the intestinal loops as compared to the case of PPM. There were no suppurative complications throughout the postsurgical period. We noticed on the 60th day after the BNC placement that collagenous elements and new capillary vessels were actively formed in the abdominal wall tissues, generating a dense postoperative cicatrix whose intraperitoneal adhesions to the intestinal loops were insignificant compared to the PPM graft.

Diagnosis and Surgical Repair of an Acute Abdominal Wall Hernia and Partial Cloacal Strangulation in a Yellow-Naped Amazon Parrot (Amazona auropalliata).

A 38-year-old female, intact yellow-naped Amazon parrot (Amazona auropalliata) presented with an acute swelling along the ventrocaudal body wall, hematochezia, and tenesmus. Physical examination identified a defect in the ventral body wall. Bimodal pain management was initiated at presentation and hematochezia and tenesmus resolved. Radiographic imaging and contrast fluoroscopy identified a partial cloacal strangulation. An exploratory celiotomy was performed. Adhesions to the body wall were identified and broken down, the cloacal position was corrected, and the abdominal musculature repaired. Contrast fluoroscopy performed 72 hours after surgery confirmed normal positioning of the cloaca. Follow-up examinations documented proper postoperative healing of the hernia repair and maintenance of visibly normal passage of droppings. Although various abdominal hernias have been described in birds, this case demonstrates an unreported variation involving partial cloacal strangulation in a parrot.

Not gastroschisis or omphalocele or anything in between: a novel congenital abdominal wall defect.

Congenital abdominal wall defects occur when normal embryonic development is interrupted and most commonly results in gastroschisis or omphalocele. Other entities, such as ruptured omphalocele, vanishing gastroschisis, and patent omphalomesenteric ducts with prolapse, have also been described and can create a confusing picture. This case of a newborn with a midline abdominal defect and a mass that was intestine-like and arose from the bowel cannot be classified, and no similar reports were found. This suggests a previously undescribed abdominal wall defect with an aberrant colonic appendage.

Preoperative preparation of «loss of domain¼ hernia. Progressive pneumoperitoneum and botulinum toxin type A. / Preparación preoperatoria de la hernia con pérdida de domicilio. Neumoperitoneo progresivo y toxina botulínica tipo A.

Preoperative progressive pneumoperitoneum and botulinum toxin type A are useful tools in the preparation of patients with loss of domain hernias. Both procedures are complementary in the surgical repair, especially with the use of prosthetic techniques without tension, that allow a integral management of these patients. The aim of this paper is to update concepts related to both procedures, emphasizing the advantages that take place in the preoperative management of loss of domain hernias.

[PROPHYLAXIS OF INFILTRATIVE-INFLAMMATORY COMPLICATIONS OF THE WOUNDS HEALING IN PATIENTS, OPERATED ON FOR NONCOMPLICATED HERNIA OF ANTERIOR ABDOMINAL WALL].

The results of investigation of the inflammatory processes dynamics in operative wounds in 238 patients after surgical intervention, performed for noncomplicated hernias of anterior abdominal wall of various localization, as well as the impact of polarized light on correction of the vegetative nervous system disorders, for prophylaxis of infiltrative-purulent complications were analyzed.

[INSTRUMENTAL DIAGNOSIS OF ADHESIVE ILEUS].

Results of diagnosis and treatment of 48 patients, suffering an acute adhesiv eileus of small intestine, were analyzed. In 22 (45.8%) patients conservative therapy have appeared effective, in 26 (54.2%) ­ operative interventions were performed. Тransabdominal ultrasonographic investigation ­ noninvasive, available, highly informative diagnostic method ­ permits to differentiate various forms of an acute ileus precisely, and, comparing with roentgenological method, it is more secure and simple, which may be used even in a severely ill patients. The method permits to diagnose an acute adhesive small intestinal ileus in a shorter terms, and to determine severity of changes not in intestine only, but in adjacent abdominal organs as well.

The growth pattern of the human intestine and its mesentery.

BACKGROUND: It remains unclear to what extent midgut rotation determines human intestinal topography and pathology. We reinvestigated the midgut during its looping and herniation phases of development, using novel 3D visualization techniques. RESULTS: We distinguished 3 generations of midgut loops. The topography of primary and secondary loops was constant, but that of tertiary loops not. The orientation of the primary loop changed from sagittal to transverse due to the descent of ventral structures in a body with a still helical body axis. The 1st secondary loop (duodenum, proximal jejunum) developed intraabdominally towards a left-sided position. The 2nd secondary loop (distal jejunum) assumed a left-sided position inside the hernia before returning, while the 3rd and 4th secondary loops retained near-midline positions. Intestinal return into the abdomen resembled a backward sliding movement. Only after return, the 4th secondary loop (distal ileum, cecum) rapidly "slid" into the right lower abdomen. The seemingly random position of the tertiary small-intestinal loops may have a biomechanical origin. CONCLUSIONS: The interpretation of "intestinal rotation" as a mechanistic rather than a descriptive concept underlies much of the confusion accompanying the physiological herniation. We argue, instead, that the concept of "en-bloc rotation" of the developing midgut is a fallacy of schematic drawings. Primary, secondary and tertiary loops arise in a hierarchical fashion. The predictable position and growth of secondary loops is pre-patterned and determines adult intestinal topography. We hypothesize based on published accounts that malrotations result from stunted development of secondary loops.

Urinary bladder herniation through a caudoventral abdominal wall defect in a mature cat.

A 16-year-old spayed female domestic shorthair cat with no history of trauma was presented to the Western College of Veterinary Medicine for assessment of urinary incontinence. Diagnostic investigation revealed herniation of the urinary bladder through a caudoventral abdominal wall defect. Clinical signs resolved after surgical reduction of the bladder.

Herniation de la vessie urinaire par un défaut de la paroi abdominale caudo-ventrale chez un chat adulte. Une chatte domestique âgée de 16 ans sans anamnèse de traumatismes a été présentée au Western College of Veterinary Medicine pour l'évaluation de l'incontinence urinaire. L'enquête diagnostique a révélé une herniation de la vessie urinaire en raison d'un défaut de la paroi abdominale caudoventrale. Les signes cliniques se sont résorbés après la réduction chirurgicale de la vessie.(Traduit par Isabelle Vallières).

Handlebar hernia: case report and literature review.

Handlebar hernia is a rare traumatic abdominal wall hernia occurring after blunt trauma. We report a case of an adolescent patient with a traumatic rectus muscle abdominal wall hernia produced by injury with the bicycle handlebar. The skin abrasion caused by the trauma and a swelling reproduced after a Valsalva maneuver suggested the diagnosis. Traumatic wall hernias after blunt trauma should be repaired primarily to avoid complications.

[A rare variant of enterocele entrapment in the abdominal cavity of a woman].

Abdominal enterocele is a result of entering abdominal organs into peritoneal pockets and folds through the holes in mesenterium or into the adjoining cavities through defects in their walls. Enteroceles are localized at the sites where one segment of the gastrointestinal tract passes into another, in a pocket behind the cecum and sigmoid, between mesenteric layers of small intestine and colon, in the holes of mesenterium of vermiform appendage, gastrocolic and falciform ligaments, pockets and holes of broad ligament of the uterine, omental foramen, rectouterine excavation, and diaphragmal defects. We observed a 26 year old woman with enterocele entrapment in the abdominal cavity complicated by necrosis of part of the small intestine.

[MORPHOMETRIC AND HISTOLOGICAL CHANGES OF TISSUES IN PATIENTS, WHO UNDERWENT OPERATIONS FOR POSTOPERATIVE ABDOMINAL HERNIAS].

The impact of hernioplasty on postoperative morphometric and histological changes in tissues of patients, suffering postoperative abdominal hernias (POAH), was studied. For POAH 135 patients were operated, in 85 of them (the main group)--combined methods of hernial gate plasty in accordance to procedures proposed, and in 50 (control group)--classical methods of hernial gate were applied. The most favorable course of the wound process of the inflammatory, changes reduction and stabilization of the tissues reaction on implant already on the 7th postoperative day was noted after application of a sub lay method in original modification.

[MORPHOLOGICAL PECULIARITIES OF MUSCULO-APONEUROTIC TISSUES OF ANTERIOR ABDOMINAL WALL IN PATIENTS, SUFFERING MORBID OBESITY].

Results of morphological investigation of musculo-aponeurotic structures of anterior abdominal wall were presented in the morbid obesity patients. The role of obesity as a primary cause for morphofunctional insufficience of musculo-aponeurotic structures was established.

[CHOICE OF THE TREATMENT TACTICS IN PATIENTS, SUFFERING POSTOPERATIVE HERNIA OF ANTERIOR ABDOMINAL WALL WITH CONCOMITANT MORBID OBESITY].

Experience of treatment of 73 patients, suffering postoperative hernia of anterior abdominal wall with concomitant obesity, was presented. In 31 (42.5%) of them in a period of reduction and stabilization of a body mass the allohernioplasty as a second stage after bariatric operation was done, and in 9 (42.5%)--simultant bariatric operations with hernioplasty and dermatolipectomy. During a follow-up period after bariatric operation and hernioplasty the hernia recurrence have occurred in 3 (9.1%) patients, after hernioplasty--in 11 (33.3%), witnessing high efficacy of staged treatment in such patients.

Dermatan sulfate epimerase 1 deficient mice as a model for human abdominal wall defects.

BACKGROUND: Dermatan sulfate (DS) is a highly sulfated polysaccharide with a variety of biological functions in extracellular matrix organization and processes such as tumorigenesis and wound healing. A distinct feature of DS is the presence of iduronic acid, produced by the two enzymes, DS-epimerase 1 and 2, which are encoded by Dse and Dsel, respectively. METHODS: We have previously shown that Dse knockout (KO) mice in a mixed C57BL/6-129/SvJ background have an altered collagen matrix structure in skin. In the current work we studied Dse KO mice in a pure NFR genetic background. RESULTS: Dse KO embryos and newborns had kinked tails and histological staining revealed significantly thicker epidermal layers in Dse KO mice when compared with heterozygote (Het) or wild-type (WT) littermates. Immunochemical analysis of the epidermal layers in newborn pups showed increased expression of keratin 5 in the basal layer and keratin 1 in the spinous layer. In addition, we observed an abdominal wall defect with herniated intestines in 16% of the Dse KO embryos. Other, less frequent, developmental defects were exencephaly and spina bifida. CONCLUSION: We conclude that the combination of defective collagen structure in the dermis and imbalanced keratinocyte maturation could be responsible for the observed developmental defects in Dse KO mice. In addition, we propose that Dse KO mice could be used as a model in pathogenetic studies of human fetal abdominal wall defects.