Comparative study of laparoscopic Keyhole and Sugarbaker technique in the treatment of terminal paracolostomy hernia / 中华外科杂志

Objective: To compare laparoscopic Keyhole repair with Sugarbaker repair in consecutive patients with parastomal hernia. Methods: From January 2015 to December 2021, 117 patients with parastomal hernia were treated with Keyhole or Sugarbaker laparoscopy repairs in the Department of Hernia and Bariatrci Surgery, the First Affiliated Hospital of University of Science and Technology of China, and the clinical data were retrospectively analyzed. There were 45 males and 72 females, aged (68.6±8.6) years (range: 44 to 84 years). Laparoscopic Sugarbaker repair was performed in 89 cases, and Keyhole repair was performed in 28 cases. The t-test, Mann-Whitney U test, χ2 test and Fisher exact test were used to compare the observation indicators between the two groups, such as operation time, incidence of operation-related complications, and postoperative recurrence rate. Results: The follow-up period was (M(IQR)) 33 (36) months (range: 12 to 84 months). Compared to the Sugarbaker group, the hernia ring area of the Keyhole group was bigger (35 (26) cm2 vs. 25 (16) cm2, Z=1.974, P=0.048), length of stay was longer ((22.0±8.0) d vs. (14.1±6.2) d, t=5.485, P<0.01), and the postoperative rate of recurrence was higher (28.6% (8/28) vs. 6.7% (6/89), χ2=7.675, P=0.006). There was no difference in operation time and postoperative complications between the two groups. Conclusions: Laparoscopic Sugarbaker repair is superior to Keyhole repair in the recurrence rate of parastomal hernia treated with compsite mesh (not funnel-shaped mesh). There are no differences in operation time and postoperative complications between the two groups.

Cecal bascule herniation through the foramen of Winslow

Bowel obstructions can have a variety of causes, including impacted feces, adhesions, volvulus, non-internal hernias, and in rare cases internal hernias. We report a 63-year-old woman who presented to the emergency department with severe abdominal pain, nausea, vomiting, and obstructive symptoms that had started 12 hours earlier. A computed tomographic scan of the abdomen and pelvis showed a right internal hernia with a cecal bascule traversing through the foramen of Winslow, concerning for a closed-loop obstruction. The patient underwent an exploratory laparotomy with cecal bascule reduction and cecopexy. Given the increased mortality risk if undiagnosed, it is important to remain aware of internal hernias. Patient outcomes are markedly improved with early diagnosis and surgical intervention.

Hernia paracecal / Paracecal hernia

RESUMEN Las hernias internas son una causa poco frecuente de obstrucción del intestino delgado (representan menos del 5 %). La hernia pericecal ocupa alrededor de la décima parte de las hernias internas; mientras que, la hernia paracecal constituye una de sus cuatro variantes, las que a su vez, pueden ser congénitas o adquiridas. Se presentó un paciente masculino de 98 años de edad, operado por obstrucción intestinal debido a hernia paracecal, que requirió resección de intestino y anastomosis, con evolución favorable. En la búsqueda realizada en Cochrane no se encontró ningún otro caso publicado por autores cubanos. Se revisó la literatura al respecto y se insistió en la necesidad de tener presente dicho diagnóstico en el actuar diario del cirujano, ya que se comporta con una alta mortalidad sino se sospecha, debido a que cursa generalmente con compromiso vascular.

ABSTRACT Internal hernias are an uncommon cause of small bowel obstruction (they represent less than 5%). The pericaecal hernia occupies about a tenth of the internal hernias while the paracaecal hernia is one of its four variants, which in turn can be congenital or acquired. We present a 98-year-old male patient operated on bowel obstruction due to paracaecal hernia, which required bowel resection and anastomosis, with favourable evolution. No other case published by Cuban authors was found when searching in Cochrane Library. Literature on this subject was also reviewed, insisting on the need for surgeons to bear this diagnosis in mind in their daily work, since it is manifested with a high mortality if it is not suspected, because it generally involves vascular compromise.

Hernia gástrica atascada en ventana pericardio-peritoneal: Una rara complicación / Gastric hernia incarcerated into the pericardio-peritoneal window: A rare complication

Presentamos el caso de una paciente septuagenaria, con vómitos, neumonía por broncoaspiración y síndrome de impregnación neoplásica. Los estudios por imágenes muestran la totalidad del estómago herniado en el pericardio a través de una ventana pericardio-peritoneal realizada previamente. Se realizó la resolución quirúrgica del caso. Se hacen consideraciones sobre las opciones para el tratamiento del derrame pericárdico persistente, la hernia gástrica intrapericárdica como complicación, su presentación clínica, hallazgos intraoperatorios, forma de estudio y tratamiento.

We report the case of a 73-year- old female patient with vomiting, aspiration pneumonia and constitutional symptoms. The imaging tests showed total gastric herniation in the pericardial sac through a pericardio-peritoneal window previously created. The case was solved with surgery. The therapeutic options for persistent pericardial effusion are considered. Intrapericardial gastric hernia as a complication, its clinical presentation, intraoperative findings, complementary tests and treatment are discussed.

Cirugía herniaria electiva en pacientes portadores de tratamiento anticoagulante / Elective hernia surgery in patients with anticoagulant treatment

Resumen Introducción: Diversas patologías requieren de tratamiento anticoagulante oral (TACO). Algunos de estos pacientes requieren resolución quirúrgica. El manejo perioperatorio de estos pacientes es variable dependiendo del centro. Objetivos: Evaluar la morbilidad y mortalidad del protocolo de manejo de patología herniaria en TACO, atendidos en nuestro hospital. Material y Métodos: Estudio descriptivo prospectivo de 37 pacientes sometidos a cirugía herniaria en TACO entre 2008-2016. Los datos fueron obtenidos de la base de datos computacional del Equipo de Hernias, con un seguimiento mínimo de 1 mes. Se evaluaron las características clínicas, quirúrgicas y la morbimortalidad postoperatoria. El traslape consistió en hospitalizar al paciente tres días previos a la cirugía, suspendiéndose el TACO e iniciando heparina de bajo peso molecular (HBPM) en dosis terapéuticas, que se suspende 24 h previas a la cirugía. Se reinicia la HPBM a las 12 a 24 h postoperatorias, y se inicia el traslape a TACO a las 24-48 h. Los datos fueron analizados con Stata v14. Resultados: De los 37 pacientes estudiados, veintiséis pacientes fueron hombres (70,2%), la media de edad fue de 67,3 años. El 48,7% tenían fibrilación auricular. El 100% consumía acenocumarol como TACO. La media en el inicio del traslape a la anticoagulación oral fue de 1,4 días. El promedio de INR al momento del alta fue de 2,04. Dos pacientes fueron dados de alta con dalteparina. Un paciente (2,7%), presentó dolor en el postoperatorio inmediato y uno (2,7%), equimosis del sitio quirúrgico. Conclusiones: El protocolo de trabajo utilizado, demostró ser seguro, con una mínima morbilidad postoperatoria.

Introduction: Various pathologies require oral anticoagulant treatment (TACO). Some of these patients present pathologies of surgical resolution. The perioperative management of these patients is variable depending on the center. Aim: To evaluate the morbidity and mortality of patients attended with hernia pathology and TACO, assisted in our hospital. Materials and Method: Prospective, descriptive study of 37 patients submmited to hernia surgery in TACO between 2008-2016. The data was obtained from the computer database of the Hernia Team, with a minimum follow-up of 1 month. Clinical, surgical characteristics and postoperative morbidity and mortality were evaluated. The treatment overlap from TACO to Low Molecular Weight Heparin (LMWH) in therapeutic doses, was initiated three days before surgery. LMWH was suspended 24 hours prior to surgery, and reinitiated 12 to 24 hours post operation. 48 to 72 hours TACO was resumed. The data was analyzed with Stata v14. Results: Twenty-six patients were men, the mean age was 67.3 years. 48.7% had atrial fibrillation. 100% consumed acenocoumarol as TACO. The mean time for resuming TACO after surgery was 1.4 days. The average INR at the time of discharge was 2.04. Two patients were discharged with dalteparin. One patient (2.7%) presented pain in the immediate postoperative period and one showed ecchymosis of the surgical site (2.7%). Conclusions: The work protocol used, proved to be safe, with minimal postoperative morbidity.

Internal hernia through mesocolon defect after left laparoscopic colectomy / Hérnia interna pelo defeito mesocólico após colectomia esquerda laparoscópica

ABSTRACT Introduction: The development of internal hernias due to the mesocolon defect after laparoscopic colectomy is a rare complication with only 39 cases described. There are controversies whether the closure of the defect of the mesocolon after resection of the colon could prevent the development of this complication. Objective: To describe a case of intestinal obstruction due to internal hernia through the mesocolon defect after laparoscopic rectosigmoidectomy and to perform a literature review. Case report: A 59-year-old woman was hospitalized for laparoscopic rectosigmoidectomy due to an adenocarcinoma located in the rectosigmoid junction. She underwent a rectosigmoidectomy by laparoscopy, with an extracorporeal mechanical anastomosis, without closure of the mesocolon defect. In the fifth postoperative day the patient presented an intestinal obstruction due to an internal hernia through the mesocolon defect confirmed by computerized tomography. During the exploratory laparotomy approximately 120 cm jejunum was identified through the mesocolon defect. The reduction of herniated small bowel was done without the need of intestinal resection. The mesocolon defect was corrected by continuous suture. After the reoperation, the patient presented a favorable recovery being discharged on the fifth day. Conclusion: Intestinal obstruction due to internal hernia after laparoscopic rectosigmoidectomy is a rare postoperative complication that can be avoided by the adequate closure of the mesocolon defect.

RESUMO Introdução: O desenvolvimento de hérnias internas pelo defeito mesocólico após a realização de colectomia laparoscópica é uma complicação rara com apenas 39 casos descritos. Existem controvérsias se fechamento do defeito após a ressecção do cólon preveniria o desenvolvimento desta complicação. Objetivo: Descrever um caso de obstrução intestinal por hérnia interna pelo defeito mesocólico, após retossigmoidectomia laparoscópica e revisar a literatura relacionada ao tema. Relato do caso: Mulher, 59 anos foi internada para realizar ressecção cirúrgica de adenocarcinoma localizado na junção retossigmoideana. Foi submetida à retossigmoidectomia laparoscópica, com confecção de anastomose mecânica extracorpórea. O defeito mesocólico não foi corrigido no final do procedimento. No quinto dia de pós-operatório, a doente apresentou quadro de obstrução intestinal cuja tomografia computadorizada identificou presença de hérnia interna pelo defeito do mesocólon. Na laparotomia exploradora identificou-se que aproximadamente 120 cm de alças jejunais estavam herniadas através do defeito mesocólico. Realizou-se a redução do intestino delgado herniado sem necessidade de ressecção intestinal. O defeito foi corrigido por sutura contínua. Após a reoperação a doente apresentou evolução favorável recebendo alta no quinto dia. Conclusão: Obstrução intestinal após retossigmoidectomia laparoscópica consequente à formação de hérnia interna é complicação pós-operatória rara, com alta mortalidade, que pode ser evitada pelo fechamento criterioso do defeito do mesocólico.

A utilização da Ozonioterapia no tratamento da lombalgia associada à hérnia de disco lombar ­ Uma Revisão Sistemática / Ozonetherapy in the treatment of Low Back Pain associated to Lumbar Disk Herniation ­ A systematic review

INTRODUÇÃO: Ozonioterapia é uma ferramenta terapêutica utilizada para o tratamento de dor lombar associada a hérnia de disco lombar. Objetivo: o objetivo dessa revisão sistemática foi ratificar a relevância desse tratamento na prática clínica e enfatizar sua possível utilização na fisioterapia. MATERIAIS AND MÉTODOS: PRISMA e PICOS foram utilizados para analisar o desenho dos manuscritos. A seleção dos manuscritos foi realizada através de busca nas bases de dados PUBMED, Periódicos CAPES e Scielo. Quatro ensaios clínicos foram selecionados de acordo com os critérios de inclusão criado para essa estudo. RESULTADOS: Todos os autores confirmaram a eficiência da ozonioterapia como método terapêutico na reversão da sintomatologia álgica de pacientes com hérnia de disco lombar. Ozonioterapia associada ao tratamento fisioterapêutico pode contribuir no alívio da dor associada a dor lombar influenciando na qualidade de vida dos pacientes. CONCLUSÃO: Ozonioterapia é uma opção terapêutica efetiva para pacientes com dor lombar associada a hérnia de disco lombar. [AU]

INTRODUCTION: Ozonetherapy is a therapeutic tool used in the treatment of low back pain associated to herniation of lumbar disks. OBJECTIVE: The objective of this systematic review was to ratify the relevance of this treatment in clinical practice, besides emphasizing its possible utilization on physiotherapy. MATERIALS AND METHODS: PRISMA and PICOS were used to analyze the manuscripts design. Manuscripts selection was made by a research in the PUBMED, Periódicos CAPES and Scielo databases. Four clinical trials were selected according to the inclusion criterias designer for the study. RESULTS: All the authors confirmed the efficiency of ozonetherapy as a therapeutic method in reversing the algic symptomatology of pacients whit lumbar disc herniation. Ozonetherapy associated to the physiotherapeutic treatment can contribute pain relief related to low back pain by influencing the improvement in patients quality of life. CONCLUSION: Ozonetherapy is an effective therapeutic option for patients whit low back pain associated whit lumbar disk herniation. [AU]

Hernia de spiegel. Nuestra experiencia / Spigelian hernia. Our experience

Introducción: La Hernia de Spiegel es una afección parietal rara de la pared abdominal, unilocular, que se localiza en el borde externo de la línea semilunar. La mayoría de las veces se encuentra ubicada bajo el músculo oblicuo mayor y corresponde a una hernia intersticial; por lo que puede pasar desapercibida. Objetivo: Describir nuestra experiencia en el diagnóstico y tratamiento de la hernia de Spiegel. Pacientes y método: estudio observacional, descriptivo, retrospectivo de pacientes con diagnóstico de Hernia de Spiegel, tratados en la II Cátedra Clínica Quirúrgica, en el período de tiempo comprendido desde marzo 1998 a diciembre 2015. Resultados :n 14, fueron del sexo femenino 8 pacientes y 6 del masculino, el promedio de edad 57,4(±50-85). El motivo de consulta: dolor abdominal de tipo difuso, acompañado de una tumoración ventro lateral, reductible. En 10 casos la tumoración se localizó en el lado derecho y en 4 en el lado izquierdo.La sospecha clínica fue confirmada por la ecografía en 8 casos y la tomografía axial computarizada en los 6 restantes, la forma de presentación de 2 casos fue como oclusión intestinal y operados de urgencia y las demás electivas - ambulatorias. En todos los casos se realizó reparación de la pared sin tensión con malla de polipropileno, en 3 pacientes se colocó plug y en 11 pacientes se realizó refuerzo de la fascia del oblicuo mayor sublay, con el mismo material. No tuvimos complicaciones ni recidivas a los 24 meses. Conclusión: El diagnóstico de la hernia de Spiegel no resulta sencillo, debe acompañarse en todos los casos de un estudio de imagen. La técnica quirúrgica sin tensión, colocación de malla sublay, es una opción por sus resultados satisfactorios.

Introducción: Spigelian Hernia is a rare abdominal wall disease, often localizated in semilunar line. Most of the time it appeas under external oblique muscle, because of that, sometimes the diagnosis can be difficult. Objective: To describe the experience in the diagnosis and treatment of Spigelian Hernia. Patient and methods: An observational, retrospective study of patients with Spigelian Hernia, at the Second Service of Surgery, between March of 1998 to December of 2015. Results: 14 patients were diagnosed of Spigelian Hernia, 8 women and 6 men, with an average age of 57 years (±50-85). The main reason from consultation was abdominal pain with a lateral abdominal tumor. Clinical suspicious was confirm by ultrasonography in 8 cases and CT scan revealed the other 6. Surgical treatment in all cases was performed without tension using a polipropilene mesh; in 3 of them they use a plug and in the other 11 a sublay mesh to reinforce the external oblique fascia. They don´t have any complications. Conclusion: The diagnosis of Spigelian Hernia is not simple, is important to attach a image study. A tension free surgical technique, a sublaymesh, are options to have success.

Histerocele inguinal com hematometra em cadela: relato de caso / Inguinal hysterocele and haematometra in bitch: case report / Histerocele inguinal con hematometra en perra - Relato de caso

As hérnias inguinais podem ser congênitas ou adquiridas, aparecendo com maior frequência nas fêmeas de meia idade, sem predileção racial. Essa afecção pode estar, usualmente, presente devido a vários fatores secundários, como os hormonais. O objetivo do presente trabalho foi relatar um caso de histerocele inguinal com hematometra atendida no Hospital Veterinário das Faculdades Integradas de Ourinhos. A ovário salpingo histerectomia e redução da hérnia foram realizadas com sucesso, após confirmação radiológica e ultrassonográfica.

Inguinal hernia may be a hereditary or acquired disease, found most commonly in middle aged bitches, without distinction of breed. This can usually be present due to several secondary factors, such as hormonal factors. The objective of the present paper was to report a case of inguinal hysterocele with associated haemometra treated at the Veterinary Hospital at Faculdades Integradas de Ourinhos. An ovariohysterectomy and hernia reduction were successfully performed after radiological and ultrasound diagnoses.

Las hernias inguinales pueden ser de origen congénitas o adquiridas, apareciendo con mayor frecuencia en hembras de media edad, sin predilección racial. Esa afección puede estar usualmente presente debido a diversos factores secundarios, como los hormonales. El objetivo de este estudio fue relatar un caso de histerocele inguinal con hematometra atendida en el Hospital Veterinario de las Facultades Integradas de Ourinhos. El ovario salpingo histerectomía y reducción de la hernia ha sido realizado con éxito, después de la confirmación radiológica y ultrasonográfica.

Left Paraduodenal Hernia Presenting with Atypical Symptoms

Paraduodenal hernias are a rare congenital malformation, but they are the most common internal hernias. They develop secondary to a failure in midgut rotation, which may lead to small bowel obstruction or other clinical manifestations. The authors recently experienced a case of a left paraduodenal hernia presenting with unusual symptoms of left flank pain and vomiting.

Avaliação do tratamento da hérnia perineal bilateral no cão por acesso dorsal ao ânus / Evaluation of surgical treatment in dogs with bilateral perineal hernia by dorsal anus access

O objetivo do presente estudo foi avaliar a evolução e as complicações pós-operatórias do tratamento de hérnias perineais bilaterais, por acesso dorsal ao ânus, em 14 cães com idade entre seis e 12 anos. Realizou-se incisão em forma de 'U' invertido, a qual se estendeu desde a porção lateral da tuberosidade isquiática do lado esquerdo, curvando-se em direção à linha mediana, dois centímetros dorsalmente ao ânus e dirigindo-se simetricamente para a extremidade da tuberosidade isquiática contralateral. Após redução da hérnia, os músculos do diafragma pélvico direito e esquerdo foram suturados pela técnica de elevação do músculo obturador interno. As complicações observadas no período pós-operatório foram incontinência fecal, contaminação da ferida, deiscência de pontos da sutura cutânea, incontinência urinária e recidiva em um cão 19 dias após procedimento cirúrgico. O acesso utilizado foi exequível e todos os cães submetidos à técnica operatória proposta não apresentaram recidivas em um período entre cinco e dez meses de avaliação pós-operatório.

Observing the evolution and complications in the treatment of bilateral perineal hernias by dorsal access to the anus was the objective of this study. Fourteen dogs of various breeds were operated with an inverted "U" shaped incision, which extended from the lateral portion of the tuberosity Isquiatica on the left, bending into the direction of the midline, dorsally to anus and heading out symmetrically to the tip of the tuberosity Isquiatica contralateral. After reduction of the hernia, the right and left muscles of the pelvic diaphragm were sutured by the technique of raising the internal obturator muscle. The complications observed in the postoperative period were fecal incontinence, contamination of the wound, dehiscence of suture points of the skin, urinary incontinence and recurrence in a dog with 19 days after surgery. The access used was feasible and all dogs undergoing surgical technical proposal showed no recurrence in a period of five to ten months of postoperative assessment.

O método Pilates no ganho de flexibilidade dos músculos isquiotibiais em pacientes portadores de hérnia de disco lombar / The Pilates method for improving flexibility of the hamstring muscles in patients with lumbar intervertebral disc herniation

A hérnia de disco intervertebral é causa comum de dor lombar. A partir do conhecimento de que a dor provocada pela hérnia discal acarreta restrição de movimentos, levando aos encurtamentos adaptativos dos músculos isquiotibiais, e tendo em vista, a crescente procura pelo método Pilates, este trabalho objetiva avaliar o ganho de flexibilidade, tomando como parâmetro os músculos isquiotibiais, através do método Pilates em portadores de hérnia de disco lombar. Participaram voluntariamente do estudo trinta e dois sujeitos (doze mulheres e vinte homens com idade média de 43 ± 7 anos) apresentando diagnóstico de hérnia discal lombar. Os pacientes participaram de sessões de Pilates com duração de 60 minutos duas vezes por semana, durante oito semanas. Foram realizadas cinco avaliações, a primeira antes do início da prática de Pilates (T0) e as subseqüentes T1, T2, T3, T4, sempre no período de 15 dias após realização da medida anterior. Foi constatado no grupo de pacientes estudados, ganho de flexibilidade dos isquiotibiais estatisticamente significantes. Uma média aritmética e um desvio padrão inicial de 48 ± 5 (T0) passou para um valor de 68 ± 6 (T4) em oito semanas de treinamento. Assim, observou-se melhora na composição da flexibilidade neste grupo de participantes do programa de exercícios do método Pilates. Com este resultado, verificamos que o método Pilates é eficaz em elevar a flexibilidade dos músculos isquiotibiais, que apesar destes resultados, merece estudos adicionais.

The intervertebral disk displacement is a common cause of back pain. Knowing that the pain caused by disc herniation entails restriction of movement, leading to adaptive hamstring muscles shortening, and in response for the increased demand for the Pilates method of exercises, this study aims to evaluate the gain in flexibility, taking as parameter hamstring muscles through the Pilates method in patients with lumbar herniated disc. Thirty-two volunteers (twelve women and twenty men average age of 43 ± 7 years) with lumbar disc herniation participated in the study. Patients were assigned to Pilates sessions with 60 minutes duration, twice a week, for eight weeks. Were performed five evaluations, the first before practicing Pilates (T0) and the subsequent T1, T2, T3, T4, fifteen (15) days after the last evaluation. The studied group showed statistically significant gain in flexibility of the hamstring. An arithmetic average and a standard deviation of initial 48 ± 5 (T0) ascended to level 68 ± 6 (T4) in eight weeks of training. It was found improvement in flexibility of this group of participants using Pilates method exercises program. With this result, we verified that the Pilates method is effective in increasing flexibility of the hamstring muscles, but, despite these results, it deserves further study.

Analysis of different causes of mechanical intestinal obstruction

To find out the frequency of different causes of Mechanical Intestinal Obstruction, presenting at CMH Rawalpindi. None random convenient sampling. The study was done in CMH Rawalpindi from July 2003 to Dec. 2003. Hundred patients fulfilling the inclusion criteria were included in the study. Most of the patients were soldiers and their families. Data was collected on the patient proforma. A total of 100 patients were treated for mechanical bowel obstruction during the study period [83 male and 17 female]. Seventy- nine [79%] patients had obstruction of the small intestine and twenty-one [21%] had obstruction of the large intestine. Adhesions and External hernia accounted for almost more than half the causes of mechanical intestinal obstruction in our patients. The adhesions represent leading cause of intestinal obstruction. There were 38 cases of intestinal obstruction due to adhesions in all these cases the plain abdominal x-rays revealed the typical features of small bowel obstruction with air fluid levels and dilated loops of bowel. In 35 of these patients there was a history of previous abdominal surgery including 9 females and 26 males. The initial treatment was conservative by keeping the patients nil orally, nasogastric decompression and intravenous fluids. Intestinal obstruction is one of the common clinical conditions in Pakistan. Mechanical intestinal obstruction due limited to adhesions, is the most common cause, followed by strangulated/ obstructed external hernia, malignancy and tuberculosis

Strangulated obturator hernia - an unusual presentation of intestinal obstruction

An 81-year-old Caucasian emaciated female presented with 3 days history of colicky abdominal pain nausea, projectile vomiting and abdominal distension. A pre-operative diagnosis of mechanical bowel obstruction was made. The absence of characteristic clinical signs in this thin elderly woman with a small bowel obstruction failed to provide a pre-operative diagnosis. She underwent a midline laparotomy and resection and anastomosis of small bowel and repair of the strangulated right obturator hernia. The high mortality rate associated with this type of abdominal hernias requires a high index of suspicion to facilitate rapid diagnosis and prompt surgical intervention if the survival rate is to be improved

A Transmesenteric Hernia in a Child: Gangrene of a Long Segment of Small Bowel through a Large Mesenteric Defect / 대한소화기학회지

Intestinal obstruction is a common surgical emergency. Transmesenteric hernia is an unusual cause of bowel obstruction that may result in irreversible damage of the bowel and a fatal outcome. Once incarceration of the bowel occurs, strangulation and gangrene follow immediately. The mortality rate associated with this condition is about 15%, but in the presence of gangrene of the bowel, the mortality rate is more than 50%. An accurate preoperative diagnosis of a transmesenteric hernia is very difficult and rarely made. Therefore, in patients with small bowel obstruction, in the absence of a history of previous surgery to suggest adhesions or an external hernia, the possibility of a transmesenteric hernia must be considered. We describe a case with gangrene of a long segment of the small bowel caused by a transmesenteric hernia through a large defect of small bowel mesentery in a child.

A Case of Left Paraduodenal Hernia Combined with Acute Small Bowel Obstruction / 대한소화기학회지

Paraduodenal hernias are rare congenital malrotational anomalies of midgut that arise in the potential spaces and folds of the posterior parietal peritoneum adjacent to the ligament of Treitz and can lead to intestinal obstruction. Also, they have shown several presentation patterns, such as asymptomatic, chronic intermittent abdominal pain, and acute severe abdominal pain. If symptomatic hernias with strangulation are untreated, according to the previous reports, they lead to overall mortality exceeding 50%. We report a case of the left paraduodenal hernia combined with small bowel obstruction from the patient who had no history of surgery before and developed abdominal pain after drinking of alcohol heavily. Abdominal CT scan showed sac-like mass of clustered in the left upper quadrant. The patient underwent the surgery of the bowel reduction and adhesiolysis and got uneventful recovery.

Mechanical intestinal obstruction: etiology and management in adults at civil hospital, Karachi

To determine the etiological factors, management and outcome of mechanical intestinal obstruction in adults at Civil Hospital, Karachi. The hospital records of all patients operated on for mechanical intestinal obstruction in Civil Hospital, Karachi, over a period of one year [July 2006 to June 2007] were reviewed. Signs and symptoms with duration, etiology, surgical management, morbidity and mortality, apart from demography, were recorded. Patients were followed until their discharge. A total of 119 patients, 74 male and 45 female, with a mean age [ +/- SD] of 37.29 [ +/- 16.08] years were operated on during the study period. Their mean [ +/- SD] duration of symptoms was 4.1 [ +/- 3.9] days. Obstructed external hernias were the most common cause of intestinal obstruction, seen in 36 [30.2%] patients, followed by intestinal tuberculosis in 24 [20.2%] patients. Stoma formation was the most common surgical procedure performed in 40 [33.6%] patients followed by hernia repair, with or without resection, and anastomosis of bowel in 36 [30.2%] patients. Complications were documented in 34.4% of patients. Mortality was 9.2% during the hospital stay. Obstructed external hernias were the commonest cause of intestinal obstruction followed by intestinal tuberculosis. Stoma formation was the commonest surgical procedure performed. During the first year of surgical training, all residents should master the skills of making an appropriate stoma, while during the second year they should be able to manage obstructed hernias properly

Internal herniation as a major cause of intestinal obstruction

To evaluate internal herniation as a rare cause of intestinal obstruction. Files of 18 cases, operated due to internal herniation between 2000 and 2006 at Selcuk University, Meram School of Medicine, General Surgery Department, were reviewed retrospectively. Sixteen patients [88.8%] were male [mean age: 58.2 years; range: 42-67] and 2 were female [mean age: 56.5 years; range: 52-61].Cases were grouped according to the location of internal herniation, and the clinical findings and applied treatment strategies were evaluated. All patients were taken into surgical operation after preoperative preparations were completed. Findings were as follows: 6 cases of paraduodenal internal herniation, 4 of internal herniation through a defect in the terminal mesoileum, 2 of herniation through a defect in the falciform ligament, 2 of herniation through a defect in the omentum majus, 1 of herniation to the recessus over the bladder, 2 of herniation through a defect in the transverse mesocolon and 1 iatrogenically caused internal herniation through a defect in the mesojejunum. In an adult patient with findings of intestinal obstruction, diagnosis is difficult. Most cases presented to date are incidental findings during laparotomy, and surgical treatment is necessary

Generalized peritonitis due perforated appendix in an Amyand's hernia: an unusual presentation of a rare condition

We report a 70 year-old male patient who had Amyand's hernia with an unusual clinical presentation. At surgery, the vermiform appendix was perforated and there was an abscess within the hernial sac associated with generalized peritonitis and multiple intra-abdominal abscesses. The preoperative differential diagnosis was incarcerated diaphragmatic hernia, colonic volvulus, or inguinal hernia associated with peritonitis. Although abdominal computed tomography successfully diagnosed the inguinal hernia, it could not demonstrate the appendix within its sac. As in the majority of published series, Amyand's hernia was discovered only intra-operatively. Through a midline laparotomy, the appendix remnants were excised and multiple intra-abdominal abscesses were evacuated. The patient had no postoperative complications and was discharged in a fair condition on the 8th postoperative day