ABSTRACT
BACKGROUND: Primary thoracoabdominal hernias involve the triad of an intercostal hernia, abdominal wall hernia, and diaphragmatic hernia. We report a case series of this rare entity and describe the evolution and outcomes. METHODS: We completed a retrospective analysis of thoracoabdominal hernia repairs performed January 2010-April 2019 at Prisma Health-Upstate and Carolinas Medical Center. This includes all patients with spontaneous defects, excluding incisional hernias or those resulting from external trauma. RESULTS: Of 16 patients with thoracoabdominal hernias, 15 patients developed hernias after forceful coughing and one patient developed a hernia after strenuous physical activity. Seven patients required at least one additional intervention; two for recurrence; two for recurrence of original intercostal repairs done elsewhere; two for wound complications; and one had a missed abdominal wall component. CONCLUSIONS: Primary thoracoabdominal hernias require a high index of suspicion. Durable repair involves complex reconstruction of the thoracoabdominal wall including the diaphragm, intercostal space, rib fracture fixation, and mesh reinforcement of the abdominal wall with permanent fixation constructs.
Subject(s)
Hernia, Ventral , Herniorrhaphy , Follow-Up Studies , Hernia, Ventral/surgery , Herniorrhaphy/methods , Humans , Recurrence , Retrospective Studies , Surgical MeshSubject(s)
Abdominal Pain , Diagnostic Imaging , Child , Chronic Disease , Emergency Service, Hospital , HumansSubject(s)
Immunoblastic Lymphadenopathy/diagnosis , Immunoblastic Lymphadenopathy/pathology , Acquired Immunodeficiency Syndrome/diagnosis , B-Lymphocytes/immunology , Biopsy , Child , Diagnosis, Differential , Growth Substances/deficiency , Humans , Hypergammaglobulinemia/complications , Immunoblastic Lymphadenopathy/complications , Immunoblastic Lymphadenopathy/diagnostic imaging , Interleukin-4 , Lung/pathology , Lymph Nodes/pathology , Lymphokines/deficiency , Lymphoproliferative Disorders/diagnosis , Male , Microscopy, Electron , RadiographyABSTRACT
Twelve cases of neonatal intussusception are presented and another 25 taken from the literature are reviewed. Intussusception in the first month of life is a distinct clinical and pathological entity, presenting as bowel obstruction in the first days and usually led by a tumor. In the past, a high mortality rate has been related to late diagnosis. The barium-enema examination is diagnostic.
Subject(s)
Infant, Newborn, Diseases , Intussusception/diagnostic imaging , Female , Humans , Infant, Newborn , Intussusception/pathology , Male , Prognosis , RadiographyABSTRACT
Retrospective analysis of 22 cases with neonatal ascites showed the most common cause to be anomalies of the urogenital system (urethral valve, hydronephrosis, rupture of bladder, rupture of ovarian cyst). Next came malformations of the gastro-intestinal tract and of the liver and congenital infections (toxoplasmosis, cytomegaly). In 4 cases the cause was not found. More than one half of the cases permitted a definitive radiologic diagnosis, mainly in malformations requiring surgery. We suggest a standardized procedure of investigation of all cases with neonatal ascites. If this procedure does not result in a positive diagnosis and if the ascites fluid does not contain blood or bile, we fell that laparotomy is not indicated.
