Hernia of De Garengeot an up to date of diagnosis, initial management and treatment: a narrative review and a case study report / Hernia de De Garengeot: diagnóstico, manejo inicial y tratamiento actualizados: una revisión narrativa y un informe de estudio de caso

INTRODUCTION A De Garengeot hernia is defined by a femoral hernia containing the appendix. Acute appendicitis within a femoral hernia is an extremely rare surgical presentation and occurs in only 0.08-0.013% of cases cited in the literature and 5 to 15% of all femoral hernias. CASE PRESENTATION A 53-year-old woman presented to the emergency room of our hospital in our ward with acute onset of a right-sided inguinal swelling that occurred earlier that day after performing a heavy lift. Her examination revealed acute appendicitis contained within an incarcerated right femoral hernia. The patient underwent laparoscopic appendectomy with open femoral hernia repair. Intraoperatively, the tip of the appendix was incarcerated within the hernial sac. She was removed through the open inguinal incision after the base of the appendix has been divided laparoscopically. The final pathology showed acute inflamed appendicitis with no evidence of neoplasm. DISCUSSION Physicians should be aware of the rare extent of an unusual presentation of appendicitis such as well as surgical options for treatment. The literature does not conclude on a gold standard for the method of approach. CONCLUSION De Garengeot's hernia remains a rare and unusual surgical presentation of femoral hernia, and the complication of the case by incarceration leading to acute appendicitis provides a challenging surgical approach that should be personalized for each patient

An Outbreak of Human Systemic Anthrax, including One Case of Anthrax Meningitis, Occurred in Calabria Region (Italy): A Description of a Successful One Health Approach.

In this report, three cases of human cutaneous anthrax are described, one complicated by meningitis, and all were linked to a single infected bullock. A 41-year-old male truck driver, along with two male slaughterhouse workers, 45 and 42, were hospitalized for necrotic lesions of the arm associated with edema of the limb and high fever. All three patients were involved in transporting a bullock to the slaughterhouse. Microbiological examination on the prescapular lymph node and a piece of muscle from the bullock carcass showed the presence of Bacillus anthracis. The three patients underwent a biopsy of the affected tissues, and all samples tested positive for B. anthracis DNA using PCR. Furthermore, the truck driver also complained of an intense headache, and a CSF sampling was performed, showing him positive for B. anthracis by PCR, confirming the presumptive diagnosis of meningitis. Fast diagnosis and appropriate treatment are crucial for the management of human anthrax. Cooperation between human and veterinary medicine proved successful in diagnosing and resolving three human anthrax cases, confirming the reliability of the One Health approach for the surveillance of zoonoses.

Gallstone ileus of the sigmoid colon. A case repor.

Gallstone ileus is a complication of cholelithiasis which is due to gallstone migration through a fistula between the gallbladder and the gastrointestinal tract followed by intraluminal impaction. This uncommon form of mechanical bowel obstruction occurs in <1% of patients with cholelithiasis. Gallstone ileus due to cholecystocolonic fistula is rare, and therefore appropriate surgical treatment is still a matter of debate. We describe a unusual case of gallstone ileus in a 74-year-old man with a history of cholelithiasis, admitted to our hospital with suspected largebowel obstruction. The diagnosis was made with abdominal computed tomography scan that showed a very large gallstone impacted in the sigmoid causing mechanical bowel obstruction. After endoscopic removal was attempted but proved unsuccessful, enterotomy was performed to remove the gallstone. At surgery a Meckel's diverticulum was discovered incidentally and removed and trasversostomy was performed. The patient was discharged on postoperative day 10. KEY WORDS: Gallstone ileus, Endoscopy, Large bowel obstruction, Cholecystocolonic fistula, Meckel's diverticulum.

Gallstone ileus. A case treated with minilaparotomy and a review of the literature.

Gallstone ileus is a rare complication of cholelithiasis which occurs in less than 1% of patients and is the cause of 1- 4% of cases of small bowel obstruction. The pathogenesis involves the formation of a bilioenteric fistula. We report the case of gallstone ileus in an 81-year old woman with typical abdominal pain, arterial hypertension and coronary artery disease. An abdominal computed tomography (CT) scan showed pneumobilia, dilated loops of small bowel and an ectopic gallstone obstructing the intestinal lumen. The patient underwent enterolithotomy and a 5-cm stone 20 cm from the ileocecal valve was removed. In the literature enterolithotomy alone is the procedure most frequently used for gallstone ileus. Enterolithotomy plus cholecystectomy and/or fistulectomy is only indicated in selected patients. The clinical signs and symptoms depend on the site of the obstruction and usually include abdominal pain, nausea and vomiting. The diagnostic test of choice is an abdominal CT scan. KEY WORDS: Cholecystoenteric fistula, Gallstone ileus, Minilaparotomy.