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1.
BMC Gastroenterol ; 22(1): 285, 2022 Jun 03.
Artículo en Inglés | MEDLINE | ID: mdl-35659254

RESUMEN

BACKGROUND: Despite numerous reports on ischemic bowel obstruction caused by internal hernia, no case presentation has been reported of an internal hernia caused by a bridge formed between the medial and lateral zones of the liver. Herein, we report the first case of ischemic bowel obstruction caused by a hepatic bridge. CASE PRESENTATION: A 24-year-old man complaining of abdominal pain was referred to our hospital and admitted. Computed tomography showed formation of a closed loop of small bowel with a hernia orifice near the hilar region, and poor contrast of the prolapsed small bowel. We suspected ischemic bowel obstruction caused by an internal hernia with a fissure of the greater omentum as the hernia orifice, and performed emergency surgery. Laparoscopic observation revealed that the medial and lateral segments of the liver formed a bridge on the dorsal side at the liver portal, and that the small intestine was ischemic in the gap created between the bridge and the medial and lateral liver segments. A Meckel's diverticulum was also invaginated in the gap. The bridge was dissected out and the hernia orifice was opened to release the bowel obstruction. The small bowel was preserved and the Meckel's diverticulum was resected. The patient's postoperative course was uneventful. CONCLUSIONS: We experienced a case of ischemic bowel obstruction caused by hepatic bridge formation, which was successfully treated by laparoscopic surgery.


Asunto(s)
Hernia Abdominal , Obstrucción Intestinal , Divertículo Ileal , Adulto , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico por imagen , Humanos , Hernia Interna , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Hígado/diagnóstico por imagen , Masculino , Divertículo Ileal/complicaciones , Adulto Joven
2.
J Investig Med High Impact Case Rep ; 10: 23247096221100500, 2022.
Artículo en Inglés | MEDLINE | ID: mdl-35610939

RESUMEN

Small bowel obstruction is a common surgical emergency and frequent cause of hospitalization. Internal hernias account for less than 6% of all small bowel obstruction cases. Less frequently, hernias through the broad ligament of the uterus can occur and account for only 4-7% of total internal hernia cases. We report a case of a small bowel hernia through broad ligament of the uterus in a young female. Multiple diagnostic modalities suggested a ruptured ovarian cyst as the most probable cause for her abdominal pain. However, her symptoms were much more severe than an ovarian cyst would normally produce. Therefore, a diagnostic laparotomy was performed, which found a small intestine hernia through the left broad ligament of the uterus. The diagnosis of intestinal hernias, specifically through the broad ligament, is often delayed due to the infrequent occurrence, varied presentation, and difficulty of confirmation on computed tomography (CT) scan. Surgery is the gold standard for the diagnosis and treatment of internal hernias. This article draws attention toward a rare and potentially life-threatening cause of abdominal pain.


Asunto(s)
Ligamento Ancho , Hernia Abdominal , Obstrucción Intestinal , Quistes Ováricos , Neoplasias Ováricas , Dolor Abdominal/etiología , Femenino , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico , Hernia Abdominal/cirugía , Humanos , Hernia Interna , Obstrucción Intestinal/diagnóstico , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Quistes Ováricos/complicaciones , Quistes Ováricos/diagnóstico , Neoplasias Ováricas/complicaciones , Útero
3.
Isr Med Assoc J ; 24(1): 11-14, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-35077039

RESUMEN

BACKGROUND: Emergency surgical repair is the standard approach to the management of an incarcerated abdominal wall hernia (IAWH). In cases of very high-risk patients, manual closed reduction (MCR) of IAWH may prevent the need for emergency surgery. OBJECTIVES: To evaluate the safety, success rate, and complications of MCR in the management of IAWH conducted in an emergency department. METHODS: The data of all patients who underwent MCR between 2012 and 2018 were retrospectively collected. Patient demographics, presenting symptoms, clinical parameters, and management during the hospitalization were retrieved from the medical charts. RESULTS: Overall, 548 patients underwent MCR during the study period. The success rate was 25.4% (139 patients). One patient had a complication that required a laparotomy 2 days after his discharge. A recurrent incarceration occurred in 23%, 60% of them underwent successful repeated MCR and the others underwent emergency surgery. Six patients (1.4%) had a bowel perforation after a failed MCR. CONCLUSIONS: MCR can be performed safely in the emergency department and should be consider as an option to treat IAWH, especially in high operative risk patients.


Asunto(s)
Hernia Abdominal , Herniorrafia , Perforación Intestinal , Laparotomía , Complicaciones Posoperatorias , Servicios Médicos de Urgencia/métodos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico , Hernia Abdominal/epidemiología , Hernia Abdominal/cirugía , Herniorrafia/efectos adversos , Herniorrafia/métodos , Herniorrafia/estadística & datos numéricos , Humanos , Perforación Intestinal/diagnóstico , Perforación Intestinal/etiología , Perforación Intestinal/cirugía , Israel/epidemiología , Laparotomía/efectos adversos , Laparotomía/métodos , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/cirugía , Reoperación/métodos , Reoperación/estadística & datos numéricos , Estudios Retrospectivos , Ajuste de Riesgo/métodos , Factores de Riesgo
4.
Surg Endosc ; 36(4): 2570-2573, 2022 04.
Artículo en Inglés | MEDLINE | ID: mdl-33988770

RESUMEN

BACKGROUND: Chylous ascites is often reported in cases with lymphatic obstruction or after lymphatic injuries such as intraabdominal malignancies or lymphadenectomies. However, chylous ascites is also frequently encountered in operations for internal hernias. We sought to characterize the frequency and conditions when chylous ascites is encountered in general surgery patients. METHODS: Data from patients who underwent operations for CPT codes related to open and laparoscopic abdominal and gastrointestinal surgery in our tertiary hospital from 2010 to 2019 were reviewed. Patients with the postoperative diagnosis of internal hernia were identified and categorized into three groups: Internal Hernia with chylous ascites, non-chylous ascites, and no ascites. Demographics, prior surgical history, CT findings, source of internal hernia, open or laparoscopic surgery, and preoperative labs were recorded and compared. RESULTS: Fifty-six patients were found to have internal hernias and were included in our study. 80.3% were female and 86% had a previous Roux-en-Y gastric bypass procedure (RYGBP). Laparoscopy was the main approach for all groups. Ascites was present in 46% of the cases. Specifically, chylous ascites was observed in 27% of the total operations and was exclusively (100%) found in patients with gastric-bypass history. Furthermore, it was more commonly associated with Petersen's defect (p < 0.001), while the non-chylous fluid group was associated with herniation through the mesenteric defect (p < 0.001). CONCLUSIONS: Chylous ascites is a common finding during internal hernia operations. Unlike other more morbid conditions, identification of chylous ascites during an internal hernia operation appears innocuous. However, in the context of a patient with a history of RYGBP, the presence of chylous fluid signifies the associated small bowel obstruction is likely related to an internal hernia through a patent Petersen's defect.


Asunto(s)
Ascitis Quilosa , Derivación Gástrica , Hernia Abdominal , Laparoscopía , Obesidad Mórbida , Ascitis Quilosa/etiología , Ascitis Quilosa/cirugía , Femenino , Derivación Gástrica/métodos , Hernia/complicaciones , Hernia Abdominal/complicaciones , Hernia Abdominal/cirugía , Humanos , Hernia Interna , Laparoscopía/métodos , Masculino , Obesidad Mórbida/cirugía , Estudios Retrospectivos
5.
Pan Afr Med J ; 40: 135, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34909103

RESUMEN

Internal hernias are quite rare, accounting for fewer than 1% of all abdominal hernias. Moreover, the most frequent cause of internal herniation is paraduodenal hernia (PDH). Diagnosing paraduodenal hernias can be difficult due to the wide range of symptoms that can occur. It is a case report of paraduodenal hernia that was diagnosed and managed in a tertiary center. We describe the case of a 55-year-old male patient who had been experiencing nonspecific abdominal discomfort for the last 5 years and had several comorbidities and positive serology. An abdominal computed tomography (CT) revealed that he had a left PDH, which was effectively treated with laparoscopic surgical repair. The study's strength is that it was correctly identified by CT and subsequently laparoscopically corrected. A gastrografin swallow study was also performed postoperatively to ensure there was no leak. The study's flaw is that the patient was misdiagnosed for five years in other medical facilities. Because paraduodenal hernia is an uncommon diagnosis, it's important to keep it in mind as one of the differential diagnoses for persistent discomfort. It also needs accurate imaging in order to identify and successfully manage it. To demonstrate the relevance of this uncommon condition, future research is needed to report on any misdiagnosis or treatment. To conclude, nowadays the best option for paraduodenal hernia repair is laparoscopic surgery. However, because it can present with a wide variety of symptoms and diagnosis might be challenging, it demands a high index of suspicion. The gold standard for identifying paraduodenal hernia is still a CT scan of the abdomen. Patients who are stable and have no signs of intestinal obstruction might decide to have their hernia repaired to avoid future problems. To demonstrate the relevance of this uncommon condition, future research is needed to report on any misdiagnosis or treatment.


Asunto(s)
Enfermedades Duodenales , Hernia Abdominal , Dolor Abdominal/etiología , Enfermedades Duodenales/diagnóstico , Enfermedades Duodenales/cirugía , Hernia/complicaciones , Hernia/diagnóstico , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico , Hernia Abdominal/cirugía , Herniorrafia , Humanos , Masculino , Persona de Mediana Edad , Hernia Paraduodenal
6.
Cir Cir ; 89(S1): 43-48, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34762631

RESUMEN

Obesity is a risk factor for the development of anterior abdominal wall hernias. Incisional hernias develop in up to 13% of laparotomies: the most difficult to repair are complex and multiple recurrent hernias with significant loss of control. The best approach to treating obese patients who concomitantly have hernias of the anterior abdominal wall is still a matter of debate. We present a clinical case of a patient with morbid obesity and abdominal hernia with loss of residence, who underwent bariatric surgery before ventral plasty.


La obesidad es un factor de riesgo para el desarrollo de hernias de la pared abdominal anterior. Las hernias incisionales se desarrollan hasta en el 13% de las laparotomías. Las más difíciles de reparar son las hernias recurrentes complejas y múltiples con pérdida significativa de domicilio. El mejor enfoque en el tratamiento de pacientes obesos y que concomitantemente tienen hernias de la pared abdominal anterior es aún un tema de debate. Presentamos el caso clínico de un paciente con obesidad mórbida y hernia abdominal con pérdida de domicilio, intervenido de cirugía bariatrica antes de la plastia ventral.


Asunto(s)
Cirugía Bariátrica , Hernia Abdominal , Hernia Ventral , Obesidad Mórbida , Hernia Abdominal/complicaciones , Hernia Abdominal/cirugía , Hernia Ventral/cirugía , Herniorrafia , Humanos , Obesidad Mórbida/complicaciones , Obesidad Mórbida/cirugía , Tempo Operativo , Mallas Quirúrgicas
8.
Rev. cuba. cir ; 60(3): e1172, 2021. tab
Artículo en Español | LILACS, CUMED | ID: biblio-1347389

RESUMEN

Introducción: Las clasificaciones de las hernias de la pared abdominal nos permiten agruparlas homogéneamente y comparar así resultados de diferentes estudios. Numerosas han sido descritas con el uso de diversas variables, pero ninguna logra cubrir todas las expectativas para lo cual fueron creadas. Objetivo: Presentar nuestra modificación a la clasificación original de Lloyd Milton Nyhus al añadir la variable reductibilidad para la estratificación de las hernias inguinocrurales. Métodos: Se realizó un trabajo descriptivo y prospectivo de 449 pacientes con hernia de la región inguinocrural atendidos en el Hospital Universitario "Dr. Juan Bruno Zayas Alfonso", de Santiago de Cuba, en el periodo comprendido de enero de 2018 a diciembre de 2019. Los datos fueron extraídos del Registro Electrónico de Hernias creado en el procesador estadístico Epi info versión 3.5.4 y presentados en tablas y porcientos. Resultados: Se presentó la nueva nomenclatura para identificar los diferentes subgrupos de hernias y se obtuvo que el 85,3 por ciento presentaban hernias reductibles, el 1,5 por ciento incarceradas, el 9,3 por ciento atascadas y el 1,7 por ciento estranguladas. Con esta nueva clasificación, disponemos en nuestro Registro de Hernias, de todos los subgrupos clínicos de hernias de la región inguinocrural. Conclusiones: La nueva modificación, nos permite estratificar y comparar homogéneamente por subgrupos a los pacientes, es sencilla de usar y de gran valor asistencial, docente y científico(AU)


Introduction: Classifications of abdominal wall hernias allow us to group them homogeneously and thus compare the results of different studies. Many have been described with the use of several variables, but none can meet all the expectations for which they were created. Objective: To present our modification to the original Lloyd Milton Nyhus's classification by adding the variable reducibility for the stratification of inguinocrural hernias. Methods: A descriptive and prospective study was carried out, in the period from January 2018 to December 2019, in 449 patients with hernia of the inguinocrural region treated at Dr. Juan Bruno Zayas Alfonso University Hospital of Santiago de Cuba. The data were obtained from an Electronic Registry of Hernias created in the statistical processor Epi info (version 3.5.4), as well as presented then in tables and percentages. Results: The new nomenclature to identify the different subgroups of hernias was presented. It was obtained that 85.3 percent had reducible hernias, 1.5 percent had incarcerated hernias, 9.3 percent had stuck hernias and 1.7 percent had strangulated hernias. With this new classification, we have, in our Hernia Registry, all the clinical subgroups of hernias in the inguinocrural region. Conclusions: The new modification allows us to stratify and compare patients homogeneously by subgroups; it is easy to use and of great care-related, teaching and scientific value(AU)


Asunto(s)
Humanos , Adulto , Sistema de Registros , Clasificación , Hernia Abdominal/cirugía , Epidemiología Descriptiva , Estudios Prospectivos , Hernia Abdominal/complicaciones
9.
Am J Case Rep ; 22: e932132, 2021 Jul 13.
Artículo en Inglés | MEDLINE | ID: mdl-34255765

RESUMEN

BACKGROUND Internal hernias involve protrusion of the small bowel through a peritoneal or mesenteric space in the abdominal or pelvic cavity. Congenital internal small bowel hernias are rare and patients with them usually present with small bowel obstruction (SBO) at a young age, whereas in older patients, internal small bowel hernias usually are acquired secondary to previous surgery. The present report is of a rare case of SBO due to dual congenital internal small bowel hernias in a 51-year-old man with no history of abdominal surgery. CASE REPORT We report a case of dual congenital internal hernias of the small bowel in a patient who presented with symptoms and signs of SBO. He had no history of abdominal trauma, surgery, or comorbid conditions. His abdomen was mildly distended with minimal tenderness in the upper left quadrant but there was no guarding or rebound tenderness. Abdominal X-rays confirmed the SBO. A contrast-enhanced computed tomography scan of the patient's abdomen revealed SBO with transition at 2 points, suggestive of a closed-loop obstruction. However, the exact cause of the SBO was confirmed at laparotomy, which revealed dual internal hernias (intramesosigmoid and paraduodenal). The hernias were managed individually and the patient had a successful outcome after surgery. CONCLUSIONS Although the present report is of a rare presentation of internal small bowel hernia, the case underscores that patients with this condition may present with SBO. Successful surgical management requires knowledge of the intra-abdominal peritoneal spaces and management of the hernia sac.


Asunto(s)
Hernia Abdominal , Obstrucción Intestinal , Dolor Abdominal , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico por imagen , Hernia Abdominal/cirugía , Humanos , Hernia Interna , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestino Delgado/cirugía , Masculino , Persona de Mediana Edad
10.
BMJ Case Rep ; 14(5)2021 May 06.
Artículo en Inglés | MEDLINE | ID: mdl-33958357

RESUMEN

An 85-year-old man with no previous laparotomies and no herniae presented with a small bowel obstruction. CT imaging did not suggest any obvious cause; however, a transition point at the terminal ileum was noted. At laparotomy, the small bowel was unexpectedly found to be obstructed through a tight anterior hiatal defect. No resection was required and the defect was closed. On retrospective review of the CT images, the herniated small bowel can clearly be seen anterior to the oesophagus and can also be appreciated as a retrocardiac air-fluid level on chest X-ray (initially felt to be a small type I hiatal hernia). Our case highlights the surgical axiom that in patients with small bowel obstruction with no scars and no herniae consideration should be given to an unusual or sinister cause.


Asunto(s)
Hernia Abdominal , Obstrucción Intestinal , Anciano de 80 o más Años , Hernia/complicaciones , Hernia/diagnóstico por imagen , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico por imagen , Hernia Abdominal/cirugía , Humanos , Hernia Interna , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/cirugía , Masculino , Estudios Retrospectivos
11.
Transplant Proc ; 53(2): 762-767, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33551186

RESUMEN

PURPOSE: To investigate risk factors for hernia recurrence, surgical site occurrence/infection (SSO/I) and those requiring procedural intervention (SSOPI) after incisional hernia repair (IHR) following abdominal transplantation. METHODS: Patients undergoing IHR following abdominal transplant were retrospectively identified in the Americas Hernia Society Quality Collaborative database. Primary outcome measures were SSO/I, SSOPI and hernia recurrence. RESULTS: There was a total of 166 patients. Seventeen patients (10%) had an SSO/I at 30 days. Overall complication rate was 26%, and there was 1 mortality (1%). Composite recurrence rate was 28% (21/75) over 2 years. In univariate analysis, history of diabetes (DM), body mass index (BMI) >35 kg/m2, and history of open abdomen were associated with SSO/I (P < .05). Immunosuppression had a negative correlation with SSO/Is and SSOPIs. BMI >35 kg/m2 was associated with 180-day recurrence, whereas history of hypertension remained significant for recurrence at 2 years (P < .05). CONCLUSION: History of an open abdomen, DM, and obesity are risk factors for SSO/I, and obesity and hypertension are associated with short-term and long-term recurrence after IHR following abdominal organ transplantation. Immunosuppression had negative correlation with SSO/I. However, long-term outcomes and those related to immunosuppression should be interpreted cautiously in view of the small sample size and low follow-up rates. Baseline comorbidities seem to be the main drive for hernia outcomes for transplant population, similar to the general population. Larger cohorts and longer follow-up are necessary to delineate preventable risk factors for SSO/Is and hernia recurrences after organ transplantation.


Asunto(s)
Hernia Abdominal/complicaciones , Hernia Abdominal/cirugía , Hernia Incisional/complicaciones , Hernia Incisional/cirugía , Trasplante de Órganos/efectos adversos , Adulto , Anciano , Comorbilidad , Diabetes Mellitus/epidemiología , Femenino , Hernia Abdominal/etiología , Herniorrafia , Humanos , Hernia Incisional/etiología , Masculino , Persona de Mediana Edad , Obesidad/epidemiología , Recurrencia , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/epidemiología
12.
Eur J Gastroenterol Hepatol ; 33(1S Suppl 1): e944-e953, 2021 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-34974467

RESUMEN

BACKGROUND AND AIMS: Since there is clinical overlap between populations with cirrhosis and those who require hernia repair (i.e. due to stretching of abdominal walls), we systematically evaluate the effects of cirrhosis on post-hernia repair outcomes. METHODS: 2011-2017 National Inpatient Sample was used to identify patients who underwent hernia repair (included: inguinal, umbilical, and other abdominal hernia repairs). The population was stratified into those with compensated cirrhosis (CC), decompensated cirrhosis (DC), and no cirrhosis; hepatic decompensation was defined as those with portal hypertension, ascites, and varices. The propensity score was used to match the no-cirrhosis controls to CC and DC using the 1:1 nearest neighbor mechanism. Endpoints included mortality, length of stay, costs, and complications. RESULTS: Postmatch, there were 392/446 CC/DC with equal number controls in those undergoing inguinal hernia repair, 714/1652 CC/DC with equal number controls in those undergoing umbilical hernia repair, and 784/702 CC/DC. In multivariate, for inguinal repair, there was no difference in mortality [CC vs. no-cirrhosis aOR 2.61, 95% confidence interval (CI) 0.50-13.52; DC vs. no-cirrhosis: aOR 1.75, 95% CI 0.84-3.63]. For umbilical repair, there was no difference in mortality for CC vs. no-cirrhosis: aOR 0.94, 95% CI 0.36-2.42); however, DC had higher mortality (aOR 2.86, 95% CI 1.76-4.63) when comparing DC vs. no-cirrhosis. For other abdominal repairs, there was no difference in mortality for CC vs. no-cirrhosis (aOR 1.10, 95% CI 0.54-2.23); however, DC had higher mortality (P < 0.001, aOR 2.58, 95% CI 1.49-4.46) when comparing DC vs. no-cirrhosis. CONCLUSION: This study demonstrates that the presence of DC affects postoperative survival in patients undergoing umbilical or other abdominal hernia repair surgery.


Asunto(s)
Hernia Abdominal , Herniorrafia , Hernia Abdominal/complicaciones , Hernia Abdominal/cirugía , Herniorrafia/efectos adversos , Hospitales , Humanos , Tiempo de Internación , Cirrosis Hepática/complicaciones , Cirrosis Hepática/cirugía , Complicaciones Posoperatorias/epidemiología , Puntaje de Propensión
13.
Cir Cir ; 88(Suppl 1): 91-93, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32963390

RESUMEN

Internal hernias are defined by the protrusion of an abdominal organ through a peritoneal or mesenteric aperture. They are responsable for up to 5.8% of all small bowel obstructions (SBOs). Pericecal hernia is a highly unusual variation. We present a case of a 17-year-old Asian male turned to the emergency department due to abrupt abdominal pain and peritonitis. An emergent laparotomy revealed a small bowel herniation through the avascular space of Treves with small bowel necrosis. A pericecal hernia is an extremely unusual clinical entity; however, it should be considered in the differential diagnosis of SBO.


ANTECEDENTES: La hernia interna se define como la protrusión de un órgano abdominal a través de un orificio peritoneal o mesentérico. Las hernias son causa de hasta el 5% de las obstrucciones de intestino delgado. La hernia pericecal es un subtipo extremadamente infrecuente. Presentamos el caso de un varón asiático de 17 años que acudió a nuestro centro por un cuadro de abdomen agudo con dolor y peritonitis. Durante la laparotomía se evidenció la herniación del intestino delgado a través del espacio avascular de Treves, con necrosis del mismo. La hernia pericecal es un subtipo extremadamente raro, pero que debemos plantearnos en el diagnóstico diferencial del síndrome de obstrucción intestinal.


Asunto(s)
Hernia Abdominal , Obstrucción Intestinal , Adolescente , Adulto , Hernia/complicaciones , Hernia/diagnóstico por imagen , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico por imagen , Humanos , Hernia Interna , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Intestino Delgado/diagnóstico por imagen , Masculino , Mesenterio
14.
BJS Open ; 4(5): 924-934, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32648645

RESUMEN

BACKGROUND: Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). METHODS: NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co-morbidity, imaging, operative treatment, and in-hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. RESULTS: NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non-operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in-hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). CONCLUSION: NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group.


ANTECEDENTES: La eventración es una enfermedad quirúrgica frecuente. Algunos pacientes acuden a urgencias por episodios de obstrucción intestinal, incarceración o estrangulación. La obstrucción del intestino delgado (small bowel obstruction, SBO) es una forma de presentación quirúrgica grave asociada a una morbilidad significativa. El objetivo de este estudio fue describir el tratamiento actual y los resultados de los pacientes con obstrucción herniaria en el Reino Unido identificados a través de la National Audit of Small Bowel Obstruction (NASBO). MÉTODOS: La NASBO recopiló datos de los pacientes adultos tratados por obstrucción del intestino delgado en 131 hospitales del Reino Unido entre enero y marzo de 2017. En este estudio se incluyeron solo los que presentaron una obstrucción por una hernia de la pared abdominal. Se registraron los datos demográficos, la comorbilidad, los estudios de imagen, el tratamiento quirúrgico y los resultados hospitalarios. Se realizó una modelización de los factores asociados con la mortalidad y las complicaciones utilizando el análisis de riesgos proporcionales de Cox y modelos de regresión multivariable. RESULTADOS: De los 2.341 pacientes incluidos en la NASBO, 415 (17,7%) presentaron una SBO por una hernia. La edad media fue de 71,2 (DE 13,9) años, con una comorbilidad moderada (índice de comorbilidad de Charlson 4,6 (DE 7,1)). Fueron operados 312/415 (75,2%). Un total de 198/312 (63,5%) pacientes precisaron una resección del intestino delgado. Se planteó el tratamiento no quirúrgico en 35/65 (53,8%) de las hernias paraestomales y en 38/106 (32,1%) de los pacientes con hernia incisional. La mortalidad hospitalaria fue de 39/415 (9,4%), siendo más elevada en pacientes con hernia inguinal (17/153 (11,1%)). El desarrollo de complicaciones fue habitual, de las que destaca la infección del tracto respiratorio inferior en el 16,3%. El aumento de la edad se asoció con un mayor riesgo de mortalidad (cociente de riesgos instantáneos, hazard ratio, HR 1,05 (1,01-1,10, P = 0,009)) y complicaciones (razón de oportunidades, odds ratio, OR 1,05 (1,01-1,10, P = 0,009)). CONCLUSIÓN: la NASBO ha puesto en evidencia los malos resultados en pacientes con SBO por hernia, subrayando la necesidad de iniciativas para mejorarlos.


Asunto(s)
Tratamiento de Urgencia/estadística & datos numéricos , Hernia Abdominal/mortalidad , Obstrucción Intestinal/mortalidad , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Hernia Abdominal/complicaciones , Hernia Abdominal/cirugía , Mortalidad Hospitalaria , Humanos , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Modelos Logísticos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Mejoramiento de la Calidad/organización & administración , Reino Unido/epidemiología
15.
BMC Urol ; 20(1): 74, 2020 Jun 25.
Artículo en Inglés | MEDLINE | ID: mdl-32586385

RESUMEN

BACKGROUND: Grynfeltt-Lesshaft hernia is a kind of lumbar abdominal wall hernia in which clinical presentations may vary from an asymptomatic bulge in the lumbar area to a symptomatic lumbar mass with back pain. It has been accepted to be a rare entity, and incarceration of the kidney through this hernia is shown to be very rare, and very few previous cases have been reported in this regard. We present a case of renal pelvic and ureteropelvic junction incarceration in a Grynfeltt-Lesshaft hernia and provide an overview of the existing literature on it. CASE PRESENTATION: A 76-year-old lady presented to the outpatient clinic with the chief complaint of right flank pain and swelling. Computed tomography (CT) scan of the abdomen was revealed a large herniated sac (60*30 mm) in the upper lumbar triangle with protrusion of retroperitoneal and omental fat, right renal pelvis, ureteropelvic junction and proximal ureter with consecutive hydronephrosis. Herniated retroperitoneal and omental fat was reduced, and closure of the abdominal wall defect was done using retro-muscular Mesh and was fixed to the fascia. The patient was discharged 24 h after the surgery without any complications. CONCLUSION: Kidney herniation through the lumbar triangle is extremely rare, and the diagnosis requires careful clinical evaluation. CT scan is the modality of choice for the assessment. Management through surgery should be done in symptomatic patients.


Asunto(s)
Hernia Abdominal/complicaciones , Enfermedades Renales/etiología , Pelvis Renal , Enfermedades Ureterales/etiología , Anciano , Femenino , Humanos
16.
Ulus Travma Acil Cerrahi Derg ; 26(4): 593-599, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32589236

RESUMEN

BACKGROUND: An incarcerated hernia is a part of the intestine or abdominal tissue that becomes trapped in the sac of a hernia. An increase in morbidity and mortality occurs after intestinal resections from strangulated hernias. This study aims to examine the markers that may be effective in determining the risk of small bowel resection due to incarcerated hernias. In particular, we aimed to investigate the effect s of blood lactate levels in determining this risk. METHODS: A cross-sectional retrospective study was designed. Patients, whose preoperative diagnosis were reported as incarcerated hernia and had essential information, were included in this study. They were divided into two groups according to whether they had resection or not. Age, gender, hernia type, hernia side, resection material, blood lactate level (BLL), white blood cell (WBC), neutrophil count (NE), lymphocyte count (LY), neutrophil/lymphocyte ratio (NLR), platelet count (PLT), lactate dehydrogenase (LDH), radiologic bowel obstruction sign and comorbidities were evaluated. RESULTS: Sixty-seven patients were included in this study. It was observed that 16 (23.9%) of these patients underwent small intestinal resection, 16 (23.9%) had an omentum resection, while no resection was performed on 35 (52.2%) patients. There was a statistically significant difference regarding radiologically intestinal obstruction (p=0.001), hernia type (p=0.005), BLL (p<0.001), WBC, NLR and LDH values (p<0.05). In incarcerated hernia patients with a lactate value ≥1.46 mg/dL, sensitivity was observed to be 84.0% and specificity 86.0% (p<0.001). CONCLUSION: In patients with a preliminary diagnosis of an incarcerated hernia, the risk of possible small bowel resection is the most important point in deciding for an operation. The presence of an intestinal obstruction in radiological examinations, and particularly the high levels of WBC, NLR, LDH and BLL, may indicate a necessity for possible small bowel resection. Concerning the risk associated with small bowel resection, blood lactate levels ≥1.46 mg/dL may be alerting.


Asunto(s)
Hernia Abdominal , Obstrucción Intestinal , Intestino Delgado/cirugía , Ácido Láctico/sangre , Estudios Transversales , Hernia Abdominal/sangre , Hernia Abdominal/complicaciones , Hernia Abdominal/epidemiología , Humanos , Obstrucción Intestinal/epidemiología , Obstrucción Intestinal/etiología , Obstrucción Intestinal/cirugía , Estudios Retrospectivos , Factores de Riesgo
18.
Arch Iran Med ; 23(6): 403-408, 2020 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-32536178

RESUMEN

BACKGROUND: Our aim was to investigate the pathologies in the hernia sac in adults, and the frequency of malignancy as well as to confirm the necessity of maintaining the current applications in histological examination of the hernia sac. METHODS: Patients who were operated for hernia in our clinic from 2013 to 2019 were included in the study. Patient data were evaluated retrospectively. We divided the patients into four groups, according to the type of hernia. We evaluated the demographic characteristics of the patients, the pathologies within the hernia sac, histopathological examination outcomes of the hernia sac and clinical features of malignancy in patients with malignancy. RESULTS: A total number of 556 adult patients underwent inguinal, femoral, umbilical or incisional hernia repair in our hospital. Nine patients (0.61%) had malignancy in the hernia sac. Three out of nine patients (33%) had no preoperative diagnosis of malignancy. Six patients (67%) had a known history of malignancy. Two tumors were located in the inguinal (22.0%), six tumors in the incisional (67%), and one in the umbilical (11%) hernia sacs. Among these, 56% were of gastrointestinal, 22% of gynecological, 11% of breast and 11% of epididymis origin. Most of the other pathologies found in the hernia sac were herniated bowel segments, lipomas and omentum. CONCLUSION: Since the hernia sac might be the first clue for an underlying cancer, if abnormal pathological findings are detected during surgery, histopathological examination should be performed to exclude malignancy. The purpose of histological examination is to detect a hidden malignancy.


Asunto(s)
Hernia Abdominal/patología , Neoplasias Abdominales/patología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Apendicitis/patología , Niño , Femenino , Hernia Abdominal/complicaciones , Hernia Abdominal/cirugía , Hernia Femoral/complicaciones , Hernia Femoral/patología , Hernia Femoral/cirugía , Hernia Inguinal/complicaciones , Hernia Inguinal/patología , Hernia Inguinal/cirugía , Herniorrafia , Humanos , Lipoma/patología , Masculino , Persona de Mediana Edad , Epiplón/patología , Estudios Retrospectivos , Adulto Joven
19.
Alcohol Alcohol ; 55(5): 497-511, 2020 Aug 14.
Artículo en Inglés | MEDLINE | ID: mdl-32558895

RESUMEN

AIMS: This meta-analysis aimed to define the perioperative risk of mortality in patients with alcoholic liver disease (ALD) undergoing extrahepatic gastrointestinal surgery. METHODS: Systematic searches of Embase, Medline and CENTRAL were undertaken to identify studies reporting about patients with ALD undergoing extrahepatic gastrointestinal surgery published since database inception to January 2019. Studies were only considered if they reported on mortality as an outcome. Pooled analysis of mortality was stratified as benign and malignant surgery and specific operative procedures where feasible. RESULTS: Of the 2899 studies identified, only five studies met inclusion criteria, representing cholecystectomy (one study), umbilical hernia repair surgery (one study) and oesophagectomy (three studies). The total number of patients with ALD in these studies was 172. Therefore, any study on liver disease patients undergoing extrahepatic surgery that crucially included a subset with alcohol aetiology was included as a secondary analysis even though they failed to stratify mortality by underlying aetiology. The total number of studies that met this expanded inclusion criteria was 62, reporting on 37,703 patients with liver disease of which 1735 (4.5%) had a definite diagnosis of ALD. Meta-analysis of proportions of in-hospital mortality in patients with ALD undergoing upper gastrointestinal cancer surgery (oesophagectomy) was 23% [95% confidence interval (CI) 14-35%, I2 = 0%]. In-hospital mortality following oesophagectomy in liver disease patients of all aetiologies was lower, 14% (95% CI 9-21%, I2 = 41.1%). CONCLUSION: Postoperative in-hospital mortality is high in patients with liver disease and ALD in particular. However, the currently available evidence on ALD is limited and precludes definitive conclusions on postoperative mortality risk.


Asunto(s)
Pared Abdominal/cirugía , Enfermedades Gastrointestinales/cirugía , Hernia Abdominal/cirugía , Hepatopatías Alcohólicas/complicaciones , Hepatopatías Alcohólicas/mortalidad , Adulto , Anciano , Niño , Colecistectomía , Esofagectomía , Femenino , Enfermedades Gastrointestinales/complicaciones , Hernia Abdominal/complicaciones , Herniorrafia , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven
20.
J Surg Res ; 253: 121-126, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32353637

RESUMEN

BACKGROUND: With the widespread use of advanced imaging there is a need to quantify the prevalence and impact of hernias. We aimed to determine the prevalence of abdominal wall hernias among patients undergoing computed tomography (CT) scans and their impact on abdominal wall quality of life (AW-QOL). METHODS: Patients undergoing elective CT abdomen/pelvis scans were enrolled. Standardized physical examinations were performed by surgeons blinded to the CT scan results. AW-QOL was measured through the modified Activities Assessment Scale. On this scale, 1 is poor AW-QOL, 100 is perfect, and a change of 7 is the minimum clinically important difference. Three surgeons reviewed the CT scans for the presence of ventral or groin hernias. The number of patients and the median AW-QOL scores were determined for three groups: no hernia, hernias only seen on imaging (occult hernias), and clinically apparent hernias. RESULTS: A total of 246 patients were enrolled. Physical examination detected 62 (25.2%) patients with a hernia while CT scan revealed 107 (43.5%) with occult hernias. The median (interquartile range) AW-QOL of patients per group was no hernia = 84 (46), occult hernia = 77 (57), and clinically apparent hernia = 62 (55). CONCLUSIONS: One-fourth of individuals undergoing CT abdomen/pelvis scans have a clinical hernia, whereas nearly half have an occult hernia. Compared with individuals with no hernias, patients with clinically apparent or occult hernias have a lower AW-QOL (by 22 and seven points, respectively). Further studies are needed to determine natural history of AW-QOL and best treatment strategies for patients with occult hernias.


Asunto(s)
Pared Abdominal/diagnóstico por imagen , Enfermedades Asintomáticas/epidemiología , Hernia Abdominal/epidemiología , Calidad de Vida , Tomografía Computarizada por Rayos X/estadística & datos numéricos , Pared Abdominal/fisiopatología , Adulto , Anciano , Estudios Transversales , Femenino , Hernia Abdominal/complicaciones , Hernia Abdominal/diagnóstico , Hernia Abdominal/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Prospectivos
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