Incarcerated groin hernias in adults: presentation and outcome.

Despite universal acceptance of the value of elective hernia repair, many patients present with incarceration or strangulation, which are associated with significant morbidity and mortality. We reviewed 147 patients who underwent emergency surgery for incarcerated groin hernias during a 10-year period in order to analyze the presentation and outcome in our practice. Median age of the patients was 70 years. There were 77 men and 70 women. Femoral hernias were seen in 77 patients and inguinal hernias in 70. Coexisting diseases were found in 82 cases (55.8%). Bowel resection was required in 19 patients (12.9%). The overall and major morbidity rates were 41.5% and 9.6%, respectively. The mortality rate was 3.4%. Longer duration of symptoms, late hospitalization, concomitant diseases, and high ASA class were found to be significant factors linked with unfavorable outcomes. Because of high morbidity and mortality associated with incarceration, elective repair of groin hernias should be done whenever possible.

Anaerobic liver abscesses as initial presentation of silent colonic cancer.

BACKGROUND: Rarely, multiple liver abscesses caused by anaerobic organisms are the presenting form of unsuspected colonic cancer in the absence of liver metastases. CASE OUTLINE: A 68-year-old man was admitted with abdominal pain, fever and chills. Imaging scans and repeated cytology yielded a diagnosis of multiple liver abscesses. Pus cultures grew Peptostreptococcus anaerobius, Bacteroides melaninogenicus and Peptostreptococcus spp. A search for the underlying cause led to the discovery of an adenocarcinoma of the sigmoid colon. After a 12-month postoperative follow-up, the patient is free of hepatic metastases. DISCUSSION: Anaerobic liver abscesses should always alert the clinician to possible silent colonic carcinoma.