RESUMO
Mesenteric cysts are uncommon intra-abdominal lesions that account for only one in every 100 000 adult hospitalizations. Their diagnosis is based on a comprehensive clinical examination as well as radiological modalities such as ultrasonography and computed tomography (CT) scans, and it is usually a clinical challenge because of non-specific symptoms. We present our first case of a 51-year-old man with a simple mesenteric cyst accompanying acute appendicitis diagnosed by CT scan of the abdomen and treated by exploratory laparotomy, complete enucleation of the cyst and appendectomy with a 10 month follow-up without complications or recurrence. This type of presentation has not been thoroughly investigated, with only two children reported during our literature review. Even if there is a high level of suspicion, a CT scan is required for confirmation.
RESUMO
The incidence of the Pfannenstiel incisional hernia (IH) is the lowest of all IHs, it can occur due to patient-related factors or faulty technique in closure of the deeper layer. The use of prosthetic mesh repair is heralding a new era of tension-free herniorrhaphy, while the optimal location for its implantation remains controversial. As a result, no strategy or technique has become the gold standard for its repair. We report our first experience with an IH through Pfannenstiel in a 49-year-old obese female patient. Inlay polypropylene open mesh repair was performed. As the only complication, the patient presented with a seroma in the wound, which was aspirated, and she is currently asymptomatic with outpatient consultation follow-up. Pfannenstiel IHs have received minimal attention on the optimal surgical approach and postoperative results, making this case a good starting point for future studies.
RESUMO
Acute traumatic abdominal wall hernia (TAWH) is a rare type of hernia that occurs after a low or high velocity impact of the abdominal wall against a blunt object with few cases reported. Perforations of the hollow viscera commonly follow abdominal trauma and likely require surgery for hemorrhage and sepsis source control. We report a case where a high velocity impact of the abdominal wall against the stump of a felled tree caused a TAWH with concomitant gastric perforation in a 20-year-old male patient who required exploratory laparotomy with primary repair of the stomach and fascia. The physical examination findings without previous history of abdominal hernia and pneumoperitoneum in the chest X-ray made suspect our diagnosis and it was confirmed intraoperatively. At 3 months postoperatively the patient has a strong abdominal wall. It is imperative to emphasize the importance of the physical examination goal of not losing diagnosis of TAWH.
