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Bayeh A, Limenh S. Richter's Type Recurrent Indirect Inguinal Hernia, an Extremely Rare Occurrence: A Case Report. Open Access Emerg Med 2022; 14:323-326. [PMID: 35837478 PMCID: PMC9275495 DOI: 10.2147/oaem.s363212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 07/05/2022] [Indexed: 12/02/2022] Open
Abstract
Background Richter’s type recurrent indirect inguinal hernia remains to be an extremely rare entity reported scarcely. It may present with grave complications in the absence of symptoms and signs of intestinal obstruction. The aim of this study is to report a rare case of Richter’s hernia after a previously repaired indirect inguinal hernia. Case Presentation A 31-year-old male farmer came up with complaints of colicky abdominal pain and two episodes of vomiting. He had a previous right inguinal surgery. A physical examination revealed a full abdomen with right inguinal tenderness and oblique surgical scar. Abdominal ultrasound showed a bowel segment entrapped in the deep inguinal ring of the inguinal canal. Right inguinal exploration was done, and the finding was a gangrenous Richter’s type recurrent indirect inguinal hernia. The patient was discharged and improved on the seventh post-operative day after resection and anastomosis. Discussion Richter’s hernia is a rare form of hernia that occurs when the anti-mesenteric border of the bowel is partly trapped in a tight hernial ring. Its rarity, combined with the fact that it may present in the absence of typical symptoms and signs of intestinal obstruction and local physical findings, poses a diagnostic challenge which often end up with complications like gangrenous bowel at the time of diagnosis. Conclusion Richter’s hernia can occur in an extremely rare form as Richter’s type recurrent indirect inguinal hernia. A high degree of suspicion, an early referral and timely imaging on the provider's side may prevent mortality and morbidity.
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Affiliation(s)
- Agegnehu Bayeh
- Department of Surgery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Simachew Limenh
- Department of Midwifery, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Su J, Deng C, Yin HM. Drain-site hernia after laparoscopic rectal resection: A case report and review of literature. World J Clin Cases 2022; 10:2637-2643. [PMID: 35434063 PMCID: PMC8968592 DOI: 10.12998/wjcc.v10.i8.2637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/27/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Drain-site hernia (DSH) has an extremely low morbidity and has rarely been reported. Small bowel obstruction is a frequent concurrent condition in most cases of DSH, which commonly occurs at the ≥ 10 mm drain-site. Here we report a rare case of DSH at the lateral 5 mm port site one month postoperatively without visceral incarceration. Simultaneously, a brief review of the literature was conducted focusing on the risk factors, diagnosis, and prevention strategies for DSH.
CASE SUMMARY A 76-year-old male patient was admitted to our institution with intermittent abdominal pain and a local abdominal mass which occurred one month after laparoscopic radical resection of rectal cancer one year ago. A computed tomography scan showed an abdominal wall hernia at the 5 mm former drain-site in the left lower quadrant, and that the content consisted of the large omentum. An elective herniorrhaphy was performed by closing the fascial defect and reinforcing the abdominal wall with a synthetic mesh simultaneously. The postoperative period was uneventful. The patient was discharged seven days after the operation without surgery-related complications at the 1-mo follow-up visit.
CONCLUSION Emphasis should be placed on DSH despite the decreased use of intra-abdominal drainage. It is recommended that placement of a surgical drainage tube at the ≥ 10 mm trocar site should be avoided. Moreover, it is advisable to have a comprehensive understanding of the risk factors for DSH and complete closure of the fascial defect at the drainage site for high-risk patients.
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Affiliation(s)
- Jin Su
- Department of General Surgery, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College of Central South University, Zhuzhou 412000, Hunan Province, China
| | - Cheng Deng
- Division of Science and Education, Zhuzhou Central Hospital, The Affiliated Zhuzhou Hospital of Xiangya Medical College of Central South University, Zhuzhou 412000, Hunan Province, China
| | - Hui-Ming Yin
- Department of General Surgery, the Second Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha 410000, Hunan Province, China
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Gardner L. Trocar-Related Safety Events in Minimally Invasive Surgical Procedures: Risks for Organ and Vascular Complications. PATIENT SAFETY 2021. [DOI: 10.33940/data/2021.3.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
A trocar is a hollow device used during minimally invasive surgery that serves as an entry port for optical scopes and surgical equipment. Insertion of this device into the body is determined using anatomical landmarks taking into consideration the patient’s history and physical attributes, e.g., scars or abdominal size. Insertion of the first trocar is the time of highest risk of injury. Intestinal and vascular injuries are two potentially life-threatening injuries that can occur. A retrospective review of trocar-related events submitted to the Pennsylvania Patient Safety Reporting System (PA-PSRS) between January 1, 2014, and June 30, 2020, identified 268 events. Internal organ and vascular injuries accounted for 81.0% of events; trocar site skin integrity injuries, bleeding/hemorrhage, and hernias accounted for 17.2% of events; and vasovagal responses accounted for 1.9% of events. Internal injuries occurring during the initial insertion of the trocar, Veress needle, or incision in preparation for a trocar insertion was reported in 64.5% of events. Adhesions were identified in 13.5% of internal injury events. Many internal injury events identified a single injury; however, in 17 instances patients sustained two trocar-related injuries. Conversion to open surgery, return to the operating room during the same admission, postoperative intensive care unit admission, ambulatory surgical facility transfer to a hospital, readmission, postdischarge return to the operating room, and death are outcomes identified in the event reports.
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Fujiwara H, Suto T, Umemura A, Tanahashi Y, Amano S, Ikeda K, Harada K, Sasaki A. Needlescopic surgery for large umbilical hernia in a patient with morbid obesity using intraperitoneal onlay mesh with fascial defect closure: a case report. Surg Case Rep 2020; 6:246. [PMID: 33000428 PMCID: PMC7527381 DOI: 10.1186/s40792-020-01005-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 09/19/2020] [Indexed: 12/27/2022] Open
Abstract
Background The European and American guidelines recommend that symptomatic umbilical hernias (UHs) are repaired using an open approach with a preperitoneal flat mesh. However, the standard treatment procedure for large UH in patients with extreme obesity is yet to be established. Here, we present the first case of a patient with morbid obesity undergoing laparoscopic UH repair using needlescopic instruments and an intraperitoneal onlay mesh plus repair (IPOM plus). Case presentation A 29-year-old man, who was classified as morbidly obese (body mass index, 36.7 kg/m2) noticed a reducible nontender mass in the umbilical region and was subsequently diagnosed with an UH, with a diameter of 4 cm. Laparoscopic IPOM plus repair was planned using a needlescopic method for a large UH in the patient with morbid obesity. A 3-mm rigid laparoscope was mainly used in the procedure. After a 12-mm trocar and two 3-mm trocars were inserted, fascial defect closure was performed using intracorporeal suturing with 0 monofilament polypropylene threads. Then, IPOM was performed laparoscopically using an 11.4-cm round mesh coated with collagen to prevent adhesions. The operative time and blood loss were 57 min and 1 g, respectively. The postoperative course was uneventful. Conclusions Reduced-port laparoscopic surgery using needlescopic instruments and an IPOM plus technique is a minimally invasive and convenient combination option for large UH in a patient with morbid obesity.
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Affiliation(s)
- Hisataka Fujiwara
- Surgery Division, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan.
| | - Takayuki Suto
- Surgery Division, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Akira Umemura
- Department of Surgery, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Iwate, 028-3695, Japan
| | - Yota Tanahashi
- Surgery Division, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Satoshi Amano
- Surgery Division, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | | | - Kazuho Harada
- Anesthesia Division, Morioka Municipal Hospital, 5-15-1 Motomiya, Morioka, Iwate, 020-0866, Japan
| | - Akira Sasaki
- Department of Surgery, School of Medicine, Iwate Medical University, 1-1-1 Idaidori, Yahaba-cho, Iwate, 028-3695, Japan
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Cano-Valderrama O, Sanz-López R, Sanz-Ortega G, Anula R, Romera JL, Rojo M, Catalán V, Mugüerza J, Torres AJ. Trocar-site incisional hernia after laparoscopic colorectal surgery: a significant problem? Incidence and risk factors from a single-center cohort. Surg Endosc 2020; 35:2907-2913. [PMID: 32556772 DOI: 10.1007/s00464-020-07729-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Trocar-site incisional hernia (TSIH) after laparoscopic surgery has been scarcely studied. TSIH incidence and risk factors have never been properly studied for laparoscopic colorectal surgery. METHODS A retrospective analytic study in a tertiary hospital was performed including patients who underwent elective laparoscopic colorectal surgery between 2014 and 2016. Clinical and radiological TSIH were analyzed. RESULTS 272 patients with a mean age of 70.7 years were included. 205 (75.4%) underwent surgery for a malignant disease. The most common procedure was right colectomy (108 patients, 39.7%). After a mean follow-up of 30.8 months 64 (23.5%) patients developed a TSIH. However, only 7 out of 64 (10.9%) patients with a TSIH underwent incisional hernia repair. That means that 2.6% of all the patients underwent TSIH repair. 44 (68.8%) patients had TSIH in the umbilical Hasson trocar. In the multivariate analysis, the existence of an umbilical Hasson trocar orifice was the only statistically significant risk factor for TSIH development. CONCLUSIONS Incidence of TSIH was high, although few patients underwent incisional hernia repair. Most TSIH were observed in the umbilical Hasson trocar, which was the only risk factor for TSIH development in the multivariate analysis. Efforts should be addressed to avoid TSIH in the umbilical Hasson trocar.
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Affiliation(s)
- Oscar Cano-Valderrama
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain. .,Department of Surgery, Universidad Complutense, Madrid, Spain. .,Instituto de Investigación Sanitaria San Carlos, Madrid, Spain.
| | - Rodrigo Sanz-López
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - Gonzalo Sanz-Ortega
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - Rocío Anula
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain
| | - José L Romera
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain
| | - Mikel Rojo
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain
| | - Vanesa Catalán
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain
| | - José Mugüerza
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
| | - Antonio J Torres
- Department of Surgery, Hospital Universitario Clínico San Carlos, C/Profesor Martín Lagos SN, 28040, Madrid, Spain.,Department of Surgery, Universidad Complutense, Madrid, Spain.,Instituto de Investigación Sanitaria San Carlos, Madrid, Spain
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Hulikal N, Singaram NK, Inamdar MB, Niak GR. Early Mechanical Intestinal Obstruction Following Laparoscopic Radical Hysterectomy. J Gynecol Surg 2020. [DOI: 10.1089/gyn.2019.0115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Narendra Hulikal
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Chittor District, AP, India
| | - Nagesh Kumar Singaram
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Chittor District, AP, India
| | - Md Basheeruddin Inamdar
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Chittor District, AP, India
| | - Guru Raghavendra Niak
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Chittor District, AP, India
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