P-025 USE OF PREOPERATORY PNEUMOPERITONEUM FOR GIANT INGUINOESCROTAL HERNIA TREATMENT WITH LOSS OF DOMAIN. A GREAT RESOURSE

Introduction

Recently, the use of neoadjuvant therapies such as preoperative progressive pneumoperitoneum has favored the treatment of large ventral hernias with loss of domain. Despite this, there are only few cases described in the literature.

Materials & Methods

We present a case of a 69-year-old male affected by giant inguinoescrotal hernia of years of evolution with loss of domain.

A preoperative CT scan with volumetric quantification is performed where giant left inguinal hernia with mesenteric fat content, small intestine, sigma, descending colon, as well as splenic angle of the colon, with a relationship between the volumes greater than 0.67. (VSH of 11,502cc and VABD of 17,061cc).

We decided to perform preoperative progressive pneumoperitoneum.

In the following 15 days up to 8L are administered without complications.

Results

Surgical repair of the inguinal hernia is performed according to the Lichtenstein technique modified by the size of the hernial sac with evidence of unstructured but intact structures of the inguinal canal. Placement of self-adhesive ProGrip TM retroaponeurotic mesh is performed with attachment of this to the inguinal ligament and pubis.

After surgery, the patient presented a good postoperative recovery without complications, without evidence of recurrence more than 6 months after surgery.

Discussion

The use of prehabilitating techniques in patients affected by large hernias can reduce the morbidity and mortality of patients, with the less aggression. In our case it allowed us to completely reduce all the hernia contents without visceral injury and perform an anatomical repair, which would not have been possible without this resource.

P-040 DIFFUSE LARGE CELL B LYMPHOMA TYPE ACTIVATED B CELL (MANTLE LYMPHOMA) AS A DIFFERENTIAL DIAGNOSIS OF INGUINAL HERNIA. A RARE FINDING

Introduction

Mantle cell lymphoma is a rare type of B-cell non-Hodgkin lymphoma. It represents 7% of lymphomas in Europe, with an incidence of between 4 and 8 cases/year per million-hab. More frequent in men with a 4:1 ratio and middle-age.

We present a diagnosed clinical case of MCL with an infrequent presentation.

Material & Methods

A 70-year-old male affected by left inguinal tumor after physical exertion 6 months before the consultation.

Abdominal ultrasound and CT scan describe an extra testicular 3cm lesion with irregular edges without extension to other structures with possible signs of malignancy.

Surgery is performed with the lesion bloc excision including left test and elements of the spermatic cord.

Results

The analysis of Pathological Anatomy shows us as a result a diffuse large cell B Lymphoma type Polymorphic Mantle Cell Lymphoma.

The postoperative extension study (PET) shows no residual tumor or medullary involvement, suggestive of stage I.

Discussion

MCL is a rare type of lymphoma, characterized by translocation (11;14) (q13; q32) leading to overexpression of cyclin D1.

Most common presentation of MCL is B symptoms (up to 40%) fever, night sweats. Others include asthenia, nighttime pruritus, adenopathies, and hepatic or splenic enlargement.

Finally, CML can present with extranodal disease, digestive system, respiratory system, nervous system, endocrine or salivary glands.

It is a highly aggressive type of lymphoma that is usually diagnosed in advanced stages (90% cases), with poor prognosis with a life expectancy of 4 years despite optimal treatment.

Current treatment consists of a combination of chemotherapy and immunotherapy.