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Dias SJT, Gobishangar S, Heerthikan K. Successful management of strangulated incisional hernia in pregnancy - A case report. Int J Surg Case Rep 2023; 110:108745. [PMID: 37659159 PMCID: PMC10509923 DOI: 10.1016/j.ijscr.2023.108745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/25/2023] [Accepted: 08/25/2023] [Indexed: 09/04/2023] Open
Abstract
INTRODUCTION Abdominal hernias, including incisional hernias, can occur due to weakness in the abdominal wall. Incisional hernias commonly occur following surgical incisions, and factors such as poor closure technique and patient-related factors can contribute to their development. CASE PRESENTATION In this case, the patient was presented with a painful, irreducible lump over a previous laparotomy scar, along with bowel obstruction symptoms. The diagnosis was supported by ultrasound findings showing obstructed bowel loop in the hernial sac. Emergency open surgical reduction and mesh repair were performed to treat the strangulated hernia and ensure the mother and fetus's safety. The patient had an uneventful postoperative period and was discharged after three days. DISCUSSION Incisional hernias can be diagnosed through clinical evaluation, and imaging studies may be necessary in complex cases. However, imaging techniques such as X-rays and Computed Tomography scans are limited in pregnant women due to the radiation risks. Ultrasonography (USS) is preferred in pregnant women for its safety and non-invasiveness, although it may have reduced sensitivity in obese patients. Complicated hernias should be treated with emergency surgical repair, while elective surgery can be considered for asymptomatic or non-complicated hernias. Laparoscopic surgery offers advantages such as shorter hospital stays and fewer complications. Mesh repair reduces the recurrence risk in subsequent pregnancies (relate the discussion with the case). CONCLUSION Overall, surgical management of hernias in pregnancy requires careful consideration of individual circumstances and the use of appropriate techniques to ensure the safety of both the mother and fetus.
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Mubashir M, Barron JO, Mubashir H, DeMare A, Raja S, Murthy S, Schraufnagel DP. Thoracoabdominal approach for traumatic diaphragmatic hernia in a hemodynamically unstable patient. Eur Surg 2022;:1-4. [PMID: 36320830 DOI: 10.1007/s10353-022-00782-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diaphragmatic hernias with strangulated contents are a surgical challenge. Thoracoabdominal incisions are commonly used for a variety of thoracic and vascular cases, although rarely used for diaphragmatic hernias, which are typically repaired with laparotomy, thoracotomy, or minimally invasive approaches. CASE REPORT We present the unique case of a 60-year-old, critically ill unstable patient with severe heart failure with a reduced ejection fraction (15-25%) and severe valve disease presenting with a left-sided diaphragmatic hernia containing strangulated small intestine and requiring urgent surgical exploration. This was safely and efficiently repaired via a thoracoabdominal approach at the index surgery, with intestines left in discontinuity and placement of temporary chest and abdominal closure. At the second planned operation, good continuity was successfully restored. RESULTS The patient had early extubation, gradual diet advancement with full recovery, and discharge home on postoperative day 17. CONCLUSION A thoracoabdominal incision can safely be used in large strangulated diaphragmatic hernias, including in critically unstable patients. This approach provides rapid access to both the chest and abdomen with excellent, speedy, and safe exposure, which can save a life in extreme conditions.
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Kimura Y, Ishioka D, Kamiyama H, Tsujinaka S, Rikiyama T. Laparoscopic surgery for strangulated diaphragmatic hernia after radiofrequency ablation for hepatocellular carcinoma: a case report. Surg Case Rep 2021; 7:206. [PMID: 34529186 PMCID: PMC8446140 DOI: 10.1186/s40792-021-01291-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 09/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Percutaneous radiofrequency ablation (RFA) is an effective treatment for hepatocellular carcinoma (HCC), but delayed thermal damage can cause diaphragmatic hernia (DH). Surgery is recommended for DH, and open surgery is widely accepted. This report presents a case of laparoscopic surgery for strangulated DH that occurred after RFA. CASE PRESENTATION An 80-year-old woman with a history of hepatitis C-induced liver cirrhosis and HCC was admitted to our institution owing to sudden-onset intense epigastric pain. Twenty-two months earlier, she received RFA treatment for HCC located in segment 6/7. Contrast-enhanced computed tomography revealed herniation of the small intestine into the thoracic cavity, with mesenteric fat haziness. Emergency laparoscopic surgery was performed, and the patient was diagnosed with strangulated DH associated with the prior RFA. The defect was closed using absorbable sutures, and the ischaemic small intestine was resected via mini-laparotomy. The patient was discharged on the 10th postoperative day without complications, and no evidence of DH recurrence 15 months after surgery was noted. CONCLUSIONS Laparoscopic surgery seems useful and feasible for strangulated DH.
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Affiliation(s)
- Yasuaki Kimura
- Department of Surgery, Chichibu Municipal Hospital, Sakuragi-cho 8-9, Chichibu-City, Saitama, 368-0025, Japan. .,Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan.
| | - Daisuke Ishioka
- Department of Surgery, Chichibu Municipal Hospital, Sakuragi-cho 8-9, Chichibu-City, Saitama, 368-0025, Japan.,Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Hidenori Kamiyama
- Department of Surgery, Chichibu Municipal Hospital, Sakuragi-cho 8-9, Chichibu-City, Saitama, 368-0025, Japan
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Amanuma-cho 1-847, Omiya-ku, Saitama-City, Saitama, 330-8503, Japan
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Germanò P, Siboni S, Milito P, Mautone G, Resta M, Bonavina L. Ventral hernia repair under neuraxial anesthesia. Eur Surg 2021;:1-5. [PMID: 34306042 DOI: 10.1007/s10353-021-00731-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 06/29/2021] [Indexed: 11/26/2022]
Abstract
Background Acute strangulated ventral hernia is associated with operative morbidity and mortality. General anesthesia may increase the operative risk, especially in morbidly obese and COVID-19-positive individuals. Methods A 67-year-old woman with body mass index (BMI) 51 kg/m2, hospitalized for SARS-CoV-2-related interstitial pneumonia and renal failure, presented with acute abdominal pain, nausea, vomiting, and abdominal tenderness secondary to giant ventral hernia strangulation. Results Due to the suspicion of vascular bowel compromise at contrast-enhanced CT scan, urgent open surgical repair surgery was performed under spinal anesthesia and Venturi mask support. There was no need for an intensive care unit (ICU) stay. Postoperative course was uneventful, and the patient was transferred to a rehabilitation center on postoperative day 10. Conclusion Although some anesthetists and surgeons may be reluctant to use regional anesthesia for both emergent and elective ventral hernia repair, this may represent an excellent option in obese patients with a high respiratory risk.
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De Simone B, Birindelli A, Ansaloni L, Sartelli M, Coccolini F, Di Saverio S, Annessi V, Amico F, Catena F. Emergency repair of complicated abdominal wall hernias: WSES guidelines. Hernia 2020; 24:359-68. [PMID: 31407109 DOI: 10.1007/s10029-019-02021-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 08/04/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE In July 2013, the World Society of Emergency Surgery (WSES) held the first Consensus Conference on emergency repair of abdominal wall hernias in adult patients with the intention of producing evidence-based guidelines to assist surgeons in the management of complicated abdominal wall hernias. Guidelines were updated in 2017 in keeping with varying clinical practice: benefits resulting from the increased use of biological prosthesis in the emergency setting were highlighted, as previously published in the World Journal of Emergency Surgery. This executive summary is intended to consolidate knowledge on the emergency management of complicated hernias by providing the broad readership with a practical and concise version of the original guidelines. METHODS This executive manuscript summarizes the WSES guidelines reporting on the emergency management of complicated abdominal wall hernias; statements are highlighted focusing the readers' attention on the main concepts presented in the original guidelines. CONCLUSIONS Emergency repair of complicated abdominal hernias remains one of the most common and challenging surgical emergencies worldwide. WSES aims to provide an essential version of the evidence-based guidelines focusing on the timing of intervention, laparoscopic approach, surgical repair following the Centers for Disease Control and Prevention (CDC) wound classification, antimicrobial prophylaxis and anesthesia in the emergency setting.
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Muqueem K, Kasa S, Patil N, Harsoori MM. Strangulated Interstitial Hernia with Strangulated Cryptorchid Testis-First Case Report in the Medical Literature. Indian J Surg 2018; 80:184-186. [PMID: 29915485 DOI: 10.1007/s12262-018-1729-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 01/22/2018] [Indexed: 10/18/2022] Open
Abstract
Interstitial hernias are a rare subtype of abdominal hernias, where sac is present in between the abdominal wall layers. Although, difficult to diagnose clinically, they are usually detected on imaging studies. Interstitial hernias presenting with undescended testis are common. Even after a meticulous online search of the medical literature, we could not find a case report of 'Strangulation of Interstitial hernia, with a strangulated undescended testis in an elderly man. We hereby present this extremely rare case, and possibly, this could be the first of its kind, case report in the medical literature. Our aim is to present a combination of rare presentations in an elderly cryptorchid person with strangulated interstitial hernia. A 65-year male patient presented with 4 days of pain abdomen and vomiting. He was having features of toxaemia. Ultrasonography revealed interstitial hernia with bowel loops. During surgery, gangrenous bowel loops with the sac between the interstitial planes, with strangulated cryptorchid testis, were found. Strangulated interstitial hernia in elderly cryptorchid person, leading to the strangulation of the undescended testis, is extremely rare, and this could be the first case reported in the medical literature.
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Affiliation(s)
- Khalid Muqueem
- Department of Surgery, Vijayanagara Institute of Medical Sciences, Ballari, Karnataka 583104 India
| | - Somasekhar Kasa
- Department of Surgery, Vijayanagara Institute of Medical Sciences, Ballari, Karnataka 583104 India
| | - Nagareddy Patil
- Department of Surgery, Vijayanagara Institute of Medical Sciences, Ballari, Karnataka 583104 India
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Passos I, Koumpoulas A, Papoutsis I, Polyzonis M, Chatzoulis G, Milias K, Spyridopoulos P. Asymptomatic gastric diverticulum as incidental radiographic finding after surgery for strangulated inguinal hernia: Report of a case. Int J Surg Case Rep 2018; 45:121-125. [PMID: 29605776 PMCID: PMC6000906 DOI: 10.1016/j.ijscr.2018.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Gastric diverticula consist a rare form of diverticula of the gastrointestinal tract. They can be described as an "out-pouching" protrusion from the gastric wall. They are usually found in patients aged between 20 and 60 years old. PRESENTATION OF CASE We present herein a case of an 82 year- old male patient who was admitted to our hospital with a strangulated inguinal hernia and a gastric diverticulum was incidentally found, as a post- operative radiographic finding. DISCUSSION For symptomatic gastric diverticula, a conservative treatment is usually preferred as first approach with PPIs and soft diet to alleviate the symptoms. Surgical treatment as first approach should be preserved for cases where a connection has been established between the patients' symptoms and the clinical presentation. CONCLUSION Resection via laparoscopic surgery is nowadays the method of choice for the treatment of gastric diverticula. Open surgery is still performed through a median laparotomy or a subcostal incision.
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Affiliation(s)
- Ioannis Passos
- Department of Surgery, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece.
| | - Alexandros Koumpoulas
- Department of Surgery, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece.
| | - Ioakeim Papoutsis
- Department of Surgery, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece.
| | - Michael Polyzonis
- Department of Surgery, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece.
| | - George Chatzoulis
- Department of Surgery, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos Milias
- Department of Surgery, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
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8
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Talukder S, Gupta A, Singh BN, Kaman L, Reddy PA. Fistulating Richter's Hernia of Groin with Necrotizing Soft Tissue Infection: A Lethal Combination. J Clin Diagn Res 2017; 11:PD05-PD07. [PMID: 28892969 DOI: 10.7860/jcdr/2017/28201.10195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 04/22/2017] [Indexed: 11/24/2022]
Abstract
Strangulation of groin hernia can result in significant morbidity and mortality. Spontaneous external fistulation following strangulation is rare and typically occurs with Richter's hernia. Spreading Necrotizing Soft Tissue Infection (NSTI) secondary to Enterocutaneous Fistula (ECF) is an ominous sign, further worsening its prognosis. Early diagnosis and prompt surgical treatment is crucial to improve outcome. Herewith the authors are presenting a case of neglected inguinal hernia. It was complicated with ECF formation and rapidly spreading NSTI of flank. He underwent resection and anastomosis of the gangrenous bowel, anatomical repair of the hernia along with soft tissue debridement of flank region. This patient however succumbed to sepsis with multi organ dysfunction. Significant delay in seeking medical care led to dismal outcome.
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Affiliation(s)
- Shibojit Talukder
- Senior Resident, Department of General Surgery, PGIMER, Chandigarh, India
| | - Ashish Gupta
- Senior Medical Officer, Department of Hospital Administration, PGIMER, Chandigarh, India
| | | | - Lileswar Kaman
- Professor, Department of General Surgery, PGIMER, Chandigarh, India
| | - P Abhinaya Reddy
- Senior Resident, Department of General Surgery, PGIMER, Chandigarh, India
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9
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Birindelli A, Sartelli M, Di Saverio S, Coccolini F, Ansaloni L, van Ramshorst GH, Campanelli G, Khokha V, Moore EE, Peitzman A, Velmahos G, Moore FA, Leppaniemi A, Burlew CC, Biffl WL, Koike K, Kluger Y, Fraga GP, Ordonez CA, Novello M, Agresta F, Sakakushev B, Gerych I, Wani I, Kelly MD, Gomes CA, Faro MP, Tarasconi A, Demetrashvili Z, Lee JG, Vettoretto N, Guercioni G, Persiani R, Tranà C, Cui Y, Kok KYY, Ghnnam WM, Abbas AES, Sato N, Marwah S, Rangarajan M, Ben-Ishay O, Adesunkanmi ARK, Lohse HAS, Kenig J, Mandalà S, Coimbra R, Bhangu A, Suggett N, Biondi A, Portolani N, Baiocchi G, Kirkpatrick AW, Scibé R, Sugrue M, Chiara O, Catena F. 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias. World J Emerg Surg 2017; 12:37. [PMID: 28804507 PMCID: PMC5545868 DOI: 10.1186/s13017-017-0149-y] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 07/31/2017] [Indexed: 02/08/2023] Open
Abstract
Emergency repair of complicated abdominal wall hernias may be associated with worsen outcome and a significant rate of postoperative complications. There is no consensus on management of complicated abdominal hernias. The main matter of debate is about the use of mesh in case of intestinal resection and the type of mesh to be used. Wound infection is the most common complication encountered and represents an immense burden especially in the presence of a mesh. The recurrence rate is an important topic that influences the final outcome. A World Society of Emergency Surgery (WSES) Consensus Conference was held in Bergamo in July 2013 with the aim to define recommendations for emergency repair of abdominal wall hernias in adults. This document represents the executive summary of the consensus conference approved by a WSES expert panel. In 2016, the guidelines have been revised and updated according to the most recent available literature.
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Affiliation(s)
| | | | | | - Federico Coccolini
- Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Luca Ansaloni
- Department of General Surgery, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Gabrielle H van Ramshorst
- Department of Surgery, Red Cross Hospital Beverwijk, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - Vladimir Khokha
- Department of General Surgery, Mozyr City Hospital, Mazyr, Belarus
| | | | - Andrew Peitzman
- Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - George Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA USA
| | | | - Ari Leppaniemi
- Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland
| | | | - Walter L Biffl
- Department of Surgery, University of Hawaii, Honolulu, HI USA
| | - Kaoru Koike
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yoram Kluger
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Gustavo P Fraga
- Division of Trauma Surgery, Hospital de Clinicas, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Carlos A Ordonez
- Department of Surgery, Universidad del Valle, Fundacion Valle del Lili, Cali, Colombia
| | - Matteo Novello
- Department of Surgery, University of Bologna, Bologna, Italy
| | | | - Boris Sakakushev
- General Surgery Clinic, University Hospital St. George/Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Igor Gerych
- Department of Surgery 1, Lviv Regional Hospital, Danylo Halytsky Lviv National Medical University, Lviv, Ukraine
| | - Imtiaz Wani
- Department of Surgery, Sheri-Kashmir Institute of Medical Sciences, Srinagar, India
| | | | - Carlos Augusto Gomes
- Federal University of Juiz de Fora (UFJF), Juiz de Fora, MG Brazil.,Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, MG Brazil
| | - Mario Paulo Faro
- Department of General Surgery, Trauma and Emergency Surgery Division, ABC Medical School, Santo André, SP Brazil
| | - Antonio Tarasconi
- Department of Emergency Surgery, Maggiore Parma Hospital, Parma, Italy
| | - Zaza Demetrashvili
- Department of Surgery, Tbilisi State Medical University, Tbilisi, Georgia
| | - Jae Gil Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Nereo Vettoretto
- Department of Surgery, Montichiari Hospital, ASST Spedali Civili Brescia, Brescia, Italy
| | | | | | - Cristian Tranà
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Kenneth Y Y Kok
- Department of Surgery, RIPAS Hospital, Bandar Seri Begawan, Brunei
| | - Wagih M Ghnnam
- Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ashraf El-Sayed Abbas
- Department of Surgery Mansoura, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Norio Sato
- Department of Primary Care and Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Sanjay Marwah
- Department of Surgery, Pt. BDS Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Muthukumaran Rangarajan
- Department of Laparoscopic and Bariatric Surgery, Health City Cayman Islands, Grand Cayman, Cayman Islands
| | - Offir Ben-Ishay
- Division of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Abdul Rashid K Adesunkanmi
- Department of Surgery, College of Health Sciences, Obafemi Awolowo University Hospital, Ile-Ife, Nigeria
| | - Helmut Alfredo Segovia Lohse
- II Cátedra de Clínica Quirúrgica, Hospital de Clínicas, Facultad de Ciencias Médicas, Universidad Nacional de Asunción, San Lorenzo, Paraguay
| | - Jakub Kenig
- 3rd Department of General Surgery, Jagiellonian University Collegium Medium, Krakow, Poland
| | - Stefano Mandalà
- Department of Surgery, G. Giglio Hospital Cefalù, Palermo, Italy
| | - Raul Coimbra
- Department of Surgery, Division of Trauma, Surgical Care, Burns and Acute Care Surgery, UC San Diego Medical Center, San Diego, CA USA
| | - Aneel Bhangu
- Academic Department of Surgery, University Hospitals Birmingham NHS Foundation Trust, Edgabaston, Birmingham, UK
| | - Nigel Suggett
- Department of Colorectal Surgery, New Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Edgbaston, Birmingham, UK
| | | | | | | | - Andrew W Kirkpatrick
- Departments of Critical Care Medicine and Surgery, Foothills Medical Centre, Calgary, AB Canada
| | - Rodolfo Scibé
- Department of Surgery, Macerata Hospital, Macerata, Italy
| | | | | | - Fausto Catena
- Department of Emergency Surgery, Maggiore Parma Hospital, Parma, Italy
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10
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Hajong R, Khongwar D, Komut O, Naku N, Baru K. Spontaneous Enterocutaneous Fistula Resulting from Richter's Hernia. J Clin Diagn Res 2017; 11:PD05-PD06. [PMID: 28969198 DOI: 10.7860/jcdr/2017/27789.10370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
Abstract
Richter's hernia is due to the entrapment of a part of circumference of the bowel wall. As the bowel continuity is maintained, the patients usually do not have intestinal obstruction. Some patients with Richter's hernia may present with enterocutaneous fistula either spontaneous or due to surgical intervention mistaking the obstructed hernia to be inguinal abscess. This is more so in developing countries due to lack of awareness among the masses or due to the delay in seeking medical attention. Presenting here is a case of a 53-year-old male patient with enterocutaneous fistula which occurred spontaneously and sought medical attention only after about three years of repeated discharge of yellowish fluid from the left inguinal region. Magnetic resonance fistulogram confirmed the diagnosis of enterocutaneous fistula. Laparotomy with resection and primary anastomosis of the fistulous bowel was done. Patient recovered uneventfully without any complications or recurrence.
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Affiliation(s)
- Ranendra Hajong
- Associate Professor, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Donkupar Khongwar
- Assistant Professor, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Ojing Komut
- Assistant Professor, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Narang Naku
- Senior Resident, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
| | - Kappa Baru
- Senior Resident, Department of General Surgery, NEIGRIHMS, Shillong, Meghalaya, India
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11
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Gero D, Azizi AM, Kessler U, Worreth M, Saadi A. Two-stage laparoscopic approach for the treatment of strangulated groin hernia (with video). J Visc Surg 2017; 154:209-210. [PMID: 28479107 DOI: 10.1016/j.jviscsurg.2017.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- D Gero
- Department of surgery, hôpital neuchâtelois, Neuchâtel, Switzerland.
| | - A M Azizi
- Department of surgery, hôpital neuchâtelois, Neuchâtel, Switzerland.
| | - U Kessler
- Department of surgery, hôpital neuchâtelois, Neuchâtel, Switzerland; Department of surgery, HFR Fribourg-Cantonal Hospital, Switzerland.
| | - M Worreth
- Department of surgery, hôpital neuchâtelois, Neuchâtel, Switzerland.
| | - A Saadi
- Department of surgery, hôpital neuchâtelois, Neuchâtel, Switzerland.
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12
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Marrelli D, Voglino C, Di Mare G, Ferrara F, Guazzi G, Croce F, Costantini M, Piagnerelli R, Roviello F. Intestinal Stenosis of Garré: An Old Problem Revisited. Viszeralmedizin 2015; 31:209-11. [PMID: 26468318 PMCID: PMC4569203 DOI: 10.1159/000433589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Intestinal stenosis of Garré, first described in 1892, is a rare condition as a consequence of a complicated strangulated hernia. Preoperative diagnosis is challenging because of unspecific symptoms. Proper anamnesis, especially in terms of clinical and surgical history, as well as careful examination of both inguinal spaces is essential. Case Report We herein present a case of intestinal stenosis of Garré in a 70-year-old female. Conclusion Intestinal stenosis of Garré should be considered in cases of occlusive symptoms occurring after a non-operative or surgical reduction of a strangulated hernia. A correct diagnosis and an adequate surgical treatment are necessary to solve this rare complication favorably.
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Affiliation(s)
- Daniele Marrelli
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Costantino Voglino
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Giulio Di Mare
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Francesco Ferrara
- Unit of General Surgery and Surgical Oncology, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Gianni Guazzi
- Unit of Diagnosis in Emergency and Urgency, Department of Emergency, Urgency, and Diagnostics Services, University of Siena, Siena, Italy
| | - Federica Croce
- Department of Diagnostic Imaging, Unit of Radiology, University of Siena, Siena, Italy
| | - Maurizio Costantini
- Department of Human Pathology and Oncology, University of Siena, Siena, Italy
| | - Riccardo Piagnerelli
- Unit of General and Mini-Invasive Surgery, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Franco Roviello
- Unit of General and Mini-Invasive Surgery, Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy
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13
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Sasaki A, Takeuchi Y, Izumi K, Morimoto A, Inomata M, Kitano S. Two-stage laparoscopic treatment for strangulated inguinal, femoral and obturator hernias: totally extraperitoneal repair followed by intestinal resection assisted by intraperitoneal laparoscopic exploration. Hernia 2014; 20:483-8. [PMID: 24908448 DOI: 10.1007/s10029-014-1272-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Accepted: 05/23/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Total extraperitoneal preperitoneal (TEP) repair is widely used for inguinal, femoral, or obturator hernia treatment. However, mesh repair is not often used for strangulated hernia treatment if intestinal resection is required because of the risk of postoperative mesh infection. Complete mesh repair is required for hernia treatment to prevent postoperative recurrence, particularly in patients with femoral or obturator hernia. CASES We treated four patients with inguinocrural and obturator hernias (a 72-year-old male with a right indirect inguinal hernia; an 83-year-old female with a right obturator hernia; and 86- and 82-year-old females with femoral hernias) via a two-stage laparoscopic surgery. All patients were diagnosed with intestinal obstruction due to strangulated hernia. First, the incarcerated small intestine was released and then laparoscopically resected. Further, 8-24 days after the first surgery, bilateral TEP repairs were performed in all patients; the postoperative course was uneventful in all patients, and they were discharged 5-10 days after TEP repair. At present, no hernia recurrence has been reported in any patient. CONCLUSION The two-stage laparoscopic treatment is safe for treatment of strangulated inguinal, femoral, and obturator hernias, and complete mesh repair via the TEP method can be performed in elderly patients to minimize the occurrence of mesh infection.
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Affiliation(s)
- A Sasaki
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan.
| | - Y Takeuchi
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan
| | - K Izumi
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan
| | - A Morimoto
- Department of Surgery, Japan Community Health Care Organization (JCHO) Nankai Medical Center, 11-20, Saiki, Oita, 876-0857, Japan
| | - M Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, 879-5593, Japan
| | - S Kitano
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita, 879-5593, Japan
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14
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Bandawar MS, Nayak P, Shaikh IA, Sakthivel MS, Yadav TD. Strangulated small bowel obstruction secondary to a transmesosigmoid hernia. Indian J Surg 2014; 76:148-9. [PMID: 24891782 DOI: 10.1007/s12262-012-0649-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 06/21/2012] [Indexed: 11/28/2022] Open
Abstract
Internal hernias are an infrequent cause of small bowel obstruction with transmesosigmoid herniation being very rare, especially in patients with no history of abdominal surgery or trauma. Early surgical intervention is important in acute presentation to reduce the high morbidity and mortality rates associated with this disease.
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Affiliation(s)
- Mayur Satish Bandawar
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Praveen Nayak
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Irfan Abubakar Shaikh
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - M S Sakthivel
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
| | - Thakur Deen Yadav
- Department of General Surgery, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012 India
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