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Chkir B, Salam A, Haq S, Mansour M. Non-Meckel Ileal Diverticulum Incarcerated Within a Strangulated Inguinal Hernia: A Case Report. Cureus 2024; 16:e75509. [PMID: 39803138 PMCID: PMC11723775 DOI: 10.7759/cureus.75509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2024] [Indexed: 01/16/2025] Open
Abstract
Non-Meckel small bowel diverticula, particularly ileal diverticula, are rare, especially when incarcerated within an inguinal hernia sac. This case involves an 80-year-old man who presented with a newly noticed tender, irreducible lump in his left groin, accompanied by symptoms of bowel obstruction such as inability to pass flatus and vomiting. His medical history included a previous right inguinal hernia repair. Physical examination and laboratory tests indicated a strangulated hernia, which was confirmed by a contrast-enhanced computed tomography scan showing small bowel obstruction at the neck of the left inguinal hernia. The patient underwent a laparoscopic mesh repair, during which a non-Meckel ileal diverticulum was discovered within the hernia sac alongside a bruised but viable segment of the small bowel. The incarcerated diverticulum was gently reduced, and the hernia was successfully repaired using a mesh. The patient had an uneventful recovery and was discharged in a stable condition. This case highlights the importance of considering rare causes of small bowel obstruction in elderly patients presenting with hernias. Prompt imaging and surgical intervention are crucial to prevent serious complications such as bowel ischemia and perforation. The successful laparoscopic approach demonstrated minimal invasiveness and facilitated a swift postoperative recovery, underscoring its effectiveness in managing such uncommon clinical scenarios.
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Affiliation(s)
- Baraa Chkir
- Urology, Royal Albert Edward Infirmary, Wigan, GBR
| | - Ammara Salam
- General Surgery, North Manchester General Hospital, Manchester, GBR
| | - Shua Haq
- Colorectal Surgery, North Manchester General Hospital, Manchester, GBR
| | - Moustafa Mansour
- Upper Gastrointestinal Surgery, North Manchester General Hospital, Manchester, GBR
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2
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Ali AM, Mohamed YG, Mohamed AN, Güler İ. Etiology, Clinical Manifestations, and Imaging Evaluation of Intestinal Obstruction in Adults at Tertiary Hospital in Mogadishu, Somalia: A Retrospective Study. Int J Gen Med 2024; 17:5563-5572. [PMID: 39628981 PMCID: PMC11611986 DOI: 10.2147/ijgm.s472935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2024] [Accepted: 11/22/2024] [Indexed: 12/06/2024] Open
Abstract
Background Intestinal obstruction (IO) is a surgical emergency with high morbidity and mortality. The leading causes in adults include adhesions, incarcerated hernias, and tumors. Methods This three-year retrospective study reviewed adult patients with IO treated at Mogadishu Somalia Turkey Training and Research Hospital from June 1, 2019, to June 1, 2022. Results Of the patients studied, 67% were male, with a male-to-female ratio of 2:1. The most common symptoms were nausea and vomiting (93.2%), abdominal distension (90.2%), and inability to pass stool or gas (70.8%). Surgical management was required for 95.1% of patients, with only 4.9% managed conservatively. The most frequent postoperative complication was surgical site infection. Hospital stays for 52% of patients ranged from 8 to 14 days. The overall mortality rate was 4.9%. Discussion IO remains a critical surgical emergency worldwide, requiring urgent intervention. Aggressive treatment of hernias and timely surgical intervention for mechanical obstruction are essential to reduce complications and mortality. Delayed presentations contribute to higher mortality rates. Conclusion Small bowel obstruction was more frequent than large bowel obstruction, with fibrous adhesions and incarcerated hernias as the leading causes. Adhesiolysis and bowel resection with anastomosis were the most common surgical procedures. Further research using prospective study designs is recommended to improve understanding and outcomes.
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Affiliation(s)
- Abdihamid Mohamed Ali
- Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Yahye Garad Mohamed
- Department of Radiology, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - Abdulkadir Nor Mohamed
- Department of General Surgery, Mogadishu Somali Turkey Recep Tayyip Erdoğan Training and Research Hospital, Mogadishu, Somalia
| | - İlkay Güler
- Department of General Directorate of Public Hospitals, Republic of Turkey, Ministry of Health, Ankara, Turkey
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3
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Raja S, Raja A, Ansari Z, Eman S, Bajaj S, Ahmed M, Kumar U, Shah YH, Jawahar S, Aftab F, Rajani D, Kumar S, Khatri M. Safety and efficacy revisited: a systematic review and meta-analysis of glue versus tack mesh fixation in laparoscopic inguinal herniorrhaphy. Front Surg 2024; 11:1321325. [PMID: 38404293 PMCID: PMC10884233 DOI: 10.3389/fsurg.2024.1321325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Background This analysis addresses the uncertainty surrounding the efficacy of glue mesh fixation (GMF) compared with tack mesh fixation (TMF) in laparoscopic herniorrhaphy. Our meta-analysis incorporates recently conducted randomized controlled trials (RCTs) to enhance the reference for assessing the efficacy and safety of GMF. Methods PubMed Central, Google Scholar, Science Direct, and Cochrane Library were extensively reviewed for articles in the English language performed from inception to May 2023 using the keywords "Glue mesh repair," "Tack mesh repair," "Inguinal Hernia," "Herniorrhaphy," "Laparoscopic," "Mesh Fixation," and "Randomized controlled trials." Results In this meta-analysis, we incorporated a total of 20 randomized controlled trials, evaluating each article individually using quality ratings. Compared with TMF, GMF demonstrated a significant reduction in the incidence of chronic pain [RR: 0.40, (0.23, 0.68)] and pain scores on postoperative day 1 [MD: -1.07, (-1.90, -0.25)]. We also used funnel plots and Egger's regression to test for publication bias. Conclusion In summary, this meta-analysis establishes the significance of GMF in reducing chronic pain and postoperative day 1 pain compared with TMF. However, no statistically significant difference was noted between the GMF and TMF groups concerning hematoma, seroma, operation time, recurrence rate, and total complications. Nonetheless, given the small number of cases in this study, the findings must be validated in the future by multicenter, large-sample, high-quality RCTs.
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Affiliation(s)
- Sandesh Raja
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Adarsh Raja
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Ziyan Ansari
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sara Eman
- Department of Surgery, Foundation University Medical College, Islamabad, Pakistan
| | - Simran Bajaj
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical University, Larkana, Pakistan
| | - Muhammad Ahmed
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Uday Kumar
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Yawar Hussain Shah
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Sachin Jawahar
- Department of Surgery, Liaquat College of Medicine and Dentistry, Karachi, Pakistan
| | - Faisal Aftab
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Deepak Rajani
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Satesh Kumar
- Department of Surgery, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Mahima Khatri
- Department of Surgery, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Kulacoglu H. Current opinions in inguinal hernia emergencies: A comprehensive review of related evidences. INTERNATIONAL JOURNAL OF ABDOMINAL WALL AND HERNIA SURGERY 2023; 6:136-158. [DOI: 10.4103/ijawhs.ijawhs_30_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 04/14/2023] [Indexed: 01/03/2025] Open
Abstract
Abstract
INTRODUCTION:
Groins hernia emergencies are evaluated under two definitions: incarceration that is defined as a hernia in which its content becomes irreducible at the passage in the abdominal wall and strangulation that compromises the blood supply to the omentum and/or intestines within the hernia sac. The purpose of this paper was to determine the latest knowledge about groin hernia emergencies.
MATERIALS AND METHODS:
PubMed and Google Scholar searches were done by using combinations of “inguinal hernia” and “emergency”, and “groin hernia” and “emergency” keywords at first. More detailed searches were performed to enrich the “Surgical treatment” part of the paper by using “emergency hernia” and “mesh”, “emergency hernia,” and “laparoscopic versus open” keywords afterward.
RESULTS:
Approximately 5%–10% of all inguinal repairs are performed in emergency settings. Both lateral and medial inguinal hernias can get incarcerated or strangulated, whereas the risk for femoral hernias is higher. Manual reduction of incarcerated inguinal hernias is successful in approximately 60% of the cases. The prediction of bowel ischemia due to strangulation may be possible with some blood tests and imaging studies like ultrasound and computed tomography. It has been shown that the longer the duration of incarceration the higher the risk of bowel ischemia. Bowel resection which is more frequently necessary in patients with advanced age, female gender, and femoral hernia, is associated with an increased risk of perioperative mortality. Some surgeons still use tissue-suture repairs in an emergency setting; however, mesh repairs have been shown to be safe unless there is an overt contamination.
CONCLUSION:
Early treatment of complicated groin hernias is the key to favorable outcomes. The need for bowel resection and advanced age are the most prominent factors for morbidity and mortality. Mesh repairs are safe in most cases. Minimally invasive approaches promise good results in experienced centers.
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McCarthy C, Alfanso Sang W, Bekhit M. Inguinal Hernia Incarceration in the Setting of Postoperative Ileus. Cureus 2023; 15:e35737. [PMID: 37016640 PMCID: PMC10067023 DOI: 10.7759/cureus.35737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/25/2023] [Indexed: 03/06/2023] Open
Abstract
Postoperative ileus (POI) occurs after gastrointestinal and other intra-abdominal surgeries, and its incidence rate is reported to range between 10 and 30% following major abdominal surgery. Should ileus remain for several days or if symptoms worsen despite management, further investigation is warranted to consider other diagnoses such as small bowel obstruction (SBO), intra-abdominal abscess, or perforation. The etiology of postoperative obstructive symptoms can evolve during the postoperative course and many possible factors contribute to postoperative gastrointestinal dysfunction. Prolonged POI may be a risk factor for hernia incarceration. We describe the case of a 72-year-old male with a history of perforated diverticulitis and Hartmann procedure status post-colostomy takedown complicated by prolonged POI for six days. Clinical workup revealed incarcerated inguinal hernia, which was treated with urgent inguinal hernia repair. Follow-up revealed resolution of gastrointestinal dysfunction within 48 hours of hernia repair.
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Ahmadinejad M, Bahri MH, Tajik A, Taherzadeh-ghahfarokhi N, Zebarjadi Bagherpour J. Bowel obstruction secondary to gallstone ileus within a strangulated inguinal hernia: Report of a rare diagnosis. Int J Surg Case Rep 2022; 97:107445. [PMID: 35952570 PMCID: PMC9403281 DOI: 10.1016/j.ijscr.2022.107445] [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: 05/27/2022] [Revised: 07/18/2022] [Accepted: 07/18/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Gallstone ileus is rare and inguinal hernias are common causes of intestinal obstruction but combination of them is a very rare cause of intestinal obstruction. It is accepted that in patients with severe comorbidities surgeons can manage inguinal hernias and gallstone conservatively. In this article we report a patient with gallstone and inguinal hernia that managed with conservatively management because of heart failure but admitted with complication of gallstone and hernia and treated successfully. CASE PRESENTATION An 80-year-old woman with a history of heart failure and two bouts of acute cholecystitis, who presented with pain and swelling in the inguinal region and obstructive symptoms. And due to the urgent nature of the condition, she underwent surgery. CONCLUSION One of the rare complications of gallstones is cholecystoduodenal fistulas, especially in patients whose episodes of cholecystitis are treated medically. Early diagnosis and appropriate surgical management in these circumstances reduce the mortality and morbidity.
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Affiliation(s)
- Mojtaba Ahmadinejad
- Department of Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Alborz, Iran
| | - Mohammad Hadi Bahri
- Department of Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Alborz, Iran
| | - Armin Tajik
- Research students committee, Alborz University of Medical Sciences, Alborz, Iran
| | | | - Javad Zebarjadi Bagherpour
- Department of Surgery, Shahid Madani Hospital, Alborz University of Medical Sciences, Alborz, Iran,Corresponding author.
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Ghimire N, Silva DJ, Bavikatte A, Olugbemi M, Mishra A, Smith SA. Bowel obstruction secondary to gallstone ileus within an inguinoscrotal hernia: a rare diagnosis in an elderly patient. BJR Case Rep 2021; 7:20200207. [PMID: 35047199 PMCID: PMC8749400 DOI: 10.1259/bjrcr.20200207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 02/02/2021] [Accepted: 02/24/2021] [Indexed: 11/05/2022] Open
Abstract
Gallstone ileus and obstructed inguinal hernias are respectively, rare and common causes of small bowel obstruction. There are no published cases of these pathologies occurring simultaneously. Here, we describe a unique case of an elderly male patient presenting with a small bowel obstruction caused by these combined pathologies. Following an acute presentation with obstructive symptoms, a CT scan demonstrated small bowel obstruction due to a large gallstone lodged in the neck of an inguinoscrotal hernia with associated pneumobilia. The case may have been managed conservatively if it was not for the presence of the gallstone. Previous imaging had incidentally demonstrated gallstones in the gallbladder and a large uncomplicated right inguinoscrotal hernia. It is presumed that a cholecystoduodenal fistula formed and a gallstone then migrated downstream to lodge within the neck of the inguinoscrotal hernia. This case underscores the concept that even in the presence of an “obvious” cause of small bowel obstruction, such as an irreducible, large inguinoscrotal hernia, we must always maintain a healthy clinical skepticism and an open mind to other unexpected aetiologies, which may account for the clinical presentation that might impact subsequent management.
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8
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Muntean A, Stoica I, McLaughlin D, Gillick J, Tareen FK. Femoral hernias: A paediatric surgical enigma. J Pediatr Surg 2021; 56:1132-1135. [PMID: 33865603 DOI: 10.1016/j.jpedsurg.2021.03.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/12/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE In the paediatric population, femoral hernia (FH) represents an uncommon and often misdiagnosed pathology. This study aimed to review our experience with the management of FH in children. METHODS Medical records were retrospectively reviewed for all patients presenting to the paediatric surgical service in Ireland over a 15-year period (2004-2019), who were operated on for FH. Collected data included demographics, preoperative diagnosis, operative details, complications and follow-up. RESULTS During the study period, n = 26 patients (n = 18 males) underwent FH repair, with a median age at surgery 6.9 years (range 3-16 years). During the same period n = 5693 patients underwent inguinal herniotomy, resulting in a FH to inguinal hernia (IH) ratio of 1:219 and a FH incidence of 0.45% of all groin hernias. The right side was affected in n = 18 (69.2%) cases and all cases were unilateral. A correct preoperative diagnosis was established in n = 16 (61.5%) cases, n = 8 (30.8%) cases were misdiagnosed as IH and the diagnosis was equivocal in 2 cases (7.7%). All operations were performed on an elective basis. In 3 patients from the misdiagnosed group, FH was found at first operation following negative groin exploration for IH. The remaining 5 patients underwent previous groin exploration for suspected IH and represented with clinical picture of groin hernia recurrence. All patients with a correct preoperative diagnosis underwent a FH repair via an inguinal or infra-inguinal approach. The content of the hernia sac was preperitoneal fat in n = 18 cases, lymph nodes in n = 2 cases, omentum in n = 1 and an empty sac in n = 1. There were no postoperative complications or recurrences. Median follow-up time was 6 weeks (range 0-2.5 years). CONCLUSION In the paediatric population, FH is a rare pathology and can be a challenging diagnosis. FH is commonly misdiagnosed as IH and may require more than one operation to correctly identify and treat. A high index of suspicion of FH should be maintained in patients who have a negative groin exploration for IH in the setting of a clear pre-operative diagnosis of a groin hernia. FH should also be considered in the differential diagnosis when an IH appears to recur.
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Affiliation(s)
- Ancuta Muntean
- Children's Health Ireland at Crumlin, Cooley Rd, Crumlin D12 N512, Dublin, Ireland.
| | - Ionica Stoica
- Children's Health Ireland at Tallaght, Tallaght University Hospital, Tallaght D24 NR0A, Dublin, Ireland
| | - Danielle McLaughlin
- Children's Health Ireland at Temple Street, Temple Street, D01 XD99, Dublin, Ireland
| | - John Gillick
- Children's Health Ireland at Crumlin, Cooley Rd, Crumlin D12 N512, Dublin, Ireland; Children's Health Ireland at Temple Street, Temple Street, D01 XD99, Dublin, Ireland
| | - Farhan Khaliq Tareen
- Children's Health Ireland at Crumlin, Cooley Rd, Crumlin D12 N512, Dublin, Ireland; Children's Health Ireland at Tallaght, Tallaght University Hospital, Tallaght D24 NR0A, Dublin, Ireland
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9
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Bowel obstruction as a serious complication of patients with femoral hernia. Surg Today 2020; 51:738-744. [PMID: 33030651 DOI: 10.1007/s00595-020-02158-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The implications of bowel obstruction occurring secondary to femoral hernia have not been discussed in the literature recently. Thus, we report our experience of treating patients with femoral hernias complicated by bowel obstruction versus patients with femoral hernias not complicated by bowel obstruction. METHODS The subjects of this retrospective study were patients admitted to our hospital for the treatment of femoral hernias between 2016 and 2019. We used the Fisher and Student's T test to compare the preoperative characteristics, treatment, and outcomes of patients with bowel obstruction versus those without bowel obstruction. RESULTS A total of 53 patients (mean age, 66.9 ± 15.1 years) were treated, 18 (33.9%) of whom underwent elective surgery and 35 (66%) of whom required emergency surgery (p = 0.001). The mean time between the development of symptoms and hospitalization was 4.5 ± 3.1 days for the patients with bowel obstruction and 1.6 ± 3.2 days for those without bowel obstruction (p = 0.001). The length of hospital stay was 11.1 ± 21.1 days for the patients with bowel obstruction and 1 ± 1.8 days for those without bowel obstruction (p = 0.028). Overall morbidity and mortality rates were 13.2% and 5.6%, respectively. CONCLUSION Femoral hernias causing bowel obstruction are associated with greater time between the development of symptoms, hospitalization, and with a longer hospital stay.
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10
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Biswas S, Morel EM, Petersen K, McCrae A. Incarcerated Bladder Diverticulum in a Femoral Hernia Presenting as Recurrent Hematuria. Cureus 2020; 12:e9681. [PMID: 32923274 PMCID: PMC7486021 DOI: 10.7759/cureus.9681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Groin hernias are extremely common surgical pathologies and usually contain intra-abdominal viscera surrounded by peritoneum. Femoral hernias are the least common types of hernia and are predominately found in females. In rare cases, an extraperitoneal organ may be pulled into the hernia sac to become part of the content. Urinary bladder diverticulum should be considered as a possible femoral hernia content in elderly patients presenting with recurrent symptoms of lower urinary tract infections and hematuria. A high index of suspicion followed by appropriate imaging assists in making a correct preoperative diagnosis and improves postoperative outcomes. We present an uncommon case of herniation of a urinary bladder diverticulum into a femoral hernia presenting with recurrent hematuria in an elderly female.
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Affiliation(s)
- Saptarshi Biswas
- Trauma and Acute Care Surgery, Grand Strand Medical Center, Myrtle Beach, USA
| | - Emma M Morel
- General Surgery, Edward Via College of Osteopathic Medicine-Carolinas, Myrtle Beach, USA
| | | | - Austin McCrae
- General Surgery, Grand Strand Medical Center, Myrtle Beach, USA
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11
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Farkas NG, Welman TJP, Ross T, Brown S, Smith JJ, Pawa N. Unusual causes of large bowel obstruction. Curr Probl Surg 2018; 56:49-90. [PMID: 30777150 DOI: 10.1067/j.cpsurg.2018.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Nicholas G Farkas
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK.
| | - Ted Joseph P Welman
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Talisa Ross
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Sarah Brown
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Jason J Smith
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Nikhil Pawa
- West Middlesex University Hospital, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Cha YS, Lee KH, Lee JW, Choi EH, Kim HI, Kim OH, Cha KC, Kim H, Hwang SO. The use of delta neutrophil index and myeloperoxidase index as diagnostic predictors of strangulated mechanical bowel obstruction in the emergency department. Medicine (Baltimore) 2016; 95:e5481. [PMID: 27902604 PMCID: PMC5134774 DOI: 10.1097/md.0000000000005481] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Early detection of bowel strangulation is difficult in patients with mechanical bowel obstruction (MBO). There have been no previous reports of predicting strangulation in MBO cases using the delta neutrophil index (DNI), which is a measure of the proportion of circulating immature granulocytes, or the myeloperoxidase index (MPXI), which is a measure of serum myeloperoxidase level. Therefore, we evaluated differences in initial DNI and MPXI upon presentation at the emergency department (ED) according to strangulation presence in MBO patients.This is a retrospective observational study of consecutive patients older than 18 years who were diagnosed with MBO over a 31-month period. MBO was ultimately confirmed by computed tomography (CT) findings by a radiology specialist. Patients were categorized by a strangulation group (SG) and nonstrangulation group (NSG). The SG was defined by surgical and pathologic findings after the surgical operation. Initial serum counts of white blood cells and neutrophils, C-reactive protein levels, and DNI and MPXI scores were investigated in the ED.Fifteen of 160 patients were allocated to the SG (9.4%), and among the inflammatory markers, median initial DNI value was the only one that was significantly higher in the SG (0% vs 3.2%, P = 0.003). Although the areas under the receiver operation characteristic (ROC) curves for initial DNI and CT for differentiating strangulated from nonstrangulated bowel obstruction were 0.713 (95% confidence interval [CI]: 0.636-0.782) and 0.883 (95% CI: 0.823-0.928), respectively; there was no significant difference between DNI and CT (P = 0.147). The area under the curve (AUC) for predicting strangulated bowel disease from a combination of initial DNI score and CT findings (0.983, 95% CI: 0.948-0.997) was higher than the AUC for CT alone, although the difference was not significant (P = 0.052).In conclusion, initial DNI, which was performed in the ED, was found to be significantly higher in the SG than in the NSG. Initial DNI might be a useful additional parameter for improving the prediction accuracy of CT.
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Affiliation(s)
- Yong Sung Cha
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju
| | - Kang Hyun Lee
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju
| | - Jong Wook Lee
- Department of Laboratory Medicine, Jincheon Sungmo Hospital, Jincheon
| | - Eun Hee Choi
- Biostatistician, Institute of Lifestyle Medicine, Wonju College of Medicine, Yonsei University, Wonju, Republic of Korea
| | - Hyung Il Kim
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju
| | - Oh Hyun Kim
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju
| | - Kyoung Chul Cha
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju
| | - Hyun Kim
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju
| | - Sung Oh Hwang
- Department of Emergency Medicine, Wonju College of Medicine, Yonsei University, Wonju
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Adamou H, Magagi IA, Habou O, Magagi A, Maazou H, Adamou M, Harouna Y. [Etiology and prognosis of acute mechanical intestinal obstructions at the National Hospital of Zinder: Cross-sectional study of 171 patients]. Pan Afr Med J 2016; 24:248. [PMID: 27800103 PMCID: PMC5075469 DOI: 10.11604/pamj.2016.24.248.8372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 06/19/2016] [Indexed: 11/11/2022] Open
Abstract
Acute mechanical intestinal obstruction (AIO) is one of the most frequent pathologies in emergency digestive surgery. The objective of this study was to describe the etiologic and prognostic features of acute mechanical intestinal obstruction at the National Hospital of Zinder (HNZ), Niger. We conducted a cross-sectional study including all the patients operated for AIO over a period of 24 months (January 2013 - December 2014) Mechanical intestinal obstructions represent 24.50% (n=171) of digestive surgical emergencies (n=622). The median age was 25 years (range: 1 day-95 years). The sex ratio was 3.5 in favour of men. Children accounted for 38.60% (n=66). The seat of the obstacle was at the level of the small bowel in 60.82% (n=104), colonic in 21.63% (n=37) and mixed in 17.54% (n=30). The mechanism of strangulation accounted for 88,89% (n=152), among these strangulated hernias were detected in 49,70% (n=85) of patients and acute intestinal invaginations in 19,88% (n=34) of patients. Anorectal malformations and tumors were the main cause of obstruction in 7.02% (n=12) and 3.51% (n=6) of cases respectively. Intestinal resection was performed in 52 cases (30.41%). Septic complications prevailed (n=39/53); among these parietal suppuration (n=23). The average length of stay in hospital was 7.82 days. The overall mortality rate was 11.70% (n=20). This was statistically correlated to intestinal necrosis (p=0.01) and to delayed hospital admission (p=0.04). There are many causes of AIO which are dominated by strangulated hernia. The high morbidity and mortality rate from AIO might be prevented by early treatment performed before intestinal necrosis occurs.
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Affiliation(s)
- Harissou Adamou
- Service de Chirurgie Générale et Digestive B, Hôpital National de Zinder, Niger
| | | | - Oumarou Habou
- Service de Chirurgie Pédiatrique, Assistant à la Faculté des Sciences de la Santé de Zinder, Niger
| | - Amadou Magagi
- Service d'Anesthésie-Réanimation, Hôpital National de Zinder, Niger
| | | | - Mansour Adamou
- Service de Chirurgie Générale et Digestive B, Hôpital National de Zinder, Niger
| | - Yacouba Harouna
- Service de Chirurgie Viscérale C, Hôpital National de Niamey, Niger
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Trilling B, Girard E, Waroquet PA, Arvieux C. [Intestinal obstruction, an overview]. REVUE DE L'INFIRMIERE 2016; 65:16-18. [PMID: 26743364 DOI: 10.1016/j.revinf.2015.10.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intestinal obstruction is a pathology commonly encountered in emergency and surgical departments. Its origin is usually mechanical, caused by obstruction of the digestive tract. It is a therapeutic emergency. Surgical treatment is required for the most severe cases.
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Affiliation(s)
- Bertrand Trilling
- Clinique universitaire de chirurgie digestive et de l'urgence, CHU de Grenoble, Boulevard de la Chantourne, 38700 La Tronche, France
| | - Edouard Girard
- Clinique universitaire de chirurgie digestive et de l'urgence, CHU de Grenoble, Boulevard de la Chantourne, 38700 La Tronche, France
| | - Pierre Alexandre Waroquet
- Clinique universitaire de chirurgie digestive et de l'urgence, CHU de Grenoble, Boulevard de la Chantourne, 38700 La Tronche, France
| | - Catherine Arvieux
- Clinique universitaire de chirurgie digestive et de l'urgence, CHU de Grenoble, Boulevard de la Chantourne, 38700 La Tronche, France.
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15
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Vagholkar K. Strangulated Femoral Hernia: A Challenging Surgical Vignette —Case Report and Review of Literature. INTERNATIONAL JOURNAL OF CLINICAL MEDICINE 2014; 05:72-75. [DOI: 10.4236/ijcm.2014.52013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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16
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Yetişir F, Salman AE, Özlü O, Kiliç M. An alternative anterior tension free preperitoneal patch technique by help of the endoscope for femoral hernia repair. Int J Surg 2013; 11:962-6. [PMID: 23792267 DOI: 10.1016/j.ijsu.2013.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Revised: 05/15/2013] [Accepted: 06/08/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Femoral hernias are relatively uncommon and have a higher risk for strangulation and incarceration. We introduce an alternative anterior tension free inlay patch technique by help of the endoscope for femoral hernia repair. METHOD Characteristics of patients undergoing femoral hernia repair between March 2006-April 2011 and description of the surgical technique is presented. RESULTS We analyzed our experience with this technique in 26 consecutive patients with femoral hernias (1 bilateral, 15 right, 10 left femoral hernia) in 5 year period. Seven of these 26 femoral hernias were recurrent and 2 of them were concomitant with inguinal hernia. Mean operation time was 30.0 ± 12.1 min. Seroma was seen in 2 patients at postoperative 1st week. There were no; hematoma, wound infection and separation of wound edges and early recurrence at postoperative 1st week and 1st month. The mean follow up period was 41.8 ± 18.2 months. All of 22 patients who were contacted were satisfied with the operation. There was no recurrence, chronic pain and foreign body feeling in any patient at the end of the follow-up period. CONCLUSION This feasible and safe alternative anterior inlay patch repair might be used in all femoral hernias with the exception of the ones requiring intestinal resection.
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Affiliation(s)
- Fahri Yetişir
- Atatürk Research and Training Hospital, General Surgery Department, Turkey.
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17
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Omari AH, Alghazo MA. Urinary bladder diverticulum as a content of femoral hernia: a case report and review of literature. World J Emerg Surg 2013; 8:20. [PMID: 23758812 PMCID: PMC3689056 DOI: 10.1186/1749-7922-8-20] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 06/07/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Long standing increase of the intravesical pressure resulting from urinary bladder outlet obstruction can cause both secondary bladder diverticula and groin hernias. In rare cases, a diverticulum can be pulled by a hernia sac and becomes a component of the hernia itself. Such cases were encountered in inguinal, perineal and obturator hernias. However, to our knowledge, there has been only one case reported in the literature of a bladder diverticulum herniated in to the femoral canal. METHODS Literature search using PubMed was performed to identify all published cases of herniation of bladder diverticula in to the femoral canal. RESULTS Literature search revealed only one case before the present one. CONCLUSION Urinary bladder diverticula should be considered as a possible content of femoral hernias especially in males with long standing obstructive lower urinary tract symptoms. As the clinical features of such a case are not specific, a high index of suspicion along with proper imaging studies are of great help in making a timely diagnosis to improve the outcome.
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Affiliation(s)
- Abdelkarim Hussein Omari
- Department of General Surgery, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan
| | - Mohammad Ahmad Alghazo
- Division of urology, King Abdullah University Hospital, Faculty of Medicine, Jordan University of Science and Technology, Irbid, 22110, Jordan
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18
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Total Extraperitoneal (TEP) Hernioplasty With Intestinal Resection Assisted by Laparoscopy for a Strangulated Richter Femoral Hernia. Surg Laparosc Endosc Percutan Tech 2013; 23:334-6. [DOI: 10.1097/sle.0b013e31828e3776] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vettoretto N, Carrara A, Corradi A, De Vivo G, Lazzaro L, Ricciardelli L, Agresta F, Amodio C, Bergamini C, Borzellino G, Catani M, Cavaliere D, Cirocchi R, Gemini S, Mirabella A, Palasciano N, Piazza D, Piccoli M, Rigamonti M, Scatizzi M, Tamborrino E, Zago M. Laparoscopic adhesiolysis: consensus conference guidelines. Colorectal Dis 2012; 14:e208-15. [PMID: 22309304 DOI: 10.1111/j.1463-1318.2012.02968.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM Laparoscopic adhesiolysis has been demonstrated to be technically feasible in small bowel obstruction and carries advantages in terms of post-surgical course. The increasing dissemination of laparoscopic surgery in the emergency setting and the lack of concrete evidence in the literature have called for a consensus conference to draw recommendations for clinical practice. METHODS A literature search was used to outline the evidence, and a consensus conference was held between experts in the field. A survey of international experts added expertise to the debate. A public jury of surgeons discussed and validated the statements, and the entire process was reviewed by three external experts. RESULTS Recommendations concern the diagnostic evaluation, the timing of the operation, the selection of patients, the induction of the pneumoperitoneum, the removal of the cause of obstructions, the criteria for conversion, the use of adhesion-preventing agents, the need for high-technology dissection instruments and behaviour in the case of misdiagnosed hernia or the need for bowel resection. CONCLUSION Evidence of this kind of surgery is scanty because of the absence of randomized controlled trials. Nevertheless laparoscopic skills in emergency are widespread. The recommendations given with the consensus process might be a useful tool in the hands of surgeons.
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Affiliation(s)
- N Vettoretto
- Laparoscopic Surgery Unit, M. Mellini Hospital, Chiari, Italy.
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20
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Uranues S, Tomasch G, Nagele-Moser D. Laparoscopic treatment of acute small bowel obstruction*. Eur Surg 2012. [DOI: 10.1007/s10353-012-0075-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Thomas PT, Kittappa K. The Thomas Repair of the strangulated femoral hernia - one skin incision for all. J Surg Case Rep 2011; 2011:8. [PMID: 24950046 PMCID: PMC3649276 DOI: 10.1093/jscr/2011.7.8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Several methods of femoral hernia repair have been described. It is the one most likely to strangulate, its repair must often be accompanied by examination of, and sometimes resection of, bowel or omentum. We describe a new method to repair such a hernia.
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Affiliation(s)
- P T Thomas
- Department of General Surgery, Blackpool Victoria Hospital, Blackpool, UK
| | - K Kittappa
- Department of General Surgery, Blackpool Victoria Hospital, Blackpool, UK
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22
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Chen HQ, Lv B. Strategies for diagnosis and treatment of small bowel obstruction. Shijie Huaren Xiaohua Zazhi 2011; 19:551-556. [DOI: 10.11569/wcjd.v19.i6.551] [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] [Indexed: 02/06/2023] Open
Abstract
Small bowel obstruction, which is caused by a variety of etiological factors and mainly manifests as abdominal pain, vomiting and distension, is one of the most common acute abdomens. A rapid and accurate diagnosis of small bowel obstruction is needed to give reasonable and effective treatment to avoid its rapid deterioration. In this paper we discuss the strategies for diagnosis and treatment of small bowel obstruction through comparing different imaging methods for diagnosis of small bowel obstruction and reviewing the current situation of diagnosis and treatment of the disease in terms of pharmacotherapy, gastrointestinal decompression, and surgical intervention.
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23
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Mortality after groin hernia surgery: delay of treatment and cause of death. Hernia 2011; 15:301-7. [DOI: 10.1007/s10029-011-0782-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 01/09/2011] [Indexed: 11/25/2022]
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Vallicelli C, Coccolini F, Catena F, Ansaloni L, Montori G, Di Saverio S, Pinna AD. Small bowel emergency surgery: literature's review. World J Emerg Surg 2011; 6:1. [PMID: 21214933 PMCID: PMC3025845 DOI: 10.1186/1749-7922-6-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 01/07/2011] [Indexed: 12/15/2022] Open
Abstract
Emergency surgery of the small bowel represents a challenge for the surgeon, in the third millennium as well. There is a wide number of pathologies which involve the small bowel. The present review, by analyzing the recent and past literature, resumes the more commons. The aim of the present review is to provide the main indications to face the principal pathologies an emergency surgeon has to face with during his daily activity.
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Affiliation(s)
- Carlo Vallicelli
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Federico Coccolini
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fausto Catena
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | - Luca Ansaloni
- General and Emergency Surgery Dept., Ospedali Riuniti Hospital, Bergamo, Italy
| | - Giulia Montori
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
| | | | - Antonio D Pinna
- General, Emergency and Transplant Surgery Dept., Sant'Orsola-Malpighi University Hospital, Bologna, Italy
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25
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Malik AM, Shah M, Pathan R, Sufi K. Pattern of acute intestinal obstruction: is there a change in the underlying etiology? Saudi J Gastroenterol 2010; 16:272-4. [PMID: 20871192 PMCID: PMC2995096 DOI: 10.4103/1319-3767.70613] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND/AIM To study the changing pattern of acute intestinal obstruction at a teaching institute. PATIENTS AND METHODS It is a prospective descriptive study conducted at a teaching hospital during the period from June 2004 to June 2009. All patients with clinical or radiological evidence of acute intestinal obstruction were included in this study regardless of the gender of the patient. Patients below the age of 10 years were excluded from the study. The treatment strategy was planned ranging from conservative treatment to emergency laparotomy after resuscitation and rehydration of the patient. Details of individual patients were recorded on a pro forma sheet and data analyzed statistically on SPSS version 14. RESULTS A total of 229 patients with acute intestinal obstruction were admitted and treated. The mean age of the study population was 43.08 ± 13.07 years. Postoperative adhesions accounted for 41% (n = 95) of the total cases, followed by abdominal tuberculosis (25%, n = 58), obstructed/ strangulated hernias of different types (18%, n = 42). There was an obvious change in the pattern of etiology of acute intestinal obstruction as the common causes were postoperative adhesions and abdominal tuberculosis instead of obstructed inguinal hernias. CONCLUSION An increase in the adhesive obstruction and a concomitant decrease in the incidence of obstructed hernias indicate a changing trend towards early operation before it gets complicated. Abdominal tuberculosis is emerging as another common cause of acute bowel obstruction.
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Affiliation(s)
- Arshad M. Malik
- Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan,Address for correspondence: Dr. Arshad M. Malik, Department of Surgery, Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan. E-mail:
| | - Madiha Shah
- Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Rafique Pathan
- Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
| | - Krishan Sufi
- Department of Surgery, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan
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26
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Patel RB, Vasava N, Hukkeri S. Non-obstructed femoral hernia containing ascending colon, caecum, appendix and small bowel with concurrent bilateral recurrent inguinal hernia. Hernia 2010; 16:211-3. [PMID: 20835740 DOI: 10.1007/s10029-010-0726-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 08/26/2010] [Indexed: 11/30/2022]
Abstract
Femoral hernias, which are less common than inguinal hernias and more often found in females, occasionally contain more than just small intestine and omentum. Uncommon contents reported in femoral hernia sacs include caecum, appendix, Meckel's diverticulum (Littre hernia), testis, ovary, transverse colon and even stomach or kidney. Strangulation of femoral hernias containing appendix, small intestine and caecum, and Meckel's diverticulum are well reported in the literature. Here, we report a case of a male patient having bilateral femoral hernia with bilateral recurrent inguinal hernia. A huge, right-sided femoral hernia contained terminal ileum, appendix, caecum and ascending colon, which were irreducible but neither obstructed nor strangulated. The patient was operated on with a Pfannenstiel incision together with an infrainguinal incision. For reduction of content, an inguinal ligament was also incised. Bilateral preperitoneal, polypropylene mesh hernioplasty was performed along with rolled plug placement in the right femoral canal. The patient had an uneventful post operative recovery and no recurrence in 6 months of follow up.
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Affiliation(s)
- R B Patel
- Department of Surgery, NHL Municipal Medical College, Ahmadabad, India.
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27
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Sorelli PG, El-Masry NS, Garrett WV. Open femoral hernia repair: one skin incision for all. World J Emerg Surg 2009; 4:44. [PMID: 19948016 PMCID: PMC2789711 DOI: 10.1186/1749-7922-4-44] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2009] [Accepted: 11/30/2009] [Indexed: 11/12/2022] Open
Abstract
Background Femoral hernias are relatively uncommon, however they are the most common incarcerated abdominal hernia, with strangulation of a viscus carrying significant mortality. Classically three approaches are described to open femoral hernia repair: Lockwood's infra-inguinal, Lotheissen's trans-inguinal and McEvedy's high approach. Each approach describes a separate skin incision and dissection to access the femoral sac. The decision as to which approach to adopt, predominantly dependent on the suspicion of finding strangulated bowel, is often a difficult one and in our opinion an unnecessary one. Methods We propose a technique for open femoral hernia repair that involves a single skin incision 1 cm above the medial half of the inguinal ligament that allows all of the above approaches to the hernia sac depending on the operative findings. Thus the repair of simple femoral hernias can be performed from below the inguinal ligament. If found, inguinal hernias can be repaired. More importantly, resection of compromised bowel can be achieved by accessing the peritoneal cavity with division of the linea semilunaris 4 cm above the inguinal ligament. This avoids compromise of the inguinal canal, and with medial retraction of the rectus abdominis muscle enables access to the peritoneal cavity and compromised bowel. Discussion This simple technique minimises the preoperative debate as to which incision will allow the best approach to the femoral hernia sac, allow for alteration to a simple inguinal hernia repair if necessary, and more importantly obviate the need for further skin incisions if compromised bowel is encountered that requires resection.
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Affiliation(s)
- Paolo G Sorelli
- Department of GI Surgery, Medway Maritime Hospital, King's College, UK.
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28
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Cox R, Dalatzui N, Hrouda D, Buchanan GN. Systematic review of internal hernia formation following laparoscopic left nephrectomy. Ann R Coll Surg Engl 2009; 91:667-9. [PMID: 19785941 DOI: 10.1308/003588409x12486167521235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
This is the first identifiable description where internal herniation following laparoscopic left nephrectomy necessitated gangrenous small intestinal resection; similar cases and prevention are discussed.
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29
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Catheter balloon mimicking incarcerated femoral hernia and co-existing small bowel diverticular perforation: a case report. CASES JOURNAL 2009. [PMID: 20184693 PMCID: PMC2827103 DOI: 10.4076/1757-1626-2-8755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The majority of patients with small bowel diverticula are asymptomatic, however, associated complications include inflammation, intestinal obstruction, perforation and gastrointestinal haemorrhage. Bladder divertulae are uncommon and can herniate into the femoral or inguinal canal as well as the scrotum. We report the case of an elderly lady who underwent laparotomy for an incarcerated femoral hernia and was found to have the catheter balloon stuck into a bladder diverticulum in the femoral canal and coexisting small bowel diverticular perforation.
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30
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Reeve K, Hotouras A, Manghat M, Pillai S. Catheter balloon mimicking incarcerated femoral hernia and co-existing small bowel diverticular perforation: a case report. CASES JOURNAL 2009; 2:8755. [PMID: 20184693 DOI: 10.1186/1757-1626-0002-0000008755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 08/19/2009] [Indexed: 09/26/2022]
Abstract
The majority of patients with small bowel diverticula are asymptomatic, however, associated complications include inflammation, intestinal obstruction, perforation and gastrointestinal haemorrhage. Bladder divertulae are uncommon and can herniate into the femoral or inguinal canal as well as the scrotum. We report the case of an elderly lady who underwent laparotomy for an incarcerated femoral hernia and was found to have the catheter balloon stuck into a bladder diverticulum in the femoral canal and coexisting small bowel diverticular perforation.
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Affiliation(s)
- Katherine Reeve
- Department of General Surgery and Colorectal Surgery, Lincoln County Hospital, Lincoln, UK.
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31
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Abdominal compartment syndrome in patients with strangulated hernia. Hernia 2008; 12:613-20. [PMID: 18682888 DOI: 10.1007/s10029-008-0394-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 05/26/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Intestinal obstruction (IO) leads to increased intra-abdominal pressure and abdominal compartment syndrome. The purpose of this study was to investigate the characteristics of abdominal compartment syndrome in patients with IO secondary to strangulated hernia. METHODS We studied 81 consecutive unselected patients presenting complicated hernias and IO. We measured intra-abdominal pressure using the intra-vesicular pressure method. RESULTS Preoperative (15 min) intra-abdominal pressure was higher in patients with strangulated hernias. Postoperative (15 min) intra-abdominal pressure in both groups decreased to similar values. Intra-abdominal pressure was measured during the preoperative period in patients with strangulated hernias and during the postoperative period at 15 min (13.8 +/- 6.4 mmHg), 24 h (9.8 +/- 3.2 mmHg) and 48 h (7.4 +/- 2.4 mmHg). Abdominal compartment syndrome developed in 47% cases with strangulated hernias with a mortality of five patients. CONCLUSIONS Serial measurements of intra-abdominal pressure evidenced the clinical severity of strangulated hernia. Intra-abdominal pressure measurement may be used as a predictor of intestinal strangulation in patients presenting acute abdominal compartment syndrome secondary to complicated hernia.
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Abstract
Mechanical obstruction of the small bowel and colon is moderately common, accounting for several hundred thousand admissions per year in the United States. Patients generally present with abdominal pain, nausea and emesis, abdominal distention, and progressive obstipation. Clinical findings of high fever, localized severe abdominal tenderness, rebound tenderness, severe leukocytosis, or metabolic acidosis suggest possible complications of bowel necrosis, bowel perforation, or generalized peritonitis. Differentiation of total mechanical obstruction from partial mechanical obstruction and pseudo-obstruction is important because total mechanical obstruction is generally treated surgically,whereas the other two entities are usually treated medically. Mechanical obstruction is usually suggested by plain abdominal radiographs, and confirmed by small bowel follow through,abdominal CT, or CT enteroclysis.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, William Beaumont Hospital, MOB 233, 3601 West Thirteen Mile Road, Royal Oak, MI 48073, USA.
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Markogiannakis H, Messaris E, Dardamanis D, Pararas N, Tzertzemelis D, Giannopoulos P, Larentzakis A, Lagoudianakis E, Manouras A, Bramis I. Acute mechanical bowel obstruction: Clinical presentation, etiology, management and outcome. World J Gastroenterol 2007; 13:432-7. [PMID: 17230614 PMCID: PMC4065900 DOI: 10.3748/wjg.v13.i3.432] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To identify and analyze the clinical presentation, management and outcome of patients with acute mechanical bowel obstruction along with the etiology of obstruction and the incidence and causes of bowel ischemia, necrosis, and perforation.
METHODS: This is a prospective observational study of all adult patients admitted with acute mechanical bowel obstruction between 2001 and 2002.
RESULTS: Of the 150 consecutive patients included in the study, 114 (76%) presented with small bowel and 36 (24%) with large bowel obstruction. Absence of passage of flatus (90%) and/or feces (80.6%) and abdominal distension (65.3%) were the most common symptoms and physical finding, respectively. Adhesions (64.8%), incarcerated hernias (14.8%), and large bowel cancer (13.4%) were the most frequent causes of obstruction. Eighty-eight patients (58.7%) were treated conservatively and 62 (41.3%) were operated (29 on the first day). Bowel ischemia was found in 21 cases (14%), necrosis in 14 (9.3%), and perforation in 8 (5.3%). Hernias, large bowel cancer, and adhesions were the most frequent causes of bowel ischemia (57.2%, 19.1%, 14.3%), necrosis (42.8%, 21.4%, 21.4%), and perforation (50%, 25%, 25%). A significantly higher risk of strangulation was noticed in incarcerated hernias than all the other obstruction causes.
CONCLUSION: Absence of passage of flatus and/or feces and abdominal distension are the most common symptoms and physical finding of patients with acute mechanical bowel obstruction, respectively. Adhesions, hernias, and large bowel cancer are the most common causes of obstruction, as well as of bowel ischemia, necrosis, and perforation. Although an important proportion of these patients can be nonoperatively treated, a substantial portion requires immediate operation. Great caution should be taken for the treatment of these patients since the incidence of bowel ischemia, necrosis, and perforation is significantly high.
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Affiliation(s)
- Haridimos Markogiannakis
- 1st Department of Propaedeutic Surgery, Hippokration Hospital, Athens Medical School, University of Athens, Vasilissis Sofias 114 Avenue, Athens 11527, Greece.
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