Thrombosed Aneurysm of Superficial Epigastric Vein Simulating Inguinal Hernia: Report of Two Cases

Aim. Presentation of two cases of superficial epigastric vein aneurysm simulating inguinal hernia. To our knowledge, only one other case is reported in the literature. Case presentation. The first case was a 34-year-old female with left inguinal pain and swelling which was clinically diagnosed as inguinal hernia. The second case was a 28-year-old female with inguinal pain and swelling, depicted with triplex ultrasonography and computed tomography, and was suspected to have inguinal hernia or enlarged inguinal lymph node. During the surgical exploration, both patients were found to have thrombosed aneurysm of the superficial epigastric vein. During the surgical exploration, both patients were found to have thrombosed aneurysm of the superficial epigastric vein. The superficial epigastric vein was ligated, and the venous aneurysms ( 6 × 4 × 3 and 2 × 3 × 2.5 c m , respectively) were excised. Histological examination of the thrombosed aneurysm showed complete replacement of the vascular wall by fibrous tissue, thrombosis, and an inflammatory reaction. There were no postoperative complications, and both patients were discharged on the second postoperative day. The 3-month and 1-year follow-up examination, respectively, was uneventful. Conclusion. Although venous aneurysms in the inguinal area are rare, they should be included in the differential diagnosis of a groin swelling.

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Pantaloon Hernia in a Female: A Rare Finding

European Journal of Medical and Health Sciences ◽

10.24018/ejmed.2021.3.2.727 ◽

2021 ◽

Vol 3 (2) ◽

pp. 1-2

Author(s):

Onyeyirichi Otuu ◽

Uche Emmanuel Eni ◽

Callistus Ugochukwu Ndunaka ◽

Nwanneka Louisa Kwentoh

Keyword(s):

Inguinal Hernia ◽

Correct Diagnosis ◽

Posterior Wall ◽

Uneventful Recovery ◽

Indirect Inguinal Hernia ◽

Left Groin ◽

Epigastric Artery ◽

Appropriate Treatment ◽

Groin Swelling

The incidence of inguinal hernia in females is less compared to the males. Pantaloon hernia in females is even rarer and may be first diagnosed during surgery. We report a rare case of pantaloon hernia in a 60 year old female patient. She presented with reducible left groin swelling of 3 years duration and a clinical diagnosis of an indirect inguinal hernia made. A direct sac and an indirect sac were discovered at operation on both sides of the inferior epigastric artery. The posterior wall was repaired by Lichtenstein method. Patient made an uneventful recovery and there was no recurrence after 12 months of follow up. Though pantaloon hernia is rare in females, proper dissection, and identification of structure in the inguinal canal is necessary to make the correct diagnosis and to offer the appropriate treatment.

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Spontaneous bilateral rod fracture of malleable penile prosthesis

Canadian Urological Association Journal ◽

10.5489/cuaj.2005 ◽

2014 ◽

Vol 8 (9-10) ◽

pp. 739 ◽

Cited By ~ 2

Author(s):

Ibrahim Halil Bozkurt ◽

Tarik Yonguc ◽

Burak Arslan ◽

Zafer Kozacioglu ◽

Tansu Degirmenci ◽

...

Keyword(s):

Erectile Dysfunction ◽

Penile Prosthesis ◽

Mechanical Failure ◽

Surgical Exploration ◽

X Ray ◽

First Case ◽

Rod Fracture

Mechanical failure with a malleable penile prosthesis is very rare.To the best of our knowledge, this is the first case reporting on a bilateral AMS 650 rod mechanical failure. We present a 50-year-old man with organic erectile dysfunction who experienced bilateral AMS 650 rod fracture after 14 years. The rod fracture of the left side was confirmed via X-ray preoperatively. The surgical exploration revealed a fracture of both rods. After the removal of both rods, we implanted a new malleable device during the same session. At the 6-month follow-up, the patient was satisfied with his prosthesis.

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A95 DO BENIGN LIVER TUMOURS ALWAYS STAY BENIGN? A CASE REPORT OF HEPATIC INFLAMMATORY PSEUDOTUMOR AND SUBSEQUENT CHOLANGIOCARCINOMA

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwz047.094 ◽

2020 ◽

Vol 3 (Supplement_1) ◽

pp. 110-111

Author(s):

K Onizuka ◽

M Schell ◽

K Tsoi

Keyword(s):

Case Report ◽

De Novo ◽

Fatty Infiltration ◽

Fibrous Tissue ◽

Inflammatory Cell Infiltrate ◽

Benign Lesions ◽

First Case ◽

Spindle Cell Proliferation ◽

History Of

Abstract Background Hepatic inflammatory pseudotumors (HIPTs) are rare, benign lesions of unclear etiology which can be challenging to diagnose and differentiate from malignant processes. The optimal treatment and follow up of these lesions is controversial, and literature exists to support both surgical resection as well as conservative medical management. The natural history of HIPTs is generally benign, however there are some reports of disease recurrence, and two reports of malignant transformation to lymphoma. Aims To describe a case of HIPT with progression to malignancy. Methods Case report and review of the literature. Results A 53-year-old male presented to St. Joseph’s Healthcare Hamilton in August 2019 with a three-week history of abdominal pain and distention. He had a previous diagnosis of HIPT, incidentally found on ultrasound four years earlier. CT in January 2016 reported two well-marginated focal liver masses with peripheral rim enhancement and central hypodensity, 3.9 x 3.9cm in segment 2, and a 6 x 4.6cm central lesion, as well as diffuse fatty infiltration of the liver. Bloodwork showed a mildly elevated Ca19-9 626 kU/L, and normal CEA and AFP. Two biopsies were performed in 2016, both demonstrating dense fibrous tissue and abundant chronic inflammatory cell infiltrate composed of lymphocytes, histiocytes, eosinophils, and plasma cells, with some areas of bland spindle cell proliferation. No malignant cells, and histology was felt to be consistent with HIPT. MRI in September 2017 showed progression of disease, prompting Rheumatology to initiate immunosuppressive medications, however serial imaging continued to show increase in the size and number of lesions. Upon presentation to hospital in August 2019 ultrasound showed new ascites, with ascitic fluid analysis reporting highly atypical cells with prominent nucleoli of uncertain origin. CT showed extensive intrahepatic lesions throughout both lobes of the liver, and tumor markers were elevated with Ca19-9 16,581 kU/L, CEA 10 ug/L, Ca125 511 kU/L, and normal AFP. Repeat liver biopsy reported adenocarcinoma, likely cholangiocarcinoma, with background cirrhosis. Medical oncology did not feel he would tolerate chemotherapy, and he was thus discharged home with palliative supports. Conclusions HIPTs are benign lesions that are often initially misdiagnosed as malignancy, however this is the first case reporting progression of HIPT to cholangiocarcinoma. It is unclear if HIPT itself has premalignant potential, or whether its presence delays diagnosis of subsequent de novo malignancies. Given these uncertainties, as well as the lack of clarity on optimal management of HIPT, this case illustrates the importance of long-term clinical and radiographic follow up of these uncommon lesions, with consideration of repeat biopsy if the disease is not following the expected clinical course. Funding Agencies None

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Laparoscopic repair of inguinal hernia: Prospective evaluation at a tertiary care center

Journal of Surgical Sciences ◽

10.3329/jss.v23i2.46111 ◽

2020 ◽

Vol 23 (2) ◽

pp. 54-58

Author(s):

ABM Mahbubur Rahman ◽

Tamjeed Alam ◽

AHM Shamsul Alam ◽

Fahim Ferdaus ◽

Gazi Gias Uddin

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Hernia Repair ◽

Groin Hernia ◽

Tertiary Care ◽

Groin Hernia Repair ◽

Groin Hernias ◽

Laparoscopic Groin Hernia Repair ◽

Repair Techniques

Background: Treatment of groin hernias continues to evolve. The emergence of laparoscopic inguinal hernia surgery has challenged the conventional gold standard Lichtenstein’s tension free mesh repair. Laparoscopic technique to achieve surgical correction over groin hernia is increasingly being practiced in our country, and it is imperative to test the overall outcome of this technique in a tertiary care setting. Objectives: Current study was aimed at evaluating the per-operative events, early and late outcomes of laparoscopic groin hernia repair techniques. End points of evaluation were postoperative pain, hospital stay, resumption of normal activities, chronic pain and recurrence. Methods: Within a 2-year period, 45 patients of groin hernias of different clinical types underwent laparoscopic inguinal hernia repair in Bangladesh Medical College Hospital were recruited in this prospective observational study. Preoperative findings, intraoperative course, postoperative and follow-up data were analyzed to evaluate the outcomes. Observations were made regarding operating time, operative hazards, postoperative pain, incidence of early post-operative morbidities, hospital stay, resumption of activities. Total 24 months follow-up was carried out with regards to normal activity, late complications notably chronic groin pain and recurrence. Results: The mean age of 38.1±11.1 years, 27(60%) patients underwent TEP repair whereas, TAPP procedure was carried out in 18 patients (40%). For unilateral hernia repair using TEP technique, mean operative time was 50.3±4.2 mints and 61.7±5.3 mints for direct and indirect variety (D/I), with the corresponding rates for TAPP repair being 65.0±2.2 mints and 72.8±3.2 mints (D/I) respectively. Conversion rate to other operative procedure was 6.67%. The overall surgery related early post-operative morbidity was 7.4% (TEP) and 16.8% (TAPP). 3 out of 45 patients (6.67%) experienced chronic pain in the groin in the study. However, there was no single incidence of recurrence observed during the follow up period. Conclusion: Laparoscopic groin hernia repair techniques are safe and feasible, offers the benefits of minimally invasive surgery and becoming the procedure of choice specially for bilateral and recurrent inguinal hernias. Journal of Surgical Sciences (2019) Vol. 23(2): 54-58

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LAPAROSCOPIC TRANS-ABDOMINAL PRE-PERITONEAL (TAPP) REPAIR FOR TREATMENT INGUINAL HERNIA DISEASE

Journal of Medicine and Pharmacy ◽

10.34071/jmp.2018.4.11 ◽

2018 ◽

Vol 8 (4) ◽

pp. 76-80

Author(s):

Thao Nguyen Minh ◽

Vu Pham Anh ◽

Tri Nguyen Huu ◽

Phu Nguyen Doan Van ◽

Phuc Nguyen Thanh ◽

...

Keyword(s):

Inguinal Hernia ◽

Operative Time ◽

Bilateral Hernia ◽

Repair Method ◽

Tapp Repair ◽

Post Operation ◽

Average Operative Time ◽

The Mean

Background: Inguinal hernia is one of the commonest surgical diseases and there are many different techniques applied. The laparoscopic trans-abdominal pre-peritoneal (TAPP) repair allows a better view of the inguinal anatomy, evaluation of opposite side and resolve combined peritoneal diseases as well. Patient and method: The study included 60 cases with inguinal hernia that have been treated by laparoscopic transabdominal pre-peritoneal (TAPP) repair. Method: Description, prospective follow-up. Result: The mean age was 58±18.2. 96.7% were males. The average operative time was 45.6±15.1 minutes for one side hernia, 73±25.2 minutes for bilateral hernia. 02 cases have been post-operation inguinal seroma complication (3.3%), 02 cases with hydrocele (3.3%), 01 case with abdominal seroma (1.7%). 04 cases (6.7%) opposite inguinal hernia were detected and 05 cases (8.3%) with combined diseases were resolved. Duration of post-operative stay was 3.9±1.1 days. Conclusion: TAPP is a safe and feasible procedure, allows evaluation of opposite side and resolve combined peritoneal diseases.

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When fever is more than infection: two cases of vancomycin-induced drug reaction with eosinophilia and systemic symptoms (DRESS)

BMJ Case Reports ◽

10.1136/bcr-2020-238006 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238006

Author(s):

Mitchell Cox ◽

Sophie Paviour ◽

Sophie Gregory ◽

Rusheng Chew

Keyword(s):

Drug Reaction ◽

Cytomegalovirus Reactivation ◽

First Case ◽

Metropolitan Hospital ◽

Orthopaedic Ward ◽

Systemic Hypersensitivity ◽

Systemic Symptoms ◽

Inflammatory Syndrome ◽

Intravenous Glucocorticoids

Drug reaction with eosinophilia and systemic symptoms (DRESS) is a rare, but serious systemic hypersensitivity reaction associated with a range of medications. We present two cases of vancomycin-induced DRESS, which occurred simultaneously in the orthopaedic ward in an outer metropolitan hospital. These cases demonstrate the complexity in the diagnosis and management of this inflammatory syndrome on the background of known infection as well as evidence for linezolid as an alternative to vancomycin. The first case was managed conservatively, but developed progressive renal and liver injury along with demonstrated cytomegalovirus reactivation and recurrent colitis, and was eventually palliated. The second was commenced on intravenous glucocorticoids and achieved remission, although had ongoing renal dysfunction at the time of discharge from outpatient follow-up.

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Complete resolution of acute pancreatitis-induced chylous ascites following transhepatic portal vein stenting

BMJ Case Reports ◽

10.1136/bcr-2020-235986 ◽

2020 ◽

Vol 13 (12) ◽

pp. e235986

Author(s):

Alexander Tindale ◽

James Jackson ◽

Darina Kohoutova ◽

Panagiotis Vlavianos

Keyword(s):

Portal Vein ◽

Complete Resolution ◽

Chylous Ascites ◽

Biliary Pancreatitis ◽

Acute Biliary Pancreatitis ◽

Portal Vein Stenosis ◽

First Case ◽

Vein Stenosis ◽

Inflammatory Changes

We introduce a case of a 73-year-old man who developed intractable chylous ascites due to portal vein compression as a result of peripancreatic inflammatory changes after acute biliary pancreatitis. After stenting the portal vein stenosis, the chylous ascites improved from requiring weekly paracentesis to requiring no drainage within 4 months of the procedure and at the 15-month follow-up. To our knowledge, it is the first case reported in the literature where portal vein stenting has successfully been used to treat pancreatitis-induced chylous ascites.

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Extremely Elevated Cerebrospinal Fluid Protein and Glucose Level in a Neonate with Hypernatremic Dehydration

Journal of Pediatric Neurology ◽

10.1055/s-0040-1708496 ◽

2020 ◽

Author(s):

Arti Maria ◽

Tapas Bandyopadhyay

Keyword(s):

Cerebrospinal Fluid ◽

Neurodevelopmental Outcome ◽

Neurological Sequelae ◽

Glucose Levels ◽

Csf Analysis ◽

First Case ◽

Time Of Admission ◽

Cerebrospinal Fluid Protein ◽

Hypernatremic Dehydration

AbstractWe describe the case of a term newborn who presented with hypernatremic dehydration on day 19 of life. The baby was otherwise hemodynamically stable with no evidence of focal or asymmetric neurological signs. The laboratory tests at the time of admission were negative except for hypernatremia and the extremely elevated levels of cerebrospinal fluid (CSF) protein (717 mg/dL) and glucose levels (97 mg/dL). The hypernatremic dehydration was corrected as per the unit protocol over 48 hours. Repeat CSF analysis done after 5 days showed normalization of the protein and glucose levels. Serial follow-up and neuroimaging showed no evidence of neurological sequelae. Unique feature of our case is this is the first case reporting such an extreme elevation of CSF protein and glucose levels that have had no bearing on neurodevelopmental outcome at 1 month and 3 months of follow-up.

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Lichtenstein inguinal hernia repairs with porcine small intestine submucosa: a 5- year follow-up. a prospective randomized controlled study

Regenerative Biomaterials ◽

10.1093/rb/rbaa055 ◽

2021 ◽

Author(s):

Baoshan Li ◽

Xin Zhang ◽

Yi Man ◽

Jiadong Xie ◽

Wei Hu ◽

...

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Hernia Repair ◽

Term Effect ◽

Control Group ◽

Small Intestine Submucosa ◽

Long Term Effect ◽

Porcine Small Intestine Submucosa

Abstract Porcine small intestine submucosa (SIS) biologic patch has been used in inguinal hernia repair. However, there are little data available to assess the long-term effect after repair. This study aimed to explore the long-term effect of SIS patch in open inguinal hernia repair. Sevent-six patients with unilateral inguinal hernia were treated with Lichtenstein tension-free hernia repair using SIS patch (Beijing Datsing Bio-Tech Co., Ltd.) and Surgisis patch (COOK, USA) in Tianjin Union Medical Center and China-Japan Friendship Hospital. In the trial, the long-term efficacy of the treatment group and the control group were compared. A total of 66 patients in both groups received long-term follow-up (> 5 years) after surgery, with a follow-up rate of 86.8%. During the follow-up period, there was one case of recurrence, one case of chronic pain in the control group. There was no statistically significant difference (P > 0.05) in terms of recurrence, chronic pain, foreign body sensation and infection between the two groups of patients. After long-term observations, it has been found that the porcine small intestinal submucosa (SIS) biological patch is safe and effective for inguinal hernia Lichtenstein repair, and has a low recurrence rate and complication rate.

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Penile Lymphoepithelioma-Like Carcinoma: A Rare Case With PD-L1 Expression

International Journal of Surgical Pathology ◽

10.1177/1066896920988340 ◽

2021 ◽

pp. 106689692098834

Author(s):

Raquel Machado-Neves ◽

Bernardo Teixeira ◽

Elsa Fonseca ◽

Pedro Valente ◽

Joaquim Lindoro ◽

...

Keyword(s):

Human Papillomavirus ◽

Tumor Cells ◽

Rare Case ◽

Malignant Tumors ◽

Squamous Cell Carcinomas ◽

The Third ◽

The Past ◽

First Case ◽

Lymphoplasmacytic Infiltrate

Most malignant tumors of the penis are squamous cell carcinomas (SCC), being divided in 2 groups, one human papillomavirus (HPV)-related and another non-HPV-related, with lymphoepithelioma-like carcinoma (LELC) being one of the rarest HPV-related SCC. In this article, we report a case of a 50-year-old man who presented testicular swelling and pain for the past 3 months. A penile mass was identified, and the patient was submitted to a total penectomy. The penectomy specimen showed an ulcerated lesion at the glans reaching the cavernous bodies. Microscopic examination showed undifferentiated epithelial cells with syncytial growth pattern mix with a dense lymphoplasmacytic infiltrate, consistent with LELC. The tumor cells expressed p16 and all 3 different clones of PDL1 (22C3, SP263, and SP142). The patient is alive and well with a follow-up of 3 months. To our knowledge, this is the third LELC of the penis reported in literature and the first case reported with PDL1 expression.

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