scholarly journals Obstructed descending colon mass pretended with Bockdalek hernia: a case report

2021 ◽  
Author(s):  
mohammad eslamian ◽  
Mohsen kolahdouzan
Keyword(s):  
Diaphragmatic Hernia ◽  
Abdominal Pressure ◽  
Right Colon ◽  
Abdominal Ct ◽  
Midline Laparotomy ◽  
Abdominal Ct Scan ◽  
Descending Colon ◽  
The Right ◽  
Thoracic And Abdominal ◽  
Diaphragmatic Hernias

Abstract Introduction: Adult Bochdalek hernia is one of the right-sided diaphragmatic hernias that less than 30 cases reported until now.Case: I herein report a 64-year-old female patient who had dyspnea, abdominal pain, and nausea. Primary imaging (thoracic and abdominal CT scan) showed a right-sided diaphragmatic hernia that was contained the liver and right colon. The patient underwent right posterior thoracotomy at first, so the 5*5 cm diaphragmatic defect was repaired. Due to peritonitis that happened after two days, a midline laparotomy was performed. Finally, it was cleared that the main problem was the obstructed and perforated descending colon mass that was presented with Bockdalek hernia. Unfortunately, she died.Conclusion It is important to determine the reason for the presentation of the symptomatic diaphragmatic hernia in adult patients. It should be considered that an increase of intra-abdominal pressure like the presence of obstructed colon mass can cause it.

scholarly journals Late-Presenting Left-Sided Morgagni Congenital Diaphragmatic Hernia in a 9-Year-Old Male

2011 ◽  
Vol 2011 ◽  
pp. 1-4
Author(s):  
Jennifer M. Kim ◽  
Marisa Couluris ◽  
Bruce M. Schnapf
Keyword(s):  
Congenital Diaphragmatic Hernia ◽  
Diaphragmatic Hernia ◽  
Gastrointestinal Symptoms ◽  
Lower Lobe ◽  
Abdominal Radiograph ◽  
Rare Occurrence ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
Diaphragmatic Hernias ◽  
Vague Abdominal Pain

Congenital diaphragmatic hernias are common, primarily occurring through the foramen of Bochdalek. However, in contrast, defects through the foramen of Morgagni are much more rare. When late presentations occur, patients may be asymptomatic or may be critically ill with respiratory and gastrointestinal symptoms. In this paper, we present a 9-year-old male who presented with recurrent, vague abdominal pain, and a previously normal abdominal CT scan. Initial investigation via an abdominal radiograph demonstrated an unexpected left lower lobe abnormality. Further evaluation and management revealed this abnormality to be an unusual left-sided congenital diaphragmatic hernia that appeared through the retrosternal foramen of Morgagni, a rare occurrence.

scholarly journals Delayed Presentation of Traumatic Right-Sided Diaphragmatic Hernia after Abdominoplasty

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Caroline C. Jadlowiec ◽  
Lois U. Sakorafas
Keyword(s):  
Diaphragmatic Hernia ◽  
Normal Pressure ◽  
Positive Pressure ◽  
Delayed Presentation ◽  
Pressure Gradients ◽  
Abrupt Changes ◽  
Thoracic And Abdominal ◽  
Pressure Changes ◽  
Surgical Manipulation ◽  
Diaphragmatic Hernias

Traumatic diaphragmatic hernias are rare and challenging to diagnose. Following trauma, diagnosis may occur immediately or in a delayed fashion. It is believed that left traumatic diaphragmatic hernias are more common as a result of the protective right-sided anatomic lie of the liver. If unrecognized, traumatic diaphragmatic injuries are subject to enlarge over time as a result of the normal pressure changes observed between the thoracic and abdominal cavities. Additionally, abrupt changes to the pressure gradients, such as those which occur with positive pressure ventilation or surgical manipulation of the abdominal wall, can act as a nidus for making an asymptomatic hernia symptomatic. We report our experience with a delayed traumatic right-sided diaphragmatic hernia presenting with large bowel incarceration two months after abdominoplasty. In our review of the literature, we were unable to find any reports of delayed presentation of a traumatic right-sided diaphragmatic hernia occurring acutely following abdominoplasty.

scholarly journals Long splenic flexure carcinoma requiring laparoscopic extended left hemicolectomy with CME and transverse-rectal anastomosis: technique for a modified partial Deloyers in 5 steps to achieve enough reach and preserving middle colic vessels

2021 ◽  
Author(s):  
Salomone Di Saverio ◽  
Kostantinos Stasinos ◽  
Weronyka Stupalkowska ◽  
Umberto Bracale ◽  
Pierpaolo Sileri ◽  
...  
Keyword(s):  
Splenic Flexure ◽  
Primary Anastomosis ◽  
Colorectal Anastomosis ◽  
Ascending Colon ◽  
Right Colon ◽  
Left Hemicolectomy ◽  
Tension Free ◽  
Descending Colon ◽  
Deloyers Procedure ◽  
The Right

Abstract Introduction This How-I-Do-It article presents a modified Deloyers procedure by mean of the case of a 67-year-old female with adenocarcinoma extending for a long segment and involving the splenic flexure and proximal descending colon who underwent a laparoscopic left extended hemicolectomy (LELC) with derotation of the right colon and primary colorectal anastomosis. Background While laparoscopic extended right colectomy is a well-established procedure, LELC is rarely used (mainly for distal transverse or proximal descending colon carcinomas extending to the area of the splenic flexure). LELC presents several technical challenges which are demonstrated in this How-I-Do-It article. Technique and methods Firstly, the steps needed to mobilize the left colon and procure a safe approach to the splenic flexure are described, especially when a tumor is closely related to it. This is achieved by mobilization and resection of the descending colon, while maintaining a complete mesocolic excision to the level of the duodenojejunal ligament for the inferior mesenteric vein and flush to the aorta for the inferior mesenteric artery. Subsequently, we depict the adjuvant steps required to enable a primary anastomosis by trying to mobilize the transverse colon and release as much of the mesocolic attachments at the splenic flexure area. Finally, we present the rare instance when a laparoscopic derotation of the ascending colon is required to provide a tension-free anastomosis. The resection is completed by delivery of the fully derotated ascending colon and hepatic flexure through a suprapubic mini-Pfannenstiel incision. The primary colorectal anastomosis is subsequently fashioned in a tension-free way and provides for a quick postoperative recovery of the patient. Results This modified Deloyers procedure preserves the middle colic since the fully mobilized mesocolon allows for a tension-free anastomosis while maintaining better blood supply to the mobilized stump. Also, by eliminating the need for a mesenteric window and the transposition of the caecum, we allow the small bowel to rest over the anastomosis and the mobilized transverse colon and reduce the possibility of an internal herniation of the small bowel into the mesentery. Conclusions Laparoscopic derotation of the right colon and a partial, modified Deloyers procedure preserving the middle colic vessels are feasible techniques in experienced hands to provide primary anastomosis after LELC with improved functional outcome. Nevertheless, it is important to consider anatomical aspects of the left hemicolectomy along with oncological considerations, to provide both a safe oncological resection along with good postoperative bowel function.

scholarly journals Dextrocardia with Situs Inversus in an 18-Year-Old Nigerian Female: The Computed Tomographic Findings and a Case Report

2021 ◽  
Vol 2 (2) ◽  
pp. 01-03
Author(s):  
Sule MB
Keyword(s):  
Situs Inversus ◽  
Congenital Abnormalities ◽  
Rare Condition ◽  
Abdominal Ct ◽  
Computed Tomographic ◽  
Abdominal Ct Scan ◽  
Displaced Spleen ◽  
Upper Abdominal ◽  
The Right ◽  
Extracardiac Abnormalities

Dextrocardia is a cardiac positional anomaly in which the heart is located in the right hemithorax with its base to apex axis directed to the right and caudad. The malposition is intrinsic to the heart and not caused by extracardiac abnormalities. Dextrocardia is a rare condition and usually found incidentally and in association with other congenital abnormalities. It has an incidence of less than 1%. This is an 18 year old Nigerian female who was referred for computed tomography (CT) of the chest on account of prolonged and recurrent cough with a suspicion of diffuse interstitial lung disease. The chest and upper abdominal CT scan showed dextrocardia with a right placed heart, displaced spleen and stomach to the right hemi-abdomen and liver displaced to the left hemi-abdomen; confirming the diagnosis of dextrocardia with situs inversus. We present this case of dextrocardia with abdominal situs inversus due to its rarity in literature.

scholarly journals NEFROLITIASIS PADA ANAK USIA TIGA TAHUN DI RSUD DR. HI. ABDUL MOELOEK, LAMPUNG: SEBUAH LAPORAN KASUS

2020 ◽  
Vol 7 (2) ◽  
pp. 47-53
Author(s):  
Angga Hendro Priyono ◽  
Exsa Hadibrata
Keyword(s):  
Laboratory Finding ◽  
Flank Region ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
Physical Examinations ◽  
The Right ◽  
Ammonium Urate ◽  
Sodium Urate ◽  
Phosphate Carbonate

ABSTRACT  Background: The incidence of nephrolithiasis in children increases over time. It has been reported an increase of 6 to 10% per year for the last twenty-five years. Research in developing country showed that urinary tract infection and metabolic disorders were the caused of nephrolithiasis. Illustration Case: Three years 10 months old boy had a complaint of pain in plank region followed by tea-like urine since two months ago. Physical examination showed that he appeared to be moderately ill and compos mentis. His physical examinations were normal except positive ballotement and positive costoverebral angle (CVA) pain in the right flank region. Laboratory finding showed positive eritrocyte in urinalysis. Ultrasonography and abdominal CT-scan consistent with nephrolithiasis. Management: Pyelolitotomy was performed under general anesthesia. Postoperatively, patient treated in a pediatric surgery room and observation was carried out. He was given  D5NS 500 ml administered 20 drops per minute microdrip IV, paracetamol 3 x 225 mg IV, and cefotaxime injection 2 x 500 mg IV after a skin test first.  Result and Follow Up: An irregular stone 1,5 cm x 1 cm in size consist of 45% ammonium urate, 31% sodium urate monohydrate, and 24% amorphous calcium phosphate carbonate was found. Discussion: Nephrolithiasis in children occurs due to several related conditions such as genetics, ethnicity, climate, and nutrition. Complications can be prevented by managing and controlling appropriate risk factors.

scholarly journals Endoscopic Submucosal Dissection of Pseudo-polyps in the Right Colon Using a Flexible Grasper With Articulating Distal Tip and Elbow-Like Bending

2021 ◽  
Author(s):  
Shinya Urakawa ◽  
Teijiro Hirashita ◽  
Yuka Hirashita ◽  
Lea Lowenfeld ◽  
Krishna Gurram ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
3D Model ◽  
Posterior Wall ◽  
Ascending Colon ◽  
Procedure Time ◽  
Right Colon ◽  
Submucosal Dissection ◽  
Descending Colon ◽  
The Right ◽  
Surgical Platform

Abstract Endoscopic submucosal dissection (ESD) is challenging in the right colon. Traction devices can make it technically easier. In this study, we evaluated a flexible grasper with articulating tip and elbow-like bending (IgE) through a double-balloon surgical platform (DESP), compared with an earlier generation grasper without elbow-like bending (Ig). The reach of Ig/IgE was investigated at eight locations using a synthetic colon within a 3D model. Using a fresh porcine colorectum, 4 cm pseudo-polyps were created at the posterior wall of the ascending colon. Fifty-four ESD procedures were performed using three techniques: standard ESD (STD), ESD using Ig (DESP+Ig), and ESD using IgE (DESP+IgE). IgE was able to reach the full circumference at all the locations, whereas the medial walls proximal to the descending colon were out of Ig’s reach. Compared with the STD, both DESP+Ig and DESP+IgE showed significantly shorter procedure time (STD vs. DESP+Ig vs. DESP+IgE = median 48.9 min vs. 38.6 vs. 29.9) and fewer injuries (1.5 vs. 0 vs. 0). Moreover, the DESP+IgE had a shorter procedure time than the DESP+Ig (p=0.0025). The IgE with DESP increased instrument reach compared to Ig, and likely represented a traction tool for excision of large pseudo-polyps in the right colon.

scholarly journals Right-sided strangulating diaphragmatic hernia in an adult without history of trauma: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Konstantinos G. Spiridakis ◽  
Mathaios E. Flamourakis ◽  
Ioannis G. Gkionis ◽  
Eleni I. Kaloeidi ◽  
Anthoula I. Fachouridi ◽  
...  
Keyword(s):  
Diaphragmatic Hernia ◽  
Clinical Status ◽  
Traumatic Injury ◽  
Postoperative Recovery ◽  
Case Presentation ◽  
Uneventful Postoperative Recovery ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
Diaphragmatic Hernias

Abstract Background Diaphragmatic hernia involves protrusion of abdominal contents into the thorax through a defect in the diaphragm. This defect can be caused either by developmental failure of the posterolateral foramina to fuse properly, or by traumatic injury of the diaphragm. Left-sided diaphragmatic hernias are more common (80–90%) because the right pleuroperitoneal canal closes earlier and the liver protects the right diaphragm. Diaphragmatic hernias in adults are relatively asymptomatic, but in some cases may lead to incarcerated bowel, intraabdominal organ dysfunction, or severe pulmonary disease. The aim of this report is to enlighten clinical doctors about this rare entity that can have fatal consequences for the patient. Case presentation We present a rare case of a right-sided strangulating diaphragmatic hernia in an adult Caucasian patient without history of trauma. Clinical examination revealed bowel sounds in the right hemithorax, which were confirmed by the presence of loops of small intestine into the right part of the thorax through the right diaphragm, as was shown on chest X-ray and computerized tomography. Deterioration of the clinical status of the patient led to an operation, which revealed strangulated necrotic small bowel. Approximately 1 m of bowel was removed, and laterolateral anastomosis was performed. The patient had an uneventful postoperative recovery and was discharged 8 days later. Conclusions Surgery is required to replace emerged organs into the abdomen and to repair diaphragmatic lesion. A delayed approach can have catastrophic complications for a patient.

scholarly journals Use of an endoscopic flexible grasper as a traction tool for excision of polyps: preclinical trial

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shinya Urakawa ◽  
Teijiro Hirashita ◽  
Yuka Hirashita ◽  
Lea Lowenfeld ◽  
Krishna C. Gurram ◽  
...  
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
3D Model ◽  
Posterior Wall ◽  
Ascending Colon ◽  
Procedure Time ◽  
Right Colon ◽  
Preclinical Trial ◽  
Descending Colon ◽  
The Right ◽  
Surgical Platform

AbstractEndoscopic submucosal dissection (ESD) is challenging in the right colon. Traction devices can make it technically easier. In this study, we evaluated a flexible grasper with articulating tip and elbow-like bending (IgE) through a double-balloon surgical platform (DESP), compared with an earlier generation grasper without elbow-like bending (Ig). The reach of Ig/IgE was investigated at eight locations using a synthetic colon within a 3D model. Using a fresh porcine colorectum, 4 cm pseudo-polyps were created at the posterior wall of the ascending colon. Fifty-four ESD procedures were performed using three techniques: standard ESD (STD), ESD using Ig (DESP + Ig), and ESD using IgE (DESP + IgE). IgE was able to reach the full circumference at all the locations, whereas the medial walls proximal to the descending colon were out of Ig’s reach. Compared with the STD, both DESP + Ig and DESP + IgE showed significantly shorter procedure time (STD vs. DESP + Ig vs. DESP + IgE = median 48.9 min vs. 38.6 vs. 29.9) and fewer injuries (1.5 vs. 0 vs. 0). Moreover, the DESP + IgE had a shorter procedure time than the DESP + Ig (p = 0.0025). The IgE with DESP increased instrument reach compared to Ig, and likely represented a traction tool for excision of large pseudo-polyps in the right colon.

scholarly journals A case of hematuria and vomiting in the emergency room: Never forget the emphysematous pyelonephritis

2021 ◽  
Vol 17 (3) ◽  
Author(s):  
Erika Poggiali ◽  
Fabio Tansini ◽  
Konstantinos Christodoulakis ◽  
Manuela Giovini ◽  
Andrea Magnacavallo ◽  
...  
Keyword(s):  
Left Kidney ◽  
Nasopharyngeal Swab ◽  
Rt Pcr ◽  
Abdominal Ct ◽  
Emphysematous Pyelonephritis ◽  
Abdominal Ct Scan ◽  
History Of ◽  
Grade 3 ◽  
The Right ◽  
B Lines

We describe the case of a 68-year-old man with a known history of hypertension and diabetes mellitus presented to our Emergency Department, complaining of hematuria and vomiting in the last 12 hours, stypsis and urinary incontinence in the last week, and worsening hyporexia in the last 6 months. Bedside ultrasound documented a slight right pleural effusion with B lines in the middle and basal right field, gastrectasis, dilated fluid-filled bowel loops, potential signs of gas in the upper right quadrant, grade 3 bilateral hydronephrosis, and bladder globe. Abdominal CT scan confirmed the bilateral hydroureteronephrosis and showed the right kidney with Emphysematous Pyelonephritis (EPN) with extension into the perinephric and muscular planes for 24 cm, and initial EPN in the left kidney. A RT-PCR nasopharyngeal swab for SARS CoV-2 was negative. A diagnosis of ileum paretic, acute renal failure and urosepsis due to EPN was made.

scholarly journals A Congenital Right Sided Diaphragmatic Hernia Presented in Pregnancy: Rare Case Report

2020 ◽  
Author(s):  
Pankaj Gharde ◽  
Sankalp Dwivedi ◽  
Pramita Muntode Gharde ◽  
Piyush Jamdade ◽  
Azeem Aalam
Keyword(s):  
Case Report ◽  
Diaphragmatic Hernia ◽  
Exploratory Laparotomy ◽  
Cardiovascular Complications ◽  
First Case ◽  
Symptomatic Management ◽  
Rare Case Report ◽  
The Right ◽  
Respiratory Complaints ◽  
Diaphragmatic Hernias

Abstract Background: Diaphragmatic hernias are infrequent and remain undiagnosed till the symptoms arise. One third of these patients are asymptomatic. Its diagnosis is only established on the emergence of gastrointestinal, respiratory or cardiovascular complications. Surgical intervention is needed if complications arise. These Diaphragmatic hernias usually involve the left side of diaphragm either through a congenital defect or from a trauma over abdomen or chest as the right side has a type of protective gear which is the Liver lying below the diaphragm. The occurrence of right sided diaphragmatic hernia is rarest of rare. Patients may present with shortness of breath, obstruction, strangulation, gangrene and perforation of gut. The mortality is very high. Symptomatic diaphragmatic hernia in pregnant females is a matter of greater concern. Case Report: A 21-yr-old female, primigravida, primipara, with 22 weeks gestation, complained of severe abdominal pain and intractable vomiting since the last 7 days and for this acute intestinal obstruction was admitted to the emergency department. At the local Primary Health Center her symptoms were partially relieved by symptomatic management, but due to recurrence of symptoms she was referred to our rural hospital.Her chest radiograph revealed a right sided diaphragmatic hernia with large and small intestine as its content. She had no abdominal or respiratory complaints in past. Initially the patient’s general condition improved by nasogastric aspiration but then she developed tachycardia, tachypnoea, nausea and vomiting despite nasogastric aspiration, so emergency exploration was done. Exploratory laparotomy along with right thoracotomy was performed. As the gut was gangrenous, resection anastomosis was done along with diaphragmatic hernia repair.Conclusion: Diaphragmatic hernia in adults and pregnancy is a very rare entity. The right sided diaphragmatic hernia is rarest of rare that too in pregnancy.What makes this case even extraordinary is, it being the first case in studied literature showing specific right sided presentation during pregnancy, as the rest are left sided. Even though the risk of morbidity and mortality is high, once complications arise, but early intervention improves the outcome.

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