scholarly journals Reversed Bowel Rotation with Midgut Volvulus and Internal Hernia

2020 ◽  
pp. 1-5
Author(s):  
Mona Mogahed ◽  
Atif Mahmoud Mahdi ◽  
Hasn Hifni ◽  
Hassan Juma ◽  
Mona Mogahed ◽  
...  
Keyword(s):  
Ct Scan ◽  
Internal Hernia ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Midgut Volvulus ◽  
Ladd Procedure ◽  
Uneventful Postoperative Recovery ◽  
Reversed Rotation ◽  
Operative Findings

Congenital intestinal malrotation is a group of intestinal rotational anomalies occurring during embryogenesis. Reversed rotation is considered the rarest type of malrotation and often presents with symptoms of bowel obstruction. We present a rare case of a 27-year-old woman who presented with acute abdomen. The patient’s preoperative computed tomography (CT) scan and operative findings confirmed reverse malrotation, internal hernia of foramen of Winslow, and midgut volvulus. The transverse colon, duodenum, small bowel, cecum, and appendix were abnormally located, with the presence of Ladd bands. The patient underwent an emergency laparotomy (Ladd procedure) with an uneventful postoperative recovery and an unremarkable follow-up CT scan of the abdomen. A review of the literature for intestinal reverse malrotation is also presented to provide an understanding of the expected clinical picture and imaging findings for this rare anomaly.

scholarly journals Rapunzel syndrome causing partial gastric outlet obstruction requiring emergency laparotomy

2020 ◽  
Vol 13 (1) ◽  
pp. e232904
Author(s):  
Robert Lyons ◽  
Granit Ismaili ◽  
Michael Devine ◽  
Haroon Malik
Keyword(s):  
Ct Scan ◽  
Gastric Outlet Obstruction ◽  
Epigastric Pain ◽  
Outlet Obstruction ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Rapunzel Syndrome ◽  
History Of

A 16-year-old girl with a background of childhood trichophagia presented with a 2-day history of epigastric pain and associated anorexia with vomiting. An epigastric mass was palpable on examination. A CT scan revealed an intragastric trichobezoar, extending into the duodenum consistent with Rapunzel syndrome with evidence of partial gastric outlet obstruction and a possible perforation. The patient underwent an urgent laparotomy and extraction of the trichobezoar. The bezoar was removed without complication and no intraoperative evidence of perforation was detected. After an uncomplicated postoperative recovery, she was discharged home with psychiatric follow-up.

scholarly journals Incarcerated Lumbar Hernia Complicated by Retroperitoneal Pseudoaneurysm 50 Years after Resection and Radiation Therapy of a Sarcoma

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Oluwatobi Onafowokan ◽  
Dabanjan Bandyopadhyay ◽  
Dale Johnson ◽  
Hugo J. R. Bonatti
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Ct Scan ◽  
Late Complication ◽  
Abdominal Hernia ◽  
Emergency Laparotomy ◽  
Incisional Hernias ◽  
History Of ◽  
The Right

Background. Lumbar hernias are rare abdominal hernias. Surgery is the only treatment option but remains challenging. Posterior incisional hernias are even rarer especially with incarceration of intra-abdominal contents.Case Presentation. A 68-year old female presented with a 3-day history of worsening acute abdominal pain and distension, with multiple episodes of emesis. A CT scan indicated a large incarcerated posterolateral abdominal hernia. The patient had a history of resection of a sarcoma on her back as a child and also received chemotherapy and radiation. During emergency laparoscopy, a hemorrhagic small bowel segment incarcerated in the hernia was reduced and resected, and the distended small bowel was decompressed. An elective hernia repair was scheduled. After temporary clinical improvement, the patient again developed abdominal pain, distention, and emesis. During emergency laparotomy, a large hematoma in the right flank was found and partially evacuated. The right colon was mobilized out of the hernia and the duodenum was kocherized. A20×20cm BIO-A mesh was placed on top of the Gerota fascia and cranially tucked under liver segment VI. Anteriorly, the mesh was fixated with absorbable tacks. The duodenum and colon were placed into the mesh pocket. A postoperative CT scan identified a 2 cm pseudoaneurysm of a side branch of a lumbar artery, and the bleeding source was embolized. The postoperative course was complicated byClostridium difficile-associated colitis, but ultimately, the patient recovered fully. At 6-month follow-up, there was no evidence for a recurrent hernia.Discussion. There is a paucity of literature concerning lumbar incisional hernias. Repair with bioabsorbable mesh seems feasible, but longer follow-up is necessary as the mesh was placed in an unusual fashion due to the retroperitoneal hematoma. The exact cause of the hemorrhage is unclear and may have been caused during the initial incarceration, during surgery, or may be a late complication of her previous radiation.

scholarly journals Gracilis Myocutaneous Flap: Adding to the Armamentarium of Complex Sacrococcygeal Defect Reconstruction

2019 ◽  
Vol 52 (02) ◽  
pp. 246-249
Author(s):  
K. Preetha Rani ◽  
J. Satish Kumar ◽  
V. Singaravelu ◽  
Fernandes Deyonna
Keyword(s):  
Myocutaneous Flap ◽  
Recovery Period ◽  
Postoperative Recovery ◽  
Skin Closure ◽  
Uneventful Postoperative Recovery ◽  
Vram Flap ◽  
Reconstructive Option ◽  
Vertical Rectus Abdominis Myocutaneous ◽  
Gracilis Myocutaneous Flap

Abstract Background With increasing radicality of rectal cancer surgeries, the postoperative defects are becoming more complex. This demands an ideal reconstructive option with minimal morbidity to the patient. Although vertical rectus abdominis myocutaneous (VRAM) flap is the commonly used flap, gracilis myocutaneous flap is increasingly being performed to avoid morbidity associated with VRAM flap. Results We share our experience about two of our patients treated for rectal malignancy with pelvic exenteration who were reconstructed immediately with pedicled gracilis myocutaneous flap. Both the patients had an uneventful postoperative recovery period and were discharged on postoperative day 10. During follow-up period both patients had a healthy flap with no evidence of recurrence. No perineal hernias or gross dehiscence of skin closure occurred. Conclusion Gracilis myocutaneous flap has its own place with unique advantages adding to the armamentarium of reconstructive options for complex perineal defects, thereby avoiding the morbidity associated with VRAM flap. It stands as a reliable alternative in patients where VRAM cannot be used.

scholarly journals Rudimentary Horn Pregnancy Diagnosed after Laparotomy

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Kurabachew Mengistu ◽  
Tufa Bobe ◽  
Gashaw Tilahun ◽  
Kibru Kifle ◽  
Dereje Geleta
Keyword(s):  
New Technologies ◽  
Postoperative Recovery ◽  
Fetal Demise ◽  
Rudimentary Horn ◽  
Unicornuate Uterus ◽  
Uneventful Postoperative Recovery ◽  
Mullerian Ducts ◽  
Primary Hospital ◽  
Ultrasound Assessment

Müllerian abnormalities are present in 0.17% of fertile women and 3.5% of infertile women, and a unicornuate uterus is observed in 0.4% of women. The uterus is normally formed during embryogenesis by the fusion of the two Müllerian ducts. If one of the ducts does not develop, only one Müllerian duct contributes to the uterine development. We report a case of Gravida II, abortion I referred from a primary hospital with a referral paper and sonography stating she had IUFD. She had regular antenatal care follow-up at the primary hospital and had 8 months of amenorrhea. Our ultrasound assessment confirmed the intrauterine fetal demise, but the rudimentary horn pregnancy was missed. Repeated attempts at the induction of labor were tried but unsuccessful. The diagnosis was confirmed at laparotomy. She underwent cesarean section with right intact rudimentary horn removal. A nonviable male fetus with birth weight of 1.2 kg was delivered. Women with this abnormality are asymptomatic and unaware of having a unicornuate uterus. Abdominal pain is the most common presenting symptom with the rudimentary horn, but communicating horn pregnancy is generally asymptomatic in early pregnancy. Early awareness of this rare clinical condition is so crucial especially in developing countries where the availability of new technologies is scarce to explore uterine abnormalities. The patient had uneventful postoperative recovery and was discharged after 3 postoperative days.

scholarly journals Comparison between the draf IIc and standard draf IIb procedure for frontal sinus drainage: single center experience and comparison of outcomes

2020 ◽  
Vol 12 (5) ◽  
pp. 167-170
Author(s):  
Aigerim Kvarantan ◽  
Gorazd Poje ◽  
Livije Kalogjera
Keyword(s):  
Frontal Sinus ◽  
Chronic Sinusitis ◽  
Postoperative Recovery ◽  
Treatment Results ◽  
Related Data ◽  
Single Center Experience ◽  
Uneventful Postoperative Recovery ◽  
Sinus Drainage ◽  
Frontal Sinuses

Aims: Inadequate surgical frontal sinus drainage in chronic sinusitis cases refractory to conservative treatment results in a poor clinical response and is associated with recurrent frontal recess stenosis. Endonasal frontal sinus drainage procedures are classified according to Draf into three groups: DrafIIb enables unilateral orbit to septum drainage and the IIc is the extension of the IIb across the midline. The purpose of our report is to review chronic sinusitis cases treated at our Department using the standard (IIb) or modified (IIc) procedure and compare results. Methods: Patient- and surgery-related data were retrieved on patients operated between 2013 and 2016 for chronic frontal sinusitis using the standard/modified DrafIIb procedure.The modified IIb (i.e. IIc) procedure was performed so that both frontal sinus ostia were visualized by performing an intersinusseptectomy: the aim was to provide drainage to both frontal sinuses simultaneously. Results: In the observed period, 26 patients were treated: 12 using the modified DrafIIb (IIc) and 14 using the standard DrafIIb procedure. There were no significant differences between groups regarding age, sex, number of previous procedures or follow-up period. All patients had an uneventful postoperative recovery and there were no cases of re-stenosis observed in the DrafIIc group; there were seven cases of restenosis in the DrafIIb group.

scholarly journals Anastomotic dehiscence following retroflexion in surveillance colonoscopy: a case report

2020 ◽  
Vol 102 (5) ◽  
pp. e100-e101
Author(s):  
H Amada ◽  
P Bhattacharya ◽  
CV Thompson ◽  
AT George
Keyword(s):  
Colorectal Cancer ◽  
English Literature ◽  
Anastomotic Dehiscence ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Surveillance Colonoscopy ◽  
Fatal Complication ◽  
Routine Surveillance ◽  
End Colostomy

Anastomotic dehiscence following colonoscopy for routine surveillance after anterior resection for colorectal cancer is unreported in the English literature. It is a potentially fatal complication requiring awareness, quick recognition and management. We present the case of a 45-year-old woman who presented 12 hours after a routine follow-up colonoscopy with peritonitis due to anastomotic rupture diagnosed on computed tomography. The patient was taken to theatre for emergency laparotomy and formation of an end colostomy. Her postoperative recovery and follow-up were optimal.

scholarly journals A rare case of intestinal obstruction caused by internal hernia through post hysterectomy peritoneal defect

2021 ◽  
Vol 8 (4) ◽  
pp. 1347
Author(s):  
Ravi Kumar Sabu Murugesan ◽  
Kannan Ross ◽  
Joyce Prabakar
Keyword(s):  
Small Bowel ◽  
Intestinal Obstruction ◽  
Internal Hernia ◽  
Rare Case ◽  
Emergency Laparotomy ◽  
Female Status ◽  
Internal Hernias ◽  
Bowel Movements ◽  
Operative Findings ◽  
Increasing Trends

Internal hernia is a rare cause of intestinal obstruction. Nowadays acquired internal hernias are in increasing trends due to increased surgical procedures thus iatrogenic causes surpassing congenital internal hernias. Internal hernias after hysterectomy due to peritoneal defect is extremely rare. Here we present a case of 67 years old female status post hysterectomy ten years back, also a known type 2 diabetic presented to the emergency department with features suggestive of intestinal obstruction. Patient was taken up for emergency laparotomy and intra operative findings revealed small bowel loops herniating in a cavity that is formed by bladder anteriorly, caecum and sigmoid colon laterally and rectum posteriorly. Bowel loops were released. The bowel was found to be viable and the defect was closed. Bowel movements resumed on the third post-operative day. This case is presented here as it is an extremely rare case of internal hernia causing small bowel obstruction.

Incidental giant cystic pheochromocytoma: a case report and review of the literature

2020 ◽  
Vol 65 (2) ◽  
pp. 64-70
Author(s):  
Hollie Alice Clements ◽  
Michael SJ Wilson ◽  
David M Smith
Keyword(s):  
Preoperative Planning ◽  
Postoperative Recovery ◽  
Malignant Potential ◽  
Beta Blockade ◽  
Review Of The Literature ◽  
Case Presentation ◽  
Uneventful Postoperative Recovery ◽  
One Year ◽  
Urinary Metanephrines

Introduction Pheochromocytoma is a tumour arising from the adrenal medulla, which secretes catecholamines. Approximately 20% of pheochromocytomas are cystic and more likely to be asymptomatic. They should be surgically resected as all have a malignant potential and pose cardiovascular risk. Case presentation: We report the case of a 61-year-old female patient admitted electively for laparoscopic adrenalectomy for a large cystic pheochromocytoma detected incidentally. Diagnosis was confirmed preoperatively by elevated 24-h urinary metanephrines. The patient was treated preoperatively with alpha and beta blockade. Surgery was without complication; she had an uneventful postoperative recovery and no evidence of recurrence at one-year follow-up. Conclusion This case highlights the necessity of investigating for biochemical function in all adrenal lesions by measuring metanephrines, even when entirely cystic on imaging. Given the surgical and anaesthetic risk in resection of pheochromocytoma, attaining a preoperative diagnosis allows for careful preoperative planning and safe surgery.

scholarly journals Localized peritoneal carcinomatosis mimicking an irreducible left inguinal hernia

2016 ◽  
Vol 98 (03) ◽  
pp. e52-e54 ◽  
Author(s):  
NC Buchs ◽  
ALA Bloemendaal ◽  
RJ Guy
Keyword(s):  
Inguinal Hernia ◽  
Peritoneal Carcinomatosis ◽  
Right Hemicolectomy ◽  
Postoperative Recovery ◽  
Emergency Laparotomy ◽  
Transverse Colon Cancer ◽  
Hernia Sac ◽  
Positron Emission ◽  
Uneventful Postoperative Recovery ◽  
Patients At Risk

Perforated colonic cancers are not rare and leave patients at risk of developing peritoneal carcinomatosis. We present a 68-year-old male patient with a perforated transverse colonic tumour who underwent emergency extended right hemicolectomy. He made an uneventful postoperative recovery, and received adjuvant chemotherapy. Unfortunately, a routine positron emission tomography–computed tomography scan 16 months later demonstrated an fluorodeoxyglucose-avid nodule in the left scrotum associated with an irreducible left inguinal hernia that contained sigmoid colon. At laparotomy, the discovery of isolated peritoneal recurrence in the hernia sac was unexpected, given the absence of local recurrence in the region of the original transverse colon cancer perforation. The etiology therefore remains uncertain, but one may speculate that cell implantation occurred within the hernia sac at the initial emergency laparotomy.

scholarly journals Laparoscopic management of a small bowel obstruction: paraduodenal hernia

2020 ◽  
Vol 7 (9) ◽  
pp. 3112
Author(s):  
Shrenik Govindaraj ◽  
Sridar Govindaraj ◽  
Mario Victor Newton ◽  
Clement Prakash
Keyword(s):  
Small Bowel ◽  
Ct Scan ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Internal Hernia ◽  
Paraduodenal Hernia ◽  
Small Bowel Mesentery ◽  
Foramen Of Winslow ◽  
One Year

Paraduodenal hernia are very rare but the commonest internal hernia. Left paraduodenal hernia is due to herniation of the small bowel into the fossa of Landzert. The fossa results from a combination of failure of fusion of the small bowel mesentery with the retro peritoneum and malrotation of the midgut. Here we present a 27 years lady who saw multiple consultants with varied presentations and underwent extensive investigations over a one-year period, with one consultant referring her to a psychiatrist for malingering. CT scan revealed a foramen of Winslow hernia. The radiologist has to be aware of the CT findings of this unusual hernia. At laparoscopy, it was a left paraduodenal containing small bowel. We reduced the contents and plicated the sac with closure of the mouth. Patient did well and was discharged on 3rd post-operative day. On follow up she is doing well.

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