Richter's type of obturator hernia with Howship Romberg sign: a case report

Obturator hernia is a rare type of pelvic hernia in which intraperitoneal contents protrude through the obturator foramen and is most commonly found in females. It accounts for about 1% of all abdominal hernias and possesses a great diagnostic challenge due to the non-specific symptoms and meagre clinical signs. Hereby we report a case of obturator hernia in an nonagenarian emaciated fragile old lady who presented with features of acute Intestinal obstruction and was diagnosed using computed tomography as right sided obturator hernia and eventually was taken up for emergency laparotomy. The herniated segment was resected and anastomosis was done with primary closure of the defect. Postoperative period was uneventful and the patient was discharged on postoperative day 7.

VP021 A WAY TO TREAT SPIGELIAN HERNIA

Aim “Spigelian hernia is uncommon and accounts for only 0.12–2% of all abdominal hernias. It is mandatory to perform surgical correction and in recent years the laparoscopic approach is gaining ground. The authors pretend to demonstrate a video of an outpatient laparoscopic repair of Spigelian hernia.” Material and Methods “53-year-old woman with a left Spigelian hernia referred to laparoscopic repair via intraperitoneal approach.” Results “The patient was submitted to laparoscopic correction with a Ventralex® mesh. The surgery went without any complication and under 30 minutes. A few hours after the surgery, the patient was discharged. In the follow-up appointment, the patient had no complaints or evidence of recurrence.” Conclusions “Spigelian hernias are rare and have a mandatory surgical indication. Traditionally, open surgical repair is most commonly used. However, laparoscopic approach is becoming increasingly popular since it allows faster recovery, shorter hospital stay, and less pain, with no commitment to recurrence. Currently, there are no studies that demonstrate the superiority of a laparoscopic technique (intraperitoneal, TAPP or TEP). The intraperitoneal route is a simple, faster, and easily reproducible approach.”

SPIGELIAN HERNIA VARIOUS PRESENTATION AND MANAGEMENT- A CASE SERIES

BACKGROUND: Spigelian hernia is rare and requires high index of suspicion. Given the case of inconsistent ndings and signs the diagnosis of spigelian hernia presents with great difculties than its treatment. Incidence of spigelian hernia ranges from 0.1% to 2% of all abdominal hernias AIM: Aim of this case series is to analyze epidemiological aspects, clinical presentation, challenges in diagnosis, surgical technique characteristics, morbidities and hospital stay MATERIALS AND METHODS: A total number of 4 patients who had undergone surgery for spigelian hernia for a period of 6 months from the month of Jan to June 2021 in the dept of general surgery in KMCH were studied. All 4 cases have been analyzed in this study period and followed up until discharge from the hospital. RESULTS: This case series consisted of 4 cases. All cases presented with pain. Only 2 among 4 cases presented with swelling. Denitive diagnosis of all cases could be done only by CT. Out of these 1 was taken up as emergency.Intraoperatively 3 cases were interstitial and 1 was subcutaneous type. All 4 cases were treated by open surgical technique and by placing mesh at different planes CONCLUSION: Diagnosis of spigelian hernia presents with great difculties and hence one must be aware of the clinical presentation. Pain is the consistent feature of all hernias and only occasionally swelling is present which may mislead easily. Computed tomography of abdomen and pelvis still prevails as the denitive radiological investigation in the diagnosis of spigelian hernia. There are many planes at which mesh can be placed for repair where the operative techniques vary. Though the outcome was good in all four cases discussed here, the post operative complication and duration of stay was considerably less when the mesh was placed in the intermuscular plane.

Incisional abdominal hernias, some consideration about it.

Background: Abdominal incision hernia is a common complication of abdominal surgery. Despite significant improvements in medical technology and healthcare, an increasing number of patients are also benefiting from complex surgical procedures. The objective of this study was to analyze the risk factors for incisional abdominal hernias and to identify measures that could reduce the incidence of this complication. Material and methods: All patients included in the study are from the University Hospital of Trauma for a period of 3 years, from January 1, 2015, to December 31, 2017. Eighty-seven adult patients who underwent surgical repair of incisional abdominal wall hernia were enrolled. Variables that are compared in this study include the type of suture material, type of suture technique and concomitant diseases .etc. Results: According to our study the risk factors for incisional hernia are related to patients and the abdominal surgery used, the size of the abdominal wall defects. Conclusions: Risk factors such as the size of the defect, wound infection, obesity, use of steroids and chronic constipation have great importance and have to be strictly evaluated as they have more chances to lead to a possible recurrence…

HÉRNIA VESICO-INGUINAL: RELATO DE CASO

Introdução: Hérnia é definida como uma protrusão anormal de um órgão ou tecido por um defeito em suas paredes circundantes. Embora uma hérnia possa ocorrer em vários locais do corpo, esses defeitos mais comumente envolvem a parede abdominal. Hérnias na região inguinal geralmente contém o omento e o intestino delgado. Entretanto, raramente pode conter conteúdos incomuns, como apêndice, ovário, bexiga urinária, cólon sigmóide e ceco. A correção cirúrgica das hérnias abdominais está entre os três procedimentos mais realizados por cirurgiões nos Estados Unidos. Relato do caso: Paciente masculino, 49 anos, sobrepeso, previamente hígido, encaminhado ambulatorialmente por hérnia inguinal bilateral, sintomático à direita. Há cerca de 5 anos observou aparecimento de hérnia inguinal à direita, tendo dor desde então, com piora no último ano, quando refere ter iniciado também com diminuição de jato miccional. Tomografia Computadorizada evidenciou hérnias inguinais, mais volumosa à direita, observando-se neste lado herniação da bexiga urinária. Internou eletivamente para realizar herniorrafia inguino-escrotal à direita, tendo sido optada por técnica de Lichtenstein. Procedimento sem intercorrências. Evolução adequada no pós operatório, apresentando na revisão boa cicatrização de ferida operatória, melhora da dor e dos sintomas urinários. Discussão: A incidência de bexiga fazendo parte de uma hérnia inguinal, chamada por Lavine, em 1951, de "cistocele escrotal", é de 1-4%, ocorrendo com mais frequência em indivíduos com mais de 50 anos de idade com história de correção de hérnia inguinal. Em função da raridade desse diagnóstico, há uma certa dificuldade de encontrar dados recentes sobre esse tema.

Understanding the physiology of bowel obstruction and its implications for patient assessment and management

Bowel obstruction causes acute abdominal pain, and, if untreated, leads to strangulation of the bowel and may lead to the patient's death. The aetiology of small bowel obstruction and large bowel obstruction can involve mechanical (dynamic) or non-mechanical (adynamic) causes, as well as pseudo-obstruction, abdominal hernias and postoperative ileus. Assessment techniques include history taking, physical examination, imaging, biochemistry and endoscopic assessment. Intervention options include symptomatic, endoscopic and conservative management, as well as surgical treatment and palliative care. Clinical nurse specialists in colorectal, stoma and palliative care play essential roles in meeting the holistic needs of these patients.

Amyand Hernia in a Pediatric Patient With Acute Perforated Appendicitis Undergoing Laparoscopy: A Brief Report and Literature Review

An 8-year-old male presented for evaluation of symptoms consistent with appendicitis. Upon laparoscopy, the patient was found to have appendicitis with a concomitant Amyand hernia. The latter pathology highlights a rare presentation of inguinal hernias in which the vermiform appendix herniates into the inguinal canal. Inguinal hernias are frequently encountered in pediatric populations; however, Amyand hernias have seemingly negligible incidence in all age demographics. These comprise roughly 1% of all diagnosed abdominal hernias. When seen in concurrence with appendicitis, the incidence is 0.13%. Recent literature has sought to classify types of Amyand hernias and criteria described by Losanoff and Basson is an attempt to guide surgical management. Although our management did not coincide with the proposed management above, the patient made a full recovery. In conclusion, Amyand hernias remain a rare entity that can be indistinguishable from routine inguinal hernias on clinical examination and management of Amyand hernia with appendicitis is not well defined.