Laparoscopic repair of sciatic hernia recognizing the ureterohypogastric nerve fascia and vesicohypogastric fascia: a case report

Background Sciatic hernias are rare pelvic floor hernias that occur through the sciatic foramen and often present as abdominal or pelvic pain, particularly in women. Historically, they were repaired using an open approach, with limited reports on their laparoscopic treatment. Case presentation Here we present the case of an 85-year-old woman who had repeated abdominal pain and was referred to our hospital for sciatic hernia surgery after conservative treatment. We laparoscopically observed the deep pelvis and identified the right sciatic hernia. When an extraperitoneal space was dissected, an ureterohypogastric nerve fascia (UNF) and a vesicohypogastric fascia (VF) were identified. Moreover, the maneuver to mobilize the fasciae inside from the pelvic wall made it possible to separate the ureter and urinary bladder, which might have otherwise incarcerated in the hernia. We repaired the defect of the sciatic foramen with a mesh plug and patch. The patient had an uneventful recovery, and the absence of sciatic herniation recurrence was confirmed 1 year after surgery. Conclusion A laparoscopic repair of a sciatic hernia could permit detailed non-invasive observations of the deep pelvis and be performed effectively by recognizing an UNF and a VF located near the sciatic foramen.

Successful treatment with radiation therapy for desmoid-type fibromatosis with unilateral hydronephrosis: a case report

Background Desmoid-type fibromatosis is a rare disease that can result in hydronephrosis. Hydronephrosis associated with desmoid-type fibromatosis often requires surgery or ureteral stent insertion. Although radiation therapy is recommended for inoperable cases of desmoid-type fibromatosis, there has been no report of treatment for hydronephrosis associated with desmoid-type fibromatosis by radiation therapy alone. We herein report a case of successful treatment for inoperable recurrence of desmoid-type fibromatosis with unilateral hydronephrosis by radiation therapy alone. Case presentation A 43-year-old Japanese female underwent resection of desmoid-type fibromatosis in the right inguinal region and combined resection of the right external iliac vein 5 years before. Other treatment was not performed because of her pregnancy. Four years after surgery, desmoid-type fibromatosis recurred in the right pelvic wall. Cyclooxygenase-2 selective inhibitor treatment was given for 1 year, but her desmoid-type fibromatosis enlarged to more than 10 cm, and she had swelling of her right leg and hydronephrosis of her right kidney. The patient received 50.4 Gy in 28 fractions of prophylactic irradiation using 10 MV X-ray and 9 Gy in five fractions of a sequential boost for the recurrent desmoid-type fibromatosis. Although there was temporary tumor progression at 1 month after radiation therapy, slow regression of the tumor was seen. At 5 years after radiation therapy, there was no disease progression or severe complications. Conclusion We experienced successful treatment for an inoperable case of desmoid-type fibromatosis with hydronephrosis. Moderate-dose radiation therapy alone is an effective and feasible approach for the management of hydronephrosis associated with desmoid-type fibromatosis.

The Clinical Efficacy of Anterior Pelvic Wall Locking Plate Fixation Through the Lateral Rectus Approach for Treating Quadrilateral Surface Acetabular Fractures

Background:Cases of acetabular fractures involving the quadrilateral surface are increasing annually. Quadrilateral surface surgery is complex, involves combined approaches, and the quality of fracture reduction closely depends on the surgical procedure. This study aimed to explore the clinical effects of the anterior pelvic wall locking plate through the lateral rectus approach for treating acetabular fractures involving quadrilateral surface. Methods:A retrospective analysis of 35 patients with acetabular fractures involving the quadrilateral surface treated with anterior pelvic wall-locking plates at the First Affiliated Hospital of Soochow University from June 2016 to December 2020. Patients included 25 males and ten females; age 23-82 years, average 52.4 years. The fracture classification was based on the Letournel-Judet classification: 13 cases of double-column fractures, seven cases of T-shaped fractures, seven cases of anterior wall with posterior semi-transverse fractures, and eight cases of transverse fractures. All patients were exposed through the lateral rectus approach, and fractures were fixed with the anterior pelvic wall-locking plate combined with the reconstruction plate. The Matta imaging standard assessed the quality of fracture reduction, and hip joint function was assessed according to the modified Merled’Aubigné-Postel scoring standard. Results:Patients meeting the inclusion and exclusion criteria were followed up for 12-42 months, with an average of 26.1 months. At the last follow-up, Matta imaging evaluation showed that 24 cases were anatomically reduced (68.6%, 24/35), seven cases were satisfied (20%, 7/35), and four cases were dissatisfied (11.4%, 4/35). The satisfaction rate was 88.6% (31/35), according to the modified Merled'Aubigné-Postel scoring standard. The hip function was excellent in 23 cases, good in six cases, fair in four cases, and poor in two cases. The excellent and good rates were 82.9% (29/35). Conclusion: The acetabular fracture involving the quadrilateral surface is clearly revealed through the lateral rectus approach. The anterior pelvic wall-locking plate combined with the reconstruction plate can fix well, with satisfactory clinical effects.

Intranodal Lymphangiography during Surgical Repair of Pelvic Lymphorrhea after Radical Cystectomy

Lymphorrhea can develop after various types of surgeries. Surgical closure of the lymphatic leakage point is an effective treatment option. However, it is difficult to identify the leakage point sometimes. Here, we report a case of pelvic lymphorrhea after radical cystectomy for bladder cancer. Identification of the leakage point was difficult during laparoscopic surgical repair of lymphorrhea. Intranodal lymphangiography was performed via the inguinal lymph node by injection of lipiodol, followed by injection of indigo carmine. Laparoscopy revealed extravasation of lipiodol and indigo carmine from the pelvic wall. The leakage point was successfully cauterized using an electric scalpel. Lymphorrhea improved after the surgical repair. This case suggests that intranodal lymphangiography may be useful for detecting the site of lymphatic leakage during the surgical repair of lymphorrhea.

185 Vascular Hitch Procedure for Accessory Lower Pole Vessels

Introduction The gold standard procedure for pelvi-ureteric junction obstruction has been the Anderson-Hynes dismembered pyeloplasty; involving the repositioning of the ureter and ureteropelvic anastomosis. However, the Hellstroem 'Vascular Hitch Procedure’ dictates the superior translocation of the accessory vessel and its fixation to the anterior pelvic wall. The latter has an estimated success rate >90%. Method During 2016-2020, at Leicester Royal Infirmary, 16 operations occurred on paediatric patients with pelvi-ureteric junction obstruction. The dismembered pyeloplasty was performed on 5 patients, 9 patients underwent the vascular hitch procedure, and 2 patients are currently awaiting the latter operation. All patients had a pre-operative functional magnetic resonance urography (fMRU) to identify and localise the accessory lower pole vessel. Results The mean hospital stay for the vascular hitch procedure was 1.5 days (range=1-2) in comparison to 4 days (range=3-5) for the dismembered pyeloplasty. The follow-up period ranged from 6 months to 3 years. Overall, it was noted that the patients were asymptomatic, had markedly reduced hydronephrosis on imaging as well as stable renal function noted on the MAG 3 renogram scan. Conclusions The laparoscopic vascular hitch procedure appears to be the superior operation for the management of pelvi-uteric junction obstruction as the patients had notably reduced hospital stay lengths.

GROSSESSE ABDOMINALE: A PROPOS D UN CAS

Abdominal pregnancy (GA) is defined as the implantation and development of the fertilized egg in the peritoneal cavity. It remains a very rare variety of ectopic pregnancy and can go undetected until late gestational age. Although the fetus may be viable, the maternal morbidity rate is high due to the occurrence of hemorrhages, which complicate management We report the case of a 27-year-old woman, G2P1 under estrogen-progetative oral contraception, having an irregular cycle; consults for abdomino-pelvic pain after 3 months of amenorhea with stable hemodynamics, the cervix is ​​closed and clean she experiences moderate pressure pain in the gastric region. The ultrasound evaluation to objectify an empty uterus with an evolving pregnancy of 11 weeks.The results of the laboratory analyzes are normal, with the exception of a hemoglobin at 10 g / l. A laparotomy allowed the demonstration of the gestational sac in the peritoneal cavity implanted on the pelvic wall adhering to the ovary and the omentum partly broken on extraction.

Diagnosis and treatment of infants with severe hydronephrosis (literature review)

Introduction. An assessment of the effectiveness of antenatal diagnosis and postnatal management of infants and infants with grade IV hydronephrosis was performed based on the analysis of domestic and foreign literature. Literature review. In the literature analysis, we used the databases СlinicalKey, Web of Science, Cyberleninka, PubMed, and Medline. The search was not limited by the publication date; instead, the searchs emphasis was placed on publications of the last 10 years. Classification. Several classification systems have been developed to assess the severity of hydronephrosis in infants. However, none of them describes the degree of expansion of the PCS and the functional state of the renal parenchyma. This work shows the stages of embryogenesis of the obstruction of the pyelourethral segment. Diagnosis. The issues of antenatal diagnostics and prognostically significant outcome criteria for an intrauterine malformation of the fetal urinary system are considered. The main diagnostic methods in the postnatal period are described. Morphological changes. Variants of pathomorphological changes in the renal parenchyma, the pelvic wall, and ureter in prolonged obstruction conditions are described. The role and variability of the number of Cajal interstitial cells in the pelvic wall and ureter in hydronephrosis have been analyzed. Treatment. Particular attention is paid to nephroprotective therapy and surgical treatment tactics of the defect. Questions regarding the timing and choice of treatment methods, the need and duration of preliminary urine diversion in infants and children with grade IV hydronephrosis remain open. Conclusion. Analysis of the world literature shows that there is no single protocol for intrauterine diagnosis and postnatal management of children with grade IV hydronephrosis. The functional state of the parenchyma is possible only with a comprehensive examination to assess the degree of hydronephrosis. Improving antenatal and postnatal diagnostics, therapeutic and surgical treatment of children with severe hydronephrosis should be based on a doctors cooperation, a specialist in ultrasound diagnostics, a nephrologist, and a pediatric surgeon.