Extralobar pulmonary sequestrations hiding congenital diaphragmatic defects: A case series

Background: Association between pulmonary sequestration and diaphragmatic hernia is well known. Extralobar sequestrations are masses of the non-functioning lung, surrounded by separate pleura, without bronchial communication, and with a systemic arterial blood supply. They may be placed in the thorax, within the diaphragm, or rarely in a sub-diaphragmatic position. Case Series: We present three cases of extra-lobar extra-thoracic pulmonary sequestrations associated with different types of diaphragmatic defects. In none of the three cases, the diaphragmatic defect was detected prenatally. Conclusion: Pulmonary sequestration may be involved in the embryological origin of the diaphragmatic defect. Simultaneously, it acts as an anatomical barrier and prevents the herniation of the abdominal content into the thorax. If extralobar pulmonary sequestration is diagnosed prenatally, a coexistent diaphragmatic hernia should always be considered.

Right funicular hydrocele accompanied by in adverted lateral inguinal hernia finding in geriatric male patient during operation: a case report

Lateral hernia is caused by patent or reopening of processus vaginalis that lead herniation of abdominal content into scrotal sac. These defects can cause atypical presentation of indirect inguinal hernia along with hydrocele. We present a case of a male 78-year-old with chief complain of painless swelling on right scrotum that gradually getting bigger since a year ago. During the examination we found trans-illuminable mass in the right scrotum along with protrusion of bowel contents at the inguinal region. Patient underwent herniotomy with mesh installation to fix the lateral inguinal hernia and then followed by hydrocele removal with Jaboulay’s technique. Prognosis of this patient is believed to be good. We have presented a case of a geriatric patient with right lateral inguinal hernias with encysted hydrocele which is a presentation that could be happen due to anatomy of the inguinal ring. This patient underwent herniotomy with mesh installation to fix the lateral inguinal hernia and this procedure maintains the principle of tension-free posterior wall, hence preventing recurrence. Then followed by hydrocele removal with Jaboulay’s technique to prevent any complications such as testicular atrophy, haematocele and pyelocele. Prognosis of this patient is believed to be good.

Analysis of pigment cell composition, pigment content, tyrosinase content and activity of three kinds of loaches, Misgurnus anguillicaudatus from Poyang Lake

Loaches, Misgurnus anguillicaudatus, from Poyang Lake are a small economic fish, falling into three categories with typical blackspot characteristics, namely, big blackspot loaches (BBL), small blackspot loaches (SBL), and non-blackspot loaches (NBL), respectively. Pigment cell composition, pigment content, tyrosinase content and activity of three kinds of loaches were investigated. Our results showed that there were three types of skin pigment cells, namely, melanophores, xanthophores and iridophores. Melanophores in dorsum were more than in abdomen. Melanophore cytosomes in BBL were larger than those in SBL and NBL, and melanosomes were the largest in stage four. The melanophores in dorsal skin of SBL or NBL were small cell bodies, spindle-like, and in chain distribution. There was an extremely significant difference in melanin content in BBL between the dorsum and abdomen (P < 0.01). There were no significant differences in melanin abdominal content, lutein and carotenoid contents among three kinds of loaches (P > 0.05). In dorsal skin, tyrosinase content was the highest in BBL, and it was significantly lower in NBL than in BBL and SBL (P < 0.01). This study reveals differences in pigment and tyrosinase content in three kinds of loaches and provides a theoretical basis for further study of the mechanism of black spot formation.

Obturator hernia: case report

Obturator hernia, protrusion of abdominal content through the obturator foramen, is a rare type of abdominal wall hernia. Late patient presentation is associated with significant morbidity and mortality. We present rare case of obturator hernia causing small bowel obstruction in a 65-year-old-female patient. She presented with crampy abdominal pain, nausea and vomiting of three days duration. She was diagnosed with acute surgical abdomen and managed surgically at Arsi University College of health sciences, Assela, Ethiopia. Intraoperative finding revealed left-side obturator hernia, which is an extremely rare occurrence. Despite delayed presentation, our patient had smooth postoperative recovery. Obturator hernia is exceedingly rare, and it poses a diagnostic challenge as signs and symptoms are often nonspecific, making a preoperative diagnosis difficult. So, it should be considered as differential diagnosis in elderly patients presenting with acute surgical abdomen.

Minimally invasive management of a paraduodenal hernia with intestinal malrotation

Paraduodenal hernias (PDHs) are rare entities that may present with acute or subacute symptoms, and which pose challenges to prompt diagnosis and treatment. The minimally invasive management of these hernias is emerging as a new compelling approach to optimize surgical recovery. We present the case of a 42-year-old female patient who presented with acute abdominal pain and symptoms of bowel obstruction. Abdominal imaging suggested the presence of a left PDH. Laparoscopic exploration was performed. Intestinal malrotation was noted with incarceration of a small bowel loop in the Landzert fossa. The incarcerated bowel loop was freed and primary repair of the hernial defect was performed. PDHs are usually congenital and involve a herniation of abdominal content into the left mesocolon, between the mesocolon and the posterior abdominal wall. Minimally invasive treatment, consisting of adhesiolysis and repair of the hernial defect, seems to be a valid and safe option.

Onfalocele gigante y acretismo placentario

El onfalocele se define como un defecto congénito de la pared abdominal por fallo en la fusión de los pliegues del disco embrionario y, como consecuencia, el contenido intraabdominal se encuentra herniado; esto debe estar cubierto por peritoneo, gelatina de Wharton, amnios, centrado en el orificio umbilical con el cordón, originándose del ápex del mismo; la incidencia es de 1 de cada 5000 recién nacidos vivos. Con la intención de describir un caso atípico, se presenta el de una paciente gestante de 35 años de edad, Gesta: IV, Cesáreas: II, Abortos: I y 13/08/2013 como fecha de última menstruación. La paciente fue atendida en la Unidad Ecográfica de Alto Riesgo del Hospital Central Pedro Emilio Carillo (Trujillo, Venezuela), por presentar onfalocele gigante; se sometió a cirugía con los diagnósticos preoperatorios siguientes: 1) embarazo simple de 35 semanas y 2 días por biometría fetal; 2) pródromo de trabajo de parto; 3) onfalocele gigante; y 4) útero cicatrizal. Se le practicó cesárea corporal, histerectomía total con conservación de anexos. El recién nacido vivo presentó onfalocele gigante. Se evidenció placenta previa oclusiva más acretismo placentario, por lo que en el presente trabajo se pretende explicar la importancia del diagnóstico temprano y manejo terapéutico, así como la posible relación entre el onfalocele y placenta acreta a propósito de este caso. Palabras clave: Bolsa de Bogotá, cordón umbilical, acretismo placentario, pentalogía de Cantrell, síndrome de Beckwith-Wiedemann. Abstract Omphalocele is defined as a congenital defect of the abdominal wall due to failure in the fusion of the folds of the embryonic disc and, as a consequence, the intra-abdominal content is herniated; this must be covered by peritoneum, Wharton's jelly, amnion, centered in the umbilical orifice with the cord, originating from the apex thereof; the incidence is 1 in 5 000 live newborns. With the intention of describing an atypical case, that of a 35-year-old pregnant woman, Gesta: IV, Caesarean section: II, Abortion: I, and 08/13/2013 as the date of the last menstruation, is presented. The patient was treated at the High Risk Ultrasound Unit of the Pedro Emilio Carillo Central Hospital (Trujillo, Venezuela), for presenting a giant omphalocele; she underwent surgery with the following preoperative diagnoses: 1) simple 35-week and 2-day pregnancy by fetal biometry; 2) labor prodrome; 3) giant omphalocele; and 4) scar uterus. Body caesarean section was performed, total hysterectomy with preservation of annexes. The live newborn had a giant omphalocele. The occlusive placenta prae plus placental accretion was evidenced, therefore, in this work we try to explain the importance of early diagnosis and therapeutic management, as well as the possible relationship between omphalocele and placenta accreta in this case. Keywords: Bogota bag, umbilical cord, placental accreta, pentalogy of Cantrell, Beckwith Wiedemann syndrome.

Preoperative progressive pneumoperitoneum for a giant incisional hernia: report of a case with a rare complication

In patients with giant incisional hernias, many anatomical and physiological changes turn hernia repair into quite a challenge. The possibility of developing complications as abdominal compartment syndrome after hernioplasty has prompted surgeons to seek for technical options. A tempting alternative is to induce progressive preoperative pneumoperitoneum (PPP) aiming to adapt the organism to an increase in the abdominal content. We describe the case of a patient with giant incisional hernia submitted to PPP. The patient complicated with a very symptomatic pneumomediastinum. Despite being frequently well tolerated, it is important to make a point that the induction of PPP may result in severe complications.

Isolated Right-Sided Posttraumatic Diaphragmatic Hernia

Diaphragm is a compliant musculoaponeurotic barrier located between thoracic and abdominal cavities. Traumatic diaphragmatic rupture is a rare clinicopathological entity. We report a case of right-sided posttraumatic hernia in a child following blunt trauma to highlight diagnostic difficulties and therapeutic specific aspects. A 10-year-old boy was admitted to the emergency surgical department with thoracic trauma following pedestrian accident. At admission a haemothorax was suspected and treated by pleural drainage. The diagnosis of a right-sided diaphragmatic rupture was made after computed tomographic scan forty-eight hours later. At surgery, a reduction of herniated abdominal content and a suture of diaphragmatic defect were performed. The postoperative recoveries were uneventful and the patient was followed up for 12 months without symptoms. The possibility of a diaphragmatic rupture should be kept in mind and sought after any trauma of the thoracoabdominal junction as the diagnosis can be challenging in emergency department.

Prenatal Diagnosis of Thoracoschisis and Review of Literature

Thoracoschisis is a rare congenital malformation characterized by herniation of the abdominal content through a defect in the thorax. There are previously 12 reported cases, most discussing the postnatal findings and management. Here we describe a case of left thoracoschisis with associated upper limb abnormality which was diagnosed antenatally with the aid of 3D ultrasound.