Groin abscess, a rare complication of strangulated femoral hernia: Case report

Femoral hernias account for 8%–11% of all groin hernias and 3%–5% of all anterior abdominal wall hernias. While groin hernias are more common in males, femoral hernias are developed more commonly in female, accounting for 22%–34% of all groin hernias compared with 1.1% in male. The lifetime risk of developing groin hernia in male is approximately 25% but in female less than 5%, so in all female patients with groin hernias, femoral hernias should be included in the differential diagnosis until proven otherwise. The main concern of a femoral hernia is the higher risk of bowel strangulation, presenting emergently in 32%–39% of patients. We report a case of strangulated femoral hernia in a 78-year-old female who was presented to emergency department with groin abscess based on ultrasound image; patient was then diagnosed as having strangulated femoral hernia and taken to the operating theater, where she was found having strangulated segment of small intestine, so the patient underwent bowel resection and anastomosis with repair of the defect extraperitoneally, and ultimately, the patient improved and discharged from the hospital. Strangulated femoral hernia can present with groin abscess. Furthermore, femoral hernia should be ruled out in elderly patient presented with groin abscess, especially female patients.

Incisional hernia after surgical correction of abdominal congenital anomalies in infants: a systematic review with meta-analysis

Incisional hernia (IH) in children could result in life-threatening complications, including incarceration and bowel strangulation. The incidence and risk factors of IH in infants are scarcely reported. Since IH-correction may require extensive surgery and a long recovery program, identifying infants and birth defects at risk, may lead to a different approach during the primary surgery. Therefore, the aim of this review is to systematically review the available data on the incidence of IH following surgery for congenital anomalies in infants. All studies describing IH were considered eligible. PubMed and Embase were searched and risk of bias was assessed. Primary outcome was the incidence of IH, secondary outcomes were difference in IH occurrence between disease severity (complex vs simple) and closure method (SILO vs primary closure) in gastroschisis patients. A meta-analysis was performed to pool the reported incidences in total and per congenital anomaly separately. Subgroup analysis within gastroschisis articles was performed. The 50 included studies represent 3140 patients. The pooled proportion of IH was 0.03 (95% CI 0.02–0.05; I2 = 79%, p ≤ 0.01) all anomalies combined. Gastroschisis (GS) reported highest pooled proportion 0.10 (95% CI 0.06–0.17; n = 142/1273; I2 = 86%; p ≤ 0.01). SILO closure (OR 3.09) and simple gastroschisis, i.e. without additional anomalies, (OR 0.18) were of significant influence. This review reports the incidence of IH in infants with different congenital abdominal anomalies, of which gastroschisis reported the highest risk. In GS patients, complex GS and SILO closure are risk factors for IH development.

Incarcerated Umbilical Hernia in a 14-Month-Old Female: A Rare Case of Bowel Strangulation

An umbilical hernia, although considered a benign condition of childhood, may rarely manifest with serious complications such as incarceration and viscous organ strangulation. One such case is presented in this report in an attempt to enrich the current literature, due to the relative lack of data in regard to complicated umbilical hernias in children and definite guidelines regarding the monitoring and management of uncomplicated cases. In addition, we discuss some of the latest advancements concerning the matter at issue.

Ileosigmoid Knotting: Analysis of Patients Clinical Profiles and Determinants of Outcomes

Introduction. Ileosigmoid knotting (ISK) is an uncommon form of bowel obstruction due to wrapping of the ileum or sigmoid colon around the base of the other. It is associated with poor prognosis. Data on ISK are scarce in our country. The aim of this study was to assess clinical profiles, management, and outcome of patients operated for ISK. Methodology. A retrospective analysis of all patients operated for ISK at St. Paul’s hospital millennium medical college (SPHMMC) from February 2014 to January 2020 was performed. Results. A total of 28 patients (M: F = 3 : 1) were studied. The mean age was 41.7 years (SD ± 19.5) and ranged from 18 to 80 years. The mean duration of illness was 1.6 days (SD ± 1.1). Abdominal pain and vomiting were seen in all patients followed by abdominal distention (24, 85.7%) and failure to pass feces or flatus (23, 82.1%). Preoperative diagnosis was correct in 6 (21.4%) patients. Almost all patients (26, 92.8%) had gangrenous bowel. The commonest procedure performed was resection of the gangrenous segments with primary ileoileal anastomosis and sigmoid end colostomy (16, 57.1%). Complications were seen in 11 (39.3%) patients and the commonest being surgical site infection (SSI) (7, 25%). Death occurred in 6 (21.4%) patients, and it was significantly (p=0.020) associated with intraoperative shock (systolic blood pressure (SBP) < 90 mmHg). Conclusion. ISK lacks specific clinical features and imposes a significant rate of bowel strangulation, which deserves high index of suspicion and urgent laparotomy. The choice of surgical procedure should be determined by intraoperative bowel status and patients’ general condition.

Ischemic bowel secondary to ventriculoperitoneal shunt knotting: a surprisingly rare complication of ventriculoperitoneal shunting. Case report

Small-bowel obstruction (SBO) and volvulus as a result of ventriculoperitoneal shunting are a rare phenomenon, especially when resulting in bowel necrosis. The authors report the rare event of SBO, bowel strangulation, and necrosis in a pediatric patient after the abdominal catheter became knotted around his small bowel, and they provide a comprehensive review of the literature. The authors argue that shunt configuration is an important consideration for a patient presenting with SBO, and that symptomatic shunt knotting is a reason for surgical correction.

Laparoscopic treatment of small bowel strangulation caused by an intramesosigmoid hernia and review of literature

An internal hernia is defined as a protrusion of an abdominal viscera through the defects of the gastrointestinal mesentery or peritoneum-lined fossa. Sigmoid mesocolic hernias are an uncommon type of internal hernias, accounting for only 6% of all internal hernias. Furthermore, intramesosigmoid hernia is one of the three subtypes of the sigmoid mesocolic hernias. Internal hernias are potentially fatal conditions with diagnostic challenges. Patients presenting with acute obstruction, no surgical history and no external hernia should receive an urgent CT scan to facilitate early surgery and to minimise the risk of strangulation and bowel resection. Here, we report a case of strangulated small bowel obstruction secondary to an intramesosigmoid hernia with a successful laparoscopic repair. We also present a literature review of all reported cases so far and give an up-to-date perspective on intramesosigmoid hernia.

Congenital Transmesenteric Hernia—Importance of a Timely Intervention

Transmesenteric hernia is a rare cause of small bowel strangulation in adults. Our patient was a 61-year-old previously healthy male, who presented with vomiting and abdominal pain with no surgical history and no trauma in the past. Computed tomography with contrast enhancement was suggestive of superior mesenteric vein (SMV) compression without any obvious cause. The emergency exploratory laparotomy revealed venous congestion of small bowel caused by a transmesenteric hernia with the herniated loop compressing the SMV. On reducing the hernia, complete reversal of the bowel congestion was noted and small bowel resection was averted. A high index of suspicion for a transmesenteric hernia in small bowel obstruction of unknown etiology and a timely surgical intervention are must for a good clinical outcome.