Ultrasonic manifestations and age distribution of internal abdominal hernia in children

Objective To observe the ultrasonic manifestations and age distribution of internal abdominal hernia in children.Methods Data of 53 children with internal abdominal hernia confirmed by operation were retrospectively analyzed.The ultrasonic findings were observed,and the age distribution of children was analyzed.Results Among 53 cases,"cross sign"was observed in 22 cases(22/53,41.51%),and"hernia ring beak sign"was detected in 26 cases(26/53,49.06%)by preoperative ultrasound,according to which 21 cases were diagnosed as internal abdominal hernia,with the accuracy of 39.62%(21/53).Meanwhile,manifestations of intestinal obstruction were noticed in 48 cases(48/53,90.57%),and intestinal necrosis was considered in 22 cases(22/53,41.51%).Four cases were misdiagnosed as intestinal perforation,appendicitis,intestinal atresia and volvulus,each in 1 case.The onset age of postoperative adhesive band internal hernia was larger than that of mesenteric hiatal hernia(P<0.05),while no significant difference of onset age was found among other types of internal abdominal hernias(all P>0.05).Intestinal ischemic necrosis was found in 25 cases,while the incidence of intestinal necrosis in children aged≤1 year,>1 and≤3 years,>3 and≤7 years and those>7 years was 66.67%(12/18),33.33%(4/12),36.36%(4/11)and 41.67%(5/12),respectively.Conclusion The characteristic ultrasonic findings of internal abdominal hernia in children included"cross sign"and"hernia ring beak sign".Internal abdominal hernia in children under 1 year had high risk of intestinal necrosis.

Drain-site hernia after laparoscopic rectal resection:A case report and review of literature

BACKGROUND Drain-site hernia(DSH)has an extremely low morbidity and has rarely been reported.Small bowel obstruction is a frequent concurrent condition in most cases of DSH,which commonly occurs at the≥10 mm drain-site.Here we report a rare case of DSH at the lateral 5 mm port site one month postoperatively without visceral incarceration.Simultaneously,a brief review of the literature was conducted focusing on the risk factors,diagnosis,and prevention strategies for DSH.CASE SUMMARY A 76-year-old male patient was admitted to our institution with intermittent abdominal pain and a local abdominal mass which occurred one month after laparoscopic radical resection of rectal cancer one year ago.A computed tomography scan showed an abdominal wall hernia at the 5 mm former drain-site in the left lower quadrant,and that the content consisted of the large omentum.An elective herniorrhaphy was performed by closing the fascial defect and reinforcing the abdominal wall with a synthetic mesh simultaneously.The postoperative period was uneventful.The patient was discharged seven days after the operation without surgery-related complications at the 1-mo follow-up visit.CONCLUSION Emphasis should be placed on DSH despite the decreased use of intra-abdominal drainage.It is recommended that placement of a surgical drainage tube at the≥10 mm trocar site should be avoided.Moreover,it is advisable to have a comprehensive understanding of the risk factors for DSH and complete closure of the fascial defect at the drainage site for high-risk patients.