Amyand's hernia is a rare condition defined by the inclusion of the appendix vermiformis within the hernia sac. Its incidence among cases of groin hernia is less than 1%. The clinical manifestation of incarcerated...Amyand's hernia is a rare condition defined by the inclusion of the appendix vermiformis within the hernia sac. Its incidence among cases of groin hernia is less than 1%. The clinical manifestation of incarcerated inguinal hernia generally masks the symptoms and signs of acute appendicitis, which renders preoperative diagnosis difficult. In this study, we present two cases of Amyand's hernia that were diagnosed preoperatively. The patients were taken for operation with the prediagnosis of ?ncarcerated inguinal hernia. We evaluated these cases along with data from prior studies.展开更多
Meckel's diverticulum is a very common congenital anomaly of the gastrointestinal tract but many cases remain asymptomatic and are diagnosed incidentally during laparoscopic or other surgical procedures. Cases of ...Meckel's diverticulum is a very common congenital anomaly of the gastrointestinal tract but many cases remain asymptomatic and are diagnosed incidentally during laparoscopic or other surgical procedures. Cases of femoral hernia involving Meckel's diverticulum are rare, with less than 50 cases reported in the literature since Littre published the first description of this coincident condition over 300 years ago. While all true "Littre's hernias" contain a Meckel's diverticulum, the involved anatomical sites are various, the most common being the inner groin(inguinal), the outer groin(femoral), and the belly button(umbilical). Complications of Littre's hernias include incarceration, strangulation, necrosis, and perforation. Herein, we describe a case of Littre's hernia that involved an incarcerated Meckel's diverticulum in a femoral hernia that was diagnosed upon investigation of symptomology manifesting from perforation and was successfully managed by surgical resection with stapler devices.展开更多
BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgi...BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgical resection remains the recommended treatment.Here we report a case of neck BSL with concomitant thick fatty deposit in the inguinal region,which concealed the signs of a right incarcerated femoral hernia.CASE SUMMARY A 69-year-old male patient was admitted to our hospital with“abdominal pain,abdominal distension,nausea-vomiting and difficult defecation for half a month”.Moreover,he had a mass in the right inguinal region for more than 10 years.An egg-sized neck mass also developed 15 years ago and had developed into a full neck enlargement 1 year later.In addition,the patient had a history of heavy alcohol consumption for more than 40 years.With the aid of computerized tomography scan,the patient was diagnosed with BSL and a low intestinal mechanical obstruction caused by a right inguinal incarcerated hernia.Under general anesthesia,right inguinal incarcerated femoral hernia loosening and tension-free hernia repair was performed.However,this patient did not receive BSL resection.After a 1-year follow-up,no recurrence of the right inguinal femoral hernia was found.Moreover,no increase in fat accumulation was found in the neck or other areas.CONCLUSION Secretive intraperitoneal fat increase may be difficult to detect,but a conservative treatment strategy can be adopted as long as it does not significantly affect the quality-of-life.展开更多
BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases.Elderly patients are a ...BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases.Elderly patients are a high-risk group for surgical treatment.If the incarceration of gallstones cannot be relieved,emergency surgery is unavoidable.CASE SUMMARY We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis.He had several coexisting,high-risk underlying diseases,had a history of radical gastrectomy for gastric cancer,and was taking aspirin before the operation.Nevertheless,he underwent emergency laparoscopic cholecystectomy,with maintenance of postoperative heart and lung function,successfully recovered,and was discharged on day 8 after the operation.CONCLUSION Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic,the key is to abide strictly by the hospital's epidemic prevention regulations,fully implement the epidemic prevention procedure for emergency surgery,fully prepare before the operation,accurately perform the operation,and carefully manage the patient postoperatively.展开更多
Surgical intervention of asymptomatic and accidentally detected pancreatic carcinoma can prolong survival. A 67-year-old man with the right incarcerated inguinal hernia was referred to our hospital, he immediately und...Surgical intervention of asymptomatic and accidentally detected pancreatic carcinoma can prolong survival. A 67-year-old man with the right incarcerated inguinal hernia was referred to our hospital, he immediately underwent manipulative treatment followed by hernioplasty on the next day. Upon the first visit, a pancreatic tumor was accidentally detected in CT images in the pancreatic tail. About approximately a month, abdominal CT revealed a slightly developed tumor;accordingly, distal pancreatectomy with lymph node dissection was performed. The patient was histopathologically diagnosed with tubular adenocarcinoma, and his final pathological stage was ypT2, pN0, cM0, Stage Ib, based on the TNM classification of malignant tumors (8th edition). For postoperative six months, he was treated with adjuvant chemotherapy using gemcitabine (1000 mg/m2). Remarkably, the patient reported no recurrence and has been alive for postoperative 7.5 years, thereby attaining excellent outcomes for accidentally detected pancreatic carcinoma at the occurrence of an incarcerated inguinal hernia.展开更多
Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or co...Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or correction of the prolapse following stoma creation. The authors report successful managements by stomal reconstruction and discuss several clinical points, including the techniques of surgical revision for incarcerated stomal prolapse in loop enterostomy. Patients: Case 1) A female infant weighing 2755 g was delivered at 34 weeks of gestation. On the first day after birth, a right supra-abdominal transverse incision of 10 cm in diameter was used for transverse loop colostomy in a cloacal malformation. Two centimeters of the stomal loop was approximated with sutures to prevent evisceration of the small intestine between the 2 limbs of the loop. Interrupted sutures of 5-0 absorbable monofilament secured the seromuscle of the colon to the peritoneum and fascia, and also to the skin. The distal limb of the colostomy prolapsed 11 months after birth. The physical findings revealed that 10 cm of the distal limb was intussuscepted. Case 2) A female infant weighing 2550 g was delivered at 39 weeks of gestation. A radiological examination by contrast enema showed no spastic rectum and colon, as in Hirschsprung’s disease. Under the laparotomy of a right supra-abdominal transverse incision of 5 cm in diameter, loop ileostomy was performed at 30cm on the proximal side of the cecum such as Case 1. Subsequently, the proximal limb of the ileostomy prolapsed 2 days after operation. The physical findings revealed that 10 cm of the proximal limb was intussuscepted. New enterostomy formation: Divided enterostomy was performed with 3-cm stitching of each limb. The stomal site was moved to the inside from the previous stomal site to oversew and fix by the rectal fascia. The children have been well without trouble since undergoing the new eneterostomy formation. Conclusions: Operation to repair the prolapse of a stoma is advised if it causes problems. We found that simple mobilization of the bowel and excision of the redundant bowel provided a satisfactory result in the present cases.展开更多
Background: The burden of COVID-19 and human immunodeficiency virus (HIV) are some of the major and persistent global health challenges of the twenty-first century. HIV and COVID-19 are expected to overlap in high HIV...Background: The burden of COVID-19 and human immunodeficiency virus (HIV) are some of the major and persistent global health challenges of the twenty-first century. HIV and COVID-19 are expected to overlap in high HIV-burden countries, posing several public health challenges as a result. Prisons are overcrowded, have limited space for social distancing and have inadequate ventilation systems, making it difficult to contain the spread of COVID-19 in addition to the high-risk behaviours of inmates which contribute to the spread of HIV within these facilities. This study aimed to determine the prevalence of COVID-19 among inmates in a prison facility with a relatively high HIV burden in Port Harcourt, Nigeria;investigating potential risk factors and co-infection with HIV. Methodology: The study employed a descriptive cross-sectional study design sampling 200 inmates from the Port Harcourt Maximum Security Custodial Centre from July to December 2022. A well-structured questionnaire was administered via interviews in addition to screening for HIV-1/2 antibodies as well as COVID-19 antigens using rapid diagnostic test kits. Descriptive statistics and chi-square were carried out on the GraphPad Prism 9 software with statistical significance defined as a p-value of less than 0.05 at a 95% confidence interval. Result: The prevalence of HIV from the current study was 6.5%, COVID-19 prevalence was reported to be 12.5% while HIV/COVID-19 co-infection was 1.5% The duration of incarceration, face mask use, frequent visitations and vaccination against COVID-19 were found to be significantly associated with the prevalence of COVID-19 in the studied population (p Conclusion: The current study reports a relatively high prevalence of HIV and COVID-19 among the inmates in the study area. It becomes expedient for the administrators of the correctional facility to properly screen new inmates for COVID-19, quarantine and manage cases, as well as provide them with personal protective equipment such as face masks. In-person visitation should be balanced with measures to prevent the spread of the infection, and mass vaccination campaigns should be promoted. Improving access to HIV screening and therapy for all prisoners should be prioritised to identify and manage the incidence of HIV early, reducing the risk of transmission, mitigating comorbidities and improving health outcomes.展开更多
Patients with an incarcerated rectal prolapse usually present in the emergency department where manual reduction is first attempted. If reduction is unsuccessful, an emergency laparotomy and internal reduction is requ...Patients with an incarcerated rectal prolapse usually present in the emergency department where manual reduction is first attempted. If reduction is unsuccessful, an emergency laparotomy and internal reduction is required. Edema in the rectal and perineal tissues and impaired blood flow are the main factors for a high percentage of anastomotic leaks. The traditional single stage perineal rectosigmoidectomy is not a safe surgical procedure for treating incarcerated or strangulated rectal prolapses associated with severe edema. Herein we report a case of an incarcerated rectal prolapse treated with the Notaras procedure.展开更多
Incarcerated gravid uterus is a rare obstetric condition that contributes to pregnancy-related adverse outcomes,especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery.An effect...Incarcerated gravid uterus is a rare obstetric condition that contributes to pregnancy-related adverse outcomes,especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery.An effective diagnosis of this condition is benefited from pelvic examination combined with imaging methods and based on suspected symptoms.We present a case of ultrasound-assisted instrument reposition of an incarcerated gravid uterus at mid-gestation and discuss its clinical characteristics,diagnosis,imaging features,and treatment.We believe that once manual reduction fails,the use of instruments will undoubtedly be a better choice.展开更多
AIM:To investigate the feasibility of endoscopic dacryocystorhinostomy(En-DCR)with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent(NDS)incarceration.METH...AIM:To investigate the feasibility of endoscopic dacryocystorhinostomy(En-DCR)with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent(NDS)incarceration.METHODS:En-DCRs were performed on 44 chronic dacryocystitis patients(46 eyes)secondary to NDS incarceration from April 2016 to October 2022.The granuloma and scar tissues were separated,and the removal of NDS incarceration was achieved during the surgery;the flap of the lacrimal sac was trimmed and anastomosed with nasal mucosal,a bicanalicular silicone tube was implanted,and lacrimal size and condition were assessed.The tube was removed 3mo after surgery.During the final follow-up of 12mo when the surgery was completed,the complications and the rates of surgical success were assessed.RESULTS:This study covered 40 patients(42 eyes).Intraoperatively,it was found that the lacrimal sac became small,and the sac wall had granulation and scar tissue attached to the incarcerated NDS in all eyes.At 12mo after surgery completed,the rates of the functional and anatomical success reached 80.95%(34/42)and 83.33%(35/42),respectively.Under the effect of intranasal ostial closure,seven eyes failed to achieve anatomical success.No serious complications(e.g.,visual impairment,sinusitis,and orbital fat prolapse)was observed.CONCLUSION:With the success rate over 80%and no serious complications,En-DCR with bicanalicular silicone tube implantation is effective in treating chronic dacryocystitis secondary to NDS incarceration.展开更多
BACKGROUND:Lumbar hernia is a rare congenital or acquired defect of the posterior abdominal wall. The acquired type is more common and occurs mainly as an incisional defect after flank surgery. Incarceration or strang...BACKGROUND:Lumbar hernia is a rare congenital or acquired defect of the posterior abdominal wall. The acquired type is more common and occurs mainly as an incisional defect after flank surgery. Incarceration or strangulation of hernia contents is uncommon. METHOD:Segmental liver incarceration through a recurrent incisional lumbar defect was diagnosed in a 58 years old woman by magnetic resonance imaging. RESULTS:The patient underwent an open repair of the com-plicated hernia. An expanded polytetraflouoroethylene(e-PTFE) mesh was fashioned as a sublay prosthesis. She had an uncomplicated postoperative course. Follow-up examinations revealed no evidence of recurrence. CONCLUSIONS:Although lumbar hernia rarely results in incarceration or strangulation,early repair is necessary because of the risks of complications and the increasing difficulty in repairment as it enlarges. Surgical repair is often difficult and challenging.展开更多
This is a case of primigravida of 35 years of age having spontaneous conception & 14.5 wks. pregnancy with retention of urine and pain in lower abdomen for 5 days. There was history of unsuccessful attempt of corr...This is a case of primigravida of 35 years of age having spontaneous conception & 14.5 wks. pregnancy with retention of urine and pain in lower abdomen for 5 days. There was history of unsuccessful attempt of correction of retroversion one day prior. Transabdominal USG (ultrasonography) confirmed 14.5 wks. live pregnancy with incarceration of uterus. In this case, only GA (general anaesthesia) corrected retroversion & incarceration.展开更多
Uterine incarceration is a rare condition thought to result from incarceration of a retroverted uterus in the small pelvis. The present case report describes a case of uterine incarceration caused by extensive pelvic ...Uterine incarceration is a rare condition thought to result from incarceration of a retroverted uterus in the small pelvis. The present case report describes a case of uterine incarceration caused by extensive pelvic adhesions after appendectomy for perforated appendicitis. A 39-year-old primigravida woman was referred to our obstetric unit for follow-up after successful in vitro fertilization. The symptoms related to uterine incarceration included anuria at 15 weeks of gestation and uterine contractions starting at 28 weeks of gestation. The absence of a cervical canal on ultrasonography is a key finding required to diagnose this rare condition. In the present case, the incision for uterotomy was determined by prenatal magnetic resonance imaging and transmyometrium ultrasonography during cesarean section. Both MRI and ultrasound images clearly showed anatomical relationships between the bladder, cervical canal and uterine wall. Clinicians need to know how the incision for uterotomy should be made and to avoid serious complications during cesarean section.展开更多
Post-traumatic stress disorder (PTSD) is a psychiatric disorder that is the result of personal experiences directly involved with or witnessing traumatic or life-threating events. PTSD has profound psychobiological co...Post-traumatic stress disorder (PTSD) is a psychiatric disorder that is the result of personal experiences directly involved with or witnessing traumatic or life-threating events. PTSD has profound psychobiological correlates, which can impair the person’s daily life and be life-threatening. The disorder is typically associated with military com-bat, acts of terrorism, sexual assault, bullying, exposure to abusive and toxic environments. The culture of prison encompasses and is the direct catalyst for consistent exposure to each of these elements. Considering that the United States leads the free world in the rate of incarceration, Prison-related PTSD is a serious public health and social issue. A sharp rise in ex-offenders that meet 3 or more of the criteria for diagnosing post-traumatic stress disorder (PTSD) from the Fifth Edition of the Diag-nostic and Statistical Manual of Mental Disorders is alarming. We review the numbers and introduce a new perspective on how the Department of Corrections and Department of Justice can play a vital role by working to correct this problem. We discuss the need to provide long-term care for this underserved population, particularly those convicted of non-violent crimes. We present arguments in support of the notion there should be professional clinical resources available for individuals released from prison to help manage the symptoms of PTSD that were created primarily through incarceration.展开更多
Meckel's diverticula incarcerated in a hernia were first described anecdotally by Littré, a French surgeon, in 1700. Meckel, a German anatomist and surgeon, explained the pathophysiology of this disease 100 y...Meckel's diverticula incarcerated in a hernia were first described anecdotally by Littré, a French surgeon, in 1700. Meckel, a German anatomist and surgeon, explained the pathophysiology of this disease 100 years later. In addition, a congenital paraduodenal mesocolic hernia, known as a Treitz hernia, is a rare cause of small bowel obstruction. These hernias are caused by an abnormal rotation of the primitive midgut, resulting in a right or left paraduodenal hernia. We treated a patient presenting with pain and diagnosed extraluminal air in the abdomen after a computed tomography examination. We performed a laparotomy and found a combination of these two seldomly occurring congenital diseases, incarceration and perforation of Meckel's diverticulum in a left paraduodenal hernia. We performed a thorough review of the literature, and this report is the first to describe a patient with a combination of these two rare conditions. We considered the case regarding the variety of terminology as well as the treatment options of these conditions.展开更多
BACKGROUND Perivascular epithelioid cell tumor(PEComa)represents a group of rare mesenchymal tumors.PEComa can occur in many organs but is rare in the colorectum,especially in children.Furthermore,PEComa is a rare cau...BACKGROUND Perivascular epithelioid cell tumor(PEComa)represents a group of rare mesenchymal tumors.PEComa can occur in many organs but is rare in the colorectum,especially in children.Furthermore,PEComa is a rare cause of intussusception,the telescoping of a segment of the gastrointestinal tract into an adjacent one.We describe a rare case of pediatric PEComa complicated with intussusception and anal incarceration,and conduct a review of the current literature.CASE SUMMARY A 12-year-old girl presented with abdominal pain and abdominal ultrasound suggested intussusception.Endoscopic direct-vision intussusception treatment and colonoscopy was performed.A spherical tumor was discovered in the transverse colon and removed by surgery.Postoperative pathologic analyses revealed that the tumor volume was 5.0 cm×4.5 cm×3.0 cm and the tumor tissue was located in the submucosa of the colon,arranged in an alveolar pattern.The cell morphology was regular,no neoplastic necrosis was observed,and nuclear fission was rare.The immunohistochemical staining results were as follows:Human melanoma black 45(HMB 45)(+),cluster of differentiation 31(CD31)(+),cytokeratin(-),melanoma-associated antigen recognized by T cells(-),smooth muscle actin(-),molleya(-),desmin(-),S-100(-),CD117(-),and Ki67(positive rate in hot spot<5%).Combined with the results of pathology and immunohistochemistry,we diagnosed the tumor as PEComa.Postoperative recovery was good at the 4 mo follow-up.CONCLUSION The diagnosis of PEComa mainly depends on pathology and immunohistochemistry.Radical resection is the preferred treatment method.展开更多
BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy ...BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.METHODS Between January 2016 and December 2018,12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position.A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis.The tissue expander was removed when the two ends of the tibial defect were close enough.RESULTS In all 12 patients,the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis.When bone transport was adequate,the expander was removed and the bone transport process was completed.During the whole process,there was no incarceration of skin and soft tissue in the bone defect area.Complications occurred in one patient,who experienced poor wound healing.CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration.The authors’primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.展开更多
Uterine incarceration is a rare disease of abnormal uterine morphology, the proportion during pregnancy was 1 in 3000 - 10,000. Previously reported patients with uterine incarceration have different symptoms. Rarely, ...Uterine incarceration is a rare disease of abnormal uterine morphology, the proportion during pregnancy was 1 in 3000 - 10,000. Previously reported patients with uterine incarceration have different symptoms. Rarely, asymptomatic cases persist into the third trimester of pregnancy. In fact, the patients with uterine incarceration can be asymptomatic and normally carry their fetuses to the term because it mainly changes the cervix, which does not affect fetal growth in utero directly. Additionally, cesarean section is both a treatment and a direct method to clarify the diagnosis again, and low-molecular-heparin anticoagulant therapy should be considered immediately after surgery. Here, we present two cases clarifying that patients with uterine incarceration can be pregnant without any discomfort during pregnancy and provide a successful treatment plan.展开更多
BACKGROUND Penial incarceration(PI)is a rare situation.It is usually caused by a foreign object which strangulates at the base of the penis.PI may derive from pranks,sexual demand,mental disease,or intention to prohib...BACKGROUND Penial incarceration(PI)is a rare situation.It is usually caused by a foreign object which strangulates at the base of the penis.PI may derive from pranks,sexual demand,mental disease,or intention to prohibit urinary disease.Generally,these situations are emergent and immediate treatments are needed.Cases of chronic PI are less reported,and their treating methods are yet to be discussed.CASE SUMMARY We reported a case on treating a 73-year-old male who had PI with a metallic hoop for three months.After multidisciplinary consultation,the operation was performed successfully with the help of a fretsaw.Despite the chronic strangulation,the prognosis of the patient was satisfying.To the best of our knowledge,this case was rare and precious as it featured the longest strangulating time,which might enlighten the treating process of future PI cases.Also,we have reviewed and summarized major published cases to encapsulate appropriate approaches when facing diverse strangulation situations.CONCLUSION The selection of surgical tools depends on the material of the strangulating objects,the availability of equipment,and the severity of the penial damage.The urination function may not be affected after three months of incarceration as in our case,whilst prudent preoperative measures and multidisciplinary evaluations are always essential.Although using a fretsaw is comparatively slow,it is safe and feasible to treat metallic penial incarceration.展开更多
文摘Amyand's hernia is a rare condition defined by the inclusion of the appendix vermiformis within the hernia sac. Its incidence among cases of groin hernia is less than 1%. The clinical manifestation of incarcerated inguinal hernia generally masks the symptoms and signs of acute appendicitis, which renders preoperative diagnosis difficult. In this study, we present two cases of Amyand's hernia that were diagnosed preoperatively. The patients were taken for operation with the prediagnosis of ?ncarcerated inguinal hernia. We evaluated these cases along with data from prior studies.
文摘Meckel's diverticulum is a very common congenital anomaly of the gastrointestinal tract but many cases remain asymptomatic and are diagnosed incidentally during laparoscopic or other surgical procedures. Cases of femoral hernia involving Meckel's diverticulum are rare, with less than 50 cases reported in the literature since Littre published the first description of this coincident condition over 300 years ago. While all true "Littre's hernias" contain a Meckel's diverticulum, the involved anatomical sites are various, the most common being the inner groin(inguinal), the outer groin(femoral), and the belly button(umbilical). Complications of Littre's hernias include incarceration, strangulation, necrosis, and perforation. Herein, we describe a case of Littre's hernia that involved an incarcerated Meckel's diverticulum in a femoral hernia that was diagnosed upon investigation of symptomology manifesting from perforation and was successfully managed by surgical resection with stapler devices.
文摘BACKGROUND Benign symmetric lipomatosis(BSL)was first described by Brodie in 1846 and defined as Madelung’s disease by Madelung in 1888.At present,about 400 cases have been reported worldwide.Across these cases,surgical resection remains the recommended treatment.Here we report a case of neck BSL with concomitant thick fatty deposit in the inguinal region,which concealed the signs of a right incarcerated femoral hernia.CASE SUMMARY A 69-year-old male patient was admitted to our hospital with“abdominal pain,abdominal distension,nausea-vomiting and difficult defecation for half a month”.Moreover,he had a mass in the right inguinal region for more than 10 years.An egg-sized neck mass also developed 15 years ago and had developed into a full neck enlargement 1 year later.In addition,the patient had a history of heavy alcohol consumption for more than 40 years.With the aid of computerized tomography scan,the patient was diagnosed with BSL and a low intestinal mechanical obstruction caused by a right inguinal incarcerated hernia.Under general anesthesia,right inguinal incarcerated femoral hernia loosening and tension-free hernia repair was performed.However,this patient did not receive BSL resection.After a 1-year follow-up,no recurrence of the right inguinal femoral hernia was found.Moreover,no increase in fat accumulation was found in the neck or other areas.CONCLUSION Secretive intraperitoneal fat increase may be difficult to detect,but a conservative treatment strategy can be adopted as long as it does not significantly affect the quality-of-life.
基金Beijing Municipal Science and Technology Commission,No.Z171100000417056。
文摘BACKGROUND The global pandemic of coronavirus disease 2019 pneumonia poses a particular challenge to the emergency surgical treatment of elderly patients with high-risk acute abdominal diseases.Elderly patients are a high-risk group for surgical treatment.If the incarceration of gallstones cannot be relieved,emergency surgery is unavoidable.CASE SUMMARY We report an 89-year-old male patient with acute gangrenous cholecystitis and septic shock induced by incarcerated cholecystolithiasis.He had several coexisting,high-risk underlying diseases,had a history of radical gastrectomy for gastric cancer,and was taking aspirin before the operation.Nevertheless,he underwent emergency laparoscopic cholecystectomy,with maintenance of postoperative heart and lung function,successfully recovered,and was discharged on day 8 after the operation.CONCLUSION Emergency surgery for elderly patients with acute abdominal disease is safe and feasible during the coronavirus disease 2019 pandemic,the key is to abide strictly by the hospital's epidemic prevention regulations,fully implement the epidemic prevention procedure for emergency surgery,fully prepare before the operation,accurately perform the operation,and carefully manage the patient postoperatively.
文摘Surgical intervention of asymptomatic and accidentally detected pancreatic carcinoma can prolong survival. A 67-year-old man with the right incarcerated inguinal hernia was referred to our hospital, he immediately underwent manipulative treatment followed by hernioplasty on the next day. Upon the first visit, a pancreatic tumor was accidentally detected in CT images in the pancreatic tail. About approximately a month, abdominal CT revealed a slightly developed tumor;accordingly, distal pancreatectomy with lymph node dissection was performed. The patient was histopathologically diagnosed with tubular adenocarcinoma, and his final pathological stage was ypT2, pN0, cM0, Stage Ib, based on the TNM classification of malignant tumors (8th edition). For postoperative six months, he was treated with adjuvant chemotherapy using gemcitabine (1000 mg/m2). Remarkably, the patient reported no recurrence and has been alive for postoperative 7.5 years, thereby attaining excellent outcomes for accidentally detected pancreatic carcinoma at the occurrence of an incarcerated inguinal hernia.
文摘Aim: Incarcerated stomal prolapse is a rare complication of enterostomy. Numerous procedures have been described, such as additional laparotomy to fix the intraabdominal intestine in place, enterostomy revision, or correction of the prolapse following stoma creation. The authors report successful managements by stomal reconstruction and discuss several clinical points, including the techniques of surgical revision for incarcerated stomal prolapse in loop enterostomy. Patients: Case 1) A female infant weighing 2755 g was delivered at 34 weeks of gestation. On the first day after birth, a right supra-abdominal transverse incision of 10 cm in diameter was used for transverse loop colostomy in a cloacal malformation. Two centimeters of the stomal loop was approximated with sutures to prevent evisceration of the small intestine between the 2 limbs of the loop. Interrupted sutures of 5-0 absorbable monofilament secured the seromuscle of the colon to the peritoneum and fascia, and also to the skin. The distal limb of the colostomy prolapsed 11 months after birth. The physical findings revealed that 10 cm of the distal limb was intussuscepted. Case 2) A female infant weighing 2550 g was delivered at 39 weeks of gestation. A radiological examination by contrast enema showed no spastic rectum and colon, as in Hirschsprung’s disease. Under the laparotomy of a right supra-abdominal transverse incision of 5 cm in diameter, loop ileostomy was performed at 30cm on the proximal side of the cecum such as Case 1. Subsequently, the proximal limb of the ileostomy prolapsed 2 days after operation. The physical findings revealed that 10 cm of the proximal limb was intussuscepted. New enterostomy formation: Divided enterostomy was performed with 3-cm stitching of each limb. The stomal site was moved to the inside from the previous stomal site to oversew and fix by the rectal fascia. The children have been well without trouble since undergoing the new eneterostomy formation. Conclusions: Operation to repair the prolapse of a stoma is advised if it causes problems. We found that simple mobilization of the bowel and excision of the redundant bowel provided a satisfactory result in the present cases.
文摘Background: The burden of COVID-19 and human immunodeficiency virus (HIV) are some of the major and persistent global health challenges of the twenty-first century. HIV and COVID-19 are expected to overlap in high HIV-burden countries, posing several public health challenges as a result. Prisons are overcrowded, have limited space for social distancing and have inadequate ventilation systems, making it difficult to contain the spread of COVID-19 in addition to the high-risk behaviours of inmates which contribute to the spread of HIV within these facilities. This study aimed to determine the prevalence of COVID-19 among inmates in a prison facility with a relatively high HIV burden in Port Harcourt, Nigeria;investigating potential risk factors and co-infection with HIV. Methodology: The study employed a descriptive cross-sectional study design sampling 200 inmates from the Port Harcourt Maximum Security Custodial Centre from July to December 2022. A well-structured questionnaire was administered via interviews in addition to screening for HIV-1/2 antibodies as well as COVID-19 antigens using rapid diagnostic test kits. Descriptive statistics and chi-square were carried out on the GraphPad Prism 9 software with statistical significance defined as a p-value of less than 0.05 at a 95% confidence interval. Result: The prevalence of HIV from the current study was 6.5%, COVID-19 prevalence was reported to be 12.5% while HIV/COVID-19 co-infection was 1.5% The duration of incarceration, face mask use, frequent visitations and vaccination against COVID-19 were found to be significantly associated with the prevalence of COVID-19 in the studied population (p Conclusion: The current study reports a relatively high prevalence of HIV and COVID-19 among the inmates in the study area. It becomes expedient for the administrators of the correctional facility to properly screen new inmates for COVID-19, quarantine and manage cases, as well as provide them with personal protective equipment such as face masks. In-person visitation should be balanced with measures to prevent the spread of the infection, and mass vaccination campaigns should be promoted. Improving access to HIV screening and therapy for all prisoners should be prioritised to identify and manage the incidence of HIV early, reducing the risk of transmission, mitigating comorbidities and improving health outcomes.
文摘Patients with an incarcerated rectal prolapse usually present in the emergency department where manual reduction is first attempted. If reduction is unsuccessful, an emergency laparotomy and internal reduction is required. Edema in the rectal and perineal tissues and impaired blood flow are the main factors for a high percentage of anastomotic leaks. The traditional single stage perineal rectosigmoidectomy is not a safe surgical procedure for treating incarcerated or strangulated rectal prolapses associated with severe edema. Herein we report a case of an incarcerated rectal prolapse treated with the Notaras procedure.
文摘Incarcerated gravid uterus is a rare obstetric condition that contributes to pregnancy-related adverse outcomes,especially if the uterus remains incarcerated and the condition goes undiagnosed until delivery.An effective diagnosis of this condition is benefited from pelvic examination combined with imaging methods and based on suspected symptoms.We present a case of ultrasound-assisted instrument reposition of an incarcerated gravid uterus at mid-gestation and discuss its clinical characteristics,diagnosis,imaging features,and treatment.We believe that once manual reduction fails,the use of instruments will undoubtedly be a better choice.
文摘AIM:To investigate the feasibility of endoscopic dacryocystorhinostomy(En-DCR)with bicanalicular silicone tube intubation for treating chronic dacryocystitis secondary to nasolacrimal duct stent(NDS)incarceration.METHODS:En-DCRs were performed on 44 chronic dacryocystitis patients(46 eyes)secondary to NDS incarceration from April 2016 to October 2022.The granuloma and scar tissues were separated,and the removal of NDS incarceration was achieved during the surgery;the flap of the lacrimal sac was trimmed and anastomosed with nasal mucosal,a bicanalicular silicone tube was implanted,and lacrimal size and condition were assessed.The tube was removed 3mo after surgery.During the final follow-up of 12mo when the surgery was completed,the complications and the rates of surgical success were assessed.RESULTS:This study covered 40 patients(42 eyes).Intraoperatively,it was found that the lacrimal sac became small,and the sac wall had granulation and scar tissue attached to the incarcerated NDS in all eyes.At 12mo after surgery completed,the rates of the functional and anatomical success reached 80.95%(34/42)and 83.33%(35/42),respectively.Under the effect of intranasal ostial closure,seven eyes failed to achieve anatomical success.No serious complications(e.g.,visual impairment,sinusitis,and orbital fat prolapse)was observed.CONCLUSION:With the success rate over 80%and no serious complications,En-DCR with bicanalicular silicone tube implantation is effective in treating chronic dacryocystitis secondary to NDS incarceration.
文摘BACKGROUND:Lumbar hernia is a rare congenital or acquired defect of the posterior abdominal wall. The acquired type is more common and occurs mainly as an incisional defect after flank surgery. Incarceration or strangulation of hernia contents is uncommon. METHOD:Segmental liver incarceration through a recurrent incisional lumbar defect was diagnosed in a 58 years old woman by magnetic resonance imaging. RESULTS:The patient underwent an open repair of the com-plicated hernia. An expanded polytetraflouoroethylene(e-PTFE) mesh was fashioned as a sublay prosthesis. She had an uncomplicated postoperative course. Follow-up examinations revealed no evidence of recurrence. CONCLUSIONS:Although lumbar hernia rarely results in incarceration or strangulation,early repair is necessary because of the risks of complications and the increasing difficulty in repairment as it enlarges. Surgical repair is often difficult and challenging.
文摘This is a case of primigravida of 35 years of age having spontaneous conception & 14.5 wks. pregnancy with retention of urine and pain in lower abdomen for 5 days. There was history of unsuccessful attempt of correction of retroversion one day prior. Transabdominal USG (ultrasonography) confirmed 14.5 wks. live pregnancy with incarceration of uterus. In this case, only GA (general anaesthesia) corrected retroversion & incarceration.
文摘Uterine incarceration is a rare condition thought to result from incarceration of a retroverted uterus in the small pelvis. The present case report describes a case of uterine incarceration caused by extensive pelvic adhesions after appendectomy for perforated appendicitis. A 39-year-old primigravida woman was referred to our obstetric unit for follow-up after successful in vitro fertilization. The symptoms related to uterine incarceration included anuria at 15 weeks of gestation and uterine contractions starting at 28 weeks of gestation. The absence of a cervical canal on ultrasonography is a key finding required to diagnose this rare condition. In the present case, the incision for uterotomy was determined by prenatal magnetic resonance imaging and transmyometrium ultrasonography during cesarean section. Both MRI and ultrasound images clearly showed anatomical relationships between the bladder, cervical canal and uterine wall. Clinicians need to know how the incision for uterotomy should be made and to avoid serious complications during cesarean section.
文摘Post-traumatic stress disorder (PTSD) is a psychiatric disorder that is the result of personal experiences directly involved with or witnessing traumatic or life-threating events. PTSD has profound psychobiological correlates, which can impair the person’s daily life and be life-threatening. The disorder is typically associated with military com-bat, acts of terrorism, sexual assault, bullying, exposure to abusive and toxic environments. The culture of prison encompasses and is the direct catalyst for consistent exposure to each of these elements. Considering that the United States leads the free world in the rate of incarceration, Prison-related PTSD is a serious public health and social issue. A sharp rise in ex-offenders that meet 3 or more of the criteria for diagnosing post-traumatic stress disorder (PTSD) from the Fifth Edition of the Diag-nostic and Statistical Manual of Mental Disorders is alarming. We review the numbers and introduce a new perspective on how the Department of Corrections and Department of Justice can play a vital role by working to correct this problem. We discuss the need to provide long-term care for this underserved population, particularly those convicted of non-violent crimes. We present arguments in support of the notion there should be professional clinical resources available for individuals released from prison to help manage the symptoms of PTSD that were created primarily through incarceration.
文摘Meckel's diverticula incarcerated in a hernia were first described anecdotally by Littré, a French surgeon, in 1700. Meckel, a German anatomist and surgeon, explained the pathophysiology of this disease 100 years later. In addition, a congenital paraduodenal mesocolic hernia, known as a Treitz hernia, is a rare cause of small bowel obstruction. These hernias are caused by an abnormal rotation of the primitive midgut, resulting in a right or left paraduodenal hernia. We treated a patient presenting with pain and diagnosed extraluminal air in the abdomen after a computed tomography examination. We performed a laparotomy and found a combination of these two seldomly occurring congenital diseases, incarceration and perforation of Meckel's diverticulum in a left paraduodenal hernia. We performed a thorough review of the literature, and this report is the first to describe a patient with a combination of these two rare conditions. We considered the case regarding the variety of terminology as well as the treatment options of these conditions.
文摘BACKGROUND Perivascular epithelioid cell tumor(PEComa)represents a group of rare mesenchymal tumors.PEComa can occur in many organs but is rare in the colorectum,especially in children.Furthermore,PEComa is a rare cause of intussusception,the telescoping of a segment of the gastrointestinal tract into an adjacent one.We describe a rare case of pediatric PEComa complicated with intussusception and anal incarceration,and conduct a review of the current literature.CASE SUMMARY A 12-year-old girl presented with abdominal pain and abdominal ultrasound suggested intussusception.Endoscopic direct-vision intussusception treatment and colonoscopy was performed.A spherical tumor was discovered in the transverse colon and removed by surgery.Postoperative pathologic analyses revealed that the tumor volume was 5.0 cm×4.5 cm×3.0 cm and the tumor tissue was located in the submucosa of the colon,arranged in an alveolar pattern.The cell morphology was regular,no neoplastic necrosis was observed,and nuclear fission was rare.The immunohistochemical staining results were as follows:Human melanoma black 45(HMB 45)(+),cluster of differentiation 31(CD31)(+),cytokeratin(-),melanoma-associated antigen recognized by T cells(-),smooth muscle actin(-),molleya(-),desmin(-),S-100(-),CD117(-),and Ki67(positive rate in hot spot<5%).Combined with the results of pathology and immunohistochemistry,we diagnosed the tumor as PEComa.Postoperative recovery was good at the 4 mo follow-up.CONCLUSION The diagnosis of PEComa mainly depends on pathology and immunohistochemistry.Radical resection is the preferred treatment method.
文摘BACKGROUND Bone transport and distraction osteogenesis has been widely used to treat bone defects after traumatic surgery,but,skin and soft tissue incarceration can be as high as 27.6%.AIM To investigate the efficacy of inserting a tissue expander to prevent soft tissue incarceration.METHODS Between January 2016 and December 2018,12 patients underwent implantation of a tissue expander in the subcutaneous layer in the vicinity of a tibial defect to maintain the soft tissue in position.A certain amount of normal saline was injected into the tissue expander during surgery and was then gradually extracted to shrink the expander during the course of transport distraction osteogenesis.The tissue expander was removed when the two ends of the tibial defect were close enough.RESULTS In all 12 patients,the expanders remained intact in the subcutaneous layer of the bone defect area during the course of transport distraction osteogenesis.When bone transport was adequate,the expander was removed and the bone transport process was completed.During the whole process,there was no incarceration of skin and soft tissue in the bone defect area.Complications occurred in one patient,who experienced poor wound healing.CONCLUSION The pre-filled expander technique can effectively avoid soft tissue incarceration.The authors’primary success with this method indicates that it may be a valuable tool in the management of incarcerated soft tissue.
文摘Uterine incarceration is a rare disease of abnormal uterine morphology, the proportion during pregnancy was 1 in 3000 - 10,000. Previously reported patients with uterine incarceration have different symptoms. Rarely, asymptomatic cases persist into the third trimester of pregnancy. In fact, the patients with uterine incarceration can be asymptomatic and normally carry their fetuses to the term because it mainly changes the cervix, which does not affect fetal growth in utero directly. Additionally, cesarean section is both a treatment and a direct method to clarify the diagnosis again, and low-molecular-heparin anticoagulant therapy should be considered immediately after surgery. Here, we present two cases clarifying that patients with uterine incarceration can be pregnant without any discomfort during pregnancy and provide a successful treatment plan.
文摘BACKGROUND Penial incarceration(PI)is a rare situation.It is usually caused by a foreign object which strangulates at the base of the penis.PI may derive from pranks,sexual demand,mental disease,or intention to prohibit urinary disease.Generally,these situations are emergent and immediate treatments are needed.Cases of chronic PI are less reported,and their treating methods are yet to be discussed.CASE SUMMARY We reported a case on treating a 73-year-old male who had PI with a metallic hoop for three months.After multidisciplinary consultation,the operation was performed successfully with the help of a fretsaw.Despite the chronic strangulation,the prognosis of the patient was satisfying.To the best of our knowledge,this case was rare and precious as it featured the longest strangulating time,which might enlighten the treating process of future PI cases.Also,we have reviewed and summarized major published cases to encapsulate appropriate approaches when facing diverse strangulation situations.CONCLUSION The selection of surgical tools depends on the material of the strangulating objects,the availability of equipment,and the severity of the penial damage.The urination function may not be affected after three months of incarceration as in our case,whilst prudent preoperative measures and multidisciplinary evaluations are always essential.Although using a fretsaw is comparatively slow,it is safe and feasible to treat metallic penial incarceration.
