Huge inguinoscrotal hernias are a challenging operation. The technical aspects of the procedure can be very difficult and the recovery may be complicated by ventilatory problems. Progressive preoperative pneumoperiton...Huge inguinoscrotal hernias are a challenging operation. The technical aspects of the procedure can be very difficult and the recovery may be complicated by ventilatory problems. Progressive preoperative pneumoperitoneum (PPP) is a method which has been used for many years to reduce both intra and postoperative complications. However, it is associated with a prolonged preoperative hospital stay which is expensive and often stressful to patients. We report a case of a morbidly obese patient with a huge inguinoscrotal hernia. PPP was not implemented. The operation was uneventful and he was discharged 8 days later with no major post-operative complications. This case therefore questions the necessity of PPP for huge inguin- oscrotal hernias.展开更多
Severe acute pancreatitis often leads to pancreatic and peripancreatic collections but,rarely,it can lead to collections at sites remote from the pancreas.Three male patients presented with abdominal pain and inguinos...Severe acute pancreatitis often leads to pancreatic and peripancreatic collections but,rarely,it can lead to collections at sites remote from the pancreas.Three male patients presented with abdominal pain and inguinoscrotal swelling.They were initially misdiagnosed with obstructed inguinal hernia,epididymo-orchitis and hydrocele,respectively.Later,their diagnosis of acute pancreatitis was revealed on laparotomy in one patient and on computed tomography(CT)in the remaining two patients.All these cases had extensive peripancreatic necrosis and paracolic collections tracking along the psoas muscle,downwards towards the pelvis.These collections were initially managed by percutaneous drainage and saline irrigation as a part of the‘step-up’approach.Two of these patients required open necrosectomy,while all required incision and drainage of inguinoscrotal collections.All the patients were discharged in satisfactory condition.Inguinoscrotal swelling is unusual as a first presentation of acute pancreatitis.A high index of suspicion,with careful study of patient’s history and examination along with CT,may provide an accurate diagnosis.Local drainage may be required to control sepsis and also provide an egress route for intra-abdominal collections.展开更多
文摘Huge inguinoscrotal hernias are a challenging operation. The technical aspects of the procedure can be very difficult and the recovery may be complicated by ventilatory problems. Progressive preoperative pneumoperitoneum (PPP) is a method which has been used for many years to reduce both intra and postoperative complications. However, it is associated with a prolonged preoperative hospital stay which is expensive and often stressful to patients. We report a case of a morbidly obese patient with a huge inguinoscrotal hernia. PPP was not implemented. The operation was uneventful and he was discharged 8 days later with no major post-operative complications. This case therefore questions the necessity of PPP for huge inguin- oscrotal hernias.
文摘Severe acute pancreatitis often leads to pancreatic and peripancreatic collections but,rarely,it can lead to collections at sites remote from the pancreas.Three male patients presented with abdominal pain and inguinoscrotal swelling.They were initially misdiagnosed with obstructed inguinal hernia,epididymo-orchitis and hydrocele,respectively.Later,their diagnosis of acute pancreatitis was revealed on laparotomy in one patient and on computed tomography(CT)in the remaining two patients.All these cases had extensive peripancreatic necrosis and paracolic collections tracking along the psoas muscle,downwards towards the pelvis.These collections were initially managed by percutaneous drainage and saline irrigation as a part of the‘step-up’approach.Two of these patients required open necrosectomy,while all required incision and drainage of inguinoscrotal collections.All the patients were discharged in satisfactory condition.Inguinoscrotal swelling is unusual as a first presentation of acute pancreatitis.A high index of suspicion,with careful study of patient’s history and examination along with CT,may provide an accurate diagnosis.Local drainage may be required to control sepsis and also provide an egress route for intra-abdominal collections.
