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
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
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
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: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
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
AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperit...AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.展开更多
The risk factors associated with strangulated ovarian hernia (SOH)in female patients (<1 year old)were identified.A retrospective analysis was conducted regarding the data from 2006 to 2017.The patients were divide...The risk factors associated with strangulated ovarian hernia (SOH)in female patients (<1 year old)were identified.A retrospective analysis was conducted regarding the data from 2006 to 2017.The patients were divided into 2groups:SOH group (n=9)and non-SOH group (n=23). Patient demographics,clinical signs,preoperative examinations and intraoperative findings were compared between the two groups,and risk factors for SOH were tested using a binary logistic regression model.To explore whether greater ovary was more likely to be twisted,leading to SOH, all the patients were divided into ovary volume <5cm^3 and ≥5cm^3 groups and the association between ovarian volume and ovary torsion was assessed.Among a total of 32 female patients (<1year old)with incarcerated ovarian herniation,9 patients developed SOH.The single variate analysis revealed that times of manual reduction,ovarian volume,ovary with or without multiple cysts,ovary torsion or not and angle of ovary torsion were found to be significant factors associated with SOH.The multivariate analysis showed ovarian volume was evidenced as an independent risk factor for SOH.Furthermore,the incidence of ovary torsion was significantly higher in ovarian volume ≥5cm^3 group than in ovarian volume <5cm^3 group,indicating that larger ovary was more likely to result in ovary torsion,leading to SOH.Our study demonstrated that the odds of SOH increased with increasing ovarian volume in female patients (<1 year old)because the relatively greater ovary at this age was more likely to be incarcerated and twisted,leading to SOH.展开更多
Development of oedema and hypoproteinaemia in a liver transplant recipient may be the first signs of graft dysfunction and should prompt a full assessment. We report the novel case of a patient who, years after liver ...Development of oedema and hypoproteinaemia in a liver transplant recipient may be the first signs of graft dysfunction and should prompt a full assessment. We report the novel case of a patient who, years after liver transplantation developed a functional blind loop in an incisional hernia, which manifested as oedema and hypoproteinaemia secondary to protein losing enteropathy. After numerous investigations, the diagnosis was made by flurodeoxyglucose positron emmision tomography (FDG-PET) imaging. Surgical repair of the incisional hernia was followed several months later by resolution of the protein loss, and confirmed at a post operative FDG-PET scan at one year.展开更多
Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, particularly if early surgical intervention is not undertaken. We report a case in which a woman presenting at 23 wk＇s gestati...Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, particularly if early surgical intervention is not undertaken. We report a case in which a woman presenting at 23 wk＇s gestation was admitted with symptoms of respiratory failure and bowel obstruction due to incarceration of viscera through a left posterolateral defect of the diaphragm （Bochdalek＇s hernia）. Surgery （left thoracoabdominal incision） demonstrated compression atelectasis, mediastinal shift, strangulation and gangrene of the herniated viscera which led to segmental resection of the involved portion of large intestine with re-establishment of bowel continuity by end to end anastomosis. The greater omentum was partly necrotic necessitating resection. The diaphragmatic defect was closed with interrupted sutures. Postoperative period was uncomplicated. Pregnancy was allowed to continue until 39 wk＇s gestation at which time elective cesarean delivery was performed. It is concluded that symptomatic maternal diaphragmatic hernia during pregnancy is a surgical emergency and requires a high index of suspicion.展开更多
BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain.There are various types of incarcerated hernias,including incarcerated hernias of the appendix.These hernias are often complicated by appendi...BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain.There are various types of incarcerated hernias,including incarcerated hernias of the appendix.These hernias are often complicated by appendiceal inflammation,necrosis,and suppuration,which affect the outcome of surgical repair.A De Garengeot hernia is a femoral hernia that contains the appendix.This type of hernia has a low incidence.When a De Garengeot hernia is clinically suspected,emergency surgical treatment should be performed as soon as possible.CASE SUMMARY A 59-year-old man was admitted to the hospital with a painful right inguinal mass that had suddenly developed 6 hours earlier.Physical examination revealed a 4 cm×2 cm palpable mass in the right groin.The mass was hard and could not be reduced due to tenderness.It did not descend into the scrotum.B-ultrasound revealed an incarcerated hernia.During surgery,the hernia was found to contain the appendix,which exhibited distal avascular necrosis.A De Garengeot hernia was diagnosed according to the classification criteria of this type of inguinal hernia.Laparoscopic reduction of the incarcerated hernia,appendectomy,and small-incision femoral hernia repair were performed in the emergency department,and cefuroxime was administered as anti-infection therapy for 2 d postoperatively.After treatment,the patient had no abdominal pain or infection and was discharged on postoperative day 4.He had no recurrence of the inguinal hernia after 16 months of follow-up.CONCLUSION De Garengeot hernias have a low incidence and are difficult to diagnose.Laparoscopy is useful for their diagnosis and treatment.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.
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: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AIM To study the utility of single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection.METHODS A 2 cm transverse skin incision was made in the umbilicus, extending to the intraperitoneal cavity. Carbon dioxide was insufflated followed by insertion of laparoscope to observe the intraperitoneal cavity. The type of hernia was diagnosed and whether there was the presence of intestinal incarceration was confirmed. When an intestinal incarceration in the hernia sac was found, the forceps were inserted through the incision site and the intestine was returned to the intraperitoneal cavity without increasing the number of trocars. Once the peritoneum was closed, totally extraperitoneal inguinal hernia repair was performed, and finally, intraperitoneal observation was performed to reconfirm the repair.RESULTS Of the 75 hernias treated, 58 were on one side, 17 were on both sides, and 10 were recurrences. The respective median operation times for these 3 groups of patients were 100 min(range, 66 to 168), 136 min(range, 114 to 165), and 125 min(range, 108 to 156), with median bleeding amounts of 5 g(range, 1 to 26), 3 g(range, 1 to 52), and 5 g(range, 1 to 26), respectively. Intraperitoneal observation showed hernia on the opposite side in 2 cases, intestinal incarceration in 3 cases, omental adhesion into the hernia sac in 2 cases, severe postoperative intraperitoneal adhesions in 2 cases, and bladder protrusion in 1 case. There was only 1 case of recurrence.CONCLUSION Single-incision totally extraperitoneal inguinal hernia repair with intraperitoneal inspection makes hernia repairs safer and reducing postoperative complications. The technique also has excellent cosmetic outcomes.
文摘The risk factors associated with strangulated ovarian hernia (SOH)in female patients (<1 year old)were identified.A retrospective analysis was conducted regarding the data from 2006 to 2017.The patients were divided into 2groups:SOH group (n=9)and non-SOH group (n=23). Patient demographics,clinical signs,preoperative examinations and intraoperative findings were compared between the two groups,and risk factors for SOH were tested using a binary logistic regression model.To explore whether greater ovary was more likely to be twisted,leading to SOH, all the patients were divided into ovary volume <5cm^3 and ≥5cm^3 groups and the association between ovarian volume and ovary torsion was assessed.Among a total of 32 female patients (<1year old)with incarcerated ovarian herniation,9 patients developed SOH.The single variate analysis revealed that times of manual reduction,ovarian volume,ovary with or without multiple cysts,ovary torsion or not and angle of ovary torsion were found to be significant factors associated with SOH.The multivariate analysis showed ovarian volume was evidenced as an independent risk factor for SOH.Furthermore,the incidence of ovary torsion was significantly higher in ovarian volume ≥5cm^3 group than in ovarian volume <5cm^3 group,indicating that larger ovary was more likely to result in ovary torsion,leading to SOH.Our study demonstrated that the odds of SOH increased with increasing ovarian volume in female patients (<1 year old)because the relatively greater ovary at this age was more likely to be incarcerated and twisted,leading to SOH.
文摘Development of oedema and hypoproteinaemia in a liver transplant recipient may be the first signs of graft dysfunction and should prompt a full assessment. We report the novel case of a patient who, years after liver transplantation developed a functional blind loop in an incisional hernia, which manifested as oedema and hypoproteinaemia secondary to protein losing enteropathy. After numerous investigations, the diagnosis was made by flurodeoxyglucose positron emmision tomography (FDG-PET) imaging. Surgical repair of the incisional hernia was followed several months later by resolution of the protein loss, and confirmed at a post operative FDG-PET scan at one year.
文摘Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, particularly if early surgical intervention is not undertaken. We report a case in which a woman presenting at 23 wk＇s gestation was admitted with symptoms of respiratory failure and bowel obstruction due to incarceration of viscera through a left posterolateral defect of the diaphragm （Bochdalek＇s hernia）. Surgery （left thoracoabdominal incision） demonstrated compression atelectasis, mediastinal shift, strangulation and gangrene of the herniated viscera which led to segmental resection of the involved portion of large intestine with re-establishment of bowel continuity by end to end anastomosis. The greater omentum was partly necrotic necessitating resection. The diaphragmatic defect was closed with interrupted sutures. Postoperative period was uncomplicated. Pregnancy was allowed to continue until 39 wk＇s gestation at which time elective cesarean delivery was performed. It is concluded that symptomatic maternal diaphragmatic hernia during pregnancy is a surgical emergency and requires a high index of suspicion.
基金Zhejiang Provincial Medical Science Research Foundation,No.2020ZH053 and No.2021KY1133.
文摘BACKGROUND An incarcerated hernia is a common cause of acute abdominal pain.There are various types of incarcerated hernias,including incarcerated hernias of the appendix.These hernias are often complicated by appendiceal inflammation,necrosis,and suppuration,which affect the outcome of surgical repair.A De Garengeot hernia is a femoral hernia that contains the appendix.This type of hernia has a low incidence.When a De Garengeot hernia is clinically suspected,emergency surgical treatment should be performed as soon as possible.CASE SUMMARY A 59-year-old man was admitted to the hospital with a painful right inguinal mass that had suddenly developed 6 hours earlier.Physical examination revealed a 4 cm×2 cm palpable mass in the right groin.The mass was hard and could not be reduced due to tenderness.It did not descend into the scrotum.B-ultrasound revealed an incarcerated hernia.During surgery,the hernia was found to contain the appendix,which exhibited distal avascular necrosis.A De Garengeot hernia was diagnosed according to the classification criteria of this type of inguinal hernia.Laparoscopic reduction of the incarcerated hernia,appendectomy,and small-incision femoral hernia repair were performed in the emergency department,and cefuroxime was administered as anti-infection therapy for 2 d postoperatively.After treatment,the patient had no abdominal pain or infection and was discharged on postoperative day 4.He had no recurrence of the inguinal hernia after 16 months of follow-up.CONCLUSION De Garengeot hernias have a low incidence and are difficult to diagnose.Laparoscopy is useful for their diagnosis and treatment.
