RESUMEN
We present a case of multiple abdominal pathologies occurring simultaneously, which emphasizes the importance of keeping a broad differential and evaluating each diagnosis. A 33-year-old female presented with abdominal pain, nausea, and vomiting. Her workup included computerized tomography which demonstrated acute appendicitis with concern for a closed-loop bowel obstruction. She was offered diagnostic laparoscopy with anticipation of laparoscopic appendectomy and further evaluation for the source of the bowel obstruction. At the time of surgery, a Meckel's diverticulum with acute diverticulitis was identified, in addition to an inflamed appendix. A small band near the base of the Meckel's diverticulum was found and divided. The appendix was treated with a laparoscopic appendectomy and the Meckel's diverticulum was resected. She did well in recovery and continued to do well at her follow-up appointment. This case emphasized the importance of a thorough evaluation of a patient's differential diagnosis, as it is possible for multiple pathologies to occur simultaneously.
RESUMEN
A 29-year-old male presented with a zone one penetrating neck injury resulting in complete transection of the left carotid sheath and its contents. The proximal common carotid artery and internal jugular vein injuries were successfully managed with vessel ligation without adverse neurological sequelae. The patient also developed a contralateral pneumothorax, which was due to an occult through-and-through esophageal injury at the junction of the cervical and thoracic esophagus. The esophageal injury was successfully managed with surgical repair and wide drainage of the neck and right chest.
RESUMEN
A 31-year-old male with a history of diverticulitis presented for acute abdominal pain and was found to have several small areas of free air on computed tomography (CT) of the abdomen/pelvis. Due to inflammatory changes seen around the sigmoid colon and small bowel, he was diagnosed with perforated diverticulitis. The patient complained of significant right-sided abdominal pain with significant tenderness on abdominal examination. The patient was initially treated with diagnostic laparoscopy and was actually found to have acute perforated appendicitis with mild appendiceal adherence to the sigmoid colon. This case highlights the importance of careful history and physical examination in an era where imaging often precedes the surgeon's evaluation. The case also provides support for laparoscopy in select cases of pneumoperitoneum, sparing patients the morbidity of undergoing an open laparotomy.
RESUMEN
Sclerosing mesenteritis is a rare and often benign condition characterized as a fibrotic disease consisting of non-suppurative inflammation of adipose tissue. Through mass effect, sclerosing mesenteritis can compromise the gastrointestinal lumen as well as mesenteric vessel integrity. There is a poor understanding of this disorder and its pathogenesis, which presents with various symptomatology and often without identification of inciting factors. Patients with sclerosing mesenteritis exhibit gastrointestinal and systemic manifestations including weight loss, fever, nausea, vomiting, diarrhea, and abdominal pain. This case presents a patient with a seven-month history of chronic, epigastric abdominal pain following laparoscopic surgery for acute uncomplicated appendicitis. The patient underwent work-up with computed tomography and magnetic resonance enterography that confirmed the presence of a mesenteric mass of unknown etiology located in the mid-epigastrium. Due to the inability to safely sample the mass, the patient underwent diagnostic laparoscopy, which was subsequently converted to an open procedure where excision of the mesenteric lesion was performed. Surgical pathology revealed fat necrosis with fibrosis, granulomatous inflammation, and dystrophic calcifications consistent with sclerosing mesenteritis. The patient was seen in follow-up with the resolution of her epigastric abdominal pain. This case report demonstrates a unique presentation of a symptomatic patient with a mesenteric mass not amenable to non-invasive biopsy. Complete excision of this lesser sac mass revealed sclerosis mesenteritis as the pathological cause.
RESUMEN
BACKROUND: Traumatic lumbar hernias are not common hernias that are encountered by general or plastic surgery teams, however it is important to understand the anatomy of the hernia in order to be able to correct the flank defect. In our patient, the oblique muscles were sheared off the iliac crest periosteum, however the attachments to the ribs and spine were maintained. We were able to successfully place a pre-peritoneal polypropylene mesh which was secured to the musculature, and re-approximate the oblique muscles to the iliac crest using Mitek QUICKANCHOR® sutures. Our case study has been reported in line with the SCARE criteria ([8] Agha et al., 2016). CASE REPORT: The subject in our case was a 47-year-old gentleman who was involved in a motor vehicle accident, and sustained a traumatic lumbar hernia due to the 3-point seatbelt he was wearing. He was transported via ambulance to our trauma center. CONCLUSION: Understanding the anatomy and mechanism of injury is the key to reconstructing traumatic lumber hernias. Although not required, mesh reinforcement has significantly reduced the recurrence of all hernias. This is the simplest and most effective way, in our opinion, to return the flank muscles to their native position while providing mesh reinforcement.