RESUMO
We encountered a rare case of appendiceal carcinoma associated with Amyand's hernia, which was difficult to diagnose preoperatively. A 74-year-old man presented to our hospital with right lower abdominal pain. A hard mass was palpable in the right lower abdomen, and blood tests showed a slightly elevated inflammatory response. Computed tomography revealed a 7 × 5 cm mass with indistinct borders and heterogeneous internal density extending from the cecum to the right lower abdominal wall. We diagnosed appendiceal abscess, however, percutaneous biopsy which was performed for differential diagnosis with appendiceal carcinoma showed no malignancy. Thereafter, the patient was followed up. Two months later, a blood test showed insignificant changes in the inflammatory response and a high serum carcinoembryonic antigen level (48.6 ng/mL). An ultrasound showed a mass contiguous to the appendix, extending to the abdominal wall, with abundant blood flow signals. Fluorodeoxyglucose-positron emission tomography showed a high accumulation of fluorodeoxyglucose in the mass. Four months after the initial visit, the patient had an open ileocecal resection combined with an abdominal wall resection based on the preoperative diagnosis of appendiceal carcinoma invading the abdominal wall. During laparotomy, an enlarged appendix tip extended from the internal inguinal ring outside the inferior epigastric artery to the abdominal wall. Histopathological examination of the appendiceal tumor revealed well-differentiated adenocarcinoma, T4b (abdominal wall), N0, Ly0, and V0. When a right lower abdominal mass extends from the cecum to the abdominal wall, appendiceal tumors associated with Amyand's hernia should be considered.
Assuntos
Adenocarcinoma , Neoplasias do Apêndice , Hérnia Inguinal , Humanos , Masculino , Idoso , Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/cirurgia , Neoplasias do Apêndice/complicações , Neoplasias do Apêndice/diagnóstico , Neoplasias do Apêndice/diagnóstico por imagem , Adenocarcinoma/patologia , Adenocarcinoma/cirurgia , Adenocarcinoma/complicações , Adenocarcinoma/diagnóstico , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Finding an ovary and/or fallopian tube within an indirect inguinal hernia is a rare occurrence that can be detected incidentally during elective surgery or present as a medical emergency requiring immediate intervention. Hence, it poses a difficult clinical picture in a reproductive-age woman with groin mass. CLINICAL PRESENTATION: We describe the case of a 45-year-old Ethiopian woman of Amhara ethnicity who presented with a left inguinal swelling that persisted for 5 years. Physical examination revealed an irreducible, non-tender lump in the left groin and an ultrasonography scan confirmed the presence of an indirect inguinal hernia. The patient was then scheduled for elective hernia repair. During the surgery, both her left ovary and fallopian tube were found within the hernial sac. The contents were released from the sac, high ligation performed, and the inguinal floor repaired with mesh. DISCUSSION: Inguinal hernias in women are rare and often present a diagnostic challenge. Although the exact pathogenesis of inguinal hernias containing female genital organs is unknown, some risk factors have been postulated. Diagnosis should start with a physical exam and imaging, but many of the cases have been intraoperative surprises. Management is primarily surgical, ranging from simple reduction and hernia repair to salpingo-oophorectomy depending on the status of the hernia contents. CONCLUSION: This report emphasizes the importance of maintaining a high index of suspicion when examining females with inguinal hernias to ensure accurate diagnosis and management of tubo-ovarian hernias. Although rare, inguinal hernias containing female genital organs should be considered in the differential diagnosis of inguinal hernias, as early detection and appropriate surgical management can prevent potential complications.
Assuntos
Tubas Uterinas , Hérnia Inguinal , Herniorrafia , Ovário , Humanos , Feminino , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Pessoa de Meia-Idade , Tubas Uterinas/patologia , Tubas Uterinas/cirurgia , Tubas Uterinas/diagnóstico por imagem , Ovário/diagnóstico por imagem , Ovário/patologia , Ovário/cirurgia , UltrassonografiaRESUMO
BACKGROUND: Testicular ischemia requires timely diagnosis and definitive management to avoid serious consequences such as orchiectomy. It is almost always caused by testicular torsion; however, there are other causes to be aware of. CASE REPORT: A 32-year-old man developed testicular ischemia following a laparoscopic robotic-assisted inguinal hernia repair with preperitoneal mesh. The ischemia progressed to a fully infarcted testicle with no evidence of torsion on subsequent surgical exploration. He ultimately did require an orchiectomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: While extremely rare, testicular ischemia or infarct must be considered in patients presenting with testicular pain shortly after inguinal hernia repair. Emergent surgical evaluation and loosening of the hernia mesh may be required to salvage the testicle.
Assuntos
Hérnia Inguinal , Infarto , Laparoscopia , Testículo , Humanos , Masculino , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Adulto , Testículo/irrigação sanguínea , Infarto/etiologia , Laparoscopia/métodos , Laparoscopia/efeitos adversos , Herniorrafia/métodos , Orquiectomia/métodos , Telas Cirúrgicas/efeitos adversosRESUMO
Spontaneous ruptured hepatocellular carcinoma (HCC) remains a life-threatening condition despite improvements in diagnostic methods and established treatment strategies. Although typical clinical presentations of spontaneous ruptured HCC facilitate easy diagnosis, this condition can present with unexpectedly varied symptoms, making diagnosis challenging. We describe an atypical clinical presentation of spontaneous ruptured HCC mimicking an inguinal hernia. A 66-year-old man presented to the emergency department with groin discomfort and swelling, suggesting an inguinal hernia. He had no history of an inguinal hernia or known liver cirrhosis. Physical examination revealed a palpable, tender left groin mass. Point-of-care ultrasonography showed bowel-like structures with an echo-free space in the left groin. Unenhanced computed tomography (CT) of the pelvis demonstrated mesenteric fat prolapse and hyperdense fluid in the left inguinal canal and scrotum. Considering the possibility of a strangulated hernia, emergency exploratory laparotomy was performed. Unexpectedly, blood retention in the hernia sac was found, with no intestinal involvement. Further exploration revealed a hematoma and tumor on the liver surface. Finally, he was diagnosed with spontaneous ruptured HCC and underwent successful emergency hepatic resection. Spontaneous ruptured HCC can potentially mimic other abdominal conditions such as an inguinal hernia, even in cases of undiagnosed liver cirrhosis. Although unenhanced CT can reveal bloody ascites suggesting hemoperitoneum, the underlying cause should be carefully considered. Emergency physicians should recognize various clinical presentations of spontaneous ruptured HCC to ensure prompt diagnosis and treatment of this potentially fatal complication.
Assuntos
Carcinoma Hepatocelular , Hérnia Inguinal , Neoplasias Hepáticas , Tomografia Computadorizada por Raios X , Humanos , Masculino , Hérnia Inguinal/complicações , Hérnia Inguinal/diagnóstico por imagem , Hérnia Inguinal/diagnóstico , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Carcinoma Hepatocelular/diagnóstico , Idoso , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico , Ruptura Espontânea , Diagnóstico Diferencial , Ultrassonografia , Serviço Hospitalar de EmergênciaRESUMO
The involvement of kidney, perirenal fat, and ureter is a rare variant of inguinal hernia. We report a case of a 78-year-old man presenting with typical clinical signs of acute appendicitis. Ultrasonography and CT scan revealed ptosis of the right kidney with a major part of the perirenal capsule involved in a large right sided inguinal hernia with acute obstruction of the ureter and urostasis. Acute surgery was performed, involving resection of perirenal fat, liberation, resection, and neoimplantation of the ureter, and hernioplasty. The postoperative period was uneventful. This case illustrates diagnostic unpredictability of acute appendicitis as well as anatomic variety of inguinal hernias.
Assuntos
Apendicite , Hérnia Inguinal , Humanos , Masculino , Idoso , Hérnia Inguinal/cirurgia , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/diagnóstico por imagem , Hérnia Inguinal/complicações , Diagnóstico Diferencial , Apendicite/cirurgia , Apendicite/diagnóstico , Doença Aguda , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Obstrução Ureteral/diagnóstico por imagemRESUMO
PMDS (persistent Müllerian duct syndrome) is a rare disorder of sex development characterised by the presence of Müllerian duct remnants in a phenotypically male individual with a 46XY karyotype. Radiological investigations play a crucial role in diagnosing and characterising this condition. Ultrasound and MRI are the modalities of choice. They help to non-invasively localise the gonads and Müllerian duct derivatives. Broadly, PMDS has two anatomical variants: male type and female type. The case report presented here does not fit into these classically described variants and can be called a variant of the female type. There is a risk of infertility and malignant transformation of undescended testis and Müllerian duct derivatives in cases of PMDS. Hence, management is focused on preventing these risks. Surgical intervention involves orchidopexy, removal of Müllerian duct derivatives and inguinal hernia repair.
Assuntos
Criptorquidismo , Transtorno 46,XY do Desenvolvimento Sexual , Hérnia Inguinal , Humanos , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Hérnia Inguinal/diagnóstico , Masculino , Criptorquidismo/cirurgia , Criptorquidismo/diagnóstico , Criptorquidismo/complicações , Transtorno 46,XY do Desenvolvimento Sexual/cirurgia , Transtorno 46,XY do Desenvolvimento Sexual/diagnóstico , Transtorno 46,XY do Desenvolvimento Sexual/complicações , Orquidopexia/métodos , Ductos Paramesonéfricos/anormalidades , Ductos Paramesonéfricos/cirurgiaRESUMO
BACKGROUND: Acute small intestinal obstruction is a common surgical emergency in the sub-Saharan region. Over the decades, complicated inguinal hernias have been identified as a leading cause. However, we observed from our clinical practice that complicated inguinal hernias were not the most common etiology. AIMS AND OBJECTIVES: This study aimed to evaluate the common etiology of acute small bowel obstruction in the study center and compare our findings with that from other centers and existing literature. MATERIALS AND METHODS: This was a retrospective, cross sectional study carried out over a period of five years (January 2017 to December 2021). This study looked at the patients presenting with acute, mechanical, small bowel obstruction that did not respond to conservative treatment in our hospital facility. Relevant information were extracted from patients' clinical details and entered into the proforma prepared for this study. RESULTS: A total of 147 patients were recruited into this study out of which 85(57.8%) were males and 62 (42.2%) were females (M:F=1.44:1). Majority (80.3%) of the patients that presented with post-operative bowel adhesion had previous appendectomy. Simple bowel obstruction was seen in 93 (63.3%) patients while strangulated obstruction and gangrenous bowel were seen in 26 (17.7%) patients and 22 (15.0%) patients respectively. Majority (47.6%) of the patients had adhesiolysis done while others had bowel resection. CONCLUSION: The common cause of acute small bowel obstruction as observed in this study is post-operative adhesions arising from previous appendectomy and laparotomies.
Résumé Contexte:Une faible obstruction intestinale a une urgence chirurgicale commune dans la région sub-saharienne. Au cours des décennies, des hernies inguiniques compliquées ont été identifiées comme une cause de premier plan. Cependant, nous avons observé de notre pratique clinique selon laquelle des hernies inguinales compliquées n'étaient pas l'étiologie la plus commune.Objectifs et objectifs:Cette étude visait à évaluer l'étiologie commune de l'obstruction aiguë aux petites interses dans le centre d'études et de comparer nos constatations avec celle d'autres centres et de la littérature existante.Matériaux et méthodes:C'était une étude rétrospective en coupe transversale réalisée sur une période de cinq ans (janvier 2017 à 2021). Cette étude a examiné les patients présentant une obstruction aiguë, mécanique et petite intestinale qui ne répondait pas au traitement conservateur dans notre installation hospitalière. Des informations pertinentes ont été extraites des détails cliniques des patients et ont conclu dans la proforma préparé pour cette étude.Résultats:Un total de 147 patients ont été recrutés dans cette étude dont 85 (57,8%) étaient des hommes et 62 (42,2%) étaient des femelles (M: F = 1.44: 1). La majorité (80,3%) des patients présentés par l'adhésion intestinale post-opératoire avaient une annexe antérieure. Un obstruction d'intestin simples a été observée dans des patients de 93 (63,3%) alors que l'obstruction étrangère et l'intestin gangreneux ont été observés dans des patients de 26 (17,7%) et respectivement respectivement les patients de 22 (15,0%). La majorité (47,6%) des patients avaient une adhésiose faite pendant que d'autres avaient une résection de l'intestin.Conclusion:La cause commune de l'obstruction aiguë aux petites interses comme observé dans cette étude est des adhérences post-opératoires découlant de l'appendecectomie et des laparotomies précédentes.
Assuntos
Obstrução Intestinal , Intestino Delgado , Humanos , Obstrução Intestinal/etiologia , Obstrução Intestinal/cirurgia , Masculino , Feminino , Nigéria/epidemiologia , Estudos Retrospectivos , Estudos Transversais , Adulto , Intestino Delgado/cirurgia , Intestino Delgado/patologia , Pessoa de Meia-Idade , Idoso , Doença Aguda , Apendicectomia , Adolescente , Adulto Jovem , Aderências Teciduais/cirurgia , Aderências Teciduais/complicações , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Complicações Pós-Operatórias/epidemiologiaRESUMO
Thanatophoric dysplasia (TD) is a rare and severe type of skeletal dysplasia. Typical clinical findings include macrocephaly, shortening of the four limbs, underdeveloped lungs, and thoracic hypoplasia. Neonates with TD develop severe respiratory problems due to thoracic hypoplasia and require respiratory management for survival. Despite the resolution of respiratory problems, long-term survival cases are rare. Previous studies have reported that surgical procedures in patients with TD are limited to those necessary for survival, including tracheostomy, laminectomy, and ventricular shunt. A 1-year-old boy with TD was treated with laparoscopic herniorrhaphy. To the best of our knowledge, this is the first report of TD treated with laparoscopic procedure.
Assuntos
Hérnia Inguinal , Herniorrafia , Laparoscopia , Displasia Tanatofórica , Humanos , Masculino , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Herniorrafia/métodos , Displasia Tanatofórica/cirurgia , Displasia Tanatofórica/complicações , LactenteAssuntos
Hérnia Inguinal , Intestino Delgado , Humanos , Masculino , Hérnia Inguinal/diagnóstico , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Hérnia Inguinal/diagnóstico por imagem , Intestino Delgado/patologia , Intestino Delgado/diagnóstico por imagem , Pessoa de Meia-Idade , Ruptura/etiologia , Traumatismos Abdominais/complicações , Patologia Legal/métodos , Ultrassonografia , Períneo/lesões , Escroto/diagnóstico por imagem , Escroto/lesões , Escroto/patologia , Tomografia Computadorizada por Raios XRESUMO
Concurrent direct and indirect inguinal, femoral, and obturator hernias are rare. This case report describes a rare case treated using the laparoscopic approach. A 68-year-old female patient presented with a moving left inguinal lump and pain. Physical examination and abdominal computed tomography scan revealed the coexistence of a left inguinal hernia or Nuck canal hydrocele and a left femoral hernia. The patient underwent laparoscopic transabdominal preperitoneal repair, and all four orifices were covered with one mesh. The patient was discharged on the second postoperative day without any complications. The concurrent presence of four hernias on the same side is rare and has not been previously reported. The laparoscopic approach is useful in such cases because it allows visualization of multiple hernia orifices from the intra-abdominal cavity.
Assuntos
Hérnia Femoral , Hérnia Inguinal , Hérnia do Obturador , Herniorrafia , Laparoscopia , Humanos , Feminino , Idoso , Hérnia do Obturador/cirurgia , Hérnia do Obturador/complicações , Hérnia do Obturador/diagnóstico por imagem , Hérnia Femoral/cirurgia , Hérnia Femoral/complicações , Hérnia Femoral/diagnóstico , Herniorrafia/métodos , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Telas CirúrgicasAssuntos
Herniorrafia , Humanos , Herniorrafia/métodos , Masculino , Sepse/etiologia , Sepse/complicações , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Infecções Urinárias/etiologia , Doenças Ureterais/etiologia , Doenças Ureterais/cirurgia , Obstrução Ureteral/etiologia , Obstrução Ureteral/cirurgia , Idoso , Hérnia Umbilical/cirurgia , Hérnia Umbilical/complicaçõesRESUMO
BACKGROUND: Amyand's hernia (AH) is an appendix (with or without acute inflammation) trapped within an inguinal hernia. Most AH with acute appendicitis had a preexisting appendix within the hernia sac. We herein report a variant of AH that has never been described before. An inflamed appendix that was managed conservatively was found to have migrated and trapped in the sac of a previously unrecognized right inguinal hernia 6 weeks after the index admission, resulting in a secondary Amyand's hernia. CASE PRESENTATION: A 25-year-old healthy Taiwanese woman had persistent right lower abdominal pain for 1 week and was diagnosed with perforated appendicitis with a localized abscess by abdominal computed tomography (CT). No inguinal hernia was noted at that time. Although the inflamed appendix along with the abscess was deeply surrounded by bowel loops so that percutaneous drainage was not feasible, it was treated successfully with antibiotics. However, she was rehospitalized 6 weeks later for having a painful right inguinal bulging mass for a week. Abdominal CT revealed an inflamed appendix with abscess formation in an indirect inguinal hernia raising the question of a Amyand's hernia with a perforated appendicitis. Via a typical inguinal herniorrhaphy incision, surgical exploration confirmed the diagnosis, and it was managed by opening the hernial sac to drain the abscess and reducing the appendix into the peritoneal cavity, followed by conventional tissue-based herniorrhaphy and a laparoscopic appendectomy. She was then discharged uneventfully and remained well for 11 months. CONCLUSIONS: Unlike the traditional definition of Amyand's hernia, where the appendix is initially in the hernia sac, the current case demonstrated that Amyand's hernia could be a type of delayed presentation following initial medical treatment of acute appendicitis. However, it can still be managed successfully by a conventional tissue-based herniorrhaphy followed by laparoscopic appendectomy.
Assuntos
Apendicite , Hérnia Inguinal , Laparoscopia , Feminino , Humanos , Adulto , Apendicectomia/métodos , Apendicite/complicações , Apendicite/diagnóstico por imagem , Apendicite/cirurgia , Hérnia Inguinal/complicações , Hérnia Inguinal/diagnóstico por imagem , Hérnia Inguinal/cirurgia , Herniorrafia/métodos , Abscesso/complicações , Doença AgudaRESUMO
OBJECTIVES: Seroma represents the most prevalent postoperative complication following laparoscopic inguinal hernia repair, particularly in the case of large inguinoscrotal hernias. This randomized controlled trial was undertaken with the objective of assessing the effects of internal orifice narrowing achieved by suturing the divided distal hernia sac in laparoscopic repair of indirect inguinoscrotal hernias. METHODS: A total of 58 patients aged 18 years or older, were randomized into two groups: Group I, which underwent internal orifice narrowing, and Group II, which served as the control without narrowing. The study's primary endpoint was the incidence and volume of seroma in the inguinal region on postoperative days 1 and 7, as well as at 1, 3, and 6 months following the procedure. Secondary outcomes encompassed metrics like total operative time, acute and chronic pain levels, duration of hospital stay, recurrence rates, and the occurrence of any additional complications. RESULTS: In comparison to the control group, the experimental group exhibited a significantly lower incidence of seroma formation at 7 days (P = 0.001). Furthermore, the ultrasonic assessment indicated a reduced seroma volume in the operative group on postoperative day 7 (8.84 ± 17.71 vs. 52.39 ± 70.78 mL; P < 0.001). Acute pain levels and hospital stay were similar between the two groups (1.22 ± 0.76 vs. 1.04 ± 0.53, P = 0.073; 1.22 ± 0.07 vs. 1.19 ± 0.08, P = 0.627, respectively). Notably, neither chronic pain nor early recurrence, nor any other postoperative complications were observed in either group throughout the follow-up period, which extended for at least 6 months (range: 6-18 months). CONCLUSION: In the context of laparoscopic inguinoscrotal hernia repair, the incidence and volume of seroma can be significantly reduced through the implementation of internal orifice narrowing achieved by suturing the divided distal hernia sac. And, this reduction in seroma formation was not associated elevation in postoperative pain levels or recurrence rates.
Assuntos
Dor Crônica , Hérnia Inguinal , Laparoscopia , Humanos , Dor Crônica/cirurgia , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Herniorrafia/métodos , Laparoscopia/métodos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Recidiva , Seroma/etiologia , Seroma/prevenção & controle , Telas Cirúrgicas/efeitos adversos , Método Duplo-CegoRESUMO
INTRODUCTION: Incarceration occurred in approximately 5% to 15% of inguinal hernia patients, with around 15% of incarcerated cases progressing to intestinal necrosis, necessitating bowel resection surgery. Patients with intestinal necrosis had significantly higher mortality and complication rates compared to those without necrosis.The primary objective of this study was to design and validate a diagnostic model capable of predicting intestinal necrosis in patients with incarcerated groin hernias. METHODS: We screened the clinical records of patients who underwent emergency surgery for incarcerated inguinal hernia between January 1, 2015, and December 31, 2022. To ensure balanced representation, the enrolled patients were randomly divided into a training set (n = 180) and a validation set (n = 76) using a 2:1 ratio. Logistic regression analysis was conducted using the rms package in R software, incorporating selected features from the LASSO regression model, to construct a predictive model. RESULTS: Based on the results of the LASSO regression analysis, a multivariate logistic regression model was developed to establish the predictive model. The predictors included in the model were Abdominal effusion, Hernia Sac Effusion, and Procalcitonin. The area under the receiver operating characteristic (ROC) curve for the nomogram graph in the training set was 0.977 (95% CI = 0.957-0.992). In the validation set, the AUC for the nomogram graph was 0.970. Calibration curve and decision curve analysis (DCA) verified the accuracy and practicability of the nomogram graph in our study. CONCLUSION: Bowel necrosis in patients with incarcerated inguinal hernia was influenced by multiple factors. The nomogram predictive model constructed in this study could be utilized to predict and differentiate whether incarcerated inguinal hernia patients were at risk of developing bowel necrosis.
Assuntos
Hérnia Inguinal , Humanos , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Modelos Logísticos , Necrose/complicações , Estudos RetrospectivosRESUMO
BACKGROUND: It remains controversial whether mesh should be fixed during laparoscopic inguinal hernia repair. A systematic review and meta-analysis of randomized-controlled trials (RCTs) was conducted to compare fixation and nonfixation in laparoscopic groin hernia repair. METHODS: A registration was listed with PROSPERO (International Prospective Register of Systematic Reviews; registration no. CRD42022350469). Databases including PubMed, Embase, Cochrane Library, and ClinicalTrials.gov were searched to identify RCTs comparing fixation with nonfixation in laparoscopic groin hernia repair. The primary outcomes were postoperative pain at 24 hours and recurrence. Secondary outcomes were mean operative time, urinary retention, and postoperative pain at 6 months. RESULTS: A total of 18 trials, including 2617 patients with 2878 hernias, were included in this meta-analysis. In contrast to the fixation group, the nonfixation group was associated with lower postoperative pain scores at 24 hours and 6 months, a shorter mean operative time, and a lower incidence of urinary retention. There were no significant differences between the 2 types of procedures in terms of the rate of recurrence for patients with an inguinal hernia orifice smaller than 4 cm in size. CONCLUSIONS: The nonfixation technique is an effective method to reduce urinary retention, mean operative time, and postoperative pain at 24 hours and at 6 months; however, the rate of recurrence was comparable to that of the fixation method.
Assuntos
Hérnia Inguinal , Laparoscopia , Retenção Urinária , Humanos , Hérnia Inguinal/cirurgia , Hérnia Inguinal/complicações , Telas Cirúrgicas/efeitos adversos , Herniorrafia/métodos , Recidiva Local de Neoplasia/cirurgia , Laparoscopia/métodos , Dor Pós-Operatória/epidemiologia , RecidivaRESUMO
Canal of nuck hernia is rarely reported in pediatric population. We report one such case of a canal of nuck hernia in a 2-month-old girl containing uterus, ovary and small bowel diagnosed on ultrasonography, and which was later confirmed and treated surgically.
Assuntos
Hérnia Inguinal , Lactente , Criança , Humanos , Feminino , Hérnia Inguinal/complicações , Hérnia Inguinal/diagnóstico por imagem , Ovário/diagnóstico por imagem , Canal Inguinal/diagnóstico por imagem , Útero/diagnóstico por imagem , PelveRESUMO
INTRODUCTION: Cryptorchidism is commonly treated with orchiopexy at 6-12 months of age, often allowing time for undescended testicle(s) (UT) to descend spontaneously. However, when an inguinal hernia (IH) is also present, some surgeons perform orchiopexy and inguinal hernia repair (IHR) immediately rather than delaying surgery. We hypothesize that early surgical intervention provides no benefit for newborns with both IH and UT. METHODS: The Nationwide Readmissions Database was used to identify newborns with diagnoses of both IH and UT from 2010 to 2014. Patients were stratified by management: IHR performed on initial admission (Repair) or not (Deferral). Demographics, outcomes, and complications were compared. Results were weighted for national estimates. RESULTS: We analyzed 1306 newborns (64% premature) diagnosed with both IH and UT. IHR was performed at index admission in 30%. Repair was more common in premature babies (43% vs. 8% full-term, p < 0.001) and patients with congenital anomalies (33% vs. 27% without congenital anomaly, p = 0.012). There was no difference in readmission rates. Repair patients had higher rates of orchiectomy than did Deferral. No Deferral patients were readmitted for bowel resection, and <1% were readmitted for orchiectomy or hernia incarceration. CONCLUSION: In newborns with UT and IH, immediate repair is not associated with improved outcomes. Even with incarceration on initial presentation, rates of readmission with incarceration or bowel compromise for patients who undergo Deferral of surgery are minimal. Moreover, Repair newborns have higher rates of orchiectomy. We found no benefit to early operative intervention; thus, we recommend waiting until 6-12 months of age to reassess for surgery. LEVEL OF EVIDENCE: Level III TYPE OF STUDY: Retrospective Comparative Study.
Assuntos
Criptorquidismo , Hérnia Inguinal , Lactente , Masculino , Humanos , Recém-Nascido , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Hérnia Inguinal/diagnóstico , Estudos Retrospectivos , Criptorquidismo/complicações , Criptorquidismo/cirurgia , Recém-Nascido Prematuro , Orquidopexia/métodos , Herniorrafia/métodosRESUMO
BACKGROUND: Hernias in patients with ascites are common, however we know very little about the surgical repair of hernias within this population. The study of these repairs has largely remained limited to single center and case studies, lacking a population-based study on the topic. STUDY DESIGN: The Michigan Surgical Quality Collaborative and its corresponding Core Optimization Hernia Registry (MSQC-COHR) which captures specific patient, hernia, and operative characteristics at a population level within the state was used to conduct a retrospective review of patients with ascites undergoing ventral or inguinal hernia repair between January 1, 2020 and May 3, 2022. The primary outcome observed was incidence and surgical approach for both ventral and inguinal hernia cohorts. Secondary outcomes included 30-day adverse clinical outcomes as listed here: (ED visits, readmission, reoperation and complications) and surgical priority (urgent/emergent vs elective). RESULTS: In a cohort of 176 patients with ascites, surgical repair of hernias in patients with ascites is a rare event (1.4% in ventral hernia cohort, 0.2% in inguinal hernia cohort). The post-operative 30-day adverse clinical outcomes in both cohorts were greatly increased compared to those without ascites (ventral: 32% inguinal: 30%). Readmission was the most common complication in both inguinal (n = 14, 15.9%) and ventral hernia (n = 17, 19.3%) groups. Although open repair was most common for both cohorts (ventral: 86%, open: 77%), minimally invasive (MIS) approaches were utilized. Ventral hernias presented most commonly urgently/emergently (60%), and in contrast many inguinal hernias presented electively (72%). CONCLUSION: A population-level, ventral and incisional hernia database capturing operative details for 176 patients with ascites. There was variation in the surgical approaches performed for this rare event and opportunities for optimization in patient selection and timing of repair.
Assuntos
Hérnia Inguinal , Hérnia Ventral , Laparoscopia , Humanos , Hérnia Inguinal/complicações , Hérnia Inguinal/cirurgia , Ascite/etiologia , Ascite/cirurgia , Herniorrafia/efeitos adversos , Recidiva Local de Neoplasia/cirurgia , Hérnia Ventral/complicações , Hérnia Ventral/cirurgia , Estudos Retrospectivos , Telas CirúrgicasRESUMO
PURPOSE: The modified 5-factor frailty index (mFI-5) is a prognostic tool based on five comorbidities from the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) database-hypertension, congestive heart failure, chronic obstructive pulmonary disease (COPD), diabetes, and non-independent functional status. Our study investigates the mFI-5 index's ability to predict morbidity, length of stay (LOS), and discharge destination in geriatric patients undergoing inguinal hernia repairs, as well as assesses the interplay of baseline functional status. METHODS: Patients aged ≥ 65 years who underwent inguinal or femoral hernia repairs from the 2018-2020 NSQIP database were studied. Separate analyses were performed for emergent and elective cohorts. Stratification was performed according to the sum of mFI-5 variables: mFI = 0, mFI = 1, mFI ≥ 2. RESULTS: A total of 41,897 consisted of 92.9% elective and 7.1% emergent cases. The sample was 37.8% mFI = 0, 47.2% mFI = 1, and 15.0% mFI ≥ 2. Median age was 73 (IQR 68-78). Of emergent mFI ≥ 2 cases, 24.2% had non-independent functional status, versus only 4.8% in elective cases. Area under the curve was calculated for emergent and elective groups, including mortality (0.86, 0.80), pneumonia (0.82, 0.77), discharge destination not home (0.78, 0.73), prolonged LOS (0.69, 0.66), and infection (0.71, 0.62). Of index variables, dependent functional status was correlated with increased complications in elective and emergent cohorts, while COPD was significant in elective cases (OR > 2.0, p < 0.05). CONCLUSION: The mFI-5 is predictive of complications in geriatric inguinal hernia repairs, especially in emergent cases. Frail patients with non-independent functional status are most at risk and, thus require proactive and watchful perioperative care.