Abdominal X-ray Research Articles

Artificial Intelligence vs. Doctors: Diagnosing Necrotizing Enterocolitis on Abdominal Radiographs

BackgroundRadiographic diagnosis of necrotizing enterocolitis (NEC) is challenging. Deep learning models may improve accuracy by recognizing subtle imaging patterns. We hypothesized it would perform with comparable accuracy to that of senior surgical residents. MethodsThis cohort study compiled 494 anteroposterior neonatal abdominal radiographs (214 images NEC, 280 other) and randomly divided them into training, validation, and test sets. Transfer learning was utilized to fine-tune a ResNet-50 deep convolutional neural network (DCNN) pre-trained on ImageNet. Gradient-weighted Class Activation Mapping (Grad-CAM) heatmaps visualized image regions of greatest relevance to the pretrained neural network. Senior surgery residents at a single institution examined the test set. Resident and DCNN ability to identify pneumatosis on radiographic images were measured via area under the receiver operating curves (AUROC) and compared using DeLong's method. ResultsThe pretrained neural network achieved AUROC of 0.918 (95% CI, 0.837–0.978) with an accuracy of 87.8% with five false negative and one false positive prediction. Heatmaps confirmed appropriate image region emphasis by the pretrained neural network. Senior surgical residents had a median area under the receiver operating curve of 0.896, ranging from 0.778 (95% CI 0.615–0.941) to 0.991 (95% CI 0.971–0.999) with zero to five false negatives and one to eleven false positive predictions. The deep convolutional neural network performed comparably to each surgical resident's performance (p > 0.05 for all comparisons). ConclusionsA deep convolutional neural network trained to recognize pneumatosis can quickly and accurately assist clinicians in promptly identifying NEC in clinical practice. Level of EvidenceIII (study type: Study of Diagnostic Test, study of nonconsecutive patients without a universally applied “gold standard”)

A plain abdominal x-ray may direct the diagnosis of primary hyperoxaluria

A plain abdominal x-ray may direct the diagnosis of primary hyperoxaluria

CONCURRENT OCCURRENCE OF PROSTATOMEGALY AND CYSTOLITHIASIS IN AN INTACT TERRIER DOG

An intact male terrier dog aged 6.25 years was referred with a history of dysuria and intermittent hematuria for the past 2 years. Clinical examination, abdominal radiography and ultrasonography revealed the presence of prostatomegaly and cystolithiasis. A large radio-opaque calculus was observed inside the urinary bladder and ultrasonographic size of the prostate gland was [Formula: see text]. The animal was diagnosed with benign prostatic hyperplasia based on anamnesis, physical examination findings and paraclinical investigations. The presence of a single large calculus within the urinary bladder was associated with incomplete voiding resulting from enlargement of the prostate. The bladder calculus which was removed by cystotomy was a mixed type of stone consisting of ammonium (10%), phosphate (20%), calcium (20%), oxalate (40%) and magnesium (10%). The enlargement of the prostate gland was also confirmed by intraoperative examination. Cystolithiasis associated with canine benign prostatic hyperplasia has not been previously reported in the literature.

NON-SURGICAL MANAGEMENT OF PERFORATED JEJUNAL DIVERTICULUM

Jejunal diverticulitis complicated by perforation is rare and shows an uncharacteristic presentation and thus poses a difficulty in the early diagnosis ofthe condition.However, diverticulitis and its complications should always be considered in geriatric men who present with an acute abdomen. We describe a 77-year-old man who originally presented with acute abdominal pain having free gas under right dome of diaphragm on X-ray abdomen, upon further evaluation with CT abdomen, a diagnosis of contained jejunal diverticular perforation was made.Onceoptimized he was then managed non-operatively with intravenous fluids, antibiotics, and total parenteral nutrition and supportive care. His overall recovery during hospitalization was uneventful. A follow-up CT abdomen showed no new pocket of fluid or free air. As jejunal perforation is a rare finding, early laparotomy done based upon free gas on X-ray alone may be correlated with an overall higher risk of mortality due to the diseases proximity to duodenojejunal flexure and thus conservative management in selected group of patients may prevent inadvertent celiotomy and morbidity and mortality arising out of it.

Oral administration of probiotic spore ghosts for efficient attenuation of radiation-induced intestinal injury

Radiation-induced intestinal injury is the most common side effect during radiotherapy of abdominal or pelvic solid tumors, significantly impacting patients’ quality of life and even resulting in poor prognosis. Until now, oral application of conventional formulations for intestinal radioprotection remains challenging with no preferred method available to mitigate radiation toxicity in small intestine. Our previous study revealed that nanomaterials derived from spore coat of probiotics exhibit superior anti-inflammatory effect and even prevent the progression of cancer. The aim of this work is to determine the radioprotective effect of spore coat (denoted as spore ghosts, SGs) from three clinically approved probiotics (B.coagulans, B.subtilis and B.licheniformis). All the three SGs exhibit outstanding reactive oxygen species (ROS) scavenging ability and excellent anti-inflammatory effect. Moreover, these SGs can reverse the balance of intestinal flora by inhibiting harmful bacteria and increasing the abundance of Lactobacillus. Consequently, administration of SGs significantly reduce radiation-induced intestinal injury by alleviating diarrhea, preventing X-ray induced apoptosis of small intestinal epithelial cells and promoting restoration of barrier integrity in a prophylactic study. Notably, SGs markedly improve weight gain and survival of mice received total abdominal X-ray radiation. This work may provide promising radioprotectants for efficiently attenuating radiation-induced gastrointestinal syndrome and promote the development of new intestinal predilection.

Migrated Intrauterine Contraceptive Device: A Case Report

The use of long-term and reversible family planning methods such as intrauterine contraceptive devices is common in Nigeria likely due to the large population, fertility as well as less economic burden of placement, and maintenance of this device. Uterine embedment, perforation, and extrauterine migration of the device is becoming more frequent with the increased number of patients benefitting from the contraceptive technique. Distant abdominal migrations and intrathoracic migrations have been reported. Transabdominal ultrasound is an initial imaging modality used in assessment of such patients; in some cases, however, plain abdominal radiograph also needs to be used. This paper will discuss a 30-year-old female who had intrauterine contraceptive device inserted at a primary healthcare facility about 7 months before presentation that got misplaced and was referred to our facility for radiologic investigations and localization of the device.

Efficacy of bowel ultrasound to diagnose necrotizing enterocolitis in extremely low birthweight infants.

Bowel ultrasound (US) is one of the methods used to enhance diagnostic accuracy of necrotizing enterocolitis (NEC) and its associated complications in premature newborns. To explore the diagnostic accuracy of bowel US in extremely low birth weight (ELBW) infants with NEC. A single-center retrospective case-control study included 84 extremely low birth weight (ELBW) infants. The infants were divided into three groups: Group 1 -infants with NEC (n = 26); Group 2 -infants with feeding problems (n = 28); Group 3 -control group (n = 30). The specific bowel US findings in premature newborns with NEC (stage 3) included bowel wall thinning, complex (echogenic) ascites, and pneumoperitoneum, p < 0.05. The diagnostic effectiveness of these sonographic signs was 96.8% (sensitivity 75.0% and specificity 97.6%), p < 0.05. These findings with high specificity were associated with the need for surgical intervention, poor outcomes, or increased mortality. Stage 2 NEC which did not require surgery showed impaired differentiation of the bowel wall layers, absent or decreased bowel peristalsis, pneumatosis intestinalis, portal venous gas, or simple ascites, with a diagnostic accuracy of 82.9% (sensitivity 55.6%, specificity 91.4%, p < 0.05). Bowel US can be used as an adjunct to abdominal radiography to aid in the diagnosis of infants with suspected NEC by providing more detailed evaluation of the intestine.

Development of an artificial intelligence-based multimodal model for assisting in the diagnosis of necrotizing enterocolitis in newborns: a retrospective study.

The purpose of this study is to develop a multimodal model based on artificial intelligence to assist clinical doctors in the early diagnosis of necrotizing enterocolitis in newborns. This study is a retrospective study that collected the initial laboratory test results and abdominal x-ray image data of newborns (non-NEC, NEC) admitted to our hospital from January 2022 to January 2024.A multimodal model was developed to differentiate multimodal data, trained on the training dataset, and evaluated on the validation dataset. The interpretability was enhanced by incorporating the Gradient-weighted Class Activation Mapping (GradCAM) analysis to analyze the attention mechanism of the multimodal model, and finally compared and evaluated with clinical doctors on external datasets. The dataset constructed in this study included 11,016 laboratory examination data from 408 children and 408 image data. When applied to the validation dataset, the area under the curve was 0.91, and the accuracy was 0.94. The GradCAM analysis shows that the model's attention is focused on the fixed dilatation of the intestinal folds, intestinal wall edema, interintestinal gas, and portal venous gas. External validation demonstrated that the multimodal model had comparable accuracy to pediatric doctors with ten years of clinical experience in identification. The multimodal model we developed can assist doctors in early and accurate diagnosis of NEC, providing a new approach for assisting diagnosis in underdeveloped medical areas.

Ileosigmoid knotting: A rare cause of acute intestinal obstruction and peritonitis

Introduction: Ileosigmoid knotting (ISK) is one of the rarer causes of bowel obstruction compared to others. This is also called compound volvulus or double loop obstruction. The presentation symptoms are similar to those of other large bowel or distal intestinal obstructions. But the pathogeny’s or disease’s progression is rapid. So the patient develops ischemia or strangulation of the involved segment of the bowel earlier than the sigmoid or ceal volvulus. One of the challenges of the disease is that, especially in low-income countries like ours, there is no access to contrast computed tomography (CT), which is more sensitive diagnostic imaging. Case Report: A 58-year-old male patient presented to our hospital with abdominal pain for two days. He was referred from the primary hospital. The pain was initially central and later diffused to other parts of the abdomen. Associated with this, he was vomiting of ingested matter for more than two episodes. On physical examinations, he was in acute pain, and his vital signs showed a pulse rate of tachycardia at 127 BPM. On abdominal examination, he had distention and diffused tenderness with gardening. So we diagnosed him with peritonitis secondary to gangrenous sigmoid volvulus obstruction (SVO). So I chose the imaging that is available in our hospital, a plain abdominal X-ray. So the patient was resuscitated with normal saline, an antibiotic was initiated, and he was taken to the operation after giving consent. The ilium and sigmoid colon were gangrened and en bloc resection was done, and the jejunum and remaining 7 cm of ilium from the ileocecal valve were anastomosed. The patient was taken to or for a relook, and the anastomosis was disrupted, then refreshed, and both the proximal and distal segments were taken out as stomas. The output was significant and later developed a controlled entrocutaneous fistula, which was closed after three weeks. Conclusion: The prognosis is poor for ISK compared to other common types of volvulus and worse prognosis challenging management in conditions with both active and passive bowel ischemia which happened to our patients. Diagnosis is also challenging before the surgery. The abdominal X-ray and ultrasound are available and commonly the surgeon commonly will not send for this unless the patient is stable. Blind rectal tube deflation the common intervention in our setup with no access for sigmoidoscopy is not indicated for this non-surgical initial management rather with a highly suspicious diagnosis early resuscitation with early surgical treatment.

SINGLE SESSION BILATERAL PERCUTANEOUS NEPHROLITHOTOMY (PCNL) IN HORSESHOE KIDNEY PATIENT WITH BILATERAL STAGHORN STONES: A CASE REPORT

Objective: To analyze the outcomes of single-session bilateral PCNL in a horseshoe kidney patient with bilateral staghorn stones in terms of safety and effectiveness. Case(s) Presentation: A 64-year-old woman with bilateral staghorn stones on HSK. She had an anesthesia status of ASA 2, with type 2 diabetes mellitus (uncontrolled with oral medication), 47% of ejection fraction from echocardiography and her body mass index was 21.7 kg/m2. A single session of bilateral PCNL was performed, with 150 minutes of surgery and total blood loss of ± 50 cc. A 4.7 Fr DJ stent was placed on the right kidney, a 5 Fr ureteral catheter was left in the left kidney, and a 16 Fr foley catheter was placed as a right and left nephrostomy. Control plain abdominal x-ray showed no residual stones. Postoperatively, the patient was hospitalized for 3 days, there were no significant complaints and discharged in good condition. Discussion: The procedure was performed in the prone position for two reasons. First, is to avoid intestinal injury during puncture and dilatation, the second is to simplify the positioning of the C arm, as well as the endourology monitor, and the other instruments. Conclusion: Single-session bilateral PCNL for HSK patients with bilateral staghorn stones, in our experience, is quite safe and effective. Keywords: Horseshoe kidney, single-session bilateral percutaneous nephrolithotomy (PCNL), staghorn stone.

ASSOCIATION BETWEEN BODY HEIGHT AND DOUBLE J STENT INTRAVESICAL POSITION AND ITS RELATION WITH THE INDONESIAN VERSION OF URETERAL STENT SYMPTOM QUESTIONNAIRE (USSQ)

Objective: This study aims to determine the relationship between the patient’s body height with the intravesical double J stent position and whether its position is related to the ureteral stent symptom questionnaire (USSQ). Material &amp; Methods: A cohort study with a study population of patients inserted with double J stent size 4.7 Fr and length 26 cm was carried out at the Department of Urology Hasan Sadikin Academic Medical Center from July 2021 to July 2022. We assess the patient’s demographic features and different body heights into two categories, below and above average. Then we evaluate its stent position using a plain abdominal X-ray and the USSQ score. Results: Ninety samples were included in this study; 30 of them had a midline intravesical double J stent position, 30 pieces of contralateral, and 30 samples of ipsilateral. Only body height correlated to the stent’s position (p&lt;0.05). The results of comparative statistical tests or the association of postoperative complications between 7 days and 30 days in the position of the double J stent midline, contralateral and ipsilateral had significant results (p&lt;0.05). Stent with ipsilateral position showed a lower USSQ score. Conclusion: Men and women above the average height have a lower risk for migration stent to the contralateral side and are also associated with lower USSQ scores. Keywords: Double J stent, USSQ score, double J stent position.

Surgical treatment of multiple magnet ingestion by children: A single-center experience from China.

The incidence of magnet ingestion in children has escalated concurrent with the rise in popularity of magnetic playthings, bearing the capacity to induce substantial morbidity. The objective of this study was to encapsulate our accumulated expertise in handling pediatric cases featuring multiple magnetic foreign bodies within the gastrointestinal tract sometimes necessitating surgical intervention, as well as to formulate a clinical management algorithm. This was a retrospective review of patients with multiple magnetic foreign bodies in the digestive tract, admitted to Shenzhen Children's Hospital, between January 2018 and December 2022. A total of 100 cases were included in this study, including 66 males and 34 females. The main clinical manifestation ns were abdominal pain and vomiting. All patients had abdominal x-ray, all of which indicated foreign bodies in the digestive tract. 33 patients had to undergo a surgical intervention. Among these cases, the gastrointestinal complications occurred in 31 patients, including gastric rupture (n = 9), intestinal obstruction (n = 11) and intestinal perforation (n = 30). Postoperative intestinal obstruction occurred in 6 children. There was no statistical significant difference in age and gender between the Surgical group and Non-surgical group, but the Surgical group had a higher number of magnets ([7.5(2-44) vs 4(2-20)], p = 0.009), a longer interval between time of misingestion to clinical visit ([48(7.2-480) vs 5(2-336)]hours, p < 0.001), and a longer length of hospital stay ([10(6-19) vs 2(1-8)]days, p < 0.001). Multiple magnet ingestion in children can lead to serious complications and carry severe risks. Timely diagnosis and effective treatment are crucial for managing such patients.

Analysis of factors influencing vascular calcification in peritoneal dialysis patients and their impact on long-term prognosis

BackgroundThis study aims to investigate the influencing factors of vascular calcification in peritoneal dialysis (PD) patients and its relationship with long-term prognosis.MethodsThis retrospective cohort study included chronic kidney disease patients undergoing peritoneal dialysis at the Peritoneal Dialysis Center of Beijing Luhu Hospital, Capital Medical University, from January 2019 to March 2019. Demographic and clinical laboratory data, including serum sclerostin (SOST), calcium (Ca), phosphate (P), serum albumin (ALB), and intact parathyroid hormone (iPTH) levels, were collected. Abdominal aortic calcification (AAC) was assessed using abdominal lateral X-ray examination to determine the occurrence of vascular calcification, and patients were divided into the AAC group and Non-AAC group based on the results.ResultsA total of 91 patients were included in the study. The AAC group consisted of 46 patients, while the Non-AAC group consisted of 45 patients. The AAC group had significantly older patients compared to the non-AAC group (P < 0.001) and longer dialysis time (P = 0.004). Multivariable logistic regression analysis indicated that risk factors for vascular calcification in PD patients included dialysis time, diabetes, hypertension, and SOST. Kaplan–Meier survival analysis showed that the AAC group had a significantly higher mortality rate than the non-AAC group (χ2 = 35.993, P < 0.001). Multivariable Cox regression analysis revealed that dialysis time, diabetes and AAC were risk factors for all-cause mortality in peritoneal dialysis patients.ConclusionLonger dialysis time, comorbid diabetes, comorbid hypertension, and SOST are risk factors for vascular calcification in PD patients. Additionally, AAC, longer dialysis time, and comorbid diabetes are associated with increased risk of all-cause mortality in peritoneal dialysis patients.

Intestinal pseudo-obstruction as systemic lupus erythematosus complication: is it time to reconsider the role of surgery?: A case report of a tailored multidisciplinary managed 44-year-old male patient

Rationale: Intestinal pseudo-obstruction (IPO) represents an unclarified dysmotility disorder characterized by clinic-radiological signs of intestinal obstruction not associated with organic conditions. IPO may occur as a rare complication of autoimmune connective tissue diseases, including Systemic Lupus Erythematosus (SLE). Surgery is recognized as having a marginal management position for IPO patients: this case investigates its role, in the context of a multidisciplinary approach, in the diagnosis and treatment of acute complications of IPO. Patient concerns: An SLE-affected 44-year-old man with a history of recurring nonspecific abdominal sub-obstructive episodes was admitted to our department for constipation, vomiting, and unintentional weight loss. Clinical examination revealed a family history of eosinophilic gastroenteritis (EG). Laboratory tests, including Systemic Sclerosis screening, presented no significant alterations. Abdominal X-ray highlighted multiple air-fluid levels; contrast-enhanced CT showed fluid surrounding dilated loops, and fluid-filled ileal loops, without evidence of organic intrinsic/ab-extrinsic obstruction, perforation, or extraluminal gas. Considering these findings, stenosing-pattern Crohn disease and strictures-complicated EG were mainly suspected. However, ileum-colonoscopy with the histological analysis resulted in inconclusive for Crohn disease and EG. Diagnosis: The histological examination, by showing an SLE fibro-inflammatory pattern, not sparing the enteric plexus, infiltrating the intestinal wall of the surgical samples collected during the right hemicolectomy intervention, allowed the diagnosis of IPO. Interventions and outcomes: The patient, indeed, was initially managed conservatively with nasogastric decompression, immunosuppressive therapy, and parenteral nutrition by a multidisciplinary team including gastroenterologists, rheumatologists, and nutritionists. Unfortunately, 2 weeks later, the worsening symptoms required a lifesaving right hemicolectomy followed by ileostomy. Lessons: IPO should be suspected in SLE patients presenting treated-unresponsive GI symptoms. Its early recognition finalized to start a tailored multidisciplinary approach appears prognostically crucial. Surgery could represent a paramount diagnostic moment and therapeutic life-saving approach.

Femoral to abdomen tunneling at the bedside for medium/long term venous access.

Femoral to abdomen tunneling of small-bore central venous catheters is a bedside technique for patients with contraindications to a thoracic approach, or as an alternative to a lower extremity catheter exit site. A femoral to abdomen tunneling technique was implemented for patients receiving medium and long-term intravenous treatments with contraindications to the thoracic venous approach or as an alternative to a lower extremity catheter exit site. All venous access devices were inserted with ultrasound guidance under local anesthesia, and catheter tip placement assessed by post procedural radiography. In this case series, from January 2020 to January 2023, a total of eight FTA-tunneled venous access devices were inserted. There were seven ambulatory patients and one bedbound patient. The median length of the subcutaneous tunnel was 20 cm, ranging from 15 to 27 cm. The median length of the intravenous catheter to the terminal tip was 31 cm, ranging from 23 to 40 cm. Tip location was confirmed by post-procedural abdominal radiograph. The catheter tip locations were interpreted to be at the level of T8-T9 (2), T12 (1), L4 (2), L2 (2), L1(1).No insertion or post insertion related complication was reported. Six patients completed the scheduled intravenous treatment. One patient was unable to be tracked due to transfer to an outside facility. One catheter initially demonstrated to be coiled over the left common iliac vessel was repositioned using a high flow flush technique. There was one reported catheter dislodgment by the nurse providing care and maintenance. The overall implant days were 961, with a median dwell time of 125 days ranging from 20 to 399 days. Femoral to abdomen tunneling provides an alternative exit site useful in select patients with complex intravenous access. The data of this small retrospective review suggests this a safe and minimally invasive bedside procedure.

Frequency of oesophageal foreign bodies ingested by children presenting to the ENT department.

Objective: To determine the frequencies of different esophageal foreign bodies ingested by children presenting to Ayub Teaching Hospital Abbottabad. Study Design: Cross-sectional study. Setting: Department of Otorhinolaryngology, Ayub Teaching Hospital Abbottabad. Period: 2nd July 2020 to 31st December 2022. Material &amp; Methods: Following the application of inclusion and exclusion criteria, a total of 168 patients, aged between 6 months and 11 years, presenting with suspected esophageal foreign bodies, were included in the study after obtaining written consent. Socio-demographic information, clinical history, and symptoms were carefully recorded. Diagnostic procedures included neck X-rays, extended to the chest, and abdominal X-rays as necessary. Rigid esophagoscopy, performed under general anesthesia, was utilized to confirm and remove foreign bodies. Subsequently, the nature and type of the extracted foreign bodies were identified and documented using a standardized pro forma. Results: The mean age of the patients was 5.63 ± 3.097, ranging from 1 to 11 years. Regarding the gender distribution, 105 (62.5%) were male, and 63 (37.5%) were female. When considering the types of foreign bodies, 129 (76.8%) presented with coins, 12 (7.1%) with metallic objects, 7 (4.2%) with battery cells, and 9 (5.4%) with fruit seeds. Additionally, there were a few cases of chicken bones, fish bones, and safety pins, accounting for 9 (5.4%) in the category of other foreign bodies. Conclusion: This study underscores the frequent occurrence of esophageal foreign body ingestion in young children, particularly males under the age of 5, with coins identified as the predominant culprits.

Comparison of the use of a spiral nasojejunal tube and transendoscopic enteral tubing in washed microbiota transplantation via the mid-gut route

BackgroundMethods for washed microbiota transplantation (WMT) through the mid-gut include transendoscopic enteral tubing (TET) and manual spiral nasojejunal tube (SNT) placement have not been studied. MethodsThis prospective interventional study was performed at a single centre. Patients were divided into the SNT and mid-gut TET groups based on their conditions and wishes. In the SNT group, an SNT was passively inserted into the stomach, and abdominal X-rays were taken within 24 h to confirm tube placement in the small intestine. In the mid-gut TET group, mid-gut TET was placed in the small intestine for gastroscopy. Data on the clinical efficacy of WMT, intubation time, cost, overall comfort score, adverse reactions, etc., were collected from the two groups. ResultsSixty-three patients were included in the study (SNT group (n = 40) and mid-gut TET group (n = 23)). The clinical efficacy of WMT in the SNT and mid-gut TET groups was 90 % and 95.7 %, respectively (P = 0.644). Compared with the mid-gut TET group, the SNT group showed a shorter operation time (120 s vs. 258 s, P = 0.001) and a lower average cost (641.7 yuan vs. 1702.1 yuan, P = 0.001). There was no significant difference in the overall comfort score or the incidence of common discomfort symptoms between the two groups. ConclusionThe different implantation methods have different advantages; compared with mid-gut TET placement, manual SNT placement provides some benefits.

CASE REPORT ON OBSTRUCTED OBTURATOR RICHTER HERNIA MANAGED BY OPEN PREPERITONEAL MESH REPAIR

Introduction: Obturator hernia is rare abdominal hernia.It occurs when part of the pelvic contents protrude through the obturator foramen adjacent to Obturator vessels and nerve.It is a diagnostic challenge in the emergency department since the signs and symptoms are non-specific and the risk of strangulation is high in such hernias. It often occurs in elderly, emaciated and thin lean body mass women.The patient may present with intestinal obstruction with diffuse abdominal pain, nausea and vomiting and constipation,because of diagnostic difficulty they often present late and most of them are diagnosed introperatively. Case report: A 60 years old female patient presented to emergency General Surgery Department of GMERS Medical College Himmatnagar with pain in Right Groin region and diffuse pain abdomen and vomiting associated with constipation since 3 days,k/c/o Hypertension on medication Tab Amlodipine 5mg 1-0-0.On examination -Abdomen distended,tenderness present in Right groin region Abdominal girth 72 cm . Abdomen Xray revealed multiple air fluid levels ,USG Abdomen and pelvis suggestive of Right Groin Hernia and multiple dilated bowel loops with diameter of 3.5 mm suggestive of Intestinal Obstruction (Usg picture is uploaded in fig 2) and as patient was not affordable for CECT Abdomen and pelvis CECT Abdomen and pelvis was not done Discussion: Emergency lower midline exploratory laparotomy under General Anaesthesia was done and intraoperatively was diagnosed as Obstructed Obturator Hernia as the bowel was found to be protruding into Obturator foramen adjacent to Obturator vessels and Obturator nerve and the bowel was reduced from foramen and was found to be healthy ,single suture was taken over the coopers ligament and obturator foremen and peritoneum was closed as there was no bowel contamination preperitoneal space was created and 15X15 cm Macroporous light weight polypropylene Mesh was placed and fixed covering all the defects to prevent recurrence and any future groin and Inguinal hernia. Conclusion: Obturator Hernia is a rare form of abdominal hernia but can cause a severe Intestinal Obstruction if it not diagnosed and treated early bowel might result into ischemia and necrosis which can turn into a fatal complication.The elderly female with lean body mass and multiparous women presenting with diffuse pain abdomen and pain in Groin region with vomiting and constipation obstructed Obturator hernia and femoral hernia should always be kept as probable diagnosis.Radiological imaging may yield the diagnosis but in this case as patient was not affordable so ,CECT Abdomen with pelvis was not done and as patient Abdomen Xray had multiple air fluid levels .Emergency lower midline Exploratory laparotomy can be done and if obstructed bowel is found to be healthy then Preperitoneal mesh repair can be done and this procedure has got a good outcome increases the abdominal strength and has got a less recurrence chances.

A RARE CASE OF TRANSMESOCOLIC HERNIATION OF SMALL BOWELTHROUGH A CONGENITAL DEFECT PRESENTING AS A CLOSED BOWEL OBSTRUCTION - A CASE REPORT AND LITERATURE REVIEW OF REPAIRS OF INTERNAL HERNIAS

Transmesocolic hernia is an uncommon type of Internal hernia with incidence ranging from approximately 5–10% of all Internal Hernias. To the best of our knowledge, this is the first reported case of a transmesocolic hernia in adults without any surgical history or trauma. Small bowel loops were found herniating into the supracolic compartment through a congenital defect in transverse mesocolon presenting clinically as Small Bowel obstruction. A 20-year-old man was admitted with clinical features of intestinal obstruction. An abdominal X-ray showed multiple small bowel loops with air fluid levels. Contrast-enhanced CT of the abdomen revealed small bowel obstruction not only on the right, but also on the left side of the collapsed descending colon. Emergency Exploratory Laprotomy was performedand bowel loops with discolouration seen enclosed in hernial sac in supracolic compartment which were milked out of defect and observed to have obtained vascularity almost immediately. The postoperative period was uneventful. Preoperative diagnosis of bowel obstruction caused by a transmesocolic hernia remains difficult despite the currently available imaging techniques. Prompt surgery can prevent serious complications such as Bowel gangrene, peritonitis and sepsis.

Spermatic cord torsion associated with perineal hernia in a cryptorchid dog

AbstractAn 8‐year‐old male German Shepherd dog with a history of dyschezia, tenesmus and perineal swelling for 1 month was referred. The dog was known to be unilaterally abdominal cryptorchid. The normally descended testis had been surgically removed a few years ago. On physical examination, a firm, non‐painful, irreducible mass was palpable in the left perineal region. Digital rectal examination revealed rectal deviation, and the pelvic diaphragm was absent on the left. The prostate gland was normal upon palpation. Abdominal radiography revealed that the urinary bladder was present in the caudal abdomen. Based on clinical, laboratory and imaging findings, a diagnosis of perineal hernia was made. Surgical exploration revealed the presence of left spermatic cord torsion in the perineal hernia. The testis was removed, and internal obturator muscle transposition was performed for herniorrhaphy. The dog had an uneventful recovery, and the results of re‐examinations 10 days, 6 months and 12 months later were normal.