Herniation Of Intra-abdominal Contents Research Articles

A case of omphalocele associated with teratoma in a new born baby: a very rare case report

An omphalocele is a congenital midline abdominal wall defect at the level of the umbilical cord insertion into the fetal abdomen that results in herniation of intra-abdominal contents into a sac comprising of an outer layer of amnion and an inner layer of peritoneum. The most common eviscerated contents are liver and small intestine though virtually any organ can be seen within the omphalocele sac including colon, pancreas, spleen, omentum, stomach, heart or genitalia. We report an unusual case of omphalocele associated with mature teratoma in Tripura medical college and DR. BRAM teaching hospital. Only five cases of teratoma arising in a case of omphalocele are reported in the literature reviewed.

Hydrocele of Canal of Nuck In an Adult Female: A Case Report

Hydrocele of the canal of Nuck is a rare abnormality, developing in the protruded part of the parietal peritoneum within the inguinal canal in a female. It is homologous to the processus vaginalis in males and obliterates from the seventh month of gestation to one year of age. Failure of obliteration, results in Nuck hydrocele or herniation of intra-abdominal contents through the patent Canal of Nuck. These are usually detected and repaired in young girls within the first five years of life. Reports of Canal of Nuck hydrocele in adults are sparse. Most of these patients are misdiagnosed on clinical examination and correctly diagnosed intraoperatively during surgery for suspected ‘inguinal hernia’. Here, this case is about a 25-year-old female, who presented with swelling in the right groin for one month. Computed Tomography of the abdomen showed features suggestive of a hydrocele within the Canal of Nuck. She underwent laparoscopic hydrocelectomy and laparoscopic hernia repair via the transabdominal preperitoneal approach. This case report highlights the novel approach of laparoscopic management of this rare case.

Long-term outcomes of biological mesh repair following extra levator abdominoperineal excision of\xa0the rectum: an observational study of 100 patients

BackgroundCurrent evidence suggests that pelvic floor reconstruction following extralevator abdominoperineal excision of rectum (ELAPER) may reduce the risk of perineal herniation of intra-abdominal contents. Options for reconstruction include mesh and myocutaneous flaps, for which long-term follow-up data is lacking. The aim of this study was to evaluate the long-term outcomes of biological mesh (Surgisis®, Biodesign™) reconstruction following ELAPER.MethodsA retrospective review of all patients having ELAPER in a single institution between 2008 and 2018 was perfomed. Clinic letters were scrutinised for wound complications and all available cross sectional imaging was reviewed to identify evidence of perineal herniation (defined as presence of intra-abdominal content below a line between the coccyx and the lower margin of the pubic symphysis on sagittal view).ResultsOne hundred patients were identified (median age 66, IQR 59–72 years, 70% male). Median length of follow-up was 4.9 years (IQR 2.3–6.7 years). One, 2- and 5-year mortality rates were 3, 8 and 12%, respectively. Thirty three perineal wounds had not healed by 1 month, but no mesh was infected and no mesh needed to be removed. Only one patient developed a symptomatic perineal hernia requiring repair. On review of imaging a further 7 asymptomatic perineal hernias were detected. At 4 years the cumulative radiologically detected perineal hernia rate was 8%.ConclusionsThis study demonstrates that pelvic floor reconstruction using biological mesh following ELAPER is both safe and effective as a long-term solution, with low major complication rates. Symptomatic perineal herniation is rare following mesh reconstruction, but may develop sub clinically and be detectable on cross-sectional imaging.

Thoracoschisis

Introduction: Thoracoschisis is a rare congenital malformation characterized by herniation of intraabdominal contents through a thoracic wall defect. There have been six previously reported cases. We describe our novel approach incorporating closure of the chest wall defect with temporary abdominal wall expansion utilizing a silastic pouch. Case report: A male child born at 29 weeks’ gestation was transferred to our institution for the management of a right anterior chest wall defect with herniation of intraabdominal contents through this defect. The patient was taken to the operating room for reduction of the herniated viscera from the right chest wall defect into the abdomen utilizing a spring-loaded silastic pouch to cover the abdominal viscera. Discussion: The cause of thoracoschisis is unclear. Multiple mechanisms have been proposed for the development of thoracoschisis, including amnionic rupture, vascular injury, and embryologic maldevelopment. In previously reported cases, a majority of patients had associated limb abnormalities. It has been proposed that this association between extremity agenesis/deformity and chest wall defects is related to the limb–body wall complex. In addition, most of the cases reported also had an accompanying diaphragmatic defect, allowing the abdominal viscera to enter the chest and then herniate through the thoracic defect. Conclusion: Overall, thoracoschisis is a very rare congenital abnormality characterized by a chest wall defect with herniation of intra-abdominal organs through this defect. Previously, only six cases have been reported, most of which had an associated limb anomaly or diaphragmatic hernia. Keywords: gastroschisis, limb–body wall complex, thoracoabdominal schisis, thoracoschisis

Incisional hernia appendicitis: A report of two unique cases and literature review

INTRODUCTIONAcute appendicitis is a common surgical emergency. The presence of an inflamed appendix in an incisional hernia is rare. Incisional hernias complicate both open and laparoscopic surgery. PRESENTATION OF CASEWe describe two unique cases of acute appendicitis within incisional hernias following an open cholecystectomy and a diagnostic laparoscopy. Acute appendicitis was diagnosed intraoperatively and a formal appendicectomy was performed with subsequent primary repair of the hernial defect in each case. DISCUSSIONThe method chosen for primary repair of an incisional hernia containing an acutely inflamed appendix depends on a number of factors including size of hernial defect and degree of contamination. Closure of 5mm port sites is not routine in current surgical practice. Herniation of intra-abdominal contents through such defects can occur rarely. The repair of an incisional hernia using mesh in a contaminated surgical field is controversial. There may be advantages in the use of biological meshes. CONCLUSIONSurgical awareness of potential complications relating to the management of incisional hernia appendicitis is of primary importance in determining intraoperative strategy.

Hat die Thorakoskopie beim Thoraxtrauma einen Platz?

A hemodynamically stable patient presenting with persistent bleeding through his chest tube (ICD) is a classic indication for early thoracoscopic intervention in trauma. The source of bleeding and air leaks can be identified and often treated: bleeding and perforated pulmonary segments can be resected, and chest wall bleeding may be coagulated or sutured. Injuries to the diaphragm are difficult to diagnose, as they might not be seen in conventional trauma imaging without gross herniation of intra-abdominal contents into the thoracic cavity. Identifying the site of diaphragm perforation can give useful hints in thoracoabdominal trauma, identifying injured cavities and localizing the bullet or stab tract. Most often, diaphragmatic defects may be closed during diagnostic thoracoscopy as well. Non- or partially drainable hemothorax is another indication for thoracoscopy. Coagulated blood can be mechanically mobilised, and aspirated or primary bleeding may be stopped. Effective lavage and a high-performance suction device are required. Correct placement of the drainage is part of optimized therapy, along with inspection of all intrathoracic organs and surfaces. Furthermore, surgical and anaesthesiological teamwork and experience are prerequisites for the fast, professional application of a minimally invasive thoracoscopic approach in chest trauma patients. Diagnostically and theurapeutically, thoracoscopy plays an important role in the trauma setting--in the case of hemodynamically stable patients.