Left Extremity Research Articles

Metachronous Brain Tumor in 177Lu-PSMA Scan in a Patient with Metastatic Castration Resistant Prostate Cancer Mimicking Disease Progression.

A 66-year old man known case of metastatic castration resistant prostate cancer underwent successful 6 cycles treatment with 177Lu- prostate-specific membrane antigen. On the last post therapy whole body scan a new lesion in the skull was noted, suspected for disease progression. One week later, the patient complained from weakness of left upper extremity and brain magnetic resonance imaging revealed a brain tumor, confirmed as glioblastoma pathologically.

A Preliminary Investigation into the Neural Correlates of Knee Loading during a Change of Direction Task in Individuals after Anterior Cruciate Ligament Reconstruction.

Central nervous system (CNS) function after ACLR, quantified by the blood oxygen level dependent (BOLD) response, is altered in regions of sensory function during knee movement after ACLR. However, it is unknown how this altered neural response may manifest in knee loading and response to sensory perturbations during sport specific movements. To investigate the relationship among CNS function and lower extremity kinetics, under multiple visual conditions, during 180° change of direction task in individuals with a history of ACLR. Eight participants, 39.3 ± 37.1 months after primary, left ACLR performed repetitive active knee flexion and extension of their involved knee during fMRI scanning. Participants separately performed 3D motion capture analysis of a 180° change of direction task under full vision (FV) and stroboscopic vision (SV) conditions. A neural correlate analysis was performed to associate BOLD signal to knee loading of the left lower extremity. Involved limb peak internal knee extension moment (pKEM) was significantly lower in the SV condition (1.89 ± 0.37 N*m/Kg) compared to the FV condition (2.0 ± 0.34 N*m/Kg) (p = .018). Involved limb pKEM during the SV condition was positively correlated with BOLD signal in the contralateral precuneus and superior parietal lobe (Voxels: 53; p = .017; z-stat max: 6.47; MNI peak: 6, -50, 66). There is a positive association between involved limb pKEM in the SV condition and BOLD response in areas of visual-sensory integration. Activation of contralateral precuneus and superior parietal lobe brain regions may be a strategy to maintain joint loading when vision is perturbed. Level 3.

A 75-year-old with left ankle pain.

A 75-year-old female with a history of smoking presented with left foot pain after a fall. She was cleaning her pool when she lost her footing while walking down a step. On extremity examination of her left ankle, there was plantar flexion weakness, a palpable dell at the insertion of the Achilles tendon, and a bony mass proximal to the gap (Figure 1). Left ankle radiographs were remarkable for an acute fracture of the posterior proximal aspect of the left calcaneus (Figure 2). Before surgery, the skin had become ecchymotic and edematous. The patient underwent open reduction with internal fixation with podiatric surgery. As there was enough bone remaining, 2 cannulated screws were placed to fix the fracture along with the attached Achilles tendon. The patient was discharged with a recommendation of non-weight-bearing status for the left lower extremity, a cast, and orthopedic follow-up in 2 weeks. Calcaneal fractures account for 1%–2% of all fractures. Calcaneal avulsion fractures account for less than 3% of calcaneal fractures.1 The calcaneus is the largest tarsal bone; it supports axial load from the body. This report demonstrates a type 2 calcaneal avulsion fracture; a “beak fracture” where the tendon pulls on the tuberosity causing a horizontal fracture.2 It also demonstrates a rare tongue-type fracture where the tuberosity splits into a superior and an inferior fragment.3 Patients often present with pain, swelling, and ecchymosis near the posterior aspect of the calcaneus. Patients can have skin tenting that can lead to skin necrosis if not treated.3 This woman had ecchymosis before surgery but did not have skin necrosis. It is important to assess these patients for neurovascular compromise and signs of other injuries. A plain radiograph is usually sufficient for diagnosis. Treatment depends on the severity. Fractures with skin tenting, neurovascular injury, or significant displacement will likely require open reduction and internal fixation in the operating room.4 This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

An unexpected case of neonatal compartment syndrome associated with congenital anomalies of kidney and urinary tract

Abstract Objectives Neonatal compartment syndrome (NCS) occurs when increased pressure within the fasciocutaneous compartment decreases capillary perfusion, causing irreversible tissue damage from ischemia. NCS is a rare condition that requires prompt diagnosis and treatment. Diagnosing NCS is highly dependent on the examination, which can be difficult in newborns. Prompt recognition provides the best chance for good outcomes. Case presentation We present a case of NCS diagnosed and treated based on physical examination findings. Fetal ultrasonography showed bladder distension, bilateral hydroceles, urethra dilation, and abdominal urinary ascites concerning for lower urinary tract obstruction and possible bladder rupture. At 1 h after birth, examination of the infant’s left upper extremity showed no spontaneous movement, the hand and forearm appeared dusky, and the hand had a large blister with desquamation. No pulse distal to the antecubital fossa was detected via Doppler ultrasonography. The infant was diagnosed with NCS and underwent urgent fasciotomy. The clinical appearance and perfusion of the left upper extremity gradually improved. At four months of age, the wounds were healed and the patient had full passive range of motion of the left upper extremity. Recovery of active motion is ongoing. Conclusions The presence of blistering and desquamation should provoke suspicion for NCS. Once NCS is diagnosed, prompt intervention is necessary to reduce the risk of poor functional outcomes. This case highlights the need for increased awareness of the risk developing compartment syndrome in utero as part of the rare sequalae in infants with congenital anomalies of kidney and urinary tract.

Surgical correction of polymelia in the perineal region of a 2-day-old indigenous bovine calf: a case report from Bangladesh

BackgroundPolymelia is an occasional and congenital malformation in bovine calves, characterized by the presence of single or multiple accessory limb(s) at various body regions, which are often called the supernumerary limb(s). One of these defects is known as pygomelia, where the additional limb is attached to the pelvis within the perineal region. This study describes such a case along with surgical management.Case presentationA 2-day-old indigenous bovine female calf of 22.7 kg BW was presented with an additional and non-functional fifth limb at the perineal region. The ectopic fifth limb was smaller in size than the other four normal limbs and was in a flexible hanging position. Other than this, the animal was apparently normal with a short and contracted tail. Clinical examinations involving the extension and flexion of the abnormal limb revealed no deep bony attachment/articulation with the pelvic girdle or the caudal spine. The curled tail having an S-shaped base indicated the skeletal defects in the caudal spine. Electrosurgery was performed under deep sedation with regional as well as local anesthesia, which exposed that the limb was internally seated into deep gluteal muscle layers with the attachments of fibrous connective tissues and cartilage to its proximal bony head and located partially to the left lateroventral extremity of the perineum without any direct involvement in the bony pelvis. Surgical excision was done to remove the supernumerary limb, and the wound was closed routinely. Postoperatively, the animal was provided with supportive medications for early healing and recovery. After 2 weeks of surgery, the calf completely recovered without any complications. The contracted tail and spine were left unaffected as no initial surgical maneuver was done due to the early age of the calf and would be considered for further long-term treatment options upon the growth and development with age.ConclusionsPygomelia of bovine calves is one of the rare congenital defects that can be found along with other developmental anomalies. However, this defect can be successfully corrected by surgical approaches following intensive postoperative care and management.

Determining factors for compensatory movements of the left arm and shoulder in violin playing.

Despite a large number of available ergonomic aids and recommendations regarding instrument positioning, violin players at any proficiency level still display a worrying incidence of task-specific complaints of incompletely understood etiology. Compensatory movement patterns of the left upper extremity form an integral part of violin playing. They are highly variable between players but remain understudied despite their relevance for task-specific health problems. This study investigated individual position effects of the instrument and pre-existing biomechanical factors likely determining the degree of typical compensatory movements in the left upper extremity: (1) left elbow/upper arm adduction ("Reference Angle α", deviation from the vertical axis), (2) shoulder elevation ("Coord x", in mm), and (3) shoulder protraction ("Coord y", in mm). In a group of healthy music students (N = 30, 15 m, 15 f, mean age = 22.5, SD = 2.6), "Reference Angle α" was measured by 3D motion capture analysis. "Coord x" and "Coord y" were assessed and ranked by a synchronized 2D HD video monitoring while performing a pre-defined 16-s tune under laboratory conditions. These three primary outcome variables were compared between four typical, standardized violin positions varying by their sideward orientation ("LatAx-CSP") and/or inclination ("LoAx-HP") by 30°, as well as the players' usual playing position. Selected biomechanical hand parameter data were analyzed as co-factors according to Wagner's Biomechanical Hand Measurement (BHM). Mean "Reference Angle α" decreased significantly from 24.84 ± 2.67 to 18.61 ± 3.12° (p < 0.001), "Coord x" from 22.54 ± 7.417 to 4.75 ± 3.488 mm (p < 0.001), and "Coord y" from 5.66 ± 3.287 to 1.94 ± 1.901) mm (p < 0.001) when increasing LatAx-CSP and LoAx-HP by 30°. Concerning the biomechanical co-factors, "Reference Angle α", "Coord y", but not "Coord x", were found to be significantly increased overall, with decreasing passive supination range (r = -0.307, p = <0.001 for "Passive Supination 250 g/16Ncm", and r = -0.194, p = <0.001 for "Coord y"). Compensatory movements were larger during tune sections requiring high positioning of the left hand and when using the small finger. Results may enable to adapt individually suitable instrument positions to minimize strenuous and potentially unhealthy compensation movements of the left upper extremity.

A Case Report of Ruptured Popliteal Aneurysm in the Setting of Blunt Trauma.

Popliteal artery aneurysms are in most cases asymptomatic but cause significant complications if ruptured. An acute popliteal aneurysm rupture is relatively rare, and few cases have been documented secondary to blunt trauma. Common presenting signs and symptoms include distal limb ischemia and absent dorsalis pedis pulses. Timely management and recognition of this rare presentation are crucial as this condition can result in limb loss or death if not treated in a timely manner. An 80-year-old man with history of hypertension presented to the emergency department complaining of inability to feel sensation below his left knee after falling from ground level. Physical examination was pertinent for bounding radial and femoral pulses bilaterally, although absent dorsalis pedis and posterior tibial pulses to the left lower extremity. Computed tomography angiography identified occlusion of the left superficial femoral arterial lumen associated with a ruptured popliteal aneurysm, approximately eight centimeters in size. He immediately received unfractionated heparin and was admitted to the hospital for left medial thigh exploration and decompressive dermatofasciotomy. After confirmation of popliteal aneurysmal rupture with advanced imaging, heparinization and vascular surgery consultation are critical steps that should be taken to prevent limb loss.

A neonate with Amniotic Band Syndrome and osteomyelitis

Amniotic band syndrome (ABS) comprises of a broad term for a group of congenital anomalies involving the limbs more often, but any other anatomic region of fetus could be involved. The prevalence of amniotic band has been reported from 0.19 to 8.1 per 10000 live births. Different theories exist for explaining the etiology of amniotic bands, but it has been considered to have a multifactorial etiology. Fetoscopic release of amniotic bands affecting one or more extremities can prevent limb loss or preserve limb function when distal fellow is still identifiable on preoperative ultrasound scans. Congenital anomalies of amniotic band syndrome will happen approximately in 77% of fetuses. There has been reported equal involvement between male and female. In general, we do not have osteomyelitis in neonates, but it would be connected to a long-term hospital admission and possible long‐term complications if not diagnosed on time. The long bones are the most frequently affected sites. Here we are introducing a neonate with left upper extremity necrosis due to ABS which needed amputation and it was associated with severe chronic osteomyelitis.

Combined exploratory laparotomy, transpsoas, and thoracic approach to resection of a giant spinal ganglioneuroma: illustrative case.

Ganglioneuromas are rare peripheral nervous system tumors of neural crest origin. Most are often asymptomatic and incidentally found, but large tumors can cause mass effect. Herein, the authors report a case of a giant ganglioneuroma that arose from the lumbar foramina into the retroperitoneal and thoracic cavities. A 62-year-old female presented with low back pain, left lower extremity swelling, and increased sensation of an abdominal mass. Surgical treatment options were reviewed with the patient and coordinated care was planned by surgical oncological specialists. The patient opted for multistage exploratory laparotomy for abdominal mobilization, diaphragm resection, and en bloc resection with neuromonitoring. After surgery, the patient experienced significant improvement in symptoms. A combined surgical exposure involving gastrointestinal, thoracic, and neurological surgeons can be important in the safe resection of ganglioneuromas that span multiple body cavities. Hence, a thorough preoperative assessment could help plan surgery accordingly.

Left Wing Extremism: Evolution and Analysis of Government’s Initial Response During Period 1967-1998

This research paper aims at identifying the root causes of the Naxalite movement in India using the Ishikawa diagram. Additionally, an attempt is made to understand initial government responses during the period from 1967-68 to 1998-99.

The impact of coordination-based movement education model on balance development of 5-year-old children.

With this study, it was aimed to examine the effect of coordination-based movement education model on the development of balance in 5-year-old children. The research was designed with a control group pre-test post-test design, which is one of the quasi-experimental research models. The research group consists of a total of 42 (n = 20 experimental n = 22 control) 5-year-old children formed by using the convenient sampling method, which is one of the purposeful sampling methods. Each participant's age, body weight, body length and lower extremity limb lengths were measured. As a data collection tool and used the three-part Y Balance Test (YBT) platform, which was previously stated to have high reliability (ICC = 0.85-0.93). Reach distances of the participants were measured in three directions, anterior posteromedial and posterolateral. YBT scores were determined by calculating the average and normalized values for lower extremity limb length for each reach direction of the obtained scores, and composite YBT scores were determined by taking the averages of anterior, posteromedial and posterolateral reach distance scores. In order to determine whether the collected data are suitable for normal distribution, Levene test was applied first and it was determined that p > 0.05 for all parameters as a result of the test. Independent sample T-test from parametric tests was used to determine the differences between groups. Paired-group T-test was used to determine within-group differences. According to the results of the research, it was found that the balance motor capacity levels between the experimental and control groups did not differ significantly compared to the pre-test, but there was a significant difference in all reach directions scores in favor of the post-test and experimental group compared to the control group and the pre-test. When the results of the right and left lower extremity ANT, PM, PL and Composite reach distances were examined according to gender, although there was no statistically significant difference, when the averages were considered, it was seen that all parameters were in favor of girls (p > 0.05). As a result, it was concluded that coordination-based movement education model had a positive effect on the balance motor capacities of 5-year-old children.

Neuromonitoring Guided Vessel Identification in Iatrogenic Arterial Injury During Meningioma Resection

ABSTRACT Neuromonitoring is commonly used in neurosurgery and allows intraoperative assessment of functional pathways in the brain during surgery. Monitoring alerts can guide surgical decision making in real-time allowing surgeons to mitigate or avoid potential iatrogenic injury and subsequent postoperative neurologic sequelae that may result from cerebral ischemia or malperfusion. Here we present a case of a patient undergoing a right pterional craniotomy for the resection of a tumor which crosses midline with multimodal intraoperative neuromonitoring including somatosensory evoked potentials, transcranial motor evoked potentials, and visual evoked potentials. During the final portion of tumor resection, arterial bleeding was noted of unknown origin shortly followed by loss of right lower extremity motor evoked potential recordings. Motor evoked potential recordings in the right upper, and left upper and lower extremities were stable, as well as all somatosensory evoked potentials and visual evoked potentials. This distinct pattern of right lower extremity motor-evoked potential loss suggested compromise of the contralateral anterior cerebral artery and guided the surgeons to a rapid intervention. The patient awoke from surgery with moderate postoperative weakness in the affected limb that resolved to preoperative status by postoperative day 2, and back to normal strength prior to three-month follow-up. In this case the neuromonitoring data suggested compromise to the contralateral anterior cerebral artery which guided the surgeons to investigate and identify the site of vascular injury. The present case reinforces the utility of neuromonitoring in emergent surgical situations to guide surgical decision making.

A stroke mimicker following inferior alveolar nerve block: a case report

Introduction: Local anesthesia administration albeit being the most common dental procedure is associated with complications that usually arise as a result of wrongly placed injections into local or distant sites. Here we present a case of an unexpected complication affecting the upper limb after dental anesthesia administration. Observation: A 26-year-old Malay female presented with the left upper extremity paralysis and paraesthesia following the administration of a local anesthesia block to the left inferior alveolar nerve, at a dental teaching center. The onset of the dental nerve block and left upper extremity weakness occurred and eventually subsided. As the provisional diagnosis was either a transient ischaemic attack or stroke, she was immediately referred to the Emergency Department. She was thoroughly assessed and monitored with the neurology team being consulted. Her vital signs remained stable and she showed no neurological deterioration throughout the observation period. She was discharged without further investigations after regaining full strength and sensation of her left upper extremity. The report tries to hypothesize the possible cause of this incident. Conclusion: This case highlights the importance of dentists being alert to possible effects of local anesthesia to regions beyond the head and neck area.

Neurolymphomatosis in Recrudescent Diffuse Large B-cell Lymphoma.

Neurolymphomatosis is an uncommon manifestation of lymphoma, often presenting with painful polyneuropathy or polyradiculopathy and concomitant distal extremity weakness. Differentiation from other etiologies resulting in similar neuropathic symptoms such as compressive or inflammatory pathologies can be difficult and often results in delayed diagnosis. Here we describe a case of neurolymphomatosis affecting a 64-year-old man with a history of diffuse large B-cell lymphoma (DLBCL) in remission presenting with a right-sided foot drop following a gunshot wound. MRI at that time demonstrated thickening and enhancement of the cauda equina nerve roots. Over the course of the subsequent eight months, he developed left lower extremity sensory symptoms, left-sided foot drop and signs of upper motor neuron involvement, including left facial weakness, dysphonia, and dysphagia. 18F-FDG PET/CT revealed intensely avid left lumbosacral nerve roots, bilateral lower extremity and left upper extremity neurovascular bundles. Left sural nerve biopsies showed infiltration of DLBCL and confirmed neurolymphomatosis. We highlight the role of 18F-FDG PET/CT, with histological verification, for the diagnosis of an extended course of neurolymphomatosis occurring in the absence of typical painful neuropathy but with cranial and peripheral neuropathies.

Артериит Такаясу после перенесенной коронавирусной инфекции у молодой женщины: клиническое наблюдение

The article describes the clinical onset of Takayasu's arteritis (non-specific aortoarteritis) which occurred after coronavirus disease in a young woman with Still's disease in her medical history. Takayasu's arteritis primarily affects young women, most commonly of Asian race. Clinical manifestations of the disease can be conditionally divided into two groups: non-specific symptoms, indicating a systemic inflammatory response, and specific symptoms associated with the damage of the aorta and its branches. Physical examination plays an important role in diagnosing Takayasu's arteritis. Characteristic signs of the disease include vascular bruits over the large arteries, arterial blood pressure differentials in the right and left extremities, and failure to palpate pulse on the radial arteries (therefore it is also called pulseless disease). Imaging diagnostic techniques include contrast-enhanced angiography and Duplex sonography of the vessels. Etiology of the disease is not fully understood. Research papers present data showing that novel coronavirus infection could be a triggering factor in the emergence of vasculitis of the large vessels, including Takayasu's arteritis. This should be taken into consideration in the management of patients belonging to the risk group. KEYWORDS: Takayasu's arteritis, non-specific aortoarteritis, COVID-19, post-COVID-19 syndrome, vasculitis, Stills' disease. FOR CITATION: Gordeev I.G., Vechorko V.I., Otarova S.M. et al. Takayasu's arteritis after coronavirus disease in young woman: case report. Russian Medical Inquiry. 2023;7(3):181–186 (in Russ.). DOI: 10.32364/2587-6821-2023-7-3-181-186.

Relationship Between Diabetic Chorea and Timing of MRI Findings: A Systematic Review with Case Reports.

Diabetic chorea is a rare complication of diabetes mellitus for which head MRI is the most common diagnostic imaging modality. Cases have been reported where CT and/or MRI findings are inconsistent or clinical symptoms and imaging findings do not appear simultaneously. We aimed to compile the cases in which imaging findings appeared on MRI retests and to examine in a systematic review whether temporal differences in the appearance of imaging findings correlate with clinical characteristics. An 80-year-old man with type 2 diabetes mellitus came to a hospital with abnormal movements of the left upper and lower extremities. Two days after the first visit, his symptoms flared up, and his head MRI showed an old cerebral infarction and no new lesion. On day 14, he retested T1-weighted imaging and showed a high signal in the right putamen, which was considered diabetic chorea. Blood glucose was controlled with insulin, and the involuntary movements disappeared. PubMed and ICHUSHI were searched to identify patients with diabetic chorea who had undergone MRI retests. Patients grouped by the temporal change in the presence/absence of imaging findings were compared on age, sex, duration of diabetes mellitus, blood glucose level, HbA1c level, side of involuntary movement, time to first MRI, and follow-up MRI. Of the 64 cases analyzed, 43 (67.2%) were female. The mean age was 69.0 years. 16 (25.0%) had worsening findings upon MRI retesting, 37 (57.8%) had improvement, and 10 (15.6%) had unchanged findings. There were no significant differences in age, sex, mean blood glucose level or HbA1c at onset among the groups. There was no association between the pattern of appearance of imaging findings over time and clinical characteristics, including glucose levels. If initial MRI findings are negative, MRI retesting after a certain time may help diagnose diabetic chorea.

Acute effects of ankle weight loading on regional activity of rectus femoris muscle and lower-extremity kinematics during walking in older adults

Ankle weight loading is a straightforward and easily applicable method to increase the physiological burden during walking in older adults. The current study investigated the acute effects of ankle weight loading on the regional activity of rectus femoris (RF) muscle and lower-extremity joint angles during walking in twenty-nine healthy older adults. Neuromuscular activities of proximal (RFP) and distal (RFD) regions of the RF into averaged rectified values (ARV) and kinematics of left lower extremities were measured during walking with and without ankle weight on a treadmill using surface electromyography (EMG) and motion capture, respectively. Significant differences in normalized ARV between RFP and RFD with ankle weight loading were found in longer periods of the stance phase (30-55 and 5-15%) and swing (70-90 and 95-100%) phases compared to without weight condition (30-40, 50, and 75-85%) (p&amp;lt;.05). The hip flexion angle at (10-25 and 60-90%), knee extension at (5%, 15%, 25-35%, and 100%), and ankle dorsiflexion at (30-55% and 75%) of the gait cycle were increased with ankle weight loading more than without it (p&amp;lt;.05). Ankle weight loading could change the neuromuscular activity pattern of RFP and improve lower-extremity kinematics during walking in older adults.

Efekat robotski potpomognutog hoda i tradicionalnog treninga na motorička oštećenja kod dece sa cerebralnom paralizom

Aims. The aim of the study was to assess the effectiveness of robotic-assisted gait treadmill training (Lokomat) as an adjunct to traditional physiotherapy in improving the range of motion, muscle strength and decreasing spasticity in lower extremities in children with cerebral palsy. Materials and Methods. Twenty-six participants, with mean 7.69 ± 2.90 years, levels I-IV on Gross Motor Classification System (38.5% level I-II and 61.5% level III-IV) with a bilateral and unilateral form of cerebral palsy underwent intensive 20 Lokomat and 20 traditional physiotherapy sessions, each training session lasting 40 minutes. Preand post-testing was done using goniometer measure, manual muscle testing and modified Ashworth scale. Results. Positive effects were seen in participant who underwent a combination of Lokomat training and traditional therapy. An increase in the range of motion was minimal (2 - 4 degrees) in hip flexion, extension, and abduction. A significant improvement was achieved in ankle dorsiflexion on the right (p = 0.003) and left side (p = 0.006), while the values of knee extension for the left and right extremity were p = 0.062 left and p = 0.075, respectively. An increase in muscle strength of the lower limb was seen in 30.8% - 80% of participants. Reduction of spasticity in adductors, hamstrings and gastrocnemius were seen in 26.9% of participants. Conclusion. Lokomat training is an adjunct to conventional physiotherapy treatment. It has a negligible effect on the increase in the range of motion and muscle strength of the lower limb and reduction of spasticity in children with cerebral palsy.

Neurosyphilis with manifesting as cerebral ring enhanced in a patient with acquired immunodeficiency syndrome

We report a case of a 45-year-old male patient who was admitted to our hospital due to the left upper extremity weakness and paroxysmal headaches. He was diagnosed with neurosyphilis by pathology. He was found to be human immunodeficiency virus-positive, with a CD4 count of 179 cells/μl. Ring-enhancing lesions were found in the right frontal cortex with adjacent dural thickening. The lesion almost disappeared after anti-syphilis treatment.

SJLA_2024_A16: Unusual Complications of Open Preperitoneal Tension-Free Inguinal Hernia Repair

Background: The purpose of this study is to report two patients referred to our hospital after developing unusual complications attributed to prior open preperitoneal tension-free inguinal hernia repair. Methods: Case # 1 A 75-year-old male developed a left proximal thigh abscess requiring incision and drainage 5 years after open prosthetic, preperitoneal inguinal hernia repair with single-layer mesh. A pelvic computed tomography (CT) scan demonstrated an abscess in the left inguinal preperitoneal space as well as diverticulosis but no diverticulitis. A colonoscopy was negative for any additional findings. The patient underwent groin exploration, debridement of the inguinal canal and sinus tract, and mesh resection followed by JP drain placement. The inguinal defect was repaired utilizing the should ice technique. Intraoperative cultures revealed penicillin-resistant Staphylococcus aureus. The drain was removed on postoperative day nine, and his recovery remains uneventful without hernia recurrence or infectious complications at 11-month follow-up. Case # 2 An 82-year-old man developed progressive left lower extremity edema and disabling claudication 1 month after open prosthetic inguinal hernia repair with a bilayer disc mesh. Venous duplex imaging revealed compression of the left common femoral and external iliac veins. A CT angiogram demonstrated left external iliac and common femoral artery thrombosis and a 5.2 cm fluid collection consistent with hematoma. An inferior vena cava filter was placed. The common femoral artery was controlled after initial exploration revealed a common femoral artery pseudoaneurysm. The mesh was densely adherent to the external iliac vein and was thus not resected. The common femoral artery pseudoaneurysm was repaired and the profunda femoris artery over sewn. An external iliac to superficial femoral artery 8 mm Polytetrafluoroethylene bypass graft was placed. The patient was discharged on systemic anticoagulation without claudication on postoperative day thirteen. Results: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Discussion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available. Conclusion: Laparoscopic inguinal hernia repair and novel, open techniques and mesh devices have popularized the placement of mesh in the preperitoneal space. Acute, severe vascular complications and latent infectious complications can occur after open, preperitoneal tension-free inguinal hernia repair and may require remedial surgery. CT scans and angiogram pictures are available.