Skin Fistula Research Articles

Nomogram model to predict postoperative infection after mandibular osteoradionecrosis surgery

Osteoradionecrosis of the mandible (ORNM) is one of the most dreaded complications of radiotherapy. The poor healing capacity of soft tissue after radiation may lead to surgical failure. The current study was designed to identify prognostic factors for postoperative infection (PPI) and propose corresponding prophylaxis and intervention protocols. A retrospective study was conducted concerning ORNM patients from 2000 to 2015. A risk-stratification score and nomogram model were established to predict the risk of PPI. A total of 257 patients were analyzed, and the total incidence of PPI was 23.3% (60/257). In multiple logistic regression analysis, radiation dose geqslant 80 Gy (versus <80 Gy, OR = 2.044, P = 0.035, 95% CI: 1.05–3.979), bilateral ORNM (versus unilateral, OR = 4.120, P = 0.006, 95% CI: 1.501–11.307), skin fistula (versus none, OR = 3.078, P = 0.040, 95% CI: 1.05–9.023), and implant utilization (versus none, OR = 2.115, P = 0.020, 95% CI: 1.125–3.976) were significantly associated with PPI. The susceptibility to PPI in patients with risk-stratification scores of 14–22 was 2.833 times that of patients with scores of 7–13, and 7.585 times that of cases defined as scores of 0–6. The discrimination capability of the nomogram model was estimated using a ROC curve with an AUC of 0.708, revealing potentially useful predictive abilities. In conclusion, current risk-stratification scores and nomogram models effectively predicted the risk of PPI in ORNM patients.

Paramedian Submandibular Approach for Removal of Foreign Bodies in the Pterygoid Muscle in Two Dogs.

The purpose of this report is to document a unique location of an oropharyngeal foreign body, diagnosed via contrast computed tomography (CT), as well as a novel surgical approach to the pterygoid muscle region. Oropharyngeal foreign objects are an uncommon but potentially serious disease that can lead to chronic abscessation and pain. Two dogs were presented with chronic complaints, including pain and inability to fully open the mouth for a 1 yr and 5 mo duration, respectively. There was no history or evidence of skin sinus or submandibular/cervical swelling on physical examination of either dog. Both dogs had normal oropharyngeal anatomy with the exception of an asymmetric contrast-enhancing lesion within the pterygoid muscle on CT imaging. As there were no gross abnormalities visible during surgery, the use of contrast CT was vital in order to isolate the focus of infection. A paramedian submandibular approach was used to explore this region, and in both cases, foreign material was successfully removed with subsequent resolution of clinical signs. The dogs were immediately free of clinical signs and showed no recurrence for at least 8 and 17 mo after the exploration, respectively. A novel surgical approach is described to remove oropharyngeal foreign objects and necrotic debris within the pterygoid muscle.

Sacral Dimple

A 5-month-old boy, the product of a normal, spontaneous, uncomplicated vaginal delivery, presented to a peripheral hospital with a 2-month history of recurrent fever, vomiting, seizures, and progressive lower limb weakness. He was discovered to have hydrocephalus secondary to a posterior fossa lesion. An external ventricular drain was inserted, and he was transferred to our hospital. Upon presentation, his head circumference was 45 cm (in the 90th percentile), pupils were equally reactive, and he was quadriparetic with the left side being weaker than the right. Spinal examination revealed a sacral dimple with purulent discharge on digital pressure. Magnetic resonance imaging revealed a brain abscess, a spinal dermoid cyst, and dermal sinus. He underwent craniotomy and abscess evacuation followed by untethering of the spinal cord, resection of the dermoid, and the skin sinus. He tolerated the procedure well, and his weakness improved. The antibiotic course was completed, and the external ventricular drain was removed. Follow-up after 2 years showed a normal neurologic examination.

虫垂炎術後30年目に手術した遺残虫垂粘液癌の1例

症例は85歳の女性で，30年前に虫垂炎の手術歴がある．7年ほど前から徐々に増大する右下腹部腫瘤あり，腫瘤上の皮膚が自潰し粘液が流出してきたため受診した．CTでは回盲部に接し，80 mm大の囊胞性腫瘤を認め，腫瘤は腹壁を貫き皮下に連続していた．MRIでは腫瘤の内部に充実性成分を示す結節を認めた．遺残虫垂原発の粘液癌を疑い手術を施行した．腹壁，回盲部と一塊となった粘液貯留囊胞様の腫瘤がみられ，腹壁合併回盲部切除を施行した．腹壁欠損部は外側大腿回旋動脈下行枝を血管柄とする有茎大腿外側広筋皮弁で再建した．摘出標本では大量の粘液を入れる囊胞性病変で皮下に浸潤していたが，回盲部への浸潤はなく，遺残虫垂は同定できなかった．病理組織学的検索では線維性の壁を円柱上皮が被覆，壁の一部に高度異型を伴う乳頭状増殖を認めた．免疫染色検査ではCDX-2，CK20，CK7がともに陽性であり，遺残虫垂原発の粘液癌と診断した．

The Experience of Negative Pressure Wound Therapy for the Small Skin Fistula Continuing in Intracavity

The Experience of Negative Pressure Wound Therapy for the Small Skin Fistula Continuing in Intracavity

Clinical Study on the Etiology of Postthyroidectomy Skin Sinus Formation.

Background. Thyroidectomy is one of the most frequently performed surgical procedures worldwide. Despite technical advances and high experience of thyroidectomy of specialized centers, it is still burdened by a significant rate of postoperative complications. Among them, the skin sinus formation is an extremely rare postthyroidectomy complication. Here, we first report the incidence of the skin sinus formation after thyroidectomy to identify the causes for skin sinus formation after thyroidectomy and to discuss its prevention and treatment options. Methods. A retrospective analysis was carried out of patients who underwent excision operation of fistula for postthyroidectomy skin sinus formation. Data were retrieved from medical records department of the Affiliated Hospital of Inner Mongolia Medical University. Results. Of the 5,686 patients who underwent thyroid surgery, only 5 patients (0.088%) had developed skin sinus formation. All 5 patients successfully underwent complete excision of fistula. Conclusion. Infection, foreign body, thyroid surgery procedure, combined disease, and iatrogenic factors may be related with skin sinus formation after thyroidectomy. To reduce the recurrence of postoperative infections and sinus formation, intra- and postoperative compliance with aseptic processing, intraoperative use absorbable surgical suture/ligature, repeated irrigation and drainage, and postoperative administration of anti-inflammatory treatment are to be followed.

Discharging sinus of neck after thyroid surgery:A rare case report

There are a number of complications after thyroid surgery such as compressing hematoma, tracheomalacia, wound infection, damage to the recurrent laryngeal nerve or superior laryngeal nerve, hypothyroidism, hypocalcemia, scar formation, and thyroid storm, but discharging skin sinus of the neck is a rare complication. We report a case of discharging pus sinus of the neck after hemithyroidectomy for 1 year; pus culture was positive for Pseudomonas aeruginosa. Thyroid function test was normal. Ultrasonography disclosed branching sinus tracts and right lobe thyroid nodule and the left lobe not visualized. Sinus tracts' excision surgery was done. Histopathology report revealed fibrocollagenous stroma with clusters of epithelioid cells, histiocytes, Langhans giant cells, and chronic inflammatory cells with foci of caseous necrosis. The diagnosis of thyroid tuberculosis (TB) was therefore made. Patient was put on isoniazid, rifampicin, ethambutol, and pyrazinamide. She responds well. Although seldom observed, TB should be kept in mind in the differential diagnosis of discharging sinus of neck.

Intervention en deux temps pour tuberculose destructrice du médio-pied : à propos de 14 cas

IntroductionTuberculosis (TB) in midfoot is often secondary to tuberculosis elsewhere in the body. The experience and literatures to treat midfoot tuberculosis are rare. Up until now, no successful method is reported to treat midfoot tuberculosis. HypothesisStage surgery is a effective method to treat midfoot bone TB. Material and methodsBetween January 2008 to January 2011, 14 patients who were diagnosed with midfoot tuberculosis and suffered stage operation were enrolled. All the patients had been diagnosed definitely relying on imaging examination and laboratory tests preoperatively. Two-stage operation was performed to all patients. At the first stage, TB tissue and infective tissue were completely removed and replaced by antibiotic bone cement. Normal foot length and arch would be restored and maintained by k-wires and external fixators. At the second stage, autologous iliac and allogeneic bone graft were used to replace bone cement and by fixed by locking plates. American Orthopaedic Foot and Ankle Society (AOFAS), SF-36 and visual analogue scale (VAS) pain score were recorded at the last follow-up. ResultsThe average bone union time was 3.8 (range 3–6) months. There is no case of local recurrence or skin sinus. Neither implant broken nor screw loosen was present in this study. The AOFAS score was increased from 51.7±6.8 (range 43–61) preoperatively to 82.9±3.9 (range 76–90) postoperatively (P<0.001). The SF-36 score increased from 46.1±6.1 preoperatively to 83.1±5.4 postoperatively (P<0.001). The VAS score decreased from 6.1±1.1 preoperatively to 1.4±0.9 points postoperatively (P<0.001). DiscussionStage operation is an effective treatment to stage III, IV midfoot tuberculosis. Levels of evidenceLevel 4, retrospective.

Migration speed of uropathogens : Determination in the ureteral splint in a practice-like in vitro model

Aurostomy with an ileum conduit or askin fistula leads to ahigh infection risk for the kidneys and the ureter of the patient. Therefore, the prevention of retrograde colonization of the artificial drain (splint) with e. g. contaminated urine is the most important objective of infection prevention measurements. We performed an in vitro experiment to determine the migration speed of clinically relevant bacteria in acommercially available splint catheter system. The migration speed of bacteria in commonly used splint catheters was determined in apractice-like in vitro model. Two storage vessels were connected with splints. The second vessel contained abacterial suspension of the test bacteria Escherichia coli, Proteus mirabilis, and Staphylococcus aureus in artificial urine. The two vessels were incubated at 36°C for 24-72h. The microbial count in the catheters was determined after each experiment to investigate the migration distance. The average migration speed was 0.63 cm/h for E.coli, 0.80 cm/h for S.aureus, and 0.94 cm/h for P.aeruginosa. This results in acolonization distance of approximately 80cm in 3days. If the system, e. g., the stoma pouch is contaminated, it can be expected that during the common application time of asplint of 10-14days, the complete splint will be contaminated due to the high bacteria migration speed. Consequently there is ahigh infection risk for kidneys and ureters. Areturn stop feature in the stoma pouch should minimize this risk. However, it is of upmost importance to not applying the splint through the return stop to prevent any contact with potentially contaminated urine.

Intraoperative radiotherapy for the treatment of thyroid cancer: a pilot study.

We preliminarily evaluated the clinical feasibility and efficacy of intraoperative radiotherapy in patients with thyroid carcinoma. Nine thyroid cancer patients received intraoperative radiotherapy using an Intrabeam system. The dose was 3-4 Gy and the irradiation time ranged from 1 min 32 s to 7 min 33s. One case was a primary thyroid carcinoma, while the other cases were recurrent disease. Adverse effects, recurrence and survival were analyzed. In one patient, poorly differentiated thyroid carcinoma recurred 5 months after treatment, one patient developed a postoperative tracheal skin fistula, and one patient developed a wound infection. Because the affected areas were treated with both surgical resection and then radiotherapy, it is difficult to know which of those led to the adverse effects. Nonetheless, our results indicate that intraoperative radiotherapy can relieve the symptoms associated with thyroid cancer and improve the quality of life for these patients. It thus appears feasible to treat thyroid cancer patients with intraoperative radiotherapy.

A Case of Relapsing Polyarthritis Associated With Hidradenitis Suppurativa: Case Report and Review of Literature.

Hidradenitis suppurativa (HS) is a chronic, inflammatory follicular skin disease with recurrent skin nodules, sinus tracts, and scarring. We observed a case of HS associated with relapsing polyarthritis. On presentation the patient had a flare of polyarthritis with an increase in the number and size of pustular nodules. He has had similar episodes 1 to 2 times yearly subsiding with antibiotic treatment. Radiographs revealed erosions and demineralization. Symptoms improved following institution of anti-inflammatory and antibiotic therapy. HS is associated with several inflammatory conditions, and dysregulation in innate immunity may play an important role in etiopathogenesis. Spondyloarthritis/sacroiliitis is the most common joint manifestation in HS and mechanism(s) underlying arthropathy is unknown. Treatment of arthritis in HS is anecdotal.

Two-stage operation to treat destructive midfoot tuberculosis: 14 cases experience

IntroductionTuberculosis (TB) in midfoot is often secondary to tuberculosis elsewhere in the body. The experience and literatures to treat midfoot tuberculosis are rare. Up until now, no successful method is reported to treat midfoot tuberculosis. HypothesisStage surgery is an effective method to treat midfoot bone TB. Material and methodsBetween January 2008 to January 2011, 14 patients who were diagnosed midfoot tuberculosis and suffered stage operation were enrolled. All the patients had been diagnosed definitely relying on imaging examination and laboratory tests preoperatively. Two-stage operation was performed to all patients. At the first stage, TB tissue and infective tissue were completely removed and replaced by antibiotic bone cement. Normal foot length and arch would be restored and maintained by K-wires and external fixators. At the second stage, autologous iliac and allogeneic bone graft were used to replace bone cement and by fixed by locking plates. American Orthopaedic Foot and Ankle Society (AOFAS), SF-36 and visual analogue scale (VAS) pain score were recorded at the last follow-up. ResultsThe average bone union time was 3.8 (range 3–6) months. There is no case of local recurrence or skin sinus. Neither implant broken nor screw loosen was present in this study. The AOFAS score was increased from 51.7±6.8 (range 43–61) preoperatively to 82.9±3.9 (range 76–90) postoperatively (P<0.001). The SF-36 score increased from 46.1±6.1 preoperatively to 83.1±5.4 postoperatively (P<0.001). The VAS score decreased from 6.1±1.1 preoperatively to 1.4±0.9 points postoperatively (P<0.001). DiscussionStage operation is an effective treatment to stage III, IV midfoot tuberculosis. Levels of evidenceLevel IV, retrospective.

Osteoradionecrosis and medication-related osteonecrosis of the jaw: similarities and differences

The purpose of this study was to compare medication-related osteonecrosis of the jaw (MRONJ) with osteoradionecrosis (ORN). Group 1 comprised 74 MRONJ patients (93 lesions) and group 2 comprised 59 ORN patients (69 lesions). Patient characteristics, clinical presentation of the lesions, the presence of complications, and the relationship with previous dental extractions were analyzed for both groups. Significant differences were found between the groups with regard to the characteristics of the patient populations, extraction as the precipitating event, the type of initial complaint, the prevalence of pain, and the location of the lesions. In the ORN group, significantly more patients complained of pain (P=0.0108) compared with the MRONJ group. Furthermore, significantly more pathological fractures (P<0.0001) and skin fistulae (P<0.0001) occurred in the ORN group. The treatment was more often conservative in the MRONJ group than in the ORN group (61.3% vs. 36.2%). Despite similarities in terms of imaging, risk factors, prevention, and treatment, MRONJ and ORN are two distinct pathological entities, as highlighted by the differences in patient characteristics, the initial clinical presentation, course of the disease, and outcome.

Early Experience in the Management of Postoperative Lymphatic Leakage Using Lipiodol Lymphangiography and Adjunctive Glue Embolization

PurposeTo evaluate the safety and efficacy of Lipiodol lymphangiography and 3 adjunctive N-butyl cyanoacrylate (NBCA) glue embolization techniques for the management of postoperative lymphatic leakage. Materials and MethodsThis retrospective study included 27 patients with postoperative lymphatic leakage (17 with ascites, 3 with chylothorax, 6 with lymphoceles, and 1 with a skin fistula) who underwent Lipiodol lymphangiography for diagnostic and therapeutic purposes in 3 tertiary referral centers between August 2010 and January 2016. Adjunctive glue embolization was performed as needed by using 3 different techniques: “lymphopseudoaneurysm” embolization, closest upstream lymph node embolization, or direct upstream lymphatic vessel embolization. ResultsSixteen patients were observed to determine the therapeutic effect of lymphangiography, and 8 patients (50%) recovered without further embolization. In 16 patients, including 11 who underwent immediate embolization after lymphangiography and 5 who underwent delayed embolization, a total of 28 embolizations (12 lymphopseudoaneurysms, 14 lymph nodes, and 2 lymphatic vessels) were performed. The technical and clinical success rates of the adjunctive embolizations were 89% (25 of 28) and 94% (15 of 16), respectively. The overall clinical success rate was 85% (23 of 27). The median time from initial lymphangiography to recovery was 5 days. No procedure-related major complications were reported. ConclusionsLipiodol lymphangiography and adjunctive glue embolization techniques appear safe and provide promising efficacy for the management of postoperative lymphatic leakage.

Clinical observation of 125I seed implantation for the treatment of ocular tumor

Objective To observe the feasibiliy, safety and efficacy of 125I seed implantation for the treatment of ocular tumor. Methods Nineteen patients received 125I seed implantation through intra-operative direct vision. In which 3 patients who had tumor spread received secondary 125I seed implantation through CT or MRI guiding. Nineteen patients received the operation successfully according to the preoperative plan. Fourteen cases were implanted 125I seed once, three cases received twice implantation, one case received implantation for three times, and one case received implantation for four times. Results The 19 cases were observed for 2 weeks to 8 years, The average follow-up time was (26.55±5.46) months. Local lesion was controlled without recurrence in 14 cases(73. 68%). New lesions occurance or the primary lesions spreading was found in 5 cases (26. 32%), and they were controlled after secondary 125I seeds implanation. No metastasis occurred. There was no complication associated with the manipulation of implantation surgery, except for 3 cases of mild eyelid swelling and subsutaneous hemorrhage. Conjunctival hyperemia and epithelializeation, tearing, increase of secretion were observed when the 125I seed implanted anterior to the equator, and eyelashes (eyebrow) loss occurred within 1 to 3 months. Those symptoms disappeared 6 months later. One case suffered skin ulceration and fistula because of the implantation site of the seed was close to the skin. In the patients that 125I seed implanted in lacrimal gland area, one case developed dry eye, and it was recovered in 6 months. In the patients that 125I seed implanted in the middle and the posterior part of orbit, fibrosis, sclerosis and skin pigmentation occurred 9 months after surgery. All the complications were recoverable. The anterior part complations were disppear 6 months after the surgery. Conclusion Implantation of 125I seed for the treatment of ocular tumor can utmostly reserve the visual function and the appearance, which has exact effect and safety with less damage and less complication. Key words: Tumors, ocular; 125I seed, implantation; Efficacy; Complication

A Clinicopathologic Series of 685 Thyroglossal Duct Remnant Cysts.

The clinical features of thyroglossal duct remnant cysts (TGDC) have been well described, however the histopathologic aspects of these lesions have not been addressed in a detailed manner. In particular, there has been no large community practice based series evaluating TGDC histologically compared with management outcomes. A retrospective review of all TGDC diagnosed between 2005 and 2015 was performed. Six hundred eighty-five patients were identified (344 males; 341 females). Age at presentation was bimodal (first and fifth decades) and ranged from 0.8 to 87years (mean 31.3years). Males predominate in children (150:111); females in adults (230:194). Patients presented most frequently with a mobile midline neck mass in an infrahyoid location. An associated skin fistula (n=67) was twice as common in pediatric as adult patients. The average cyst size was 2.4cm (range 0.4-9.9cm) by imaging studies and 2.6cm (range 0.2-8.5cm) by pathologic examination; pediatric patients had smaller cysts (mean2.1cm) than adults (mean2.8cm). Histologically, 257 (38%) TGDC were lined by respiratory epitheliumalone, 68 (10%) squamous epithelium alone, 347 (51%) exhibited both respiratory and squamous epithelium, and 13 (1%) had no identifiable epithelial lining. Four hundred eighty-four (71%) TGDC had associated thyroid gland tissue present within the cyst wall (n=282), skeletal muscle (n=71), adipose tissue (n=34), or a combination of these sites (n=97). The hyoid bone was identified in 647 (grossly and/or histologically), and absent in 38. Surgical management consisted of Sistrunk procedure (n=647), cystectomy (n=31), or thyroidectomy/thyroid lobectomy (n=7). Treatment related complications were observed in 6 patients, which included vocal cord damage, seroma, and hematoma. Recurrences developed in 20 (3%) patients, 14 of whom were managed initially by cystectomy. Papillary thyroid carcinoma was identified in 22 (3.2%) TGDC. In summary,TGDC show a bimodal peak in the 1st and 5th decades, commonly presenting as a midline cervical lesion below the hyoid bone, associated with a skin fistula in 10%. Histologically TGDC are most commonly lined by a combination of respiratory and squamous epithelium. Thyroid gland tissue is identified in 71% of cases (0.45cm mean size), although not limited to the cyst wall, but present in the surrounding soft tissues. Rare TGDC may harbor malignancy (3.2%). TGDC are most effectively managed by Sistrunk procedure rather than excision, which carries low rates of complications(1%) and recurrence(3%).

A possible venous connection between the cranial and nasal cavity.

The foramen cecum (FC) is a fine bony canal with the aperture located immediately anterior to the crista galli (CG). The venous structures in the regions of the FC and CG have been inconsistently described and are not well understood. Here we explore these veins using magnetic resonance imaging. We enrolled 101 patients who underwent contrast examinations and exhibited intact skin, skull, dura mater, and intracranial dural sinuses. Imaging data were obtained as thin-sliced, seamless sagittal sections and were transferred to a workstation for analysis. In 84% of the patients, tubular-shaped venous extensions arose from the rostral end of the falx cerebri and were confirmed to lie in the FC. These extensions were supplied by the superior sagittal sinus or the frontal cortical vein, and were classified into four types: rudimental slight projections, short and straight extensions, long and straight channels, and long and tortuous channels. Furthermore, 27.7% of the patients exhibited a distinct venous channel between the venous extension in the FC and the median vestibular submucosa of the nasal cavity. Among these channels, 81.5% were connected to the vein lying in the FC via a short channel that vertically pierced the CG. The FC contains tubular-shaped venous extensions that are supplied by the rostral end of the superior sagittal sinus or the frontal cortical vein. The cranial cavity, FC, and nasal cavity may be connected by a venous channel.

Prospects for the development of hypospadiology

On the basis of follow-up studies on 1584 patients with hypospadias identified key points in the treatment of such patients. Data cited in the article indicate that the currently accepted methods of forming the head of the penis do not match the normal anatomy of the head. The paper analyzes the techniques of straightening the penis and causes the formation of skin and urethral fistulas. To improve the results of treatment of the proposed new operational solutions.

Clinical Characteristics of Odontogenic Cutaneous Fistulas.

BackgroundOdontogenic cutaneous fistula appears as dimpling or a nodule with purulent discharge, usually in the chin or jaw. Affected patients usually seek help from dermatologists or surgeons rather than from dentists. However, clinical symptoms of facial skin fistula without dental problems can lead to misdiagnosis.ObjectiveThe purpose of this study was to investigate the clinical characteristics of patients with odontogenic cutaneous fistulas.MethodsThis retrospective observational study was performed at Chungbuk National University Hospital by analyzing patients who visited from April 1994 to September 2014. Following clinical and radiographic examinations, the paths and origins of sinus fistulas were determined. Investigated factors were gender, age, morphology, location, originating tooth, time to evolution, recurrence, and treatment method.ResultsThirty-three patients (22 males, 11 females; average age 49.2 years) were examined during the investigation period. Thirty-four fistulas were diagnosed as odontogenic cutaneous fistulas. The most common morphology was dimpling (n=14, 41.2%). The various locations observed were related to the originating tooth. The most common site was the mandibular body related to mandibular molars. The referral clinical diagnosis was of odontogenic origin in 6 cases (18.2%). The majority of patients had experienced recurrence after treatment in previous clinics that had failed to diagnose odontogenic cutaneous fistula. Surgical fistulectomy and/or tooth treatment were performed in all cases. All patients were followed-up for 1 year. None showed signs of recurrence.ConclusionExtraoral and dental examinations are required to make a diagnosis of odontogenic cutaneous fistula. Thus, cooperation between dermatologists and dentists is essential.

ヘルニア嚢内で内ヘルニアをきたし結腸皮膚瘻を生じた臍ヘルニアの1例

症例は79歳，女性．現病歴:BMI36と肥満のある患者．排便をしようといきんだところ，右側臍部から便が出たとのことで，近医を受診し入院加療，手術目的に当院紹介となった．臍部に手拳大の膨隆を認め，一部皮膚壊死を起こした部位より便汁の流出が認められた．腹部CT上，臍部にヘルニアを認め，ヘルニア門は35×80mm，ヘルニア内容は小腸，大腸，および大網で，ヘルニア嚢内にfree airを認めた．ヘルニア嵌頓に伴う消化管穿孔の診断にて手術となった．手術は皮膚瘻の創を延長するように正中切開を行った．ヘルニア嚢を皮下より全周性に剥離し，開放すると大網がヘルニア嚢に癒着しており，大網の間隙から横行結腸が脱出し嵌頓，穿孔していた．小腸は虚血の所見なく，臍ヘルニア自体による絞扼は認めなかった．穿孔部位を切除し，end GIAを用いてfunctional end-to-endにて吻合した．汚染創であるためメッシュは用いず，単閉鎖にてヘルニア修復とした．術後経過は良好で20病日目に退院となった．