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Annals of Ibadan Postgraduate Medicine Dec 2023Congenital Hernia of umbilical cord (CHUC) is a rare presentation. The failure of return of intestinal loops following physiological herniation has been postulated as...
BACKGROUND
Congenital Hernia of umbilical cord (CHUC) is a rare presentation. The failure of return of intestinal loops following physiological herniation has been postulated as the embryological basis of this condition. This is usually mistakenly termed as omphalocele minor. We aim to highlight this rare finding, the clinical features, diagnostic dilemma, and management of CHUC.
CASE PRESENTATION
He is a 4-day old male with obstructed CHUC. He had an oedematous umbilical stump, with circumferential normal abdominal wall skin folds in the form of a collar wrapping round the proximal aspect of the protrusion. The umbilical defect measured about 4 cm in diameter. Subsequently, surgical reduction and repair of defect was done, with resolution of symptoms.
CONCLUSION
CHUC though a rare entity and easily missed, accurate diagnosis and management offer good prognosis. Also, recognition will prevent iatrogenic bowel injury from careless clamping of the cord with associated morbidity and mortality. It also helps to prevent mis categorization and prevent unwarranted anxiety with misdiagnosis.
PubMed: 38706623
DOI: No ID Found -
International Journal of Surgery Case... Aug 2023Abdominal wall hernia is a protrusion of abdominal contents through an acquired or congenital weakness or wall defect. A ventral hernia, including an appendix, is a rare...
INTRODUCTION AND IMPORTANCE
Abdominal wall hernia is a protrusion of abdominal contents through an acquired or congenital weakness or wall defect. A ventral hernia, including an appendix, is a rare condition. The appendix in the hernial sac is already known as inguinal and femoral hernia and has been named Amyand hernia and De Garengeot hernia, respectively.
CASE PRESENTATION
We have presented a 74-year-old woman with complaints of point tenderness in the right lower abdomen and para-umbilical and a palpable non-reducible mass over the para-umbilicus with some erythema on the skin, which started two days ago. With the help of imaging, diagnosis of abdominal wall hernia was made, with the appendix as the possible content, as there was evidence of an inflamed appendix lumen incarcerated through the abdominal wall.
CLINICAL DISCUSSION
We have provided a detailed review of recent articles. Our comprehensive discussion includes an exploration of the typical manifestations, the significance of imaging in accurate diagnosis, and the appropriate measures to facilitate optimal surgical preparation. The treatment for ventral hernia typically involves appendectomy and abdominal wall hernia repair, with the specific approach depending on the severity of inflammation.
CONCLUSION
Although abdominal wall hernia containing appendicitis is extremely rare, its clinical manifestations are hernia and acute appendicitis, the most common diseases in general surgery. Imaging may be helpful in diagnosis. According to our study, diagnostic laparoscopy could be used in case of clinical suspicion of abdominal wall hernia containing an appendix, although more studies are needed.
PubMed: 37450995
DOI: 10.1016/j.ijscr.2023.108497 -
Pakistan Journal of Medical Sciences 2024Laparoscopic surgery is generally considered as better than open surgery in terms of less complications, minimal hospital stays and quick healing of the wounds. Our...
BACKGROUND & OBJECTIVE
Laparoscopic surgery is generally considered as better than open surgery in terms of less complications, minimal hospital stays and quick healing of the wounds. Our objective was to compare the immediate and early outcome of the different incarcerated hernias of anterior abdominal wall operated on as emergency cases by open and laparoscopic approach.
METHODS
This is a retrospective comparative study which was conducted at two hospitals of AlAhsa city of the Eastern region of the Kingdom of Saudi Arabia from July, 2017 to June, 2022. The data were retrieved from the medical records of the hospitals. All male and female patients having different types of incarcerated hernias of anterior abdominal wall presenting to the emergency room were included in the study. The patients were divided in two groups; those who were operated on by open approach (Group-I) and those who were operated on by laparoscopic approach (Group-II).
RESULTS
Out of total 70 male and female patients, 42 were in Group-I and 28 in Group-II. The variety of the incarcerated hernias in both groups overall was para-umbilical 26(37.14%), incisional 18(25.71%), inguinal (right & left) 17(24.28%) and epigastric 9(12.86%). The mean operative time taken by Group I and II was 126.07 (±9.728) and 98.57 (±10.079) minutes respectively with a difference of 27.50 minutes (p=0.807). The mean hospital stay of the patients in Group I and II was 1.36(±0.719) and 1.57(±0.997) days respectively (p=0.482). The post-operative complications rate in Group-I was 6(14.28%) and in Group-II, 6(21.43%) (p=0.658). Overall, 12(17.14%) patients developed the complications in both groups. When the number of the complications is compared, it shows that there was no significant difference between the two groups (p=0.583).
CONCLUSION
Laparoscopic approach is not superior to the open approach in the terms of the immediate and early outcome/complications of the incarcerated hernias of the anterior abdominal wall operated as emergency cases in this study.
PubMed: 38827864
DOI: 10.12669/pjms.40.5.8899 -
Cureus Sep 2023Medicinal leech therapy (MLT) is used in various medical disciplines, among which are reconstructive surgery and microsurgery. Medicinal leech therapy is also often...
Medicinal leech therapy (MLT) is used in various medical disciplines, among which are reconstructive surgery and microsurgery. Medicinal leech therapy is also often adopted by alternative and traditional medicine, aiming to treat various common medical symptoms, such as fever and arthritis. Congenital umbilical hernia is a rather common physical finding in the pediatric population, where every third Caucasian newborn, roughly, is being diagnosed with the condition, and even more so among the African population. Fortunately, most cases resolve spontaneously in the first years of life. Toddlers whose hernia does not close typically require umbilical hernia repair. This article describes the case of a five-year-old girl with an asymptomatic congenital umbilical hernia who was admitted to the ER due to an omental eventration that occurred following the placement of a leech on her umbilicus in her parents' attempt to treat a febrile episode. She subsequently underwent an urgent umbilical exploration and a repair of her umbilical hernia. The main known risks of leeching are bacterial infection, anemia, prolonged bleeding, and, less frequently, pruritus, allergies, marked edema, and cellulitis. This article presents yet another possible complication that, to the best of our knowledge, has not been documented before in the literature. Several old-school therapies transcended over time into medical disciplines. Given that "traditional" practices often take place within households and communities, it is of crucial importance to point out potential complications, both rare and common, that can be caused by those practices in order to reduce the risk of severe, undesired outcomes. Indeed, the growing interface between traditional, alternative therapies and modern, conventional medicine urges better parental guidance and improved education regarding potentially harmful and unauthorized interventions.
PubMed: 37809215
DOI: 10.7759/cureus.44831 -
Journal of Perinatal Medicine Jun 2024Infants with anterior abdominal wall defects (AWD) can suffer from pulmonary complications. Our aims were to determine if the chest radiographic thoracic areas (CRTAs)...
OBJECTIVES
Infants with anterior abdominal wall defects (AWD) can suffer from pulmonary complications. Our aims were to determine if the chest radiographic thoracic areas (CRTAs) on day one differed between infants with exomphalos or gastroschisis, whether this related to differing severity of outcomes and if they were lower than those of controls indicating abnormal antenatal lung growth.
METHODS
A review of infants with exomphalos or gastroschisis born between January 2004 and January 2023 was conducted. The control group was term, newborn infants ventilated for poor respiratory drive at birth. Chest radiographs on day one were analysed and the highest CRTA in the first 24 h after birth for each infant included in the analysis.
RESULTS
The 127 infants with gastroschisis had a lower gestational age and birthweight than the 62 exomphalos infants and 130 controls (all p<0.001) The CRTAs of the controls were greater than the CRTAs of the exomphalos and the gastroschisis infants (p = 0.001). The median CRTA corrected for birthweight was lower in the exomphalos infants [688, IQR 568-875 mm/kg] than the gastroschisis infants [813, IQE 695-915 mm/kg] No gastroschisis infant developed bronchopulmonary dysplasia (BPD). A CRTA of 1759 mm had a sensitivity of 81 % and specificity of 71 % in predicting BPD in infants with exomphalos.
CONCLUSIONS
Infants with gastroschisis or exomphalos had lower CRTAs than controls suggesting both groups had abnormal antenatal lung development. The CRTA was lower in the exomphalos infants who also had worse respiratory outcomes, hence CRTA assessment may a useful prognostic aid.
Topics: Humans; Infant, Newborn; Female; Gastroschisis; Male; Retrospective Studies; Radiography, Thoracic; Hernia, Umbilical; Abdominal Wall; Gestational Age; Case-Control Studies
PubMed: 38613796
DOI: 10.1515/jpm-2024-0102 -
Journal of Medical Case Reports Aug 2023Superior mesenteric artery syndrome (SMAS), also known as Wilkie's syndrome, is a rare disease that mainly presents as intestinal obstruction with a variable incidence...
BACKGROUND
Superior mesenteric artery syndrome (SMAS), also known as Wilkie's syndrome, is a rare disease that mainly presents as intestinal obstruction with a variable incidence ranging from 0.013 to 0.3% (Salehzadeh et al. in Case Rep Gastrointest Med, 2019, 10.1155/2019/3458601). In this syndrome, the third part of the duodenum, located between the abdominal aorta and the superior mesenteric artery, is wholly or partially obstructed (Mosalli et al. in J Pediatr Surg 46:e29-31, 2011). Case presentation An 8-years-old Arabian male patient was admitted to the gastrointestinal department at the pediatric hospital in Damascus, Syria, with complaints of chronic abdominal pain and periodic vomiting since he was two years old. At the age of Seven, he was diagnosed with appendicitis, and after two months of persistent symptoms, he was diagnosed with an umbilical hernia. Finally, after a long time of suffering, he was diagnosed with SMAS and underwent a successful surgical operation. After 3 months of follow-up, he was in good health with no symptoms.
CONCLUSION
Whenever a patient complains of vomiting and chronic abdominal pain, intestinal obstruction is suspected, Common differential diagnoses were excluded and the cause is anonymous, we should consider superior mesenteric artery syndrome.
Topics: Child; Male; Humans; Infant; Child, Preschool; Superior Mesenteric Artery Syndrome; Duodenum; Mesenteric Artery, Superior; Intestinal Obstruction; Abdominal Pain
PubMed: 37568225
DOI: 10.1186/s13256-023-04061-2 -
Cureus Apr 2024Omphalocele, a congenital anomaly characterized by the protrusion of abdominal viscera through the umbilical ring, often presents challenges in surgical management,...
Omphalocele, a congenital anomaly characterized by the protrusion of abdominal viscera through the umbilical ring, often presents challenges in surgical management, especially when concurrent with other anomalies such as intestinal atresia. We presented a case of a female infant weighing 2.6 kg born with omphalocele and concurrent ileal atresia. The child was successfully managed through prompt surgical intervention. Preoperative investigations revealed signs suggestive of intestinal obstruction, necessitating immediate surgical exploration. Intraoperatively, meticulous reduction of the omphalocele sac and resection of the atretic segment were performed. Postoperative care in the neonatal intensive care unit ensured optimal recovery. This case underscored the importance of timely intervention and multidisciplinary collaboration in managing complex congenital anomalies in neonates.
PubMed: 38803742
DOI: 10.7759/cureus.59147 -
Cureus Jul 2023Indications for laparoscopic surgeries are increasing in the current era in view of the advantages they offer in terms of less perioperative morbidities, early...
Indications for laparoscopic surgeries are increasing in the current era in view of the advantages they offer in terms of less perioperative morbidities, early mobilization, and better cosmesis. These benefits are perceived even more in obese women. However, there are special challenges in this population, associated with their body habitus, poor visibility, and perioperative anesthesia risks. Difficulty in port closure is one such problem encountered in these women causing inadequate rectus suturing and leading to port site hernia. We report a case of a 59-year-old morbidly obese lady who underwent a total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection for carcinoma endometrium. The intraoperative course was uneventful. In the postoperative period, she developed acute obstruction due to port site herniation of the small bowel, which was not suspected till postoperative day five. This was due to an inaccurate assessment of her abdomen because of her body habitus. A CT scan was done in view of the non-resolving obstruction, which revealed herniation of a small bowel loop through the umbilical port. Immediate correction was resorted to under local anesthesia. Rectus sheath closure was done in the same sitting. The patient had a quick recovery after that and was discharged three days later. Rectus sheath closure should be done for all ports 10 mm or greater in diameter. There should be a low threshold to get cross-sectional imaging in postoperative obese women with non-resolving gastrointestinal symptoms.
PubMed: 37605666
DOI: 10.7759/cureus.42264 -
International Journal of Surgery Case... May 2024OEIS complex is a rare and complex anomaly of the genitourinary and intestinal tract. It includes Omphalocele, Exstrophy of cloaca, Imperforate anus and Spinal defects.
INTRODUCTION AND IMPORTANCE
OEIS complex is a rare and complex anomaly of the genitourinary and intestinal tract. It includes Omphalocele, Exstrophy of cloaca, Imperforate anus and Spinal defects.
PRESENTATION OF CASE
We are reporting a case of OEIS complex.
CLINICAL DISCUSSION
Cloacal exstrophy is considered the most severe ventral abdominal wall defect. Diagnosis is primarily antenatal based on the presenting features on ultrasonography. Management requires initial resuscitation and stabilization followed by either single staged closure or multistage procedures by multi-disciplinary surgical team.
CONCLUSION
The introduction of better diagnostic techniques and the detection of fetal malformations during pregnancy is it's the cornerstone of care.
PubMed: 38643654
DOI: 10.1016/j.ijscr.2024.109640 -
BMC Veterinary Research Jul 2023Male pseudohermaphroditism is a developmental anomaly wherein animals are genetically and gonadally male, but their internal and/or external genitalia resemble those of...
BACKGROUND
Male pseudohermaphroditism is a developmental anomaly wherein animals are genetically and gonadally male, but their internal and/or external genitalia resemble those of females. In cattle, pseudohermaphroditism is often accompanied by multiple severe malformations. To the best of our knowledge, this is the first report of male pseudohermaphroditism in a complex malformed calf born with an acardius amorphous cotwin.
CASE PRESENTATION
This report describes the case of a three-day-old, male anurous Japanese Black calf born with an acardius amorphous cotwin, complete absence of the tail, agenesis of the anus, separate scrota, and umbilical hernia. Transthoracic echocardiography and computed tomography revealed serious malformations in the skeletal system and the circulatory, digestive, urinary, and genital organs. Necropsy revealed rectal atresia, immature testes, epididymis, and penis, but no male accessory gonads. Histological analyses revealed vaginal- and uterine-like tissues adjacent to or fused to the rectum. Fluorescence in situ hybridization detected X and Y chromosomes, and some cells presented two X-probe signals in the same nucleus.
CONCLUSIONS
In contrast to the male genitalia, the female genitalia derived from the Müllerian ducts were difficult to detect by necropsy in the presented case. Many similar cases may be overlooked in clinical practice.
Topics: Male; Animals; Cattle; Female; In Situ Hybridization, Fluorescence; Disorder of Sex Development, 46,XY; Genitalia, Female; Rectum; Vagina; Abnormalities, Multiple; Heart Defects, Congenital; Cattle Diseases
PubMed: 37464343
DOI: 10.1186/s12917-023-03639-8