1/5. Paraduodenal hernia evoking intermittent abdominal pain.PURPOSE: Description of a very rare case of internal abdominal hernia, namely herniation of the proximal jejunum in the Landzert fossa, through a hole in the mesocolon transversum. MATERIAL AND methods: Based on preoperative history, clinical state and radiological findings, the diagnosis of internal hernia was strongly suspected. RESULTS: Suspected diagnosis was confirmed during laparotomy. After reduction of the jejunum and closure of the hernia orifice, the patient recovered promptly. CONCLUSION: The diagnosis of internal herniation should always be considered in every patient who presents with an acute abdomen, signs of (sub)obstruction and non-typical history. The most important diagnostic tool is computer tomography, that is accurate in 77%.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
2/5. Acute free perforation as a presenting sign of regional enteritis. Case report and collective review of the literature.Regional enteritis rarely presents as free peritoneal perforation. A case of such a manifestation is described and the literature is reviewed. Resection of the diseased segment is mandatory, for it is associated with the least postoperative morbidity and mortality. Satisfactory results are achieved with cutaneous double-barrel ileotransverse colostomy and subsequent reanastomosis or closure but primary anastomosis can be accomplished safely with construction of a "T-vent" (cutaneous transverse colostomy with ileotransverse colostomy). Perforation of an area of regional enteritis, although uncommon, should be considered in the differential diagnosis of the acute abdomen with peritonitis- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
3/5. A case presentation and review of neutropenic enterocolitis.Neutropenic enterocolitis (NE) is an unusual complication of neutropenia. Its presentation is dramatic, treatment is controversial, and the outcome may be devastating. The available literature about this entity is mainly case reports and autopsy studies. We have recently performed a celiotomy on a patient who developed sepsis and an acute surgical abdomen three days following chemotherapy and radiotherapy for a metastatic adenocarcinoma with no known primary tumor. At surgery he was found to have a boggy right and recto-sigmoid colon with a grossly normal transverse colon. Intraoperative colonoscopy revealed mucosal ulceration and necrosis extending from the dentate line to the cecum. A total abdominal colectomy, closure of the rectal stump, and an ileostomy was performed. Postoperatively, the patient recovered from the abdominal septic process only to succumb to multiple system organ failure secondary to pulmonary sepsis. Upon review of the literature, we found 65 cases of NE that were suspected or diagnosed in the antemortem state and confirmed at surgery or autopsy. In this review, we intend to analyze these case reports, summarize the salient features of the disease and outline the optimal therapeutic approach.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
4/5. The excluded small-bowel segment. A source of complications after small-bowel bypass.Two cases of obstruction of the bypassed small intestine after jejunoileal shunt for obesity are presented. These cases illustrate the possible failure of radiologic visualization of the obstructed bowel since no gas traverses this bowel, as well as two of the possible causes-internal herniation and volvulus. A third cause, intussusception of the blind loop into the colon, has been reported. Obstruction of the bypassed bowel demands surgical intervention and could lead to perforation and peritonitis if untreated. Its prevention involves the closure of all mesenteric defects at the original operation. Surgeons should be aware of the possibility of these conditions in any patient who has had a small-bowel bypass operation.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |
5/5. Gastric necrosis after fundoplication: a novel approach for esophageal preservation.An 11-year-old boy presented moribund, with massive abdominal distension. A Nissen fundoplication and gastrostomy tube had been established at age 2 years. After attempts to pass a nasogastric tube were unsuccessful, the old gastrostomy site was used to gain percutaneous access to the stomach resulting in release of gastric contents and stabilization of blood pressure and perfusion. During operation, massive gastric distention with gastric necrosis was found. Subtotal gastrectomy was performed with stapled closure of the distal intraabdominal esophagus and prepyloric region. Sump suction was placed in the proximal esophagus and the abdomen was drained widely. A distal esophageal perforation was apparent on postoperative day 19 confirmed by imaging and endoscopy. A nasoesophageal tube was passed into the abdomen, tied to a Jackson-Pratt drain, and the composite tube repositioned in the midesophagus allowing controlled proximal and distal drainage. Six months later, a Hunt-Laurence esophagojejunal pouch was created. At age 13, the child is clinically well, and enjoys 50% of his nutritional needs orally, with the remainder delivered overnight via tube feedings. This case describes gastric necrosis after gas bloat syndrome as a late complication of Nissen fundoplication. A novel approach to the management of distal esophageal perforation allowed preservation of a functional, intact native esophagus.- - - - - - - - - - ranking = 1keywords = closure (Clic here for more details about this article) |