1/40. Pneumomediastinum as a complication of extraperitoneal laparoscopic inguinal hernia repair.A 52-year-old man with left indirect groin hernia was admitted for elective inguinal repair using the totally extraperitoneal (TEP) approach. After an uneventful intubation, TEP repair of the hernia was performed with three midline trocars. Immediately after extubation, the patient noted severe chest pain. There was a decrease in PaO2 saturation, and neck subcutaneous emphysema was detected. There was no emphysema of the abdomen or of the back. A chest film and thoracic computed tomographic (CT) scan confirmed the presence of pneumomediastinum without pneumothorax. The patient was discharged without complications.- - - - - - - - - - ranking = 1keywords = back, chest (Clic here for more details about this article) |
2/40. solitary fibrous tumors arising in abdominal wall hernia sacs.Solitary fibrous tumor (SFT) of the peritoneum is an unusual spindle-cell neoplasm. SFT was originally described in the pleura; however it is now diagnosed in multiple extrathoracic sites. Most believe that the tumor is of mesenchymal origin and should be classified as a variant of fibroma. SFT of the pleura and peritoneum have also been called fibrous mesothelioma, and the cell of origin is felt to be a pluripotential submesothelial mesenchymal cell. Primary tumors arising in hernia sacs are rare, and we report on two patients with hernia SFT. The first is a 67-year-old man who had a diffusely thickened distal left inguinal hernia sac. Within the sac was copious myxoid material mimicking pseudomyxoma peritonei. herniorrhaphy and orchiectomy were performed. The second is a 44-year-old woman with a midepigastric mass attached to a ventral hernia. Wide local excision was performed. Both tumors demonstrated plump spindle cells, one with myxoid background and the other with keloidal collagen. Calretinin immunostaining was positive in both tumors, whereas CD34 was negative. This suggests tumor origin from a submesothial pluripotential cell that maintains potential for mesothelial differentiation. Surgical excision is the treatment of choice with the degree of resectability being a powerful predictor of outcome.- - - - - - - - - - ranking = 0.6858132848145keywords = back (Clic here for more details about this article) |
3/40. Pulmonary hemorrhage in association with negative pressure edema in an intubated patient.Negative pressure pulmonary edema due to upper airway obstruction following extubation is a well-recognized problem. However, frank pulmonary hemorrhage as a manifestation of upper airway obstruction is uncommon. We report a case of significant pulmonary hemorrhage and negative pressure pulmonary edema in an intubated patient. bronchoscopy showed a collection of blood in the right lower lobe of the lungs, suggesting a localized source of bleeding. There have been two previously reported cases of pulmonary hemorrhage after upper airway obstruction. One suggested that the bleeding was due to damage to the pulmonary capillaries, the other that it was due to disruption of the bronchial vessels. We feel that in our case there was some indication that the pulmonary bleeding was a result of bronchial vessel damage. A number of factors might have been involved in its development, including negative pulmonary pressure, recent respiratory tract infection, and positive airways pressure (due to coughing).- - - - - - - - - - ranking = 0.21491414983901keywords = upper (Clic here for more details about this article) |
4/40. Testicular proximity can induce gubernaculum formation after delivery.PURPOSE: This paper presents the hypothesis that after delivery as late as 38 weeks' gestation, a testis placed near the internal ring can induce the formation of a gubernaculum and undergo a belated but otherwise normal descent. methods: Two boys with a gastroschisis were each born with one of their testes prolapsed through the defect. The testis was sutured just lateral to the deep inferior epigastric vessels at the time of the primary closure of the gastroschisis. RESULTS: One boy born at 34 weeks had his left testis prolapsed through a left-sided gastroschisis defect. At 3 months, he was admitted to the hospital with a large left inguinal hernia. The repair was complicated by the presence of a large mass of jellylike tissue extending through the internal ring to the upper scrotum. A second boy was born at 38 weeks' gestation. The testis made its way uneventfully into the right hemiscrotum by 10 months of age. CONCLUSION: These cases suggest that testicular proximity is a critical factor in the formation of the gubernaculum and that the testis can induce the formation of the gubernaculum as late as 38 weeks gestation.- - - - - - - - - - ranking = 0.071638049946338keywords = upper (Clic here for more details about this article) |
5/40. Sliding appendiceal inguinal hernia with a congenital fibrovascular band connecting the appendix vermiformis to the right testis.It is not uncommon to find the appendix vermiformis within a hernia sac; however, sliding appendiceal inguinal hernia is rare. A 9-month-old boy with an incarcerated right scrotal hernia is presented in this case report. Although the hernia was reduced through a conservative approach, appendix vermiformis remained in the hernia sac because of its attachment to the upper pole of the right testis. Exploratory surgery during the inguinal hernia repair revealed a connecting band that extended from the appendix vermiformis into the scrotum and attached to the right testicle. Histologic examination showed that the band was congenital. After reduction of an incarcerated hernia, the persistence of a thickened or a cord-like structure is a warning for the presence of a sliding hernia. We suggest that this uncommon developmental anomaly is likely to cause the processus vaginalis to remain patent, thus facilitating hernia formation.- - - - - - - - - - ranking = 0.071638049946338keywords = upper (Clic here for more details about this article) |
6/40. High Gz induced acute inguinal herniation in an F-16 aircrew member: case report and review.This paper describes previously unreported, acute inguinal herniation during high Gz air combat maneuvers. The flight surgeon aircrew member involved incorrectly analyzed the etiology of the abdominal wall discomfort during and immediately after the mission. Several factors contributed to the delayed diagnosis. Surgical exploration and repair revealed larger than expected defects. An open, anterior "tension-free" repair using polypropylene mesh grafts adequately reinforced the muscular and fascial defects. Return to full flight status occurred 4 wk following surgery. Post-operatively, repeat exposures to both a high Gz flight environment and exertionally induced increased intra-abdominal pressures were well tolerated. Minimal sequelae from the injury and repair resolved within 1 yr of the surgery and did not affect mission capability or lifestyle activities. This article includes a review of hernia repairs and their aeromedical implications, with a discussion of epidemiology, surgical techniques, risk factors, surgical complications and recovery times for return to full activity.- - - - - - - - - - ranking = 26.770277110508keywords = discomfort (Clic here for more details about this article) |
7/40. The efficacy of laparoscopy in detecting and treating associated congenital malformations in children.One of the main advantages of laparoscopy in children is the fact that it enables a magnified view and the possibility to explore the whole abdominal cavity. This case report clearly shows these advantages. We report the case of a 3-yr-old girl, suffering from severe GERD and right inguinal inguinal hernia, who had already been operated at birth for esophageal atresia. We performed a laparoscopic fundoplication according to Nissen and, at the end of procedure, we decided to turn the optic down to control the right inguinal region to confirm the presence of an inguinal hernia. To our great surprise we found a right oblique external hernia as well as a direct inguinal hernia on the same side. Both hernias was treated successfully in laparoscopy. At a 1-year follow-up, the patient presented no reflux and no recurrence of the inguinal hernias. The laparoscopy in this case permitted operation on two different pathologies involving the upper and lower parts of the abdominal cavity using the same ports and without enlarging the incision, as would happen in laparotomy. The main relevance of this case is that laparoscopy allowed the detection of an associated pathology like a direct inguinal hernia that would have been certainly overlooked in open surgery and could have caused a recurrent hernia if operated via open surgery.- - - - - - - - - - ranking = 0.071638049946338keywords = upper (Clic here for more details about this article) |
8/40. Focal testicular infarction from laparoscopic inguinal hernia repair.A 53-year-old Caucasian male underwent laparoscopic total extraperitoneal repair of a right indirect inguinal hernia. Postoperatively, the patient developed right testicular swelling and pain that increased over the course of a week. On examination, the patient was found to have a tender, swollen, high-riding testicle, and testicular torsion was of main concern. Doppler sonography and testicular scan suggested an infarction only to the upper pole of the right testicle. Subsequent exploration of the right testicle revealed a hydrocele and focal ischemia to the upper pole of the right testicle. Intraoperative Doppler study and a urology consultation were obtained with an initial impression of possible intermittent torsion. This report describes a rare complication seen in laparoscopic inguinal hernia repairs.- - - - - - - - - - ranking = 0.14327609989268keywords = upper (Clic here for more details about this article) |
9/40. laparoscopy for hemoperitoneum after traditional inguinal hernia repair.hemoperitoneum after inguinal hernia repair, with the exception of laparoscopic herniorrhaphy, is extremely rare. No other case of hemoperitoneum after traditional open inguinal hernia repair has been reported in the English-language literature. A 39-year-old woman had undergone inguinal hernia repair with the Bassini repair technique. Lower abdominal pain and anemia occurred on postoperative day 1. laparoscopy was performed and revealed hemoperitoneum caused as a complication of inguinal hernia repair. The abdominal cavity was thoroughly washed with saline solution, and the aspirated blood was processed and reinfused. laparoscopy for hemoperitoneum as a complication after inguinal hernia repair was very useful for both diagnosis and treatment.- - - - - - - - - - ranking = 5.6642355065342keywords = abdominal pain (Clic here for more details about this article) |
10/40. Occupational rehabilitation following open mesh surgical repair of an inguinal hernia.BACKGROUND AND PURPOSE: The purpose of this case report is to describe an occupational rehabilitation program for a person whose work-related inguinal hernia was surgically repaired. CASE DESCRIPTION: A 35-year-old baggage service attendant acquired an inguinal hernia while lifting at work. Postoperatively, the patient had discomfort in the groin, weakness of the lower extremities and trunk, limited ability to walk, and a decreased ability to work due to impaired lifting tolerance. OUTCOMES: Following postoperative rehabilitation, the patient was able to return to full-time, full-duty work. DISCUSSION: This case report describes occupational rehabilitation as a method to treat patients with work-related inguinal hernias following surgical repair.- - - - - - - - - - ranking = 26.770277110508keywords = discomfort (Clic here for more details about this article) |
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