Emergency laparoscopic repair of an incarcerated obturator hernia, a case report.
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ABSTRACT:
SUBMITTER: Yee FZY
PROVIDER: S-EPMC7334541 | biostudies-literature | 2020
REPOSITORIES: biostudies-literature
Publications
Emergency laparoscopic repair of an incarcerated obturator hernia, a case report.
Yee Francis Zheng Yi FZY Chok Aik Yong AY Wong Ting Hway TH
International journal of surgery case reports 20200620
Obturator hernias are rare hernias with high morbidity and mortality if not diagnosed and treated promptly. Various minimally invasive techniques have been reported in literature. Here we describe a novel technique of repairing an obturator hernia complicated by small bowel incarceration and obstruction, via a laparoscopic trans-abdominal approach. ...[more]
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Project description:IntroductionObturator hernias account for less than 0.073% of all hernias and less than 1.6% of all cases of mechanical bowel obstructions.Presentation of caseWe present a case of a 79 year-old elderly female with two recurrent bowel obstructions that have resolved with conservative management. On the third presentation we performed a totally extraperitoneal repair (TEP) with conscious sedation and a L3/4 spinal block. An obturator defect was patched with a self gripping mesh (progrip). The patient was discharged day 2 post operatively.DiscussionLaparoscopic surgery can be safely performed in high risk patients with careful monitoring. Laparoscopic surgery is usually associated with a shorter post-operative length of stay.ConclusionThis case demonstrates the successful but unconventional repair of an obturator hernia in a patient who had a high risk of significant morbidity and mortality with a more conventional anaesthesia and surgery.
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Project description:IntroductionMorgagni Hernia (MH) is a type of congenital diaphragmatic hernia (CDH). CDH is a diaphragmatic discontinuity that permits abdominal viscera to herniate into the chest during development. It does not only occur in early childhood but also has been reported in adults. The most prevalent clinical sign of MH is respiratory disorder of all ages.Case presentationAn elderly woman with a known history of diabetes, ischemic heart disease, hypertension, and constipation presented to us with increased abdominal pain. Besides, her PCR test results were positive for COVID-19. She underwent diagnostic laparoscopy surgery. The incision was closed with an intracorporeal suture, and then dual mesh was fixed to diaphragmatic wall. The postoperative progress was satisfactory two weeks after surgery. Based on a negative PCR test, the patient was discharged from the hospital.DiscussionThe foramina of Morgagni is a defect in the costosternal trigons produced by a lack of anterior pleuroperitoneal membrane muscularization. Although gastrointestinal symptoms and cardiorespiratory discomfort are typically connected with the diagnosis and treatment of MH in youngsters, there are a few middle-aged people who, like our case, develop symptoms suddenly. Albeit a paradigm change in the 21st century deems less invasive laparoscopic surgery to be the treatment of choice, open surgical procedures via a trans-thoracic or trans-abdominal route are still used.ConclusionMH is indeed uncommon in adults, but in patients with an acute onset of intestinal obstruction, the possibility of MH should be in mind. It can be fatal if it is misdiagnosed.
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Project description:We present a rare case of sciatic ureteral herniation with consecutive renal unit obstruction. 72 year old woman presented with gross hematuria associated with unilateral hydronephrosis. During work up IVP and MRI were performed, and the diagnosis of sciatic ureteral hernia was established. Condition was resolved by laparoscopic hernia repair.
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Project description:BackgroundAcquired perineal hernia is a rare complication following extensive pelvic surgery. Radiotherapy is also a predisposing factor. Perineal hernia can cause chronic perineal pain, bowel obstruction, urinary disorders and a cosmetically disfiguring defect. The treatment of perineal hernia is surgical, usually consisting of mesh repair via an abdominal or perineal approach.Case presentationWe present a case report and a surgical video of a 42-year-old woman with history of a squamous cell carcinoma. This patient had 3 recurrences since the diagnosis and a symptomatic perineal hernia. Complete regression of the recurrent malignancy allowed us to treat the perineal hernia. We performed laparoscopic repair with prosthetic mesh in this patient who had undergone multiple surgeries and radiotherapy, while preserving the omental flap that was used to reconstruct the posterior part of the vagina.ConclusionThere is no consensus concerning the preferred surgical approach, perineal or laparoscopic, as no study has demonstrated the superiority of either of these approaches. Laparoscopic repair for an acquired perineal hernia is safe and feasible. However, further studies including randomized trials are required to precisely evaluate the best surgical approach and type of mesh.
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Project description:IntroductionUmbilical hernia usually manifests as a bulging of umbilicus. Invisible incarcerated umbilical hernia has never been reported.Case presentationA 53-years-old obese woman admitted to hospital with abdominal pain and vomitus one day after discharged from other hospital, was managed conservatively as an adhesion small bowel obstruction (ASBO) for seven days. There was history of caesarean section 20 years ago. Abdomen was bloated, there was transverse scar wound in hypogastric region and no signs of external abdominal hernia. Plain abdominal x-ray showed dilated small bowel located in the central part of the abdomen. Abdominal CT scan was done to determine the other cause besides adhesion, it showed incarcerated umbilical hernia and gallbladder stone. Herniorrhaphy and laparoscopic cholecystectomy were performed. During surgery, there was a loop of vital small bowel, trapped in the umbilical defect. Mayo method was performed to close the defect.DiscussionThe other causes of small bowel obstruction should be determined besides adhesion, infectious disease and trauma. Umbilical hernia should be considered in obese women even without bulging in the umbilicus. Abdominal CT scan with oral water-soluble contrast is preferred as diagnostic tool to identify the cause of small bowel obstruction.ConclusionInvisible incarcerated umbilical hernia is possible in obese patients. Routine palpation on potential sites of developing hernia and abdominal CT Scan are necessary to be done in obese patients with small bowel obstruction.
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Project description:IntroductionIncarcerated femoral hernia is a common surgical acute abdominal disease. Laparoscopic surgery is considered a safe and effective method for treating incarcerated femoral hernias, which have different surgical approaches to releasing the contents of the hernia.Presentation of caseWe report the case of a 65-year-old female with a right incarcerated femoral hernia with an irreducible mass in the right femoral region for 2 days diagnosed by physical examination and abdominal ultrasonography. We used a catheter to inject normal saline into the hernia sac during surgery. Injury and rupture of the small intestine were avoided, and the polypropylene mesh was successfully repaired.DiscussionIncarcerated femoral hernias is a common surgical emergency that can lead to intestinal obstruction, strangulation, or infarction. Laparoscopy is advantageous for treating incarcerated femoral hernias. In our case, spatial replacement theory was used to release the incarcerated small intestine. The principle is that changing the internal and external pressures of the hernial sac returns the hernia contents. The non-necrotic small intestine did not lead to intraperitoneal infection, and the standard transabdominal preperitoneal repair was simultaneously performed with a polypropylene mesh.ConclusionLaparoscopic incarcerated femoral hernia repair is a common emergency surgery that is safe and feasible for treating incarcerated femoral hernia using the spatial replacement method, the most beneficial to patients.
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