DOCSLIB.ORG

Allergic Response Is Due to an Unknown Allergen Strangulated

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Allergic Response Is Due to an Unknown Allergen Strangulated Postgrad Med J: first published as 10.1136/pgmj.29.332.323 on 1 June 1953. Downloaded from June 1953 Clinical Section 323 curring in the above case is difficult to correlate. allergic response is due to an unknown allergen Before the appearance of rash on the face the and the finding of tuberculosis is just a coincident. patient gave a history of sore throat and joint pains, Whatever may have been the cause of the original and as the throat swab and the E.N.T. reports illness, this case clearly emphasizes the point were both negative it is suggested that initially which MacKenna (I95I) makes in his excellent she had subclinical tubercular infection of her review on the pathogenesis and treatment of all tonsils which, when the patient's resistance was forms of lupus erythematosus, that unless the lowered after the pelvic operation, spread to the etiology of the disease is well established no cervical glands and later by the blood stream treatment can be of lasting value and that perhaps causing miliary changes in kidneys, spleen and more than one factor is responsible for this intestinal glands as observed at necropsy. It is dreaded malady. difficult to understand why the lungs escaped this miliary invasion. Lupus erythematosus of the face Summary can be regarded as an allergic response in the A case presenting an unusual combination of collagen tissue of the face and the harmful agent, lupus erythematosus, periarteritis nodosa and as subsequent course showed, may have been a miliary tuberculosis, not hitherto recorded, is tubercular focus. This allergic response at first discussed in the light of our present knowledge of remained localized to face but as the tuberculosis the etiology of lupus erythematosus. spread the allergic response also became more I wish to express my thanks to Dr. J. S. Marr marked, causing more advanced joint changes and for referring this patient to me. later culminating into periarteritis nodosa affecting BIBLIOGRAPHY the small bowel and the clinical DUFF, G. L. (1948), Canad. Med. Ass. J., 58, 317. producing picture ORR, H. (195o). Canad. Med. Ass. J., 62, 432. of acute abdomen. The other possibility is that the MACKENNA, R. M. B. (I95I), The Medical Annual, i6x. by copyright. AUTO-REDUCTION EN MASSE OF AN INGUINAL HERNIA By ROBERT W. BAILIE, M.B., F.R.C.S.(Edin.) Lately Senior Surgical Registrar, Sefton General Hospital, Liverpool Reduction en masse of a strangulated hernia is strangulated hernia reduced en masse has been http://pmj.bmj.com/ now a very rare occurrence, but one gains the briefly summarized by Casten and Bodenheimer impression from the literature that it was more ( 941) as follows:- common during the last century, though Corner I. An inguinal or femoral hernia has been and Howitt, in a report in I908 on investigations present for several years and may have been of the records of St. Thomas's and St. Bartholo- operated on previously. mew's Hospitals, found only five cases in I,6I8 2. This hernia has become incarcerated an incidence of cent. pre- strangulated herniae, 0.3 per viously on several occasions but has always been on September 26, 2021 by guest. Protected As taxis was then very often employed in the re- reduced duction of strangulated herniae (14 per cent. of by manipulation. cases of strangulated hernia admitted to St. 3. The last reduction was accomplished with Thomas's Hospital 'escaped operation by under- more difficulty and was accompanied by pain. going reduction,' Corner and Howitt), a higher 4. The symptoms of intestinal obstruction do incidence of reduction en masse would be expected. not subside as expected or subside for only a brief Berger (1876) gave the incidence of strangula- interval. (This interval, in fact, is not necessarily tion as 2.5 per cent., and hence the incidence of very brief being, apparently, two months in one reduction en masse would be 0.0075 per cent. of of Walsham's cases.) all herniae. In a review of I2,000 cases, Eliason The continuation of symptoms of intestinal (192I) found no such case, but Nason and Mixter obstruction after the apparent reduction of a (I935), on the other hand, found three cases of this strangulated hernia is very suggestive of reduction type in a group of 73 cases of strangulated hernia. en masse and often there is absence of local signs The common course of events in a case of of the disorder though a tumour may be palpable Postgrad Med J: first published as 10.1136/pgmj.29.332.323 on 1 June 1953. Downloaded from 324 POSTGRADUATE MEDICAL JOURNAL June 1953 in the lower abdomen or above the internal in- guinal ring. Case Report The present case is described because it shows an added complication which I cannot find pre- viously reported in the literature. A male patient, aged 56 years, was admitted to Sefton General Hospital on May 9, 1950, and gave ·.b the following history: A left inguinal hernia had been present for about 20 years and was easily reducible, descended into the scrotum and, more recently, had been controlled by a truss. Three days before admission he had developed pains across the lower abdomen and tenderness in the hernial sac. He reduced the hernia easily and the pains disappeared soon afterwards. On the afternoon of the day of admission, pain ;n~. developed suddenly in the left iliac fossa which doubled him up and was followed in about 15 t.J minutes by vomiting. The pain was griping in character and further vomiting occurred. The bowels opened once after the onset of pain and the SS motion was formed. 1§ Examination revealed the patient to be in fair - general condition and not distressed. His tem- perature was 98° F., pulse rate 60 and respira- by copyright. tions 24 per minute. The abdomen was relaxed and non-tender; the left superficial inguinal ring was empty but proximal to it, in the position of Saggital section to show operation findings. The the deep inguinal ring, was a deeply placed, tender herial sac lies in the properitoneal position and swelling. Rectal examination was negative. contains strangulated bowel. The original neck A of hernia of has been invaginated into the more distal part of diagnosis strangulated pro- the sac, the constricting mechanism being now the peritoneal or interparietal type was made. inverted walls of the sac or the neck of the sac Operation was performed under pentothal, which had progressed by a form of intussusception curare and closed circuit and ether I. to lie outside and compress the entering funnel of oxygen (Dr. http://pmj.bmj.com/ Emerson). peritoneum. A left inguinal incision was used and after incis- ing the external oblique aponeurosis, the internal strangulated small bowel which was quite viable oblique muscle was retracted strongly upwards and was returned to the abdomen. The sac was and outwards to expose the sac of the hernia. This then transfixed through the neck, ligatured, ex- was found to be lying extraperitoneally, slightly cised and a Willys Andrew's modification of the above and lateral to the usual position of the deep Bassini repair carried out. inguinal ring. All attempts to find the neck of the The post-operative course was uneventful apart on September 26, 2021 by guest. Protected sac were unsuccessful as the walls of the sac ap- from some chest infection and the patient was peared to become invaginated or infolded in that discharged on the i6th post-operative day. He was region. On opening the sac near its fundus and seen at the out-patient clinic three months later dividing the wall in the general direction of the and there was no sign of recurrence of his hernia. neck, it was found that the proximal part or neck of the herial sac had apparently been invaginated Aetiology and Mechanism or intussuscepted into the more distal part of the In discussing the mechanism of reduction en sac. The constricting mechanism was formed by masse, Pearse (1931) postulates three main types, the inverted walls of the latter or the neck of the viz.: latter, which had progressed by a form of intus- Type i. The conversion of an inguino-pro- susception to lie outside and compress the entering peritoneal hernia into the properitoneal type. funnel of peritoneum. When the constricting Type 2. Change of the sac to the properitoneal mechanism was divided, the sac unfolded easily. position by its separation from its surrounding It was then found to be an indirect sac containing tissues without relief of the obstruction at its neck. Postgrad Med J: first published as 10.1136/pgmj.29.332.323 on 1 June 1953. Downloaded from June 1953 Clinical Section 325 Type 3. Removal of the strangulated bowel that the occurrence of such a secondary complica- from the inguinal to the properitoneal pouch of tion, especially in minor degree, may have been an inguino-properitoneal hernia without dis- missed in other cases as it would not be very locating the inguinal sac. obvious when viewed from the abdominal side and Types i and 3 above depend for their occurrence might be reduced by manipulation of the neck of on the presence of a preformed properitoneal sac, the sac before being recognized. and Halsted considered the important factors in In a limited review of the literature since producing this were: The presence of a badly Pearse's article (I93I), it is interesting to note that fitting truss closing the external ring but not the the mortality rate has fallen from 44.6 per cent. inguinal canal, the repeated and vigorous attempts in his cases to I5.3 per cent.
Load more

Recommended publications
  • Intestinal Obstruction
    Intestinal obstruction Prof. Marek Jackowski Definition • Any condition interferes with normal propulsion and passage of intestinal contents. • Can involve the small bowel, colon or both small and colon as in generalized ileus. Definitions 5% of all acute surgical admissions Patients are often extremely ill requiring prompt assessment, resuscitation and intensive monitoring Obstruction a mechanical blockage arising from a structural abnormality that presents a physical barrier to the progression of gut contents. Ileus a paralytic or functional variety of obstruction Obstruction: Partial or complete Simple or strangulated Epidemiology 1 % of all hospitalization 3-5 % of emergency surgical admissions More frequent in female patients - gynecological and pelvic surgical operations are important etiologies for postop. adhesions Adhesion is the most common cause of intestinal obstruction 80% of bowel obstruction due to small bowel obstruction - the most common causes are: - Adhesion - Hernia - Neoplasm 20% due to colon obstruction - the most common cause: - CR-cancer 60-70%, - diverticular disease and volvulus - 30% Mortality rate range between 3% for simple bowel obstruction to 30% when there is strangulation or perforation Recurrent rate vary according to method of treatment ; - conservative 12% - surgical treatment 8-32% Classification • Cause of obstruction: mechanical or functional. • Duration of obstruction: acute or chronic. • Extent of obstruction: partial or complete • Type of obstruction: simple or complex (closed loop and strangulation). CLASSIFICATION DYNAMIC ADYNAMIC (MECHANICAL) (FUNCTIONAL) Peristalsis is Result from atony of working against a the intestine with loss mechanical of normal peristalsis, obstruction in the absence of a mechanical cause. or it may be present in a non-propulsive form (e.g. mesenteric vascular occlusion or pseudo-obstruction) Etiology Mechanical bowel obstruction: A.
    [Show full text]
  • Diverticular Abscess Presenting As a Strangulated Inguinal Hernia: Case Report and Review of the Literature
    Ulster Med J 2007; 76 (2) 107-108 Presidential Address 107 Case Report Diverticular Abscess Presenting as a Strangulated Inguinal Hernia: Case Report and review of the literature. S Imran H Andrabi, Ashish Pitale*, Ahmed AS El-Hakeem Accepted 22 December 2006 ABSTRACT noted nausea, anorexia and increasing abdominal pain. She had no previous history of any surgery or trauma and was on Potentially life threatening diseases can mimic a groin hernia. warfarin for atrial fibrillation. We present an unusual case of diverticulitis with perforation and a resulting abscess presenting as a strangulated inguinal hernia. The features demonstrated were not due to strangulation of the contents of the hernia but rather pus tracking into the hernia sac from the peritoneal cavity. The patient underwent sigmoid resection and drainage of retroperitoneal and pericolonic abscesses. Radiological and laboratory studies augment in reaching a diagnosis. The differential diagnosis of inguinal swellings is discussed. Key Words: Diverticulitis, diverticular perforation, diverticular abscess, inguinal hernia INTRODUCTION The association of complicated inguinal hernia and diverticulitis is rare1. Diverticulitis can present as left iliac fossa pain, rectal bleeding, fistulas, perforation, bowel obstruction and abscesses. Our patient presented with a diverticular perforation resulting in an abscess tracking into the inguinal canal and clinically masquerading as a Fig 2. CT scan showing inflammatory changes with strangulated inguinal hernia. The management warranted an stranding of the subcutaneous fat in the left groin and a exploratory laparotomy and drainage of pus. large bowel diverticulum CASE REPORT On admission, she had a tachycardia (pulse 102 beats/min) and a temperature of 37.5OC.
    [Show full text]
  • De Garengeot's Hernia
    Turkish Journal of Trauma & Emergency Surgery Ulus Travma Acil Cerrahi Derg 2013;19 (4):380-382 Case Report Olgu Sunumu doi: 10.5505/tjtes.2013.37043 De Garengeot’s hernia: a case of acute appendicitis in a femoral hernia sac De Garengeot fıtığı: Femoral fıtık kesesi içinde bir akut apandisit olgusu Ceren ŞEN TANRIKULU,1 Yusuf TANRIKULU,2 Nezih AKKAPULU3 The presence of an appendix vermiformis in a femoral her- Femoral fıtık kesesi içerisinde apendiksin bulunması de nia sac is called De Garengeot’s hernia. It is a very rare Garengeot fıtığı olarak adlandırılır. Bu klinik durum, clinical condition and requires emergency surgery. How- oldukça nadir görülen ve acil cerrahi girişim gerektiren bir ever, preoperative diagnosis of De Garengeot’s hernia klinik durumdur ve De Garengeot fıtığı tanısının ameliyat is difficult. Herein, we report a 58-year-old female who öncesi konulması oldukça zordur. Bu yazıda sunulan olgu presented with sudden-onset painful swelling in the right sağ kasık bölgesinde aniden başlayan ağrısı olan 58 yaşın- groin region. Diagnosis was established based on com- da kadın hastadır. Tanı, bilgisayarlı tomografi bulguları ile puted tomography findings, and appendectomy with mesh- konuldu ve apendektomiyle birlikte greftsiz fıtık onarımı free hernia repair was performed. The postoperative period uygulandı. Ameliyat sonrası komplikasyon gelişmedi. was uneventful, and the histopathologic examination of the Histopatolojik inceleme gangrenli apandisit ile uyumluy- specimen revealed gangrenous appendicitis. du. Key Words: Appendicitis; De Garengeot’s hernia; femoral hernia; Anahtar Sözcükler: Apandisit; De Garengeot fıtığı; femoral fıtık; hernia. fıtık. The presence of appendix vermiformis in a femoral palpation. Her bowel sounds were normoactive, and hernia sac is quite a rare entity.
    [Show full text]
  • Small Bowel Diseases Requiring Emergency Surgical Intervention
    GÜSBD 2017; 6(2): 83 -89 Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi Derleme GUSBD 2017; 6(2): 83 -89 Gümüşhane University Journal Of Health Sciences Review SMALL BOWEL DISEASES REQUIRING EMERGENCY SURGICAL INTERVENTION ACİL CERRAHİ GİRİŞİM GEREKTİREN İNCE BARSAK HASTALIKLARI Erdal UYSAL1, Hasan BAKIR1, Ahmet GÜRER2, Başar AKSOY1 ABSTRACT ÖZET In our study, it was aimed to determine the main Çalışmamızda cerrahların günlük pratiklerinde, ince indications requiring emergency surgical interventions in barsakta acil cerrahi girişim gerektiren ana endikasyonları small intestines in daily practices of surgeons, and to belirlemek, literatür desteğinde verileri analiz etmek analyze the data in parallel with the literature. 127 patients, amaçlanmıştır. Merkezimizde ince barsak hastalığı who underwent emergency surgical intervention in our nedeniyle acil cerrahi girişim uygulanan 127 hasta center due to small intestinal disease, were involved in this çalışmaya alınmıştır. Hastaların dosya ve bilgisayar kayıtları study. The data were obtained by retrospectively examining retrospektif olarak incelenerek veriler elde edilmiştir. the files and computer records of the patients. Of the Hastaların demografik özellikleri, tanıları, yapılan cerrahi patients, demographical characteristics, diagnoses, girişimler ve mortalite parametreleri kayıt altına alındı. performed emergency surgical interventions, and mortality Elektif opere edilen hastalar ve izole incebarsak hastalığı parameters were recorded. The electively operated patients olmayan hastalar çalışma dışı bırakıldı Rakamsal and those having no insulated small intestinal disease were değişkenler ise ortalama±standart sapma olarak verildi. excluded. The numeric variables are expressed as mean ±standard deviation.The mean age of patients was 50.3±19.2 Hastaların ortalama yaşları 50.3±19.2 idi. Kadın erkek years. The portion of females to males was 0.58.
    [Show full text]
  • 1 Abdominal Wall Hernias the Classical Surgical Definition of A
    Abdominal wall hernias The classical surgical definition of a hernia is the protrusion of an organ or the fascia of an organ through the wall of the cavity that normally contains it. Risk factors for abdominal wall hernias include: obesity ascites increasing age surgical wounds Features palpable lump cough impulse pain obstruction: more common in femoral hernias strangulation: may compromise the bowel blood supply leading to infarction Types of abdominal wall hernias: Inguinal hernia Inguinal hernias account for 75% of abdominal wall hernias. Around 95% of patients are male; men have around a 25% lifetime risk of developing an inguinal hernia. Above and medial to pubic tubercle Strangulation is rare Femoral hernia Below and lateral to the pubic tubercle More common in women, particularly multiparous ones High risk of obstruction and strangulation Surgical repair is required Umbilical hernia Symmetrical bulge under the umbilicus Paraumbilical Asymmetrical bulge - half the sac is covered by skin of the abdomen directly hernia above or below the umbilicus Epigastric Lump in the midline between umbilicus and the xiphisternum hernia Most common in men aged 20-30 years Incisional hernia May occur in up to 10% of abdominal operations Spigelian hernia Also known as lateral ventral hernia Rare and seen in older patients A hernia through the spigelian fascia (the aponeurotic layer between the rectus abdominis muscle medially and the semilunar line laterally) Obturator A hernia which passes through the obturator foramen. More common in females hernia and typical presents with bowel obstruction 1 Richter hernia A rare type of hernia where only the antimesenteric border of the bowel herniates through the fascial defect Abdominal wall hernias in children: Congenital inguinal Indirect hernias resulting from a patent processusvaginalis hernia Occur in around 1% of term babies.
    [Show full text]
  • Clinical Acute Abdominal Pain in Children
    Clinical Acute Abdominal Pain in Children Urgent message: This article will guide you through the differential diagnosis, management and disposition of pediatric patients present- ing with acute abdominal pain. KAYLEENE E. PAGÁN CORREA, MD, FAAP Introduction y tummy hurts.” That is a simple statement that shows a common complaint from children who seek “M 1 care in an urgent care or emergency department. But the diagnosis in such patients can be challenging for a clinician because of the diverse etiologies. Acute abdominal pain is commonly caused by self-limiting con- ditions but also may herald serious medical or surgical emergencies, such as appendicitis. Making a timely diag- nosis is important to reduce the rate of complications but it can be challenging, particularly in infants and young children. Excellent history-taking skills accompanied by a careful, thorough physical exam are key to making the diagnosis or at least making a reasonable conclusion about a patient’s care.2 This article discusses the differential diagnosis for acute abdominal pain in children and offers guidance for initial evaluation and management of pediatric patients presenting with this complaint. © Getty Images Contrary to visceral pain, somatoparietal pain is well Pathophysiology localized, intense (sharp), and associated with one side Abdominal pain localization is confounded by the or the other because the nerves associated are numerous, nature of the pain receptors involved and may be clas- myelinated and transmit to a specific dorsal root ganglia. sified as visceral, somatoparietal, or referred pain. Vis- Somatoparietal pain receptors are principally located in ceral pain is not well localized because the afferent the parietal peritoneum, muscle and skin and usually nerves have fewer endings in the gut, are not myeli- respond to stretching, tearing or inflammation.
    [Show full text]
  • Incarcerated Gallbladder in Inguinal Hernia: a Case Report and Literature
    Tajti Jr. et al. BMC Gastroenterol (2020) 20:425 https://doi.org/10.1186/s12876-020-01569-5 CASE REPORT Open Access Incarcerated gallbladder in inguinal hernia: a case report and literature review János Tajti Jr., József Pieler, Szabolcs Ábrahám, Zsolt Simonka, Attila Paszt and György Lázár* Abstract Background: Treating hernias is one of the oldest challenges in surgery. The gallbladder as content in the case of abdominal hernias has only been reported in a few cases in the current literature. Cholecyst has only been described in the content of an inguinofemoral hernia in one case to date. Case presentation: A 73-year-old female patient was admitted to the Emergency Department due to complaints in the right inguinal area, which had started 1 day earlier. The patient complained of cramp-like abdominal pain and nausea. Physical examination confrmed an apple-sized, irreducible hernia in the right inguinal region. Abdominal ultrasound confrmed an oedematous intestinal loop in a 70-mm-long hernial sac, with no circulation detected. Abdominal X-ray showed no signs of passage disorder. White blood cell count and C-reactive protein level were elevated, and hepatic enzymes were normal in the laboratory fndings. Exploration was performed via an inguinal incision on the right side, an uncertain cystic structure was found in the hernial sac, and several small abnormal masses were palpated there. The abdominal cavity was explored from the middle midline laparotomy. During the exploration, the content of the hernial sac was found to be the fundus of the signifcantly ptotic, large gallbladder. Cholecystectomy and Bassini’s repair of the inguinal hernia were performed safely.
    [Show full text]
  • Digestive Conditions, Miscellaneous Examination (Tuberculous
    Digestive Conditions, Miscellaneous Examination (Tuberculous peritonitis, Inguinal hernia, Ventral hernia, Femoral hernia, Visceroptosis, and Benign and Malignant new growths) Comprehensive Worksheet Name: SSN: Date of Exam: C-number: Place of Exam: A. Review of Medical Records: B. Medical History (Subjective Complaints): 1. State date of onset, and describe circumstances and initial manifestations. 2. Course of condition since onset. 3. Current treatment, response to treatment, and any side effects of treatment. 4. History of related hospitalizations or surgery, dates and location, if known, reason or type of surgery. 5. If there was hernia surgery, report side, type of hernia, type of repair, and results, including current symptoms. 6. If there was injury or wound related to hernia, state date and type of injury or wound and relationship to hernia. 7. History of neoplasm: a. Date of diagnosis, exact diagnosis, location. b. Benign or malignant. c. Types of treatment and dates. d. Last date of treatment. e. State whether treatment has been completed. 8. For tuberculosis of the peritoneum, state date of diagnosis, type(s) and dates of treatment, date on which inactivity was established, and current symptoms. C. Physical Examination (Objective Findings): Address each of the following and fully describe current findings: 1. For hernia, state: a. type and location (including side) b. diameter in cm. c. whether remediable or operable d. whether a truss or belt is indicated, and whether it is well- supported by truss or belt e. whether it is readily reducible f. whether it has been previously repaired, and if so, whether it is well-healed and whether it is recurrent g.
    [Show full text]
  • Pediatric Hernia
    Pediatric Surgery Pediatric Hernia Pediatric Hernias: Definitions, Diagnosis and Treatment Hernia repair is among the most common type of general surgical procedure performed in children each year. The two most common types of congenital hernias in children are umbilical and inguinal hernias. The infor- mation below offers information on symptoms, diagnosis and treatment of these medical conditions. Umbilical Hernia Umbilical hernias are fairly common among newborns and infants younger than 6 months. Caused when the umbilical ring fails to close after birth, umbilical hernias present as an outward bulging in the abdominal area at the umbilicus. Umbilical hernias can vary in width from less than 1 cm to more than 5 cm and may seem to expand when the child cries or strains. Although the exact incidence of umbilical hernias in children is unknown, they are reported slightly more often in African Americans. Symptoms and Diagnosis • Present as a soft swelling at the navel that bulges when the baby or child sits up, cries or strains and usually disappears when the baby or child lies flat. • Usually painless. • Often detected on physical exam, without the need for additional testing. Treatment • Often closes by 1 or 2 years of age. • Surgery needed when hernia has not closed by 2 to 4 years of age. • Emergency surgery required if intestinal blood supply is cut off (strangulation). Inguinal Hernias There are two types of inguinal hernias — direct and indirect. Direct inguinal hernias are very rare in children and are caused by a weakness in the abdominal wall that allows intestines to protrude through.
    [Show full text]
  • Patient Selection Criteria
    M∙ACS MACS Patient Selection Criteria The objective is to screen, on a daily basis, the Acute Care Surgical service “touches” at your hospital to identify patients who meet criteria for further data entry. The specific patient diseases/conditions that we are interested in capturing for emergent general surgery (EGS) are: 1. Acute Appendicitis 2. Acute Gallbladder Disease a. Acute Cholecystitis b. Choledocholithiasis c. Cholangitis d. Gallstone Pancreatitis 3. Small Bowel Obstruction a. Adhesive b. Hernia 4. Emergent Exploratory Laparotomy (Refer to the ex-lap algorithm under the Diseases or Conditions section below for inclusion/exclusion criteria.) The daily census for patients admitted to the Acute Care Surgery Service or seen as a consult will have to be screened. There may be other sources to accomplish this screening such as IT and we are interested in learning about these sources from you. From this census, a list can be compiled of patients with the aforementioned diseases/conditions. The first level of data entry involves capture and entry of the patient into the MACS Qualtrics database. All patients with the identified diseases/conditions will have data entered regardless of whether or not they received an operation during admission/ED visit. The second level of data entry takes place if an existing MACS patient returns to the hospital (ED or admission) or has outcome events identified within the 30-day post-operative time frame if the patient had surgery, or within 30 days from discharge for the non-operative patients. You will see that we are capturing diagnostic, interventional, and therapeutic data that extend beyond what is typically captured for MSQC patients.
    [Show full text]
  • Management of Incidental Amyand Hernia with a Case Report
    CASE REPORT East J Med 24(4): 551-553, 2019 DOI: 10.5505/ejm.2019.82787 Management of Incidental Amyand Hernia With A Case Report Tolga Kalayci*, Ümit Haluk Iliklerden Department of General Surgery,Yuzuncu Yil University Faculty of Medicine,Van,Turkey ABSTRACT The presence of appendix vermiformis in inguinal hernia is known as Amyand hernia. Amyand hernia is a rare condition estimated to account for approximately 1% of all inguinal hernias. In our case we want to show our approach to incidental Amyand hernia. An 80-year-old male patient was received at urology service at Van Yuzuncu Yil University Department of Medicine because of prostatic symptoms. There were comorbid factors like hypertension,chronic obstructive lung disease and geriatric age. On surgery with spinal anesthesia, surgeons invited us to evaluate his left inguinal hernia. We evaluated hernia and saw distal ileal segments, proximal right colonic segments and inflamme appendix at hernia defect. Because of appendix inflammation we performed appendectomy. Hernia was repaired with mesh. We put a drain at surgery area. At postoperative first day, the patient discharged with drain. The fifth day of post-surgery, the drain was pulled out. At the time of 1st and 3rd month check of the patient, there was no problem about surgery. Amyand hernia is one of the rare conditions encountered by the surgeon during hernia surgery. The surgeon must know the Rosanoff and Bassoon Classification of Amyand Hernia to successfully manage Amyand hernia surgery. The surgeon also must know the situation in which case an appendectomy should be performed and in which case the mesh should be used.
    [Show full text]
  • Surgical Management of Primary Crohn's Disease
    Open Access Austin Journal of Gastroenterology Special Article - Crohn’s Disease and Colitis Surgical Management of Primary Crohn’s Disease Makni A*, Magherbi H, El Héni A, Daghfous A, Rebai W, Chebbi F, Fterich F, Ksantini R, Jouini Abstract M, Kacem M and Ben Safta Z Inflammatory bowel disease is a chronic gastrointestinal condition that is Department of General Surgery ‘A’, La Rabta Hospital, characterized by chronic gastrointestinal inflammation. The management of Tunisia Crohn’s disease is complex and requires skill, knowledge and experience with *Corresponding author: Makni Amin, Department current advances in the field. Over the past several years, there have been of General Surgery ‘A’, La Rabta Hospital, Jabbari 1007, a number of achievements and progress made in the care and management Tunis, Tunis El Manar University, Faculty of Medicine of of this disorder. The diagnostic tools have greatly improved. The therapeutic Tunis, 15 Rue Djebel Akhdhar, Tunisia armamentarium has expanded. The genetics of IBD has become more detailed and the role of the gut microbiome has been better defined. The evolution Received: February 14, 2017; Accepted: March 13, of biological agents has revolutionized the way we approach this disease. 2017; Published: March 24, 2017 However, surgery is still required in more than 80% of patients with Crohn’s disease (CD). This article aims to study the epidemiological, anatomical and therapeutic principles of surgical forms of CD. Keywords: Crohn’s disease; Surgery; Recurrence; Stricture; Fistula Introduction we should assess the severity and type of symptoms, failure of medical treatment, the onset of adverse effects and surgical risk/ Surgery is required in more than 80% of patients with Crohn’s benefit.
    [Show full text]