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Meng M, Teklu Y, Parikh HR, Sathya Prakash G, Silletti J, Singh A. A Complicated Case of Strangulated Inguinal Hernia of the Sigmoid Colon With Secondary Ischemic-Compromise of Scrotal Tissue: A Multi-Disciplinary Surgical Approach. Cureus 2023; 15:e48510. [PMID: 38024026 PMCID: PMC10631566 DOI: 10.7759/cureus.48510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 12/01/2023] Open
Abstract
Inguinal hernia is amongst the most common acute abdominal disease that presents in the Emergency Department (ED). Pathologically, it involves the displacement and herniation of abdominal, pelvic, or groin tissue through weaknesses in the abdominal wall. Many inguinal hernias are simple and asymptomatic, managed conservatively without the need for surgical intervention. However, under rare circumstances, hernias are susceptible to significant complications requiring emergent surgery. This report follows the case of a 61-year-old Hispanic-American male presenting to the ED with signs of a complex strangulated inguinal hernia and consequent infarction of the testis with Fournier's Gangrene. Clinical evaluation elucidated a one-week worsening abdominal pain, non-reducible painful inguinal hernia, nausea, vomiting, constipation, groin discoloration, dysuria, and a history of failed primary hernia repair during childhood. The patient underwent emergent surgery to excise ischemic-necrotic portions of the sigmoid colon, creation of end-colostomy, non-mesh repair of inguinal hernia, and right-sided complete orchiectomy with the removal of adjacent scrotal-Dartos tissues and spermatic cord due to Fournier's Gangrene. This report provides both a report for a potentially preventable consequence in one of the most common surgical presentations and a review of the multi-disciplinary expertise that is required in the surgical management of complex inguinal hernias.
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Affiliation(s)
- Muzi Meng
- School of Medicine, American University of the Carribean, Cupecoy, SXM
- General Surgery, BronxCare Health System, Bronx, USA
| | - Yonas Teklu
- General Surgery, BronxCare Health System, Bronx, USA
| | - Harsh R Parikh
- Department of Surgery, Regions Hospital, St. Paul, USA
- Department of Orthopedic Surgery, University of Minnesota School of Medicine, Minneapolis, USA
- General Surgery/Internal Medicine, BronxCare Health System, Bronx, USA
- School of Medicine, St. George's University, Grenada, GRD
| | | | | | - Ajit Singh
- General Surgery, BronxCare Health System, Bronx, USA
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2
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Das A, Pandurangappa V, Tanwar S, Mohan SK, Naik H. Fishbone-Induced Appendicular Perforation: A Rare Case Report of Amyand's Hernia. Cureus 2023; 15:e37313. [PMID: 37181973 PMCID: PMC10166774 DOI: 10.7759/cureus.37313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/16/2023] Open
Abstract
Amyand's hernia is a rare type of hernia where the appendix is found to be the content of the inguinal hernial sac. It is most often diagnosed intraoperatively wherein the appendix may be found healthy, incarcerated, inflamed, or perforated. Claudius Amyand performed a successful appendectomy on a patient with an appendix noted in the inguinal canal and this condition was hence named after him. The incidence of Amyand's hernia is rare in inguinal hernia patients. There are no defined guidelines for the management of Amyand's hernia but adequate resuscitation followed by immediate appendectomy is widely followed. Here is a case report of a 60-year-old male presenting to the Emergency Department with an irreducible right-side inguinal hernia with features of small bowel obstruction. On exploration, Amyand's hernia was identified with appendicular tip perforation due to an impacted fishbone with pyoperitoneum. Appendectomy was done through midline laparotomy with impacted fishbone removal from the hernial sac with tissue repair of the hernia. There are as such no reported cases of fishbone-induced appendicular perforation in an Amyand's hernia in the available literature. After the exploration, we found the management of the case challenging regarding the closure of the hernia.
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Affiliation(s)
- Anirban Das
- Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Vikas Pandurangappa
- Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Sushant Tanwar
- Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Sajith K Mohan
- Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Harish Naik
- Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
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3
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Tarasov EE, Nishnevich EV, Prudkov MI, Bagin VA, Salemyanov AZ, Korishch YA, Korishch DA, Anferov ID. [Laparoscopic totally extraperitoneal repair of strangulated groin hernia]. Khirurgiia (Mosk) 2022:42-47. [PMID: 35477199 DOI: 10.17116/hirurgia202204142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the possibility of totally extraperitoneal repair combined with diagnostic laparoscopy in the treatment of strangulated groin hernias (Laparoscopy-Assisted Totally Extraperitoneal Plasty, LATEP). MATERIAL AND METHODS We analyzed the results of laparoscopic totally extraperitoneal hernia repair. The trocar placement technique was modified. There were 38 patients with strangulated groin hernia. The sample included 26 patients with strangulated inguinal hernia, 9 ones with strangulated femoral hernia and 3 patients with recurrent strangulated inguinal hernia. RESULTS LATEP was attempted in 38 patients and successful in 37 (97.3%) cases. In 1 (2.6%) patient, correction of small bowel strangulation was failed and conversion to open surgery was required. In 29 patients (76.3%), correction of strangulation was performed after laparoscopy-assisted external manipulations and careful traction from abdominal cavity. In 8 (21%) cases, strangulation spontaneously regressed before laparoscopy. Laparoscopy confirmed viability of strangulated organs in 36 patients. One (2.6%) patient required bowel resection due to small intestine wall necrosis. Later, all patients underwent totally extraperitoneal repair. We were able to prevent the contact of hernia sac fluid with the implant in all cases. At the stage of preperitoneal repair, local damage to peritoneum occurred in 9 patients. Nevertheless, sealing was not required since hernia fluid was previously removed from abdominal cavity. There were no signs of implant infection and hernia recurrence within 6-14 months. CONCLUSION Totally extraperitoneal repair combined with diagnostic laparoscopy is possible for strangulated groin hernias.
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Affiliation(s)
- E E Tarasov
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
| | - E V Nishnevich
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
| | - M I Prudkov
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
| | - V A Bagin
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
| | | | - Ya A Korishch
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
| | - D A Korishch
- Ural State Medical University, Yekaterinburg, Russia
| | - I D Anferov
- Ural State Medical University, Yekaterinburg, Russia.,City Clinical Hospital No. 40, Yekaterinburg, Russia
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Zwols TLR, Akkersdijk WL, Bökkerink WJV, Andeweg CS, Pierie JPEN, Koning GG. Emergency TREPP for Strangulated Inguinal Hernia Repair: A Consecutive Case Series. Surg J (N Y) 2020; 6:e62-e66. [PMID: 32258411 PMCID: PMC7108950 DOI: 10.1055/s-0040-1705171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/03/2020] [Indexed: 10/31/2022] Open
Abstract
Background Patients with strangulated inguinal hernia (SIH) require emergency surgical treatment. International guidelines do not specify the surgical technique of preference. Frequently, an open anterior approach such as the Lichtenstein technique is used. The TransREctus sheath Pre-Peritoneal (TREPP) technique is an alternative, open posterior approach, which has shown promising results in the elective treatment of inguinal hernias. This study aims to evaluate the feasibility and safety of the TREPP technique in the emergency setting of SIHs. Materials and Methods After medical ethical approval was warranted, all consecutive patients, who underwent emergency TREPP (e-TREPP) at a high-volume hernia institute, were retrospectively included from 2006 up to and including 2016. Data retrieved from the electronic patient files were combined with the findings during a long-term outcome physical investigation at an outpatient department visit. e-TREPP was, prior to the start of the study, defined as TREPP performed immediately at the operation room. Results Thirty-three patients underwent e-TREPP for SIH. Ten patients were clinically evaluated, ten patients were deceased, nine patients could not be contacted, and four patients did not or could not consent. Of the ten deceased patients, one patient died perioperatively due to massive aspiration followed by cardiac arrest. Nine patients died due to other causes. Two patients developed a recurrence after (after 13 days and 16 months respectively). Two patients were surgically treated for a wound infection (mesh removal in one). No patient reported chronic postoperative inguinal pain. Conclusion e-TREPP in experienced hands seems feasible and safe (Level of Evidence 4) for the treatment of patients with strangulated inguinal hernia, with percentages of postoperative complications comparable to other techniques.
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Affiliation(s)
- T L R Zwols
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.,Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands
| | - W L Akkersdijk
- Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands
| | - W J V Bökkerink
- Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands.,Department of Surgery, Gelderse Vallei Hospital, The Netherlands
| | - C S Andeweg
- Department of Surgery, St Jansdal Hospital, Harderwijk, The Netherlands
| | - J P E N Pierie
- Department of Surgery, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.,Postgraduate School of Medicine, University Medical Centre Groningen, Groningen, The Netherlands
| | - G G Koning
- Department of Surgery, Ikazia Hospital, Rotterdam, the Netherlands
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Matsuda A, Miyashita M, Matsumoto S, Sakurazawa N, Kawano Y, Kuriyama S, Sekiguchi K, Ando F, Matsutani T, Uchida E. Laparoscopic transabdominal preperitoneal repair for strangulated inguinal hernia. Asian J Endosc Surg 2018; 11:155-159. [PMID: 29052338 DOI: 10.1111/ases.12438] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 08/07/2017] [Accepted: 09/20/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Laparoscopic transabdominal preperitoneal repair (TAPP) is widely accepted in elective inguinal hernioplasty. However, given the scarcity of data, the feasibility and safety of TAPP in strangulated hernia cases have not yet been determined. METHODS We retrospectively evaluated the data from a consecutive series of 33 patients who had undergone surgery for acute strangulated inguinal hernia associated with suspected visceral ischemic damage by either TAPP (TAPP group, n = 11) or conventional open hernioplasty via the anterior approach (anterior group, n = 22). RESULTS The TAPP group had a significant longer surgical duration than the anterior group (147 vs 84 min) and relatively less blood loss. Incision and enlargement of the hernial orifice, which enables easy reduction of the strangulated organ, was performed in the last 7 of 11 cases in the TAPP group. The morbidity was lower in the TAPP group, but the difference was not statistically significant (18% vs 23%). The TAPP group had a significantly shorter postoperative hospital stay than the anterior group (7 vs 10 days). CONCLUSION For surgeons with sufficient knowledge of the anatomy and expertise in reducing the strangulated organ, TAPP for strangulated inguinal hernia is at least comparable to open hernioplasty via the anterior approach in short-term outcomes.
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Affiliation(s)
- Akihisa Matsuda
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Masao Miyashita
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Satoshi Matsumoto
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Nobuyuki Sakurazawa
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Youichi Kawano
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Sho Kuriyama
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Kumiko Sekiguchi
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Fumihiko Ando
- Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan
| | - Takeshi Matsutani
- Department of Digestive Surgery, Nippon Medical School, Tokyo, Japan
| | - Eiji Uchida
- Department of Digestive Surgery, Nippon Medical School, Tokyo, Japan
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Srinivasa Rao RC, Radhakrishna V, Rao N, Rakshit S. Torsion of a Splenule in a Case of Splenogonadal Fusion Mimicking a Strangulated Inguinal Hernia. J Indian Assoc Pediatr Surg 2018; 23:100-102. [PMID: 29681703 PMCID: PMC5898199 DOI: 10.4103/jiaps.jiaps_191_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Splenogonadal fusion (SGF) is a rare anomaly, and to the best of our knowledge, none have mimicked a strangulated inguinal hernia. A 6-year-old boy presented with a painful left inguinal swelling mimicking a strangulated hernia but turned out to be a SGF, which was managed successfully with an inguinal procedure.
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Affiliation(s)
| | | | - Nilima Rao
- Department of Paediatrics, Manipal Hospital, Bengaluru, Karnataka, India
| | - Susmita Rakshit
- Department of Pathology, Manipal Hospital, Bengaluru, Karnataka, India
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Sigua BV, Zemlyanoy VP, Petrov CV, Rutenburg GM, Kozobin AA, Danilov AM. [Strategy of surgical treatment of strangulated inguinal hernias in elderly and senile age.]. Adv Gerontol 2017; 30:901-904. [PMID: 29608836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We analyzed the results of treatment of 80 patients of elderly and senile age with strangulated inguinal hernias, which were divided into two groups. From 2011 to 2014 were treated 58 patients (group 2) - in the treatment of this group used the traditional approach without the use of endovideosurgical technologies. From 2015 to 2016, it treated 22 patients (group 1) in the treatment of this group used individual diagnostic and treatment tactics with the use of diagnostic laparoscopy and laparoscopic hernioplasty. In the course of work were developed indications and contraindications to the use of prosthetic hernioplasty and endovideosurgical methods. The proposed algorithm allowed to reduce the level of complications from 27,6% (16) to 4,5% (1) (p<0,05) and local complications from 24,1% (14) to 4,6% (1) (p<0,05), as well as the fatality rate from 10,3% (6) to 0%.
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Affiliation(s)
- B V Sigua
- I.I.Mechnikov North-Western State Medical University, 47, Piskarevsky pr., St. Petersburg, 195067, Russian Federation;
| | - V P Zemlyanoy
- I.I.Mechnikov North-Western State Medical University, 47, Piskarevsky pr., St. Petersburg, 195067, Russian Federation;
| | - C V Petrov
- I.I.Mechnikov North-Western State Medical University, 47, Piskarevsky pr., St. Petersburg, 195067, Russian Federation;
| | - G M Rutenburg
- I.I.Mechnikov North-Western State Medical University, 47, Piskarevsky pr., St. Petersburg, 195067, Russian Federation;
| | - A A Kozobin
- I.I.Mechnikov North-Western State Medical University, 47, Piskarevsky pr., St. Petersburg, 195067, Russian Federation;
| | - A M Danilov
- I.I.Mechnikov North-Western State Medical University, 47, Piskarevsky pr., St. Petersburg, 195067, Russian Federation;
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Diabaté I, Ouédraogo B, Thiam M. [Acute scrotal swellings at Louga Regional Hospital, Senegal: epidemiologic, etiologic and therapeutic aspects]. Pan Afr Med J 2016; 24:214. [PMID: 27800069 PMCID: PMC5075445 DOI: 10.11604/pamj.2016.24.214.9876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 06/07/2016] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Acute scrotal swellings (ASS) are a common reason for emergency consultation. This study aims to determine the frequency of hospitalization for ASS at the Louga Amadou Sakhir Mbaye Regional Hospital, Senegal, to identify its clinical forms and to evaluate the care management. METHODS This is a retrospective descriptive study involving 114 patients hospitalized for ASS at the Louga Amadou Sakhir Mbaye regional hospital, from May 2010 to August 2013. The variables studied were: the frequency of ASS among scrotal swellings and urological emergencies, age, consultation period, causes, treatment, post-treatment evolution and hospitalization length. RESULTS During the study period, 356 scrotal swellings and 420 urological emergencies were recorded. Thus, 114 cases with ASS accounted for 32.0% of scrotal swellings and 27.1% of urological emergencies. The average age was 42.25 ± 25 years (5 months and 89 years represent the extremes). The median of consultation time was 4 days. The diagnosis at admission was: acute orchiepididymitis (n=66), ASS with abscess formation (n=18), suspicion of torsion of the spermatic cord (n=14), traumatic ASS (10 cases), strangulated inguinoscrotal hernia (06 cases). Treatment was exclusively medical in 66 cases (57.8 %). Surgical exploration, which was indicated in 48 patients, was performed in 45 of them (93.7%), three patients (6.2%) refused it. In total there were 9 cases with orchiectomies and 36 conservative procedures. The average length of stay in hospital was 3 ± 2 days. Eighty-one patients (71.0%) were hospitalized for at least 24 hours. They were divided into two groups: 42 surgical patients and 39 medical patients. No deaths were recorded. CONCLUSION ASS are common in our hospital, people of all ages can be affected. They are dominated by ASS of infectious origin, torsion of the spermatic cord and scrotal trauma. Delayed consultation is often the rule, this may affect functional prognosis of the testicle.
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Affiliation(s)
| | | | - Mbaye Thiam
- Service de Chirurgie, CHR Amadou Sakhir MBaye de Louga, Sénégal
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Menezes RG, Padubidri JR, Raghavendra Babu YP, Naik R, Kanchan T, Senthilkumaran S, Chawla K. Sudden unexpected death due to strangulated inguinal hernia. Med Leg J 2016; 84:101-4. [PMID: 26837567 DOI: 10.1177/0025817216629848] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sudden unwitnessed, unexpected deaths when the bodies are found in public places require a complete and meticulous medicolegal autopsy to ascertain the cause and manner of death to avoid further unnecessary investigations by the legal authorities. Such deaths attributed to gastrointestinal causes at autopsy are relatively uncommon. We report a case of sudden unexpected death due to strangulated inguinal hernia in a 60-year-old man. The body was discovered in a public area near a place of worship. The present case illustrates a potentially preventable sudden unexpected death due to a surgically correctable gastrointestinal condition. In the present case, the individual feared being hospitalised for treatment of his scrotal swelling with potential surgery and the eventual loss of daily income. In our opinion, such apprehensions may have delayed the potentially life-saving hospital surgical intervention in the individual.
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Affiliation(s)
| | | | | | - Ramadas Naik
- Yenepoya Medical College, Yenepoya University, Mangalore, India
| | - Tanuj Kanchan
- Kasturba Medical College (Affiliated with Manipal University), Mangalore, India
| | | | - Khushboo Chawla
- Kasturba Medical College (Affiliated with Manipal University), Mangalore, India
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