Strangulated Bochdalek Hernia in Adults: Timely Recognition and Surgical Intervention Can Prevent a Lethal Outcome

Bochdalek hernias are rare diaphragmatic hernias most commonly seen in pediatric populations. Adults with this condition may be asymptomatic or present with gastrointestinal symptoms such as abdominal pain, pressure, choking, or dysphagia. Computed tomography imaging is a gold standard in diagnosing the condition. The definitive treatment is surgery, recommended and encouraged for asymptomatic patients as well to reduce the risk of future complications. Whilst the approach to surgical management differs on a case-by-case basis, the main goal is to reduce the herniating organ and repair the defect. It is important to note that in severe cases, intestinal obstruction and strangulation may occur. We present a unique case of this very phenomenon in a patient diagnosed and treated as a case of strangulated Bochdalek hernia. We aim to highlight the importance of diagnosing this condition as clinical symptoms may be non-specific, and rapid surgical intervention is necessary.

Strangulated diverticulum: a new acute complication of small bowel diverticulosis

Complicated jejunal diverticulosis is a difficult entity to diagnose, which can cause significant morbidity and mortality. We present the case of an 88-year-old female who presented with a unique complication of small bowel diverticulosis progressing to a strangulated diverticulum requiring emergency surgery. We present the case of an 88-year-old female who presented with abdominal pain associated with a new mass on a background of perforated diverticulitis and previous laparoscopic abdominal surgeries for division of adhesions. Due to high suspicion for the mass containing necrotic bowel, the patient was taken directly to theatre for an exploratory laparotomy and was found to have ischaemic small bowel secondary to a strangulated jejunal diverticulum. When evaluating the acute abdomen consideration should be given to the diagnosis of a strangulated jejunal diverticulum causing ischaemic small bowel, with a view to expedite to emergency surgery as the primary treatment.

A Rare Case of a Non-strangulated Bladder Pantaloon Hernia

A pantaloon hernia occurs when an indirect and direct hernia develop at the same time. The urinary bladder is a rare component of pantaloon hernias. There is a lack of literature regarding an ipsilateral pantaloon with a herniated urinary bladder. Clinically, it has a vague presentation associated with abdominal pain and urinary retention symptoms. The best diagnostic modality is an abdominal CT scan. Surgery is the treatment of choice, rendering a good prognosis. Untreated bladder hernia may lead to strangulation and necrosis of the urinary bladder. We present a rare case of a right-sided pantaloon hernia with a bladder herniation in a 65-year-old man.

Open Emergent Groin Hernia Repair: Anterior or Posterior Approach?

Introduction: The current literature has not yet provided a definitive conclusion on the best emergency groin hernia repair. The aim of this study was first to compare the short and long-term outcomes between open preperitoneal and anterior approach in emergency groin hernia repair and second to identify risk factors for postoperative complications, mortality, and recurrence. Materials and Methods: This retrospective cohort study included patients who underwent emergency groin hernia repair between January 2010 and December 2018. Short and long-term outcomes were analyzed comparing approach and repair techniques. The predictors of complications and mortality were investigated using multivariate logistic regression. Cox regression multivariate analysis were used to explore risk factors of recurrence. Results: A total of 316 patients met the inclusion criteria. The most widely used surgical techniques were open preperitoneal mesh repair (34%) and mesh plug (34%), followed by Lichtenstein (19%), plug and patch (7%) and tissue repair (6%). Open preperitoneal mesh repair was associated with lower rates of recurrence (p = 0.02) and associated laparotomies (p < 0.001). Complication and 90-day mortality rate was similar between the techniques. Multivariable analysis identified patients aged 75 years or older (OR, 2.08; 95% CI, 1.14-3.80; p = 0.016) and preoperative bowel obstruction (OR, 2.11; 95% CI, 1.20-3.70; p = 0.010) as risk factors for complications and Comprehensive Complication Index ≥26.2 as risk factor for 90-day mortality (OR, 44.76; 95% CI, 4.51-444.59; p = 0.01). Female gender was the only risk factor for recurrence. Conclusion: Open preperitoneal mesh repair may be superior to other techniques in the emergency setting, because it can avoid the morbidity of associated laparotomies, with a lower long-term recurrence rate.

Strangulated Epigastric Hernia: A Rare Occurrence

An epigastric hernia is a rare type of abdominal hernia, described in the literature mostly as small, containing only preperitoneal fat. A large true epigastric hernia with herniation of the abdominal viscera is even rarer. Only a few case reports have given an account of strangulation in such an epigastric hernia. This case report describes a middle-aged, morbidly obese man with a big epigastric hernia presenting with incarceration and acute abdominal pain. Emergency surgical exploration revealed a 7 cm midline defect in the rectus sheath and a 30 cm segment of the jejunum and a 6 cm segment of the transverse colon were gangrenous. The gangrenous bowel segments were resected, and an end-to-end jejuno-jejunal and colo-colic anastomosis were done. The patient had an uneventful postoperative recovery.

Small Bowel Perforation as a Consequence of Strangulated Direct Inguinal Hernia

Inguinal hernia is probably one of the most common surgical conditions, with strangulation accounting for a good number of acute surgical admissions. It has always been known that direct hernias are less likely to strangulate due to wide hernial defects in comparison to indirect hernia. For that reason, some surgeons do not attempt repair of direct hernias in elderly patients. We present a relatively uncommon case of a 58-year-old gentleman who presented with clinical signs of an incarcerated inguinal hernia; which was found at exploration to be a strangulated direct hernia with small bowel perforation. We believe that direct inguinal hernia should always be included in the differential diagnosis of incarcerated or strangulated groin hernia.

The acute management of haemorrhoids

INTRODUCTION

Although the acute thrombosis and strangulation of haemorrhoids is a common condition, there is no consensus as to its most effective treatment.

METHODS

A PubMed search was undertaken for papers describing the aetiology and treatment of the acute complications of haemorrhoids.

RESULTS

The anatomy and treatments for strangulated internal haemorrhoids and thrombosed perianal varices are discussed. Studies of the effectiveness and complications of conservative and operative treatments are reviewed.

CONCLUSIONS

Ambiguities exist in the terminology used to describe the two separate pathologies that make up the acute complications of haemorrhoids. These complications have traditionally been treated conservatively. There is evidence that early operative intervention for strangulated internal haemorrhoids is safe and effective. A suggested algorithm for treatment is given, based on the published literature.