Double traumatic diaphragmatic injury: a case report
Publication date: Available online 19 July 2019Source: International Journal of Surgery Case ReportsAuthor(s): Dario Iadicola, Massimo Branca, Massimo Lupo, Eugenia Maria Grutta, Stefano Mandalà, Gianfranco Cocorullo, Antonino MirabellaAbstractIntroductionTraumatic diaphragmatic injuries are rare complications resulting from a thoracic-abdominal blunt or penetrating trauma. Left-sided diaphragmatic injuries are more commonly reported in literature. Bilateral injuries are extremely rare, occurring in about 3% of the patients and just few cases reported in literature. Traumatic diaphragmatic hernias are definitely a marker of a severe trauma, in fact diaphragmatic injuries are often related to thoracic and abdominal organs injuries. Sometimes the classic clinical signs and symptoms of diaphragmatic injuries may initially not be present so that definitive evaluation is delayed or even missed.Case ReportA 62-years old woman was admitted in Emergency Department after a pedestrian accident. A whole-body CT scan showed multiple fractures (ribs, pelvic and vertebral) but no organ injury. The next CT detected a left-sided posterior diaphragmatic hernia involving transverse colon. Thus we performed an explorative laparoscopy and found a double diaphragmatic injury. A primary repair with non-absorbable sutures and a prosthetic titanized patch was performed.
We present a case of a 60-year-old male patient presented with bilateral inguinal swelling associated with urinary hesitancy and intermittency. He had undergone transabdominal preperitoneal (TAPP) repair for a left inguinal hernia 8 years ago. CT scan confirmed the presence of a bilateral hernia with the bladder herniating bilaterally. He underwent an elective bilateral open Lichtenstein tension-free mesh repair.
Conclusion: Modified placement of composite mesh is safe and helps in minimising mesh-related complications of the Sugarbaker technique for parastomal hernias.
ConclusionsPDH are not usually associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of knowledge and clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair, seeming to be the optimum treatment strategy.
Authors: Ramkumar J, Lu D, Scott T Abstract Abdominal wall hernias are prevalent in patients undergoing peritoneal dialysis (PD). Obturator hernias, first described by Arnaud de Ronsil in 1724, are an uncommon type of hernia where intra-abdominal contents protrude through the obturator foramen. The following case highlights a rare presentation of bilateral obturator hernias with right femoral and inguinal hernia in an 82-year-old woman post-PD. This patient presented with 5 months of bilateral thigh pain and swelling and was found to only have a right-sided obturator hernia on computer tomography (CT) scan. Intraop...
CASE SUMMARY: A 63-year-old woman with history of stage II rectal adenocarcinoma status postneoadjuvant chemoradiation and subsequent abdominoperineal resection presented with worsening bulge and inability to pouch stoma. CT scan revealed a 4-cm parastomal hernia. After discussion with the patient regarding management options, she elected to undergo repair of hernia defect. A robot-assisted laparoscopic parastomal hernia repair with synthetic mesh via the Sugarbaker technique was performed. After a short stay in the hospital, the patient recovered well and reported no recurrent symptoms.
CONCLUSION: This novel approach could be safely performed in ventral hernia patients. Early evaluation of this surgical technique demonstrates quick recovery and minimal complications. PMID: 30307355 [PubMed - as supplied by publisher]
AbstractBackgroundLaparoscopic ventral hernia repair (LVHR) has gained popularity, since it can decrease the incidence of surgical site complications while providing similar recurrence rates as open repairs. The role of defect closure in LVHR has been a subject of controversy and has not been fully elucidated. We aimed to compare outcomes of LVHR with and without defect closure in a contemporary cohort.MethodsSingle-institution retrospective review of consecutive adults undergoes elective LVHR for 2 –8 cm defects. Demographics, perioperative, and post-operative data were included for analysis. Surgical site even...
ConclusionDespite being a rare entity, handlebar hernias should be suspected when significant blunt force is applied to the abdominal wall from a handle bar injury. They may not be obvious on physical examination and therefore further imaging is often important. Management involves prompt surgical repair to prevent complications.
AbstractASBO is a common cause of emergency surgery and the use of laparoscopy for the treatment of these patients is still under debate and conflicting results have been published, in particular regarding the high risk of iatrogenic bowel injury. In fact, although over the last few years there has been an increasing enthusiasm in the surgical community about the advantages and potential better outcomes of laparoscopic management of adhesive small bowel obstruction (ASBO), recently published studies have introduced a significant word of caution. From 2011 in our centre, we have started to systematically approach ASBO in ca...
ConclusionsA PPS is a relatively common complication after LVHR with an ePTFE mesh of usually larger hernias. A “wait-and-see” approach seems justified in most cases. Some require laparoscopic excision of the thick neoperitoneum. A PPS can cause tack and mesh detachment but the clinical consequences are unclear. Recurrences have not been observed in this series.