Pub Date : 2024-03-27DOI: 10.18203/2349-2902.isj20240760
Ankita Khurana, M. S. Utaal, Anmol Singh Ahluwalia
The pre-operative diagnosis of wandering gallbladder is challenging until complicated by torsion or necrosis. Ultrasonography remains the mainstay radiological investigation for gall bladder pathologies. Computed tomography can be used in complicated cases like gall bladder torsion. Free floating gall bladder may not be appreciated on ultrasonography as in our case report which has been discussed below.
{"title":"Incidental wandering gall bladder: a rare case report","authors":"Ankita Khurana, M. S. Utaal, Anmol Singh Ahluwalia","doi":"10.18203/2349-2902.isj20240760","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240760","url":null,"abstract":"The pre-operative diagnosis of wandering gallbladder is challenging until complicated by torsion or necrosis. Ultrasonography remains the mainstay radiological investigation for gall bladder pathologies. Computed tomography can be used in complicated cases like gall bladder torsion. Free floating gall bladder may not be appreciated on ultrasonography as in our case report which has been discussed below.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"95 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140377540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.18203/2349-2902.isj20240766
Mrugen Thakor, Subhash Chawla, M. S. Utaal, Rijuta De, Sakshi Ramnani, Dakshita Adlakha
Fungi are usually a rare cause of gastric perforation (about 0.65%), with most cases of gastric perforation occurring as complications of peptic ulcer disease (PUD), nonsteroidal anti-inflammatory drugs (NSAIDs) and gastric neoplasms. Here, we report the case of a 60-year-old male who presented to our hospital with severe epigastric pain, multiple episodes of vomiting and no history of PUD, NSAIDs use or gastric neoplasm. Exploratory laparotomy revealed a pre-pyloric gastric perforation which was repaired with modified graham’s patch repair. Histopathological examination of the gastric perforation edge biopsy revealed an intense Candida colonization invading and destroying the gastric wall. Intra-operative fluid sends for culture and sensitivity also revealed growth of candida species. He was subsequently treated with fluconazole antifungal and discharged home after an uneventful postoperative period.
{"title":"A rare case of gastric perforation caused by Candida infection","authors":"Mrugen Thakor, Subhash Chawla, M. S. Utaal, Rijuta De, Sakshi Ramnani, Dakshita Adlakha","doi":"10.18203/2349-2902.isj20240766","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240766","url":null,"abstract":"Fungi are usually a rare cause of gastric perforation (about 0.65%), with most cases of gastric perforation occurring as complications of peptic ulcer disease (PUD), nonsteroidal anti-inflammatory drugs (NSAIDs) and gastric neoplasms. Here, we report the case of a 60-year-old male who presented to our hospital with severe epigastric pain, multiple episodes of vomiting and no history of PUD, NSAIDs use or gastric neoplasm. Exploratory laparotomy revealed a pre-pyloric gastric perforation which was repaired with modified graham’s patch repair. Histopathological examination of the gastric perforation edge biopsy revealed an intense Candida colonization invading and destroying the gastric wall. Intra-operative fluid sends for culture and sensitivity also revealed growth of candida species. He was subsequently treated with fluconazole antifungal and discharged home after an uneventful postoperative period.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"6 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140374333","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.18203/2349-2902.isj20240762
Suryalok Pratap Shah, Shahbaz Ahmad Pandit, A. Pandey, Supreet Kumar, Rahul Gautam, Vivek Tandon, Deepak Govil, Bhrigu Prajapat, Aishwarya Bhalerao
Pancreatic cancers usually metastasize through the lymphoid system to organs such as the lung, liver, bone and spleen. Ovarian metastasis in pancreatic cancers is extremely rare, hence, it is difficult to distinguish between primary and metastatic ovarian tumors, especially in tumors with a primary source from the GIT & Hepatobiliary system. We present the case of a periampullary carcinoma with ovarian metastasis in a middle-aged female who presented with complaints of abdominal pain, constipation, yellowish discoloration of eyes and dark colored urine along with loss of appetite and weight loss for a duration of 6 to 8 weeks. Radiological examination revealed right adnexal lesion and nodular thickening along periampullary region. ERCP guided biopsy of the growth in periampullary region revealed moderately differentiated adenocarcinoma. She underwent pancreatico-duodenectomy with bilateral salpingo-oophorectomy. The histopathological examination revealed invasive carcinoma in both the ovaries, and moderately differentiated adenocarcinoma in periampullary and intra-ampullary region. As per the findings in previous studies, bilateral ovarian tumors of any size, or a unilateral tumor less than 10 cm likely represents metastatic disease rather than primary ovarian tumor. The rarity of co-presentation of pancreatic and adnexal mass makes the diagnosis tough however it is important to differentiate between primary ovarian mucinous cancers and ovarian metastasis from primaries in GIT for further treatment and follow up.
{"title":"An unusual case report of metastatic periampullary carcinoma","authors":"Suryalok Pratap Shah, Shahbaz Ahmad Pandit, A. Pandey, Supreet Kumar, Rahul Gautam, Vivek Tandon, Deepak Govil, Bhrigu Prajapat, Aishwarya Bhalerao","doi":"10.18203/2349-2902.isj20240762","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240762","url":null,"abstract":"Pancreatic cancers usually metastasize through the lymphoid system to organs such as the lung, liver, bone and spleen. Ovarian metastasis in pancreatic cancers is extremely rare, hence, it is difficult to distinguish between primary and metastatic ovarian tumors, especially in tumors with a primary source from the GIT & Hepatobiliary system. We present the case of a periampullary carcinoma with ovarian metastasis in a middle-aged female who presented with complaints of abdominal pain, constipation, yellowish discoloration of eyes and dark colored urine along with loss of appetite and weight loss for a duration of 6 to 8 weeks. Radiological examination revealed right adnexal lesion and nodular thickening along periampullary region. ERCP guided biopsy of the growth in periampullary region revealed moderately differentiated adenocarcinoma. She underwent pancreatico-duodenectomy with bilateral salpingo-oophorectomy. The histopathological examination revealed invasive carcinoma in both the ovaries, and moderately differentiated adenocarcinoma in periampullary and intra-ampullary region. As per the findings in previous studies, bilateral ovarian tumors of any size, or a unilateral tumor less than 10 cm likely represents metastatic disease rather than primary ovarian tumor. The rarity of co-presentation of pancreatic and adnexal mass makes the diagnosis tough however it is important to differentiate between primary ovarian mucinous cancers and ovarian metastasis from primaries in GIT for further treatment and follow up.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"19 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140374402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.18203/2349-2902.isj20240751
Hareesh Kumar R., Alfred Arulraj Solomon, Rajakumar Veeraraghavan
Background: Ventral hernia repair (VHR) is one of the common surgical procedures carried out in general surgery. This study assessed the post operative outcomes in patients with primary ventral hernia undergoing repair using monofilament polyester composite ventral patch Parietex™ Covidien (PCO-VP). Methods: A prospective single proportion observational study of 54 patients undergoing open VHR for primary ventral hernia with the PCO-VP in a community-based hospital was carried out. The patients were followed up for a period of one year from day of surgery. Primary outcome was recurrence, and secondary outcomes were reoperations and complications including seroma, hematomas, abdominal wall abscess, wound infections, and mesh infections. Results: Our sample size of (n=54) included 35 (65%) females and 19 (35%) males with a mean hernia defect diameter of 3.5±0.4 cm. 83% (45) underwent elective surgery (EL) and 17% (9) underwent emergency surgery with a mean operative time of 98.5 minutes, 11% (n=6) patients needed alteration of the technique and 20% (n=11) patients needed mesh repositioning, 12 adverse events were noted during the hospital stay. No mesh infections, early recurrences, readmissions or revision surgeries were noted. Patients had a average Carolina comfort scale score of 4/115 noted at the end of study. Conclusions: The use of PCO-VP to repair primary ventral hernia yielded nearly nil early recurrence rate, low postoperative complications and high satisfaction ratings, PCO-VP repair is a highly effective method for small and moderate size ventral hernias in both elective and emergency setting.
{"title":"Outcome of primary ventral hernia repair with monofilament polyester composite ventral patch in a community-based hospital","authors":"Hareesh Kumar R., Alfred Arulraj Solomon, Rajakumar Veeraraghavan","doi":"10.18203/2349-2902.isj20240751","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240751","url":null,"abstract":"Background: Ventral hernia repair (VHR) is one of the common surgical procedures carried out in general surgery. This study assessed the post operative outcomes in patients with primary ventral hernia undergoing repair using monofilament polyester composite ventral patch Parietex™ Covidien (PCO-VP).\u0000Methods: A prospective single proportion observational study of 54 patients undergoing open VHR for primary ventral hernia with the PCO-VP in a community-based hospital was carried out. The patients were followed up for a period of one year from day of surgery. Primary outcome was recurrence, and secondary outcomes were reoperations and complications including seroma, hematomas, abdominal wall abscess, wound infections, and mesh infections.\u0000Results: Our sample size of (n=54) included 35 (65%) females and 19 (35%) males with a mean hernia defect diameter of 3.5±0.4 cm. 83% (45) underwent elective surgery (EL) and 17% (9) underwent emergency surgery with a mean operative time of 98.5 minutes, 11% (n=6) patients needed alteration of the technique and 20% (n=11) patients needed mesh repositioning, 12 adverse events were noted during the hospital stay. No mesh infections, early recurrences, readmissions or revision surgeries were noted. Patients had a average Carolina comfort scale score of 4/115 noted at the end of study.\u0000Conclusions: The use of PCO-VP to repair primary ventral hernia yielded nearly nil early recurrence rate, low postoperative complications and high satisfaction ratings, PCO-VP repair is a highly effective method for small and moderate size ventral hernias in both elective and emergency setting.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"20 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140374653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.18203/2349-2902.isj20240764
Suraj B. Pawar, K. Bagul, Rishikesh D. Nilapwar, Hitesha Bhandari, Aditya S. Pawar
Esophagectomy is the mainstay treatment for cancer of the esophagus. Over the last two decades robotic assisted minimally invasive oesephagectomy (RAMIE) have become increasingly popular in esophageal surgery. We present a rare complication of an air leak following RAMIE. Our patient underwent a robotic assisted total esophageal mobilization, lymph node dissection transthoracically for a lower oesophageal tumour. He developed persistent air leak and needed oxygen support. Following which thoracoscopic bullectomy was done, lung was successfully re-inflated. To the authors’ knowledge, this rare complication has only handful cases reported in the medical literature; other surgeons should be made aware of this problem.
{"title":"Lessons learnt from uncommon events during robotic assisted minimally invasive oesophagectomy","authors":"Suraj B. Pawar, K. Bagul, Rishikesh D. Nilapwar, Hitesha Bhandari, Aditya S. Pawar","doi":"10.18203/2349-2902.isj20240764","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240764","url":null,"abstract":"Esophagectomy is the mainstay treatment for cancer of the esophagus. Over the last two decades robotic assisted minimally invasive oesephagectomy (RAMIE) have become increasingly popular in esophageal surgery. We present a rare complication of an air leak following RAMIE. Our patient underwent a robotic assisted total esophageal mobilization, lymph node dissection transthoracically for a lower oesophageal tumour. He developed persistent air leak and needed oxygen support. Following which thoracoscopic bullectomy was done, lung was successfully re-inflated. To the authors’ knowledge, this rare complication has only handful cases reported in the medical literature; other surgeons should be made aware of this problem.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"41 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140376922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.18203/2349-2902.isj20240758
Naveenraj R., Bhavin Patel, Hiten Patel, Ajay Tiwari
Spontaneous femoral artery pseudoaneurysm (PSA) is a rare disease and there are few reported cases. We report a case of a 45 year-old male with painless, non-pulsatile swelling in the medial aspect of left lower thigh, which is gradually increasing in size for a period of 2 months. He had no history of trauma or surgery. CT Angiography confirmed a large pseudoaneurysm of the left distal superficial femoral artery (SFA). Then patient had sudden rupture of the pseudoaneurysm and it was treated surgically by ligation of SFA proximal and distal to pseudoaneurysm with excision of large surrounding hematoma.
{"title":"Spontaneous superficial femoral artery pseudoaneurysm: a rare case report","authors":"Naveenraj R., Bhavin Patel, Hiten Patel, Ajay Tiwari","doi":"10.18203/2349-2902.isj20240758","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240758","url":null,"abstract":"Spontaneous femoral artery pseudoaneurysm (PSA) is a rare disease and there are few reported cases. We report a case of a 45 year-old male with painless, non-pulsatile swelling in the medial aspect of left lower thigh, which is gradually increasing in size for a period of 2 months. He had no history of trauma or surgery. CT Angiography confirmed a large pseudoaneurysm of the left distal superficial femoral artery (SFA). Then patient had sudden rupture of the pseudoaneurysm and it was treated surgically by ligation of SFA proximal and distal to pseudoaneurysm with excision of large surrounding hematoma.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"22 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140374782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.18203/2349-2902.isj20240756
Ata M. Ghaith, Ahmad A. Al-Sakarneh, Mohammad I. Al-Sakarnh, Osama M. Ghaith
Internal hernia is an uncommon occurrence contributing to intestinal obstruction, posing diagnostic challenges. Among the infrequent manifestations, one noteworthy type is associated with the sigmoid colon, categorized into three subtypes: inter-sigmoid, trans-mesosigmoid, and intra-mesosigmoid. We present a case of a 48-year-old female who presented with small bowel obstruction as an emergency. CT showed intestinal obstruction with translational point at mid jejunum without any mass identified. At laparotomy we identified an internal hernia in the sigmoid mesocolon with full thickness mesentery defect (transmesosigmoid), bowel was viable and reduced where the defected was closed. Early identification of internal hernia and early management prevent mortality and morbidity; sigmoid related hernia is rear type of internal hernia. Most internal hernia diagnosed during laparotomy searching for case of acute intestinal obstruction.
{"title":"Small bowel obstruction caused by transmesosigmoid internal hernia","authors":"Ata M. Ghaith, Ahmad A. Al-Sakarneh, Mohammad I. Al-Sakarnh, Osama M. Ghaith","doi":"10.18203/2349-2902.isj20240756","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240756","url":null,"abstract":"Internal hernia is an uncommon occurrence contributing to intestinal obstruction, posing diagnostic challenges. Among the infrequent manifestations, one noteworthy type is associated with the sigmoid colon, categorized into three subtypes: inter-sigmoid, trans-mesosigmoid, and intra-mesosigmoid. We present a case of a 48-year-old female who presented with small bowel obstruction as an emergency. CT showed intestinal obstruction with translational point at mid jejunum without any mass identified. At laparotomy we identified an internal hernia in the sigmoid mesocolon with full thickness mesentery defect (transmesosigmoid), bowel was viable and reduced where the defected was closed. Early identification of internal hernia and early management prevent mortality and morbidity; sigmoid related hernia is rear type of internal hernia. Most internal hernia diagnosed during laparotomy searching for case of acute intestinal obstruction.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"82 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140376233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.18203/2349-2902.isj20240765
Sujan N. Agrawal, Manisha Goyal, Sanjay Prasad
Epithelial neoplasm of ovaries is common and almost 40% of them are benign. Cystadenoma of ovary is the commonest epithelial neoplasm. They can be serous or mucinous. They arise from the surface epithelium of ovary, some of them may have germ cell origin. They are multilocular. 80% of ovarian mucinous cyst are benign cystadenoma. They are unilateral in 95% of cases. In this case presentation, it was bilateral and appendix was also showing mucinous cystic degeneration. The mucinous cystadenoma of the appendix is the most common mucinous cyst of the appendix, but the definite diagnosis is made at the time of surgical intervention only. The confirmation is reached by histopathology examination of specimen. This interesting case report is that of a giant bilateral ovarian mucinous cystadenoma of ovary along with the cystic degeneration of appendix. This is a rare case presentation scenario where bilateral giant cyst is found along with same pathology in appendix.
{"title":"Mucinous cystadenoma of both ovaries and appendix: a case report","authors":"Sujan N. Agrawal, Manisha Goyal, Sanjay Prasad","doi":"10.18203/2349-2902.isj20240765","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240765","url":null,"abstract":"Epithelial neoplasm of ovaries is common and almost 40% of them are benign. Cystadenoma of ovary is the commonest epithelial neoplasm. They can be serous or mucinous. They arise from the surface epithelium of ovary, some of them may have germ cell origin. They are multilocular. 80% of ovarian mucinous cyst are benign cystadenoma. They are unilateral in 95% of cases. In this case presentation, it was bilateral and appendix was also showing mucinous cystic degeneration. The mucinous cystadenoma of the appendix is the most common mucinous cyst of the appendix, but the definite diagnosis is made at the time of surgical intervention only. The confirmation is reached by histopathology examination of specimen. This interesting case report is that of a giant bilateral ovarian mucinous cystadenoma of ovary along with the cystic degeneration of appendix. This is a rare case presentation scenario where bilateral giant cyst is found along with same pathology in appendix.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"99 19","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140377343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-27DOI: 10.18203/2349-2902.isj20240759
A. Gajbhiye, L. V. Tamgadge, Sarita Durge, Ayyappa Sai Kumar Kolasani
Diaphragmatic eventration (DE) is a distinctive condition characterised by the abnormal elevation or displacement of a portion of the diaphragm, often leading to a protrusion of abdominal contents into the thoracic cavity. Unlike diaphragmatic hernias, eventrations involve a congenital or acquired weakness of the diaphragmatic muscle itself rather than a structural defect. Congenital eventrations typically arise from the incomplete development or muscular hypoplasia of the diaphragm, while acquired forms may result from trauma, surgery, or neurological disorders affecting the phrenic nerve. Clinical manifestations vary widely, with some individuals remaining asymptomatic, while others may experience respiratory difficulties, especially when lying down. The case involves a 65-year-old female with a history of breathlessness exacerbated in the lying position, improved when upright. Examination revealed low oxygen saturation, absent breath sounds on the left chest, and bowel sounds in that region. Chest X-ray and HRCT indicated bowel loops in the left chest due to eventration of the left hemidiaphragm. Surgical intervention involved thoracotomy, identifying a lax left hemidiaphragm, mobilising abdominal contents, and performing plication with proline 1-0. Closure was completed with an intercostal drainage (ICD) in the left thoracic cavity. Postoperative period was uneventful. This case emphasises the significance of prompt diagnosis and surgical intervention in managing DE, showcasing the effectiveness of thoracotomy, hemidiaphragm plication, and ICD placement.
膈肌偶发症（DE）是一种独特的疾病，其特征是膈肌的一部分异常升高或移位，通常会导致腹腔内容物突出到胸腔。与膈疝不同，膈肌偶发症涉及膈肌本身的先天性或后天性薄弱，而非结构性缺陷。先天性膈肌偶发症通常是由于膈肌发育不全或肌肉发育不良造成的，而后天性膈肌偶发症可能是由于外伤、手术或影响膈神经的神经系统疾病造成的。临床表现差异很大，有些人没有症状，有些人则会出现呼吸困难，尤其是躺下时。本病例涉及一名 65 岁的女性，平卧时呼吸困难加剧，直立时有所改善。检查显示血氧饱和度低，左胸呼吸音消失，该区域有肠鸣音。胸部 X 光片和 HRCT 显示，由于左侧半膈的连通，左胸部出现肠套叠。手术治疗包括开胸手术，确定松弛的左侧半膈，移动腹腔内容物，并用脯氨酸 1-0 进行缝合。在左胸腔内用肋间引流管（ICD）完成闭合。术后一切顺利。本病例强调了及时诊断和手术干预在治疗 DE 方面的重要性，展示了开胸手术、半膈成形术和 ICD 置入术的有效性。
{"title":"Massive diaphragmatic eventration: plication","authors":"A. Gajbhiye, L. V. Tamgadge, Sarita Durge, Ayyappa Sai Kumar Kolasani","doi":"10.18203/2349-2902.isj20240759","DOIUrl":"https://doi.org/10.18203/2349-2902.isj20240759","url":null,"abstract":"Diaphragmatic eventration (DE) is a distinctive condition characterised by the abnormal elevation or displacement of a portion of the diaphragm, often leading to a protrusion of abdominal contents into the thoracic cavity. Unlike diaphragmatic hernias, eventrations involve a congenital or acquired weakness of the diaphragmatic muscle itself rather than a structural defect. Congenital eventrations typically arise from the incomplete development or muscular hypoplasia of the diaphragm, while acquired forms may result from trauma, surgery, or neurological disorders affecting the phrenic nerve. Clinical manifestations vary widely, with some individuals remaining asymptomatic, while others may experience respiratory difficulties, especially when lying down. The case involves a 65-year-old female with a history of breathlessness exacerbated in the lying position, improved when upright. Examination revealed low oxygen saturation, absent breath sounds on the left chest, and bowel sounds in that region. Chest X-ray and HRCT indicated bowel loops in the left chest due to eventration of the left hemidiaphragm. Surgical intervention involved thoracotomy, identifying a lax left hemidiaphragm, mobilising abdominal contents, and performing plication with proline 1-0. Closure was completed with an intercostal drainage (ICD) in the left thoracic cavity. Postoperative period was uneventful. This case emphasises the significance of prompt diagnosis and surgical intervention in managing DE, showcasing the effectiveness of thoracotomy, hemidiaphragm plication, and ICD placement.","PeriodicalId":14372,"journal":{"name":"International Surgery Journal","volume":"53 26","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140376550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-16DOI: 10.18203/2349-2902.isj20240683
Kirra G. Parks, Nicholas E. Williams
Bariatric surgeries are amongst the most commonly performed yet technically demanding laparoscopic procedures in Australia. The use of barbed suture has been widely adopted for use in gastric bypass surgeries to avoid the need for intracorporeal knot tying while maintaining tension and improving surgical efficiency. Whilst barbed suture has been reported as safe with similar outcomes to traditional suture use in bariatric surgery there is a risk that the barbs on the tail of the suture can grasp other tissues and form band adhesions resulting in small bowel obstruction (SBO). We present a series of four cases of barbed suture related SBO post Roux-en-Y gastric bypass (RYGB) surgery. In all four patients the SBO was caused by a band adhesion related to the tail of the non-absorbable (permanent) barbed suture used to close the mesenteric defect adjacent to the jejunojejunostomy. The time to presentation with SBO ranged from 1 day to 20 months post RYGB and all patients underwent diagnostic laparoscopy where the adhesion was divided and the tail of the suture trimmed. To avoid this uncommon complication, we recommend the use of absorbable barbed suture with two extra passes beyond the completion of the suture line and the tail cut almost flush with the tissue. Further data is needed to determine if the recommended modified technique still poses a risk of SBO or if use of absorbable suture to close the mesenteric defect increases the risk of internal hernia.
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