Traumatic Diaphragmatic Hernia with Delayed Presentation in an Adult

A diaphragmatic hernia in adult can result from delayed presentation of congenital or traumatic diaphragmatic defect. of all congenital diaphragmatic hernia, 5~25% present beyond the neonatal period. Diaphragmatic injury due to blunt or penetrating truncal trauma is relatively common, and can be missed during immediate posttraumatic period. If the diaphragmatic injury is not recognized at the time of the initial trauma, the patient may recover and remain symptom free, or suffer from chronic nonspecific abdominal and/or chest symptoms. After a variable interval acute symptom associated with intestinal obstruction or strangulation can arise because of a herniation of the abdominal organs through the diaphragmatic defect. A delay in diagnosis may occur and be associated with a high morbidity, so a careful history and examination, are essential for the successful management of patients, as is maintaining an awareness of the possibility of the delayed presentation of traumatic diaphragmatic hernia and its complication. We present a 35-years-old male patient with delayed presenting, traumatic diaphragmatic hernia, and discuss a literature a review.

Clinical Analysis of Right Colon Diverticulitis

PURPOSE: There are several ways of treating for right colon diverticulitis, based on its complications or location. The kind of operation emplolyed with cecal diverticulitis is still controversial, due to its similar symptoms to those of acute appendicitis, and is usually diagnosed during an appendectomy. This study is an analysis of 65 patients, which we experienced over the past 10 year, with right colon diverticulitis. METHODS: The hospital records of 65 patients with right colon diverticulitis, between January 1991 and January 2001, from the Catholic University School of Medicine, St. Paul's Hospital department of surgery were retrospectively reviewed. We analyzed the clinical data and outcomes, according to three different types of operation. RESULTS: The male to female ratio of the patients was 1.4:1, with a mean age of 36.8, ranging from 14 to 81 years. The most common manifestation was abdominal pain and tenderness (100%). Of the 65 cases, 53 underwent a diverticulectomy and an appendectomy, 5 a right hemicolectomy or an ileocecetomy and 7 an appendectomy only. The most common location of the diverticulum was cecum (62 cases), and the majority were single diverticulum (62 cases). There were complications in 4 cases (6.1%) following the operation, but their symptoms were mild. The complication rates in the diverticulectomy and appendectomy and appendectomy only groups were 5.6 and 14.2% respectively. However, there were no significant differences in the complication rates among 3 groups. There was no recurrence in the group with a right hemicolectomy or ileocecectomy, or in the group with a diverticulectomy and an appendectomy. The recurrences in the appendectomy only group were significantly higher than the groups, with 3 (42.8%) out of 7 cases (P=0.001). CONCLUSION: We suggest that an operation may be the primary safe treatment of right colon diverticulitis and that a diverticulectomy and an appendectomy may be reasonable operative methods that decrease the recurrence and morbidity of right colon diverticulitis.

Metaplastic Squamous Cell Carcinoma of the Breast

Metaplastic carcinomas of the breast are very rare malignancy and accounts for less than 1% of all mammary tumors. Metaplastic breast cancers are a highly heterogeneous group of neoplasms, where an adenocarcinoma is found to co-exist with an admixture of spindle, squamous and chondroid or bone-forming neoplastic cells. The degree of differentiation of metaplastic cells is also quite variable. Due to the rarity and highly heterogeneous nature of metaplastic breast cancer, there has been controversy regarding the nomenclature and classification of these neoplasms. Also there is little information on the treatment and prognosis of metaplastic breast cancer in the literature. A 75-year old woman presented with a rapidly-growing huge mass in the outer upper quadrant of her left breast of 5 months duration. The mass was a metaplastic squamous breast cancer. We report this case with a review of the literature.

Perforated Cecal Diverticulitis with Right Mesocolic Hernia

Mesocolic hernias are rare congenital anormalies resulting from abnormalities in the intestinal rotation during embryonic development, and comprise approximately 53% of all congenital internal hernias. A right mesocolic hernia is formed by the arrest of further rotation of the prearterial segment of gut in the right side of the abdomen, with continued rotation of the postarterial segment, during the second stage of embryonic intestinal rotation, leading to the entrapment of almost the entire small bowel behind the right colonic mesentery. The condition may be discovered incidentally during at laparotomy, or may be the cause of an acute small bowel obstruction. Cecal diverticulitis is a rare disease, whose symptoms are similar to acute appendicitis. It is difficult to diagnose the two diseases accurately prior to operation. We report on a 48-year old man, who had perforated cecal diverticulitis and an incidental right mesocolic hernia, with a review of the literature.