ABSTRACT
A 51-year-old female underwent recurrent open incisional hernia repair with retrorectus mesh placement. Early in the post-operative course, she developed a hernia reoccurrence secondary to breakdown of the staple line, at the level of the posterior rectus sheath, resulting in a small bowel obstruction. This hernia could not be felt upon physical examination but was detected by imaging. The patient was promptly taken to the operating room for laparoscopic reduction of the incarcerated loop of small intestine, along with laparoscopic repair of the posterior rectus sheath defect. It is critical for surgeons to recognize the possibility of a staple line breakdown at the level of posterior rectus sheath early on in the diagnosis which would prompt urgent surgical intervention in the setting of a bowel obstruction.
ABSTRACT
A 51-year-old female underwent recurrent open incisional hernia repair with retrorectus mesh placement. Early in the post-operative course, she developed a hernia reoccurrence secondary to breakdown of the staple line, at the level of the posterior rectus sheath, resulting in a small bowel obstruction. This hernia could not be felt upon physical examination but was detected by imaging. The patient was promptly taken to the operating room for laparoscopic reduction of the incarcerated loop of small intestine, along with laparoscopic repair of the posterior rectus sheath defect. It is critical for surgeons to recognize the possibility of a staple line breakdown at the level of posterior rectus sheath early on in the diagnosis which would prompt urgent surgical intervention in the setting of a bowel obstruction.
Subject(s)
Acrodermatitis/chemically induced , Aged , Anti-Inflammatory Agents/therapeutic use , Antineoplastic Agents, Alkylating/adverse effects , Dacarbazine/adverse effects , Dexamethasone/therapeutic use , Drug Eruptions/drug therapy , Erythema/chemically induced , Glucocorticoids/therapeutic use , Humans , Male , Paresthesia/chemically inducedABSTRACT
BACKGROUND: Hemorrhagic cystitis (HC) is a dose limiting side effect of cyclophosphamide (CYP). AIM: In this study, we aimed to investigate the role of amifostine in the protection of CYP-induced HC and compare its efficacy with mesna. SETTING AND DESIGN: This animal study was conducted in the Experimental Animals Breeding and Research Center of the Medical Faculty of Uludag University. MATERIALS AND METHODS: Male Wistar rats (150-200 g; 10 rats per group) were randomly assigned to four groups. Group I (control group) received no drugs, group II received CYP (200 mg/kg, i.p.) alone, group III received amifostine (200 mg/kg, i.p.) and CYP, and group IV received CYP and mesna (40 mg/kg, i.p.) immediately and 4 and 8 h after administration of CYP. Bladders of animals were assessed macroscopically and histologically 24 h later. Gross assessment for presence of edema and hemorrhage and histological evaluation of damage to the bladder were scored according to Gray's criteria. STATISTICAL ANALYSIS USED: For macroscopic and microscopic data, we used statistical evaluation by Kruskal-Wallis nonparametric analysis of variance followed by the Mann-Whitney U-test. RESULTS: All the animals in group II had evidence of HC. Significant histological damage and macroscopic changes were present in this group compared to control group (P<0.001). The median scores for bladder damage in group III and IV were significantly lower compared to group II (P<0.001). When the median scores for bladder damage of group I, III, and IV were compared, there was no significant difference among these groups. CONCLUSION: This study demonstrated the efficacy of amifostine in prevention of cyclophosphamide-induced hemorrhagic cystitis.