ABSTRACT
Fetus in fetu (FIF) is a rare congenital anomaly in which a malformed fetus is incorporated within the body of its twin. It was first described in the late 18th century and has an incidence of 1:500,000 live births. In most cases, the diagnosis is made in infants or young adults. To date, the oldest patient reported in the literature was 47 years old. We describe the case of a 65-year-old patient with FIF, now the oldest reported in the literature. Our patient meets all the diagnostic criteria for FIF, including the presence of a limb in advanced formation inside the lesion. The treatment was surgical excision. FIF should be considered in the differential diagnosis of abdominal masses, typically recognized in infancy. Symptoms arise from mass effects. Surgical resection should be performed due to the potential for malignant transformation.
Subject(s)
Humans , Male , Aged , Twins, Conjoined , Congenital Abnormalities/diagnostic imaging , Fetus/abnormalities , Retroperitoneal SpaceABSTRACT
ABSTRACT Background: Repair of inguinal hernia concomitant with cholecystectomy was rarely performed until more recently when laparoscopic herniorrhaphy gained more adepts. Although it is generally an attractive option for patients, simultaneous performance of both procedures has been questioned by the potential risk of complications related to mesh, mainly infection. Aim: To evaluate a series of patients who underwent simultaneous laparoscopic inguinal hernia repair and cholecystectomy, with emphasis on the risk of complications related to the mesh, especially infection. Methods: Fifty patients underwent simultaneous inguinal repair and cholecystectomy, both by laparoscopy, of which 46 met the inclusion criteria of this study. Results: In all, hernia repair was the first procedure performed. Forty-five (97,9%) were discharged within 24 h after surgery. Total mean cost of the two procedures performed separately ($2,562.45) was 43% higher than the mean cost of both operations done simultaneously ($1,785.11). Up to 30-day postoperative follow-up, seven (15.2%) presented minor complications. No patient required hospital re-admission, percutaneous drainage, antibiotic therapy or presented any other signs of mesh infection after three months. In long-term follow-up, mean of 47,1 months, 38 patients (82,6%) were revaluated. Three (7,8%) reported complications: hernia recurrence; chronic discomfort; reoperation due a non-reabsorbed seroma, one in each. However, none showed any mesh-related complication. Satisfaction questionnaire revealed that 36 (94,7%) were satisfied with the results of surgery. All of them stated that they would opt for simultaneous surgery again if necessary. Conclusion: Combined laparoscopic inguinal hernia repair and cholecystectomy is a safe procedure, with no increase in mesh infection. In addition, it has important advantage of reducing hospital costs and increase patient' satisfaction.
RESUMO Racional: Reparo da hérnia inguinal concomitante à colecistectomia era raramente realizado até mais recentemente, quando a herniorrafia laparoscópica ganhou mais adeptos. Embora geralmente seja opção atraente para pacientes, a realização simultânea tem sido questionada pelo risco potencial de complicações relacionadas à tela, principalmente infecção. Objetivo: Avaliar uma série de pacientes submetidos a colecistectomia e herniorrafia inguinal laparoscópica simultâneas, com ênfase no risco de complicações relacionadas a tela, em especial infecção. Métodos: Cinquenta pacientes foram submetidos a herniorrafia e colecistectomia simultâneas por videolaparoscopia, dos quais 46 atenderam aos critérios de inclusão. Resultados: Em todos, a herniorrafia foi realizada inicialmente. Quarenta e cinco (97,9%) tiveram alta em 24 h. O custo médio total dos dois procedimentos realizados separadamente ($2.562,45) foi 43% maior do que o custo médio das duas operações feitas simultaneamente ($1.785,11). Após 30 dias de acompanhamento pós-operatório, sete (15,2%) apresentaram complicações menores. Após três meses, nenhum necessitou de readmissão hospitalar, drenagem, antibioticoterapia ou sinal de infecção de tela. No seguimento em longo prazo, média de 47,1 meses, 38 (82,6%) foram reavaliados. Três (7,8%) relataram complicações: recorrência de hérnia; desconforto crônico; reoperação por seroma não reabsorvido. No entanto, nenhum apresentou qualquer complicação relacionada à tela. Questionário de satisfação revelou que 36 (94,7%) ficaram satisfeitos com o resultado da operação. Todos afirmaram que optariam pela ela simultânea novamente se necessário. Conclusão: O reparo da hérnia inguinal concomitante com colecistectomia por laparoscopia é procedimento seguro, sem aumento de infecção da tela. Além disso, tem a vantagem importante de reduzir custos hospitalares e aumentar a satisfação do paciente.