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Inguinal incarcerated hernia in adults is a common acute abdomen in hernia and abdominal wall surgery. If not treated in time, it is easy to progress to constrictive hernia, lead to intestinal ischemic necrosis, cellulitis of tegmental tissue outside the hernia, hernia sac empyema, intestinal fistula, and even cause toxic shock, with significantly increased mortality. The types of incarceration are different and the corresponding management methods are different. Based on the proposal of the concept of musculopubic foramen hernia repair, inguinal incarcerated hernia includes incarcerated indirect hernia, incarcerated direct hernia, incarcerated femoral hernia, etc. At present, there is no uniform standard for the comprehensive treatment of different types of inguinal incarcerated hernia, and the clinical management strategies of adult inguinal incarcerated hernia still face serious challenges.
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El paciente con multimorbilidad crónica forma parte de una población que se ha incrementado en los últimos años. La hernia inguinal incarcerada representa una emergencia. El abordaje transabdominal preperitoneal (TAPP) presenta ventajas para evaluar el contenido de la hernia. Se presenta el caso de un hombre de 77 años con múltiples comorbilidades y cirugías abdominales previas, que se presentó con cuadro de oclusión intestinal. En tomografía computada: asa de intestino delgado incarcerada en región inguinal. Se observó asas intestinales dilatadas con cambio de calibre en región inguinal izquierda. Se retiró asa intestinal atascada en hernia directa. Se disecó defecto herniario y se colocó malla de 10 x 15 cm en espacio preperitoneal. La técnica TAPP es eficaz y segura para la reparación de hernias complicadas en pacientes con multimorbilidad crónica, en manos de cirujanos experimentados.
The patient with chronic multimorbidity is part of a population that has increased in recent years. Incarcerated inguinal hernia represents an emer-gency. The preperitoneal transabdominal approach (TAPP) has advantages to evaluate the content of the hernia. A 77-years-old man with multiple comorbidities and previous abdominal surgeries presented with intestinal occlusion. Computed tomography: small bowel loop incarcerated in the inguinal region. The cavity is inspected by observing dilated intestinal loops with a change of caliber in the left inguinal region. The intestinal loop is removed observing a direct hernia. The hernia defect is repaired, and 10 x 15 cm mesh is placed in the preperitoneal space. The TAPP te-chnique is effective and safe for the repair of complicated hernias in patients with chronic multimorbidity, in the hands of experienced surgeons.
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Humans , Male , Aged , Laparoscopy , Multimorbidity , Hernia, Inguinal , Case Reports , Chronic DiseaseABSTRACT
Objective@#To investigate the risk factors of postoperative complications after laparoscopic transabdominal preperitoneal hernia repair.@*Methods@#The clinical data of 481 cases of laparoscopic preperitoneal hernia repair in the Central People's Hospital of Tengzhou from March 2014 to February 2018 were retrospectively analyzed.The patients were divided into complications group and control group according to whether complications occurred.The clinical data of the two groups were compared and the risk factors of complications were summarized.@*Results@#Postoperative complications occurred in 78 cases of 481 patients(16.22%). The proportions of age, operation time, diameter of hernia sac, intraoperative bleeding volume, incarcerated hernia and recurrent hernia in the complications group were 65.3%, 32.0%, 29.5%, 85.9%, 20.5% and 5.1%, respectively, which in the control group were 46.6%, 2.4%, 53.8%, 30.7%, 3.4% and 1.4%, respectively, the differences were statistically significant(χ2=9.175, 17.354, 84.692, 82.959, 32.444, 4.252, all P<0.05). The results showed that age>60 years, operation time>100 minutes, intraoperative bleeding>15 mL, hernia sac diameter>4 cm, incarcerated hernia were the risk factors of postoperative complications after laparoscopic transabdominal preperitoneal hernia repair.@*Conclusion@#Age>60 years old, operation time>100 minutes, intraoperative bleeding>15 mL, hernia sac diameter>4 cm, incarcerated hernia are the independent risk factors of postoperative complications after laparoscopic transperitoneal hernia repair.The patients combined with characteristics above should be given early intervention.
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Objective To investigate the risk factors of postoperative complications after laparoscopic transabdominal preperitoneal hernia repair.Methods The clinical data of 481 cases of laparoscopic preperitoneal hernia repair in the Central People's Hospital of Tengzhou from March 2014 to February 2018 were retrospectively analyzed.The patients were divided into complications group and control group according to whether complications occurred.The clinical data of the two groups were compared and the risk factors of complications were summarized.Results Postoperative complications occurred in 78 cases of 481 patients(16.22％).The proportions of age,operation time,diameter of hernia sac,intraoperative bleeding volume,incarcerated hernia and recurrent hernia in the complications group were 65.3％,32.0％,29.5％,85.9％,20.5％ and 5.1％,respectively,which in the control group were 46.6％,2.4％,53.8％,30.7％,3.4％ and 1.4％,respectively,the differences were statistically significant(x2 =9.175,17.354,84.692,82.959,32.444,4.252,all P ＜ 0.05).The results showed that age ＞ 60 years,operation time ＞ 100 minutes,intraoperative bleeding ＞ 15 mL,hernia sac diameter ＞ 4 cm,incarcerated hernia were the risk factors of postoperative complications after laparoscopic transabdominal preperitoneal hernia repair.Conclusion Age ＞ 60 years old,operation time ＞ 100 minutes,intraoperative bleeding ＞ 15 mL,hernia sac diameter ＞ 4 cm,incarcerated hernia are the independent risk factors of postoperative complications after laparoscopic transperitoneal hernia repair.The patients combined with characteristics above should be given early intervention.
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Objective To investigate the characteristics of Amyand's hernia (AH) in neonates in order to decrease the complications and to improve the prognosis.Methods Data about neonates with AH in Department of Neonatal Surgery,Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology,were collected from January 2010 to February 2017,and the AH cases published from 1997 to 2017 in PubMed and Wanfang Data were also reviewed.Results Twenty-two cases were collected,including 8 cases treated in Wuhan Children's Hospital,Tongji Medical College,Huazhong University of Science and Technology,and 14 cases from literature reports.In this group,4 cases underwent traditional operation and 4 cases underwent laparoscopy,respectively.All the patients underwent appendix resection and the ligation of the hernia sac.Among the 4 cases who underwent laparoscopic operation,contra-lateral hernia was found in 2 cases and pyocelia in 1 case.However,the appendix had a solid adhesion with the inguinal canal in those 4 cases and it was difficult to return the appendix to the cavity.Thus,the laparoscopy had to be terminated and the traditional procedure was carried out to separate the adhesion.In those 4 cases to whom the traditional operation was applied,1 case presented inflammation in abdomen and the contra-lateral hernia after operation.According to the pathological results of appendix,in this group,there were 3 cases,4 cases,and 1 case that presented Ⅱ,Ⅲ,Ⅳ type,respectively.In literature cases,there were 13 cases and 1 case that underwent traditional operation and laparoscopy,respectively.There were 4 cases,9 cases,and 1 case that presented Ⅱ,Ⅲ,Ⅳ type,respectively.The complications included located peritonitis (1 case),testicular torsion (1 case) and orchitis (1 case).All cases recovered smoothly.Conclusion Most of the AH cases in neonates present appendix suppuration,gangrene or perforation.The neonatal cases with AH also present obvious local infection and they are prone to develop into pyocelia in inguinal canal and abdominal cavity.In AH cases,laparoscopy has its own advantages,which not only help to make it clear if there is the contralateral hernia,but also helps to treat the complicated pyocelia in abdominal cavity,which help to avoid the residual infection efficiently.
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La incidencia de la hernia de Amyand es muy baja. Siempre es diagnosticada en el transoperatorio, resulta casi imposible de realizar durante el pre-operatorio. Paciente femenina de 75 años de edad, con antecedentes de hernia inguinal derecha recidivante. Comenzó con dolor en epigastrio y en región inguinal derecha, además de náuseas y vómitos. Se identificó cicatriz quirúrgica y aumento de volumen en región inguinal derecha. Se decidió intervenir quirúrgicamente con el diagnóstico clínico de hernia inguinal derecha recidivante encarcelada. Durante el acto operatorio se identificó apendicitis aguda supurada como contenido del saco herniario inguinal. Se procedió a la realización de la apendicetomía y reparación de la hernia, en el mismo tiempo quirúrgico, y colocó la malla de polipropilenoe. Se aplicó antibióticos de amplio espectro. La paciente evolucionó de forma favorable. La biopsia confirmó el diagnóstico. El siguiente caso se presentó, pues a pesar de ser conocido, su incidencia es muy baja, por lo que existen dificultades para su diagnóstico (AU).
The incidence of Amyand's hernia is very low. It is always diagnosed in the trans-operatory period, being almost impossible during the pre-operatory period. This is the case of a female patient, aged 75 years, with antecedents of recidivist right inguinal hernia. It began with pain in epigastrium and in the right inguinal region in addition to nausea and vomits. Surgical scar and volume increase in the right inguinal region were identified. It was decided to make a surgery with the clinical diagnosis of incarcerated recidivist right inguinal hernia. During the surgery an acute suppurated appendicitis was identified as the content of the inguinal hernial sac. The appendectomy was carried out and hernia was repaired in the same surgical time; a polypropylene mesh was placed. Broad spectrum antibiotics were applied. The evolution of the patient was satisfactory. The biopsy confirmed the diagnosis. The case was presented because despite of being known, its incidence is very low, so there are difficulties for diagnosing it (AU).
Subject(s)
Humans , Female , Aged , Appendix/abnormalities , Appendix/surgery , Hernia, Inguinal/surgery , Hernia, Inguinal/complications , Hernia, Inguinal/diagnosis , Hernia, Inguinal/epidemiology , Appendicitis/surgery , Appendicitis/complications , Appendicitis/diagnosis , General Surgery/methodsABSTRACT
Objective To explore the clinical value of trans-umbilicus two-port laparoscopic operation on the treatment for special kinds of incarcerated inguinal hernias in children. Methods A retrospective analysis of the clinical data of 11 children underwent transumbilicus two-port laparoscopic operation for a special kind of incarcerated inguinal hernia from Dec. 2012 to Nov. 2015 in Wuhan Children’s Hospital of Tongji Medical College of Huazhong University of Science & Technology. Then we analyzed the general data, operative methods, hospital stay and postoperative complications of the children. Results Four children with Amyand ' s hernia were curedby laparoscopic surgery. A Meckel’s diverticulum was found in 3 children, 2 ofthem underwentthe laparoscopic resection of Meckel’ s diverticulum, and one was Litter’s hernia and was cured with transumbilical incision for Meckel’s diverticulum resection and anastomosis. One case had direct inguinal hernia with greater omentum hernia and was cured by laparoscopy. Three cases had seromuscular tear of incarcerated intestine and were cured by aparoscopic intestinal repair surgery. The average hospital stay of all cases was (5. 9±2. 4) d, and no incision infection or postoperative scrotal hematoma were found. All the children were followed up for 10 months to 3 years, and recurrence or testicular atrophy were not seen. Conclusion Transumbilical two-port laparoscopic operation is safe, minimally invasive and quick has recovery for the special kinds of incarcerated inguinal hernias, making it of worthy popularizing widely.
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Objective To investigate the preoperative management and the clinical effeciency of Lichtenstein tension-free hernioplasty in adult patients with inguinal incarcerated hernia.Methods Clinical data of 86 patients with inguinal incarcerated hernia were analyzed retrospectively.Hernia was repaired with Lichtenstein tension free after reposition.Results There were 59 male patients and 27 female patients with median age of (63 ± 18) years.There were 8 patients with liver cirrhosis.The operation was performed successfully in all patients.Segmental bowel resection with end-to-end anastomosis was performed in 38 emergency cases.Operative time was 20-120 min,with an average time of 54 min.The postoperative hospitalization was 5-17 d,with an average of 8 d.There were 7 cases of skin ecchymosis at the scrotum,there were no intestinal perforation,hepatic encephalopathy and upper gastrointestinal hemorrhage after operation.In early series of 24 cases without drainage tube left in place,there were 10 cases of fat liquefaction,10 cases of hydrops of hernial sac,6 cases of seroma and 3 cases of wound infection after operation.After 12 to 48 months of follow-up,there was no mortality after 2 years,no hernia recurrence.Conclusions Tension free repair in the treatment of incarcerated inguinal hernia is safe and feasible.
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La hernia de Amyand es un padecimiento muy raro, que se reconoce ante la presencia de apendicitis aguda dentro de un saco herniano. El diagnóstico preoperatorio es excepcional. El tratamiento recomendado es la apendicectomía y reparación de la hernia en el mismo tiempo operatorio. Se presentó el caso de un paciente de 56 años de edad con antecedentes de hernia inguinal derecha desde hace 10 años que acudió con dolor abdominal relacionado con la presencia de esta, que se encontraba en esos momentos irreductible, el dolor se irradiaba a todo hemiabdomen inferior, con defensa muscular hacia fosa iliaca derecha. Se realizó intervención quirúrgica detectándose en el transoperatorio la presencia de epiplón y apéndice cecal edematoso dentro de saco herniano. Se procedió a la realización de la apendicetomía y reparación de la hernia inguinal en el mismo tiempo quirúrgico, se decidió la colocación de malla de Marlex. La evolución fue satisfactoria.
Amyand's Hernia is a very rare pathology that is recognized by the presence of inflamed appendix inside an inguinal hernia. The pre-operative diagnosis is exceptional. The recommended treatment is the appendectomy with herniotomy in the same operative time. A 56 -year- old male patient with history of right inguinal hernia of approximately 10 years of evolution was presented. He was attended because of abdominal pain related to the presence of an inflamed inguinal mass, non-reducible, associated to muscular defense to the right inguinal region. Surgical intervention was performed detecting the presence of epiplon and edematous vermiform appendix within the hernia sac. An Appendectomy and reparation of the inguinal hernia were done in the same surgical time, Marlex mesh was decided to use. The patient´s evolution was satisfactory.
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Objective To discuss curative effects of tension-free herniorrhaphy for phrase I and traditional herniorrhaphy on the treatment of incarcerated hernia.Methods 84 cases with incarcerated hernia were selected and divided into the observation group ( n=42 ) and control group ( n=42 ) by random number table, who were given tension-free herniorrhaphy for phrase I and traditional herniorrhaphy respectively.The operation time, amount of bleeding,out-of-bed activity time,analgesic rate and length of stay ( LOS) after the operation,and complication and reoccurrence rates during and after the medical treatment were observed and compared.Results The operation time, out-of-bed activity time,analgesic rate and length of stay ( LOS) after the operation of patients in the observation group[(45.7 ±10.3) min,(28.7 ±7.5) h,14.29%,(4.13 ±0.97) d] were all much shorter than those in the control group[(53.9 ±11.7)min,(41.5 ±10.3)h,35.71%,(6.07 ±1.04)d](t or χ2 =2.15,2.39,5.14,2.41, P0.05).3 and 10 cases of complication appeared in the observation group and control group after the operation respectively.The occurrence rate of complication in the observation group after the operation was much lower than that in the control group (χ2 =4.46,P<0.05).Following up for 6 to 67 months, no reoccurrence appeared in the observation group after the operation,while 6 cases of which appeared in the control group.And the postoperative reoccurrence rate of patients in the observation group was much lower than that in the control group (χ2 =4.49,P<0.05).Conclusion Tension-free herniorrhaphy for phrase I has confirmative curative effect on incarcerated hernia,with the following advantages like short operation time and out-of-bed activity time after the operation,low postoperative analgesic rate,short LOS,little complication,low reoccurrence rate and etc,which can gradually take the place of traditional herniorrhaphy and become the first operation method to treat incarcerated hernia with no intestinal necrosis.
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ObjectiveTo evaluate the application value of the emergency laparoscopic surgery in incarcerated inguinal hernia of children. MethodsManual reduction of incarcerated hernia was laparoscopic- assisted after anesthesia, high-ligation of hernia sac was done by one hole method of laparoscopic treatment.ResultsAll of 22 cases of pediatric incarcerated hernia were done, no complications occurred. Eighteen patients were followed up for 3 - 15 months, 9.3 months on average, without serious complications. ConclusionsThe emergency laparoscopic surgery in children of incarcerated inguinal hernia is safe and feasible,with smaller trauma, quicker recovery and smaller health risk.
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The term "Littre's hernia" was originally defined by Reinke in 1841 as "the presence of a Meckel's diverticulum in any hernia sac." Littre's hernia is a very rare disease, which accounts for less than 1% of all Meckel's diverticula. We report a case of Littre's hernia experienced in a 45 day-old infant.
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Humans , Infant , Diverticulum , Hernia , Meckel Diverticulum , Rare DiseasesABSTRACT
Patients who have undergone peritoneal dialysis can frequently experience abdominal wall complications, such as hernia due to increased intraabdominal pressure and peritoneal leakage. However, no case of incarcerated abdominal wall hernia through catheter insertion site of CAPD has yet been reported Recently the authors experienced a case of intestinal obstruction due to an incarcerated hernia at the catheter insertion site of CAPD. We report this case and present a literature review.
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Humans , Abdominal Wall , Catheters , Hernia , Intestinal Obstruction , Peritoneal Dialysis , Peritoneal Dialysis, Continuous AmbulatoryABSTRACT
Objective:To present the experience in diagnosis and treatment on newborn's incarcerated hernia.Methods:The clinical data of 34 cases of newborn's incarcerated hernia was analysed from 1999 to 2006.Results:32 cases of newborn's incarcerated hernia were treated by operation with 8 cases in intestinal necrosis and 5 cases in spermary necrosis.2 cases were treated by hands.There are 8 cases with complications and 2 dead cases post-operation.The cure rate of operation,complication rate and mortality were 94.11%,22.52% and 5.88%respectively.Conclusions:The early diagnosis and operation treatment is value for newborn's incarcerated hernia.Nutritional supportive treatment and preventing toxic shock are elevation curative effect criticality.
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Objective To evaluate the clinical effect of tension-free mesh-plug repair in the treatment of inguinal incarcerated hernia. Methods The mesh & plug tension-free hernia repair was administered in 45 patients with incarcerated indirect hernia using the Bard Mesh PerFix Plug. Results The operation time was 48～98 min (mean, 75 min). The patients got out of bed 12～24 hours after surgery. Wound pain lasted 2～4 days. Postoperative subcutaneous hydrops occurred in 2 patients and dysuria happened in 2 patients. The postoperative hospital stay was 3～10 days (mean, 5 days). Follow-up for 5～18 months (mean, 12.5 months) in 39 patients found no recurrence. Conclusions Tension-free mesh-plug repair has advantages of reliability, minimal invasion, rapid recovery and low recurrence rate. This method can be applied to those with incarcerated hernia with satisfactory outcomes.