ABSTRACT
Rectus sheath block is an interesting analgesic technique for umbilical hernia repair and there are some case reports where it was even used as the sole anesthetic. We describe the clinical case of a patient who required an urgent surgery for an incarcerated umbilical hernia and who was successfully managed with a bilateral rectus sheath block along with light sedation. Ultrasound-guided bilateral rectus sheath block provided anesthesia for our patient, avoiding the risks of the general and spinal anesthesia for his particular clinical situation and achieving an excellent postoperative analgesia, a fast recovery and hospital discharge without any complications.
El bloqueo de la vaina de los rectos es una técnica analgésica interesante para la reparación de la hernia umbilical y hay casos descritos donde incluso se ha usado como único anestésico. Describimos el caso clínico de un paciente que precisó reparación urgente de una hernia umbilical incarcerada y que fue manejado con éxito con un bloqueo de la vaina de los rectos bilateral junto con sedación ligera. El bloqueo ecoguiado de la vaina de los rectos bilateral aportó anestesia quirúrgica para nuestro paciente, evitando los riesgos de la anestesia general y espinal en su peculiar situación clínica y consiguió una analgesia postoperatoria excelente, una rápida recuperación y alta hospitalaria sin complicacione
Subject(s)
Humans , Male , Aged , Anesthetics, General/administration & dosage , Hernia, Umbilical/surgery , Anesthesia/methods , Nerve Block/methods , Rectus Abdominis/innervation , Emergencies , Hernia, Umbilical/complications , Hernia, Umbilical/diagnostic imagingABSTRACT
Rectus sheath block is an interesting analgesic technique for umbilical hernia repair and there are some case reports where it was even used as the sole anesthetic. We describe the clinical case of a patient who required an urgent surgery for an incarcerated umbilical hernia and who was successfully managed with a bilateral rectus sheath block along with light sedation. Ultrasound-guided bilateral rectus sheath block provided anesthesia for our patient, avoiding the risks of the general and spinal anesthesia for his clinical situation, and achieving an excellent postoperative analgesia, a fast recovery and hospital discharge without any complications.
El bloqueo de la vaina de los rectos es una técnica analgésica interesante para la reparación de la hernia umbilical y hay casos descritos donde incluso se ha usado como único anestésico. Describimos el caso clínico de un paciente que precisó reparación urgente de una hernia umbilical incarcerada y que fue manejado con éxito con un bloqueo de la vaina de los rectos bilateral junto con sedación ligera. El bloqueo ecoguiado de la vaina de los rectos bilateral aportó anestesia quirúrgica para nuestro paciente, evitando los riesgos de la anestesia general y espinal en su peculiar situación clínica y consiguió una analgesia posoperatoria excelente, una rápida recuperación y alta hospitalaria sin complicaciones.
Subject(s)
Humans , Male , Aged , Hernia, Umbilical/surgery , Anesthesia, Local/methods , Nerve Block/methods , Ultrasonography, Interventional , Rectus Abdominis/innervation , Emergencies , Hernia, Umbilical/complicationsABSTRACT
RESUMEN Antecedentes: la ascitis es una complicación de frecuente aparición en el paciente cirrótico que al producir un aumento de la presión intraabdominal puede originar una hernia de la pared abdominal; el defecto umbilical latente es su localización más habitual. Objetivo: presentar la incidencia y los beneficios que ofrece la resolución electiva de la patología um bilical en estos pacientes. Material y método: se presentan 15 pacientes, todos masculinos, que fueron intervenidos por hernia umbilical sintomática en forma electiva en el medio hospitalario. El período comprende desde enero del año 2015 a enero de 2019. El 100% de los enfermos cursa un cuadro de cirrosis hepática, con antecedentes de etilismo crónico. Se efectuó la reparación de la hernia con cierre del defecto y malla supraaponeurótica de polipropileno en la mayoría de los casos. Resultados: los pacientes fueron evaluados desde el punto de vista clínico con la escala (score) de Child en el preoperatorio. Se procedió a la evacuación de la ascitis en todos los casos y el control posoperatorio se efectuó cada 30 días los primeros 6 meses. Luego dos veces al año. No se evidenció recidiva. Dos pacientes no volvieron al control luego del año de la cirugía y 1 paciente falleció por la enfermedad de base a los 6 meses de la cirugía. Conclusiones: los enfermos con cirrosis hepática y hernia umbilical deben ser intervenidos quirúrgica mente en forma electiva. La observación y abstención quirúrgica conllevan el riesgo de rotura del saco herniario con alta morbimortalidad.
ABSTRACT Background: Background: Ascites is a common complication in patients with cirrhosis, and elevated intraabdominal pressure can lead to the development of abdominal wall hernias, particularly in patients with latent umbilical defects. Objectives: The aim of this study was to report the incidence and benefits of elective surgery for the management of umbilical hernias in cirrhotic patients with ascites. Material and methods: Between January 2015 and January 2019 15 patients with symptomatic umbi lical hernia underwent elective surgery in a public hospital; 100% were men with a history of alcoho lism and were hospitalized due to liver cirrhosis. The defect was closed, and a polypropylene mesh was placed in the supra-aponeurotic plane in most cases. Results: The preoperative risk was estimated using the Child-Pugh score. Ascites was evacuated in all the cases. Patients were followed-up every 30 days during the first 6 months and then twice a year. There were no hernia recurrences. Two patients were lost to follow-up 12 months after surgery and 1 patient died 9 months after the procedure due to progression of cirrhosis. Conclusions: Patients with liver cirrhosis and umbilical hernia should undergo elective surgery. Wat chful waiting is associated with higher risk of hernia rupture and high morbidity and mortality.
Subject(s)
Humans , Hernia, Umbilical/complications , Liver Cirrhosis , Ascites , Hernia, Abdominal , Conservative Treatment , Hernia , Hernia, Umbilical/drug therapyABSTRACT
Resumen La ascitis es la complicación más común en los pacientes con cirrosis hepática. Las hernias umbilicales (HU) ocurren en 20% de estos pacientes y 40% en aquellos con ascitis severa. La HU ocurre debido al aumento de presión intraabdominal, al debilitamiento de la fascia abdominal y la pérdida de masa muscular. Además, tienen tendencia a aumentar rápidamente y presentar alto riesgo de complicaciones que amenazan la vida del paciente. El tratamiento de la HU no complicada es controversial, tanto el manejo quirúrgico (herniorrafia) como el manejo conservador (control de ascitis) presentan alta tasa de complicaciones, en consecuencia incrementa la morbimortalidad. Actualmente, se recomienda herniorrafia umbilical con previo control de la ascitis en el manejo de HU no complicada, reduce el riesgo de infección de herida operatoria, evisceración, drenaje de ascitis, peritonitis y reduce hasta 41% la recidiva de HU. El éxito de este enfoque también depende del grado de disfunción hepática. El tratamiento de la HU complicada es quirúrgico (herniorrafia sin malla), con menor tasa de mortalidad respecto al manejo conservador. Estudios revelan ventajas de la herniorrafia umbilical laparoscópica (mínimamente invasiva y sin tensión) en comparación a la cirugía abierta, sin embargo, aún no hay evidencia al respecto.
Ascites is the most common complication in patients with liver cirrhosis. Umbilical hernias (HU) occur in 20% of these patients and 40% in those with severe ascites. HU occurs due to increased intra-abdominal pressure, weakening of the abdominal fascia and loss of muscle mass. In addition, they have a tendency to enlarge rapidly and present high risk of complications that threaten the patient's life. The treatment of the uncomplicated HU is controversial, both the surgical management (herniorrhaphy) and the conservative management (control of ascites) present high rate of complications, consequently high morbidity and mortality. Currently, umbilical herniorrhaphy is recommended with prior control of ascites in uncomplicated HU management, it reduces the risk of surgical wound infection, evisceration, ascites drainage, peritonitis, and it reduces up to 41% of HU recurrence. The success of this approach also depends on the degree of liver dysfunction. The treatment of complicated HU is surgical (herniorrhaphy without mesh), with lower mortality rate compared to conservative management. Studies reveal advantages of umbilical herniorrhaphy laparoscopy (minimally invasive and stress-free) compared to open surgery; however there is still no evidence about it.
Subject(s)
Humans , Ascites/etiology , Hernia, Umbilical/complications , Hernia, Umbilical/therapy , Liver Cirrhosis/complications , Herniorrhaphy , Hernia, Umbilical/surgeryABSTRACT
We report the first case of a newborn presenting with a celio-mesenteric trunk variation associated with a giant omphalocele. The celio-mesenteric trunk was unexpected and unseen during the staged surgical closure. After partial reintegration of the liver, the newborn presented refractory hypovolemia with anuria, leading to redo surgery. This procedure revealed ischemia of the liver and necrosis of the entire gastrointestinal tract except the colon. Despite treatment, including liver externalization, the infant did not survive. The autopsy revealed a celio-mesenteric trunk, a rare anomaly characterized by a common origin of the celiac axis and the superior mesenteric artery from the aorta. This association may explain the dramatic consequences of the staged closure procedure. Awareness of the association of celio-mesenteric trunk and omphalocele would allow the surgeon to take extra care during this delicate surgery.
Presentamos el primer caso de un recién nacido que presenta una variación del tronco celíaco-mesentérico asociada con un onfalocele gigante. El tronco celíaco-mesentérico fue inesperado y no se vio durante las etapas del cierre quirúrgico. Después de la reintegración parcial del hígado, el recién nacido presentó hipovolemia refractaria con anuria, lo que condujo a la repetición de la cirugía. Este procedimiento reveló isquemia del hígado y necrosis de todo el tracto gastrointestinal excepto el colon. A pesar del tratamiento, incluyendo la externalización hepática, el bebé no sobrevivió. La autopsia reveló un tronco celíaco-mesentérico, una rara anomalía caracterizada por un origen común del tronco celíaco y la arteria mesentérica superior, a partir de la aorta. Esta asociación puede explicar las dramáticas consecuencias del procedimiento durante las etapas del cierre. El conocimiento de la asociación de tronco celíaco-mesentérico y onfalocele permitiría al cirujano tomar especial cuidado durante esta delicada cirugía.
Subject(s)
Humans , Female , Infant, Newborn , Hernia, Umbilical/complications , Mesenteric Arteries/abnormalities , Mesenteric Ischemia/pathology , Fatal Outcome , Hernia, Umbilical/surgeryABSTRACT
Introduction : Dans le but d'améliorer la prise en charge des hernies ombilicales étranglées, une étude descriptive à recueil rétrospectif couvrant la période de janvier 2008 à décembre 2013 soit en 6 ans, a été réalisée dans le service de chirurgie pédiatrique portant sur les enfants opérés en urgence pour une hernie ombilicale étranglée. Matériel et méthodes : Les enfants de 3 mois à 15 ans, hospitalisés pour une hernie ombilicale étranglée et dont les dossiers étaient exploitables ont été retenus. Les paramètres étudiés étaient : la fréquence, l'âge, le sexe, le niveau socio-économique, la période saisonnière, le délai de consultation, le mode de révélation de l'étranglement, la voie d'abord, le viscère hernié, les gestes pratiqués et l'évolution post-opératoire. Résultats : Au total, 134 enfants ont été traités pour hernie ombilicale pendant cette période. Parmi eux, 39 cas (29%) l'étaient pour une hernie ombilicale étranglée. Ils avaient un âge moyen de 3,5 ans [extrêmes : 3 mois et 15 ans]. Le délai moyen de consultation était de 52 heures [extrêmes : 5 heures et 192 heures]. Trente-neuf (100%) cas avaient une masse ombilicale douloureuse irréductible. Le diamètre du collet herniaire variait entre 0,5 à 1,5 cm. L'incision curviligne péri-ombilicale inférieure était réalisée dans tous les cas. L'intestin grêle était le principal organe retrouvé dans le sac herniaire (79,5%). Une nécrose intestinale était notée dans 4 cas (10%) dont 3 avaient consulté au-delà de 72 heures, ayant nécessité une résection intestinale suivie d'une anastomose iléo iléale termino-terminale. Six (15%) cas de suppuration pariétale ont été notés. Conclusion : Le risque de nécrose intestinale retrouvé dans notre étude nécessite que la prise en charge soit précoce. Ainsi lorsque la taille du collet ombilical est inférieure ou égale à 1,5 cm, l'acte chirurgical s'impose
Subject(s)
Academic Medical Centers , Child , Congo , Emergency Service, Hospital , Hernia, Umbilical/complications , PediatricsABSTRACT
Several embryopathies involve umbilicus including midgut herniation, omphaloceles, urachal and vascular anomalies. Although described earlier, hernia into umbilical cord has not found enough mention in the literature. Poor understanding of its clinical characteristics has made to miscategorization of this entity as "omphalocele minor" by many. Some of these undergo spontaneous reduction or epithelialisation if left alone. The present study describes a series of four consecutive cases of this entity and describe their clinical characteristics, associated GI anomalies and possible embryogenesis.
Subject(s)
Diverticulitis/congenital , Female , Hernia, Umbilical/complications , Hernia, Umbilical/diagnosis , Hernia, Umbilical/surgery , Humans , Ileum/abnormalities , Infant, Newborn , Intestinal Atresia/complications , Intestinal Obstruction/complications , Intestinal Obstruction/congenital , Male , Meckel Diverticulum/surgeryABSTRACT
Umbilical hernias in calves commonly present to veterinary clinics, which are normally secondary to failure of the normal closure of the umbilical ring, and which result in the protrusion of abdominal contents into the overlying subcutis. The aim of this study was to compare the suitability of commonly-used herniorrhaphies for the treatment of reducible umbilical hernia in calves. Thirty-four clinical cases presenting to the Veterinary Teaching Hospital, Chittagong Veterinary and Animal Sciences University, Chittagong, Bangladesh from July 2004 to July 2007 were subjected to comprehensive study including history, classification of hernias, size of the hernial rings, presence of adhesion with the hernial sacs, postoperative care and follow-up. They were reducible, non-painful and had no evidence of infection present on palpation. The results revealed a gender influence, with the incidence of umbilical hernia being higher in female calves than in males. Out of the 34 clinical cases, 14 were treated by open method of herniorrhaphy and 20 were treated by closed method. Complications of hernia were higher (21%) in open method-treated cases than in closed method-treated cases (5%). Hernia recurred in three calves treated with open herniorrhaphy within 2 weeks of the procedure, with swelling in situ and muscular weakness at the site of operation. Shorter operation time and excellent healing rate (80%) were found in calves treated with closed herniorrhaphy. These findings suggest that the closed herniorrhaphy is better than the commonly-used open method for the correction of reducible umbilical hernia in calves.
Subject(s)
Animals , Cattle , Female , Male , Cattle Diseases/surgery , Hernia, Umbilical/complications , Surgical Procedures, Operative/adverse effectsABSTRACT
BACKGROUND: Umbilical defects may cause technical problems for general surgeons in patients during laparoscopic cholecystectomy (LC) operations and may increase the incidence of incisional hernia. AIM: The objectives of this study were to determine the optimal repair method for umbilical hernias that already exist or are encountered incidentally and to present data regarding potential problems that may occur during LC. SETTINGS AND DESIGN: Medical records of patients who had received simultaneous umbilical hernia repair (UHR) with LC were investigated retrospectively. MATERIALS AND METHODS: Cholelithiasis was accompanied by umbilical hernia in 64 (8.6%) out of 745 patients who underwent LC and UHR simultaneously in our hospital between 2000 and 2004. STATISTICAL ANALYSIS USED: The Mann-Whitney U, Chi-square, One-Way Anova, Kaplan-Meier survival analysis, the log-rank test and t test were used for statistical analyses. RESULTS: LC was followed by UHR using primary suture (Group 1), Mayo repair (Group 2) and flat mesh-based repair (Group 3) in 32 (50%), 18 (28.1%) and 14 (21.9%) patients, respectively. Mean body mass indexes (BMI) of patients were 26.6 kg/m 2, 29.2 kg/m 2 and 39.9 kg/m 2 in Groups 1, 2 and 3, respectively. Recurrence rates were 9.4%, 5.6% and none (0%) in Groups 1, 2 and 3, respectively. Recurrence was observed in three (7.0%) out of 43(67.2%) patients with BMI > or = 30 kg/m 2 while umbilical hernia recurred in one (4.8%) out of 21 (32.8%) patients with BMI < 30 kg/m 2. Overall morbidity and mortality rates were 14.1% and 0%, respectively. CONCLUSIONS: The outcomes of the UHR with mesh after laparoscopic surgeries appear to be better for either obese or non-obese patients than primary suture techniques in recurrence rates.
Subject(s)
Adult , Aged , Aged, 80 and over , Cholecystectomy, Laparoscopic , Cholelithiasis/complications , Female , Hernia, Umbilical/complications , Humans , Male , Middle Aged , Retrospective Studies , Surgical Mesh , Suture TechniquesABSTRACT
Introducción: Onfalocele y gastrosquisis son los defectos de la pared abdominal (DPA) más frecuentes. Ambos necesitan un diagnóstico precoz y tratamiento quirúrgico oportuno para sobrevivir. Objetivos: Determinar la prevalencia al nacimiento de los DPA en la maternidad del Hospital Clínico de la Universidad de Chile (HCUCH) y compararla con la del total de maternidades chilenas (MCh) y los resultados del Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC). Resultados: La prevalencia global de onfalocele fue de 3,4/ 10 000 nacimientos y 3,8/10 000 para gastrosquisis. La prevalencia de onfalocele fue 9/10.000 en HCUCH y 2,77/10 000 en MCh (p = 0,006) y la de gastrosquisis fue 1,9/10 000 en HCUCH y 1,1/10 000 en MCh (p = 0,036). El promedio de edad materna fue 24,2 años para gastrosquisis y 33,6 para onfalocele (p < 0,004). La sobrevida de gastrosquisis fue 100 por ciento versus 31,7 por ciento en onfalocele (p < 0,0425). Todos los RN con onfalocele, salvo uno, presentaban asociación con otras MC graves. El peso de nacimiento y edad gestacional fueron significativamente menores en onfalocele. Conclusión: La prevalencia de DPA fue significativamente mayor en el HCUCH que en el resto de las maternidades chilenas. Gastrosquisis se presentó en hijos de mujeres más jóvenes y onfalocele en las de mayor edad.
Subject(s)
Male , Female , Infant, Newborn , Adult , Humans , Gastroschisis/epidemiology , Hernia, Umbilical/epidemiology , Abdominal Muscles/abnormalities , Birth Weight , Chile/epidemiology , Gestational Age , Gastroschisis/complications , Gastroschisis/etiology , Hernia, Umbilical/complications , Hernia, Umbilical/etiology , Maternal Age , Prevalence , Survival RateABSTRACT
The appendix is not uncommonly encountered within an external hernial sac. However, acute appendicitis in hernia is quite rare. We report a female patient who was admitted and operated as a case of incarcerated, strangulated paraumbilical hernia and the hemial sac was found to contain part of the greater omentum, pus and acutely inflamed, gangrenous appendix, perforated at the tip. Appendicectomy and hernial repair were carried out through the same incision
Subject(s)
Humans , Female , Appendicitis/diagnosis , Appendicitis/surgery , Hernia, Umbilical/complications , Hernia, Umbilical/diagnosis , Hernia, Umbilical/surgery , Intestinal Perforation/etiology , AppendixABSTRACT
The survival rate of patients with abdominal wall defects has gradually improved with the advances in the investigation and treatment modalities. The present paper reviews the results of various treatment modalities and also analyses the long term results in these patients. A meta-analysis was performed via a medline search of English written clinical studies containing the text words "abdominal wall defects", gastroschisis and 'omphalocele or exomphalos" from 1953 to 1998. The present consensus on operative management of abdominal wall defect is to provide primary closure, if it can be achieved without haemodynamic or respiratory compromise. Patients with primary closure on analysis were found to have better survival rates, reduced risk of sepsis and overall, a shorter hospital stay. However, resumptions of oral feeds, duration of total parenteral nutrition (usually lasting 10-15 days) and ventilatory support required postoperatively did not significantly differ in the primary and silo technique. Long term outcome of these patients is generally good, but they have high incidence of GER (40-50%) for which they should be on regular follow up.
Subject(s)
Digestive System Surgical Procedures/methods , Gastroschisis/complications , Hernia, Umbilical/complications , Humans , Infant, Newborn , PrognosisSubject(s)
Humans , Male , Female , Child , Hernia, Umbilical/complications , Hernia, Umbilical/surgery , Medicine , VenezuelaABSTRACT
Se presenta dos casos de recién nacidos de sexo masculino con diagnóstico de Síndrome de Beckwith Wiedeman con diferentes características del Síndrome. Ambos fueron intervenidos quirúrgicamente por Onfalocele practicándose un cierre primario sin problemas respiratorios posteriores. El primero evolucionó favorablemente saliendo de alta al 12avo. día postoperatorio, mientras que el segundo falleció al tercer día de operado por un cuadro séptico. En el presente trabajo se comparan ambos casos con los publicados en la literatura nacional: Freyre (1973) y Bazán (1987) y se revisa la literatura internacional actual
Subject(s)
Humans , Male , Infant, Newborn , Hernia, Umbilical/surgery , Beckwith-Wiedemann Syndrome/diagnosis , Otitis/diagnosis , Peru , Hernia, Umbilical/complications , Beckwith-Wiedemann Syndrome/epidemiologyABSTRACT
A new bedside clinical test for the diagnosis of minimal ascites associated with reducible umbilical hernia is described. This test is based on transillumination of the hernial sac in the knee-elbow position. The test is easy to perform and has no equivocal results.