Wandering spleen in the pelvic region in an adult man with symptoms of acute abdomen

Wandering or ectopic spleen is a condition characterised by migration of spleen in the abdomen or pelvis. This anomaly is rare, with a reported incidence of <0.2%. It occurs mostly in women between 20 and 40 years of age. Clinical diagnosis is difficult because of lack of precise signs, symptoms, and nonspecific laboratory data. Diagnosis of a wandering spleen highly depends on the results of imaging studies such as abdominal ultrasound and abdominopelvic computed tomography [CT] scanning. Treatment includes surgery with the choice between splenopexy in a noninfarcted spleen and splenectomy when infarction has occurred. We report a rare case of wandering spleen in a 27-year-old man with infarction due to torsion of its pedicle, which was diagnosed by CT and treated by splenectomy. Conclusion: Despite the rarity of wandering spleen, the possibility of torsion of its long pedicle with acute splenic infarction should be considered in the differential diagnosis of acute abdomen

Comparative study between open anterior approaches using the prolene patch and open posterior [pre-peritoneal] using a configured prolene mesh in treatment of recurrent inguinal hernia

Recurrence of inguinal hernia is not an infrequent problem seen by the surgeon. Usually repair of such hernia is technically more demanding than a primary repair, with a potential for new recurrence and a high risk of complications. The objective of this study is to compare between the anterior approach using the prolene patch and a pre-peritoneal approach with prolene mesh configuration. A comparative study was done from June2004 to December 2006, at Assiut university hospital on thirty patients with recurrent inguinal hernia selected for this prospective comparative study. The studied patients were allocated into two groups: group A [anterior approach n=15 patients] and group B [posterior approach n= 15 patients]. Thirty patients with recurrent inguinal hernia were operated. All of them were males. Incidence of cord injury in group A was 6.6%, while no injury of the occurred in group B. the incidence of haematoma [6.6%], scrotal oedema [20%] and testicular atrophy [6.6%] were encountered in group A while no reported cases were seen in group B. Although both anterior and posterior approachs are effective treatment modalities for treatment of recurrent inguinal hernias, yet the open pre-peritoneal approach is technically easier, safer, cheaper, is followed by minimal morbidity and has a low re-recurrence rate

Management of giant ventral hernia by polypropylene MESH and host tissue barrier

Surgical management of giant ventral hernias is a surgical challenge due to limited abdominal cavity. This study evaluates our experience in the management of massive ventral hernias using polypropylene mesh. From January 2005 and September 2006, we operated on 30 patients with giant ventral hernias by using polypropylene mesh. The mesh was separated from the viscera by a small part of the hernial sac and the greater omentum. The age ranged from 39 and 64 years. Seventeen had post-operative incisional and 13 had para-umbilical hernias. The vertical and horizontal diameters of defects ranged from 10-to 22 cm. Mean body mass index was 33. Follow up ranged from 6-18 months. No patient required ventilation after operation. Recurrent seroma, which responded to repeated aspiration, was experienced in 3 patients. Minor wound infection was observed in 4 patients. Small hernia recurrence occurred in one patient. The use of polypropylene and host tissue barrier is relatively simple, safe, and reliable surgical solution to the problem of giant ventral hernia