Emergency department diagnosis of an ovarian inguinal hernia in an 11-year-old female using pointof-care ultrasound / 世界急诊医学杂志（英文）

@#Inguinal hernias affect 5% of children and are usually defined as a protrusion of intestine or omentum through abdominal wall or inguinal canal defects.[1] Inguinal hernias may contain structures other than bowel and unique cases have been documented since the early 1900's.[2–10] Ultrasound has been demonstrated to differentiate superficial swellings and has been used by radiologists to evaluate inguinal masses for decades.[1–5,11–13] Although the use of radiology-performed ultrasound for the diagnosis of congeni tal inguinal hernias containing ovaries, uterus, and fallopian tubes has been documented; the use of point-of-care ultrasound for the evaluation of the acute inguinal mass prior to reduction has not been demonstrated. Accurate identification by the emergency physician of the herniated structures may lead to earlier diagnosis, faster consultation, improve patient management, and superior patient outcomes.

Inguinal hernia and cord lipomas / 国际外科学杂志

Cord lipoma is a trite lipoma, it is a protrusion of extraperitoneal fatty tissue through the internal inguinal ring. The incidence is between 20% to 30%.It is often caused by a protrusion of extraperitoneal fatty tissue through the internal inguinal ring, lobular retroperitoneal fat insinuates itself through the internal ring and over time dilates it. Patients with a higher BMI are more prone to having a cord lipoma. Incidence of lipoma associated with Type II and Ⅲ hernias was bigher. it is suggest that the incidence of lipoma assoeiated with the type of hernias and patients with a larger hernias are more prone to having a coM lipoma. The cord lipoma is difficult to diagnosis before surgery,because it is similar to hernias in symptom. Ultrasound is safe and useful in finding hernias and cord lipoms, the overall accuracy is 92%. It is necessary to resect lipomas and repair as long as the extraperitoneal fatty tissue through into the inguinal canal.

Development and Implementation of a Critical Pathway for Pediatric Inguinal Hernias

PURPOSE: Critical pathway (CP) refers to the standardized care process that predefines the treatment sequence and timing for a specific group of diseases and patients. The recent interest in CPs has increased as a quality improvement tool and a cost-effective delivery system for medical services. The authors applied a CP for pediatric inguinal hernias, and we investigated the cost effectiveness and also the satisfaction of the patients and the medical staff. METHODS: The CP was applied to 24 patients (the CP group) and the characteristics of the patients, the length of the hospital stay, the postoperative course, the medical costs and the results of the survey were compared with 26 other patients (the non-CP group). RESULTS: There was no difference in the patients' characteristics, the length of the hospital stay, the postoperative complications and the course of between the two groups. The cost for the medications, injections, treatments and examinations for the CP group were significantly lower than those for the non-CP group (P<0.05). The satisfaction of patients was significantly improved after the application of the CP (P<0.05), and the satisfaction of the medical staff was high. CONCLUSION: The application of a CP for pediatric inguinal hernia can save treatment-related medical costs. Moreover, the CP is an effective, excellent care process that improves the satisfaction of both the patients and the medical staff.

Histologia dos sacos herniários das hérnias inguinais indiretas, diretas, recidivadas e encarceradas em adultos e crianças: identificação de fibras musculares lisas / Histology of the hernial sacs of direct, indirect, relapsed and incarcerated inguinal hernias in adults and children: identification of smooth muscles fibers

OBJETIVO: Pesquisar a presença de fibras de músculo liso (FML) nos sacos peritoneais das hérnias indiretas, diretas, recidivadas e encarceradas e estudar a influência do sexo, cor e idade dos pacientes, bem como a região do saco herniário, largura, comprimento e espessura da biópsia coletada. MÉTODO: Foram obtidos 252 sacos herniários no período de fevereiro de 1999 a dezembro de 2000 e encaminhados para o estudo histopatológico através da coloração por hematoxilina-eosina e tricrômico de Gomori. A idade variou entre um mês a 87 anos com média de 42,3 anos e desvio-padrão de 22,5 anos. RESULTADOS: Foi utilizado o teste do Qui-quadrado e observada FML em 76,5 por cento dos pacientes com hérnia indireta, 55,9 por cento direta, 46,4 por cento encarcerada e 68,7 por cento recidivada. No estudo global foram encontradas FML em 67,9 por cento dos espécimes com maior incidência na porção proximal do saco herniário (53,2 por cento) e em pacientes melanodérmicos (75 por cento). As FML estiveram presentes em maior freqüência no lado direito (67,7 por cento) e no sexo feminino (73,3 por cento). Do total de 252 amostras de sacos herniários examinados, foi encontrada FML em 171 biópsias, e esse achado foi menos freqüente nas hérnias diretas e encarceradas quando comparadas com as indiretas e recidivadas. CONCLUSÕES: Como hipótese, a presença de FML na parede do saco herniário pode representar um reforço tecidual no sentido de dificultar o crescimento do saco peritoneal, comportando-se como fator de resistência elástica e dinâmica à expansão da hérnia. Por outro lado, pode também significar uma formação aberrante ou a persistência de uma estrutura que deveria regredir ou mesmo desaparecer durante o desenvolvimento normal.

BACKGROUND: To determine the presence of smooth muscle fibers (SMF) in the peritoneal sacs of indirect, direct, recurrent and strangulated hernias and to evaluate the influence of sex, color and patients'age well as location, width, length and thickness of the hernia sac collected biopsy. METHOD: 252 hernia sacs - obtained between February 1999 and December 2000 - were sent to histopathological examination using hematoxylin and eosin stain and Gomori Trichrome. The ages varied between 1 month to 87 years with a mean age of 42,3± 22,5 years. RESULTS: SMF were observed in 76,5 percent of the patients with indirect hernia, 55,9 percent with direct hernia, 46,4 percent with strangulated hernia and 68,7 percent with recurrent hernia. Overall , SMF were found in 67,9 percent of the specimens , with larger incidence in the proximal portion of the hernia sac (53,2 percent) , and in melanodermic patients (75 percent). SMF were present, in larger frequency, on the right side (67,7 percent) and in the feminine sex (73,3 percent). Of the total of 252 samples of examined hernia sacs , SMF were found in 171 biopsies, wich wass less frequent in direct and strangulated hernias when compared with to indirect and recurrent hernias. CONCLUSIONS: The presence of SMF in the hernia sac wall could represent tissue reinforcement by hindering peritoneal sac growth, behaving as factor of elastic and dynamic resistance to the hernia expansion. On the other hand, it could also mean an aberrant formation or persistence of a structure that could be subject to regression or even disappear during normal development.

The application of mesh-plug tension-free hernioplasty in eldly bilateralnguinal hernias / 临床外科杂志

Objective To summarize the therapeutic effects of mesh-plug tension-free hernioplasty in eldly bilateral inguinal hernia.Methods 22 patients were treated by mesh-plug hernia repair in one operation.The operative procedure, postoperative pain,ability recovery, com-plications and recurrence rate were studied. Results All the operativeprocedure were performed smoothly. The postoperative complications included:4 cases of scrotal hydroceles, 3 urinary retention and 2 (subcutaneous) haematoma. 1～23 months follow-up were taken, no recent recurrence was founded.Conclusions Mesh-plug tension-free hernioplasty has the advantages of simple performance, less trauma and fewer recurrence.It is especially suitable to the eldly patients with bilateral inguina hernia.