Hernies pariétales au CHU Souro Sanou de Bobo Dioulasso: profil sociodémographique, diagnostique et thérapeutique / Parietal hernias at the CHU Souro Sanou in Bobo Dioulasso: sociodemographic, diagnostic and therapeutic profile

But : étudier le profil sociodémographique, diagnostique et thérapeutique des hernies pariétales au Centre Hospitalier Universitaire Sourô Sanou. Patients et méthodes Il s'est agi d'une étude transversale descriptive allant du 1ier janvier au 31 décembre 2022. Les patients opérés pour une hernie pariétale ont été inclus. Résultats Il s'agissait de 101 patients d'un âge moyen de 45,6 ans avec un sex-ratio de 2,1. Parmi les patients avec une activité physique intense, les cultivateurs étaient au nombre de 34 (32,7%), les ouvriers au nombre de 10 (9,9%) et les militaires au nombre de 10 (9,9%). Il y'avait 104 cas de hernie selon le siège. Trois patients étaient porteurs d'une hernie inguinale bilatérale. La hernie était congénitale dans 23 (22%) cas. Il s'agissait d'une récidive après cure chirurgicale sans prothèse dans 16 (15,4%) cas. Le siège de la hernie était inguinal dans 65 (62,5%) cas, la ligne blanche 24 (23,1%) cas, ombilical dans 12 (11,5%) cas, crural dans 3 (2,9%) cas. La hernie était étranglée dans 39 (37,5%) cas. L'anesthésie était générale chez 73 (72,3%) patients et on avait une rachianesthésie chez 28 (27,7%) patients. Quatre résections intestinales ont été réalisées. La cure herniaire était une plastie prothétique dans 15 (14,4%) cas. Sept (6,9%) patients ont présenté une complication dont cinq (4,9%) infections du site opératoire et deux (2%) hématomes scrotaux. Aucun décès n'a été enregistré. Conclusion Les hernies pariétales étaient fréquentes et de siège inguinal, compliquées d'étranglement, avec la présence de cas de récidive. Les prothèses herniaires étaient peu utilisées.

Introduction Objective: to study the sociodemographic, diagnostic and therapeutic profile of parietal hernias at the Sourô Sanou University Teaching Hospital. Patients and methods This was a descriptive cross-sectional study lasting one year from January 1 to December 31, 2022. Patients operated on for a parietal hernia were included. Results There were 101 patients with an average age of 45.6 years and a sex-ratio of 2.1. Among the patients with intense physical activity, the farmers were 34 (32.7%), the workers 10 (9.9%) and the military 10 (9.9%). There were 104 cases of hernia depending on the site. Three patients had a bilateral inguinal hernia. The hernia was congenital in 23 (22%) cases. It was a recurrence after surgical treatment without prosthesis in 16 (15.4%) cases. The site of the hernia was inguinal in 65 (62.5%) cases, the linea alba in 24 (23.1%) cases, umbilical in 12 (11.5%) cases, crural in 3 (2.9%) . The hernia was strangulated in 39 (37.5%) cases. The anesthesia was general in 73 (72.3%) patients and there was spinal anesthesia in 28 (27.7%) patients. Four bowel resections were performed. The hernia cure was a prosthetic plasty in 15 (14.4%) cases. Seven (6.9%) patients presented a complication including five (4.9%) surgical site infection and two (2%) scrotal hematomas. No deaths have been recorded. Conclusion Parietal hernias were frequent and inguinal in location, complicated by strangulation, with the presence of cases of recurrence. Hernial prostheses were rarely used.

Bourse aiguë de l'enfant en chirurgie pédiatrique du chu Gabriel touré / Acute bursa of the child in pediatric surgery at the teaching hospital Gabriel Touré

La bourse aiguë est une urgence médico-chirurgicale de part ses nombreuses étiologies menaçant le pronostic fonctionnel des testicules et leurs annexes. Objectifs : Identifier les causes des bourses aiguës de l'enfant et décrire leurs aspects cliniques et thérapeutiques. Matériels et méthode : Il s'agissait d'une étude descriptive retroprospective allant du 1er janvier 2010 au 31 Décembre 2015 portant sur tous les enfants âgés de 0 à 15 ans reçus et traités pour bourse aiguë dans le service de Chirurgie Pédiatrique du CHU Gabriel Touré. Résultats: En 6 ans, nous avons enregistré 42 patients soit une fréquence de 1,4% des urgences chirurgicales. L'âge moyen était de 2,98 ans (24jours-14 ans). La prématurité a représenté 11,9 % des cas. La tuméfaction scrotale douloureuse était le principal motif de consultation (76,2%), Les principales étiologies étaient la HISE (90,5%), le traumatisme scrotal (4,7%), l'orchiépididymite (2,4%) et la torsion testiculaire (2,4%). Le traitement était chirurgical dans 97,6% des cas. L'évolution après 3 mois était simple dans 97,6% des cas. Conclusion: La bourse aigue de l'enfant est une pathologie peu fréquente touchant surtout les nourrissons. La hernie inguino-scrotale étranglée était la principale étiologie. Le diagnostic doit être précoce et le traitement adéquat afin de reduire la morbi-mortalité

Acute bursa is a medico-surgical emergency because of its many etiologies threatening the functional prognosis of the testes and their appendages. Objectives: Identify the causes of acute bursaries in the child and describe their clinical and therapeutic aspects. Materials and method: This were a retrospective descriptive study from January 1, 2010, to December 31, 2015, on all children aged 0 to 15 years received and treated for acute scholarship in the Pediatric Surgery department at the teaching hospital Gabriel Touré. Results: In 6 years, we registered 42 patients, ie a frequency of 1.4% of surgical emergencies. The mean age was 2.98 years (24 days-14 years). Prematurity represented 11.9% of cases. Painful scrotal tumefaction was the main reason for consultation (76.2%), The main a etiologies were HISE (90.5%), scrotal trauma (4.7%), orchi epididymitis (2.4%) and testicular torsion (2.4%). The treatment was surgical in 97.6% of cases. The course after 3 months was simple in 97.6% of cases. Conclusion: Acute bursa in children is an uncommon condition, especially affecting infants. Strangulated inguino-scrotal hernia was the main aetiology. The diagnosis must be early and the treatment adequate in order to reduce morbidity and mortality

Clinical characteristics and risk factors of acute mechanical small bowel obstruction in adults / 中华全科医师杂志

Objective:To analyze the clinical characteristics and the risk factors of acute mechanical small bowel obstruction in adults.Methods:The clinical data of 487 adult patients with acute mechanical small bowel obstruction treated in Drum Tower Hospital Clinical College of Nanjing Medical University from June 2010 to December 2020 were retrospectively analyzed. There were 259 cases of strangulated obstruction (strangulation group) and 228 cases of non-strangulated obstruction (simple group). The cases in the strangulation group were confirmed by operation or pathology, the cases in the simple group were confirmed by non-operative therapy ( n=167) or operation ( n=61). The clinical data, including age, abdominal pain, vomiting, tenderness, rebound pain and muscle defense; the CT signs, including transitional zone, dilatation of intestinal loop, high density of intestinal wall; laboratory test results, including white blood cell count, lactate dehydrogenase (LDH) and C-reactive protein (CRP) were analyzed in both groups. Univariate and multivariate regression were used to identify risk factors of strangulated small bowel obstruction. Results:There were significant significances in gender (male vs.female: χ2=4.35, OR=0.67), rebound pain (χ2=170.98, OR=45.12), muscle tension(χ2=113.79, OR=29.32), American Society of Anesthesiologists score (ASA score)≥3 (χ2=12.94, OR=51.58), white blood cell count ( t=6.19, OR=1.14), LDH ( t=2.37, OR=1.00), CRP ( t=2.23, OR=1.01), albumin ( t=2.04, OR=0.97), mesenteric fluid sign (χ2=49.44, OR=5.40), increased bowel wall density (χ2=222.78, OR=62.66), bowel wall thickening sign (χ2=43.81, OR=3.49), ascites (χ2=237.29, OR=43.01), beak sign (χ2=231.50, OR=56.62), mesenteric fat stranding (χ2=242.65, OR=34.90), and stranding sign(χ2=224.79, OR=53.48) between strangulation group and simple group ( P<0.01). The multivariate regression analysis showed that mesenteric fluid sign ( OR=12.94), muscle tension ( OR=7.28), ascites ( OR=6.42), increased bowel wall density ( OR=4.30), bowel wall thickening sign ( OR=1.85), white blood cell count ( OR=1.14) and gender (male vs. female: OR=0.50) were risk factors of strangulated small bowel obstruction. Conclusion:In acute mechanical small bowel obstruction,for female patients presenting mesenteric fluid sign, muscle tension, ascites, increased bowel wall density, bowel wall thickening sign and increased white blood cell count, the strangulated obstruction is likely to occur.

Correlation of intestinal fatty acid binding protein and diamine oxidase with intestinal injury in strangulated bowel obstruction mice / 中华内分泌外科杂志

Objective:To investigate the correlation of intestinal fatty acid binding protein and diamine oxidase with intestinal injury in strangulated bowel obstruction mice.Methods:160 SD rats were divided into 5 groups by random number table: group A ( n=32) : normal control group; group B ( n=32) : sham operation group; group C ( n=32) : simple intestinal obstruction group; The strangulated intestinal obstruction group was divided into group D ( n=32) : acute superior mesenteric artery ischemia group and group E ( n=32) : acute mesenteric arterial and venous ischemia. Except group A, other groups were given operation for modeling. Venous blood and small intestinal segment of group A was collected after anaesthesia, and venous blood and small intestinal segment of other groups were collected after modeling for 4 h. Serum samples were collected from venous blood, and intestinal fluid samples were collected by soaking the small intestinal segments. The intestinal segments were observed and the intestinal injury was evaluated. The levels of intestinal fatty acid binding protein (I-FABP) and activity of diamine oxidase (DAO) in serum and intestinal fluid were detected. Pearson correlation analysis was used to analyze the correlation between intestinal injury and the serum and intestinal fluid levels of I-FABP and activity of DAO, respectively. Results:The intestinal damage scores in group B, C, D and E were higher than that in group A, the intestinal damage scores in groups C, D and E were higher than that in group B, the intestinal damage scores in groups D and E were higher than that in group C, and the intestinal damage score in group E was higher than that in group D ( P<0.05) . The serum I-FABP level and DAO activity in group C, D and E were higher than those in group A and B, and the serum I-FABP level and DAO activity in group D and E were higher than those in group C ( P<0.05) . The level of I-FABP and DAO activity in intestinal fluid in group C, D and E were higher than those in groups A and B, and the level of I-FABP and DAO activity in intestinal fluid in group D and E were higher than those in group C ( P<0.05) . There were positive correlations between intestinal injury and the serum and intestinal fluid levels of I-FABP and activity of DAO, respectively ( r=0.972, P<0.001; r=0.899, P<0.001; r=0.961, P<0.001; r=0.828, P<0.001) . Conclusions:Intestinal injury of strangulated bowel obstruction mice is related to the intestinal ischmia. There are increases of serum and intestinal fluid levels of I-FABP and activity of DAO in strangulated bowel obstruction mice, which are closely related to the degree of intestinal injury.

Incarcerated Amyand hernia: a rare entity

Right sided inguinal hernia containing vermiform appendix in its sac is called as amyand’s hernia. It accounts for ∼1% of all inguinal hernias. It is an intra operative finding during an inguinal hernia repair. A 64 years old male patient came with complains of swelling in the right inguinal region, associated with pain and vomiting. On examination of the right inguinal region there was a tender irreducible swelling palpable. Based on the characteristic finding it was diagnosed clinically as right sided irreducible obstructed inguinal hernia. Ultrasound abdomen was done which was suggestive of right inguinal hernia with herniation of bowel and omentum with features of strangulated/ obstructed hernia. Patient was taken up for right inguinal hernia repair and appendix was noted in the hernial sac intra-operatively. Although occurrence of amyand’s hernia is rare. The attendant surgeon should be vigilant about the presence of it. Preoperative diagnosis of amyand’s hernia is not common because in majority of cases objective of imaging is to exclude conditions that predispose to inguinal hernia formation. The Losanoff and Basson’s criterion is used as a guide for deciding whether to perform appendectomy and type of repair, depend on the clinical scenario.

Iatrogenic diaphragmatic hernia after laparoscopic gastric band removal: a rare case report

Iatrogenic diaphragmatic hernia is a rare complication of esophageal and upper abdominal surgery. The use of the gastric band has been an established and popular surgical treatment for morbid obesity. We describe a rare case of a patient who had undergone laparoscopic surgery to remove an adjustable gastric band, who presented 5 months later with an acute intense thoracic pain. The computed tomography scan revealed a diaphragmatic hernia containing the stomach. The patient required emergent laparoscopic surgery to reduce the hernia, repair the defect and resection of the ischemic stomach. In this case report, we discuss the etiology, diagnosis and treatment of this very rare complication of laparoscopic gastric banding removal.

Profile and Management of Complicated (Strangulated) Prolapsed Internal Hemorrhoids at a Tertiary Care Hospital – A Prospective Study

Introduction: Neglected cases of hemorrhoids presentingwith complications like strangulation are not uncommon,as observed in our tertiary care hospital. Under the abovebackground we conducted the present study to look into theprofile and management of the patients with complicated(especially strangulated) prolapsed hemorrhoids attending toour tertiary care hospital.Material and methods: This prospective hospital based studywas conducted in unit-II of department of general surgery inShri Maharaja Harisingh (SMHS) hospital Srinagar over aperiod of 5 years from January 2013 to December 2017. Allpatients with complicated prolapsed internal hemorrhoids(strangulation with infection, ulceration, gangrene, and/or necrosis) were enrolled in this study. Patients presentingwith features suggestive of complicated prolapsed internalhemorrhoids were subjected to clinical history, local inspectionand examination to confirm the diagnosis, and were managedappropriately.Results: During the study period of 5 years, 31 patients ofcomplicated (strangulated) prolapsed internal hemorrhoidswere enrolled. The age of our patients ranged from forty-fourto seventy-two years with mean age of 59.12±6.56 (SD=6.56)years. In our study 20 patients (64.5%) were from rural areaand 11 patients (35.5%) were from urban background. Mostcommon presentation in our study was strangulated prolapsedinternal hemorrhoid with pain, ulceration and infection.Conclusion: Patients with grade 3 and 4 internal hemorrhoids,patients having difficult access to health care facilities, andpatients having poor compliance to conservative treatment,should be offered surgical intervention at the earliest beforethe complications arise. Complicated prolapsed internalhemorrhoids can be managed initially conservatively (byprone position, bed rest, saline compresses, hot baths, icepacks, soothing topical applications, laxatives, antibiotics, sitzbath with antiseptic solutions)

Early diagnosis and surgery timing of strangulated intestinal obstruction / 局解手术学杂志

Objective To investigate the early diagnosis and surgery timing of strangulated intestinal obstruction.Methods The clinical data of 90 patients with strangulated intestinal obstruction who were admitted into our hospital from January 2013 and January 2016 were retrospectively analyzed.And these patients were divided into the early stage group (28 cases) and the later stage group (62 cases).The rate of mortality and the rate of necrotic bowel resection of the two groups were analyzed.Results Among the 90 patients underwent emergency surgery,there were 88 cases cured and 2 cases died,and there were 10 cases (11.11％) of necrotic bowel resection among the survivor.In the early stage group,there were 8 cases of necrotic bowel resection and 1 case of death.In the later stage group,there were 2 cases of necrotic bowel resection and 1 case of death.Conclusion Early diagnosis and prompt surgical treatment can reduce the mortality of strangulation obstruction and necrosis of bowel resection.

Effect of laparoscopy-assisted partial small bowel resection on patients with strangulated inguinal hernia / 中国内镜杂志

Objective To investigate the effect of laparoscopy-assisted partial small bowel resection combined with open tension-free hernioplasty on patients with strangulated inguinal hernia. Methods 98 patients with strangulated inguinal hernia from January 2013 to December 2015 in our hospital were enrolled in the study and divided into the minimally invasive group (n= 41, laparoscopy-assisted partial small bowel resection combined with open tension-free hernioplasty) and laparotomy group (n=57, open partial small bowel resection combined with Bassini repair) ac﹣cording to the operation mode. Preoperative baseline data, operation time, postoperative complications, postoperative hospital stay, survival status and recurrence rate were compared between two groups. Results There were no signifi﹣cant differences in preoperative baseline data between the two groups (P> 0.05). The incidence of postoperative chronic pain and recurrence in the minimally invasive group were significantly lower than that in laparotomy group (P0.05). Conclusions For patients with strangulated inguinal hernia, laparoscopy-assisted partial small bowel resection combined with open tension-free hernioplasty could not only make full use of advantages of tension-free repair patch, but also avoid pol﹣lution of the bowel resection to patch, which can reduce the risk of infection and recurrence, it is worthy of clinical application.

Diagnostic value of histidine decarboxylase for strangulated intestinal obstruction / 国际外科学杂志

Early diagnosis is one of the difficulties in strangulated intestinal obstruction.Serological markers for the early diagnosis of intestinal obstruction has become a hot spot resently.Studies have shown that histidine decarboxylase had a high sensitivity and specificity in the diagnosis of gastric mucosal injury of intestinal obstruction,which would be expected to become an effective serological marker for the early diagnosis of strangulated intestinal obstruction.In this review,the author will describe the advance of serum histidine decarboxylase level for diagnosis of strangulated intestinal obstruction.

A Case of Left-sided Morgagni Hernia Complicating Incarcerated Small Bowel Hernia / 대한소화기학회지

Morgagni hernia is an uncommon presentation representing about 3% in incidene and usually located in the right-sided anterior diaphragm. We experienced a case of Morgagni hernia in a seventy four-year-old male who was admitted complaining of intermittent abdominal pain. The diagnosis was made initially by chest and abdominal radiography, and an incarcerated Morgagni hernia was finally diagnosed with abdominal CT scans. Emergent laparotomy was performed. Morgagni foramen was located on the left-sided anterior diaphragm and Morgagni hernia which contained greater omentum and strangulated small intestine was gently reducted. Morgagni foramen measuring 4x5 cm was repaired with a Gortex mesh. We reported the experience of left-sided Morgagni hernia complicating incarcerated small bowel hernia in an old male patient.

Strangulated Obturator Hernia: Mesh-Plug Technique

Although obturator herniae are rare, they are associated with a high mortality, as diagnosis is often delayed and the condition tends to occur in the elderly. The preoperative diagnosis is difficult because of nonspecific symptoms and sign. They often produce a small bowel obstruction. The treatment is always surgical. Several repair techniques have been described: a sac ligation alone, a direct suture repair, and the use of autologous tissue or prosthetic repair. Recently, the placement of permanent mesh prostheses, in a clean contaminated operative field, has been performed due to the minimal wound-related morbidity and patient mortality. Thus, utilization of a permanent mesh in an obturator hernia is a new, simple and effective method for repair. Two cases of a strangulated obturator hernia were experienced in elderly women. The peritoneal cavity was not overly contaminated, with only necrotic foci on the herniated small bowel wall noted. A segmental resection of the small bowel was performed. Consequently, the hernia defect was closed with mesh- plug between the peritoneum and periosteum of the obturator foramen. Here, two cases of obturator herniae treated by use of a mesh-plug are reported, with a brief review of the literature.

Preoperative Diagnosis of Strangulated Obturator Hernia Using CT

Obturator hernia is a rare pelvic hernia, occuring most frequently in elderly, debilitated women. Because of nonspecific symptoms, the diagnosis of obturator hernia is often delayed until laparotomy for bowel obstruction. This leads to high bowel resection and mortality rates, which represents a diagnostic and therapeutic challenge for surgeons today. We experienced an unusual case of right obturator hernia with strangulation in an 81-year-old female patient who presented with intermittent generalized, particularly right lower quadrant, abdominal pain and distension. The hernia was diagnosed by computed tomography (CT) scan and repaired using the lower midline transperitoneal approach. CT scan in the evaluation of patients with nonspecific intermittent gastrointestinal symptoms leads to a diagnosis of occult hernia. We report these findings with a brief review of the literature focusing on finding indicators leading to early diagnosis and treatment.

Strangulated Obturator Hernia

An obturator hernia is an extremely rare rupture that protrudes through the canal that transmits the obturator vessels. We performed computed tomography of the abdomen and pelvis on two elderly debilitated women patients with small bowel obstructions to make a correct diagnosis. We report these with a brief review of the literature.