Acute intestinal obstruction secondary to left paraduodenal hernia: a case report and literature review.

INTRODUCTION: An internal hernia is a protrusion of bowel through a normal or abnormal orifice in the peritoneum or mesentery. Although they are considered as a rare cause of intestinal obstruction, paraduodenal hernias are the most common type of congenital hernias. METHODS: A literature search using PubMed was performed to identify all published cases of left paraduodenal hernia (LPDH). RESULTS: In Literature search between 1980 and 2012 using PubMed revealed only 44 case reports before the present one. Median age was 47 years (range 18 - 82 years). Nearly 50% reported previous mild symptoms. Two-third of patients required emergency surgery in form of laparotomy or laparoscopic repair. Reduction of hernia contents with widening or suture repair of the hernia orifice were the most common standards in surgical management of LPDH. CONCLUSION: Intestinal obstruction secondary to internal hernias is a rare presentation. High index of suspicion and preoperative imaging are essential to make an early diagnosis in order to improve outcome.

SPECT/CT of axillofemoral graft infection.

A 73-year-old woman was admitted to the hospital via the emergency room with increasing pain and tenderness in the right axilla and high fevers. She had a long history of peripheral vascular disease with multiple graft failures and recent insertion of a right axillofemoral graft. A computed tomography study of the chest obtained at admission confirmed graft patency and a small fluid collection around the graft at the level below the right axilla. It also confirmed a saccular aneurysm of the aortic arch. A SPECT/CT study of the chest at 3 hours after reinjection of autologous leukocytes labeled with Tc-99m showed intense labeled leukocyte uptake around the vascular graft in the lateral chest wall. Culture of the infected tissue around the excised graft grew Staphylococcus aureus sensitive to all tested antibiotics. Vascular graft infections are rare, with few reported cases of axillofemoral graft infections utilizing Ga-67. Labeled leukocytes have been used successfully in the setting together with CT scanning. This is a rare case of labeled leukocyte uptake in an infected axillofemoral graft by SPECT/CT.