Transomental hernia - An enigmatic case report causing bowel obstruction in a virgin abdomen.

INTRODUCTION: Transomental hernias are very uncommon form of internal hernias. Occasionally they may be seen in present clinical practice after bariatric surgery. Yet, this type of internal hernia remains mostly incidental and enigmatic in its presentation. CLINICAL FINDINGS: We present a case of transomental hernia that caused subacute small bowel obstruction in a patient with no past history of any surgical procedure, i.e. in a virgin abdomen. DIAGNOSIS AND THERAPEUTIC INTERVENTION: CT Scan of the abdomen revealed the presence of transomental hernia and it was addressed by laparoscopic surgery and an uneventful postoperative outcome. CONCLUSION: Transomental Hernias can be present in virgin abdomen also. Its presence should be considered in all suspicions of internal hernia occurrence even though they are commonly known to be associated with bariatric surgery, liver surgery, etc.

The efficacy of periprostatic local anaesthetic infiltration in transrectal ultrasound biopsy of prostate: a prospective randomised control study.

OBJECTIVE: It is still uncertain as to which form of anaesthesia is the optimum. We conducted a study to identify the best location and optimum volume of anaesthetic agent in order to achieve best pain relief and cooperation from our patients. We also assessed the need for local anaesthetic gel for probe lubrication and if the number of cores during biopsy makes a difference in the pain score. MATERIALS AND METHOD: A total of 386 patients were randomised into 4 groups i.e. no anaesthesia (Group A), 10 cc 1% Lignocaine at apical region of prostate (Group B), 5 cc 1% Lignocaine each at both bases (Group C) and lastly, 4 cc at apex and 3 cc each at both bases (Group D). Pain assessment was performed using the 10-point Visual Analog Scale after the procedure with regard to probe insertion and during the biopsy. RESULTS: The groups were comparable in number and mean age. Group B recorded the lowest mean pain score of 2.59. Comparative analysis showed significant pain relief when comparing Group B vs. Group A (P = 0.001). The other groups were not as effective. The overall mean pain score for the probe insertion and the number of cores during biopsy was also not significant. CONCLUSIONS: We suggest that a 10 cc 1% Lignocaine infiltration at the apical region of the prostate be used to obtain best pain relief during this procedure. Plain lubricant jelly is sufficient for probe insertion. There is no need to alter the anaesthetic requirement if number of cores is increased.