ABSTRACT
INTRODUCTION: Littre's hernia (LH) is due to the presence of a Meckel's diverticulum (MD) in a hernial sac. It is an extremely rare condition in less than 1 % of all MD cases. It is often asymptomatic and is diagnosed incidentally during routine surgery for hernia repair. Surgery is the main treatment. Although the management of uncomplicated MD remains controversial, MD's management in the setting of either bowel obstruction or of Littre's hernia is done according to the clinical principles combined with the availability of local expertise. PRESENTATION OF CASE: We report a case of an 11-year-old boy presented to the emergency room with a diagnosis of acute obstructive syndrome. Radiological exams were inconclusive. Intra-operatively findings showed a strangulated MD trapped in a small umbilical hernia. A simple wedge resection, followed by a primary closure of the remaining defect was performed. During 12 months of observation the patient remains in good condition. DISCUSSION: LH is an uncommon type of abdominal wall hernia. Preoperative diagnosis is difficult. Even abdominal ultrasound and computed tomography (CT) cannot reveal the right diagnosis and it is generally performed intraoperatively. The main treatment is surgery. Repair of a Littre hernia requires both management of Meckel's diverticulum and repair of the hernia with sutures or mesh. CONCLUSION: LH is a very rare type of hernia. Diagnosis is very difficult. All surgeons should be aware of this type of hernia to avoid life-threatening complications. The application of hernia repair recommendations for children may anticipate the happening of complicated LH.
ABSTRACT
Gallbladder agenesis is a rare congenital anomaly. This study aimed to highlight the epidemiological aspects of this condition as well as the peculiarities of its diagnostic and therapeutic management through three case reports. Two adults were admitted to Hospital with hepatic colics and dyspepsia. Ultrasound showed multilithiasic scleroatrophic vesicle. In one of the two patients, CT scan results showed a stone at the level of scleroatrophic vesicle. These two patients were wrongly operated for vesicular lithiasis by using conventional method. The absence of gallbladder was detected during surgery. In order to confirm post-operative diagnosis, the first patient underwent biliary MRI. The other patient was lost to follow-up. The third patient was a 13-year old child hospitalized with acute pancreatitis. Vesicular agenesis was suspected based on its scannographic aspect and then confirmed using biliary MRI. This patient didn't underwent surgery.
Subject(s)
Congenital Abnormalities/diagnosis , Gallbladder/abnormalities , Magnetic Resonance Imaging/methods , Tomography, X-Ray Computed/methods , Ultrasonography/methods , Adolescent , Congenital Abnormalities/diagnostic imaging , Dyspepsia/etiology , Female , Gallbladder/diagnostic imaging , Humans , Male , Middle Aged , Pancreatitis/diagnosisABSTRACT
Blunt chest trauma remains a public health problem due to the severity of caused injuries, diagnostic difficulties and therapeutic orientation. There is no correlation between the parietal lesions and endothoracic abnormalities. Instead radiological examinations are far from accurate. Through a study of 72 cases of closed chest trauma and a literature review we propose to identify risk factors of endothoracic lesions, to clarify the role of radiological examinations in the exploration of these injuries and propose a decisional algorithm.
Subject(s)
Radiography, Thoracic , Thoracic Injuries/diagnosis , Wounds, Nonpenetrating/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Diagnosis, Differential , Female , Hemothorax/diagnosis , Hemothorax/epidemiology , Hemothorax/etiology , Humans , Infant , Infant, Newborn , Lung Diseases/diagnosis , Lung Diseases/epidemiology , Lung Diseases/etiology , Male , Middle Aged , Radiography, Thoracic/standards , Retrospective Studies , Rib Fractures/diagnosis , Rib Fractures/epidemiology , Rib Fractures/etiology , Risk Factors , Thoracic Injuries/complications , Thoracic Injuries/epidemiology , Thoracic Injuries/therapy , Tomography, X-Ray Computed , Wounds, Nonpenetrating/complications , Wounds, Nonpenetrating/epidemiology , Wounds, Nonpenetrating/therapy , Young AdultSubject(s)
Chylous Ascites/complications , Peritonitis/etiology , Acute Disease , Child , Chylous Ascites/diagnosis , Humans , Male , Peritonitis/diagnosisABSTRACT
BACKGROUND: Mesh- based hernioplasties became the reference in inguinal hernia repair. AIM: To evaluate the results of combining a conic Plug to the Lichtenstein Mesh for inguinal hernia repair. METHODS: Between January 2007 and January 2009 we included 50 patients with primary or recurrent inguinal hernia in a prospective comparative randomized controlled trial. The randomization concerned the association of the conic Plug to the Lichtenstein Mesh. The primary objectives were to establish if any differences in operation time, postoperative pain response and/or postoperative recovery time, chronic pain and recurrence could be detected between the 2 groups. All patients were seen and data were collected after 2 weeks, 6 months and 2 years. RESULTS: Twenty two patients were treated by Lichtenstein Mesh (group A) and we associated the conic Plug to 28 patients (group B). The mean age was 56 years. Forty three patients were discharged after 24 hours. The postoperative pain was low with visual analogue scores ≤ 5 for 48 patients. One patient had residual pain treated efficiency with medical treatment. No recurrence in the 2 groups in 2 years outcome. There were no significant differences between the 2 groups. CONCLUSION: Results of the Lichtenstein plus Plug technique are similar to the Lichtenstein results. There were no significant differences between the 2 groups concerning early or late complications. The recurrence will be revaluated after 5 and 10 years outcome.
