Paraduodenal hernias: a systematic review of the literature.

PURPOSE: Paraduodenal hernias (PDH), also called mesocolic hernias, account for up to 53% of all internal hernias, but they cause only 0.2-0.9% of all cases of intestinal obstruction. This is the first systematic review of all reported cases so far, investigating their clinical presentation, radiological imaging, and treatment outcomes. METHODS: After a detailed search in PubMed and Medline, using the keywords "paraduodenal hernia", 115 studies matched our criteria. A review of these reports was conducted and the full texts were examined. RESULTS: A total of 159 patients were included in our analysis, with 69.8% and 30.2% of them suffering from either a left or a right PDH, respectively. Mean age at diagnosis was 44.1 years, with a 2/1 male/female ratio. PDH were associated with non-specific symptoms and signs; abdominal pain being the most common. Computed tomography (CT) scan of the abdomen was the most frequently used diagnostic modality. Regardless of PDH localization, all patients were operated on, with approximately one-third of them undergoing a laparoscopic operation, which was associated with a significantly decreased morbidity rate as well as length of hospital stay, compared with the open repair. CONCLUSIONS: PDH are not usually associated with specific symptoms and signs; thus, they constitute a diagnostic challenge, requiring a high level of knowledge and clinical suspicion. Undoubtedly, CT scan of the abdomen is the gold standard diagnostic tool. Their operative repair is mandatory, with the laparoscopic approach demonstrating significant advantages over the open repair, seeming to be the optimum treatment strategy.

An alternative management of a Littré hernia case: food for thought.

AIM: We present a novel approach to a Littré hernia case. CASE REPORT: A 62-year old male presented at our department with a painless mass in the inguinal area and was successfully treated for an inguinal Littré hernia. A Lichtenstein tension-free mesh repair was used without performing simultaneous diverticulectomy. DISCUSSION: Resection of an asymptomatic Meckel's diverticulum remains a controversial issue. In adult population, leaving an accidentally found silent Meckel's diverticula in situ could reduce the risk of postoperative complications without increasing late complications. Mesh-based techniques provide lower recurrence rates compared to non-mesh techniques. CONCLUSIONS: Management of asymptomatic Littré hernias presents a challenge for the operating surgeon. Treatment guidelines should be developed for the optimal management of these patients.

Littre's hernia: a systematic review of the literature.

PURPOSE: A hernia containing Meckel's diverticulum is called a Littre's Hernia. It's a rare entity and its diagnosis is often incidental during routine hernia repair surgery. The objective of this study is the evaluation of the current evidence on Littre's hernias regarding their clinical presentation and optimal treatment approach. METHODS: PubMed and Cochrane bibliographical databases were searched from the beginning of time (last search: August 1st, 2018) for studies reporting on Littre's hernias in adult population. RESULTS: Forty-five studies met our inclusion criteria and reported collectively on 53 patients (21 males and 32 females) presenting at health care units with a Littre's hernia. The most common sites of occurrence were femoral (39.6%) and inguinal (34%). The vast majority of cases (77.4%) concerned incarcerated hernias. All patients underwent surgical hernia repair accompanied by a diverticulectomy and 16.9% of them received mesh. Only 7.5% of patients experienced immediate postoperative complications. CONCLUSIONS: A Littre hernia is a rare complication of Meckel's diverticulum. It requires surgical attention and all medical professionals should be encouraged to report such cases to expand our experience and optimize the therapeutic approach.

[Presence of microcilia on the apical extremity of the cilia of the epithelium of the Fallopian tubes]. / Présence de microcils sur l'extrémité apicale des cils de l'épithélium de la trompe utérine.

The role played by the ciliated cells of the salpinx in the transport of the ovum has been the subject of numerous studies. In this work we examined the ultrastructure of the cilia of the ampullary portion of the oviductal epithelium in a series of mammals and in man. We found the classical structure of the motile cilia. The free part of the cilia, surrounded by the cell membrane, is composed by nine peripheral doublets and by a pair of central microtubules. In the species we examined, we had the occasion to observe an ultrastructural particularity of the cilia. It is about a group of microcilia placed on their apical extremity. These formations were observed in longitudinal sections and appeared aligned on the top of the cilium. They have a length of 200-300 A and a diameter of 100 A. Their number varies with the species examined. The proportion of cilia which presented microcilia is also different from species to species. The functional role of the microcilia is unknown.

Electron microscopic study of the oviduct epithelium of the rabbit: normal structure and modifications in 4 weeks experimental hydrosalpinx.

The ultrastructure of the oviduct epithelium in its ampullary portion has been examined in 10 rabbits. As normal control material we used microbiopsies of tubal mucosa, taken before ligature of the oviduct. The experimental material consisted of microbiopsies of tubal mucosa, taken in the same animals, 4 weeks after ligature of the oviduct and subsequent induction of hydrosalpinx. The main morphological alteration of the epithelium in hydrosalpinx consisted of absence of cilia in certain areas and presence of vacuoles in the cytoplasm of the ciliated cells. The secretory cells showed an increased number of granules in their cytoplasm. These observations suggest that 4 weeks after ligature of the oviduct the destruction of cilia and the increase of secretions may cause an impairment in the ovum transport through the oviduct.