ABSTRACT
External fistulization or subcutaneous rupture of liver echinococcal cyst (EC) is found occasionally with total of 15 cases reported in the literature. We report a case of 60-year-old female previously misdiagnosed as fistulizated osteomyelitis of the 11(th) rib. At computed tomography scan, non-vital EC was noted in the third liver segment. Under suspicion of external fistulization of perforated EC the patient underwent one-stage operation-pericystectomy and complete fistula excision. A retrospective analysis of the reported cases in the literature was performed with special references to classifying this rare entity. The main purpose of this report is to highlight the possibility of such a diagnosis when cutaneous fistula occurs in a same anatomic area with hydatid EC, even that cyst is proven to be calcified. We emphasize the role of a swift and radical surgical procedure including complete fistula excision to prevent secondary dissemination and post-operative complications.
ABSTRACT
A number of investigations advocate various classification systems for liver hydatid cysts. However, none permits predicting the treatment outcome or making clinical decisions regarding medical treatment; open surgery; punction, aspiration, injection, reaspiration (PAIR); or laparoscopy. An international hydatid disease registry employing an uniform nomenclature and consistent reporting methods would allow more rational comparison of different management strategies. TN(R)C (topography, nature, recurrent, complication) classification is a comprehensive system based on four criteria: location (T), natural history (N), recurrence (R) and complications (C) of the cyst. This pictorial review illustrates the classification and puts accent of its clinical usefulness. The TN(R)C classification provides a standardized description formula of every liver hydatid cyst, permitting multiple comparisons and analyses.
Subject(s)
Echinococcosis, Hepatic/classification , Animals , Decision Making , Digestive System Surgical Procedures/methods , Echinococcosis, Hepatic/surgery , HumansSubject(s)
Abscess/diagnosis , Bacteroides Infections/diagnosis , Bacteroides fragilis/isolation & purification , Foreign-Body Migration/diagnosis , Pelvic Infection/diagnosis , Abscess/surgery , Adult , Bacteroides Infections/therapy , Drainage/methods , Female , Follow-Up Studies , Foreign-Body Migration/complications , Foreign-Body Migration/surgery , Humans , Laparotomy , Pelvic Infection/etiology , Pelvic Infection/surgery , Pelvis , Risk Assessment , Time Factors , Treatment OutcomeABSTRACT
Only two cases of appendicitis in strangulated obturator hernia have been previously reported. In the present case, an 83-year-old woman had fatal anaerobic myonecrosis of the thigh that resulted from gangrenous appendicitis in the right obturator foramen. Early diagnosis, prompt surgical intervention, and perioperative resuscitation are critical for survival in a case of appendicitis in a strangulated obturator hernia with thigh sepsis, especially when it occurs in an elderly, emaciated female patient.
Subject(s)
Appendicitis/etiology , Gangrene/etiology , Hernia, Obturator/complications , Aged , Aged, 80 and over , Appendicitis/diagnosis , Appendicitis/therapy , Fatal Outcome , Female , Gangrene/diagnosis , Gangrene/therapy , Hernia, Obturator/diagnosis , Hernia, Obturator/therapy , HumansABSTRACT
Isolated infection and/or gangrene of the round and falciform liver ligaments is among the rarest causes of acute abdomen. The diagnosis is based on demonstrating localized or patchy inflammatory or gangrenous changes in the ligaments without apparent etiology. We report the case of an 18-year-old male who presented with a 24-hour history of generalized abdominal pain and distention, nausea, and vomiting. With a preoperative diagnosis of probable perforated duodenal ulcus and generalized peritonitis the patient underwent emergency surgery. Multiple patchy gangrenous areas of the round and falciform ligaments were found starting from the umbilicus up to the hepatic hilum. The ligaments were resected in toto. The patient's postoperative course was unremarkable. No apparent etiology of the condition was found. We provide the first extensive review of the world literature. Isolated infection and/or gangrene of the round and falciform liver ligaments should be suspected in patients with upper abdominal complaints when imaging studies demonstrate ligament abnormality, tumor, or fluid. Treatment is only surgical. Depending on surgeon's expertise, patient's condition, and severity and extent of disease either open or laparoscopic surgery may be performed.
Subject(s)
Abdomen, Acute/etiology , Ligaments/pathology , Liver , Peritonitis/etiology , Adolescent , Gangrene , Humans , Ligaments/surgery , MaleSubject(s)
Hernia/diagnosis , Herniorrhaphy , Aged , Humans , Lumbosacral Region , Male , Prostheses and Implants , Surgical MeshSubject(s)
Paraphilic Disorders/complications , Rectum/injuries , Animals , Humans , Male , Middle Aged , Peritonitis/etiology , SwineABSTRACT
Frequentemente as camadas profundas do canal inguinal nao tem consistencia adequada para permitir a recontrucao natural apenas com estes tecidos; as vezes a utilizacao de estruturas mais superficiais torna-se necessario desde que o reforco local com proteses sinteticas nao possa ser empregado. O objetivo deste estudo e comparar os resultados obtidos no tratamento da hernia inguinal pela tecnica de Stetten com os resultados historicos observados em...
