Ultrasound-guided reduction of an incarcerated Spigelian hernia.

Spigelian hernia is a rare abdominal hernia. We report a case in which its diagnosis proved ultrasonography to be an effective tool, not only to diagnose an incarcerated Spigelian hernia but, moreover, to reduce it by echo-probe palpation. Ultrasound (US) is an aid for therapy of various diseases. In our experience, US-guidance prevented possible damage related to forced and wrongly applied compression during the hernia reduction, and allowed us to perform surgical repair on an elective basis. In conclusion, if an incarcerated Spigelian hernia is suspected, a US examination should be done on an emergency basis to confirm the diagnosis and to attempt US-guided reduction.

Ultrasonographic detection of portal branches and hepatic vein gas associated with mesenteric artery occlusion: a new finding correlated with patient prognosis?

The diagnosis of bowel infarction is still a challenge. In some cases, portal venous gas is an associated feature and in these patients, the prognosis is very poor. We report on our experience with two consecutive cases in which ultrasonography showed gas in the portal venous branches, and also in the hepatic veins in one of them. At laparotomy, advanced bowel necrosis was found, and both patients died within 24 hours. Other cases of portal venous gas associated with bowel infarction have been reported, but this is the first report of gas also being found in the hepatic veins. There may be a relationship between the amount of gas in the intrahepatic veins and the stage of bowel ischemia. Confirmation of this might improve the selection of patients and eliminate unnecessary procedures.

[Videothorascopic treatment of benign tumors of the chest wall. Report of a case of neurilemmoma]. / Trattamento videotoracoscopico dei tumori benigni della parete toracica. Rapporto su di un caso di neurilemmoma.

Intercostal nerve sheat tumors are rare and normally benign tumors. The successful thoracoscopic resection of an intercostal neurilemmoma is reported. It occurred in an asymptomatic 44 year-old woman. Diagnostic flowchart consisted in an enhanced CT of the chest and in a fine needle biopsy under CT guidance of the chest wall mass. The videothoracoscopic resection was carried out with three small incisions, in a relatively brief time and without high technical difficulties. Postoperative course was uneventful and the patient was discharged in the fourth postoperative day. In authors' opinion thoracoscopic approach is actually mandatory as a first attempt to cure benign neurogenic tumors of the chest wall.

The usefulness of ultrasonography in the diagnosis of the Spigelian hernia.

Normally acquired, the Spigelian hernia is rare. Due to low incidence and frequent atypical presentations diagnosis is often difficult. Controversies exist about the diagnostic approach. We report our experience in two cases in which ultrasonography permitted a correct diagnosis of surgically confirmed Spigelian hernias. One of the two cases proved to be a carrier of bilateral Spigelian hernia at ultrasonography and at surgery. In our opinion ultrasonography represents the gold standard in the diagnosis of Spigelian hernias and we recommend its use as the first step in all cases of abdominal wall mass.