ABSTRACT
The finding of appendicitis within an inguinal hernia is a recognized phenomenon: Amyand's hernia. The development of necrotising soft tissue infection-necrotising fasciitis-is associated with high morbidity and mortality. We present a case of Amyand's hernia resulting in a severe, life-threatening necrotising soft tissue infection, which is previously unreported in English literature. We outline features relating to the diagnosis of this rare condition, and improve awareness among clinicians of the possibility of appendicitis within a direct inguinal hernia, and highlight the importance of appropriate initial surgical intervention for necrotising soft tissue infection to improve survival for these patients.
Subject(s)
Abdominal Wall , Appendicitis/complications , Fasciitis, Necrotizing/etiology , Hernia, Inguinal/complications , Aged , Appendicitis/diagnosis , Appendicitis/microbiology , Appendicitis/surgery , Debridement , Diagnosis, Differential , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/microbiology , Fasciitis, Necrotizing/surgery , Female , Hernia, Inguinal/diagnosis , Hernia, Inguinal/surgery , HumansSubject(s)
Cholelithiasis/pathology , Aged , Aged, 80 and over , Cholelithiasis/diagnostic imaging , Female , Humans , UltrasonographySubject(s)
Pancreatitis/complications , Splenic Infarction/etiology , Acute Disease , Humans , Male , Middle Aged , Splenic Infarction/diagnosisABSTRACT
We report a case of colovesical fistula caused by chronic perforation of sigmoid colon diverticulum due to a swallowed chicken bone. This appears to be the fifth case of its kind ever reported in the literature.
Subject(s)
Foreign Bodies/complications , Intestinal Fistula/etiology , Intestinal Perforation/etiology , Urinary Fistula/etiology , Animals , Bone and Bones , Chickens , Chronic Disease , Diverticulum, Colon/diagnosis , Diverticulum, Colon/etiology , Foreign Bodies/diagnosis , Foreign Bodies/surgery , Humans , Intestinal Fistula/surgery , Intestinal Perforation/diagnosis , Intestinal Perforation/surgery , Male , Middle Aged , Urinary Fistula/surgeryABSTRACT
Warfarin therapy is associated with a variety of haemorrhagic complications. We report a representative series of six cases of warfarin-induced bleeding in non-cerebral sites admitted to one unit. In all of these cases, there was inadequate control of anticoagulation, resulting in major morbidity and one death. In particular, closer attention must be paid to the indications for and duration of warfarin treatment.
Subject(s)
Hematoma/chemically induced , Hemorrhage/chemically induced , Warfarin/adverse effects , Aged , Aged, 80 and over , Female , Hematoma/surgery , Hemorrhage/surgery , Humans , Male , Middle Aged , Retroperitoneal Space/blood supply , Warfarin/therapeutic useSubject(s)
Osteomyelitis/microbiology , Sternum/microbiology , Streptococcal Infections/microbiology , Aged , Female , HumansABSTRACT
To investigate anorectal function in solitary rectal ulcer syndrome 22 patients were studied by means of balloon expulsion, intestinal transit time, barium enema and evacuation proctography. Half of the patients tested had difficulty in expelling a water filled balloon. Delay in intestinal transit was noted in only three patients. Barium enema was of little benefit in diagnosing the condition. Evacuation proctography was the investigation of choice in that it showed at least one abnormality of pelvic floor function in all of the patients and can help select patients for surgery.
Subject(s)
Rectal Diseases/physiopathology , Adult , Barium Sulfate , Defecation , Enema , Female , Gastrointestinal Transit , Humans , Male , Middle Aged , Radiography , Rectal Diseases/diagnosis , Rectal Diseases/diagnostic imaging , Rectal Diseases/etiology , Ulcer/diagnosis , Ulcer/diagnostic imaging , Ulcer/etiology , Ulcer/physiopathologySubject(s)
Spermatic Cord Torsion/diagnosis , Adolescent , Adult , Child , Child, Preschool , Humans , Male , Retrospective Studies , Spermatic Cord Torsion/surgery , Testis/surgerySubject(s)
Leukoplakia/etiology , Rectal Diseases/complications , Vaginal Neoplasms/etiology , Female , Humans , Middle Aged , Syndrome , Ulcer/complicationsABSTRACT
We have found excessive perineal descent to be associated with a variety of anorectal problems and have reviewed the clinical features in 29 patients who were noted to have excessive perineal descent as measured by perineometer. The condition mostly occurs in women and is usually associated with straining at stool, rectal bleeding, mucus discharge, perineal or abdominal pain and urinary incontinence.
Subject(s)
Fecal Incontinence/etiology , Perineum/anatomy & histology , Rectal Prolapse/physiopathology , Adult , Aged , Female , Humans , Male , Middle Aged , Perineum/physiopathologyABSTRACT
Rectal prolapse and solitary rectal ulcer syndrome are both benign conditions affecting the rectum, mainly in women; prolapse tends to occur late in life, while solitary rectal ulcer syndrome has a predilection for the younger adult. Complete rectal prolapse probably starts as a mid-rectal intussusception, although a combination of this theory and the 'sliding hernia' theory has been proposed by Altemeier et al (1971). The pelvic floor weakness associated with prolapse, which gives rise to incontinence, is most likely due to a traction injury to the pudendal nerve. Anorectal manometry will indicate those incontinent patients likely to benefit from rectopexy. Abnormal descent of the perineum may be found in rectal prolapse and solitary rectal ulcer syndrome as well as descending perineum syndrome per se. The clinical features of these three conditions can overlap. Solitary rectal ulcer syndrome is essentially due to prolapse and traumatization of the rectal mucosa. Inappropriate puborectalis contraction, abnormal perineal descent, and overt rectal prolapse have all been cited as possible mechanisms of development of the condition. Defecography is the radiologic investigation of choice. Electromyography, as in rectal prolapse, may show evidence of pudendal nerve damage although incontinence is rare.
