ABSTRACT
A 61-year-old man presented to the emergency department with severe abdominal pain. Three months prior to presentation, he had sustained blunt trauma to his right side while cycling, but had not sought medical attention. On admission, a CT scan showed small bowel obstruction (SBO) and he underwent an emergency open laparotomy. Intraoperatively, a subcapsular liver haematoma was identified, with incarcerated, necrotic small bowel within the liver capsule. The patient underwent deroofing of the haematoma with an omental patch and a small bowel resection with primary anastomosis. We believe this is the first reported case of SBO secondary to small bowel herniation into the liver capsule following trauma.
Subject(s)
Intestinal Obstruction , Abdominal Pain/etiology , Humans , Intestinal Obstruction/diagnostic imaging , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intestine, Small/diagnostic imaging , Intestine, Small/surgery , Laparotomy , Liver/diagnostic imaging , Liver/surgery , Male , Middle AgedABSTRACT
To systematically analyse the published randomized, controlled trials (RCTs) comparing the use of oral bowel preparation (OBP) versus enema bowel preparation (EBP) for diagnostic or screening flexible sigmoidoscopy. Published RCTs, comparing the use of OBP versus EBP, were analysed using RevMan(®), and the combined outcomes were expressed as odds ratios (OR). Eight RCTs evaluating 2457 patients were retrieved from the standard electronic databases. There was significant heterogeneity among included trials. The compliance of the patients (p = 0.32) and the acceptability of both bowel preparation regimens (OR, 1.42; 95% CI, 0.67, 2.99; z = 0.92; p = 0.36) were similar in both groups. In addition, the incidence of adverse reactions (OR, 0.87; 95% CI, 0.54, 1.41; z = 0.57; p = 0.57), the risk of incomplete procedure due to poor bowel preparation (p = 0.18) and the incidence of poor bowel preparation (OR, 1.21; 95% CI, 0.63, 2.33; z = 0.59; p = 0.56) were also similar in both groups. EBP and OBP were equally effective for bowel preparation in patients undergoing flexible sigmoidoscopy. Although this study failed to demonstrate the superiority of EBP, at least equivalent efficacy for bowel cleansing may be extrapolated.
Subject(s)
Cathartics/administration & dosage , Enema/methods , Sigmoidoscopy , Administration, Oral , Cathartics/adverse effects , Enema/adverse effects , Humans , Patient Compliance , Patient Satisfaction , Randomized Controlled Trials as Topic/standards , Risk FactorsABSTRACT
AIM: To report a systematic review of published randomized controlled trials (RCTs) investigating the role of absorbable suture (AS) against non-AS (NAS) used for the closure of surgical incisions. METHODS: RCTs investigating the use of AS vs NAS for the closure of surgical incisions were statistically analysed based upon the principles of meta-analysis and the summated outcomes were represented as OR. RESULTS: The systematic search of medical literature yielded 10 RCTs on 1354 patients. Prevalence of wound infection (OR = 0.97; 95%CI: 0.56, 1.69; Z = 0.11; P = 0.92) and operative morbidity (P = 0.45) was comparable in both groups. Nonetheless, the use of AS lead to lower risk of wound break-down (OR = 0.12; 95%CI: 0.04, 0.39; Z = 3.52; P < 0.0004). CONCLUSION: This meta-analysis of 10 RCTs demonstrates that the use of AS is similar to NAS for skin closure for surgical site infection and other operative morbidities. AS do not increase the risk of skin wound dehiscence, rather lead to a reduced risk of wound dehiscence compared to NAS.
ABSTRACT
BACKGROUND: The aim of this study was to systematically analyze the randomized trials comparing tacker mesh fixation with glue mesh fixation (GMF) in laparoscopic inguinal hernia repair (LIHR). METHODS: Standard electronic database were searched to retrieve relevant randomized trials comparing tacker mesh fixation with GMF in LIHR, which were analyzed systematically using RevMan. RESULTS: Five randomized controlled trials encompassing 1,001 patients were retrieved from the electronic databases. In a random-effects model, operating time, postoperative pain, postoperative complications, length of hospital stay and risk for hernia recurrence were statistically comparable between the 2 techniques of mesh fixation in LIHR. However, GMF was associated with a reduced risk for developing chronic groin pain. CONCLUSIONS: GMF in LIHR does not increase the risk for hernia recurrence and reduces the risk for developing chronic groin pain. It is comparable with tacker mesh fixation in terms of operation time, postoperative pain, postoperative complications, length of hospital stay, and risk for hernia recurrence.
Subject(s)
Chronic Pain/etiology , Hernia, Inguinal/surgery , Herniorrhaphy/methods , Laparoscopy , Pain, Postoperative/etiology , Surgical Mesh , Groin , Herniorrhaphy/adverse effects , Humans , Length of Stay , Odds Ratio , Operative Time , Randomized Controlled Trials as Topic , Recurrence , Risk Assessment , Risk Factors , Surgical Mesh/adverse effectsABSTRACT
A 55-year-old woman presented with sudden onset upper abdominal pain and vomiting. On examination she had tender epigastric mass with "succusion splash" on auscultation. Straight abdominal x ray showed a distended and displaced stomach with another gas filled viscus around it. Subsequent computed tomography suggested caecal volvulus herniated through the epiploic foramen obstructing the gastric outlet. The patient underwent reduction of the internal hernia and right hemicolectomy. Postoperative recovery was uneventful. Herniation of caecal volvulus through the epiploic foramen is a very rare condition and its presentation as a gastric outlet obstruction has not been reported before.
