A neglected case of strangulated right groin hernia presenting with perforated ileum, vanished right testis and necrotizing fasciitis of the right groin: A case report.

INTRODUCTION AND IMPORTANCE: Hernias are one of the commonest procedures performed by general surgeons. Irreducibility, intestinal obstruction, and strangulation are common outcomes of a groin hernia when there is disregard and a delay in elective surgery. Studies have shown a considerable incidence of these hernia complications, along with the associated morbidity and death, because of delayed presentation. Testicular gangrene following incarcerated hernias is a rare entity in the adult population. CASE PRESENTATION: Here we present a case of a 30-year-old male presented with gangrenous vanished testis, perforated ileum and necrotizing fasciitis of the right groin after a neglected strangulated right inguinal hernia. CLINICAL DISCUSSION: Testicular infarction/gangrene is most commonly secondary to testicular torsion, an emergency that teenagers frequently experience. When it complicates inguinal hernia, it typically results in ischemia, infarction, and gangrene due to compression and impairment of the vascular supply within the inguinal canal. In cases like our where there is a necrotizing process in the groin, we feel it's appropriate to approach from the abdomen and do the resection first and proceed with the radical debridement after that. CONCLUSION: Early diagnosis and intervention with emergency surgery are crucial for strangulated inguinal hernia and prevents unnecessary escalation of the problem with progressive infectious and necrotic destruction of adjacent tissues.

A non-lethal left sided thoracic impalement injury: A case report.

INTRODUCTION AND IMPORTANCE: Impalement injuries are those injuries that result from the injuring object or weapon being stuck on to the victim's body parts. Such cases occur rarely and when they do they pose a great challenge starting from transportation to anesthesia induction and surgical decision. The extremities are the commonest parts of the body where this occurs. Only a few reports of thoracic impalement injuries have been documented in the literature. CASE PRESENTATION: Here we present a case of a 25 years old male patient who presented 36 hours after sustaining an impalement injury to his left chest by a metallic spear. He was explored via a left posterolateral thoracotomy incision and the spear was removed under direct vision successfully. CLINICAL DISCUSSION: Thoracic impalement injuries occur very rarely in the civilian setting. The most important pillar in the management of such injuries is to avoid any manipulation of the impaled object outside of an operation theater where it's done under direct vision in a controlled manner. Post-operative care includes tube thoracostomy, antibiotics and chest physiotherapy and the other components of the enhanced recovery after surgery protocol components. CONCLUSION: Thoracic impalements are extremely uncommon, as are impalement injuries in general. When they do occur, multidisciplinary teams-primarily the surgeon, anesthesiologists, and emergency physicians. Early cardiothoracic consultation and avoiding manipulation of the impaled object by all means necessary outside of operating room along with the standard advanced trauma life support principles are cornerstones in the management of this patients.