ABSTRACT
Morgagni hernia (MH) is a congenital diaphragmatic hernia that is often asymptomatic in adult patients. These defects may be discovered incidentally during the intraoperative period and repaired laparoscopically with tension-free synthetic mesh when surgery is warranted. Presently, there is a dearth of studies addressing incidental MH repair in the setting of concomitant bariatric surgery. As such, there are no clear guidelines as to whether or not asymptomatic hernias found incidentally during bariatric surgery require operative repair. Herein, we present the case of a morbidly obese female patient with an incidental Morgagni defect that was identified during an elective sleeve gastrectomy. We also reviewed the literature to assess the efficacy of concurrent bariatric surgery and hernia repair.
ABSTRACT
Subcutaneous emphysema (SE ) is a phenomenon in which air occupies structures under the skin and soft tissues. Common sites for SE include the neck and chest wall, which can extend to other body regions. In this case report, we describe the development of extensive SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in an elderly female following blunt trauma to her right flank. The etiology of SE is broad and includes blunt and penetrating traumas; surgical, infectious, spontaneous causes; or any condition that yields a gradient between intra-alveolar and perivascular interstitial pressures. The incidence of SE has been reported to be 1.4%, while that of spontaneous pneumothorax has been reported to be 0.8% in patients receiving a percutaneous tracheostomy. Conversely, the occurrence of SE, pneumothorax, pneumomediastinum, and pneumoperitoneum in the same patient is rare. The most common signs and symptoms of SE are neck swelling and chest pain. Involvement of the deeper tissues of the thoracic outlet, chest, and abdominal wall often manifests in severe life-threatening conditions. SE can be diagnosed by detecting edema and crepitus of the scalp, neck, thorax, abdomen, and other body regions. Radiograph imaging can confirm the presence of soft-tissue air entry. Extensive SE in the setting of pneumothorax is an unusual entity for which there is, as of now, no consensus in management. Methods of treatment include supportive care, placement of blow holes for evacuation of soft-tissue emphysema, and bilateral infraclavicular incisions. SE is a rare complication that can arise from several etiologies. At the same time, various methods for managing this phenomenon have been mentioned with varying successful outcomes.
ABSTRACT
The reduction of air pollution during the #COVID19 lockdown in Mexico City possibly reduced the exacerbation rate in #COPD patients due to biomass and tobacco despite that the self-isolation was not as strict as expected. https://bit.ly/3Iyv98t.
ABSTRACT
BACKGROUND: Necrosis of the falciform and round ligaments is extremely rare, thus making the diagnosis challenging. It is often misdiagnosed as gallbladder pathology due to the presenting symptoms. Due to the rarity of this pathology, there is limited literature available. CASE PRESENTATION: A 53-year-old white man presented to our hospital with signs and symptoms of gallbladder pain but turned out to have the rare entity of necrosis of the falciform and round ligaments. An extensive review of the world literature was performed using PubMed. Manual cross-referencing of reference lists was performed to obtain all available articles. The personal operative log of the senior author was also searched to reveal one additional case. Statistical analysis was descriptive only, given the small number of reported cases. Thirty-nine articles were found, among which forty-three case were identified, and one additional case was extracted from the operative log of the senior author. Unlike previous reports, we found that isolated inflammation and necrosis of the ligaments occurs at nearly the same frequency in both men and women, not predominantly in women as previously reported in smaller series. The mean age at presentation was 59.5 years old, and cases were typically initially diagnosed as gallbladder pathology, most commonly acute cholecystitis. Computed tomography more frequently than ultrasound revealed the falciform and round-ligament pathology. CONCLUSIONS: Isolated falciform and round-ligament inflammation and necrosis is a rare condition that is difficult to diagnose because it can present mimicking a wide variety of intra-abdominal pathologies, particularly gallbladder pathologies. It is often best treated by laparoscopic resection. Unlike prior reports, our review of the literature, which is the largest that we know of to date, shows that males and females are equally affected. Greater awareness of this entity will aid in future diagnosis.
