ABSTRACT
Type IV hiatal hernia of the esophagus is characterized by herniation of the stomach and associated organs, such as the spleen, large and small bowel, and pancreas, through the esophageal hiatus. It is a relatively rare form of hiatal hernia that sometimes requires emergency surgery due to gastric incarceration, volvulus, and strangulation. Of these, small bowel obstruction is extremely rare and requires surgery. We report the case of an 83-year-old woman who was admitted to the hospital for small bowel obstruction caused by an ileum that had incarcerated the esophageal hiatus; emergency laparoscopic surgery was performed.
ABSTRACT
Isolated superior mesenteric artery dissection (ISMAD) is rare, with symptoms ranging from asymptomatic to acute intestinal ischemia. Risk factors for ISMAD include hypertension, atherosclerosis, abnormal elastic fibers, and pregnancy. In the present case, blunt trauma, which has not been previously reported, was suggested as a risk factor. A 46-year-old man was brought to the emergency room after he was found unconscious after a motor vehicle collision. At presentation, he had no abdominal symptoms; however, on the fourth day of admission, he presented with severe abdominal pain and vomiting. A contrast-enhanced computed tomography scan revealed an ISMAD with associated intestinal ischemia and necrosis; hence, emergency surgery was performed. Herein, we report a case of ISMAD caused by blunt abdominal trauma.
ABSTRACT
Hernial repair is a common procedure performed by general surgeons. The use of laparoscopic hernial repair has recently increased; it was introduced in the 1980s, is minimally invasive and has few complications. However, because of this increase, rare complications that were previously unknown have been reported. A 63-year-old man underwent transabdominal preperitoneal patch plasty (TAPP) for a left inguinal hernia. Tension was felt in the peritoneum during peritoneal closure. On the fifth postoperative day, the patient was admitted for small bowel obstruction (SBO) and underwent reoperation; the closed peritoneum was lacerated, causing SBO because of herniation of the preperitoneal space. After the hernia was released, the peritoneum was closed again, and the surgery was completed. SBO after TAPP surgery is a rare complication. Several reports have shown staplers, barbed sutures and tacks causing SBO; this complication can be prevented with appropriate peritoneal closure techniques and treated with early laparoscopic surgery.
ABSTRACT
Methotrexate-related lymphoproliferative disorder (MTX-LPD) is a rare but serious complication that occurs in patients treated with methotrexate (MTX); although MTX-LPD has been reported recently, the incidence in the colon is very low. A 79-year-old woman who had been receiving MTX for 15 years came to our hospital complaining of postprandial abdominal pain and nausea. Computed tomography scan showed the dilation of the small bowel and a tumor in the cecum. In addition, numerous nodular lesions were seen in the peritoneum. Ileal-transverse colon bypass surgery was performed for small bowel obstruction. Histopathological findings of both the cecum and the peritoneal nodules revealed the diagnosis of MTX-LPD. We report MTX-LPD occurring in the colon; it is important to consider MTX-LPD when intestinal symptoms occur during MTX therapy.
ABSTRACT
Meckel's diverticulum is the most common congenital abnormality of the gastrointestinal tract. Histologically, it is a true diverticulum comprising all four layers of the intestinal tract. The complications associated with Meckel's diverticulum include bleeding, bowel obstruction, and intussusception. Torsions are an extremely rare complication. The patient was a 15-year-old boy who presented to the emergency department with acute-onset lower abdominal pain and was admitted to the hospital for a follow-up of abdominal pain due to nonspecific imaging findings. The symptoms of the patient worsened 12 hours after admission, and he underwent emergency laparoscopic surgery. A large Meckel's diverticulum with torsion and necrosis was observed 30 cm proximal to the ileocecal valve. The diverticulum was twisted around the base of the neck. Subsequently, wedge resection of the small intestine, including the diverticulum, was performed. Stem torsion is a rare complication of Meckel's diverticulum. As definitive preoperative diagnosis was difficult to obtain through imaging studies, early laparoscopic surgery was considered effective.
