High recurrence rate 12 years after primary inguinal hernia repair.

OBJECTIVE: To find out the long term recurrence rate after repair of the inguinal ligament (Griffith) for inguinal hernia in one hospital. DESIGN: Retrospective study. SETTINGS: Teaching hospital, The Netherlands. SUBJECTS AND INTERVENTION: All patients who had had a Griffith repair for a primary inguinal hernia in 1985 were re-examined after at least 12 years by an independent examiner. RESULTS: Of the 102 patients included in the study, 45 patients had died and 17 could not be traced. Of the remaining 40 patients (45 hernias), 10 (22%) had developed recurrences. In 4 patients the asymptomatic hernia was discovered by the investigator. 11 further patients had developed a hernia on the opposite site resulting in a total of 16 patients (40%) with bilateral hernias. CONCLUSIONS: The long term recurrence rate of an inguinal hernia by reconstruction of the inguinal ligament is high and even higher when assessed by physical examination. The high recurrence rate and frequent bilateral recurrence might favour repairs with mesh reinforcement.

Haematoma of the rectus abdominis muscle.

OBJECTIVE: To describe our experience in the diagnosis and treatment of haematoma of the rectus abdominis. DESIGN: Retrospective study. SETTING: St. Antonius Hospital, Nieuwegein, The Netherlands. SUBJECTS: 40 patients treated between 1976 and 1991 for haematoma of the rectus abdominis muscle. MAIN OUTCOME MEASURES: Correct diagnosis and treatment of the haematoma. RESULTS: The mean age of the patients was 63 years (range 31-83), and just over half were women. Predisposing factors included the use of anticoagulant drugs (n = 30, 75%), the presence of scars on the abdominal wall (n = 27, 68%), the haematoma had been provoked by coughing (n = 24, 60%), and coexistent cardiovascular disease (n = 22, 55%). Nineteen of the haematomas were in the right lower quadrant and 15 in the left; in only four was the upper part of the rectus muscle affected. Eight patients had bled severely enough to require blood transfusion, and 32 were successfully treated conservatively. CONCLUSION: The single most important factor in the diagnosis of haematoma of the rectus abdominis is awareness of its existence; it should be included as a differential in all patients who present with an acute abdomen. Once the diagnosis has been confirmed (by ultrasonography or computed tomography) patients should be treated conservatively as those that are operated on are at risk of developing complications.

The dynamic condylar screw in subtrochanteric fractures of the femur.

Early experience with the AO dynamic condylar screw in subtrochanteric fractures of the femur showed a solid and stable osteosynthesis in 19 patients. The ease of insertion of the dynamic condylar screw, the firm proximal fixation, the increased strength and resistance to stress failure should, in our opinion, make this technique a favoured form of treatment for this particular type of fracture.

Campylobacter-associated appendicitis: prevalence and clinicopathologic features.

To determine the prevalence of Campylobacter fetus subspecies jejuni-associated appendicitis, we studied, retrospectively, by means of immunohistochemistry, the appendectomy specimens of 116 consecutive patients, operated upon because of suspected acute appendicitis. We found immunohistochemical evidence of Campylobacter fetus subspecies jejuni infection in three patients. These findings were confirmed by electron microscopy. Based upon these three cases and five additional appendectomy specimens from patients with Campylobacter enteritis diagnosed by stool cultures, the clinical and histologic picture of Campylobacter-associated appendicitis is described. It is concluded that Campylobacter infection may present with an acute appendicitis-like clinical picture. In contrast with acute phlegmonous appendicitis, the histologic abnormalities in Campylobacter-associated appendicitis are limited to the appendiceal mucosa.

Intubation of inoperable tumours of the oesophagogastric junction.

When obstruction occurs in inoperable tumours of the oesophago-cardiac region, intubation with an endoprosthesis is an important palliative measure. Although the endoscopic placing of a prosthesis is preferable, inoperability can often only by established at laparotomy. In this event a Celestin, Mousseau-Barbin or Häring tube can be introduced. The problems surrounding these surgical procedures are discussed on the basis of 42 patients with an average age of 66 1/2 years. There was an operative mortality of 28%. Thirty patients were discharged. The desired palliation was nearly always achieved. The average survival rate was 11 weeks. One patient lived for 80 weeks. The most important postoperative complication of the discharged patients was wound infection. Adequate antibiotic prophylaxis can diminish the complication rate.

Meckel's diverticulum - an investigation based on pathological findings in 130 patients treated by surgery.

A retrospective investigation was carried out involving 130 patients from 5 hospitals in order to correlate symptoms with pathological findings in a surgically removed Meckel's diverticulum. In 20% of the patients surgery was performed because of complications due to the diverticulum, of which strangulation of the intestine and acute diverticulitis were the commonest. Heterotropic issue was found in 23% of the patients. The indication for prophylactic removal is dependent on the risk of complications; unanimity on this point does not exist in the literature and our own findings do not permit conclusions. However, they do confirm that the mortality rate for prophylactic removal of a diverticulum is virtually negligible.

Yersiniosis as a surgical disease.

An infection with Yersinia strains may develop with the picture of acute appendicitis. Laparotomy will then not reveal an acutely inflamed appendix, but will often show mesenteric lymphadenitis or acute terminal ileitis. These conditions have been observed in four patients. The differential diagnostic possibilities are discussed. It is pointed out that acute terminal ileitis is practically never transformed into chronic terminal ileitis (Crohn's disease).

Congenital cystic adenomatoid malformation of the lung report of a case.

The case history of male child is reported. At the ages of five and fifteen months he suffered attacks, of left upper lobar pneumonia. When ninteen months old, he underwent a lobectomy because of persistent air trapping in this lobe, accompanied by mediastinal displacement to the right side. He has since made a good recovery. From the pathological findings, congenital cystic adenomatoid malformation was diagnosed. Various aspects of this rare condition are discussed.

Spontaneous hematoma of the abdominal wall.

In the differential diagnosis of the acute abdomen, the possibility should be considered of a hematoma in the anterior abdominal wall, especially if the patient is a woman of advanced age with abdominal scars, with a chronic cough and on anticoagulant treatment. Cystography is valuable as a supplementary method of examination.