Life-threatening vomiting caused by large Morgagni hernia in an octogenarian.

An 84-year-old woman presented with frequent severe vomiting, dyspnea and generalized muscle weakness associated with diaphragmatic hernia. Her poor general condition and muscle weakness resembling cranial pathology were considered to be due to severe vomiting caused by a Morgagni hernia. An urgent subcostal laparotomy confirmed the diagnosis. The critical role of urgent surgery, even in advanced age, is emphasized.

Laparoscopic removal of a swallowed sewing needle that migrated into the greater omentum without clinical evidence.

We report a case of a sewing needle, presumably originating from the transverse colon or the ligament of Treitz, that migrated to the greater omentum. A 24-year-old woman was referred to our clinic with a complaint of abdominal pain which was exacerbated by breathing or any physical activity. Abdominal plain x-ray showed a needle in the left upper abdominal area. Abdominal computed tomography (CT) and contrast enhanced x-ray studies was unable to reveal whether the needle was in the colonic lumen. Virtual colonoscopy examination demonstrated that the foreign body was not in the lumen. The foreign body was removed from the patient's greater omentum in a fluoroscopy- guided laparoscopic surgery. An accurate and rapid diagnosis of a perforation in the gastrointestinal tract as the result of an ingested foreign body is difficult in the absence of peritonitis or abscess formation. In such cases, the virtual colonoscopy is useful if there is uncertainty whether the foreign body is in the lumen. Perioperative fluoroscopy can be useful to overcome the lack of tactile discrimination in laparoscopy, in patients who have been scheduled for surgery who have no signs of the localization of the foreign body (such as abscess or solid organ migration).

Fresh autologous transplantation of ovarian cortical strips to the anterior abdominal wall at the pfannenstiel incision site.

OBJECTIVE: To describe an open surgical technique for transplanting fresh ovarion tissue to the anterior abdominal wall at the incision site and to determine whether ovarian function would be restored after transplantation. DESIGN: Case study. SETTING: Academic medical center. PATIENT(S): A 44-year-old patient who underwent an operation for uterine fibroids. INTERVENTION(S): Microsurgical reconstruction of ovarian cortex and its transplantation to the anterior abdominal wall at incision site of Pfannenstiel. MAIN OUTCOME MEASURE(S): Follicular development evident by ultrasound examination; restoration of serum FSH and LH levels to nonmenopausal range; and disappearance of menopausal symptoms. RESULT(S): Early postoperative FSH, LH, and E(2) levels showed that menopause was confirmed. Postoperative hormone levels at months 2, 3, and 6 were as follows: FSH: 77.86, 79.50, and 13.70 mIU/mL; LH: 34.60, 33.92, and 8.78 mIU/mL; E(2): 29, 46, and 48 pg/mL. The patient is still followed-up for postmenopausal status. CONCLUSION(S): Autotransplantation of cortical strips to the anterior abdominal wall at the incision site without further incision can be a logical solution for the patients at early climacteric age.