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1.
Ann R Coll Surg Engl ; 103(1): e29-e34, 2021 Jan.
Article in English | MEDLINE | ID: mdl-32969261

ABSTRACT

There are fewer than 100 documented cases of transanal small bowel evisceration in the literature. We report two cases of this rare surgical emergency in an 84-year old man and a 79-year old woman. Both patients required urgent laparotomy, resection of ischaemic bowel and transabdominal resection of the rectal defect with colostomy. Postoperative recovery was uneventful. Rare imaging and clinical photography are shared to highlight the extreme nature of this condition. We identified 38 relevant cases of reported bowel evisceration through our literature review. Most patients were elderly women with untreated rectal prolapse. Gynaecological comorbidity was another risk factor. The aetiological mechanism is suspected to stem from chronic ischaemic insult to the rectal wall, resulting in thinning and subsequent perforation. Surgical management may consist of primary suture repair of the rectal tear, or a Hartmann's procedure. Timely intervention is essential to minimise patient morbidity and mortality.


Subject(s)
Emergency Treatment/methods , Intestinal Diseases/surgery , Intestine, Small/blood supply , Rectal Prolapse/complications , Visceral Prolapse/surgery , Aged , Aged, 80 and over , Colonic Diseases , Colostomy , Emergencies , Female , Humans , Intestinal Diseases/etiology , Intestinal Perforation/etiology , Intestinal Perforation/surgery , Intestine, Small/surgery , Ischemia/etiology , Ischemia/surgery , Male , Rectal Prolapse/surgery , Treatment Outcome , Visceral Prolapse/etiology
2.
Pediatr Emerg Care ; 36(9): e527-e529, 2020 Sep.
Article in English | MEDLINE | ID: mdl-32701870

ABSTRACT

The umbilical hernia is common in children. Most of the cases have a spontaneous regression around the age of 3 years. Complications are very rare, and thus surgery is not routinely indicated before the age of 3 years. We report an exceptional case of spontaneous rupture of an umbilical hernia with emphasis on the management of this rare complication and a literature review of similar cases.


Subject(s)
Hernia, Umbilical/complications , Rupture, Spontaneous/complications , Visceral Prolapse/etiology , Child, Preschool , Female , Herniorrhaphy , Humans , Rupture, Spontaneous/surgery , Visceral Prolapse/surgery
3.
G Chir ; 41(1): 99-102, 2020.
Article in English | MEDLINE | ID: mdl-32038019

ABSTRACT

Most diaphragmatic ruptures are due to the traumatic or penetrating injury, while the spontaneous diaphragmatic rupture is considered uncommon. The spontaneous transdiaphragmatic hernia is a consequence of violent coughing, vomiting that increase the thoracoabdominal pressure causing the diaphragmatic rupture. Even rarer is the concomitant prolapse of abdominal viscera into the thoracic subcutis through the chest wall, a condition known as spontaneous transdiaphragmatic intercostal hernia. Herein, we present a rare case of spontaneous transdiaphragmatic intercostal hernia presenting as a thoracoabdominal emergency.


Subject(s)
Diaphragm/injuries , Hernia, Diaphragmatic/etiology , Rare Diseases/etiology , Thoracic Wall/injuries , Visceral Prolapse/etiology , Cough/complications , Humans , Rupture, Spontaneous , Vomiting/complications
4.
BMJ Case Rep ; 20172017 Jun 22.
Article in English | MEDLINE | ID: mdl-28645925

ABSTRACT

Strangulated gastric prolapse through a percutaneous endoscopic gastrostomy tract is a rare and potentially life-threatening complication that requires surgical intervention. We describe a case of a 74-year-old woman who was debilitated and ventilator-dependent and who presented with acute gastric prolapse with resultant ischaemic necrosis. The patient underwent an emergent exploratory laparotomy, partial gastrectomy, repair of gastrostomy defect and placement of a gastrojejunostomy feeding tube remote to the previous location. Literature on gastric prolapse in adult patients is sparse, and therefore treatment is not standardised. In this patient with strangulated tissue, the principles of management included the assessment of gastric mucosa viability, resection of ischaemic tissue and closure of the gastrostomy defect.


Subject(s)
Enteral Nutrition/adverse effects , Gastrectomy , Gastric Mucosa , Gastrostomy/adverse effects , Intubation, Gastrointestinal/adverse effects , Visceral Prolapse/etiology , Aged , Equipment Failure , Female , Humans , Ischemia/etiology , Jejunostomy , Necrosis/etiology , Surgical Stomas , Visceral Prolapse/pathology , Visceral Prolapse/surgery
7.
BMJ Case Rep ; 20162016 Feb 26.
Article in English | MEDLINE | ID: mdl-26921365

ABSTRACT

Vaginal evisceration can be defined as a defect in the vaginal wall resulting in prolapse of the intraperitoneal contents. This is a rare complication of hysterectomy, but may result in severe morbidity. We report the case of a postmenopausal woman with transvaginal evisceration of the sigmoid colon 1 year after an abdominal hysterectomy. An exploratory laparotomy was undertaken to reduce the prolapsed sigmoid colon through a combined vaginal-abdominal route. Repair of the defect of the vaginal vault was made using an absorbable running suture. Two years later, the patient presented at the emergency department with a transvaginal evisceration of the omentum. An exclusively vaginal approach was then chosen to repair the smaller vaginal defect and vaginal cuff was closed using non-absorbable sutures. As two different surgical approaches were used in this patient, a discussion of the different treatment options and also of the principles of prevention of vaginal cuff dehiscence is provided.


Subject(s)
Hysterectomy/adverse effects , Peritoneal Diseases/diagnosis , Vagina/surgery , Visceral Prolapse/etiology , Aged , Female , Humans , Laparotomy/methods , Omentum/pathology , Peritoneal Diseases/surgery , Recurrence , Treatment Outcome , Vagina/abnormalities , Vagina/anatomy & histology , Visceral Prolapse/complications , Visceral Prolapse/surgery
8.
J Med Case Rep ; 9: 280, 2015 Dec 17.
Article in English | MEDLINE | ID: mdl-26674349

ABSTRACT

INTRODUCTION: Prolapse of the fallopian tube after hysterectomy is a rare but known complication. Cases of prolapse of the fallopian tube through the vaginal vault have been reported after abdominal, vaginal or laparoscopic hysterectomies. This is the first case report to the best of our knowledge on the prolapse of a fallopian tube through an abdominal wound after caesarean section. CASE PRESENTATION: We report a case of the prolapse of the fimbrial end of a fallopian tube through an abdominal scar after caesarean section mimicking scar endometriosis. A 24-year-old primipara South Asian woman of Punjabi ethnicity presented to our institute with a fleshy mass protruding through her abdominal scar and bleeding from the mass during menstruation for the past 5 months. She underwent a caesarean section 6 months earlier for breech presentation. Her history revealed she had wound dehiscence on the sixth postoperative day. The major portion of her wound healed in 1 month leaving a 2 cm area in the middle of her vertical scar. An abdominal examination revealed a 2×2 cm fleshy mass protruding through the middle part of her infraumbilical abdominal scar. At the time of the surgery we found that the fimbrial end of her left fallopian tube was protruding through her abdominal scar. CONCLUSION: Awareness of this complication may prevent improper management of wound dehiscence and such complication causing prolonged agony to the patient.


Subject(s)
Cesarean Section/adverse effects , Fallopian Tube Diseases/diagnosis , Fallopian Tube Diseases/etiology , Fallopian Tubes/pathology , Visceral Prolapse/etiology , Adult , Cicatrix , Diagnosis, Differential , Endometriosis/diagnosis , Fallopian Tube Diseases/pathology , Fallopian Tube Diseases/surgery , Female , Humans , Treatment Outcome
9.
BMJ Case Rep ; 20132013 May 09.
Article in English | MEDLINE | ID: mdl-23667228

ABSTRACT

Vaginal evisceration is a rare condition most commonly associated with previous vaginal surgery. It usually presents with vaginal bleeding, lower abdominal pain and a protruding mass, and requires immediate assessment and surgical management to salvage the prolapsed bowel. Any delay in the treatment may result in bowel ischaemia and perforation which is associated with higher morbidity and mortality. We report a case of spontaneous vaginal evisceration during defaecation in a 56-year-old postmenopausal women 11 months post hysterectomy. This case highlights the benefits of a combined laparoscopic and transvaginal approach in the successful management of this surgical emergency.


Subject(s)
Hysterectomy/adverse effects , Intestinal Diseases/surgery , Intestines/surgery , Postoperative Complications/surgery , Vagina/surgery , Vaginal Diseases/surgery , Visceral Prolapse/surgery , Defecation , Female , Humans , Intestinal Diseases/etiology , Intestines/pathology , Laparoscopy/methods , Middle Aged , Postmenopause , Vagina/pathology , Vaginal Diseases/etiology , Visceral Prolapse/etiology
10.
Arch Gynecol Obstet ; 288(2): 311-23, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23400356

ABSTRACT

OBJECTIVE: Small bowel obstruction after unrecognized or conservatively treated uterine perforation is extremely rare. It is a surgical emergency and the delay in diagnosis and treatment has deleterious consequences for the mother. The purpose of this study is to critically review the available literature and ascertain the level of evidence for the mechanisms, diagnosis and management of small bowel obstruction after uterine perforation due to surgical abortion. METHODS: Systematic literature search was conducted in Pubmed (1946 to 2012) and Pubmedcentral (1900 to 2012) including all available English and French language fulltext articles. Three evaluators reviewed and selected all available case reports and case series. Search terms included small bowel obstruction, bowel obstruction, bowel incarceration, bowel entrapment, vaginal evisceration, uterine perforation, uterine rupture, and abortion. The exclusion criteria were (1) complex injuries where small bowel incarceration was present but with bleeding and/or bowel perforation as the leading symptomatology; (2) articles only numbering the patients without details on the topic. Analyses of incidence, risk factors, mechanisms of the disease, time of clinical presentation, diagnostic modalities, treatment, and maternal outcome were included. RESULTS: Of the 73 articles screened 30 cases of small bowel obstruction were included in the review forming incidence, risk factors, and mechanisms of the disease, diagnosis, therapy, and maternal outcome. CONCLUSIONS: A systematic review defined four mechanisms of small bowel obstruction after transvaginal instrumental uterine perforation with significant variations in clinical presentation and time of presentation. Duration of symptoms depend on the mechanism of small bowel obstruction. Vaginal evisceration is surgical emergency and treatment is mandatory without diagnostic workup. Survival rate during last century is 93 %. Multicentric trials and publication of all such cases are needed to determine algorithms for diagnosis and management of small bowel obstruction caused by instrumental uterine perforation.


Subject(s)
Abortion, Induced/adverse effects , Intestinal Obstruction/diagnosis , Intestinal Obstruction/etiology , Uterine Perforation/diagnosis , Uterine Perforation/etiology , Female , Humans , Intestinal Obstruction/therapy , Intestine, Small , Prognosis , Risk Factors , Uterine Perforation/complications , Uterine Perforation/therapy , Visceral Prolapse/etiology
11.
Tech Coloproctol ; 17(4): 437-40, 2013 Aug.
Article in English | MEDLINE | ID: mdl-23292111

ABSTRACT

BACKGROUND: The aim of the present study was to classify the short-term outcomes of local correction of stoma prolapse with a stapler device. METHODS: The medical records of 11 patients undergoing local correction of stoma prolapse using a stapler device were retrospectively reviewed. RESULTS: No mortality or morbidity was observed after the surgery. Median operative time was 35 min (range 15-75 min), and blood loss was minimal. Median duration of follow-up was 12 months (range 6-55 months). One of the 11 patients had a recurrent stoma prolapse. CONCLUSIONS: This technique can be a feasible, safe and minimally invasive correction procedure for stoma prolapse.


Subject(s)
Colorectal Neoplasms/surgery , Colostomy/adverse effects , Surgical Staplers , Visceral Prolapse/surgery , Adult , Aged , Aged, 80 and over , Cohort Studies , Colectomy/methods , Colonic Diseases/surgery , Colorectal Neoplasms/pathology , Colostomy/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Reoperation/methods , Retrospective Studies , Risk Assessment , Time Factors , Treatment Outcome , Visceral Prolapse/etiology
12.
Eur J Med Genet ; 55(10): 548-51, 2012 Oct.
Article in English | MEDLINE | ID: mdl-22781752

ABSTRACT

Gastrointestinal complications are common in patients with Ehlers-Danlos syndrome, affecting up to 50% of individuals depending on the subtype. The spectrum of gastrointestinal manifestations is broad and ranges from life threatening spontaneous perforation of the visceral organs to a more benign functional symptoms. Here we describe the clinical and radiographic manifestations of visceroptosis of the bowel, a rare complication of Ehlers-Danlos syndrome that is characterized by prolapse of abdominal organs below their natural position. We further review the literature on gastrointestinal complications in the different forms of Ehlers-Danlos syndrome.


Subject(s)
Ehlers-Danlos Syndrome/complications , Visceral Prolapse/diagnosis , Visceral Prolapse/etiology , Adult , Female , Humans , Lower Gastrointestinal Tract/diagnostic imaging , Radiography , Upper Gastrointestinal Tract/diagnostic imaging , Visceral Prolapse/diagnostic imaging
13.
J Obstet Gynaecol Res ; 38(12): 1385-8, 2012 Dec.
Article in English | MEDLINE | ID: mdl-22612271

ABSTRACT

Vaginal evisceration after a pelvic operation is a rare gynecological emergency. When intercourse is the cause, most cases occur within 1 year of surgery. A 53-year-old woman presented to the emergency room for vaginal evisceration half a day after the first postoperative occurrence of intercourse 3 years after an abdominal hysterectomy and bilateral salpingo-oophorectomy. In an emergency laparotomy, the protruding small bowel was replaced within the abdominal cavity. The avulsed vaginal cuff, which measured 6 cm in length and had atrophic but non-necrotic margins, was sutured. Women who go for long periods without intercourse after a hysterectomy, especially post-menopausal women, should be made aware of unrecognized vaginal atrophy that could, in some cases, lead to rupture and evisceration during the next occurrence of intercourse.


Subject(s)
Coitus , Hysterectomy/adverse effects , Intestine, Small , Vagina/injuries , Visceral Prolapse/etiology , Female , Hernia , Herniorrhaphy , Humans , Middle Aged , Postmenopause , Visceral Prolapse/surgery
14.
Pediatr Surg Int ; 28(5): 467-70, 2012 May.
Article in English | MEDLINE | ID: mdl-22466720

ABSTRACT

Umbilical hernias occur frequently in children but complications are very rare and thus surgery is not routinely indicated. In this literature review, we report 19 cases of spontaneous evisceration of abdominal contents through umbilical hernias. Precipitating causes included umbilical ulceration or sepsis, crying, respiratory infection, intussusception and ascites. Management involved resuscitation and surgical repair. Mortality is low. As the incidence of spontaneous rupture is very low, the current management of an umbilical hernia remains appropriate. However, we encourage physicians to be aware of the potential risk factors for spontaneous rupture and in these patients expedite surgical repair.


Subject(s)
Hernia, Umbilical/complications , Hernia, Umbilical/surgery , Herniorrhaphy/methods , Visceral Prolapse/etiology , Visceral Prolapse/surgery , Child , Child, Preschool , Humans , Infant , Risk Factors , Rupture, Spontaneous
15.
Br J Surg ; 99(4): 454-68, 2012 Apr.
Article in English | MEDLINE | ID: mdl-22307828

ABSTRACT

BACKGROUND: Proctocolectomy with ileal pouch-anal anastomosis (IPAA) has been developed and refined since its introduction in the late 1970s. Nonetheless, it is a procedure associated with significant morbidity. The aim of this review was to provide a structured approach to the challenges that surgeons and physicians encounter in the management of intraoperative, postoperative and reoperative problems associated with ileoanal pouches. METHODS: The review was based on relevant studies identified from an electronic search of MEDLINE, Embase and PubMed databases from 1975 to April 2011. There were no language or publication year restrictions. Original references in published articles were reviewed. RESULTS: Although the majority of patients experience long-term success with an ileoanal pouch, significant morbidity surrounds IPAA. Surgical intervention is often critical to achieve optimal control of the situation. CONCLUSION: A structured management plan will minimize the adverse consequences of the problems associated with pouches.


Subject(s)
Colitis, Ulcerative/surgery , Colonic Pouches , Intraoperative Complications/etiology , Postoperative Complications/etiology , Proctocolectomy, Restorative/methods , Venous Thrombosis/etiology , Abdominal Abscess/etiology , Abdominal Abscess/surgery , Anastomosis, Surgical/methods , Constriction, Pathologic/etiology , Constriction, Pathologic/surgery , Crohn Disease/diagnosis , Cutaneous Fistula/etiology , Cutaneous Fistula/surgery , Delayed Diagnosis , Dilatation/methods , Drainage/methods , Female , Fibromatosis, Aggressive , Gastrointestinal Neoplasms/etiology , Gastrointestinal Neoplasms/surgery , Humans , Ileostomy/methods , Intestinal Fistula/etiology , Intestinal Fistula/surgery , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Intestine, Small , Intraoperative Complications/prevention & control , Laparoscopy/methods , Portal Vein , Postoperative Complications/prevention & control , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/prevention & control , Pouchitis/etiology , Pouchitis/surgery , Proctitis/etiology , Proctitis/surgery , Reoperation/methods , Salvage Therapy/methods , Surgical Stapling/methods , Vaginal Fistula/etiology , Vaginal Fistula/surgery , Venous Thrombosis/surgery , Visceral Prolapse/etiology , Visceral Prolapse/surgery
16.
J Emerg Med ; 43(2): e125-8, 2012 Aug.
Article in English | MEDLINE | ID: mdl-21903354

ABSTRACT

BACKGROUND: Evisceration of bowel contents through the vagina is a rare event that may be complicated by bowel obstruction. OBJECTIVE: We report a case of vaginal evisceration with small bowel obstruction which, in contrast to previous, more dramatic case reports in the literature, is a more subtle and, in fact, characteristic clinical presentation for this unusual occurrence. CASE REPORT: A 72-year-old woman with a previous history of pelvic surgery presented to the Emergency Department with lower abdominal discomfort and a prolapsing mass from her vagina. She was initially discharged home after bedside reduction of the mass, but returned 48 h later with worsening symptoms. A computed tomography scan on her repeat visit confirmed evisceration of bowel into the vaginal vault with obstruction of distal bowel loops. Surgical and gynecologic services were consulted and the patient underwent partial small bowel resection and vaginal cuff repair in the operating room. CONCLUSION: Early recognition of subtle presentations of vaginal evisceration is crucial for preserving bowel viability and preventing morbidity from bowel ischemia or infarction. Risk factors for this rare condition include postmenopausal status, previous pelvic surgery, and presence of an enterocele.


Subject(s)
Intestinal Obstruction/etiology , Uterine Prolapse/complications , Visceral Prolapse/etiology , Aged , Female , Humans , Intestinal Obstruction/surgery , Intestine, Small , Rectocele/complications , Risk Factors , Uterine Prolapse/surgery , Visceral Prolapse/diagnosis , Visceral Prolapse/surgery
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