Gastrointestinal bleeding due to whipworm (Trichuris trichiura) infestation: a case report.

Severe whipworm infestation, an exceedingly uncommon cause of gastrointestinal bleeding, has not been reported in Taiwan. The reported case concerns a 59-year-old female who had suffered from abdominal pain and passage of tarry stool for several days. Esophagogastroduodenoscopy was performed, and several roundworms were seen in the second portion of duodenum. After removal, the characteristic appearance of Trichuris trichiura was apparent. After exploratory laparotomy for intractable bloody stool, the result of operative findings and pathological reports also confirmed our diagnosis. This is a case presented of massive gastrointestinal bleeding in which the cause of bleeding was diagnosed before operation to be whipworm infestation by endoscopic examination. The clinical and pathologic characteristics of the trichuriasis are described, with a brief review and discussion.

Intraoperative laparoscopic diagnosis of contralateral patent processus vaginalis in children with unilateral inguinal hernia.

The contralateral internal ring of 96 children was examined laparoscopically during unilateral hernia repair to minimize the chance of development of contralateral hernia. Laparoscopy was performed through the hernia sac before ligation. Of 29 patients with positive laparoscopic findings, 28 had a patient processus vaginalis as confirmed by simultaneous contralateral exploration and there was one false positive. Patency of the contralateral processus vaginalis was found in 28 (29 per cent) of the 96 patients. Children under 2 years of age had a significantly higher incidence of patent contralateral processus vaginalis than older patients. The only complication of the procedure was wound infection in two patients. This is a simple, safe and accurate procedure to select children for contralateral surgical exploration.

Shouldice inguinal hernioplasty.

Since 1978, 108 patients with 111 inguinal hernias have been treated with Shouldice hernioplasty in our hospital, including 97 males and 11 females with a mean age of 54 years. 85.6% of them were primary hernias and 14.4% of them were recurrent ones. Local anesthesia was performed in 67.6%. The average operation time was 84 min. Immediate postoperative complications were present in 4.5% of the patients. 93.5% of the patients were followed for an average period of 4.6 years. There was only one recurrence (1.0%). These results indicate that Shouldice hernioplasty is an effective repair for both primary and recurrent inguinal hernia in which most cases can be performed under local anesthesia with early recovery.