Bowel Obstruction Caused by Broad Ligament Hernia Successfully Repaired by Laparoscopy in an Elderly Patient: A Case Report.

The most common causes of small bowel obstruction (SBO) are adhesions, Crohn's disease, neoplasms, and hernias. Internal hernias are rare, and they occur when the small bowel herniates through a defect in the abdominal cavity. The occurrence of internal hernias due to a broad ligament defect is very rare and accounts for 4%-7% of cases of internal hernia. We present a case of a 71-year-old female who was previously healthy with no significant past medical or surgical history and who presented with symptoms of small bowel obstruction. Imaging with X-ray and computed tomography (CT) confirmed the diagnosis, but not the etiology. A decision was made to perform a laparoscopy to manage the obstruction, which revealed a healthy small bowel loop that herniated through a defect in the right broad ligament. Acute abdominal pain due to intestinal obstruction is a relatively common surgical emergency. Internal hernias are the consequence of the herniation of a bowel loop, most commonly the small bowel, through a peritoneal or mesenteric defect into a compartment in the abdominal and pelvic cavity, and they have a high mortality rate than can be higher than 50%. CT imaging is very useful in the diagnosis of internal hernias, although it may not always reveal the etiology. To facilitate wider recognition, broad ligament hernia should be in the differential diagnosis of internal hernias evident in the pelvis on CT imaging. Early recognition of small bowel obstruction caused by broad ligament internal hernia allows for prompt surgical management and vastly facilitates postoperative recovery. Although most surgeons opt for a laparotomy approach to manage such cases, a laparoscopic approach is feasible.

Monomicrobial Necrotizing Fasciitis of the Breast: A Case Managed by Partial Mastectomy and Hydrogel Dressing.

Necrotizing fasciitis (NF) is a rare life-threatening bacterial infection, which can be monomicrobial or polymicrobial, involving the fascia and eventually leading to necrosis. The course of the disease is rapidly progressive and can be misdiagnosed as an abscess or cellulitis. The disease requires more attention with respect to early diagnosis and treatment as it has a high mortality rate. In this report, we present the case of a 60-year-old female, who was a known case of hypertension and type 2 diabetes mellitus (T2DM). The patient presented to the emergency department on the 21st of October 2020, complaining of left breast pain for 10 days, which was associated with fever and nausea. On physical examination, the left breast was swollen and tender to palpation. There was a single patch of inflamed skin measuring 1 x 1 cm with greenish discoloration in the inframammary fold. Ultrasound of the breast showed a patch of focal mastitis with edema seen at 4-8 o'clock with no underlying fluid collection. She was admitted as a case of left breast abscess and was started on antibiotics. Despite the antibiotic therapy, the patient was still febrile and developed two more inflammatory and necrotic patches with no discharge. The patient underwent urgent surgical debridement of the necrotic tissues, leaving the wound packed for postoperative dressing. The patient stayed in isolation for a total of 25 days as she was found to be positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The surgical wound was closed, and the patient was discharged. Early diagnosis and management of NF is the key to saving the patient's life and improving outcomes.

Prognosis of functional mitral regurgitation after aortic valve replacement for pure severe aortic stenosis.

OBJECTIVE: Whether patients with severe aortic stenosis (AS) and significant functional mitral regurgitation (MR) should undergo isolated aortic (aortic valve replacement [AVR]) or double aortic-mitral valve procedure (DVP) remains controversial. We sought to determine outcomes of such patients undergoing surgical (surgical aortic valve replacement [SAVR]) and transcatheter AVR (TAVR) or DVP, identify echocardiographic parameters predictive of significant residual MR after isolated AVR, and determine its impact on long-term survival. METHODS: Data prospectively collected from 736 consecutive patients with severe AS and significant MR undergoing AVR or DVP were retrospectively analyzed. Exclusion of organic MR, other valve diseases and concomitant CABG yielded a final population of 74 patients with significant functional MR (32 TAVR, 23 SAVR, 19 DVP). Demographics, postoperative complications and age-adjusted survival were compared. Echocardiographic predictors of significant residual MR and its impact on survival were analyzed for patients undergoing isolated AVR. RESULTS: In the isolated AVR group, MR improvement occurred in 60% of patients and was associated with a significant increase in survival compared to persistence of significant MR (p = .03). Patients with improved MR had significantly greater preoperative left ventricular dilatation (LVEDD: 49 vs. 43 mm, p = .001; LVESD: 35 vs. 29 mm, p = .03; LVEDV: 101 vs. 71 ml, p = .0003; LVESV: 57 vs. 33 ml, p = .002). There was no significant difference in perioperative mortality (5.3 vs. 4.4 vs. 9.4%, p = .85) or age-adjusted long-term survival between isolated AVR and DVP groups (76.3 vs. 84.2% survival at 2-year follow-up, p = .26), or between SAVR, TAVR and DVP groups (78.2 vs. 75.0 vs. 84.2% survival at 2-year follow-up, p = .13). CONCLUSIONS: After isolated AVR, MR improvement occurs in 60% of patients. It is predicted by greater ventricular dimensions and associated with significantly better long-term survival. Whether a staged approach with transcatheter correction of MR should be considered in patients with significant residual MR following AVR remains undetermined.

Caseous Calcification of the Mitral Annulus: A Role for Surgery.

An 80-year-old man followed for aortic stenosis was found to have an intracardiac mass. Multiple imaging modalities were inconclusive in characterizing the mass but raised concerns about the potential malignancy of the mass. Fear of operating on an elderly patient with a potential for cardiac neoplasia led to a percutaneous transseptal biopsy that failed to provide a clear diagnosis. Cardiac valvular surgery was performed in addition to excisional biopsy of the mass that turned out to be caseous necrosis of mitral annular calcifications.

Recurrent infarction of sphenoid bone with subperiosteal collection in a child with sickle cell disease.

Infarction of the orbital bone in patients with sickle cell disease is very rare. The authors report a young boy who presented twice with marked acute proptosis and eyelid swelling of the right eye resulting from infarction in the greater wing of the sphenoid bone accompanied by an orbital subperiosteal collection. The time interval between the 2 attacks was 3 years.