Paracaecal hernia: a case report on the evolving role of laparoscopy.

A paracaecal hernia, a type of pericaecal hernias, is a rare cause of small intestinal obstruction. Failure of early recognition and reduction of this type of internal hernia may lead to strangulation of the herniated intestine. There has been a number of case reports in the literature about the different types of pericaecal hernias, however the anatomy of these hernias is still poorly understood and the management is still evolving. We are presenting a 75year old woman, who presented clinically and radiologically with distal small intestinal obstruction. Her past medical history was unremarkable and she had no prior abdominal surgery. After resuscitation, she was taken to the operating theatre for a diagnostic laparoscope, which showed a herniated loop of ileum through a congenital defect in the parietocaecal fold. Reduction of that loop and closure of the peritoneal defect were achieved laparoscopically. Following the procedure, the patient recovered very quickly and she was discharged home within 48h of her initial admission. Patients with pericaecal hernias tend to present with symptoms of distal small intestinal obstruction. The presence of localised peritonism in the right iliac fossa usually indicate strangulation and that should prompt an urgent surgical intervention. In summary, based on our case, excellent results were achieved from early laparoscopic intervention. Therefore, we recommend early laparoscopy for patients presenting with small intestinal obstruction with no history of abdominal surgery.

Implementation and evaluation of a checklist to improve patient care on surgical ward rounds.

BACKGROUND: Key aspects of care may be overlooked on a busy surgical ward round. This study assessed the use of a checklist to correct these omissions. Its use as the basis of structured ward round documentation was then measured. METHODS: Using a structured checklist, key aspects of surgical care were observed and recorded during ward rounds. Initially, members of the surgical team were unaware of the checklist. Subsequently, rounds were performed with a designated member of the team acting as 'prompter' if aspects of care were not considered per the checklist. A structured ward round progress form was developed and its completion assessed before and after specific education in its use. Changes in the use of checklist and documentation using the structured form were analysed for statistical significance. RESULTS: Following the use of a checklist and prompting during ward rounds, significant improvement occurred in the consideration of the majority of criteria included in the checklist, all of which reached statistical significance (P < 0.05). Provision of a structured progress form did not initially improve documentation but this was substantially improved with specific education (P < 0.05). CONCLUSION: The use of a checklist during surgical ward rounds makes significant improvement in the consideration of most key aspects of care and education in the completion of a structured progress form substantially improved documentation.