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BACKGROUND: The occurrence of pressure injuries (PIs) in an inpatient is a serious medical condition that requires a rigorous clinical evaluation. Management of these lesions should be comprehensive, including general measures and local care. Wound care occupies a large part of the treatment. For large skin loss, the treatment requires plastic surgery techniques for reconstruction. Myocutaneous advancement flaps are a good therapeutic option due to the provision of vascularized tissue within the skin defect. To ensure the success of the surgery, a good surgical technique preceeded by careful preparation of the patient in conjunction with the anesthesia team is imperative. CASE PRESENTATION: We report the case of a 60-year-old bed ridden man for more than two months following an ischemic stroke with left spastic hemiplegia and loss of sensitivity. He was transferred to our surgical unit for the management of a chronic stage 4 PIs in the sacral area complicated with cellulitis, subcutaneous abscess and severe sepsis. Initial management consisted of resuscitation measures combining fluid therapy, antibiotic therapy, analgesics, blood transfusion, nutritional support, physioteherapy, wound care as well as preventive measures and psychological support. Once the granulation tissues were fully developed, the patient underwent reconstruction surgery with a V-Y myocutaneous advancement flap. The graft was successful with complete wound healing thereafter. CONCLUSION: PIs are a multifactorial, complex and disabling pathology that requires multidisciplinary care. Surgeons, anesthetists, nutritionists, physiotherapists, nurses must act in agreement in order to provide optimal treatment. Prevention is the rule.
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INTRODUCTION: Posterior abdominal wall hernias are rare, mainly post traumatic or post-operative. This case is particular first by its mechanism, it is a primary lumbar hernia and secondly it is a concomitant hernia of the Jean Louis Petit triangle and the Grynfeltt triangle. PRESENTATION OF CASE: The patient was a 67 years old man, a former farmer. He complaint of a painful tumefaction on his back evolving for the last 2 years. After clinical examination, a diagnosis of lumbar hernia was retained. The CT scan which is the gold standard was not performed due to financial limitations. An hernioplasty with a porcine collagen mesh was done, in per operative we found a Jean Louis Petit hernia and a Grynfeltt-Lesshaft hernia. Any post-operative complications. DISCUSSION: Lumbar hernia is not a common diagnosis, and most of time is misdiagnosed. Acquired primary lumbar hernia can be due to profession involving lumbar constraints leading to the weakness of muscles. This was the case of our patient. Another particularity was the double hernia, the upper and lower lumbar triangles. We already know the impact of his profession and may be 20 years of this leaded to the double hernia? An hernioplasty in open surgery was proposed for multiples reasons: the age of the patient, the weakness of the muscle, a large exploration of the hernia, to reinforce the posterior lumbar wall and to prevent a recidivism. CONCLUSION: Jean Louis Petit and Grynfeltt-Lesshaft hernias are very uncommon. Few cases have been reported.
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Intestinal myxoma is among the rarest presentations of this benign tumour. Moreover, the association of an intestinal myxoma and a mesenteric lipoma is even more surprising. Intestinal tumours are often diagnosed inadvertently: a routine physical exam may identify these tumours or an abdominal computed tomography scan or abdominal ultrasound for another indication. Acute intestinal obstruction is rare. We hereby report the case of a 6-year-old boy who presented in the emergency room of our institution with acute intestinal obstruction and the management of this case.
