Ubiquitous use of prosthetic mesh in inguinal hernia repair: the dilemma

Summary The omnipresence of prosthetic materials (mesh) used in hernia repairs throughout the world deserves careful review. The propensity to develop operative techniques wherein prosthetic mesh is used routinely, regardless of type hernia, has reached an unacceptable level of practice. Being foreign bodies, postoperative complications occur which directly can be traced to the implanted meshes. Recent interest in mesh complications, i.e., infection, mesh shrinkage, migration and fistula formation, has escalated. Although mesh foreign body tumorigenesis has not been seen in humans following hernia repair, there is sufficient animal data to cause concern. Similarly, neural complications following use of mesh, particularly after the open anterior notension repair methods, are being reported at alarming rates. Many types of inguinal hernias do not need mesh repairs. It is our premise that these hernias must be identified preoperatively. Certainly, type I, II and III C inguinal hernias of our classification, should not receive a prosthetic mesh repair. If prosthetic mesh is to be used, it should be placed to buttress the inguinal wall posteriorly so that advantage of Pascal's law may be assured.     

Carcinoma of the sigmoid presenting as a right inguinal hernia

We present the case of a 44-year-old man who presented with nausea, vomiting and acute pain in the right groin. On physical examination an irreducible mass was palpated in the right inguinal region. Ultrasound suggested an inguinal hernia sac with bowel contents. Subsequent right inguinal exploration revealed only unspecified necrotizing tissue, but no hernia sac or bowel contents were identified. Two days later laparotomy was required since the inguinal wound produced faecal discharge. The sigmoid appeared to be necrotic and perforated, and was subsequently resected. Histology revealed a perforated adenocarcinoma without lymph node involvement. Incarcerated inguinal hernias containing an adenocarcinoma of the colon are rare, but should be considered in patients presenting with an irreducible palpable mass in the inguinal region. Moreover, a carcinoma of the sigmoid may invade the right inguinal region. An intestinal perforation to skin-level in this population is even rarer and is associated with high morbidity and mortality rates.     

Isolated terminal ileum perforation after a kick blow to an inguinal hernia

Small bowel perforation caused by direct blunt trauma to an inguinal hernia has rarely been reported. In this report, we present a patient with terminal ileum perforation after direct blunt trauma to an inguinal hernia region. Both perforation and hernia repair were managed surgically in the same stage. This case demonstrates that leaving an inguinal hernia unrepaired may lead to dangerous outcomes, such as intestinal strangulation and perforation. Inguinal hernias with intestinal perforation need urgent surgical intervention. It is possible to repair the intestinal perforation and inguinal hernia in the same operation.     

Perforation of the cecum from ingested foreign body in a 14 year old adolescent with autism spectrum disorder and epilepsy: A case report

Introduction and importanceAlthough foreign body ingestion is a common medical issue, intestinal perforations following foreign body ingestion are rare. Diagnosing foreign body ingestion is challenging especially in children with neurodevelopmental disorders such as Autism Spectrum Disorder (ASD). It is believed that approximately 80–90% of ingested foreign bodies pass through the gastrointestinal tract without causing any luminal damage, and only approximately 1% of foreign bodies are known to remain lodged within the bowel and cause luminal erosion and perforation.Case presentationA 14-year-old boy, diagnosed to have Autism Spectrum Disorder was brought in by his parents to our hospital with right lower quadrant (RLQ) abdominal pain and fever. On examination, he was tachycardic and there was direct tenderness over the RLQ of the abdomen. Acute appendicitis was entertained and the patient was examined with ultrasound. The ultrasound reported, “The tip of the appendix was dilated (0.62cm) and there is minimal RLQ intra-peritoneal fluid collection”. With the impression of acute appendicitis, the patient was explored and he was found to have a cecum perforation due to an ingested foreign body (twig). Initially we did tube cecostomy but later we did right hemicolectomy because the cecostomy tube had leaked.ConclusionForeign body ingestion should be taken into account during the evaluation of children and adolescents with neurodevelopmental disorders who presented with acute abdominal pain. Since diagnosis is difficult clinicians who are involved in acute care medicine should take a thorough history with a high index of suspicion for foreign body ingestion.     

Laparoscopic repair of esophageal hiatal hernia

Hiatal hernias are usually classified into three distinct types: type I, sliding hernia; type II, paraesophageal hernia; and type III, a combination of type I and II hernias. Presentation of type I hernia is so-called reflux symptoms, in contrast with the symptoms associated with mechanical obstruction of the herniated stomach in type II and III hernias. Surgical indications for type I hernia depend upon the severity of esophagitis. In type II and III hernias, severe symptoms and complications represent the chief indications for repair. Totally intrathoracic stomach hernias generally present such a risk of volvulus, strangulation, and perforation that surgery is indicated even in asymptomatic and uncomplicated cases. Although the pathophysiology is different, the Nissen procedure is the surgical procedure of choice for both types of hiatal hernia. Since the first report in 1993, the laparoscopic Nissen procedure has gained wide acceptance. We have so far experienced 26 cases of hiatal hernia, 18 of type I and 8 of type II and III hernias. We used the laparoscopic Nissen procedure in all cases. There were no conversions to the open procedure. Hiatal hernia recurred only in one case with a short esophagus preoperatively. The laparoscopic Nissen procedure is here to stay for the repair of hiatal hernias regardless of their type.     

Laparoscopic repair of incarcerated paraesophageal hernias

Paraesophageal hernias comprise only 2–5% of all hiatal hernias, yet unlike the more common sliding hiatal hernia, paraesophageal hernias are prone to undergo volvulus, with obstruction, ischemia, and gangrenous perforation. Due to their propensity toward calamitous complications, they must be recognized and repaired as expeditiously as possible. Traditionally these hernias have been repaired by either an open transabdominal or an open transthoracic approach. Laparoscopic repair with Nissen fundoplication has already been successfully applied to the repair of the more common sliding hiatal hernia. Described here is the laparoscopic repair of two paraesophageal hernias. The merit of an anti-reflux procedure as part of this repair is discussed.     

Small bowel perforation due to blunt trauma directly to the inguinal region: A case report

We report on a patient with intestinal perforation caused by direct blunt trauma to the inguinal region. The patient had been previously diagnosed with an inguinal hernia. The perforation was managed surgically, and he subsequently underwent hernia repair. In our opinion, intestinal perforation caused by inguinal region trauma in patients with inguinal hernias is a rare and unfortunate situation but one that reveals the importance of inguinal hernia repair.     

Mediastinal mass and radiolucent esophageal foreign body

The diagnosis of radiolucent esophageal foreign bodies can be difficult, particularly in patients with predominant respiratory symptoms. The consequences of the impaction of a foreign body in the esophagus are serious, and esophageal stenosis, perforation, acquired tracheoesophageal fistulas are among the complications already reported. An unusual complication of a nondiagnosed radiolucent plastic coin that remained impacted for 11 months on the posterior esophageal wall of a 20-month-old child, who presented only with respiratory symptoms, is reported. The foreign body eroded through the esophageal wall, causing an intramural abscess that was initially interpreted as a mediastinal mass, and the patient was operated on with the diagnosis of a foregut duplication. Literature on this situation was reviewed, and the problems associated with the diagnosis and treatment of children with radiolucent esophageal foreign bodies are discussed.     

高频超声在不同类型腹股沟疝患者中的鉴别及与精索腹壁下动脉的关系研究

目的探讨高频超声在不同类型腹股沟疝患者中的鉴别价值及与精索腹壁下动脉的关系。 方法选择2018年5月至2021年6月武汉大学中南医院收治疑似腹股沟疝患者116例为对象，均采用高频超声检查，以手术为腹股沟疝确诊及分类分型的"金标准"，分析高频超声在腹股沟疝中的检出率、鉴别效能及不同类型腹股沟疝超声特点，比较不同类型腹股沟疝疝环直径及与精索腹壁下动脉的关系。 结果116例疑似腹股沟疝患者经手术检查确诊67例，确诊率为57.76%。腹股沟疝患者中排在前两位的分别为：易复性疝或难复性疝与直疝；高频超声检查确诊62例，检查准确度为82.63%（P>0.05）；诊断灵敏度为82.09%、特异度为85.71%；高频超声在直疝、易复性疝或难复性疝、嵌顿性疝及绞窄性疝中的检出率与手术检查结果差异无统计意义（P>0.05）；高频超声下直疝、易复性疝、绞窄性疝疝环直径略高于手术检查，而难复性疝及嵌顿性疝疝环直径略低于手术检查，差异均无统计意义（P>0.05）。 结论高频超声用于腹股沟疝患者中具有较高的检出率，能实现不同类型腹股沟疝鉴别，且与精索腹壁下动脉关系密切。     

Uncommon case of incomplete left paraduodenal hernia

Internal hernias are very rare. The hernial orifice, sac and content are situated inside the abdomen. Paraduodenal hernias are relatively rare congenital malformations and account about 50 per cent of all internal hernias. The cause of this malformation is the incomplete rotation of the mid-gut. Right and left paraduodenal hernias are different, varying in anatomic structure and embryological origin. In right paraduodenal hernia the small bowel is partially or completely localised behind the mesocolon of the ascending colon, in left paraduodenal hernia behind the mesocolon of the descending colon. That is why the widely used name "mesocolic" hernia is more convenient, because it refers on the pathogenesis of the disorder. The complaints can vary from recurrent atypical abdominal pains to the complete small bowel obstruction, but often there are no complaints. Abdominal CT scan and the barium meal provide the best diagnostic approach for paraduodenal hernias, but it will be recognised very often only at an emergency operation. A case of small bowel obstruction caused by incomplete left paraduodenal hernia discovered after swallowing a foreign body is described with pathogenesis, diagnosis and possible treatments for the disease.     

Strangulated Umbilical Hernia in a Child: Report of a Case

Most umbilical hernias in children close spontaneously. Complications associated with umbilical hernias are rarely observed during follow-up. We report herein a 5-month-old girl with a strangulated umbilical hernia. Her umbilicus was hard, reddish, and irreducible. Plain radiography of the abdomen showed signs of mechanical ileus. The patient was thus diagnosed to have a strangulated umbilical hernia. A 5-cm section of the ascending colon and a 5-cm section of the terminal ileum, as well as the cecum and appendix, were congested, edematous, and erythematous, and together were enclosed by a firm hernial ring. A closure of the fascial defect and umbilicoplasty were performed. The postoperative course was uneventful. In patients with infantile umbilical hernias, strangulation may occur as the fascial defect decreases in size. Received: May 30, 2000 / Accepted: January 9, 2001     

An irreducible left scrotal hernia containing a sigmoid colon tumor (adenocarcinoma) – Case report

INTRODUCTION

In relation to all inguinal hernias, large irreducible scrotal hernias are quite rare, while such hernias containing colon tumors in the sac have so far been described in fewer than 30 cases.

PRESENTATION OF CASE

A 61-year-old patient was admitted for a planned surgery because of a large irreducible left-sided scrotal hernia. Intraoperatively, a large tumor of the sigmoid colon was found in the hernial sac. In a histopathological examination it was diagnosed as adenocarcinoma. A palliative operation was performed and he was referred to further systemic and palliative treatment (because of numerous coexisting liver metastases).

DISCUSSION

Until now, only about 30 cases of colon tumor in inguinal hernia sac have been reported.

CONCLUSION

It should be remembered that even the most obvious preoperative diagnosis may be verified intraoperatively.     

Ingested foreign bodies of the gastrointestinal tract.

Seven case reports of ingested foreign bodies are presented. Although ingestion of foreign bodies may be a frequent occurrence, 80 per cent of documented ingested foreign bodies pass through the gastrointestinal tract spontaneously. The most frequent victims of foreign body ingestion are children, denture-wearing adults, and the mentally ill. Most foreign bodies are best managed by "intelligent neglect". Some require surgical removal because of perforation hemorrhage or obstruction. The ileocecal region is the most common site for perforation. Close observation for signs of perforation, hemorrhage, and/or obstruction is mandatory.     

Perforation of gastric ulcer in inguinal hernia]

We report about a case of perforation of a peptic ulcer in an inguinal hernia. A 64-year-old female patient had been suffering from bilateral inguinal hernias for several years, without digestive complaints. The sudden occurrence of symptoms resulted not from strangulation, but from a specific complication of the incarcerated organ, ie. the perforation of an ulcer of the antrum, probably secondary to the intake of nonsteroid anti-inflammatories. Surgical treatment consisted in the suture of the perforation and the cure of the hernia with a net.     

Relationship between different body size indicators and hernia development in CAPD patients

AIMS: A small body size may increase the risk for hernia development in patients on continuous ambulatory peritoneal dialysis (CAPD). The present study investigates whether there is a relationship between body size and hernia development in CAPD patients. MATERIAL AND METHODS: The records of 78 patients on CAPD were reviewed retrospectively. Body mass index (BMI), body surface area (BSA) and total body water (TBW) were calculated in all patients. Correlations between different body size indicators (BMI, BSA and TBW) and hernia development were assessed using analysis of covariance in which we adjusted for sex. RESULTS: A total of 14 patients (17.9%) with no physical evidence of hernia before catheter insertion developed hernias. Body size was significantly lower in CAPD patients with hernias than those without hernias when adjusted for sex. CONCLUSIONS: We conclude that patients with small body size tend to have an increased risk for hernia development. A simple estimation of patients' height, weight, body surface area and total body water would be helpful to predict development of hernias or other complications related to increased intraperitoneal pressure in CAPD patients.     

Bailing out the bowel and bladder – A rare case report of rectal impalement injury with iatrogenic bladder rupture

Introduction and importanceRectal perforations due to foreign body impalement are infrequently encountered in practice. Accidental or intentional foreign body insertions pose a diagnostic challenge to surgeons and put them in demanding circumstances for successful extraction.Case presentationWe report a case of a 60-year-old male with alleged history of accidental foreign body insertion into the rectum. Radiographs showed a linear metallic foreign body with crooked end. Computed Tomography (CT) with rectal contrast revealed contrast extravasation indicating anterior wall perforation of upper rectum. Patient was taken urgently for exploration and foreign body removal. Intra-operatively, bladder was injured inadvertently. Primary repair of enterotomy and loop sigmoid-ostomy was done besides bladder repair. Patient tested positive for COVID-19. Patient was observed in critical care unit for two days. Post-operative period was unremarkable apart from midline abdominal wound gape for which secondary closure was done. Patient was discharged with urinary catheter in-situ. Patient followed-up with a normal cystourethrogram and a well-functioning stoma. Stoma closure after two months was uneventful.Clinical discussionA thorough history and clinical examination is required and one should raise a high index of suspicion of perforation in patients with rectal foreign bodies, which should be managed appropriately and promptly to prevent sepsis and multi-organ dysfunction. Inadvertent bladder injuries are common with lower-midline incisions. However, give good results when repaired suitably.ConclusionThe rationale behind this report is to explicate the complexity and hurdles in the surgical management of rectal foreign bodies causing impalement injury.     

Surgical repair of incisional ventral hernias: tension-free technique using prosthetic materials (expanded polytetrafluoroethylene Gore-Tex Dual Mesh)

Repairing an incisional ventral hernia is a major challenge for a surgeon. The high recurrence rates observed during hernia repair by tissue approximation led to development of tension-free procedures by using prosthetic materials. The purpose of this study is to report the results of a tension-free repair technique using expanded polytetrafluoroethylene Gore-Tex Dual Mesh (Gore-Tex Soft Tissue Patch, W.L. Gore and Associates Inc, Flagstaff, AZ) in patients with primary or recurrent incisional ventral hernias. Over 3 years, 52 patients with incisional hernias have undergone this procedure in our clinic. Fourteen of them had recurrent hernias which had been primarily repaired by Mayo hernioplasty. Six of our patients had irreducible hernias preoperatively. Twenty-five patients had hernias on midline incisions, and the rest of them had hernias on transverse abdominal incisions. The median patient age was 65 years, and all were operated on under general anesthesia. The majority of the patients had 4 to 6 days of hospitalization. A subcutaneous seroma developed in eight patients. They all were treated by multiple paracentesis. Four of our patients experienced wound infection and were treated by mesh removal. None of the patients presented with cardiovascular or pulmonary complications. During the follow-up period, no other hernia recurrence, except the cases with mesh removal, has been noticed. The tension-free incisional hernia repair using expanded polytetrafluoroethylene mesh is, to our experience, a safe and easy procedure with no major morbidity or recurrence.     

Lethal Intestinal Perforation After Foreign Body Ingestion in a Superobese Patient

Accidental ingestion of foreign bodies is common in the general population. Most foreign bodies pass through the entire digestive tract without incidents. However, in some cases, the ingested foreign body can cause complications such as acute abdomen due to intestinal perforation and even death. Bowel perforation may not be more common in the massively obese than in the normal-weight population but may be more problematic. We describe a super-obese female (body mass index, 52.3 kg/m²) who underwent emergency surgery for small-bowel perforation caused by an ingested foreign body (fish bone); the patient died despite segmental intestinal resection and intensive care.     

Laparoscopic repair of strangulated hernias

Background Although laparoscopic transabdominal preperitoneal polypropylene (TAPP) hernia repair is now a recognized procedure for groin hernia repair in patients undergoing elective surgery, there is a scarcity of data on TAPP repair in emergency situations such as those involving strangulated hernias. Methods Unless contraindicated, the authors’ department considers laparoscopic TAPP repair the procedure of choice for all strangulated hernias. A prospective database of 1,532 consecutive hernia repairs performed between May 1998 and April 2004 was reviewed. Results A total of 28 irreducible strangulated hernias were observed and repaired through laparoscopic TAPP. There were three conversions (10.7%): one because of extensive adhesions and two because of bowel distention. Resection became necessary in 9 (36%) of the 25 cases involving effective TAPP repair of strangulated hernias. The mean operation time, with and without resection, was 103 and 55 min, respectively. The rate of postoperative morbidity was 4% because of one inguinal hematoma case. During a mean follow-up period of 340 days, there were no recurrences after TAPP repair. Conclusions For selected patients, the TAPP approach appears to be a good therapeutic option for strangulated hernias.