Direct radionuclide cystography imaging in colovesical fistula due to inguinal hernia operation complication

Colovesical fistula is an abnormal connection between the enteric and urinary systems, usually sigmoid colon, caused by various conditions. One cause of colovesical fistula is iatrogenic injury, such as induced by inguinal hernia surgery. We present a case of colovesical fistula. A 57-year-old male was admitted to a local hospital with complaints of dysuria and pneumaturia. He had a past history of total extraperitoneal laparoscopic inguinal hernia repair operation 7 years previously for bilateral inguinal hernia. The case was assessed with radiologic and scintigraphic techniques. Radiologic techniques (plain abdominal radiography, intravenous pyelogram, ultrasound examination, double-contrast barium enema, CT, MRI) were inadequate to determine the colovesical fistula. The colovesical fistula was visualized with direct radionuclide voiding cystography as an alternative scintigraphic method.     

Herniography in atypical inguinal hernia

In patients with unclear groin pain herniography has revealed hernia in 36% of the patients with a normal physical examination. Most of the hernias detected on herniography are of indirect, direct or femoral type. The former two are found predominantly among men and the latter among women. These types of hernia are defined herniographically according to their location and shape. Whether or not a hernia is present is usually obvious although small hernias may be obscured by pelvic bone and contrast medium in the inguinal fossae and pouch of Douglas. In most patients the hernias are conspicuous and easy to classify correctly. Problems may, however, arise in the precise definition of some types of hernia. In this respect positive contrast herniography contributes to the pre-operative evaluation in patients with inguinal hernia. The aim of the present report is to describe some less well-known herniographic findings. The clinical impact of the particular findings is discussed.     

疝环充填式无张力疝修补术治疗老年腹股沟疝临床分析

目的探讨疝环充填式无张力疝修补术在老年腹股疝治疗中的临床效果。方法回顾性分析我科116例老年腹股沟疝患者接受疝环充填式无张力疝修补术治疗的临床资料。结果全组均痊愈,手术时间短,下床时间早,无切IZl感染,无复发病例。结论疝环充填式无张力疝修补术安全,在减少术后并发症、降低术后复发率方面具有传统手术方式无法比拟的优势。     

疝环充填式无张力疝修补术治疗老年腹股沟疝临床分析

目的探讨疝环充填式无张力疝修补术在老年腹股疝治疗中的临床效果。方法回顾性分析我科116例老年腹股沟疝患者接受疝环充填式无张力疝修补术治疗的临床资料。结果全组均痊愈,手术时间短,下床时间早,无切口感染,无复发病例。结论疝环充填式无张力疝修补术安全,在减少术后并发症、降低术后复发率方面具有传统手术方式无法比拟的优势。     

Omental torsion with right-sided inguinal hernia

Omental torsion is a rare cause of acute abdomen. The diagnosis is usually not established before surgery, but recently some reports have described the usefulness of computed tomography (CT) for the detection of this condition. We encountered a 58-year-old man with torsion of the greater omentum secondary to right-sided inguinal hernia, and present the characteristic CT findings of a whirl-like mass with hyperattenuated fatty tissue.     

Herniographic appearance of contralateral inguinal hernia

In 303 adults (185 men, 118 women) with unilateral groin pain and a normal physical examination, positive contrast herniography was performed. In 32 per cent of the patients a symptomatic hernia (ipsilateral) and in 18 per cent an asymptomatic hernia (contralateral) were found. The type of hernia was indirect, direct, femoral or obturator. Indirect and direct inguinal hernias were significantly more frequent on the ipsilateral side compared with the contralateral in men with right-sided groin pain. In women with left-side groin pain femoral hernias were significantly more frequent on the ipsilateral side compared with the contralateral. The size alone could not discriminate between ipsi- and contralateral hernias. The results indicate that in most patients there is no specific radiographic appearance which can discriminate between symptomatic and asymptomatic hernias.     

Radiologic investigation after laparoscopic inguinal hernia repair

Laparoscopic instead of open surgical repair of inguinal hernias is becoming more frequent. Radiologists may expect different postoperative findings depending on the technique used. We studied how radiology had been used postoperatively and what findings were encountered after laparoscopic herniorraphy. Postoperative radiologic examinations related to hernia repair of all consecutive patients that had had laparoscopic herniorraphy in Malmö University hospital between 1992 and 1998 were retrospectively evaluated. A total of 538 groins were included, 3.9% (n=21) of these were postoperatively examined with ultrasound (n=10), herniography (n=7), plain abdominal films (n=2), CT (n=1), or fistulography (n=1). Significant findings were found in five groins, namely, one sinus tract, two hematomas, one small bowel obstruction, and one recurrence of hernia. Four insignificant seromas were found. The characteristics of the findings and pitfalls are described. Symptoms resulting in radiologic examination are rare after laparoscopic herniorraphy. The radiologist must be familiar with the spectrum of such findings.     

Abdominal wall neurofibroma presenting as an inguinal hernia

Inguinal hernias are a common cause of abdominal wall pain and are the most common abdominal wall abnormality. They can usually be differentiated from other abnormalities by history and physical examination. Occasionally, the diagnosis may be difficult with very small or very large lesions. The following case report describes an abdominal wall neurofibroma presenting as an inguinal hernia in a young, active duty, male soldier with previously undiagnosed neurofibromatosis.     

When to use mesh in inguinal hernia repair

With people living longer today, averaging 73 years old, the type of patients with inguinal hernias are different than in the past. At the present time, to avoid the high incidence of recurrence due to the aged and weakened tissue component of the groin area, we reinforce the posterior wall of the inguinal canal with Mersilene (dacron) mesh. Most surgeons agree to use a prosthetic mesh in recurrent inguinal hernia repairs. Moreover, sometimes it is necessary to use mesh in patients with connective tissue disorders like Ehlers syndrome, Marfan syndrome, and acquired absence of the posterior wall fascia transversalis. Currently, polypropylene and dacron mesh are the most satisfactory, since they are readily available and become well incorporated by connective tissue.     

Unexpected fatal outcome of laparoscopic inguinal hernia repair

In this paper we report the autopsy findings of a long-term warfarinized 60-year-old man who died unexpectedly 2 days after undergoing laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair. In his medical records it was stated that the perioperative and postoperative period was uneventful with no sign of bleeding and he was discharged the day after surgery. Autopsy revealed massive bleeding in the pre-peritoneal space at the surgery site and a massive left inguinal canal hematoma spreading through the spermatic cord to the left scrotum. There was no evidence of retroperitoneal bleeding. No sign of traumatic injury to the abdominal wall, major abdominal and pelvic vessels was revealed. The cause of death was hemorrhagic shock. We believe that this is the first documented case of fatal outcome after TAPP inguinal hernia repair in Slovakia. Inguinal hernias account for approximately two-thirds of all abdominal wall hernias. The reported case demonstrates that routine procedures such as TAPP hernia repair can have a fatal outcome, not due to any surgical mishap but because of the altered health status of the patient.     

超声诊断腹股沟斜疝的体会

本文总结分析超声检查诊断腹股沟斜疝63例，61例经手术证实，探讨超声诊断腹股沟斜疝的声像图表现及临床意义。     

Retroperitoneal gas gangrene complicating elective inguinal hernia repair.

Gas gangrene is a well recognised complication of contaminated military wounds. A case of Clostridial myonecrosis following elective inguinal hernia repair is described. The pathology, clinical features and management of this life-threatening condition are reviewed.     

输卵管突入腹股沟疝囊1例

患者 女，32岁。1995年头胎顺产，继而带避孕器5年，2年前取环，性生活正常，一直未孕，故来我院就诊。     

疝环充填式无张力疝修补术在成人腹股沟疝

目的:评价疝环充填式无张力疝修补术治疗腹股沟疝的临床价值。方法:应用聚丙烯网塞及网状补片治疗腹股沟疝96例,对手术时间,手术方法,术式的优点,并发症及术中注意事项进行回顾性总结。结果:全组均痊愈,手术时间平均48.5min,术后疼痛轻微,平均6h后即可下床活动,无感染病例,主要并发症为4例尿潴留和3例阴囊积液。42例出现术后低热。随访无复发病例。结论:该方法操作简便,符合腹股沟区生理解剖特点,术后疼痛轻,患者恢复快,复发率低,是治疗腹股沟疝的理想复发。