Appendicitis in paraumbilical hernia mimicking strangulation: a case report and review of the literature

Purpose

The contents of umbilical or paraumbilical herniae are usually omentum or bowel; rarely, metastatic deposits, appendix epiploicae, or an inflamed vermiform appendix may be found. Unexpected contents cause confusion in the diagnosis, especially when inflamed, and may mimic a strangulated umbilical hernia. Appendicitis in the hernial sac is known in inguinal and femoral herniae; however, only four reported cases of appendicitis within an umbilical hernia could be identified.

Case

A 54-year-old female presented to the emergency with a 2-day history of vomiting, severe pain and irreducibility of a paraumbilical swelling. On examination, we found tachycardia, with a tender, erythematous and irreducible paraumbilical swelling. With a diagnosis of strangulated paraumbilical hernia, the abdomen was explored through an infraumbilical incision. Opening the sac revealed inflammatory fluid, omentum, and an inflamed and edematous appendix. Appendicectomy was performed with anatomical double-breasted repair of the fascial defect. Histopathological examination of the specimen revealed acute appendicitis, periappendicitis and panniculitis in the omentum.

Conclusion

Appendiceal inflammation inside a hernia sac is probably due to extrinsic compression and partial ischemia. Symptoms manifest late, and the final diagnosis is mostly made during the operation. CT scan provides only indirect clues to diagnosis. Appendicectomy and anatomical repair is the appropriate treatment for appendicitis within a paraumbilical hernia.     

Appendicitis as a rare cause of mechanical small-bowel obstruction: A literature review of case reports

IntroductionAlthough bowel paralysis accompanying acute appendicitis is well known, mechanical bowel obstruction as a direct consequence of appendicitis remains a rare, but potentially life-threatening, acute abdomen. The aim of our literature review was to find all documented cases of this particular complication and compare them with our own case study.MethodsWe searched the PubMed database for relevant articles published from 1963 to 2015. The study included patients for whom direct links between appendicitis and strangulation of the terminal ileum were found, and for which the disease course had been documented in detail. The study also included our own case report since it met the inclusion criteria. A total of 190 articles were examined with a final yield of 17 case reports from 13 articles.Results17 patients (11 men and 6 women), with a mean age of 48 ± 23.9 years, met the inclusion criteria. The average period between symptom onset and surgery was 3.4 ± 3.7 days. Symptoms of the disease were consistent with small-bowel obstruction. Treatment included simple appendectomy (n = 7), possibly supplemented by segmental resection (n = 5), followed by ileocecal resection (n = 4), and one case that required a right-sided hemicolectomy (n = 1).ConclusionWe found mechanical bowel obstruction directly related to appendiceal inflammation to be extremely rare, and relatively few individual cases involving this potentially life-threatening complication have been documented in the literature. Clinical signs of the disease are variable, non-uniform, and consistent with symptoms of small-bowel obstruction during their progression.     

An undiagnosed left sided traumatic diaphragmatic hernia presenting as small intestinal strangulation: A case report

INTRODUCTIONPost traumatic diaphragmatic hernia is very often missed particularly in polytrauma patients. We present case of an isolated post traumatic diaphragmatic hernia with strangulation, a very rare finding.PRESENTATION OF CASEA 35 year old man presented with features of intestinal obstruction with past history of a seemingly trivial blunt thoracic injury 15 years back. Findings of X-ray abdomen and chest with high leukocyte count raised suspicion of obstructed diaphragmatic hernia which on exploration revealed obstructed diaphragmatic hernia with gangrenous bowel segment.DISCUSSIONBlunt injury of diaphragm is relatively common and is considered as a marker of severe trauma and it can clinically be occult as other violent injuries may mask and disguise its initial clinical presentation¹ resulting in late presentation with obstruction and/or rarely strangulation. An early diagnosis of the condition is prudent to avoid morbidity and mortality associated with late presentations.CONCLUSIONIn a patient of intestinal obstruction with history of even trivial throraco- abdominal injury, diagnosis of diaphragmatic hernia should be kept in mind.     

Cotton Bezoar- a rare cause of intestinal obstruction: case report

Background  

Bezoars usually present as a mass in the stomach. The patient often has a preceding history of some psychiatric predisposition. Presentation could be in the form of trichophagy followed by trichobezoar (swallowing of hair leading to formation of bezoar), orphytobezoar (swallowing of vegetable fibres). Rapunzel syndrome is a condition where the parent bezoar is in the stomach and a tail of the fibres or hair extends in to the jejunum. Presentation as intestinal obstruction due to a bezoar in the intestine without a parent bezoar in the stomach is rare, therefore we report it here.     

腹膜后肠道重复畸形一例报告并文献复习

目的探讨肠道重复畸形的基本情况、病理与临床特点、诊断和治疗效果。 方法收集2016年9月份广东省人民医院泌尿外科收治的1例30岁男性患者资料，患者因"发现左侧肾上腺肿物1个月"入院，术前增强CT提示腹膜后左侧肾上腺区见圆形囊性低密度肿块，考虑左侧肾上腺囊性占位，良性，囊肿可能性大。完善检查后在我科行后腹腔镜下左侧肾上腺肿物切除术，术中冰冻病理检查提示囊性病变，未见恶性证据。 结果术后结合病理诊断为腹膜后肠道重复畸形，患者恢复良好，目前仍在随访当中。 结论腹膜后肠道重复畸形临床上罕见，临床表现不典型，影像学、实验室检查多无特异性，临床工作中易发生误诊，最终需病理明确诊断，手术完整切除为最佳治疗方式。     

Total small bowel strangulation: a case report.

A case of strangulation of the entire small intestine caused by an internal incarcerated hernia is presented. At laparotomy the small intestine was severely discoloured, paralytic and the viability of the bowel was questionable. No resection was performed. At a second laparotomy 10 h later the intestine was hyperaemic and exhibited lively motor activity. Recovery was complete. The importance of prolonged conservative management in avoiding extensive resection is stressed.     

Eosinophilic enteritis presenting as acute intestinal obstruction: a case report and review of the literature

A 37-year-old man was admitted to our hospital complaining of severe abdominal pain and vomiting. His abdomen was distended, and there was diffuse tenderness and guarding in all four quadrants. Laboratory examinations revealed leukocytosis without eosinophilia. Abdominal radiograph revealed air-fluid levels in the small intestine. Computed tomography confirmed a dilatation of the small intestine and the presence of ascites. An emergency laparotomy was performed for a diagnosis of peritonitis due to intestinal obstruction. A large amount of yellow transudate was present in the abdominal cavity. An area of induration in the ileum was identified about 40 cm from the ileocecal valve. The ileum proximal to the induration was dilated, and the site of obstruction seemed to be the indurated segment. A partial iliectomy was performed. Histologically, dense infiltration of eosinophils was found transmurally, and eosinophilic enteritis was diagnosed. One year later, the patient was free of gastrointestinal symptoms. The relevant literature on eosinophilic gastroenteritis is discussed.     

Perisplenitis as a cause of acute abdomen: a case report

Splenitis can complicate blood-borne sepsis in hemodialysis patients. Symptoms include left upper quadrant pain and tenderness in addition to generalized systemic manifestation of infection. Clinical diagnosis is difficult and there is no specific investigation to confirm it. Computed tomography scan of the spleen can help in identifying a splenic abscess, rupture, or infarction. A splenectomy is the treatment of choice in splenic abscess, in splenitis to avoid spontaneous rupture, and in recurrent perisplenitis.     

Erdheim-Chester disease as cause of end-stage renal failure: a case report and review of the literature

International Urology and Nephrology -     

Wandering spleen as a cause of acute abdomen: a case report

We report a case of acute abdomen due to torsion of the long vascular pedicle of a wandering spleen, displaced in the abdominal cavity, and caused by partial infarction of the spleen. The 46-year-old patient presented to the casualty department with piercing abdominal pain, fever, vomiting, leukocytosis, thrombocytopenia, and a palpable mass in the mesogastric region. US and CT scan revealed the presence of a mass compatible with an ectopic spleen in the mesohypogastric region, featuring necrotic-haemorrhagic areas, a long, contorted vascular pedicle twisted on its axis, and an empty splenic space. We performed an emergency laparoscopic splenectomy. Conservative surgery (splenopexy) could not be done because of the severe impairment of the vascular supply to the organ. Nowadays, conservative surgery is preferred in cases without vascular impairment, especially in children, by creating an omental or synthetic pouch after fixing the organ in the splenic space.     

Oxidised regenerated cellulose as a cause of paraplegia after thoracotomy: case report and review of the literature

STUDY DESIGN: Case report. OBJECTIVE: To report an unusual case of paraplegia. SETTING: University Hospital Bursa, Turkey. CASE REPORT: A 22-year-old woman presented with paraplegia following a left-sided thoracotomy. Magnetic resonance imaging showed a dorsal epidural mass at the level of T6. The patient underwent an emergency T6/7 laminectomy and removal of a tuft of oxidised regenerated cellulose, which had migrated through the intervertebral foramen causing spinal cord compression. CONCLUSION: In cases of neurological deficits after surgery at the posterolateral edge of a thoracotomy, the clinician should be aware of the above possibility. Urgent radiological diagnosis and decompressive laminectomy is the treatment of choice.     

Traumatic abdominal hernia associated with large bowel strangulation: case report and review of the literature

A rare case of traumatic rupture of the abdominal wall with ventral herniation and strangulation of the right colon is presented. The defect was detected by computed tomography on admission. The patient was operated on 3 days after injury, and irreversible ischaemia of the right colon was found. Right hemicolectomy was performed. The pathogenesis and treatment of this complication is discussed.     

小肠移植术后慢性移植物失功1例报道及文献复习

目的探讨小肠移植术后慢性移植物失功(chronic graft dysfunction,CGD)的诊断及治疗。方法报道国内首例同种异体小肠移植患者术后CGD的临床资料,复习相关文献。结果患者因"门静脉血栓、脾静脉血栓致肠系膜血栓"切除了大部分小肠,后行同种异体小肠移植术。术后长期服用他克莫司(FK506),屡次发生排斥反应。术后3次因"小肠狭窄、不全性肠梗阻"行"小肠节段切除吻合术"。其中术后576d第3次出现肠梗阻,予经皮内镜下胃空肠造瘘术胃肠减压等治疗,确定移植肠不可逆性失功后行移植小肠切除术。结论 CGD治疗困难,预后不佳,预防胜于治疗。在确诊CGD不可逆后应尽快切除移植小肠,挽救患者生命,有条件应尽快安排再次移植。