Paravesical abscess as an unusual late complication of inguinal hernia repair in children

PURPOSE: We analyzed pitfalls in the etiology, diagnosis and treatment of pediatric patients who had a paravesical abscess (PVA) resulting from previous inguinal hernia repair. MATERIALS AND METHODS: We retrospectively reviewed the records of 6 children undergoing operation for PVA related to previous inguinal hernia repair between 1994 and 2002. RESULTS: All patients were male and 1.5 to 8 years old. The location of PVA was the right side of the bladder in 4 patients and the left side in 2. History showed that only 2 cases were complicated by early postoperative wound infection. Four patients were hospitalized with a relapse of symptoms following antibiotic treatment for possible urinary tract infection. The interval between initial inguinal hernia repair and the diagnosis of PVA was 6 to 48 months. Five patients had from recurrent lower urinary tract symptoms, 2 had ipsilateral groin discomfort and 1 had lower abdominal discomfort. There were swelling and tenderness at palpation of the ipsilateral groin in 5 patients not present at previous examinations. Only 1 patient had fever and leukocytosis. Urinalysis showed microscopic hematuria in all patients, of whom 2 had also leukocyturia. All patients had negative urine cultures. Ultrasound and computerized tomography findings suggested features of abscess formation at the paravesical space with concomitant focal thickening of the adjacent bladder wall. At surgery when entering the abscess cavity, thick pus and granulation tissues were débrided. Transfixing silk sutures were found to be secured to the adjacent bladder wall in 2 patients and in the area of the internal ring in 4. They were removed. The adjacent bladder walls needed no additional intervention. Biopsy specimens revealed only chronic inflammatory components. Antibiotics were continued for a mean of 7 days. Weekly ultrasound was performed to evaluate bladder wall thickening, which resolved completely within 3 to 5 weeks. Followup was 5 months to 6 years and no recurrence was noted. CONCLUSIONS: In children presenting with lower urinary tract symptoms (early period) plus findings of soft tissue infection at the ipsilateral inguinal region (late period) after inguinal hernia repair clinicians should be aware of the possibility of PVA as a primary problem to avoid insufficient treatment because its definitive treatment is removal of the infected suture material.     

Vesicocervical fistula: an unusual complication of vesicocaginal fistula repair

A rare case of vesicocervical fistula following repair of a vesicovaginal fistula is presented. The patient complained of cyclical menouria since the first repair done 15 years ago and gradually worsening urinary incontinence. A laparoscopic assisted repair of the fistula was performed and the patient is fully continent at 12-months follow up.An erratum to this article can be found at     

Gastrosplenic fistula: A rare complication of splenic abscess

Gastrosplenic fistulas are rare complications of malignant gastric or splenic diseases and, less frequently, are the result of benign diseases such as gastric ulcers and Crohn's disease. Spontaneous gastrosplenic fistula as a result of splenic abcess has not been reported in the literature so far. A 70‐year‐old man presented with a splenic abscess which had spontaneously developed a gastrosplenic fistula. The fistula was diagnosed by computed tomography scan and upper gastrointestinal endoscopy and was successfully managed by splenectomy with en bloc resection of part of the greater curvature of the stomach. Although gastrosplenic fistulas are a relatively rare complication of gastric or splenic diseases, an awareness might lead the clinician to early recognition and surgery can be offered earlier as the treatment of choice.     

An unusual complication after a cystectomy: A case of iliac artery-neobladder fistula

Iliac artery-neobladder fistula is very rare and only a few cases have been reported. The authors report a case of a 62-year-old man, diagnosed with a CT scan and an angiographic procedure and treated with a vascular endoprothesis placed through a percutaneous femoral access. The important role of early recognition is focussed on.     

An unusual enterovesical fistula

A 52-year-old woman, who had received radiation therapy for cervical cancer, presented with sepsis as the result of an enterovesical fistula. A loop of necrotic small bowel was retrieved through the urethra on removal of the urethral catheter.     

Incarcerated inguinal hernia presenting as spontaneous scrotal fecal fistula

We report a case of neglected, strangulated, inguinal hernia in a middle-aged male, which presented as a scrotal fecal fistula. This is the first such case reported in an adult. The patient was treated by resection and anastamosis of the ileum, local debridement of the scrotum and Shouldice repair for the inguinal defect.     

Late intestinal fistula formation after incisional hernia using intraperitoneal mesh

Enteric fistulas are a rare but serious complication following the repair of an incisional hernia using a prosthesis. We report the case of a 52-year-old man who developed an enterocolocutaneus fistula after incisional hernia repair with intra-abdominal polyester mesh. This case shows that one may want to avoid placing the parietal prostheses in direct contact with intestinal loops.     

Neonatal incarcerated inguinal hernia with spontaneous scroto-fecal fistula

This report describes the presentation of an incarcerated inguinal hernia in a neonate with the formation of a spontaneous scroto-fecal fistula. Delay in seeking medical attention in the present case was the cause of incarceration and formation of the spontaneous fecal fistula. We advocate that development of an inguinal hernia in an infant should be managed as an urgent problem even if it is easily reducible at presentation. There should be an early repair policy for all pediatric hernias, especially the neonatal ones.     

Vesicocutaneous fistula caused by giant bladder calculus

A rare case of giant bladder calculus presenting with vesicocutaneous fistula is described. A 62-year-old woman presented with dysuria and ulcer of the hypogastric wall. Urine drained through the ulcer. Both X-ray and computed tomography (CT) of the abdomen showed a giant bladder calculus with vesicocutaneous fistula. We performed cystolithotomy followed by closure of the fistula. The calculus measured 95 × 60 × 55 mm and weighed 350 g. Worldwide, it is the second reported case of vesicocutaneous fistula caused by giant bladder calculus.     

Approach to a giant inguinoscrotal hernia

We present an extremely huge and longstanding, giant inguinoscrotal hernia extending to below the knee with an ulcer at its base. Though hernias of this magnitude are rare, their management can be demanding and challenging. Nevertheless, in an emergency situation, the repair of the hernial defect is not essential, especially in a compromised patient. In fact, the most important step is excision of the devitalised tissue, and the final surgery can be delayed. In nonemergency management, definitive surgery can be planned either by a period of preoperative staged pneumoperitoneum, repairing after a resection of bowel and omentum, or replacing the content and ventilation of the patient to avoid the pressure on the cardiorespiratory system by forcing the tissue. This case highlights the problems encountered in management of huge hernias.     

An unusual groin exploration: De Garengeot's hernia

De Garengeot's hernia is a rare surgical phenomenon and describes the presence of the vermiform appendix within a femoral hernia. We describe a case of acute appendicitis mimicking an irreducible femoral hernia and reiterate key operative techniques necessary to prevent post-operative morbidity associated with this pathology.     

Late enterocutaneous fistula as a complication after umbilical hernioplasty

Umbilical hernia is a high-prevalence problem in adults. Traditional herniorrhaphy is marked by high recurrence rates, but nowadays, the use of prosthetic materials has improved results and has even brought about lower morbidity rates, making the enterocutaneous fistula an exceptional complication of umbilical hernioplasty. We report on a case of a 54-year-old male who developed a high-debt enterocutaneous fistula 1 year after undergoing an operation for an umbilical hernia by means of a plug-technique hernioplasty. We discuss the case, treatment, and preventable aspects of this complication.     

Complications of inguinoscrotal bladder hernias: a case series

Although the urinary bladder is involved in 1–4% of all inguinal hernias, extensive inguinoscrotal herniation of the bladder, termed scrotal cystocele, is very rare. Most small asymptomatic bladder hernias are commonly encountered and reduced successfully via the same incision during elective inguinal hernia repair. However, larger bladder herniations can be associated with bladder infarction or obstruction, which require urgent intervention to preserve renal function and reduce morbidity and mortality. We present two cases of elderly men presenting with significant scrotal cystocele complications which necessitated urgent surgical intervention. We compare and contrast the two cases and discuss the presentation, investigation, diagnosis and treatment of these pathophysiological conditions. Sources of financial support: none.     

Spontaneous entero-labial fistula complicating Richters hernia: Report of a case

BackgroundRichter's hernia is defined as a type of hernia in which only part of the circumference of the antimesenteric border of a bowel wall is incarcerated within the hernia sac leading to ischemia, gangrene and perforation of the hollow viscus. Richter's hernia is known to cause strangulation without obstruction due to involvement of only a part of the circumference of a bowel wall. Inguino-labial Richter's hernia presenting with the complication of spontaneous entero-cutaneous fistula is rare.AimThis is to report a case of spontaneous entero-labial fistula complicating Richters hernia occurring in an adult female.Case reportA 61-year-old woman presented with a history of sudden generalized abdominal pain. She had a prior history left inguino-labial swelling of six years duration, which was initially reducible but became irreducible two weeks prior to presentation. There was associated discharge from the swelling a few days later. She was pale and febrile. Her temperature was 39.2 °C, pulse rate was 110 per minute and blood pressure was 130/60 mmHg. A diagnosis of left inguinolabial hernia was made.She was resuscitated and an exploration of the groin swelling was made. A rupture of the anti-mesenteric border of the ileum with strangulated preperitoneal fat was found. She had resection and anastomosis of the ileum.ConclusionSpontaneous faecal fistula in inguinal region following rupture of strangulated Richter's hernia especially in adults is uncommon and can occur even in absence of obstructive symptoms. In presentation of any groin swelling, there is need for an early accurate diagnosis followed by prompt treatment. The delay in its diagnosis and management may result in this rare complication of spontaneous faecal fistula. This reflects the state of health care in the developing world and needs to be addressed by the concerned authorities.     

An unusual hernia complication: a late presentation

A 67-year-old man presented with a 10-year history of intermittent right iliac fossa pain. His only significant past medical history was an inguinal hernia repair 10 years ago. After investigations, the patient underwent a laparotomy. He had a localised caecal perforation secondary to a misplaced prolene suture. A right hemicolectomy was performed.     

An unusual presentation of an incarcerated Spigelian hernia

Spigelian hernias are rare hernias, occurring through a defect in the Spigelian aponeurosis. Like other hernias, they may contain abdominal contents but are more likely to be incarcerated due to the small size of the fascial defect. Multiple intra-abdominal organs have reportedly been found in Spigelian hernias. A search of the literature showed only nine reported cases in which an appendix has been found within a Spigelian hernia. We present a patient with a history of lower abdominal pain since 10 weeks with a large intra-abdominal mass in the right iliac fossa. Due to abscess formation with spontaneous evacuation through the abdominal wall, drainage and incision were performed and the patient was treated with broad-spectrum antibiotics. An explorative laparoscopy after six weeks showed an incarcerated appendix in a Spigelian hernia.     

Lichtenstein和腹腔镜经腹腹膜前疝修补术在腹股沟阴囊疝患者中的临床应用

目的比较腹腔镜经腹腹膜前疝修补术（TAPP）与开放Lichtenstein手术,在腹股沟阴囊疝治疗中的疗效,并探讨其可行性及术后并发症的发生率。 方法选择2016年1月至2018年12月,南京市高淳人民医院阴囊疝患者48例。按照术式不同分为TAPP组（20例）和Lichtenstein组（28例）。比较2组术中及术后并发症,包括手术时间、术中出血、术后疼痛、伤口及网片感染和术后复发等。 结果本组患者均顺利完成手术。Lichtenstein组手术时间（59±12）min,TAPP组手术时间（56±9）min,差异无统计学意义（P>0.05）;Lichtenstein组术中出血量（30.0±10.5）ml,TAPP组为（10.0±5.1）ml,差异有统计学意义（P<0.05）。Lichtenstein组住院时间（9.0±5.2）d,TAPP组（3.0±2.4）d,差异有统计学意义（P<0.05）。Lichtenstein组术后疼痛VAS评分（术后1周）为（4.0±1.4）分,TAPP组（2.0±1.2）分,差异有统计学意义（P<0.05）。2组患者在随访期间均无补片感染、复发及慢性疼痛发生。Lichtenstein组切口并发症（浅表感染及血肿,渗血,渗液）6例,阴囊积液6例;TAPP组切口并发症0例,阴囊积液7例。均经过换药或者保守治疗,均治愈出院。 结论TAPP可以进行腹股沟阴囊疝修补术,其疗效与腹股沟疝开放修补术相当,TAPP具有术后疼痛轻、伤口并发症少,住院时间较短的优点。