Rupture of adductor longus tendon due to ciprofloxacin

We present a rare case of spontaneous rupture of the adductor longus tendon induced by ciprofloxacin. A 35-year-old man was diagnosed with pneumonia and was recommended ciprofloxacin 500 mg iv twice a day for 7 days. Three days after receiving the initial dose, he developed discomfort in his left medial thigh, and pain and swelling in the same area followed ten days later. He consulted us when he noted a palpable mass on the medial side of his left thigh, and MRI study revealed adductor longus tendon rupture. There was no obvious underlying disease or other factor causing fragility of his adductor longus tendon. We review the pathophysiological mechanisms leading to fluoroquinolone-related tendon rupture as well as the risk factors and discuss proper management.     

Surgical Management of Sportsman's Hernia in Professional Soccer Players

Soccer players frequently experience acute and chronic groin pain. Sportsman's hernia is a common injury in professional soccer players, that causes inguinal pain. The authors discuss their experience with the management of sportsman's hernia in professional soccer players competing in national and international competition in a retrospective review of prospectively collected data. Between March 2004 and December 2009, seventy-one professional soccer players were surgically treated for sportsman's hernia. Average age at surgery was 24 years, and average duration of symptoms from onset to surgical repair was 11 months. Conservative treatment improved symptoms temporarily or to some extent in 18 athletes. All athletes underwent a bilateral open hernia repair with concurrent adductor tendon release. Average follow-up was 4 years, and average time to return to competitive sport was 4 months. At final follow-up, 95% of soccer players were still active, 48 at the same level and 19 at a lower level. Four athletes had stopped their careers because of another injury (n=2) or recurrence (n=2).Sportsman's hernia is a potentially career-ending injury in professional soccer players. Conservative management is often unsuccessful. An open surgical hernia repair combined with an adductor longus tenotomy relieves the symptoms caused by a sportsman's hernia and restores activity in 95% of athletes. This study offers insight into the management of sportsman's hernia and offers a successful treatment to salvage the careers of professional soccer players.     

Ruptured abdominal aneurysm disguised as an incarcerated inguinal hernia

An incarcerated inguinal hernia is a textbook example of a basic and straightforward diagnosis. In rare cases, an incarcerated hernia may be a symptom of more complex underlying pathology. In this case report a patient with a ruptured abdominal aortic aneurysm presented with an incarcerated left inguinal hernia. Only two other cases have been reported with a stable patient at initial presentation. The diagnosis was suspected when blood seeping next to the internal inguinal ring was detected, and an urgent ultrasound in the operating room confirmed the diagnosis. Whether or not patients with an inguinal hernia are more at risk for an AAA remains unclear.     

腹腔镜技术在急性腹股沟嵌顿疝中的应用价值(附11例报道)

目的探讨腹腔镜技术在腹股沟嵌顿疝复位及修补中的价值。方法回顾性分析我院2007年3月至2008年2月期间利用腹腔镜治疗11例急性腹股沟嵌顿疝患者（腹股沟直疝3例，腹股沟斜疝8例）的临床资料。结果7例患者在全身麻醉后嵌顿疝自动复位，4例在腹腔镜下行松解、复位；11例患者在腹腔镜下观察或采取促进嵌顿肠管血液循环恢复的措施后，均行经腹腹膜前补片植入术（TAPP）。术后所有患者均恢复良好，平均随访6．6个月（2～12个月），无复发。结论腹腔镜下腹股沟嵌顿疝复位及修补是一种安全并具有一定优势的手术方式，值得在临床推广。     

Impact of paediatric surgery training on the attitudes and experience of frontline general surgeons in common paediatric surgical emergencies

Aim: The present study is a survey of the attitudes and experience of frontline general surgeons in common paediatric surgical emergencies, and their exposure to paediatric surgery (PS) during training. Methods: Questionnaires were sent to higher trainees and junior specialists in general surgery. Their experience in the management of common paediatric emergency conditions including acute scrotum, toddler appendicitis, infant incarcerated inguinal hernia and intussusception was asked. Results: Of the surgeons, 60.8% and 41.2% had no exposure to PS in their internship and basic surgical training, respectively. The majority of them managed less than five cases of intussusception (82.4%) and incarcerated inguinal hernia (66.7%); 19.6% and 37.3% indicated that they were competent in managing intussusception and incarcerated inguinal hernia, respectively. The majority believed that general surgeons should know how to manage these common paediatric emergency conditions. However, 56.9% and 78.4% opined that infants with incarcerated inguinal hernia and intussusception, respectively, should be managed in paediatric surgical centres. Conclusions: Although most frontline general surgeons opined that they should know how to manage common paediatric surgical emergencies, the majority of them did not feel competent to manage infantile intussusception and incarcerated inguinal hernia due to inadequate clinical exposure. They believed that intussusception and incarcerated inguinal hernia should be managed in a paediatric surgical centre.     

Significance of sesamoid ossification in peroneus longus tendon ruptures

Ruptures of the peroneus longus tendon are uncommon, with a small number of case reports found in published studies. The presence of an os peroneum can predispose the peroneus longus tendon to rupture at the cuboid level with or without concomitant fracture, or fracture through a partite os peroneum. Whether the os peroneum can be represented by various stages of ossification is still a matter of debate. We present 2 cases of acute peroneus longus tendon rupture at the cuboid notch in the presence of an intact os peroneum in the ossified and nonossified form. We treated patients with excision of the os peroneum and tenodesis of the peroneus longus to the peroneus brevis tendon.     

Duodenal rupture due to giant inguinal hernia: A case report

IntroductionGiant inguinal hernia is unusual, and duodenal rupture accompanying it is particularly very rare and significantly hard to manage surgically.Presentation of caseAn 81-year-old man was admitted to our institution with upper abdominal pain. He had tenderness of the upper mid abdomen and a bilateral large inguinal hernia but he did not have pain in the inguinal–scrotal area. Computed tomography (CT) showed slight dilatation of the small bowel and stomach. There were no remarkable signs of incarceration of the inguinal hernia. Therefore, he was admitted to the internal ward. On the second day in hospital, he suddenly went into shock. CT revealed that there was free air and ascites in the inguinal hernia and therefore an emergency operation was performed.The tranverse colon, ascending colon, and ileum were incarcerated, and perfolation of the cecum was found. We also detected duodenal rupture at the inferior duodenal angle. We resected the terminal ileal (almost 90 cm) and ileocecal area, followed by side-to-side anastomosis of duodenum and jejunum. We only repaired the peritoneum at the internal hernia ring. After the operation, despite intensive-care therapy, this patient passed away on the 18th postoperative day.DiscussionThe mesocolon and third portion of the duodenum were strongly pulled down into giant inguinal hernia, probably causing the rupture of the inferior duodenal angle.ConclusionGiant inguinal hernia possibly provokes duodenal rupture and therefore should definitively be repaired if feasible.     

Laparoscopy in the evaluation of the incarcerated mass in groin hernia

BACKGROUND: In hernia patients, the preoperative diagnosis of strangulation is difficult. In this prospective study, we investigated the usefulness of an exploratory laparoscopy to evaluate the viability of a viscus incarcerated in a groin hernia. METHODS: Twenty-seven patients with an acute irreducible inguinal mass underwent exploratory laparoscopy. The hernia was reduced, and the viability of the incarcerated viscus was judged laparoscopically on the basis of color, congestion, and contractility. RESULTS: Twenty-four hernias were found. In sixteen patients, the contents of the hernia were viable. In five patients, a necrotic bowel segment was found, and a laparotomy and resection were done. In three patients, no hernias were found. The cause of inguinal pain was spermatic cord hematoma in one patient and inguinal abscess in another; however, the cause of pain in the third patient remained unclear. After laparotomy, one patient developed a fascial rupture that required reoperation. There were no other complications. CONCLUSION: At laparoscopy, the judgment of the viability of the contents of the hernia is similar to that at laparotomy. The early use of laparoscopy can prevent many unnecessary laparotomies.     

Hybrid method using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia in a patient with liver cirrhosis and severe varicose veins: A case report

IntroductionCirrhosis is a significant determinant of postoperative morbidity and mortality. Patients with severe liver cirrhosis are substantially contraindicated for surgical treatment of inguinal hernia because of the substantial recurrence rate and high postoperative morbidity and mortality. However, hernia with incarceration and strangulation, which could become life-threatening, should be repaired urgently even for patients with severe liver cirrhosis. No clear surgical guidelines have been established regarding the treatment strategy for inguinal hernia in patients with cirrhosis.Presentation of caseA 62-year-old man with a history of chronic C-type liver cirrhosis (Child-Pugh classification C) and hepatocellular carcinoma was referred to us for surgical treatment of an irreducible right inguinal hernia. An abdominal computed tomography (CT) scan revealed that the small intestine had herniated into the scrotum and severe abdominal wall varicose veins due to liver cirrhosis. We performed a hybrid method that combines examination laparoscopy and Lichtenstein's technique to observe the abdominal cavity and to avoid the risks due to severe varicosis of the inferior epigastric vein.DiscussionThere have been some reports of inguinal hernia with cirrhosis and ascites, but no reports of incarcerated inguinal hernia with abdominal wall varicose veins. In the present case, we chose a laparoscopic approach to observe the abdominal cavity to confirm intestinal necrosis. Hybrid surgery using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia could be performed safely.ConclusionHybrid surgery using laparoscopy and Lichtenstein's technique may be an effective method for patients with incarcerated inguinal hernia with end-stage cirrhosis and severe abdominal varicosis.     

Imaging of adductor-related groin pain

Groin pain is a common condition in athletes and results from various causes. Osteitis pubis, adductor dysfunction, inguinal hernia, or a combination of all three entities, generally explains the onset of symptoms. Adductor longus tendinopathy is the main cause of adductor-related groin pain. It leads to a significant reduction of sports participation and can require surgical management. Diagnosis is based on ultrasonography and magnetic resonance imaging. Asymptomatic findings (tendinosis, calcifications, cortical erosions) are common in athletes and care should be taken when assessing groin pain. The most specific sign of tendinopathy is an intratendinous tear of the adductor longus.     

Laparoscopic preperitoneal mesh repair of incarcerated obturator hernia and contralateral direct inguinal hernia

Most cases of obturator hernia are diagnosed during surgery for treatment of acute small bowel obstruction resulting from incarceration. We present the case of a patient with incarcerated obturator hernia that was correctly diagnosed by computed tomography preoperatively. Laparoscopic preperitoneal mesh repair of the incarcerated obturator hernia and a contralateral direct inguinal hernia found incidentally was successfully performed.     

老年腹股沟斜疝合并小肠破裂6例诊治体会

目的探讨老年腹股沟斜疝合并小肠破裂的原因、临床特点和治疗方式。方法回顾分析2006年9月～2009年12月我院收治6例老年腹股沟斜疝合并小肠破裂的临床资料。结果自行粗暴还纳嵌顿性疝导致肠破裂2例、阴囊外伤致肠破裂1例、散步时绊倒发生2例、打篮球跳起投篮时发生1例。手术6例,治愈5例,死亡1例。结论嵌顿性疝粗暴还纳、阴囊外伤是老年腹股沟斜疝和并小肠破裂的常见原因,特殊条件下身体过度后仰亦可诱发肠破裂。肠破裂修补加疝囊颈荷包缝合是治疗腹股沟斜疝合并小肠破裂较好的手术方式。     

TAPP在急性嵌顿性腹股沟疝中的应用体会

目的总结16例急性腹股沟嵌顿疝患者行腹腔镜腹膜前疝修补术(TAPP)的体会,探讨其应用技巧及价值。方法2007年8月至2009年8月对16例急性腹股沟嵌顿疝患者实施TAPP术,对其相关临床资料进行回顾性分析。结果本组手术全部成功,平均手术时间137.5 min,平均住院时间5.13 d。术后1例发生阴囊血清肿,1例发生腹腔脓肿,1例发生皮下气肿。随访6个月至2年无复发。结论熟练掌握TAPP的手术技巧,掌握好适应征,TAPP术可以安全、有效的应用于急性嵌顿性腹股沟疝患者。     

老年急性嵌顿性腹股沟疝合并肠梗阻的危险因素分析及风险列线图模型的建立

目的探讨老年急性嵌顿性腹股沟疝合并肠梗阻（POI）的危险因素及风险列线图模型的建立,为临床护理工作提供参考依据。 方法回顾性分析2012年6月至2018年6月因急性嵌顿性腹股沟疝于我院就诊的259例老年患者的临床资料。按照是否并发POI,分为并发POI组和非POI组。分别使用单因素和Logistic回归多因素分析老年急性嵌顿性腹股沟疝合并发肠梗阻的独立危险因素。然后纳入筛选出的独立危险因素建立列线图预测模型,并对模型的预测性及准确度进行验证。 结果2组患者性别、文化程度、身体质量指数、高血脂、高血压、冠心病、吸烟史、酗酒史、术前贫血和手术时间等信息的比较,均无统计学差异（χ²=0.239,0.324,0.179,0.485,0.282,0.069,0.402,0.146,0.108,0.994;P>0.05）,而年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间和术后感染等资料差异有统计学意义（χ²=5.963,9.954,17.644,17.281,9.154,8.831;P<0.05）。以并发POI情况为因变量,以并发POI组和非POI组单因素分析中有统计学意义的6个项目（年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间、术后感染）为自变量,进行多元Logistic回归分析,结果表明,年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间及术后感染是老年急性嵌顿性腹股沟疝并发POI的独立危险因素,具有统计学差异（OR=3.515,4.506,8.805,17.526,3.937,2.770,0.015;95% CI：1.437～8.601,1.519～13.372,2.349～33.011,3.986～77.067,1.615～9.598,1.147～6.686;P<0.05）,均与老年急性嵌顿性腹股沟疝并发POI高度相关。基于年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间和术后感染这6项老年急性嵌顿性腹股沟疝并发肠梗阻的独立危险因素,建立预测老年急性嵌顿性腹股沟疝并发肠梗阻的列线图模型,经验证,其预测值同实测值基本一致,说明本研究的列线图预测模型具有较好的预测能力,同时本研究该列线图模型使用Bootstrap进行内部验证法,C-index指数高达0.846（95% CI：0.812~0.880）,模型对于老年急性嵌顿性腹股沟疝并发POI诊断的ROC也高达0.846,说明本研究列线图模型具有良好的精准度和区分度。 结论老年急性嵌顿性腹股沟疝并发肠梗阻的风险较高,年龄、糖尿病、恶性肿瘤、腹部手术史、嵌顿时间和术后感染是老年急性嵌顿性腹股沟疝并发肠梗阻的独立危险因素,相关列线图预测模型的建立能够提高对老年急性嵌顿性腹股沟疝并发肠梗阻的诊断效能,为进一步优化护理模式提供方向,临床应用价值较高,值得进一步推广使用。     

A rare presentation of Amyand's hernia. Case report and review of the literature

Amyand's hernia is defined as an inguinal hernia within the hernial sac containing the appendix. It is a rare disease, reported in 1% of cases of inguinal hernia repair. The appendix can be complicated by acute appendicitis in 0.13% of cases. This disease is often very difficult to diagnose, and most of the time it can be confused with an incarcerated or strangulated inguinal hernia. Often, it requires an emergent surgical treatment. This article describes the case of a 82-year-old female who was admitted for an intestinal obstruction and a bulge in the right inguinal region. An abdominal computed tomography scan showed dilated small bowel loops with multiple air/liquid levels and one loop herniating into the right inguinal canal. The patient underwent a laparotomy that showed the presence of an acute appendicitis and a necrotized ileal loop protruding into the right inguinal canal. The patient underwent an appendectomy and small bowel resection and she was discharged on postoperative day 10. Amyand's hernia can be a challenge for the surgeon. Its treatment depends on the grade of inflammation of the appendix. In fact, it can range from the simple repair of the abdominal defect with a prosthetic mesh, to appendectomy, small bowel resection and repair of the abdominal wall defect without a mesh.     

Acute inguinal pain associated with iliopectineal bursitis in four professional soccer players

Four professional soccer players were investigated for acute or subacute pain in the inguinal region. Clinical tests were negative for an inguinal hernia or adductor tendinitis. Resisted hip flexion caused pain. MRI in these four patients showed the onset of iliopectineal bursitis, with signal abnormalities predominantly at the periphery of the psoas tendon in contact with the iliopectineal eminence. Ultrasound-guided steroid injection allowed the two players injected to continue their sporting activity. The two other players were treated by 3 and 7 days rest and oral anti-inflammatory treatment.     

An exceptional complication following appendectomy: Acute inguinal and scrotal suppuration

Inguinal and scrotal suppuration following appendectomy is a rare event, occurring mostly when a patent processus vaginalis is present. Herein we report a small series of children operated for appendicitis and presented with acute inguinal and scrotal symptoms postoperatively. Although acute scrotum is commonly attributed to torsion of testis or its appendage, epididymo-orchitis and incarcerated hernia, following appendicitis scrotal and/or inguinal abscess should be considered.     

Boerhaave’s syndrome secondary to an incarcerated inguinal hernia: A case report

IntroductionBoerhaave’s syndrome is defined as the spontaneous perforation of the esophagus. Although it has been reported in association with different gastrointestinal pathologies, there are no previous reports in association with an incarcerated inguinal hernia containing ischemic small bowel.Presentation of caseWe present an unusual case of a gentleman who presented with severe chest pain after a 24-h period of emesis. He was found to have developed an esophageal perforation presumed secondary to an incarcerated inguinal hernia causing small bowel obstruction. The patient underwent a thoracotomy to repair the perforated esophagus followed by a groin exploration, small bowel resection and repair of the inguinal hernia.DiscussionBoerhaave’s syndrome is well known to be a postemetic phenomenon in association with upper gastrointestinal obstruction. However, to our knowledge, this is the first reported case of esophageal perforation secondary to strangulated bowel in an inguinal hernia. In similar situations, we recommend the surgical correction of the esophageal perforation, followed by exploration and resection of any ischemic small bowel.ConclusionHere we present a patient who was diagnosed with a perforated esophagus after forceful emesis secondary to an incarcerated inguinal hernia containing ischemic bowel.     

Acute rupture of extensor pollicis longus tendon due to avulsed fracture of the second metacarpal base: a case report.

Acute tendon rupture of the extensor pollicis longus (EPL) is rare. We present acute EPL tendon rupture associated with avulsed fracture of the second metacarpal at the insertion of extensor carpi radialis longus. Tendon rupture of the EPL was repaired with end-to-end suture and avulsed fracture of the second metacarpal base was treated with open reduction and internal fixation.