1/18. Internal hernias and gastric perforation after a laparoscopic gastric bypass.A 27-year-old woman underwent laparoscopic Rouxen-Y gastric bypass. A retrocolic-retrogastric herniation of most of the small bowel and later a gastric perforation due to internal hernia at the mesenteric defect of the jejuno-jejunostomy occurred. These unusual, but not rare, complications are directly related to the neoanatomy that follows gastric bypass and can lead to rapidly progressing and life-threatening situations. Proper evaluation of clinical signs and symptoms, early abdominal CT scan, and urgent operative intervention are mandatory to achieve a successful outcome.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/18. Small bowel herniation through subumbilical port site following laparoscopic surgery at the time of reversal of anesthesia.Incisional hernias through laparoscopic trocar sites are unusual complications of laparoscopy. Two cases of small bowel herniation at subumbilical port site occurred at the time of withdrawal of the trocar sheath at the end of the laparoscopic procedure are reported. The herniations were precipitated by the coughing movements of the patients as a result of too early reversal of the general anesthesia. awareness of the complication, precaution at time of sheath withdrawal and a well-timed reversal of the general anesthesia are important in avoiding such a complication.- - - - - - - - - - ranking = 6keywords = herniation (Clic here for more details about this article) |
3/18. Small bowel herniation around an anterior gastropexy for a gastric volvulus: a case report.Gastric volvulus can be a medical emergency with life-threatening complications. Early surgical intervention is important to avoid potential ischemic complication that may lead to infarction of the stomach. The condition has been reported in children and in the elderly, but the majority of cases are reported in the fifth decade of life. We present a case of a complication arising from corrective laparoscopic surgery for gastric volvulus, whereby most of the small bowel herniated around the anterior laparoscopically performed gastropexy. The herniation was reduced during a laparotomy, and the space through which the herniation occurred was closed.- - - - - - - - - - ranking = 6keywords = herniation (Clic here for more details about this article) |
4/18. Bowel herniation after traumatic symphysis pubis diastasis.The authors describe a patient with small bowel herniation after traumatic symphysis disruption. Although gastrointestinal problems occur rarely with pelvic fractures, in a patient with a pubic diastasis and paralytic ileus, the development of abdominal hernia through torn peritoneum should be considered. Treatment of the patient with a pubic diastasis and a bowel problem should include early careful exploration and management of the gastrointestinal tract during pelvic surgery.- - - - - - - - - - ranking = 5keywords = herniation (Clic here for more details about this article) |
5/18. Small-bowel herniation under the infrarenal arterial conduit in a liver transplant recipient.We report a case of herniation of the entire small bowel under an infrarenal conduit 8 months after orthotopic liver transplantation. The conduit was compressed by the mesentery and developed a stricture and thrombosis. Liver revascularization was accomplished by an urgent thrombectomy, resection of the stricture, and reanastomosis of the conduit. Suspicion of this serious complication should arise in transplant recipients who present with bowel obstruction associated with liver dysfunction.- - - - - - - - - - ranking = 5keywords = herniation (Clic here for more details about this article) |
6/18. Preperitoneal herniation into a laparoscopic port site without a fascial defect.BACKGROUND: Port site herniation is an uncommon event that usually occurs as a result of incomplete fascial closure. This allows the omentum or viscera to herniate through the incompletely closed defect. However, in laparoscopic surgery for morbid obesity, the omentum and viscera can herniate through the thick preperitoneal space even with a complete closure of the fascia. CASE REPORT: A 19-year-old female with BMI 55 underwent uneventful long limb laparoscopic Roux-en-Y gastric bypass. On postoperative day 1 the patient had limited pain, was ambulating well, and was tolerating slps of liquids. A limited upper GI series performed on postoperative day 2 revealed no leak or obstruction. Several hours later the patient developed abdominal pain associated with nausea, which progressed to vomiting. CT of the abdomen suggested a port site herniation into the left subcostal port. The cause of the obstruction appeared to be herniation through the left subcostal port site. At laparotomy, a segment of bowel just distal to the anastomosis was found herniated through the port site. The Richter's hernia was reduced. Careful inspection of the fascia revealed a complete fascial closure, with the strangulated portion of the bowel incarcerated in the preperitoneal space. Following repair of the preperitoneal defect, her subsequent recovery was unremarkable. CONCLUSION: Laparoscopic surgery for morbid obesity presents the possibility for preperitoneal herniation. Closure, using a fascial closure device, under laparoscopic control, may offer a solution by closing both the fascia and peritoneum all at once.- - - - - - - - - - ranking = 8keywords = herniation (Clic here for more details about this article) |
7/18. Massive incisional hernia of the bowel and urinary bladder: a case report.Abdominal hernias are not rare in women, but incisional bladder herniation is uncommon. Incisional hernias are an iatrogenic condition caused by protrusion of the abdominal viscera through the abdominal fascia. omentum and small intestines are by far the most common viscera involved, and the condition is diagnosed on clinical examination either visually or by palpation of an abdominal bulge. We describe a case of bladder and bowel herniation through a lower transverse abdominal incision (Pfannenstiel), which followed emergent operative intervention for ectopic pregnancy.- - - - - - - - - - ranking = 2keywords = herniation (Clic here for more details about this article) |
8/18. Internal hernia after pancreas transplantation with enteric drainage: an unusual cause of small bowel obstruction.BACKGROUND: Although complications involving leaking at the enteric anastomosis site, graft thrombosis, and intraabdominal abscess formation have been well documented after pancreas transplantation, the occurrence of small bowel obstruction in this setting has received scant attention. Although uncommon, intestinal obstruction after pancreas transplantation may have atypical etiologies. In this article, we will review three unusual cases of intestinal obstruction in pancreas transplant recipients. The value of computed tomographic (CT) enteroclysis in equivocal situations in the diagnosis of the obstruction is emphasized. methods: In this study, we reviewed the posttransplant course of all pancreas transplants performed between July 1, 2002 and June 1, 2004. We specifically focused on all patients that required reexploration for suspected small bowel obstruction at any time after transplantation. RESULTS: A total of 65 pancreas transplants were performed between July 1, 2002 and June 1, 2004. Pancreas graft survival was 97%, and patient survival was 98.5%. Five (7.7%) patients presented with mechanical small bowel obstruction, three of which were secondary to internal herniation of small intestine through a defect posterior to the pancreas allograft. All patients recovered well postsurgically. DISCUSSION: Small bowel obstruction is an uncommon complication after pancreas transplantation. CT enteroclysis in the evaluation of small bowel obstruction may assist the patient care decision-making process by providing information on the location and severity of the obstruction in the clinical situation where conventional abdominal CT and radiography are equivocal. Prompt detection of small bowel obstruction with early surgical intervention can minimize complications and preserve allograft function.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
9/18. Incisional hernia of the vaginal apex following vaginal hysterectomy in a premenopausal, sexually inactive woman.A woman experienced a small-bowel herniation through a rupture in the vaginal fascia at the apex of a well-supported vagina, leaving the small bowel covered only by a transparent mucosal membrane. This condition developed after a vaginal hysterectomy, with prophylactic plication of the uterosacral ligaments to obliterate the cul-de-sac, had been performed for uterine prolapse, which in turn developed subsequent to a high retropubic urethral suspension. This woman was premenopausal and sexually inactive, and had no other risk factors for failure of the vaginal apical scar. At the time of surgical repair, it appeared that the vaginal incision had failed because the apex was placed on tension between the anterior vaginal wall's attachment to the iliopectineal line and the opposing posterior traction of the uterosacral plication on the posterior vagina. This phenomenon seemed to be a consequence of the original alteration of the vaginal axis by the urethral suspension combined with subsequent enterocele prophylaxis.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
10/18. Foramen of Winslow hernia.Two cases of caecal herniation through the foramen of Winslow are presented. The diagnosis was made at laparotomy, but could have been suspected from the clinical features and plain abdominal x-rays. Early operative intervention is the key to avoiding strangulation and the high mortality associated with this uncommon internal hernia.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
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