Introduction and importance: Primary internal hernias are rare in adults. Internal hernias present clinically as a sign of small intestinal obstruction. If left untreated, internal hernias might lead to high morbidity and mortality due to strangulation. Internal hernias are usually diagnosed intraoperatively. Here, we present an internal hernia diagnosed with an abdominal computed tomography (CT) scan. The importance of preoperative diagnosis for internal hernias leads to early surgery and keeps the patient from suffering intestinal strangulation. Case presentation: We report here the case of a 67-year-old male who presented with acute intestinal obstruction and underwent an abdominal CT scan. The patient was diagnosed with an internal hernia from the imaging of the abdominal CT scan and scheduled for an exploratory laparotomy. An internal hernia was found in the mesocolon of the sigmoid colon; one loop of jejunum was trapped in the hernia defect. After reduction, the hernial defect was closed; no resections were done, and the patient was discharged after 5 days without complication. Clinical discussion: Our finding represents a transmesosigmoid hernia, a rare variant of sigmoid mesocolon hernias. The clinical sign and the judgment of the surgeon for the diagnosis of an internal hernia became important factors related to the patient’s outcome. Conclusion: The proper adjunct imaging, correct diagnosis, and timing of surgery for internal hernias save the patient from morbidity or intestinal death.
Background: Intraperitoneal adhesions are formed due to the inflammatory response in releasing proinflammatory cytokines such as IL-6. Triamcinolone Acetonide (TA) acts as an anti-inflammatory by inhibiting the production and release of IL-6 cytokines. This study aims to determine the effectiveness of triamcinolone acetonide in preventing intraperitoneal adhesions and its effect on assessing IL-6 levels in post-exploratory laparotomy in rats.Methods: An experimental study was conducted among 40 male Wistar rats from January and March 2021 in the Animal Laboratory of Universitas Padjadjaran, Bandung, Indonesia. Blood samples were taken before treatment and on the 14th day after treatment. In rats, laparotomy and cecum abrasion were performed with a needle. Rats in the treatment group were given triamcinolone acetonide at a dose of 0.1 mg, 0.3 mg, or 0.5 mg. On the 14th day, a microscopic examination of the degree of adhesion was performed. Data were analyzed using SPSS version 20 for Windows.Results: The results of the Kruskal-Wallis test analysis on the formation of intraperitoneal adhesions microscopically showed a significant difference between the control group and the treatment group (p < 0.001) with the lowest mean rank in the TA group of 0.3 mg (11.4), which stated that this dose was more effective in preventing intraperitoneal adhesions. The One-Way ANOVA test on IL-6 examination had a significant difference in postoperative IL-6 reduction between the control and treatment groups (p < 0.001).Conclusion: Triamcinolone acetonide was effective in preventing intraperitoneal adhesions and reducing IL-6 levels in post-exploratory laparotomy rats.
Background: Medical decision making is a complex cognitive process of choosing in establishing a diagnosis and selecting a management option in the context of healthcare. Patients may desire to take part in obtaining and exchanging information, discussing over options and making the final decisions about treatment and or care. The focus of the study was to identify the health information and decision making preference on diseases treatment. Methods: A descriptive study was conducted to 110 respondents from Hegarmanah Village, Sumedang, Indonesia, aged 18-65 years old who had the experience in consulting doctors for their medical problems. This study was carried out during the period of September to October 2013. The respondents were selected using random stratified sampling. A tested questionnaire, consisted of 2 sections, was used to collect the data. The collected data were presented using frequency tabulation. Results: Most of the respondents preferred to be offered choices and asked for their opinions by their doctors. Furthermore, 55.45% preferred to rely on physicians for medical knowledge and 93.64% agreed that they had rights in getting all the information on their medical problems, so they submitted their decision to the doctors for care or treatment. Conclusions: This study shows that preference of the patients varies with regard to how much patients want to participate as one, which may have different preference for different components of the decision making process, yet there is a shift of paradigm from paternalistic to collaborative decicion making between doctor and patient. [AMJ.2015;2(4):
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