No abstract

Gastric volvulus is a rare but potentially life-threatening clinical entity due to possible gastric necrosis. A wandering spleen may also be associated with gastric volvulus. Patients presenting with the triad epigastralgia, vomiting followed by retching, and difficulty or inability to pass a nasogastric tube into the stomach are likely to have gastric volvulus. The operating surgeon should include this rare entity in the differential diagnosis when dealing with a patient with such a clinical profile. Herein, we present a case of gastric volvulus associated with a wandering spleen in a 28-year-old Caucasian woman and we provide a brief review of the literature on this issue.

QOL of patients after surgical treatment of AF is unalterable on the understanding that the AF is simple and the treatment is not associated by incontinence or recurrence. Pre-operative AM is important regarding the choice of the proper surgical procedure.

For 5 years (January 1998 to November 2002) our department has applied the Marlex Mesh Perfix Plug hernioplasty. This article demonstrates the experience gained in operative and postoperative aspects, costs, and outcome along with the results of a follow-up analysis. Altogether, 801 patients (749 males, 52 females) were operated on Sixty-four males had bilateral groin hernias, so the total number of hernioplasties amounted to 865. A total of 19 hernias were recurrent, 297 were direct, 545 were indirect or scrotal (or both) 21 were femoral, and 2 were Spigelian. Fifty-three operations were performed on an emergency basis. Preoperative routine use of antibiotics was minimized throughout the years. Operating time fluctuated from 20 to 25 min (30-40 minutes for recurrent hernias), and the postoperative hospital stay was 28 hours (6-72) hours. The complication rate was 5% and the recurrence rate less than 1%. Early patient mobilization and return to everyday activities (1-2 weeks) was encouraged. The follow-up of 95% of the patient population lasted 12 to 60 months and was performed at 1 week, 1 month, 1 year, and yearly thereafter. The technique demonstrates less overall postoperative pain, discomfort, and complications combined with a remarkably low recurrence rate. The rapid rehabilitation with great patient comfort and decreased operating room time, resulting in lower financial costs, have led us nowadays to repair all types of inguinal hernias, femoral and recurrent ones, using this technique.

Fournier gangrene is a very rare and a rapidly progressing, polymicrobial necrotizing faciitis or myonecrosis of the perineal, perianal and genital regions, with a high mortality rate. Infection is associated with superficial traum, urological and colorectal diseases and operations. The most commonly found bacteria are Escherichia coli followed by Bacteroides and streptococcal species. Diabetes mellitus, alcoholism, and immunosuppression are perpetuating co-factors. Fournier's gangrene complicating inflammatory bowel disease has been reported in three patients so far, two with Crohn's disease. A 78-year-old man diagnosed with ulcerative pancolitis was referred for fever, and painful perianal and scrotal swelling after perianal surgery for a horseshoe-type perianal abscess. Since bowel disease diagnosis, patient was on mesalazine and achieved long-term remission. Perianal abscess occurred suddenly one week before perianal surgery without any evidence of pre-existing fistula or other abnormalities. Physical examination showed extensive edema and crepitus of perineum and genitalia and patient had symptoms of significant toxicity. The diagnosis of Fournier's gangrene was made and patient underwent emergency surgery with extensive surgical debridement of the scrotal and perianal area and Hartman procedure with a diverting colostomy. In addition, patient started on therapy with mesalazine 3gr, methylprednisolone 16 mg, parenteral nutrition and broad spectrum of antibiotics. Two days after the first operation the patient needed a second operation for perianal debridement. On the fourth day, blood cultures showed E. coli. Patient had an uneventful recovery and was discharged after 34 days of hospitalization. On follow up, disease review is scheduled and colostomy closure is planned.