HighlightsUrgent abdominal examination with palpation of the region is necessary in the diagnosis of strangulated hernias but may be misleading so further studies are necessary.Serological testing of a patient with a strangulated hernia may show lactic acidosis and leukocytosis.Operative management is necessary for strangulated hernias especially in patients with altered mental status and a clinical picture showing decline.Intercostal incisional herniation following a previous surgical procedure is a rare entity which should be diagnosed and treated rapidly.This case highlights the clinical picture associated with an emergent strangulated hernia and highlights the critical steps in its management.
This report presents an interesting and unusual case of an injury sustained from a blowgun dart. The dart penetrated zone 2 of the neck, resulting in a neurological deficit consistent with a variant of Brown-Séquard syndrome referred to as “Brown-Séquard plus syndrome.”
Ventral and incisional hernias of the abdominal wall are common problems treated by surgeons around the globe. Incisional hernias are common postoperative complications of abdominal laparotomies with a reported incidence of up to 20 per cent. The increasing use of prosthetic mesh in open ventral hernia repairs necessitated the development of different operative techniques used in the repairs. It also required that surgeons become facile with placement of the mesh in different anatomical positions on the abdominal wall. One of the most common locations is placement of the mesh in the underlay position. Many surgeons who use the underlay technique have expressed significant concerns. Among these are fear of an inadvertent bowel injury while placing the mesh, poor visualization during mesh placement, and the inability to use the underlay technique for difficult hernias. We present a very useful, if not, novel technique of open hernia repair using mesh in the underlay position that helps to 1) prevent complications, 2) facilitate easier mesh fixation, 3) simplify open repair of atypical ventral hernias, and 4) reduce total operative time while still adhering to the important fundamental principles of a tension-free hernia repair. This technique as we describe it has been compared with the old parachute technique, but we think this is a significant improvement of that seldom used technique. We believe the use of this technique for the underlay position makes open ventral hernia repair safer, faster, and easier; however, our goal for this article is to describe the procedure in detail. In addition, we recently have started using this technique to fix the mesh when doing the retrorectus approach as well.
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