Interstitial hernias are a rare subtype of abdominal hernias, where sac is present in between the abdominal wall layers. Although, difficult to diagnose clinically, they are usually detected on imaging studies. Interstitial hernias presenting with undescended testis are common. Even after a meticulous online search of the medical literature, we could not find a case report of 'Strangulation of Interstitial hernia, with a strangulated undescended testis in an elderly man. We hereby present this extremely rare case, and possibly, this could be the first of its kind, case report in the medical literature. Our aim is to present a combination of rare presentations in an elderly cryptorchid person with strangulated interstitial hernia. A 65-year male patient presented with 4 days of pain abdomen and vomiting. He was having features of toxaemia. Ultrasonography revealed interstitial hernia with bowel loops. During surgery, gangrenous bowel loops with the sac between the interstitial planes, with strangulated cryptorchid testis, were found. Strangulated interstitial hernia in elderly cryptorchid person, leading to the strangulation of the undescended testis, is extremely rare, and this could be the first case reported in the medical literature.
Background Primary spontaneous upper extremity deep vein thrombosis is rare with an estimated annual incidence of 1 to 2 cases per 100,000 population. The majority of cases are secondary and related to central venous cannulation (eg, central line, pacemaker) or prothrombotic states. On the offset of COVID-19 pandemic such cases could become a common entity. Case Report An elderly diabetic and hypertensive female patient presented with a history of acute onset swelling, heaviness, tingling and numbness of left upper limb since 1 week. Examination revealed, diffuse swelling of left upper limb extending to neck with small dilated veins in left upper chest. A provisional diagnosis of left upper limb DVT was made based on Constants criteria and was confirmed on Duplex scanning. The patient was started on LMWH for anticoagulation. Evaluation for occult cancers was unremarkable. Patient showed symptomatic improvement and recanalisation of thrombosed veins was noted on repeat duplex scan. Conclusion Upper extremity DVT (UEDVT), once a rare entity, can be seldom thought of, due to widespread interventions and ongoing COVID-19 pandemic. Focus on evaluation of occult malignancy rather for hypercoagulable states which do not change the management. This case report highlights the importance of early recognition of UEDVT and stresses on the evidence that no added benefit is achieved by performing expensive tests to rule out prothrombotic states. Early diagnosis based on Constants criteria and anticoagulation would save time and prevent grave complications.
Aims To determine the presentation and outcomes of cases of intestinal Ischemia amidst COVID -19 pandemic and to review latest guidelines in its management. Methods A case series analysis of 11 patients admitted and managed under Department of Surgery, over a duration of 17 months from September 2020 to January 2022. Results Out of the total of 11 cases of intestinal ischemia, 4 were COVID-19 positive, overall mortality was 54.5% and patients with COVID-19 were found to have 100% mortality. Mortality in conservatively managed patients was also 100%, Mortality in surgically managed patients was 55.5%. Preoperative acidosis, hypoxia and hypotension were found to be important determinants of outcome of the disease. Conclusion Occurrence of intestinal Ischemia in COVID - 19 patients is a life threatening complication which demands surgical management with significant mortality. Treatment of COVID - 19 and intestinal Ischemia should go simultaneously and in line with the latest evidence based guidelines of COVID 19, Patients who survive an acute event are likely to die of other complications related to the COVID-19 like ARDS, Disseminated Intravascular Coagulation etc that could have predisposed them to intestinal ischemia
Aim To determine the efficacy of single layer bowel repair with respect to postoperative complications such as leakage rates, duration of repair, overall length of hospital stay, cost effectiveness, to assess the morbidity, mortality and outcome. Methods This prospective study was done on 21 patients admitted under department of surgery from the period of January 2020 to September 2021. All the patients under bowel repair in continuous single layer extramucosal fashion for various etiology, follow up data was collected and analysed. Results In our study, 81% (17 cases) of the single layer bowel repair were done in an emergency setting. The study consisted of 42.9% (9 cases) of perforation repair and 57.1% (12 cases of resection and anastomosis of large or small bowel). The average time duration of anastomosis was 14.45 minutes with the average hospital stay of 13.2 days. Our study showed an anastomotic leak rate of 9.5% (2 cases) with an overall mortality of 19.04% (4 cases) which included 2 cases with COVID-19 related ARDS. Conclusion Our study was determined to analyse the effectiveness of single layer bowel repair and found that it is a quicker and theoretically better technique for bowel repair which avoids unnecessary tissue ischemia. The leakage rates within the study was comparable with other studies published and the studies with double layer bowel repair technique in terms of leak rates and mortality. A meticulously done single layer repair will best double layer repair and surgical trainees must be trained early to perfect the art of bowel anastomosis.
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