Meckel’s diverticulum occurs in 2% of the population and is the most common congenital anomaly of the small intestine. It is the only true diverticulum of the small intestine and occurs due to the persistence of a part of the vitello intestinal duct that does not undergo normal obliteration by the fifth to ninth week of gestation. Though the majority are clinically silent, there is a 4-6% lifetime risk of complications. Axial torsion is the rarest complication associated with Meckel’s diverticulum and its coexistence with intestinal obstruction is largely unheard of with reported cases being few and far between. Here we discuss one such case of axial torsion of a giant Meckel’s diverticulum associated with intestinal obstruction in an adult male.
Primary internal hernias are very rare in adults. They are an unusual cause of small intestinal obstruction and lead to high morbidity and mortality if left untreated. Clinical presentation of internal hernia is highly nonspecific. Imaging has limited role in diagnosing the cause of acute intestinal obstruction. Internal hernias are usually detected at laparotomy. We report a case of a 61-year-old male who presented with acute intestinal obstruction which was attributed later to a very rare type of internal hernia on exploratory laparotomy. A loop of ileum was found to enter the retroperitoneum through a hernia gate which was located lateral to the caecum and ileo ileal intussusception was noted proximal to the herniated loop. The segment of intestine was resected and anastamosed then hernial defect was closed. Paracaecal hernias are the rare type of hernias in internal hernia. In our case, intussusception was noted proximal to the herniated ileal loop which is a very rare presentation. Intussusception was reported previously with paraduodenal type. One should always keep in mind while conducting emergency laparotomy, internal hernias can be a cause for intestinal obstruction.
Fournier’s gangrene (FG) is a fulminant and lethal condition usually occurring in the immunocompromised, first described in 1883 by the French dermatologist Jean Alfred Fournier. It is a form of necrotizing fasciitis of the perineal, genitourinary and perianal regions mostly in males with a mortality of nearly 20-50%. It is a surgical emergency and requires early diagnosis aided by scores such as laboratory risk indicator for necrotising fasciitis (LRINEC) and FG severity index (FGSI), extensive debridement combined with supportive procedures to manage associated complications and broad-spectrum antibiotics. Management of FG thus required a multimodal approach and emphasis on reconstruction after recovery in patients who survive was crucial to improving the quality of life in these patients. Here we were presenting 7 cases of FG successfully managed at our institution, grouped under the four methods by which wound closure was achieved: fecal diversion and split skin grafting of scrotum, urinary diversion and penoscrotal split skin grafting, delayed primary closure (with and without orchidectomy) and wound healing by secondary intention.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.