Intestinal obstruction caused by strangulated hernia in the prevesical space: One case and revision of the literature Introduction: Prevesical space is an infrequent location of hernias. Prevesical hernia is a rare cause of bowel obstruction. We present a case operated at our institution and review the available evidence in literature. Case report: A 67-years-old mail, without any relevant medical history, came to the Emergency Department complaining of suprapubic pain during the last 24 h. Physical examination revealed abdominal distension and suprapubic pain. A CT scan revealed small bowel dilation with a gauge change in the pelvis. Exploring laparotomy was performed, observing a hernia in the prevesical space and 25 cm of ileal loops incarcerated with ischemic aspect. A small bowel resection and latero-lateral manual running suture anastomosis was performed. Histological findings were not relevant. The patient presented an uneventful postoperative course and was discharged the 5th day after surgery. Conclusions: Hernias in the prevesical space are infrequent causes of abdominal pain and bowel obstruction. They are located between lateral umbilical ligaments and bladder fundus, where a ring is located. They must be suspected in cases of inguinal or suprapubic pain without palpable lump in the lower abdominal quadrants. Diagnosis can be only radiologically achieved, by CT scan. Surgical treatment is mandatory, often requiring bowel resection.
Background In spite of the global implementation of standardized surgical safety checklists and evidence-based practices, general surgery remains associated with a high residual risk of preventable perioperative complications and adverse events. This study was designed to validate the hypothesis that a new “Trigger Tool” represents a sensitive predictor of adverse events in general surgery. Methods An observational multicenter validation study was performed among 31 hospitals in Spain. The previously described “Trigger Tool” based on 40 specific triggers was applied to validate the predictive power of predicting adverse events in the perioperative care of surgical patients. A prediction model was used by means of a binary logistic regression analysis. Results The prevalence of adverse events among a total of 1,132 surgical cases included in this study was 31.53%. The “Trigger Tool” had a sensitivity and specificity of 86.27% and 79.55% respectively for predicting these adverse events. A total of 12 selected triggers of overall 40 triggers were identified for optimizing the predictive power of the “Trigger Tool”. Conclusions The “Trigger Tool” has a high predictive capacity for predicting adverse events in surgical procedures. We recommend a revision of the original 40 triggers to 12 selected triggers to optimize the predictive power of this tool, which will have to be validated in future studies.
Background: Subdural fluid collection in patients with internal cerebrospinal fluid (CSF) shunts has generally been linked to overdrainage and more rarely to pus accumulation. The authors present a previously unrecognized condition leading to extra-axial CSF accumulation: shunt underdrainage. Treatment of coexisting subdural fluid collection and hydrocephalus, disorders that have previously only been reported concurrently following head trauma or subarachnoid hemorrhage, is controversial. In addition, we intend to provide insight into the physiopathology of abnormal CSF accumulation within both the subdural space and ventricles simultaneously. Case Description: A 42-year-old female with a history of hypothalamic glioma and obstructive hydrocephalus during childhood presented with headache, vomiting, and gait disturbance. Following the insertion of her first ventriculoperitoneal shunt (VPS) by the age of 8, she underwent several surgeries due to shunt failure, all of them associating ventriculomegaly. Ventricles remained notably enlarged following insertion of her most recent VPS, and the computed tomography scan performed 2 months later at her admission showed a large subdural collection. Afterward, a malpositioned distal catheter causing shunt blockage was confirmed. Both, the subdural accumulation and hydrocephalus, were resolved following adequate placement of the peritoneal catheter. Conclusion: This case demonstrates that subdural fluid accumulations may occur following VPS underdrainage with hydrocephalus. Development of such extra-axial collection was probably caused by pressure related to CSF spillage from the ventricles into the subdural space. Our case also supports that a mass-effect subdural accumulation with hydrocephalus can be satisfactorily treated with adequate VPS alone, without directly treating the subdural collection.
Mujer de 61 años diagnosticada de obesidad mórbida e hipertensión arterial, que acude a urgencias por dolor periumbilical de 2 días de evolución. En la ecografía abdominal se observa escaso líquido libre y conglomerado de asas intestinales sin herniación. Venticuatro horas después la paciente presenta un cuadro de fallo multiorgánico. En la tomografía computarizada de abdomen con contraste intravenoso, se observa neumatosis intestinal de la totalidad de asas del intestino delgado con eventración abdominal anterior incarcerada ( fig. 1) y presencia de gas en venas mesentéricas, perihepáticas, periesplénicas y ramas distales intrahepáticas (fig. 2). En la cirugía se evidencia isquemia mesentérica masiva y colon transverso incarcerado.
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