Volume-normalized flow-rate index with BV as denominator (Q/BV(2)) is has highly discriminative value in screening for voiding dysfunction. Population-specific Q-BV nomograms are more specific and predictive than Caucasian Q-VV nomograms.
Internal hernias are an infrequent cause of small bowel obstruction with transmesosigmoid herniation being very rare, especially in patients with no history of abdominal surgery or trauma. Early surgical intervention is important in acute presentation to reduce the high morbidity and mortality rates associated with this disease. Keywords Transmesosigmoid hernia . Internal hernia . Strangulated hernia Case ReportInternal hernias are an infrequent cause of small bowel obstruction and are estimated to account for 1-6 % of all cases, with transmesosigmoid hernias constituting 6 % of all internal hernias [1]. Previously, paraduodenal hernias were regarded as the most common type of internal hernia; however, it has recently been reported that transmesenteric hernias are increasing in incidence [2]. Although transmesenteric hernias are increasing in incidence, transmesosigmoid herniation is very rare, especially in patients with no history of abdominal surgery or trauma [3].A 42-year-old man presented acutely with a 2-day history of central abdominal pain, abdominal distension, vomiting, and absolute constipation. He had no previous history of abdominal surgery. Physical examination revealed dry tongue, feeble pulse rate 110/min, blood pressure 80/ 60 mmHg, respiratory rate 32/min, and decreased urine output 20 ml/h. Abdominal examination revealed distension, no tenderness; bowel sounds was absent and digital rectal examination was normal. Laboratory investigations revealed a leucocytosis of 11.4×10 9 g/dl, and arterial blood gas analysis showed metabolic acidosis. Plain abdominal radiography demonstrated dilated small bowel loops with multiple air fluid levels. The patient was resuscitated with intravenous fluids, central line placed. A nasogastric tube was inserted and, after stabilizing, decision was made to perform an emergency exploratory laparotomy with the possibility of bowel gangrene or closed-loop obstruction causing septic shock.An abdominal midline incision was made, revealing an abnormal defect, about 2 cm×3.5 cm in size, in the sigmoid mesocolon with about 25 cm of incarcerated small intestine, located approximately 50 cm proximal to the ileocecal junction. Both proximal and distal bowels were dilated and edematous (Fig. 1). After manual reduction of the hernia, mesenteric defect repaired, the necrosed part of the small intestine was resected, and double-barrel ileostomy was created. The patient had an uneventful recovery in postoperative period. After 2 months stoma was closed. No evidence of recurrence has been seen on follow-up examinations.Congenital internal hernias of the sigmoid mesentery are divided into three categories: intersigmoid, intramesosigmoid, and transmesosigmoid [4]. Transmesosigmoid hernias occur when a loop of small bowel passes through a defect in the sigmoid mesentery. This type of hernia involves the two layers of the mesentery and does not have a hernial sac. The underlying embryology of this defect has not been fully elucidated; however, there are several theories as to...
Background There are a lot of advancement in techniques of elective inguinal hernia surgery, but progress for management of complicated inguinal hernia repair in emergency, fall behind. The aim of study was to know age distribution, pattern of presentation, to evaluate the outcome of various types of surgical procedure done for complicated inguinal hernia and their post-operative complications. Methods and Materials This retrospective study included 62 patients suffering from complicated inguinal hernia,and who underwent emergency surgery, from Jan-2016to Dec-2019. Results The mean of age of sampled patients was 53.88 + 14.23 years, with increased incidence in males.Right sided, indirect inguinal hernia was frequently involved.Commonest postoperative complication was wound infection.Tension free repair Lichenstein’s technique (Hernioplasty) was done in maximum cases. Conclusion Mesh repair (hernioplasty) is acceptable and safe option for inguinal hernia repair in emergency setting. Early hospitalization and timely surgical intervention are associated with better outcome.
Peripheral vascular disease is a rare feature of pheochromocytoma. This potentially catastrophic but curable tumor should be suspected in combination of distal necrosis with hypertension and palpable pulses. We report such an unusual case of pheochromocytoma presenting as toe necrosis.
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