Introduction Spigelian hernia is a rare differential diagnosis of abdominal pain. It affects mainly women above the fifth decade of life, more on the left side than on the right side, usually with comorbidities that lead to an increase in intra-abdominal pressure, described as risk factors for the outbreak of ventral hernias. The content of a ventral hernia might be an epiploic appendix and lead to appendagitis. Presentation of case This article presents the case of an 82-year-old female patient who presented epiploic appendagitis in a Spigelian hernia. Discussion Spigelian hernia is a rare type of ventral hernia, especially in association with an epiploic appendagitis. A literature search of this rare entity yielded three publications presenting epiploic appendagitis in a Spigelian hernia. The initial approach after the diagnosis should be adequate analgesia associated with surgical correction of the hernia. There is no gold standard treatment for the repair. European and American societies suggest that if there is no palpable nodule, laparoscopic repair is preferable, always using a mesh. Conclusion Epiploic appendagitis in a Spigelian hernia is a rare condition whose diagnosis is a big challenge. However, the correct diagnosis can lead to a shorter hospital stay, with less cost and avoid the use of unnecessary medications.
Introduction Paget-von Schroetter Syndrome is a rare condition, which refers to primary venous thrombosis of the subclavian-axillary bed. It is related to vigorous activities involving the upper limbs, presenting pain, edema and muscle swelling. Its diagnosis involves, besides the clinical suspicion, Doppler ultrasonography and should be performed early to ensure immediate treatment. The therapy is initially made with anticoagulation, but thrombolysis, decompression surgery, venolysis and venoplasty should be considered, which can lead to a better prognosis and lower risk of complications. Case report This article refers to a report of a male patient, with a history of physical activity, who developed thrombosis in the left upper limb and evolved, after anticoagulant treatment, to post-thrombotic syndrome. Discussion Paget-von Schroetter syndrome can be asymptomatic, but common features include hyperemia, edema, heaviness and pain in the affected arm, usually 24 h after the initial event and may be accompanied by low fever. In diagnostic investigation, imaging exam is essential. Early diagnosis of the syndrome allows the early start of treatment, leading to better results and prognosis. Conclusion Therefore, this study has the goal of making the diagnosis more effective and improves the clinical-surgical management, from the increase in the level of medical professionals' suspicion regarding the disease.
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