Purpose: A randomized clinical trial was undertaken to test the hypothesis that patients receiving a nerve stimulator guided pudendal nerve block for hemorrhoidectomy would experience more effective and prolonged postoperative analgesia and shorter hospital stay compared to patients receiving general anesthesia. Methods:This was a prospective randomized observer-blinded study. Following Ethics Committee approval and informed consent, 80 patients scheduled for hemorrhoidectomy were randomized to two groups of 40 patients each: general anesthesia alone, or nerve stimulator guided pudendal nerve block. Postoperative pain, the primary outcome variable of the study, was assessed by visual analogue scale scores at pre-determined intervals during the postoperative period. Analgesic consumption, time to return to normal activities, patients' and surgeons' satisfaction, and duration of hospital stay were recorded. Results:The guided pudendal nerve block group failed in three patients, requiring their conversion to general anesthesia. Otherwise, patients in the pudendal nerve block group experienced better postoperative pain relief at rest (P < 0.0001), on walking, sitting, and defecation (P < 0.001), reduced need for opioids (11/35 vs 32/37; P < 0.0001), a more rapid return to normal activities (7.2 vs 13.8 days; P < 0.0001) and also a shorter hospital stay (25/35 vs 3/37 outpatient cases; P < 0.0001) compared to the general anesthesia group. Pudendal nerve block was also associated with overall higher patient satisfaction compared to general anesthesia (30/35 vs 9/37; P < 0.0001). Conclusion:Nerve stimulator guided pudendal nerve block is associated with reduced postoperative pain, shortened hospital stay, and earlier return to normal activity compared to general anesthesia for hemorrhoidectomy.
HighlightsWandering accessory spleen of giant sizeis a rare clinical presentation of a common disease that carry significant morbidity and mortality.To highlight the awareness of the disease and familiarity of its typical radiological findings especially in the acute setting.To review the literature and describe the different surgical options according to the size and expertise.
HighlightsIleocecal lipomas present typically with intussusception.There are only few reported cases of ileocecal lipomas presenting as lower GI bleeding.Histopathological evaluation remains the gold standard in precise diagnosis.The treatment of colonic lipomas is debatable among specialists.
Patient: Male, 38Final Diagnosis: Inflammatory myofibroblastic tumorSymptoms: Abdominal pain • anorexia • weight lossMedication: —Clinical Procedure: OperationSpecialty: SurgeryObjective:Rare diseaseBackground:Inflammatory pseudotumors can affect any organ, whereas primary omental tumors are very rare. A few cases have been reported in the literature, all affecting adult patients. They are usually difficult to diagnose preoperatively and pathology remains the criterion standard for diagnosis. Surgical resection is considered the first-line treatment in limited disease, whereas recurrent or metastatic disease is treated by re-excision. There is no role for chemo- or radio-therapy in limited disease. Here, we present a rare case of omental myofibroblastic tumor in an adult male.Case Report:A 38-year-old healthy man presented to our clinic complaining of lower abdominal pain associated with anorexia and low-grade fever, and he also reported weight loss. His initial hemoglobin was 9.7 g/dl. Magnetic resonance imaging (MRI) showed an enhancing solid mass in the lower abdomen, with close proximity to the appendix and the urinary bladder. The patient was treated successfully with laparotomy and excision of the tumor. Histopathology of the mass revealed spindle cells of vague fascicular pattern. Further immunohistochemical staining showed presence of reaction for CD68, CD34, and ALK. No omental infiltration was noted. No adjuvant treatment was applied and the patient was free of disease after 1-year follow-up.Conclusions:Omental pseudotumors are a rare pathology. They are usually slowly- growing, circumscribed tumors with a low malignant potential. They have a predilection for children.The overall mortality is reported to be 5–7% in cases with multiple recurrences.
IntroductionThe incidence of Bile duct injury after laparoscopic cholecystectomy approaches 0.11%–1.4%. Ducts of Luschka are the second most common site of bile leaks. The rarity of these ducts with cases of anatomical alterations in the gastrointestinal tract such as mini-gastric bypass makes the management a challenging option.Presentation of caseHereby we present a unique case of 28 year old female patient with mini-gastric bypass who had done uneventful cholecystectomy. Day 3 postoperatively patient complained of diffuse abdominal pain. Computed tomography showed free fluid in the abdomen. Liver enzymes were normal. Relaparoscopy showed leaking bile duct of Luschka, which was closed by surgical clips and drains left in the spaces. However bile leak continued for 4 weeks then stopped. Patient did well after all.DiscussionEndoscopic retrograde cholangiopancreatography with sphincterotomy played a crucial role for diagnosis and treatment of bile leaks with success rate near 94%. However no data were available using this method in a patient with Mini-gastric bypass procedure. Many authors have argued the role of relaparoscopy, but it is still an important way for adequate drainage and control of bile leakage. The only significant factor in determining clinical outcome in cases of non-surgical management is the type of bile duct injury.ConclusionTo the best of our knowledge, this is the first case report of bile leak from duct of Luschka after mini-gastric bypass treated successfully with relaparoscopy and drainage. Herein we will discuss all the available options of treatment and the challenge of it.
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