AAIH should be always suspected when chest swelling occurs after a minor or major trauma, and CT must be promptly performed to rule out diaphragmatic or abdominal viscera injury. This condition requires surgery to prevent serious complications, the first-choice technique should be mesh tension-free repair.
After long-term follow-up, the incidence of TSH following LC was higher than expected. The insertion of large trocars at the umbilical site plays a key role in the development of TSH. Other conditions such as obesity and large gallstones can be additional risk factors since the umbilical defect must often be widened in these cases.
We report a case of endometriosis of the round ligament in a 29-year-old woman, who complained of a lump with a diameter of about 2.5 cm in the right inguinal region, which increased in bulk and was accompanied by intense pain during the menstrual period. The clinical suspicion of inguinal endometriosis, supported by ultrasonography and Magnetic Resonance (MR), was confirmed by histological examination of the surgical specimen, which included the mass and the extraperitoneal segment of the round ligament. The authors conclude that the appearance of a lump in the inguinal region associated with subjective and objective changes of the lesion in relation to the menstrual cycle must raise the suspicion of endometriosis among the possible diagnoses.
We report a typical case of right paraduodenal hernia (RPH) and review the literature on the pathogenesis, diagnosis and treatment of this uncommon entity. A 32-year-old woman was hospitalized with acute abdominal cramps, nausea, and vomiting. Computed tomography (CT) findings suggested RPH, which was confirmed by explorative laparoscopy. We performed an open repair by suturing the orifice after reducing the hernia. At her 2-year follow-up, the patient reported complete resolution of her symptoms. Because RPH is rare and its clinical signs are nonspecific, radiological examinations are essential for a correct preoperative diagnosis. CT is currently the most accurate diagnostic tool, but laparoscopy may be necessary to confirm the diagnosis. This hernia can be repaired by simple suturing of the hernial orifice, either laparoscopically or via an open procedure, although several authors consider complete intestinal derotation to be the best option.
In a large number of patients suffering from breast carcinoma the surgeon is still forced, for strictly technical reasons and/or by the patient's choice, to perform a radical operation that psychologically and practically compromises the quality of life of the patient, in varying degrees from patient to patient. The authors have analyzed the main characteristics of BR from the esthetic-functional, psychological, and oncological points of view, in the light of a careful examination of the literature and of the data relating to a sample group of 500 BR treated according to a protocol in which BR has been included, with times and modalities depending on the histological type of tumor and the level of local evolution of the disease. The variety of BR techniques available is such as to permit this option in a great variety of cases. Whenever possible, immediate BR, with placement of a breast prosthesis at the same time or after positioning a tissue expander, is to be preferred. If additional skin or muscle is needed, BR is to be performed at a later time by means of more complex techniques (latissimus dorsi myocutaneous flap plus prosthesis, TRAM flap, free flap). When performed after adequate evaluation and in a technically valid way, BR gives good esthetic and psychological results, has a low incidence of complications or sequelae, and does not affect the natural history of the disease; in particular, BR does not change the percentage of local recurrence or its early diagnosis and allows adequate multidisciplinary treatment.
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