Meckel’s diverticulum occurs in 2% of the population and is the most common congenital anomaly of the small intestine. It is the only true diverticulum of the small intestine and occurs due to the persistence of a part of the vitello intestinal duct that does not undergo normal obliteration by the fifth to ninth week of gestation. Though the majority are clinically silent, there is a 4-6% lifetime risk of complications. Axial torsion is the rarest complication associated with Meckel’s diverticulum and its coexistence with intestinal obstruction is largely unheard of with reported cases being few and far between. Here we discuss one such case of axial torsion of a giant Meckel’s diverticulum associated with intestinal obstruction in an adult male.
Fournier’s gangrene (FG) is a fulminant and lethal condition usually occurring in the immunocompromised, first described in 1883 by the French dermatologist Jean Alfred Fournier. It is a form of necrotizing fasciitis of the perineal, genitourinary and perianal regions mostly in males with a mortality of nearly 20-50%. It is a surgical emergency and requires early diagnosis aided by scores such as laboratory risk indicator for necrotising fasciitis (LRINEC) and FG severity index (FGSI), extensive debridement combined with supportive procedures to manage associated complications and broad-spectrum antibiotics. Management of FG thus required a multimodal approach and emphasis on reconstruction after recovery in patients who survive was crucial to improving the quality of life in these patients. Here we were presenting 7 cases of FG successfully managed at our institution, grouped under the four methods by which wound closure was achieved: fecal diversion and split skin grafting of scrotum, urinary diversion and penoscrotal split skin grafting, delayed primary closure (with and without orchidectomy) and wound healing by secondary intention.
Managing a giant inguinal hernia/ incisional/ ventral hernia had its own complications. The overtime adaptation of peritoneal cavity to a lower abdominal pressure was one of the most important factors responsible for these complications. Surgical repair is also quite a challenge because of the massive contents in sac, adhesions and concomitant fibrosis. In order to reduce the complications like intra-abdominal hypertension, cardiorespiratory problems and to increase the abdominal wall compliance, many techniques were described. Progressive preoperative pneumoperitoneum is a well described technique for the repair of giant inguinal hernia/ incisional/ ventral hernia with loss of domain which helps in conditioning the abdominal wall in the preoperative period, increasing the likelihood of primary closure and decreasing the incidence of compartment syndrome.
Abdominal cocoon is a rare condition leading to acute or chronic bowel obstruction. Though multiple etiologies have been defined, many are idiopathic. We had three different cases of intestinal obstruction. First one was a case of intestinal obstruction in a young female and was diagnosed to have tuberculosis. She had abdominal cocoon along with perforation where even adhesiolysis was unsuccessful. Second one was a cause of right inguinal hernia in a 62-year-old male. Bowel was enclosed in a membrane and diagnosed as localised variant of abdominal cocoon. Membrane was removed and right herniorrhaphy was done. Third one was a 35-year-old male with abdominal cocoon. No previous tuberculosis history was noted and adhesiolysis was done. Thus, abdominal cocoon can present with enigmatic etiology and presentation. Only an occasional case can be due to tuberculosis as described in literature. It must always be a differential diagnosis for a case of acute or chronic intestinal obstruction.
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