Perforated Carcinoma of the Sigmoid Colon in an Incarcerated Inguinal Hernia: Report of a Case

Kouraklis, Gregory; Kouskos, E; Glinavou, A.; Raftopoulos, John; Karatzas, Gabriel

doi:10.1007/s00595-002-2552-5

Cited by 36 publications

(24 citation statements)

References 8 publications

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“…In addition, the importance of the neuroendocrine stress response in patients following surgical trauma is shown by the positive clinical effects of epidural analgesia in the postoperative course after major gastro-intestinal surgery [125]. Epidural analgesia, which blocks the regional innervation to the intestine and interrupts the transmission of pain from the area, attenuates the stress response, as shown by lower postoperative levels of adrenocorticotropic hormone (ACTH), cortisol, aldosterone and glucose [126,127].…”

Section: The Effects Of Severe Stress and Critical Illness On The Intmentioning

confidence: 99%

The Role of Microbiota and Probiotics in Stress-Induced Gastrointestinal Damage

Lutgendorff

Akkermans

Söderholm³

2008

CMM

165

106

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Stress has a major impact on gut physiology and may affect the clinical course of gastro-intestinal diseases. In this review, we focus on the interaction between commensal gut microbiota and intestinal mucosa during stress and discuss the possibilities to counteract the deleterious effects of stress with probiotics. Normally, commensal microbes and their hosts benefit from a symbiotic relationship. Stress does, however, reduce the number of Lactobacilli, while on the contrary, an increased growth, epithelial adherence and mucosal uptake of gram-negative pathogens, e.g. E. coli and Pseudomonas, are seen. Moreover, intestinal bacteria have the ability to sense a stressed host and up-regulate their virulence factors when opportunity knocks. Probiotics are "live microorganisms which, when administered in adequate amounts, confer a health benefit on the host", and mainly represented by Lactic Acid Bacteria. Probiotics can counteract stress-induced changes in intestinal barrier function, visceral sensitivity and gut motility. These effects are strain specific and mediated by direct bacterial-host cell interaction and/or via soluble factors. Mechanisms of action include competition with pathogens for essential nutrients, induction of epithelial heat-shock proteins, restoring of tight junction protein structure, up-regulation of mucin genes, secretion of defensins, and regulation of the NFkappaB signalling pathway. In addition, the reduction of intestinal pain perception was shown to be mediated via cannabinoid receptors. Based on the studies reviewed here there is clearly a rationale for probiotic treatment in patients with stress-related intestinal disorders. We are however far from being able to choose the precise combination of strains or bacterial components for each clinical setting.

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Section: The Effects Of Severe Stress and Critical Illness On The Intmentioning

confidence: 99%

The Role of Microbiota and Probiotics in Stress-Induced Gastrointestinal Damage

Lutgendorff

Akkermans

Söderholm³

2008

CMM

165

106

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“…In the majority of the reported cases, a laparotomic resection of the colon followed a traditional inguinal repair through two separate incisions [2,4]. In cases of perforation or occlusion, most authors performed a colonic resection through the inguinal incision to prevent the peritoneal cavity from contamination and completed the operation via a midline laparotomy [3,5]. Other authors described a transverse left iliac fossa incision for a sigmoid cancer incarcerated into a left inguinal hernia [6].…”

Section: Discussionmentioning

confidence: 99%

Locally advanced carcinoma of the cecum presenting as a right inguinal hernia: a case report and review of the literature

et al. 2013

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IntroductionAn inguinal hernia is a common surgical disease in elderly patients, but an association with intra-abdominal malignancies is rare.Case presentationWe report a case of a 78-year-old Caucasian woman presenting with a right inguinal mass suspected to be an irreducible hernia. A computed tomography scan showed the presence of the cecum in her inguinal canal, with an irregular thickening of the cecal wall suggesting a neoplasm within the inguinal hernia. A colonoscopy was not completed owing to the huge involvement of the cecum into the hernia sac. A laparotomy was performed, at which time the cecum was herniated through her right inguinal canal and the cecal tumor had infiltrated her abdominal wall and femoral artery. A right inguinal incision was necessary for good vascular control and to carry out an en bloc resection of the tumor with the inguinal wall. A right colectomy was performed and the inguinal wall repaired. The postoperative course was uneventful and our patient received adjuvant radiochemotherapy.ConclusionWe describe a rare case of a locally advanced cecal tumor presenting as a right inguinal hernia. Both diagnosis and surgical treatment in elderly patients represent a challenge for the surgeon in cases of aggressive tumors as reported in this paper.

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“…In most cases small intestine and omentum are usually contained in the hernia sac, but urinary bladder, fallopian tube with the ovary, Meckel's diverticulum, appendix and inflamed colonic diverticulum have also been reported. [6][7][8][9][10][11] Inguinal hernia sacs in 0.5% of cases contain malignancies, either of saccular origin or generating from the herniated organ, usually sigmoid, cecum and other parts of colon. [12][13][14] In our case the content of hernia sac was the strangulated loop of an otherwise normal sigmoid colon.…”

Section: Discussionmentioning

confidence: 99%