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Strangulated Femoral Hernia Turned to Be Peritoneal Cyst  [PDF]
Dionysios Dellaportas,George Polymeneas,Christina Dastamani,Evi Kairi-Vasilatou,Ioannis Papaconstantinou
Case Reports in Surgery , 2012, DOI: 10.1155/2012/528780
Abstract: Introduction. A peritoneal inclusion cyst is a very rare mesenteric cyst of mesothelial origin usually asymptomatic. A rare case of an 82-year-old white Caucasian female with a femoral hernia containing a large peritoneal inclusion cyst, mimicking strangulated hernia, is presented herein. Case Presentation. The patient was admitted to our hospital suffering from a palpable groin mass on the right, which became painful and caused great discomfort for the last hours. Physical examination revealed a tender and tense, irreducible groin mass. An inguinal operative approach was selected and the mass was found protruding through the femoral ring. After careful dissection it turned out to be a large unilocular cyst, containing serous fluid, probably originating from the peritoneum. McVay procedure was used to reapproximate the femoral ring. Histologic examination showed a peritoneal inclusion cyst. Discussion. Peritoneal inclusion cysts are usually asymptomatic but occasionally present with various, nonspecific symptoms according to their size. Our case highlights that high index of clinical suspicion and careful exploration during repair of a hernia is mandatory in order to reach the correct diagnosis about hernia’s contents. 1. Introduction A peritoneal inclusion cyst is a very rare mesenteric cyst of mesothelial origin occurring in the peritoneal cavity, mostly affecting women in the reproductive age. Unilocular peritoneal inclusion cysts are usually asymptomatic, but occasionally present with various, nonspecific symptoms, which makes correct preoperative diagnosis difficult [1]. They may be attached or lie free in the peritoneal cavity, and occasionally they may involve the round ligament simulating an inguinal hernia. Femoral hernias comprise 6–17% of abdominal wall hernias and usually contain abdominal viscera [2]. We present a rare case of an 82-year-old white female with a femoral hernia containing a large peritoneal inclusion cyst, mimicking strangulated hernia. 2. Case Presentation An 82-year-old white Caucasian female was admitted to our hospital suffering from a palpable groin mass on the right, which appeared two days ago, but for the last hours before admission it became painful and caused great discomfort. The mass was tender and tense on physical examination measuring at least 8?cm on diameter, and it was not reducible. The initial differential diagnosis was either a strangulated femoral or groin hernia. She had no history of other hernias and her laboratory findings were within normal range. Also no history of previous surgery, endometriosis,
Strangulated Femoral Hernia Turned to Be Peritoneal Cyst
Dionysios Dellaportas,George Polymeneas,Christina Dastamani,Evi Kairi-Vasilatou,Ioannis Papaconstantinou
Case Reports in Surgery , 2012, DOI: 10.1155/2012/528780
Abstract: Introduction. A peritoneal inclusion cyst is a very rare mesenteric cyst of mesothelial origin usually asymptomatic. A rare case of an 82-year-old white Caucasian female with a femoral hernia containing a large peritoneal inclusion cyst, mimicking strangulated hernia, is presented herein. Case Presentation. The patient was admitted to our hospital suffering from a palpable groin mass on the right, which became painful and caused great discomfort for the last hours. Physical examination revealed a tender and tense, irreducible groin mass. An inguinal operative approach was selected and the mass was found protruding through the femoral ring. After careful dissection it turned out to be a large unilocular cyst, containing serous fluid, probably originating from the peritoneum. McVay procedure was used to reapproximate the femoral ring. Histologic examination showed a peritoneal inclusion cyst. Discussion. Peritoneal inclusion cysts are usually asymptomatic but occasionally present with various, nonspecific symptoms according to their size. Our case highlights that high index of clinical suspicion and careful exploration during repair of a hernia is mandatory in order to reach the correct diagnosis about hernia’s contents.
Falciform ligament abscess: report of a case
Melo, Valdinaldo Arag?o de;Melo, Gustavo Barreto de;Silva, Renata Lemos;Arag?o, Jo?o Fernandes Britto;Rosa, José Eraldo Marques;
Revista do Hospital das Clínicas , 2003, DOI: 10.1590/S0041-87812003000100008
Abstract: falciform ligament abscess is rare. we report a case of a 65-year-old man who presented with right upper quadrant abdominal pain, postprandial fullness, and fever. computed tomography disclosed a cylindrical mass in the anterior abdomen that aroused suspicion of a hepatic abscess. at laparoscopic surgery, an abscess of the falciform ligament was found and drained. two months later, the patient developed recurrence of the abscess secondary to acute calculous cholecystitis. abscess drainage and cholecystectomy were performed. the presence of right uppper quadrant abdominal pain, epigastric tenderness, fever, leukocytosis, and a mass in the anterior abdomen should arouse suspicion of falciform ligament abscess. its treatment consists of abscess drainage.
Falciform ligament abscess: report of a case  [cached]
Melo Valdinaldo Arag?o de,Melo Gustavo Barreto de,Silva Renata Lemos,Arag?o Jo?o Fernandes Britto
Revista do Hospital das Clínicas , 2003,
Abstract: Falciform ligament abscess is rare. We report a case of a 65-year-old man who presented with right upper quadrant abdominal pain, postprandial fullness, and fever. Computed tomography disclosed a cylindrical mass in the anterior abdomen that aroused suspicion of a hepatic abscess. At laparoscopic surgery, an abscess of the falciform ligament was found and drained. Two months later, the patient developed recurrence of the abscess secondary to acute calculous cholecystitis. Abscess drainage and cholecystectomy were performed. The presence of right uppper quadrant abdominal pain, epigastric tenderness, fever, leukocytosis, and a mass in the anterior abdomen should arouse suspicion of falciform ligament abscess. Its treatment consists of abscess drainage.
Single Incision Laparoscopic Transabdominal Preperitoneal Repair for Strangulated Groin Hernia  [PDF]
Po Ching Cathy Ng, George Pei Cheung Yang, Michael Ka Wah Li
International Journal of Clinical Medicine (IJCM) , 2013, DOI: 10.4236/ijcm.2013.46A007
Abstract:

Introduction: Single incision laparoscopic surgery (SILS) has become more popular for various surgical procedures including hernia surgery. Initial results of SILS in elective hernia repair were comparable to those of conventional laparoscopic approaches. However the use of SILS in emergency case has not been widely reported. This study aimed to evaluate the feasibility of the use of single incision laparoscopic transabdominal preperitoneal (TAPP) repair for patients presenting with strangulated groin hernia. Method: Emergency single incision laparoscopic TAPP repair were performed in our unit from June 2011 onwards for selected patients. Retrospectively data including the patient demographics, operative time, type of hernia, hospital stay, complications and recurrence rate were collected and analyzed. Result: There were a total of five patients in this series from June 2011 to June 2012. The median age was 62 years old with a male to female ratio of 4:1. Four patients had unilateral hernia (one femoral and three inguinal hernias) and one had bilateral hernia (unilaterally strangulated femoral hernia and bilaterally reducible indirect inguinal hernia). The median operative time was 75 minutes for patients with unilateral repair. None of the patients required bowel resection. The conversion rate to either conventional laparoscopic or open repair was zero. The median hospital stay was 2 days. No major complication or recurrence was detected. Conclusion: This series showed that single port laparoscopic TAPP repair for strangulated groin hernia is a feasible option with no major complication reported.

Falciform ligament abscess from left sided portal pyaemia following malignant obstructive cholangitis  [cached]
Warren Leigh R,Chandrasegaram Manju D,Madigan Daniel J,Dolan Paul M
World Journal of Surgical Oncology , 2012, DOI: 10.1186/1477-7819-10-278
Abstract: Abscess formation of the falciform ligament is incredibly rare and perplexing when encountered for the first time. It is reported to occur in the setting of cholecystitis and cholangitis, but the pathophysiology is poorly understood. In this case report, we present a 73-year-old man with falciform ligament abscess following cholangitis from an obstructive ampullary carcinoma. The patient was referred to the Royal Adelaide Hospital from a country hospital, with progressive jaundice, anorexia and nausea. Prior to transfer, he deteriorated with cholangitis, dehydration and renal failure. On arrival, his abdomen was exquisitely tender along the course of the falciform ligament. His blood tests revealed an elevated white cell count of 14.9 x 103/μl, bilirubin of 291μmol/l and creatinine of 347 μmol/l. His CA 19-9 was markedly elevated at 35,000 kU/l. A non-contrast computed tomography (CT) demonstrated gross biliary dilatation and a collection tracking along the path of the falciform ligament to the umbilicus. The patient was commenced on intravenous antibiotics and underwent an urgent endoscopic retrograde cholangiopancreatogram (ERCP) with sphincterotomy and biliary stent drainage. Cholangiogram revealed a grossly dilated biliary tree, with abrupt transition at the ampulla, which on biopsy confirmed an obstructing ampullary carcinoma. Following ERCP, his jaundice and abdominal tenderness resolved. He was optimized over 4 weeks for an elective pancreaticoduodenectomy. At operation, we found abscess transformation of the falciform ligament. Copious amounts of pus and necrotic material was drained. Part of the round ligament was resected along the undersurface of the liver. Histology showed that there was prominent histiocytic inflammation with granular acellular eosinophilic components. The patient recovered slowly but uneventfully. A contrast CT scan undertaken 2 weeks post-operatively (approximately 7 weeks after the initial CT) revealed left portal venous thrombosis, which was likely to be a delayed discovery and was managed conservatively. We present this patient’s operative images and radiographic findings, which may explain the pathophysiology behind this rare complication. We hypothesize that cholangitis, with secondary portal pyaemia and tracking via the paraumbilical veins, can cause infectious seeding of the falciform ligament, with consequent abscess formation.
Meckel′s diverticulum strangulated in an umbilical hernia  [cached]
Komlatse Akakpo-Numado,Komla Gnassingbe,Komla Attipou,Azanledji Boume
African Journal of Paediatric Surgery , 2009,
Abstract: Background: Strangulated Meckel′s diverticulum (MD) in an umbilical hernia (UH) is a rare event. We present herein a case of strangulated MD in UH in a child. Case Report: An 18-month girl was admitted with clinical features suggesting upper intestinal strangulation since seven days. Many attempts of reduction were done before admission. She was resuscitated and had exploratory laparotomy, which revealed the hernia sac containing a completely gangrenous MD. She had bowel resection and had an uneventful postoperative period. Conclusion: An MD may be the content of a strangulated UH. Bowel resection of the segment bearing the diverticulum is advisable if the latter is gangrenous.
Laparoscopic repair of strangulated Morgagni hernia
Michael D Kelly
World Journal of Emergency Surgery , 2007, DOI: 10.1186/1749-7922-2-27
Abstract: Morgagni hernia is a rare diaphragmatic hernia that develops through a congenital retrosternal defect. In adults they are generally asymptomatic and are found incidentally during laparoscopy or imaging for another condition. However, they may present as an emergency with abdominal pain due to strangulation of the hernia contents. An unusual case is reported of a strangulated Morgagni hernia, which presented with vomiting and abdominal pain due to a gastric volvulus.A 73-year-old man presented with a 24-hour history of vomiting and severe, constant epigastric pain. In the preceding three months he had noticed intermittent, dull epigastric pain worse on lying flat. He suffered from type II diabetes, hypertension, asthma and intermittent claudication. He had previously undergone treatment for a transitional cell carcinoma (TCC) of the bladder and repair of umbilical and inguinal hernias. He was a retired electrician with previous asbestos exposure and he was an ex-smoker. On examination, he was tachycardic and pyrexial with a distended, generally tender abdomen but no signs of peritonitis. Respiratory examination was unremarkable and his blood tests showed a raised white cell count (16.1 × 109/L) along with raised serum creatinine (189 μmol/L) and urea (11.9 mmol/L). Chest x-ray showed an unusual air fluid level in the lower chest (fig 1). Under fluoroscopy, a fine bore tube was inserted and a gastrografin? (Schering AG, Germany) study was done (fig 2, 3). This showed a gastric volvulus with complete obstruction within a Morgagni hernia.An emergency laparoscopy was done via open insertion of a 10 mm port at the umbilicus and subsequent insertion of two 5 mm ports. The stomach, transverse colon and omentum were trapped in the hernia (fig 4). They were reduced with difficulty after incising the neck of the sac and the edge of the diaphragmatic defect (fig 5). There was a large section of necrotic omentum, which was resected and placed into a retrieval bag and subsequentl
Low grade fibromyxoid sarcoma of the falciform ligament: a case report
K Harish, AC Ashok, NK Alva
BMC Surgery , 2003, DOI: 10.1186/1471-2482-3-7
Abstract: We report a 37 year old man who presented with an abdominal mass and dragging pain. Pre-operative imaging suggested the possibility of a subcapsular hemangioma of liver.Laparoscopy was useful to locate the tumor as arising from falciform ligament and made the subsequent surgery simpler. This is one of the large fibromyxoid sarcomas to be reported.Low grade fibromyxoid sarcomas (LGFMS) of the soft tissues are usually situated in the deep soft tissues of the lower extremity, particularly the thigh [1]. It is seen in a young or middle aged adult and is more common in the male. Though they are sporadically seen in other areas like the chest wall or shoulder they are very rarely reported in an intra-abdominal location. We report a 37-year old man with a giant intra-abdominal low grade fibromyxoid sarcoma measuring 21 cm in size; which was mistaken for a possible hemangioma of the liver on CT scan.A 37 year old man noticed a mass in the epigastric region since four months and dull non radiating pain in the epigastrium since a month and a half. A few distended veins were seen over the abdominal wall. Abdominal examination revealed a non tender firm intra-abdominal mass in the epigastrium moving with respiration. A doubtful lateral mobility was present. An ultrasound study of the abdomen showed a large well encapsulated mass in the left lobe of liver with caudal exophytic expansion [Fig 1]. CT scan demonstrated the lesion extrinsically indenting stomach showing initial peripheral enhancement with centripetal filling on time delay [Fig 2]. There was no calcification. The mass was situated between the anterior abdominal wall and liver; but in close relation to the latter. In view of these findings, the possibility of a sub capsular mass, probably a hemangioma on the anterior surface of the left lobe of liver was considered. Biochemical and hematological investigations were within normal limits including liver function tests.A pre-operative fine needle aspiration was not done
Cystic lymphatic malformation of the falciform ligament: a rare cause of abdominal mass
Abbas T, Ismail A, Amir E
Open Access Surgery , 2011, DOI: http://dx.doi.org/10.2147/OAS.S24485
Abstract: tic lymphatic malformation of the falciform ligament: a rare cause of abdominal mass Case report (2224) Total Article Views Authors: Abbas T, Ismail A, Amir E Published Date September 2011 Volume 2011:4 Pages 35 - 37 DOI: http://dx.doi.org/10.2147/OAS.S24485 Tariq O Abbas1, Adel Ismail1, Emran Amir2 1Paediatric Surgery Department, 2Pathology Department, Hamad General Hospital, Doha, Qatar Introduction: Lymphatic malformations are benign proliferations of the lymphatic vessels that occur most frequently in the skin of the axilla and neck. However, they can also occur in the mediastinum and retroperitoneum, and very rarely in the abdominal cavity. Case report: An 11-year-old male who presented with an intra-abdominal cyst is described here. Laparoscopic exploration showed that it was a cystic mass of the falciform ligament and it was resected laparoscopically. Histopathology confirmed the swelling to be a lymphatic malformation. To the authors' knowledge, this is only the second report of a pediatric patient with a lymphatic malformation in the falciform ligament. Conclusion: Intra-abdominal cystic lymphatic malformations should be considered in the differential diagnosis of any intra-abdominal cystic mass. Management is surgical excision.
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