Introduction: Paracecal hernia on the lateral side of the cecum is one of the least common types of internal hernia. We report herein a case of paracecal hernia on the lateral side of the cecum that was successfully diagnosed preoperatively by computed tomography (CT) and treated laparoscopically.
Case presentation: A 95-year-old man with a history of appendectomy was referred to our hospital for further evaluation. He was admitted with a diagnosis of small bowel obstruction (SBO) and was treated conservatively with placement of a long intestinal tube. Symptoms and abdominal findings immediately improved, but a large amount of fluid continued to be drained. We therefore carefully reevaluated the obstruction. CT revealed SBO caused by paracecal hernia resulting from intestinal invagination into a pouch on the lateral side of the cecum. Laparoscopic surgery was performed on hospital day 8, and we intraoperatively confirmed and repaired lateral paracecal hernia. The patient was discharged without major complications.
Conclusions: Preoperative diagnosis of internal hernia, including paracecal hernia, is relatively difficult. CT represents the most successful diagnostic modality, but requires careful examination, and laparoscopic surgery can play a useful role in definitive diagnosis and repair of SBO. Moreover, preoperative decompression facilitates safe laparoscopic surgery.
Background: A concurrent underlying infection must be considered when immunocompromised patients present with multiple muscle abscesses. Disseminated nocardiosis is a rare infectious disorder that may disseminate to the muscle and other tissues, including the central nervous system. Here we describe the case and management of an immunocompromised patient who presented with disseminated nocardiosis and multiple muscle abscesses. In such cases, the by surgical drainage of muscle abscesses and subsequent early diagnosis and identification of the causative organism may facilitate appropriate treatment.
A 70-year-old woman was admitted with general fatigue and left lower abdominal and hip pain. She had a 10-year history of treatment with azathioprine and prednisolone for AQP4-antibody-related neuromyelitis optica spectrum disorders. Although her vital signs were normal, laboratory data indicated a C-reactive protein concentration of 22.9mg/dL, and computed tomography revealed a coin-sized lesion in her right lung and abscesses in the left abdominal oblique and gluteal muscles. A blood culture was positive for multidrug-resistant Staphylococcus epidermidis. We surgically drained the multilocular abscesses and conducted a bacteriological evaluation, which revealed the presence of Nocardia spp. The patient recovered and was given a plan of sulfamethoxazole–trimethoprim therapy for 6 months.
Regardless of the positive result of blood culture consistent with multiple abscess formation, we should consider for disseminated nocardiosis in immunocompromised patients. To prevent central nervous infection and relapse, aggressive bacteriological evaluation and appropriate antibiotics therapy may be essential.
The component separation technique (CST) allows reconstruction of large ventral defects, which may be beneficial under contaminated conditions, but the rate of surgical site infection is relatively high. Negative pressure wound therapy (NPWT) potentially offers better wound closure in such conditions.
We present a patient having multiple complex incisional hernias with parastomal hernias who underwent ventral herniorrhaphy with the combined use of CST and NPWT.
This 78-year-old woman had a history of Hartmannʼs operation 5 years previously. She was complicated with median incisional hernia and parastomal hernia. We performed herniorrhaphy with stoma closure simultaneously, with CST and NPWT. After colon anastomosis and simple suture repair of the parastomal hernias, her median abdominal wall defects were assessed as 180mm at upper and 150mm at lower abdomen. Although fascial closure was completed by CST with some tension, dead space remained under the skin and subcutaneous fat layer. Therefore, we combined NPWT on the fascial plane. There was no severe surgical site infection and there was no evidence of hernia recurrence for a year after the operation.
CST followed by NPWT may be an effective alternative for repair of huge and complex incisional hernias, particularly in contaminated conditions.