Case Report
Strangulated Transmural Hernia of the Uterus After Myomectomy: A Rare Cause of Bowel Obstruction
Camara Mamadouba*
,
Bly Persédoué Romuald,
Cissé Fodé,
Camara Mamadou
Issue:
Volume 13, Issue 3, June 2024
Pages:
29-32
Received:
9 April 2024
Accepted:
7 May 2024
Published:
30 May 2024
Abstract: Consultation for mechanical bowel obstruction is one of the most common reasons in emergency and surgical departments. Transmural hernia of the strangulated uterus after myomectomy is a rare etiology of intestinal obstruction. Their diagnosis is increasingly complex and is discovered during an exploratory laparotomy. In this observation, we report the case of this 34-year-old patient with a history of myomectomy, nulliparous admitted for persistent abdominal pain and vomiting. an abdominopelvic ultrasound showed images of uterine myomas in necrobiosis. the patient presented an occlusive syndrome for which an abdominopelvic MRI which confirmed the diagnosis of aseptic necrobiosis. This unusual image mimicking that of a necrobiosis of uterine myoma was the difficulty which allowed this diagnostic error and the delay in the treatment of this patient. As this philosophy emphasizes (never let the sun rise or set in case of mechanical obstruction of the small intestine). Given the persistence of clinical signs, an abdominal CT scan was requested and confirmed the diagnosis of occlusive syndrome. conclusion: Faced with the diagnosis of an acute intestinal obstruction following a myomectomy by a combination of persistent abdominal pain, vomiting, cessation of materials and gas, systematically look for an obstruction of internal hernia by incarceration in a myomectomy cubicle. Exploratory laparotomy makes it possible to find the etiology and treat it.
Abstract: Consultation for mechanical bowel obstruction is one of the most common reasons in emergency and surgical departments. Transmural hernia of the strangulated uterus after myomectomy is a rare etiology of intestinal obstruction. Their diagnosis is increasingly complex and is discovered during an exploratory laparotomy. In this observation, we report ...
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Research Article
Early Surgical Management of Appendicular Mass: Evaluation of Surgical Outcome in Selected Private and Government Hospitals, Bangladesh
Jahangir Md Sarwar,
Abul Kalam Md Shamsuddin,
Sirajam Munira*
Issue:
Volume 13, Issue 3, June 2024
Pages:
33-38
Received:
16 May 2024
Accepted:
31 May 2024
Published:
19 June 2024
DOI:
10.11648/j.cmr.20241303.12
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Abstract: Background: Appendicular mass, a common occurrence in acute appendicitis (10% of cases), develops within 24-48 hours of symptom onset. Management strategies, including early appendectomy, non-operative management with or without drainage, and interval appendectomy, vary widely. This study aims to evaluate the outcomes of early surgical management and compare different surgical approaches. Methodology: This retroospective observational study was performed in different private and government hospital at Jamalpur, Manikgonj for a period of 8 years from January 2015 to December 2022. A total of 288 consecutive patients meeting eligibility criteria underwent open appendectomy within 24 hours of hospital admission due to appendicular lump diagnosis based on clinical or ultrasonographic findings. Two surgical techniques were employed: appendicectomy with generalized peritoneal toileting and appendicectomy with loco-regional peritoneal toileting All data were collected from hospital records. Follow-up records for a period of 2 weeks and at the end of 1 year were reviewed. Results: Patients had a mean age of 30.04 years, mostly male and under 30 years old. Appendicular lump with abscess was predominant (73.96%), along with perforated appendix and presence of pus (71.18% and 75.35% respectively). 68.75% underwent appendicectomy with loco-regional toileting, and 31.25% with generalized peritoneal toileting. Both groups were similar in demographics and perioperative findings, with common difficulties in localization and dissection (76.79% and 88.89% respectively). No bowel injuries occurred in the loco-regional toileting group. Postoperative complications were significantly lower in this group, especially superficial and deep wound infections (11.61% vs 16.67%, 2.53% vs 10%). Fecal fistula and incisional hernia were observed in the generalized peritoneal toileting group (1.11%, 2.22%). Operative time was notably shorter in the loco-regional peritoneal toileting group (92 minutes vs 65 minutes) Conclusion: Early appendicectomy allows for single-admission treatment, serving as an effective alternative to conservative therapy by significantly reducing hospital stays and expenses. Specifically, early appendicectomy with loco-regional peritoneal toileting demonstrates shorter operative times and lower post-operative complications compared to generalized peritoneal toileting, suggesting its favorable utility in managing appendicular mass and warranting further optimization in surgical strategies.
Abstract: Background: Appendicular mass, a common occurrence in acute appendicitis (10% of cases), develops within 24-48 hours of symptom onset. Management strategies, including early appendectomy, non-operative management with or without drainage, and interval appendectomy, vary widely. This study aims to evaluate the outcomes of early surgical management a...
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