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Case Report: Intestinal obstruction secondary to an internal hernia following Lichtenstein hernia repair
Get PDFIntroduction: Inguinal hernias are usually treated with surgical repair. Intestinal obstruction immediately after inguinal hernia repair is rare. This report describes a case of intestinal obstruction due to an internal hernia after a Lichtenstein hernia repair.
Case: An 80-year-old male presented with intestinal obstruction and underwent a Lichtenstein repair of a right inguinal hernia. On the 5th postoperative day, he developed recurrent obstructive symptoms not improving with nonoperative management, and surgery was undertaken. On entering the peritoneal cavity, the small intestine was herniated through a peritoneal defect in the right lateral inguinal fossa. Absorbable adhesion barrier (INTERCEED®) was applied at site of the defect after laparoscopic resolution of intestinal obstruction. The patient has had no evidence of recurrence 4 months post-operation.
Discussion: The original inguinal hernia was repaired by the Lichtenstein technique, but intestinal obstruction developed postoperatively, which laparoscopy revealed to be an internal hernia. Preperitoneal hernia as a postoperative complication may have occurred due to peritoneal defect. Intraoperative placement of absorbable adhesion barrier at the site of the resected peritoneal defect may help prevent recurrence.departmental bulletin pape
Middle rectal artery arising directly from the internal iliac artery in a patient with rectal cancer treated by robot-assisted surgery: A case report
Get PDF症例は43歳，男性。直腸癌術前の3D-CTangiographyで中直腸動脈が内腸骨動脈から直接分岐するという血管走行を認めたが，術前のシミュレーションにより安全にロボット支援下直腸括約筋間切除術が施行可能であった。中直腸動脈は側方リンパ節の転移ルートとなる腫瘍学的にも重要な構造物であるが，その定義や変異についてはあまり知られていない。今回，ロボット支援下手術の拡大視効果によって，詳細な解剖の理解が可能であった中直腸動脈の稀な分岐形態を認めた症例を経験したので文献的考察を加えて報告する。departmental bulletin pape
A case of cyclic Cushing’s disease requiring short-term hormone replacement therapy after surgery
Get PDFCyclic Cushing’s syndrome (CS) is a rare disease defined as a periodic excessive production of cortisol. Here, we report a case of a 55-year-old woman diagnosed with Cushing’s disease (CD) with intermittent increases in cortisol levels, indicating cyclic CD. Contrast-enhanced magnetic resonance imaging and surgery revealed a pituitary adenoma beside a cystic lesion. After surgical treatment, although the patient temporarily presented with adrenal insufficiency, she could discontinue hormone replacement therapy only 4 months later. This report suggests that a patient with cyclic CD can cease postoperative hormone replacement therapy within a short period.departmental bulletin pape