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Acute Care Emergency Surgery
Published in Mansoor Khan, David Nott, Fundamentals of Frontline Surgery, 2021
Marcelo A. F. Ribeiro, Mansoor Khan
In a situation of limitation of resources, the best approach to umbilical hernia repair is as follows:After anaesthesia, the patient is re-examined. If a palpable mass is identified, the incision can be located over the mass.Classical incision is a vertical or curvilinear incision adjacent to the hernia sac (Figure 11.2a).Identification and dissection of the sac to its fascial attachments (Figure 11.2b).Once the fascia has been cleared, the hernia sac can either be inverted or excised, then the fascia can be closed with a nonabsorbable suture (Figure 11.2c).In the cases where the fascial defect is too big and cannot be closed without tension, the surgeon may consider the use of a mesh (Sublay; Figure 11.2d).Whenever possible, a suture to tack the skin of the umbilicus to the fascia to recreate a cosmetically appealing umbilicus should be done (Figure 11.2e).
Introduction to the clinical stations
Published in Sukhpreet Singh Dubb, Core Surgical Training Interviews, 2020
Paediatric umbilical hernias typically close by the age of 4–5 without intervention; however, although complications are rare they must be recognised and acted on immediately. The umbilicus transmits the contents of the umbilical cord via a defect in the linea alba. The umbilical ring usually closes by contraction, the umbilical vein fibroses to become the round ligament of the liver, and attaches to the umbilicus. This provides anchorage to the umbilicus and protects against the formation of a hernia, however, a minority of patients are susceptible to hernia formation if this process does not occur correctly. Important risk factors for umbilical hernia formation include: Low birth weightAfrican ancestryTrisomy 13, 18 and 21Congenital hypothyroidismHurler's syndromeBeckwith-Wiedemann syndrome
Inguinal hernia, hydrocele, and other hernias of the abdominal wall
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Sophia Abdulhai, Todd A. Ponsky
An umbilical hernia is very common in infants and young children. The hernial sac protrudes through a defect in the umbilical ring due to a failure of complete obliteration at the site where the fetal umbilical vessels (umbilical vein and the two umbilical arteries) enter the abdominal wall.
An unusual presentation of non-IBD related colorectal primary extranodal diffuse large B cell lymphoma with a colo-colonic fistula
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Rima Nakrani, Ho-Man Yeung, Matan Arnon, Alexandra Selby, Christine Burgert-Lon, Bhishak Kamat
His past medical history includes hypertension, hyperlipidemia, hypothyroidism, two cerebral arteriovenous malformations, and transient ischemic attack. He has a history of chronic tobacco use but denied alcohol or recreational drug use. He denied a family history of inflammatory bowel disease or hematological or oncological disorders. Four months prior to presentation, he underwent an emergency laparotomy for repair of a large strangulated umbilical hernia. His last colonoscopy was five years prior to presentation and was notable for severe sigmoid diverticular disease and a small benign polyp, although the preparation was suboptimal. On physical examination, he was awake, alert, and oriented to person, time, and place. He was in no acute distress, but thin appearing. Bowel sounds were normal. A midline laparotomy incision from his hernia repair appeared well healed and clean with well-approximated edges. His abdomen was soft with no palpable mass and he had suprapubic tenderness only to deep palpation. Laboratory results were significant for a leukocytosis of 27 K/mm3, acute kidney injury with a creatinine of 1.55 mg/dL, and a lactic acidosis of 2.3 mmol/L.
Co-occurrence of incontinentia pigmenti and down syndrome: examining patients’ potential susceptibility to autoimmune disease, autoinflammatory disease, cancer, and significant ocular disease
Published in Ophthalmic Genetics, 2021
David C. Gibson, Natario L. Couser, Kayla B. King
Physical examination showed a well-nourished infant. Facial features included epicanthal folds, up-slanted palpebral fissures, flat nasal bridge, and a large protruding tongue. Ocular examination revealed bilateral astigmatism. There were no lid, conjunctival, scleral, or corneal lesions. Fundus examination was unremarkable and showed normal vasculature. There was no strabismus or nystagmus present. Neurological examination revealed no global or focal deficits; however, musculoskeletal examination revealed mild hypotonia. A large umbilical hernia was noted upon abdominal examination, but there were no other masses or hepatosplenomegaly present. The rest of the physical examination was normal besides upper airway stridor and a soft 1–2/6 ejection murmur upon auscultation of the neck and thorax.
Why now? Delayed drug-induced pancreatitis due to dapsone for dermatitis herpetiformis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Youssef Yousry Soliman, Megan Sue Soliman, Farrukh Abbas
A 75-year-old man with history of celiac disease, dermatitis herpetiformis, hypertension, and hyperlipidemia presented to the emergency department with sharp upper abdominal pain after eating a fatty meal. He had intermittent abdominal pain for a few weeks. A few days prior to presentation, he was diagnosed with acute pancreatitis (lipase 1149) as an outpatient. Due to increased pain and anorexia, he was sent to the hospital for further evaluation. Other history included uncomplicated umbilical hernia repair 6 months prior to admission. His medications included aspirin, dapsone, furosemide 10 mg once daily, losartan, ranitidine, and simvastatin. He had been taking dapsone for over 5 years for dermatitis herpetiformis, and his dose was increased 4 weeks prior to presentation, coinciding with his history of intermittent abdominal pain. His furosemide dose has been unchanged for years. He consumed 1–2 alcoholic beverages monthly.