Symptomatic colon lipoma is a rare occurrence in clinical practice, and its association with sigmoid volvulus is even rarer. We present a case of a man in his 70s who presented to our emergency ...department with suspected intestinal obstruction. Upon examination, sigmoid volvulus was diagnosed and successfully treated endoscopically through decompression and detorsion. However, the patient experienced a recurrence, leading to the decision to perform sigmoid resection as a Hartmann’s procedure. Subsequently, a prolapsed tumor was observed through the stoma, which was endoscopically resected, revealing a pedunculated submucous colonic lipoma. This case report highlights the potential association between sigmoid volvulus and the presence of a large colon lipoma. Thus, giant colonic lipoma should be considered as a differential diagnosis among the causes of colonic volvulus.
An acquired esophago-respiratory fistula represents an abnormal connection between the esophagus and the respiratory system. It is usually caused by malignancy and infection, or it occurs as a ...complication after surgery or radiation therapy. It can be divided according to its anatomical level into esophago-tracheal fistula, esophago-bronchial fistula, and in the rarest case, esophago-pulmonary fistula (EPF). We present a case of EPF aggravating an anastomotic leak (AL) after the Ivor-Lewis operation for esophageal cancer. The leak was treated with endoscopic vacuum therapy (EVT) using the Eso-Sponge® system (B. Braun Melsungen AG, Melsungen, Germany). In the further course of treatment, an EPF was suspected by a new onset of severe cough after oral fluid intake. The suspicion was confirmed by injecting methylene blue dye into the paraesophageal-extraluminal cavity during endoscopy and attesting to its presence in the respiratory tract by simultaneous bronchoscopy. Furthermore, an oral contrast computed tomography scan showed the presence of contrast in the right lower lobe of the lung. This complication was treated conservatively with EVT and antibiotics. Nutrition was administered through the existing jejunostomy. Both fistulas and the paraesophageal cavity were fully healed, oral intake was maintained, and the patient was discharged. This rare life-threatening complication can be treated conservatively. Its management is challenging, controversial, and lacks a general consensus.
The foramen of Winslow hernia (FWH) is a rare type of internal hernia. In one-third of cases, the cecum was found in the lesser sac. More rarely, the herniated cecum might be volvulated, which ...represents 1-1.5% of the causes of intestinal obstruction. Once diagnosed, surgical reduction and/or resection of the nonviable herniated bowel is crucial for a positive outcome.
The authors report a case of retroperitoneal cecal volvulus that complicated FWH in a patient with a history of laparoscopic cholecystectomy.
A delay in the diagnosis is associated with high morbidity and even higher mortality. Because of lacking a consensus, the treatment of FWH depends on the team's surgical experience.
Reporting this case will help us to keep in mind this differential diagnosis while treating patients in our daily practice.
Inguinal hernia repair is one of the most common procedures performed in general surgery. Approximately 20 million hernia surgeries are performed every year worldwide. Conventionally, hernial repair ...is carried out with the open Lichtenstein technique; however, laparoscopic and robotic inguinal hernia repairs have been developed as a minimally invasive alternative to the classic Lichtenstein repair. The prosthetic mesh can be placed by totally extraperitoneal and transabdominal pre-peritoneal approaches. Choosing the best technique for repairing an inguinal hernia is a challenge because the available data are contradictory. However, a growing number of studies have claimed that robotic-assisted hernia repair is not only feasible and safe, but it is associated with outcomes that are comparable to those obtained with laparoscopy and open surgery, including shorter hospital stay, and fewer complications. The aim of the review article is to provide an overview of the current practice of inguinal hernia repair, with a focus on the advances in robotic-assisted inguinal hernia repair, as well as the advantages and disadvantages of this surgical procedure compared to the laparoscopic technique in view of the current reports in the literature.
Introduction and importanceThe foramen of Winslow hernia (FWH) is a rare type of internal hernia. In one-third of cases, the cecum was found in the lesser sac. More rarely, the herniated cecum might ...be volvulated, which represents 1-1.5% of the causes of intestinal obstruction. Once diagnosed, surgical reduction and/or resection of the nonviable herniated bowel is crucial for a positive outcome.Case presentationThe authors report a case of retroperitoneal cecal volvulus that complicated FWH in a patient with a history of laparoscopic cholecystectomy.Clinical discussionA delay in the diagnosis is associated with high morbidity and even higher mortality. Because of lacking a consensus, the treatment of FWH depends on the team's surgical experience.ConclusionReporting this case will help us to keep in mind this differential diagnosis while treating patients in our daily practice.
Needle stick injuries (NSIs) are preventable hazards that can be avoided with appropriate staff training and safety systems. We assessed the prevalence and awareness of NSIs among health-care workers ...and cleaners in hospitals in Gaza.
We did a cross-sectional study in four hospitals from July 14 to Oct 25, 2018. All cleaners and health-care workers were eligible to participate. Data were gathered via a survey tool designed for the study that covered sociodemographic data, NSI prevalence, and response to possible injuries. The primary outcomes were prevalence and staff awareness of NSIs.
538 staff participated in the survey, among whom the mean age was 28.9 (SD 7.71) years, 331 (62%) were men, 119 (22%) were doctors, 262 (49%) were nurses, 72 (13%) were medical students, and 85 (16%) were cleaners. 289 participants (54%) had had at least one NSI: 59 doctors (50% of all doctors), 142 nurses (54%), 32 students (44%), and 56 cleaners (66%). NSIs were obtained during various activities, including 168 incidents (40%) during drug administration, 82 (20%) while recapping needles, 78 (19%) during wound suturing, 63 (15%) while cleaning, and 27 (6%) during arterial blood gas sampling. Only 94 (33%) of 289 participants with NSIs reported their injuries. Among the 195 (67%) participants who did not report NSIs, 41 (21%) did not know that they should do so, 65 (33%) did not know how to report, 62 (32%) believed that reporting was useless, and 27 (14%) forgot to report.
More than half the participants had had NSIs, but reporting of injuries was low. The Ministry of Health should provide targeted interventions and training to improve risk awareness and understanding of the importance of reporting for health-care employees. The strengths of this study are the large sample size and recruitment from diverse professional backgrounds. The main limitation was the lack of validation of the study instrument.
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