Romanian Journal of Emergency Surgery

ILEON PERFORATION AS A LATE COMPLICATION OF VIDEO CAPSULE ENDOSCOPY – A CASE REPORT AND REVIEW OF THE LITERATURE

Alexandru Munteanu — 2023-12-21

Wireless capsule endoscopy is a valuable and minimally invasive tool for evaluating the small bowel. This technology has revolutionized the field of gastrointestinal imaging, providing several advantages over traditional endoscopic methods. After 10 years, however, the first articles were published regarding acute complications such as retention and/or perforation of the small intestine after this procedure. We present the first case of perforation of the small intestine after 22 months after the administration of the video capsule in a multi-operated patient with adhesion syndrome and several areas of ileal stenosis.

EMERGENCY SURGICAL MANAGEMENT OF AMYAND HERNIA: A CASE SERIES STUDY

Cătălin Cosma — 2023-12-21

Introduction: Amyand’s hernia, named after Claudius Amyand, is a rare hernia variant characterized by the presence of the vermiform appendix within the hernial sac. Accounting for about 1% of all inguinal hernias, its exact development mechanism remains unclear. The clinical presentation can vary significantly, often mirroring symptoms of a hernia or acute appendicitis.

Material & Method: A retrospective case series study was conducted at the General Surgery Clinic 1 of the SCJU Tg. Mures Emergency County Hospital. It involved a comprehensive review of medical records of patients diagnosed with Amyand’s hernia who underwent emergency surgery. Data collected included demographics, clinical presentation, surgical management, postoperative complications, and follow-up details. Descriptive statistical analysis was performed using EasyMedStat software.

Results: Over five years, seven cases of Amyand’s hernia were reported, with an increase in 2023. The average age of the patients was 77.8 years, all male, demonstrating a higher incidence in older males. Symptom onset varied widely, from four months to nearly 20 years. Most patients experienced abdominal pain, with approximately half reporting fever. The primary diagnosis was often intestinal occlusion with an incarcerated inguinal-scrotal hernia. Surgical approaches varied, with the Lichtenstein operation being the most common. Mesh repair was used in most cases, and all patients underwent appendectomy. The median hospital stay was five days, with minimal postoperative complications.

Conclusion: Amyand’s hernia presents a surgical challenge due to its rarity and variable clinical presentation. This study underscores the need for individualized treatment strategies to optimize patient outcomes. The findings contribute to understanding Amyand’s hernia, highlighting the importance of tailored surgical approaches and diligent postoperative care.

LAPAROSCOPIC RESOLUTION OF A LEFT-SIDED STAB WOUND WITH DIAPHRAGM LESION - A CASE REPORT

Roxana Craciun — 2023-12-21

Traumatic diaphragm injuries (TDI) are infrequent but can have profound implications for respiratory function. Penetrating chest trauma, particularly stab wounds, poses unique challenges due to small lesion sizes. The incidence of TDI, ranging from 1% to 8%, is higher in penetrating trauma. Left-sided diaphragmatic injuries predominate, potentially linked to assailants being predominantly right-handed. Imaging for TDI is challenging, with contrast-enhanced computed tomography being the gold standard, though limitations persist. We present a case of a 45-year-old woman with a left chest stab wound, illustrating the importance of timely diagnosis and intervention. Clinical presentation included pain on inspiration and signs of ethanol intoxication, but no signs of respiratory distress. Imaging revealed a diaphragmatic injury, prompting exploratory laparoscopy, confirming a two-centimeter laceration that was repaired with nonabsorbable sutures. No other incidents were reported during hospitalization.

TDI mortality rates vary (1%-30%), influenced by associated injuries. Minimally invasive approaches are recommended in stable patients, with thoracoscopy preferred. Prompt diagnosis and intervention are essential, given the risk of complications if treatment is delayed. This case underscores the importance of a high index of suspicion in penetrating chest trauma, ensuring rapid surgical intervention for improved patient outcomes.

STRANGULATED OBTURATOR HERNIA - A RARE CASE OF INTESTINAL OBSTRUCTION AND REVIEW OF THE LITERATURE

Tudor Bratiloveanu — 2023-12-21

Comprising merely 1% of all abdominal wall hernias, obturator hernias exhibit a notable morbidity and mortality, with reported rates ranging from 15-25%, and in certain instances, escalating up to 70%. We present the case of a 79-year-old thin, frail lady who was admitted with a 5-day history of nausea, vomiting, constipation, and lower left quadrant abdominal pain that radiated down the left medial thigh. Howship-Romberg sign was positive. Plain X-rays revealed dilated bowel loops with multiple central air-fluid levels suggestive of complete small bowel (SB) obstruction with no signs of perforation. An urgent CT scan of the abdomen and pelvis was performed which found a dilated SB loop with a transition point caused by herniation through the left obturator foramen, suggestive of a strangulated obturator hernia. Decision to take the patient to surgery was adopted. After laparotomy, a segment of ileum was strangulated in the left obturator foramen. The SB segment was freed and found to be viable. A plug mesh repair was performed. This case report highlights the importance of considering obturator hernia in elderly, thin, multiparous women with chronic health conditions presenting with symptoms such as bowel obstruction or thigh pain. The diagnostic utility of imaging modalities, particularly CT scans, is crucial in accurately identifying obturator hernias preoperatively. Surgical intervention remains the mainstay of treatment, with a lower midline laparotomy being the preferred approach in emergency situations.

THE CHALLENGING MANAGEMENT OF ACUTE MESENTERIC ISCHEMIA: A CASE REPORT OF A 45-YEAR-OLD WOMAN WITH SHORT BOWEL SYNDROME

Andreea Pușcașu — 2023-12-21

This case report explores the fatal prognosis of acute mesenteric ischemia leading to short bowel syndrome in a 45-year-old female patient. Acute mesenteric ischemia, a rare but critical condition, is caused by impaired blood flow to the intestines, necessitating prompt diagnosis and treatment to mitigate high mortality risks. The patient's case is complex, involving multiple surgeries for ischemic bowel resection, resulting in short bowel syndrome, characterized by a severe reduction in functional intestinal length. This syndrome presents significant challenges, including malnutrition and the necessity for long-term parenteral nutrition, which are difficult to manage and significantly impair quality of life. Despite surgical success in bowel resection, the patient's condition deteriorated due to complications from short bowel syndrome and resulted in her death six months post-surgery. This report underscores the need for early diagnosis and intervention in acute mesenteric ischemia, the limitations of current surgical treatments, and the dire consequences of short bowel syndrome. It also highlights the potential yet limited role of intestinal transplantation in managing these complex cases.