Recurrent Incisional Hernia due to Pseudomyxoma Peritonei

Pseudomyxoma peritonei is a rare but challenging neoplastic disease which is characterized with intraperitoneal mucinous-gelatinous fluid accumulation. It rarely presents as a mass mimicking abdominal wall hernias A recurrent incisional hernia due to pseudomyxoma peritonei is presented here. A 60-year-old female patient had been operated on for a left mucinous ovarian cyst 20 cm in diameter in 1998. Mucinous material had disseminated into interloop spaces through the right subdiaphragmatic region. Total abdominal hysterectomy + bilateral salpingooophorectomy and peritoneal toilet had been performed. She was rehospitalized for abdominal distention and a 4 cm defect over the incision and underwent a hernia repair using polypropylene mesh in 2001. Abdominal distention recurred to give a rise to an incisional hernia in 2006. She was reoperated for decompression and repair, but nothing could be done because of sticky adhesions and the incision were simply closed. The patient was referred to our department for operation. A prosthetic hernia repair with 30 × 30 cm polypropylene mesh was performed. The patient was discharged on the postoperative 5th day following an uneventful recovery. However, she died of disseminated disease after 18 months

Preemptive Use Of Etofenamate In Laparoscopic Cholecystectomy: A Randomized, Placebo-Controlled, Double-Blind Study

Aim : To investigate the preemptive effect of etofenomate on postoperative pain and emesis in the first 24 hours after elective laparoscopic cholecystectomy. Method : Patients were randomly assigned to two groups each consisting of 60 patients. Group A was received 19 (2 ml) etofenomate intramuscularly, group B was received 0.9% saline intramuscularly one hour before surgery. All patients were administered meperidine HCl in the patient -controlled analgesia (PCA) intravenous mode in order to treat postoperative pain. Pain intensity was assessed on visual analog scales (VAS) at four times; 1 hour, 6 hours, 12 hours and 24 hours. The total meperidine HCl consumptions, VAS scores and antiemetic requirements were recorded and comparisons among the two groups were evaluated. Result : The mean total meperidine HCl consumptions within first 6 and 24 hours of the group A were significantly less than the group B. The VAS scores at 1 and 6 hours in the group A were significantly lower than that in the group B. There was no significant difference in the postoperative antiemetic requirement among two groups. Conclusion : Preemptive use of etofenamate reduces pain intensity and meperidine HCl requirement, but it doesn′t affect the antiemetic requirement in elective laparoscopic cholecystectomy

Extensive hepatic-portal and mesenteric venous gas due to sigmoid diverticulitis

Hepatic portal venous gas is most often associated with extensive bowel necrosis due to mesenteric infarction. Mortality exceeds 75% with this condition. The most common precipitating factors include ischemia, intra-abdominal abscesses and inflammatory bowel disease. In this report, we present a 75-year-old woman with extensive hepatic portal and mesenteric venous gas due to colonic diverticulitis. She had a 10-year history of type II diabetes mellitus and hypertension. She was treated by sigmoid resection and Hartmann’s procedure and discharged from the hospital without any complications