Left Paraduodenal Hernia: A Rare Complication following Laparoscopic Appendectomy

Paraduodenal hernias are rare congenital internal hernias accounting for <2% of intestinal obstruction. Left paraduodenal hernias (LPDHs) into the fossa of Landzert are the more common type and result from abnormal rotation of the midgut and failure of peritoneal fusion. Sequelae of these hernias usually occur spontaneously in the 4th or 5th decade of life and are more common in males and have a significant risk of incarceration and subsequent strangulation. We describe a case of a 15-year-old female who develops a LPDH following laparoscopic appendectomy, resulting in jejunal incarceration and subsequent small intestinal obstruction. The patient discussed is from an atypical demographic, being young and female. In addition, the precipitating event prompting incarceration of the hernia appears to be the application of pneumoperitoneum, placement in the Trendelenburg position, and manipulation of small intestine for the purpose of facilitating laparoscopic appendectomy. To our knowledge, this is the first reported case of LPDH exacerbated by laparoscopic procedure

External validation of prognostic scores and comparison of predictive accuracy for patients with colorectal cancer with peritoneal metastases considered for cytoreductive surgery and intraperitoneal chemotherapy

Background and Objectives Prognostic scores are developed to facilitate the selection of patients with colorectal cancer peritoneal metastases (CRPM) for treatment with cytoreductive surgery (CRS) ± intraperitoneal chemotherapy (IPC). Three prominent prognostic scores are the Peritoneal Surface Disease Severity Score (PSDSS), the Colorectal Peritoneal Metastases Prognostic Surgical Score (COMPASS), and the modified COloREctal-Pc (mCOREP). We externally validate these scores and compare their predictive accuracy. Methods Data from consecutive CRPM patients who underwent CRS/IPC from 1996 to 2018 was used to externally validate COMPASS, PSDSS, and mCOREP. Analysis evaluated the efficacy of each score in predicting (1) open–close laparotomy—those found at laparotomy to not be eligible for curative intent CRS/IPC, (2) surgical futility—those who underwent open–close laparotomy, palliative debulking surgery, or had an overall survival of less than 12 months, and (3) overall and recurrence-free survival (OS, RFS). Results Prognostic scores were calculated for the 174-patient external validation cohort. COMPASS was most accurate in predicting open–close laparotomy, futile surgery, and survival (OS and RFS). Area under the curve (AUC) for open–close prediction was 0.78 (95% confidence interval, CI: 0.68–0.87), representing useful discrimination. However, AUC for futility prediction was 0.62 (95% CI: 0.52–0.71), and C-statistic for OS was 0.65 indicating only possibly helpful discrimination. C-statistic for RFS was 0.59 indicating poor discrimination. Conclusion While COMPASS showed the best statistical behavior, accuracy for several clinically relevant outcomes remains low, and thus applicability to clinical practice limited

Surgical tetralogy : simultaneous perforated gastric ulcer and appendicular perforation with liver and cerebral abscesses

A 73-year-old alcoholic male was referred to our surgical service with rigors and a 3-week history of abdominal pain. He reported regular use of non-steroidal anti-inflammatory medications (NSAIDs) for treatment of his presenting symptoms