Outcomes of Emergency Groin Hernia Repair in the Elderly: A Systematic Review

Introduction: The number of surgeries for groin hernia (GH) among the elderly follows the increase in life expectancy of the population. The greater number and severity of comorbidities in this group increases the surgical risk, promoting discussion regarding the indication of elective surgery and the benefits of watchful waiting approach (WWA). The aim of the present study was to evaluate the outcomes of emergency hernia surgery among the elderly population.Materials and methods: A systematic review was performed in Pubmed and Scielo databases for the past early 10 years, until July 2022. The subject was groin hernia in the emergency setting focusing the elderly population. The PRISMA statement was followed and the classification of elderly was based on the World Health Organization’s definition.Results: A total of 1,037 results were returned and we ended with nine original articles with emphasis in groin hernia in the emergency among the elderly population. In these subjects, the complications rate ranged between 21.2% and 28.9% and the mortality rate ranged between 1.2% and 6%. Cardiopulmonary disease, high ASA and Charlson’s scales were associated with greater risk of complications and death.Conclusion: Emergency GH surgery in the elderly population carries an increased risk of complications and mortality. GH surgery is safe or, at least, less harmful when done electively. The risk and benefits of WWA and upfront surgery needs to be assessed and exposed to the patients. Our review sugest that elective surgery should be the option over WWA in this patient population

Management of pneumatosis cystoides intestinalis with pneumoperitoneum: 5-years systematic review.

SummaryBackground: Pneumatosis Cystoides Intestinalis (PCI) is a rare condition, characterized by gas-filled cysts in the intestinal wall. Rarely, it may also involve other places, such as the mesentery. It is classified as primary and secondary and associated with multiple predisposing factors. Its differential diagnosis is mesenteric ischemia.Methods: We conducted a systematic literature review according to PRISMA statement. PubMed and LILACS databases were searched for articles published between January 2015 and December 2020. The subject headings were "Pneumatosis cystoides intestinalis" and "pneumoperitoneum", "pneumatosis intestinalis" and "pneumoperitoneum" or "mesenteric pneumatosis".Results: 51 articles with 58 patients with PCI and pneumoperitoneum were included. Most patients were male and the average age was 64.9 years. The idiopathic etiology was recorded in 29.31% and the most common predisposing factor were immune dysfunction (28.3%). 24.13% were asymptomatic and the most commons symptoms were abdominal pain (43.1%), nausea and vomiting (41.37%) and abdominal distention (37.93%). Diagnostic surgery was performed in 26 patients (44.8%). Just one patient underwent to surgery with treatment intent.Conclusion: PCI is a benign disease that can be confused with a potentially fatal condition, mesenteric ischemia. Treatment is conservative, with periodic clinical evaluations. Surgical procedure is usually not necessary for the diagnosis or management of PCI.

Retroperitoneal fetus in fetu in a 65-year-old man.

Fetus in fetu (FIF) is a rare congenital anomaly in which a malformed fetus grows within the body of its twin. It was first described in the late 18th century and has an incidence of 1:500,000 live births. The diagnosis is established in infancy or young adults in most cases. The oldest patient reported so far was a 47-year-old patient. We described the case of a 65-year-old patient with FIF, the oldest reported in the literature. Our patient meets all criteria for the diagnosis of FIF, with the presence of a limb in advanced formation inside the lesion. The treatment was surgical excision. FIF must be considered in the differential diagnosis of an abdominal mass, typically recognized in infancy. Symptoms arise from the mass effect and treatment is surgical resection due to the potential for malignancy

Management of pneumatosis cystoides intestinalis with pneumoperitoneum: 5-years systematic review.

SummaryBackground: Pneumatosis Cystoides Intestinalis (PCI) is a rare condition, characterized by gas-filled cysts in the intestinal wall. Rarely, it may also involve other places, such as the mesentery. It is classified as primary and secondary and associated with multiple predisposing factors. Its differential diagnosis is mesenteric ischemia.Methods: We conducted a systematic literature review according to PRISMA statement. PubMed and LILACS databases were searched for articles published between January 2015 and December 2020. The subject headings were "Pneumatosis cystoides intestinalis" and "pneumoperitoneum", "pneumatosis intestinalis" and "pneumoperitoneum" or "mesenteric pneumatosis".Results: 51 articles with 58 patients with PCI and pneumoperitoneum were included. Most patients were male and the average age was 64.9 years. The idiopathic etiology was recorded in 29.31% and the most common predisposing factor were immune dysfunction (28.3%). 24.13% were asymptomatic and the most commons symptoms were abdominal pain (43.1%), nausea and vomiting (41.37%) and abdominal distention (37.93%). Diagnostic surgery was performed in 26 patients (44.8%). Just one patient underwent to surgery with treatment intent.Conclusion: PCI is a benign disease that can be confused with a potentially fatal condition, mesenteric ischemia. Treatment is conservative, with periodic clinical evaluations. Surgical procedure is usually not necessary for the diagnosis or management of PCI.

Retroperitoneal fetus in fetu in a 65-year-old man.

Fetus in fetu (FIF) is a rare congenital anomaly in which a malformed fetus grows within the body of its twin. It was first described in the late 18th century and has an incidence of 1:500,000 live births. The diagnosis is established in infancy or young adults in most cases. The oldest patient reported so far was a 47-year-old patient. We described the case of a 65-year-old patient with FIF, the oldest reported in the literature. Our patient meets all criteria for the diagnosis of FIF, with the presence of a limb in advanced formation inside the lesion. The treatment was surgical excision. FIF must be considered in the differential diagnosis of an abdominal mass, typically recognized in infancy. Symptoms arise from the mass effect and treatment is surgical resection due to the potential for malignancy