Lesser omental hernia without intestinal gangrene - Case report

INTRODUCTION: There are several types of internal hernia. Herniation through the defect in the lesser omentum is extremely rare. Symptoms of this type of hernias may vary a lot and diagnosis is difficult. In this case report a young adult with nonspecific symptoms is diagnosed with an intestinal herniation through the defect in the lesser omentum. CASE PRESENTATION: A 35-year-old man with the history of laparoscopic colectomy presented with abdominal pain but no symptoms of peritonitis or acute bowel obstruction. Abdominal computed tomography (CT) revealed displacement of mesenteric vessels, small intestine and stomach. Intestinal herniation through the lesser omentum was suspected. Laparoscopic reposition of small intestine was performed. The greater curvature of the stomach was sutured to the transverse mesocolon to prevent recurrence of hernia. DISCUSSION: Previous surgery, low body mass index (BMI), absence of adhesions may predispose the lesser omental hernia. Herniating of intestines through the large openings may occur without presence of acute obstruction or gangrene. CT is helpful in making a correct diagnosis. CONCLUSION: When evaluating the patient with abdominal pain, internal hernia should be considered. CT modalities may aid in the detection of these rare hernias and ensure timely treatment. Perioperative inspection and repair of the hepatogastric ligament may help to prevent lesser omental hernias

The value of outdoor behavioral healthcare for adolescent substance users with comorbid conditions

The damage inflicted on our society by mental health and substance use issues is reaching epidemic proportions with few signs of abating. One new and innovative strategy for addressing these comorbid issues has been the development of outdoor behavioral healthcare (OBH). This study compared the effectiveness of three post-acute adolescent substance use situations: OBH, treatment as usual (TAU), and no structured treatment (NST). The simulated target population was 13-17 years old with comorbid substance use and mental health issues. When costs were adjusted for actual completion rates of 94% in OBH, 37% in TAU, and $0 for NST, the actual treatment costs per person were$27 426 for OBH and $31 113 for TAU. OBH also had a cost–benefit ratio of 60.4$36 100, and 424% better treatment outcomes as measured by the Youth Outcome Questionnaire (YOQ) research instrument

The automation of concrete gravitation spillway dam’s on basis of CAD programs

The thesis is presenting and considerating CAD programs, that can help to project hydrotechnique pales. The thesis is analyzing spillway concrete gravitation dam (SCGD) on the ground substructure, spillway design automation, calculations of stresses under spillway and spillway stability. This work supposes two CAD programs – AutoCad and MathCad - to automate spillway design. Manually mould and draw the spillway profile take a lot of time. Spillway is the main part of the SCGD, so it must be done high precision. There are all automate stages of spillway profile in this article. All automate stages are programming in MathCad program. All results from MathCad program are transporting to AutoCad program. All results are transporting with help of AutoLISP.AutoCad program can draw spillway profile, set its area, center of gravity. All these parameters are using to calculate the stability of spillway. The thesis consist of 4 chapters, conclusions and references. It covers 50 pages without appendixes, 5 tables and 22 pictures are included. Number of references – 25. There are 3 appendixes in the end of thesis.Žemės ūkio akademijaVytauto Didžiojo universiteta

Slenkstinės betoninės gravitacinės užtvankos slenksčio profilio formavimo automatizavimas CAD programų pagrindu

Vytauto Didžiojo universitetasŽemės ūkio akademij

Longterm outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study

AbstractBackgroundThe aim of this retrospective study was to evaluate the perioperative and longterm outcome after early repair with a hepaticojejunostomy (HJ).MethodsBetween 1995 and 2010, a nationwide, retrospective multicentre study was conducted. All iatrogenic bile duct injury (BDI) sustained during a cholecystectomy and repaired with HJ in the five HepatoPancreaticoBiliary centres in Denmark were included.ResultsIn total, 139 patients had an HJ repair. The median time from the BDI to reconstruction was 5 days. A concomitant vascular injury was identified in 26 cases (19%). Postoperative morbidity was 36% and mortality was 4%. Fortytwo patients (30%) had a stricture of the HJ. The median followup time without stricture was 102 months. Nineteen out of the 42 patients with postreconstruction biliary strictures had a reHJ. Twentythree patients were managed with percutaneous transhepatic cholangiography and dilation. The overall success rate of reestablishing the biliodigestive flow approached 93%. No association was found between timing of repair, concomitant vascular injury, level of injury and stricture formation.ConclusionIn this national, unselected and consecutive cohort of patients with BDI repaired by early HJ we found a considerable risk of longterm complications (e.g. 30% stricture rate) and mortality in both the short and the longterm perspective

Patients with Crohn's disease have longer post-operative in-hospital stay than patients with colon cancer but no difference in complications' rate

BACKGROUNDRight hemicolectomy or ileocecal resection are used to treat benign conditions like Crohn's disease (CD) and malignant ones like colon cancer (CC).AIMTo investigate differences in pre- and peri-operative factors and their impact on post-operative outcome in patients with CC and CD.METHODSThis is a sub-group analysis of the European Society of Coloproctology's prospective, multi-centre snapshot audit. Adult patients with CC and CD undergoing right hemicolectomy or ileocecal resection were included. Primary outcome measure was 30-d post-operative complications. Secondary outcome measures were post-operative length of stay (LOS) at and readmission.RESULTSThree hundred and seventy-five patients with CD and 2,515 patients with CC were included. Patients with CD were younger (median = 37 years for CD and 71 years for CC (P < 0.01), had lower American Society of Anesthesiology score (ASA) grade (P < 0.01) and less comorbidity (P < 0.01), but were more likely to be current smokers (P < 0.01). Patients with CD were more frequently operated on by colorectal surgeons (P < 0.01) and frequently underwent ileocecal resection (P < 0.01) with higher rate of de-functioning/primary stoma construction (P < 0.01). Thirty-day post-operative mortality occurred exclusively in the CC group (66/2515, 2.3%). In multivariate analyses, the risk of post-operative complications was similar in the two groups (OR 0.80, 95%CI: 0.54-1.17; P = 0.25). Patients with CD had a significantly longer LOS (Geometric mean 0.87, 95%CI: 0.79-0.95; P < 0.01). There was no difference in re-admission rates. The audit did not collect data on post-operative enhanced recovery protocols that are implemented in the different participating centers.CONCLUSIONPatients with CD were younger, with lower ASA grade, less comorbidity, operated on by experienced surgeons and underwent less radical resection but had a longer LOS than patients with CC although complication's rate was not different between the two groups