Hahnloser, D.

Tschuor, Ch

RERO DOC Digital Library

COMMENTReply to: Venous aneurysms of saphena magna: Is this reallya rare disease?Ch. Tschuor • D. HahnloserReceived: 17 September 2012 / Accepted: 12 October 2012 / Published online: 27 November 2012 Springer-Verlag France 2012Dear Editors,We would like to thank our colleagues for their letter to theEditor [1] with regard to the article ‘‘A challenging hernia:primary venous aneurysm of the proximal saphenous vein’’[2]. We are happy to learn that Donati et al. agreed with usthat a primary venous aneurysm of the great saphenousvein is a rare disease and therefore seldom considered inthe differential diagnoses of a lump in the inguinal region.The authors of this letter asked several questions and madeseveral comments and vague hypotheses which we wouldlike to reply on and clarify.• We apologize for not having stated clearly enough thatthe histological finding confirmed postoperatively thediagnosis of a primary venous aneurysm. We neverstated that it is possible to distinguish preoperatively aprimary venous aneurysm from a secondary one.• This young patient had absolutely no clinical signs ofvaricosis or chronic venous insufficiency (CVI) oneither leg. For these reasons, we did not thinkpreoperatively in this direction and did not perform aDoppler ultrasound. Assessing your figure (Fig. 1.1)provided with the patient suffering from a severe CVI,we agree that having this clinical finding and notthinking of a venous aneurysm would be an affront tothe ability of a surgeon to draw a clinical diagnosis. Thenext diagnostic tool in this patient has to be a Dopplerultrasound. However, this was not the picture we hadwhen examining our patient. He showed no signs ofCVI.• By reading the article, the readers notice that thesurgical exploration of this lump was done in additionto a planned treatment for perianal condylomata withprecancerous cells under general anesthesia in an HIV-positive patient. Surgical exploration was never said tobe the diagnostic tool of choice for venous aneurysms.• In their letter, the authors raised the point: ‘‘…lookingat the published image of the upper thigh, it is veryclear that this ‘hernia’ is surely not an inguinal herniabut could be, in the best hypothesis, a femoral one…’’.Of course, we agree that the location and clinicalpresentation of this lump is rather atypical for any kindof hernia. Therefore, we stated in the article that thisfinding can be ‘‘confused’’ with a hernia and pointedout ‘‘rather with a femoral hernia’’. Besides this, wewould like to emphasize on the fact that there havebeen several publications discussing the problem ofconfusing a venous aneurysm with an inguinal orfemoral hernia [3, 4].• Our short article had no intention to describe a raredisease, nor the correct workup or all treatment options.However, this article is a case report. The intention ofthis case report was to share a surprising and incidentalintraoperative finding of an unusual clinical presenta-tion of a seldom and rarely in the differential diagnosesconsidered disease. According to our understanding, acase report should report the true course of a case eventhough it was not running optimally. In our widegrades, it is common to learn from morbidity andThis reply refers to the comment available at10.1007/s10029-012-1003-5.Ch. TschuorClinic for Visceral and Transplantation Surgery, UniversityHospital Zurich, Raemistrasse 100, 8091 Zurich, SwitzerlandD. Hahnloser (&)Clinic for Visceral Surgery, Centre Hospitalier UniversitaireVaudois, Rue du Bugnon 46, 1011 Lausanne, Switzerlande-mail: dieter.hahnloser@chuv.ch123Hernia (2013) 17:119–120DOI 10.1007/s10029-012-1004-4mortality conferences where such cases are discussed,so everyone can learn something. In retrospective, onealways knows more!In the spirit of a cooperative reply, we would like tothank the editors for the possibility to answer for the raisedpoints and commenting on the vague hypotheses.Cordiali saluti dalla Svizzera,Christoph TschuorDieter HahnloserCorrigendum (1): On the first page, case report, sec-tion 2: However, since surgical treatment for condylomataaccuminata under general anesthesia had yet beenplanned…Conflict of interest None.References1. Donati M, Biondi A, Brancato G, Donati A, Basile F (2012)Venous aneurysms of saphena magna: is this really a rare disease?Hernia. doi:10.1007/s10029-012-1003-52. Tschuor C, Dindo D, Clavien P, Hahnloser D (2012) A challenginghernia: primary venous aneurysm of the proximal saphenous vein.Hernia. E-pub 17 Mar3. Majeski J (2002) Surgical repair of primary saphenous veinaneurysm of the proximal leg after initial presentation as aninguinal hernia. Am Surg 68:999–10024. Marcucci G, Accrocca F, Antignani PL, Siani A (2010) Anisolated aneurysm of the thigh anterolateral branch of the greatersaphenous vein in a young patient presenting as an inguinal hernia.Interact Cardiovasc Thorac Surg 10:654–655120 Hernia (2013) 17:119–120123

Reply to: Venous aneurysms of saphena magna: Is this really a rare disease?

http://doc.rero.ch/record/309716/files/10029_2012_Article_1004.pdf

Reply to: Venous aneurysms of saphena magna: Is this really a rare disease?

Abstract

Similar works

Full text

Available Versions

RERO DOC Digital Library