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Richter Type of Incarcerated Obturator Hernia; Misery Still Continues

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Jayant K., Agarwal R., Agarwal S.

Polish Journal of Surgery

2015

vol. 86

issue 10

490-492

Obturator hernia is a rare type of hernia which accounts for only 0.07-1.4% of all intra-abdominal hernias and 0.2-5.8% of small-intestinal obstructions. It develops predominantly in elderly underweight women. It has nonspecific early symptoms, so these hernias are usually discovered only after they have become incarcerated. Incarcerated obturator hernias are usually discovered on abdominal computed tomography scan or emergency surgery due to bowel obstruction. Here we present a case of a 65-year-old female who presented with intermittent abdominal pain, distension and nausea for last 3 days. She was a known case of hypothyroidism, taking Levothyroxine in inadequate dose. Her intial abdominal Xray was showing few air-fluid level with air present in rectum. She was initially managed conservatively but later developed features of peritonitis for which she was operated. In laparotomy, Richter type of right-sided incarcerated obturator hernia was discovered with a small necrotic area and perforation of small bowel. Bowel resection was performed and obturator hernia was closed with interrupted sutures. The patient recovered without complications. Obturator hernia, due to its rarity and nonspecific early symptoms, can still be misleading even to the most experienced clinicians. Delay in diagnosis of obturator hernia can lead to bowel necrosis and perforation with significant postoperative morbidity and mortality.

En bloc liver and pancreas transplantation after total pancreatectomy with autologous islet transplantation

46%

Generette G. S., Bachul P. J., Golab K., Basto L., Pyda J. S., Borek P., Tibudan M., Anteby R., Perea L., Charlton M., Perez-Gutierrez A., Jayant K., Lucander A., Matthews J. B., Millis J. M., Fung J., Witkowski P.

European Journal of Translational and Clinical Medicine

2020

vol. 3

issue 2

11-17

We present a patient with intractable and debilitating pain secondary to chronic pancreatitis who was effectively treated with total pancreatectomy with islet autotransplantation (TPIAT). Islets engrafted into his liver significantly contributed to improved blood glucose control and quality of life. Subsequently, the patient developed alcohol related acute liver failure and en bloc liver and pancreas transplantation was performed to replace the failing liver with engrafted islets. Pancreas transplantation was required to resolve his life-threatening severe hypoglycemic episodes. Herein, we detail an innovative and multidisciplinary management of this complex medical problem.

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1 European Journal of Translational and Clinical Medicine

1 Polish Journal of Surgery

1 2020

1 2015

2 Jayant K.

1 Agarwal R.

1 Agarwal S.

1 Anteby R.

1 Bachul P. J.

1 Basto L.

1 Borek P.

1 Charlton M.

1 Fung J.

1 Generette G. S.

1 Golab K.

1 Lucander A.

1 Matthews J. B.

1 Millis J. M.

1 Perea L.

1 Perez-Gutierrez A.

1 Pyda J. S.

1 Tibudan M.

1 Witkowski P.

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Richter Type of Incarcerated Obturator Hernia; Misery Still Continues

En bloc liver and pancreas transplantation after total pancreatectomy with autologous islet transplantation