By Justin B. Dimick MD, Gilbert R. Upchurch Jr. MD, Christopher J. Sonnenday MD
Clinical situations in surgical procedure: selection Making and Operative strategy offers one hundred twenty five circumstances in all parts of basic surgical procedure: GI, breast, hepatobiliary, colorectal, cardiothoracic, endocrine, vascular, trauma, pediatric, severe care, and transplant. every one full-color case starts off with a sufferer presentation and proceeds via differential prognosis, analysis and remedy, surgeries, postoperative administration, and a case conclusion. each one case contains key technical steps, capability pitfalls, take-home issues, and instructed readings.
The sufferer tales in those medical eventualities supply context to faciliate studying the rules of secure surgical care. This publication should be fairly priceless for senior surgical citizens and up to date graduates as they arrange for the yankee Board of surgical procedure oral examination.
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Extra info for Clinical scenarios in surgery : decision making and operative technique
Surg Endosc. 2004;18:228–231. Kouhia ST, Huttunen R, Silvasti SO, et al. Lichtenstein hernioplasty versus totally extraperitoneal laparoscopic hernioplasty in treatment of recurrent inguinal hernia—a prospective randomized trial. Ann Surg. 2009;249:384–387. Sevonius D, Gunnarsson U, Nordin P, et al. Repeated groin hernia recurrences. Ann Surg. 2009;249:516–518. 3/16/2012 2:19:50 PM 4 Ventral Incisional Hernias VIVIAN M. F. ITANI Presentation A 74-year-old male smoker with diabetes, obesity, and hypertension presents to the outpatient clinic with complaints of intermittent periumbilical abdominal pain of 3 months’ duration.
The mass is reducible, but it immediately recurs after reduction. Differential Diagnosis Groin discomfort usually is associated with an inguinal or femoral hernia or a process involving the spermatic cord or round ligament structures. Although, inguinal hernias are common, there are other medical conditions that can have similar presentation. Femoral hernias, enlarged inguinal nodes, hydroceles, testicular torsion, epididymitis, varicocele, spermatocele, epididymal cyst, and testicular tumors are less frequent but should be included in the differential diagnosis of a patient presenting with a symptomatic groin mass or groin discomfort.
It is important to avoid the reduction of necrotic bowel into the peritoneal cavity. If this is the case, the patient will likely have continued or worsening bowel obstruction with overall deterioration of the clinical picture. If left untreated, abdominal sepsis will ensue. Case Conclusion The patient was taken emergently to the Operating room (OR) for open repair. Portions of the small bowel as well as the sigmoid colon were found to be in a large direct hernia sac. A lower midline laparotomy was made due to the difficulty in reduction of the sac and questionable bowel viability.
Clinical scenarios in surgery : decision making and operative technique by Justin B. Dimick MD, Gilbert R. Upchurch Jr. MD, Christopher J. Sonnenday MD