A mentally challenged patient has been
admitted in our hospital for long lasting right inguino-scrotal hernia with
associated hydrocoele. The ultrasound scan of the scrotum confirmed the
diagnosis.
He was done herniorrhaphy on 2nd
May 2012 but it was an extremely difficult and stressful operation. The hernia,
probably congenital, had very stiff adhesions to the tunica vaginalis of the
testis. We therefore started with the hydrocoelectomy with evagination of
tunica vaginalis. Thereafter it was a very difficult job to detach the
intestinal loops from the adhesions to the tunica itself and to the sac.
Finally we succeeded, just to realize that we were in front of a very abnormal
segment of intestine, probably ileum, coiled and adherent in many parts to an
abnormal mesenter.
Nevertheless we have reduced the
intestinal loops because they were viable. Reduction was not easy because the
internal inguinal ostium was quite small compared to the coiled and malformed
loops.
The day after the patient has developed
signs of acute abdomen with board like rigidity of the abdomen, abdominal pains
and biliary vomiting.
We have therefore decided on explorative
laparatomy, during which we have found a big volvolus around the abnormal
intestinal loops, which probably acted as a hub. We have patiently de-rotated
the volvolus. The loops were still viable and therefore we have positioned the
intestine in the correct position without doing intestinal resection. Neither
Valentina nor I had enough experience for a wide ileal resection with
ileo-colic anastomosis.
But God has been with us and the patient
has thereafter improved slowly; today we have discharged him: he is passing
stool normally, the wounds are completely closed and the stitches removed. It
has been a scaring experience, but it ended up well.
The patient was also very tender (as all
the mentally challenged people), and when we have greeted him it was like a
small party.
Dr Br Giuseppe Gaido
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