Highlights Boerhaave’s syndrome is a rare life-threatening condition, usually requiring urgent surgical treatment. Thoracic drainage may confirm diagnosis rapidly. Debridement and drainage of pleural space and mediastinum are essential in sepsis control. Damage control approach with oesophageal T-tube drainage may help in sepsis control, allowing delayed definitive oesophageal repair. The outcome is determined by rapid diagnosis and timely and effective treatment.

Patient: Female, 93-year-old Final Diagnosis: Incarcerated obturator hernia Symptoms: Diffuse abdominal pain Medication:— Clinical Procedure: Hernioplasty Specialty: Surgery Objective: Rare disease Background: Obturator hernia is an uncommon (0.07-1% incidence rate) subtype of hernia of the abdominal wall, with its incarceration being a rare cause of bowel obstruction. Obturator hernia has a higher incidence in elderly women and in malnourished people. This type of hernia has the highest morbidity and mortality rates of all abdominal wall hernias. This article reports a case of an emaciated 93-year-old woman who presented with small bowel obstruction due to incarcerated obturator hernia, successfully managed surgically with a modified mesh-plug hernioplasty. Case Report: An emaciated 93-year-old woman presented with diffuse abdominal pain, more intense on the right iliac fossa, radiating to the right thigh, with 8-h evolution and associated with dark-colored vomiting but normal bowel transit. This patient had a surgical history of right Richter´s femoral hernia, strangulated, with previous intestinal resection and a right femoral hernioplasty. A computed tomography (CT) scan revealed an incarcerated obturator hernia on the right side containing a short segment of small intestine. The patient underwent an exploratory laparotomy and a mesh-plug hernioplasty. During follow-up, there was no evidence of recurrence or complications. Conclusions: Obturator hernia diagnosis is challenging due to its rarity and its signs and symptoms being often unspecific. CT scan has the highest sensitivity and is the best diagnostic tool. Surgical management is the only possible treatment for obturator hernia. Awareness of this condition is essential to allow an earlier approach and attempt to mitigate the associated high morbidity and mortality rates.

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Spigelian hernia (SH) is uncommon and accounts for only 0.12–2% of all abdominal hernias. Spigelian hernia is a protrusion through a defect in the aponeurosis of the transversus abdominis muscle (Spigelian fascia) that is limited by the semilunar line and the lateral edge of the rectus abdominis muscle. It is more common in women 50–60 years and it is twice as common on the right side. Patients may present with non-specific abdominal pain. Clinical diagnosis may be difficult, especially in obese patients, and radiologic exams are essential to obtain the correct diagnoses. This type of hernia has a mandatory indication to surgical repair due to the risk of incarceration that can occur in about 25% and strangulation that can occur in about 40%. Traditionally, open surgical repair is most commonly used. However, laparoscopic approach is becoming increasingly popular since it allows faster recovery, shorter hospital stay, and less pain, with no commitment to recurrence. Currently, there are no studies that demonstrate the superiority of a laparoscopic technique (intraperitoneal onlay mesh (IPOM), transabdominal pre-peritoneal (TAPP) or extraperitoneal approach (TEP)). The intraperitoneal route is a simple, faster, and easily reproducible approach.

Aim “Spigelian hernia is uncommon and accounts for only 0.12–2% of all abdominal hernias. It is mandatory to perform surgical correction and in recent years the laparoscopic approach is gaining ground. The authors pretend to demonstrate a video of an outpatient laparoscopic repair of Spigelian hernia.” Material and Methods “53-year-old woman with a left Spigelian hernia referred to laparoscopic repair via intraperitoneal approach.” Results “The patient was submitted to laparoscopic correction with a Ventralex® mesh. The surgery went without any complication and under 30 minutes. A few hours after the surgery, the patient was discharged. In the follow-up appointment, the patient had no complaints or evidence of recurrence.” Conclusions “Spigelian hernias are rare and have a mandatory surgical indication. Traditionally, open surgical repair is most commonly used. However, laparoscopic approach is becoming increasingly popular since it allows faster recovery, shorter hospital stay, and less pain, with no commitment to recurrence. Currently, there are no studies that demonstrate the superiority of a laparoscopic technique (intraperitoneal, TAPP or TEP). The intraperitoneal route is a simple, faster, and easily reproducible approach.”