Highlights Adult Hirschprung’s Disease (AHD) can be a difficult diagnosis to make, due to its rarity. We report a possible case of AHD and conduct a systematic review of the literature. A typical patient would be male, average age of 30-years-old, with a history of chronic constipation complicated by repeated acute obstruction. Surgical resection, such as with Duhamel’s procedure, is curative. Early identification of these patients and definitive diagnoses would eliminate unnecessary and ineffective surgical interventions.

Objective. This retrospective cohort study is aimed at determining the safety and efficacy between Femoral Open-Cutdown access and Percutaneous access with Endovascular Aneurysm Repair (EVAR) by contrasting perioperative complication rates. We hypothesized that the percutaneous approach is a better alternative for aortic aneurysm patients as it is minimally invasive and has been demonstrated to decrease the length of hospital stay. Methods. We retrospectively reviewed data for patients undergoing EVAR between the years of 2005 and 2013. We then compared overall mortality, hematoma or seroma formation, graft infection, arterio-venous injury, distal embolization, limb loss, myocardial infarction or arrhythmia, and renal dysfunction. Results were demonstrated using a retrospective cohort study design to confirm the hematoma rate associated with EVAR open compared to percutaneous access. Results. Our series involves 73 patients who underwent percutaneous access for EVAR ( n = 49 ) or traditional open cutdown ( n = 24 ). Percutaneous access resulted in significantly less hematoma formation when compared to the traditional open cutdown (4% vs. 12.5%; p < 0.059 ). Our analysis suggests decreased mortality rates associated with EVAR as compared to the Open-Cutdown method using Northside Medical Center’s Study and the OVER Veterans Affairs Cooperative Study ( p = 0.0053 ). Conclusion. Percutaneous access for EVAR is safe and effective when compared to Open-Cutdown access for aortic aneurysm patients. Percutaneous access was associated with decreased rates of in-hospital mortality, hematoma formation, graft infection, and respiratory failure.

Highlights Two problems of non-healing sacral ulcer and an incarcerated ventral hernia. Creation of diverting ostomy and incarcerated ventral hernia repair in one. The patient achieved a good outcome. Wound healing improved and hernia did not recur.

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