A 22 year-old male patient was admitted to our clinic with complaints of swelling and pain at the left groin area as well as inability to palpate his right testicle. The patient was diagnosed as right undescended testicle accompanied by left indirect inguinal hernia. According to the scrotal Doppler ultrasonography the right undescended testicle was localized in the inguinal canal very close to the inner ring. As totally extra peritoneal (TEP) approach is widely used for inguinal hernia repair by hernia surgeons, the same technique was planned for both inguinal hernia repair and orchiectomy simultaneously. Using videoscopic TEP approach, left inguinal hernia repair and right prophylactic inguinal hernia repair with polypropylene mesh was carried out following successful laparoscopic right orchiectomy. In patients with undescended testicle who are indicated for orchiectomy and accompanied by inguinal hernia, videoscopic TEP operation is a safe procedure, also providing the oppurtunity for prophylactic hernia repair at the orchiectomy site.
Acute gastric dilatation is a rare surgical condition in children, which often results from blunt abdominal trauma. This condition is characterized by the gut-brain connection disorder or gastric muscular layer damage, which results in atony. Gradual gastric stretching with fluid contents and gases in the end leads to the development of various types of intestinal obstruction. When conservative measures are not sufficient (in rare cases), it is reasonable to resort to operative intervention. Several cases of such a pathology have been published around the world. This condition has been observed not only at the blunt abdominal trauma, but also at lesions of central and peripheral nervous systems and in patients with anorexia nervosa and bulimia in the event of excessive food consumption. The article presents a clinical case study and a follow-up analysis of a child with posttraumatic acute gastric dilatation. The authors describe clinical manifestations, pathogenesis and diagnostic algorithm, which allowed establishing this rare diagnosis. Along with the conventional drugs and intensive care measures, the treatment involved a complex of mini-invasive endosurgical and endoscopic manipulations, including laparoscopic jejunostomy, which was performed in order to provide long-term enteral feeding. The clinical case study demonstrated that the use of diagnostic laparoscopy helps to establish nature of the gastric damage correctly and formulate the following optimal treatment tactics on the basis of the obtained data.
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