Laparoscopic Treatment of an Incarcerated Meckel’s Diverticulum in a Femoral Hernia

Meckel’s diverticulum (MD) is the persistence of the omphalomesenteric duct. It is usually asymptomatic but may present with bleeding, infections, and intestinal obstruction. It also may be a content of a hernia sac, a so-called Littre hernia. Herein, we will present the case of a 75-year-old female, who suffered from a painful swelling of the right inguinal region. Ultrasound imaging detected an inguinal hernia with incarcerated blind ending small bowel. Immediately, a laparoscopy was conducted. We diagnosed a right femoral hernia with an incarcerated MD. A TAPP (transabdominal preperitoneal) procedure was performed and the MD tangential stapled. Due to an uneventful postoperative course, the patient left the hospital after two days. An incarceration of a MD in a femoral hernia is rare. Tangential resection of the MD with simultaneous hernia repair in a TAPP technique seems to be a sufficient approach, when it is conducted by an experienced surgeon.

Popliteal vein aneurysm: Is it necessary to apply anticoagulants after a surgery?

SummaryAim: This study is intended to evaluate indications for antithrombotic therapy in patients with tangentially resected popliteal vein aneurysm.Methods: Evaluation of the course of therapy in a patient with popliteal vein aneurysm. Literature review covered literature data published within the last decade. Studies were identified by searching Medline and PubMed databases for the following phrases: ”popliteal venous aneurysm” and ”popliteal vein aneurysm”.Results: The case study and literature review revealed that thromboembolic risk cannot be entirely eliminated by means of tangential resection of popliteal vein aneurysm. Vein suture and residual postoperative dilatation of the popliteal vein can be considered predisposing factors to thromboembolic complications.Conclusion: Patients with tangentially resected popliteal vein aneurysm involving vein suture can be administered oral antithrombotic therapy within three months postoperatively. Therapy extension should be made conditional on the degree of vein dilation reduction. Where the diameter at surgical site is larger than 20 mm, it appears appropriate to continue antithrombotic therapy and to repeat assessment in six months time.

Recurrent pulmonary embolism secondary to popliteal vein aneurysm with intraluminal wall ulcer

The popliteal vein is the most frequent site of venous aneurysm. Surgical treatment is indicated above a 2.5 cm diameter to prevent complications, notably deep venous thrombosis and pulmonary embolism (PE). Here we report a case of recurrent episodes of severe PE, leading to cardio-circulatory shock caused by a popliteal vein aneurysm (PVA) despite oral anticoagulant therapy. When surgical correction of the aneurysm was performed, we found an ulcerative lesion in the inner aspect of the vein that was acting as a ‘thrombogenic focus’ inside the aneurysm. An accurate inspection of the intimal wall is always important during surgery of PVA, particularly when tangential resection is performed.