28193213 Visualization

A 62 Age - year Age - old Age female Sex presented Clinical_event to the outpatient Nonbiological_location department Nonbiological_location of Wuhan Nonbiological_location Central Nonbiological_location Hospital Nonbiological_location of Nonbiological_location Tongji Nonbiological_location Medical Nonbiological_location College Nonbiological_location in September Date 2015with a complaint of recurrent Detailed_description infections Disease_disorder in the umbilical Biological_structure region Biological_structure .
She reported abdominal Biological_structure pain Sign_symptom similar to a burning Detailed_description sensation Detailed_description that accompanied the discharge Activity of Activity faecal Activity matter Activity .
These symptoms Coreference and Coreference signs Coreference waxed Frequency and Frequency waned Frequency but lasted Duration for Duration 5years Duration .
Our attention was piqued by the fact that the patient’s family described the patient as an individual who cried History easily History .
The patient had no History history History of History diarrhoea, History constipation History or History other History abdominal History disturbances History .
No History surgical History treatment History was mentioned in her prior medical history.
Acoordinated physical Diagnostic_procedure examination Diagnostic_procedure revealed normal Qualitative_concept vital Diagnostic_procedure signs Diagnostic_procedure .
An external Detailed_description fistula Sign_symptom was located in the umbilical Biological_structure region Biological_structure with redness Sign_symptom of the surrounding skin Biological_structure .
Morphological Diagnostic_procedure examination Diagnostic_procedure indicated that fistula Sign_symptom secretions Sign_symptom mainly consisted of small Detailed_description intestinal Detailed_description juice Detailed_description .
The abdominal Biological_structure wall Biological_structure was soft Sign_symptom , with no tenderness Sign_symptom .
Bowel Diagnostic_procedure sounds Diagnostic_procedure were regular Lab_value .
Escherichia Disease_disorder coli Disease_disorder and Enterococcus Disease_disorder faecalis Disease_disorder were detected in the fistula Detailed_description secretion Detailed_description culture Diagnostic_procedure .
Other findings from laboratory Diagnostic_procedure examinations Diagnostic_procedure were normal Lab_value .
A CT Diagnostic_procedure scan of the abdomen Biological_structure revealed that part of the intestinal Biological_structure wall Biological_structure was adhered Sign_symptom to the abdominal Biological_structure wall Biological_structure in the navel Biological_structure region Biological_structure , although no bowel Biological_structure obstruction Sign_symptom was detected (Fig.1).
A presumptive diagnosis of ECF Disease_disorder was reached; this diagnosis was mainly based on digital Detailed_description radiography Diagnostic_procedure of the fistulous tract conducted using iopamidol-370 as Detailed_description a Detailed_description contrast Detailed_description agent Detailed_description .
This procedure was performed under local Detailed_description anaesthesia Medication and revealed that the distal Biological_structure ileum Biological_structure approximately 40 Distance cm Distance from the ileocaecal Biological_structure junction Biological_structure was entrapped Sign_symptom (Fig.2).
The patient agreed to surgery Therapeutic_procedure after a clear preoperative Clinical_event conversation Clinical_event .
She understood the operative risk factors and signed an informed consent.
After bowel Therapeutic_procedure preparation Therapeutic_procedure , the patient received an exploratory laparotomy Therapeutic_procedure .
The abdominal Biological_structure cavity Biological_structure was completely exposed Therapeutic_procedure , and a loop of the terminal Biological_structure ileum Biological_structure (approximately 40 Distance cm Distance proximal Biological_structure to Biological_structure the Biological_structure ileocaecal Biological_structure junction Biological_structure ) was found entrapped Sign_symptom in the internal Biological_structure hernia Biological_structure ring Biological_structure ; this finding was consistent with the preoperative contrast image.
The defect Sign_symptom in the abdominal Biological_structure wall Biological_structure was less Distance than Distance 1.0 Distance cm Distance , and an extremely small portion of the bowel Biological_structure wall Biological_structure was stuck Sign_symptom and could not be retrieved back into the cavity (Fig.3).
Nonetheless, this defect Coreference resulted in perforation Disease_disorder over the loop (Fig.4).
Side Detailed_description - to Detailed_description - side Detailed_description ileo Detailed_description - ileal Detailed_description anastomosis Therapeutic_procedure was completed by utilizing a 75 Distance mm Distance linear Therapeutic_procedure stapler Therapeutic_procedure to remove Therapeutic_procedure the affected ileum Biological_structure segment Biological_structure .
The internal Biological_structure hernia Biological_structure ring Biological_structure was closed Therapeutic_procedure with plication Detailed_description sutures Therapeutic_procedure instead of via mesh repair due to the patient’s small defect and infection risk.
The abdominal cavity was thoroughly cleaned Therapeutic_procedure with saline Medication solution Medication , and a rubber Detailed_description drainage Therapeutic_procedure tube Therapeutic_procedure was placed in the pelvis Biological_structure .
The scar Biological_structure tissue Biological_structure was removed Therapeutic_procedure to improve wound healing; subsequently, relaxation Detailed_description sutures Therapeutic_procedure were available to close the abdomen in layers.
A final diagnosis of Richter’s Disease_disorder hernia Disease_disorder presenting as spontaneous Detailed_description ECF Disease_disorder was reached.
The patient was discharged Clinical_event 2 Date weeks Date after Date surgery Therapeutic_procedure without serious complications Disease_disorder .
No hernia Disease_disorder recurrence was observed during 10 Duration months Duration of follow Clinical_event - up Clinical_event .