OBSTRUCTED UMBILICAL HERNIA IN PATIENT ON DIALYSIS: HOW WE MANAGED
We had a patient referred by an eminent nephrologist for obstructed umbilical hernia.He is only 52yr old and on maintanence haemo-dialysis twice a week for the last 5 yrs.He has been post-poning his umbilical hernia treatment for over an year in view of his compromised health status due to renal failure and dialysis requirement.Of late he had severe pain and obstructed umbilical hernia and presented for surgical treatment for the same.He was thoroughly evaluated by our team of critical care specialist,cardiologist,nephrologist,and anaesthesiologist apart from the treating surgeon.Hemo-dialysis was done the previous afternoon.Clindamycin and cefoperazone/sulbactam were started at appropriate doses.Cardiologist cleared the pt. with moderate risk for peri-operative cardiac events.The team of doctors decided to go ahead after proper counselling and taking family members into confidence.
We decided to go ahead with hernioplasty under TAB BLOCK with ultrasound guidance (Transversus Abdominis Block).Both Spinal anaesthesia and General anaesthesia appeared to add to hemodynamic instabilty inview of chronic renal failure and obstructed hernia.
We used Mindray portable ultrasound machine and high frequency probe (doppler probe) to guide the exact placement of needle and instillation of local anaesthetic in transversus abdominis plane.We used 20ml 1%xylocaine on each side.After ensuring the adequacy of the block in the area of umbilicus and surrounding 5-6cm, the surgery was uneventfully completed.Patient had a painfree post operative period for 12 hrs.He also had ascitis which could have been a problem if we had not used ultrasound as our guide for TAB block.
We had a patient referred by an eminent nephrologist for obstructed umbilical hernia.He is only 52yr old and on maintanence haemo-dialysis twice a week for the last 5 yrs.He has been post-poning his umbilical hernia treatment for over an year in view of his compromised health status due to renal failure and dialysis requirement.Of late he had severe pain and obstructed umbilical hernia and presented for surgical treatment for the same.He was thoroughly evaluated by our team of critical care specialist,cardiologist,nephrologist,and anaesthesiologist apart from the treating surgeon.Hemo-dialysis was done the previous afternoon.Clindamycin and cefoperazone/sulbactam were started at appropriate doses.Cardiologist cleared the pt. with moderate risk for peri-operative cardiac events.The team of doctors decided to go ahead after proper counselling and taking family members into confidence.
We decided to go ahead with hernioplasty under TAB BLOCK with ultrasound guidance (Transversus Abdominis Block).Both Spinal anaesthesia and General anaesthesia appeared to add to hemodynamic instabilty inview of chronic renal failure and obstructed hernia.
We used Mindray portable ultrasound machine and high frequency probe (doppler probe) to guide the exact placement of needle and instillation of local anaesthetic in transversus abdominis plane.We used 20ml 1%xylocaine on each side.After ensuring the adequacy of the block in the area of umbilicus and surrounding 5-6cm, the surgery was uneventfully completed.Patient had a painfree post operative period for 12 hrs.He also had ascitis which could have been a problem if we had not used ultrasound as our guide for TAB block.
Thanks for sharing the information about the obstructed umbilical hernia and how you manage the problem
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