br Discussion Based on a literature

Discussion Based on a literature review, it is stated that there are two requirements for tension pneumocephalus to develop after a VP shunt: the presence of a CSF diversion system causing a decrease in intracranial pressure and the existence of a craniodural defect. In the presence of a craniodural defect, the negative pressure resulting from the siphoning effect of the shunt will allow the entry of trapped air into the brain, causing pneumocephalus. We think these mechanisms can explain the occurrence of tension pneumocephalus in our case. The mechanism of the cerebral hemorrhagic infarction following cranioplasty for depressed skull is not clear in our case. Cecchi and colleagues reported a case of hemorrhagic infarction occurring after an autologous cranioplasty in a patient with sinking flap syndrome. They thought that a sudden increase of cerebral blood flow in the cerebral hemisphere where the cranioplasty had been performed caused reperfusion injury because the autoregulation might have been impaired during the previous stroke insult. In contrast to the patient of Cecchi et al, who experienced ipsilateral hemispheric hemorrhagic infarction, our patient developed bilateral hemorrhagic infarction. Eom et al reported a patient with right internal carotid artery occlusion who underwent intra-arterial thrombolysis with urokinase and subsequent decompressive craniectomy, and then had diffuse hemorrhagic infarction following cranioplasty. However, the patient had not recovered from anesthesia and became comatose. A cranial CT showed increasingly diffuse RG2833 swelling and multifocal hemorrhagic transformation in both frontal lobes and basal ganglia. They then stated that deep cerebral venous occlusion or congestion was the possible cause for the bilateral hemorrhagic infarction. This patent underwent decompressive craniectomy for a large cerebral infarction, and all these might have diffusely damaged the small intracranial vessels. When collaterals are insufficient, cranioplasty can cause a rapid increase in cerebral blood flow and blood volume bilaterally in the chronic dysfunctional brain, resulting in venous stasis, secondary venous congestion and thrombosis, and subsequent extensive intracerebral hemorrhagic infraction. To sum up the above-mentioned opinion, we think that the explanation of Eom et al may be applied to our case.
Introduction De Garengeot\'s hernia is a rare condition that involves acute appendicitis of an incarcerated femoral hernia. Surgery for groin hernias is common, and nearly all abdominal organs as well as a variety of unusual pathologies can be discovered in the hernia sac. However, a femoral hernia sac containing the appendix is a rare condition that was first described by Rene Jacques Croissant De Garengeot in 1731. Preoperative diagnosis of De Garengeot\'s hernia is generally difficult; however, accurate diagnosis is critical for reducing morbidity. In this study, we report a 74-year-old female patient who presented with severe and painful right groin swelling.
Case report A 74-year-old woman visited our out-patient department because of severe pain over the right side of the groin, which had persisted for 4 days. Two days prior to admission, the patient arrived at the emergency department, where a femoral lymphadenopathy was diagnosed. Based on the clinical findings and the bedside ultrasound results, the patient was treated with broad-spectrum antibiotics. The patient reported that the protruding bulge around her right groin area had been present for approximately 6 months. The patient also expressed increasing pain and redness in this area. The patient had no significant medical or surgical history. An abdominal examination revealed a soft nondistended abdomen with an erythematous mass in the right inguinal region, measuring 3 cm × 3 cm, approximately 3 cm below the inguinal ligament. The mass was mildly tender on palpation and nonreducible (Fig. 1). The patient underwent blood tests, which revealed a borderline rise in white blood cell (WBC) count of 13.2 × 103/μL, and the remainder of the hematological results were within normal limits. A clinical examination revealed a femoral hernia. Ultrasonography confirmed that the bowel was present in the hernia sac. Therefore, an emergency hernioplasty was arranged.