Hernias

Ruptured ectopic pregnancy — hemoperitoneum (Courtesy Dr. V. Penopoulos)

Ruptured abdominal aortic aneurysm (Courtesy Dr. V. Penopoulos)

Ruptured abdominal aortic aneurysm (Courtesy Dr. V. Penopoulos)

Perirenal hematomas — anticoagulant therapy (Courtesy Dr. V. Penopoulos)

Perirenal hematomas — anticoagulant therapy (Courtesy Dr. V. Penopoulos)

Left perirenal hematoma and right iliopsoas hematoma — anticoagulant therapy (Courtesy Dr. V. Penopoulos)

Rectus abdominis hematoma — anticoagulant therapy (Courtesy Dr. V. Penopoulos)

Ruptured corpus luteum — hemoperitoneum (Courtesy Dr. V. Penopoulos)

Bleeding ovarian cyst (Courtesy Dr. V. Penopoulos)

Ectopic pregnancy (Courtesy Dr. V. Penopoulos)

Spontaneous left adrenal hemorrhage (Courtesy Dr. V. Penopoulos)

Spontaneous left adrenal hemorrhage (Courtesy Dr. V. Penopoulos)

Spontaneous left adrenal hemorrhage (Courtesy Dr. V. Penopoulos)

Spontaneous left adrenal hemorrhage (Courtesy Dr. V. Penopoulos)

Bilateral spontaneous renal hemorrhage — Wegener's granulomatosis (Courtesy Dr. V. Penopoulos)

Spontaneous renal rupture/hemorrhage — renal cell carcinoma (Courtesy Dr. V. Penopoulos)

Spontaneous renal rupture/hemorrhage — angiomyolipoma (Courtesy Dr. V. Penopoulos)

Spontaneous rupture of hepatocellular carcinomas (Courtesy Dr. V. Penopoulos)

Surgical specimens of excised endometriomas (Courtesy Dr. V. Penopoulos)

Surgical specimens of excised endometriomas (Courtesy Dr. V. Penopoulos)

Surgical specimens of excised endometriomas (Courtesy Dr. V. Penopoulos)

Spontaneous splenic rupture (Courtesy Dr. V. Penopoulos)

Left adrenalectomy after spontaneous hemorrhage in a transplanted hematological patient (Courtesy Dr. V. Penopoulos)

Bilateral adrenal hemorrhage (Courtesy Dr. V. Penopoulos)

Spontaneous left adrenal hemorrhage (Courtesy Dr. V. Penopoulos)

Spontaneous left adrenal hemorrhage (Courtesy Dr. V. Penopoulos)

Small bowel liberated following meticulous adhesiolysis (Courtesy Dr. V. Penopoulos)

Contrast-enhanced CT of the upper abdomen showing a cluster of dilated small bowel loops in the centre giving a cauliflower appearance (arrows) (Courtesy Dr. V. Penopoulos)

Contrast-enhanced CT of the upper abdomen showing a cluster of dilated small bowel loops in the centre giving a cauliflower appearance (arrows) (Courtesy Dr. V. Penopoulos)

Contrast-enhanced CT of the abdomen showing the small bowel in the centre of the abdomen within a thick fibrous membrane (Courtesy Dr. V. Penopoulos)

CT of the abdomen. Protrusion of large bowel through the inferior lumbar triangle (Courtesy Dr. V. Penopoulos)

CT of the abdomen 1 (one) year after surgical repair of the lumbar hernia. Complete elimination of the defect (Courtesy Dr. V. Penopoulos)

CT of the abdomen 1 (one) year after surgical repair of the lumbar hernia. Complete elimination of the defect (Courtesy Dr. V. Penopoulos)

CT of the abdomen 1 (one) year after surgical repair of the lumbar hernia. Complete elimination of the defect (Courtesy Dr. V. Penopoulos)

Closure of the defect with interrupted Vicryl No. 2 sutures without tension (Courtesy Dr. V. Penopoulos)

Complete repair of the hernia (Courtesy Dr. V. Penopoulos)

Protruding lumbar hernia. Petit triangle (triangle of Petit) (Courtesy Dr. V. Penopoulos)

Protruding lumbar hernia. Petit triangle (triangle of Petit) (Courtesy Dr. V. Penopoulos)

Completely freed trachea (Courtesy Dr. V. Penopoulos)

Retrosternal goiter surgical specimen (Courtesy Dr. V. Penopoulos)

Chest-Neck CT. Red arrows — Very large retrosternal goiter. Yellow arrows — Clavicles (Courtesy Dr. V. Penopoulos)

Thyroid scintigraphy. Retrosternal position is evident, without hot or cold areas (Courtesy Dr. V. Penopoulos)

Kocher cervical incision (Courtesy Dr. V. Penopoulos)

Right thyroid lobe segment (Courtesy Dr. V. Penopoulos)

Neubauer thyroid artery. Thyroidea ima artery (Courtesy Dr. V. Penopoulos)

Surgical field after sternotomy (Courtesy Dr. V. Penopoulos)

Recording of inferior laryngeal nerve potentials (Courtesy Dr. V. Penopoulos)

Histopathological examination — Multinodular goiter (Courtesy Dr. V. Penopoulos)

Histopathological examination — Multinodular goiter (Courtesy Dr. V. Penopoulos)

Histopathological examination — Multinodular goiter (Courtesy Dr. V. Penopoulos)

Histopathological examination — Multinodular goiter (Courtesy Dr. V. Penopoulos)

Histopathological examination — Multinodular goiter (Courtesy Dr. V. Penopoulos)

Normal chest X-Ray two months following surgery (Courtesy Dr. V. Penopoulos)

Normal chest X-Ray two months following surgery (Courtesy Dr. V. Penopoulos)

Normal chest X-Ray two months following surgery (Courtesy Dr. V. Penopoulos)

Normal chest X-Ray two months following surgery (Courtesy Dr. V. Penopoulos)

Normal chest X-Ray two months following surgery (Courtesy Dr. V. Penopoulos)

Normal chest X-Ray two months following surgery (Courtesy Dr. V. Penopoulos)

Normal chest X-Ray two months following surgery (Courtesy Dr. V. Penopoulos)

Normal chest X-Ray two months following surgery (Courtesy Dr. V. Penopoulos)

Normal chest X-Ray two months following surgery (Courtesy Dr. V. Penopoulos)

Chest X Ray following plication of the left diaphragm . Full expansion of the left lung is obvious . Left diaphragm is now seen flattened in a normal position (Courtesy Dr. V. Penopoulos)

The final appearance of the plication sutures , the overlying mesh and the Nissen fundoplication at the end of the procedure (Courtesy Dr. V. Penopoulos)

Preoperative ( Left ) and Postoperative ( Right ) Chest X Rays (Courtesy Dr. V. Penopoulos)

Additional clinical images (Courtesy Dr. V. Penopoulos).

: Puncture of the abscess (Courtesy Dr. V. Penopoulos).

: Green arrow - Proximal Jejunum. Blue arrow - Abscess (Courtesy Dr. V. Penopoulos).

: Green arrow - Stomach. Red arrow - Abscess (Courtesy Dr. V. Penopoulos).

Operative view of the Spiegelian hernia . ( Courtesy Dr . V . Penopoulos ) (Courtesy Dr. V. Penopoulos).

Exploratory Laparotomy . Midgut malrotation clearly seen . Small bowel occupying right abdomen while large bowel the left . Note appendix lying in the left iliac fossa (Courtesy Dr. V. Penopoulos)

The cut of Ladd s bands is pointed by anatomic forceps (Courtesy Dr. V. Penopoulos)

The cut of Ladd s bands is pointed by anatomic forceps (Courtesy Dr. V. Penopoulos)

The cut of Ladd s bands is pointed by anatomic forceps (Courtesy Dr. V. Penopoulos)

The cut of Ladd s bands is pointed by anatomic forceps (Courtesy Dr. V. Penopoulos)

Figure 2 . Giant inguinoscrotal hernia , extending up to the knee joint . (Courtesy Dr . V . Penopoulos) .

Figure 1 . The extreme size of the scrotal “swelling” is obvious .( Courtesy Dr. V . Penopoulos ) .

Microscopic cross-section of stricture showing hypertrophic muscularis propria with vertically orientated muscle fibres and submucosal fibrosis (Courtesy Dr. V. Penopoulos)

Microscopic cross-section of stricture showing hypertrophic muscularis propria with vertically orientated muscle fibres and submucosal fibrosis (Courtesy Dr. V. Penopoulos)

Enterectomy. Green arrow mucosal ulceration. Blue arrow diaphragm (Courtesy Dr. V. Penopoulos)

Video capsule endoscopic view showing a small bowel stricture (Courtesy Dr. T. Maris)

CT scan. Marked hematoma extending into the prevesical space (Courtesy Dr. V. Penopoulos).

Chest-Abdomen CT scan. Bochdalek hernia (Courtesy Dr. V. Penopoulos)

Different stages of hernia identification and repair (Courtesy Dr. V. Penopoulos)

Normal chest X-ray after hernia repair (Courtesy Dr. V. Penopoulos)

Postoperative gastrografin swallow. Stomach in normal position after gastropexy (Courtesy Dr. V. Penopoulos)

Postoperative gastrografin swallow. Stomach in normal position after gastropexy (Courtesy Dr. V. Penopoulos)

Postoperative gastrografin swallow. Stomach in normal position after gastropexy (Courtesy Dr. V. Penopoulos)

Blue arrow. The hernia orifice through which the ascitic fluid enters the intercostal hernia (Courtesy Dr. V. Penopoulos)

Blue arrow. The hernia orifice through which the ascitic fluid enters the intercostal hernia (Courtesy Dr. V. Penopoulos)

Blue arrow. The hernia orifice through which the ascitic fluid enters the intercostal hernia (Courtesy Dr. V. Penopoulos)

Postoperative gastrografin swallow. Stomach in normal position after gastropexy (Courtesy Dr. V. Penopoulos)

Abdominal CT scan. Red arrow - Pancreatitis - Peripancreatic collection in the splenorenal space (Courtesy Dr. V. Penopoulos)

Abdominal CT scan. Red arrow - Pancreatitis - Peripancreatic collection in the splenorenal space (Courtesy Dr. V. Penopoulos)

Computed tomography scan. Suspicious upper abdominal mesentery intorsion , right lower quadrant intestinal loop , middle abdominal line separation (Courtesy Dr. V. Penopoulos)

Schema showing a membrane separating the peritoneal cavity into two compartments (A) and descending mesocolon dorsal root connecting with the ascending colon (B) (Courtesy Dr. V. Penopoulos)

Schema showing a membrane separating the peritoneal cavity into two compartments (A) and descending mesocolon dorsal root connecting with the ascending colon (B) (Courtesy Dr. V. Penopoulos)

Abdominal and kidney ultrasonography showing no mass and fluid collection (A), left (B) and right (C) normal kidney structure (Courtesy Dr. V. Penopoulos)

Abdominal and kidney ultrasonography showing no mass and fluid collection (A), left (B) and right (C) normal kidney structure (Courtesy Dr. V. Penopoulos)