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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Hiatus hernias of the diaphragma are rarely recorded under forensic aspects. Their relevance is demonstrated by the case of an elderly lady who was suffering from severe abdominal pain after dinner. She vomited several times and died 4 days later. After a forgery of the notarial last will and testament was revealed, a post-mortem was performed and a paraesophageal hiatus hernia was detected. The toxicological investigation revealed high levels of pethidin, and a married couple, both of them medical doctors, responsible for the forgery of the last will was charged with murder. The pathogenetic reconstruction led to the conclusion that a mechanism of 'self-tamponing' was initiated on the grounds of a pre-existing paraesophageal hernia filled up by the last meal ingested. The blockage of the gastrointestinal passage way induced severe abdominal pain and permanent vomiting, furthermore resulting in hemorrhagic infarction and perigastritis. Death from natural cause was finally appreciated by the court and the accused were acquitted. The post-mortem estimation of paraesophageal hiatus hernias is discussed, particularly, the necessity of an in situ preparation with separate incision of the translocated part and histological investigation. A synoptic expertise of clinicians, toxicologists and forensic pathologists is mandatory for estimating the relevance of high levels of analgesics.
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PMID:Death from paraesophageal hiatus hernia: post-mortem assessment and forensic relevance. 1293 7

Gastric volvulus is a rare condition which usually presents with intermittent abdominal pain. It is typically associated with a paraoesophageal hiatus hernia and may present with acute strangulation or perforation. The mortality associated with an acutely obstructed volvulus may be up to 50%. Correspondingly, this condition is regarded as a surgical emergency. We present the history of a patient with an acute gastric volvulus and unexplained hypotension.
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PMID:A case report of acute gastric volvulus with avulsion of the splenic vessels. 1470 48

We report a 94-year-old woman, who underwent percutaneous endoscopic Jejunostomy (PEJ) tube feeding for enteral nutrition, developed the intussusception of the small intestine. She suffered from nontuberculous mycobacterium (NTM), and her lung inflammation deteriorated due to aspiration pneumonia and malnutrition. Because of old age, dysphagia, esophageal hiatus hernia, gastro-esophageal reflux and her bedridden condition due to severe osteoporosis, oral nutritional supplementation is nearly impossible. To reduce the aspiration risk, we chose PEJ instead of percutaneous endoscopic gastrostomy (PEG) as the route of tube feeding. Six months after the placement of a PEJ tube, aspiration pneumonia was diagnosed and she was readmitted to our hospital. During hospitalization, she had sudden diarrhea, vomiting, and lower abdominal pain. Abdominal CT scan and radiographs using contrast medium showed small intestinal intussusception related to the PEJ tube. We observed the clinical course without performing surgery, pulling it back towards the stomach and placing an ileus tube, because the small intestine was not completely obstructed. Two months later, although she suffered from aspiration pneumonia once more, she remained in a stable condition without further intervention so that she could move to aother hospital. Recently PEJ has been expected to prevent aspiration pneumonia, but we believe that it can be a risk factor for intussusception. Although the PEJ can be a good parenteral nutrition route for frail elderly with dysphagia, we need to consider possible complications including intussusception.
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PMID:[A 94-year-old woman with nontuberculous mycobacterium who developed small intestinal intussusception associated with a percutaneous endoscopic jejunostomy tube]. 1804 13

A type IV paraesophageal hernia is a rare complication in esophageal hiatus and is an uncommon presentation of hiatal hernia. We report herein a 71-year-old man who presented with abdominal pain, nausea and constipation that was attributed to a sigmoid volvulus. At laparotomy, the sigmoid volvulus was identified as strangulated and involved in a type IV paraesophageal hernia in which the esophageal junction was located in its normal anatomic position. The esophageal hiatus was impressively dilated and there was no evidence suggesting previous mechanical disruption of the esophageal hiatus.
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PMID:A type IV paraesophageal hernia containing a volvulized sigmoid colon. 1819 47

Patients who have undergone bariatric surgery and present with upper abdominal symptoms pose a diagnostic and management challenge. This is a case report of a 53-year-old lady who presented a number of years after vertical banded gastroplasty with upper abdominal pain and weight gain. Radiological investigation demonstrated a large para-esophageal hernia including the stapled area of the stomach, but with a staple-line dehiscence. She successfully underwent repair of the hiatus hernia and conversion to a Roux-en-Y gastric bypass resulting in resolution of the abdominal pain and weight loss.
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PMID:Revision of vertical banded gastroplasty complicated by a large para-esophageal hernia. 1895 36

Congenital paraesophageal hiatal hernias are rare and can be associated with gastric incarceration, volvulus,mucosal ulceration, and anemia. Primary repair of the hernia and fundoplication are recommended. In this paper,we report a case of a 3-year-old child with abdominal pain who was noted to have a paraesophageal hiatal hernia with partial gastric volvulus. A 5 mm robot platform was utilized to facilitate hernia sac dissection,hiatal repair, and fundoplication.
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PMID:Robotic repair of congenital paraesophageal hiatal hernia. 1933 24

The hiatus hernia and sigmoid volvulus are usually found in older patients. The delay of the treatment of both of these illnesses may result in increased morbidity and mortality. We report a case of an isolated intrathoracic hiatal herniation of the twisted sigmoid colon. The patient complained about cramping abdominal pain, vomiting, and dyspnea. Chest X-ray and CT scan of the thorax showed a distended colonic segment in the posterior mediastinum. The patient underwent cruroplasty, Nissen fundoplication, and sigmoid colon resection. This is the first report of such a rare case.
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PMID:Isolated intrathoracic hiatal herniation of the twisted sigmoid colon: report of a case. 1940 83

Bariatric surgery dramatically alters the normal stomach anatomy resulting in a significant incidence of hiatal hernia and gastroesophageal reflux disease. Although the majority of patients remain asymptomatic, many complain of severe heartburn refractory to medical management and additional highly atypical symptoms. Here, we describe the diagnosis and treatment regarding four cases of symptomatic hiatal hernia following bariatric surgery presenting with atypical symptoms in the University Hospital, USA. Four patients presented following laparoscopic Roux-en-Y gastric bypass or duodenal switch/pancreaticobiliary bypass (DS) with disabling and intractable midepigastric abdominal pain characterized as severe and radiating to the jaw, left shoulder, and midscapular area. The pain in all cases was described as paroxysmal and not necessarily associated with eating. All four patients also experienced nausea, vomiting, and failure to thrive at various intervals following laparoscopic bariatric surgery. Routine workup failed to produce any clear mechanical cause of these symptoms. However, complimentary use of multidetector CT and upper gastrointestinal contrast studies eventually revealed the diagnosis of hiatal hernia. Exploration identified the presence of a type I hiatal hernia in all four patients, with the stomach staple lines densely adherent to the diaphragm and parietal peritoneum. Operative intervention led to immediate and complete resolution of symptoms. The presence of a hiatal hernia following bariatric surgery can present with highly atypical symptoms that do not resolve without operative intervention. Recognition of this problem should lead to the consideration of surgery in cases where patients are dependent on artificial nutritional support and whose symptoms are poorly controlled with medication alone.
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PMID:Diagnosis and treatment of atypical presentations of hiatal hernia following bariatric surgery. 1985 36

We investigated the indications for and findings of gastrointestinal (GI) endoscopy in all children < or = 16 years old referred for the procedure to the endoscopy unit at Soba University Hospital, Khartoum from January 2004 to January 2006. Thus 113 children were enrolled; 73% underwent upper GI endoscopy, 27% lower GI endoscopy (15% colonoscopy, 12% flexible sigmoidoscopy). Indications for upper GI endoscopy included haematemesis (24%), portal hypertension (21%), abdominal pain (16%) and vomiting (15%). Diagnoses included oesophageal varices (16%), gastritis (7%) and hiatus hernia (6%). Indications for lower GI endoscopy included rectal bleeding (87%), diarrhoea (19%) and anaemia (10%).
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PMID:Paediatric gastrointestinal endoscopy: experience in a Sudanese university hospital. 2018 56

Although mesenterioaxial gastric volvulus is an uncommon entity characterized by rotation at the transverse axis of the stomach, laparoscopic repair procedures have still been controversial. We reported a case of mesenterioaxial intrathoracic gastric volvulus, which was successfully treated with laparoscopic repair of the diaphragmatic hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication. A 70-year-old Japanese woman was admitted to our hospital because of sudden onset of upper abdominal pain. An upper gastrointestinal series revealed an incarcerated intrathoracic mesenterioaxial volvulus of the distal portion of the stomach and the duodenum. The complete laparoscopic approach was used to repair the volvulus. The laparoscopic procedures involved the repair of the hiatal hernia using polytetrafluoroethylene mesh and Toupet fundoplication. This case highlights the feasibility and effectiveness of the laparoscopic procedure, and laparoscopic repair of the hiatal defect using a polytetrafluoroethylene mesh associated with Toupet fundoplication may be useful for preventing postoperative recurrence of hiatal hernia, volvulus, and gastroesophageal reflux.
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PMID:Laparoscopic repair of hiatal hernia with mesenterioaxial volvulus of the stomach. 2152 87


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