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Query: UMLS:C0017168 (gastroesophageal reflux disease)
 11,783 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Para-oesophageal hiatus hernia, a condition in which the fundus and part of the body of the stomach wrapped in a peritoneal sac herniate into the mediastinum, is a relatively uncommon entity. It tends to grow progressively and may become so large as to lead to symptoms of intrathoracic organ compression. In some exceptional cases, the entire stomach together with other abdominal viscera might herniate through the hiatus into the thorax. Paraesophageal hiatus hernias are characterised clinically by vague symptomatology, absent gastro-oesophageal reflux, and possible onset of gastric volvulus, generally without consequent incarceration of the portion of the herniated organ. Such an event is uncommon but dangerous and life-threatening. These cases often require resection of the incarcerated viscera, followed by hiatoplasty and Nissen fundoplication. The authors report on the case of a patient presenting with acute abdomen as a result of incarcerated and perforated para-oesophageal hiatus hernia.
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PMID:[Acute abdomen due to a strangulated and perforated para-esophageal hernia. A case report]. 1223 70

Nissen fundoplication is the procedure of choice for the management of gastroesophageal reflux disease. We report a case of acquired gastric volvulus following open fundoplication. The mechanism of formation and correction of the volvulus is discussed.
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PMID:Acquired volvulus following Nissen fundoplication. 1297 16

Acute abdominal pain in children occurs often and requires rapid clarification. Hints as to the condition are often given by the first impression and the case history of the patient. When the clinical examination and laboratory results do not lead to a clear finding, imaging methods such as a sonography can clarify the case. The most common cause for abdominal pain in infants is acute enteritis, mostly brought about by rotaviruses. Additional diagnoses are abdominal hernia, malrotation, hypertrophic pyloric stenosis, invagination or gastroesophageal reflux. In school-age children, the classic finding is "appendicitis". This should be differentiated from constipation, gastritis, pancreatitis, sigmoid volvulus, bowel and intestinal obstruction or, perhaps, gallstone trouble.
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PMID:[Acute abdominal pain in childhood]. 1536 66

The subject of malrotation in infants and children without other congenital anatomical abnormalities is reviewed from the perspective of experience with 97 patients operated in 11 years. Fifty-five patients were younger than 6 weeks at operation. They often presented with bilious vomiting, in contrast to older children who presented with non-bilious vomiting or feeding problems. Patients younger than 6 weeks were operated more often acutely than older patients. Volvulus was more common in infants younger than 6 weeks. Two patients with a resulting short bowel syndrome died. In 73 of the surviving 95 (76.8%) children their symptoms disappeared. In the children younger than 6 weeks persisting abdominal problems were significantly less frequent than in older children. In the children presenting with proven gastro-esophageal reflux disease before the malrotation operation, abdominal problems persisted significantly more often. Although there remains considerable controversy over how older children without signs of vascular problems should be managed, failure to respond to radiographic evidence of malrotation could be considered malpractice if volvulus was to occur subsequently. For this reason, every patient with a radiological proven malrotation merits diagnostic laparoscopy.
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PMID:Surgical intervention of intestinal malrotations in paediatric patients without other congenital anatomical abnormalities: overview from a single center. 1667 79

Observations about the natural history of aging in Cornelia de Lange syndrome (CdLS) are made, based on 49 patients from a multidisciplinary clinic for adolescents and adults. The mean age was 17 years. Although most patients remain small, obesity may develop. Gastroesophageal reflux persists or worsens, and there are early long-term sequelae, including Barrett esophagus in 10%; other gastrointestinal findings include risk for volvulus, rumination, and chronic constipation. Submucous cleft palate was found in 14%, most undetected before our evaluation. Chronic sinusitis was noted in 39%, often with nasal polyps. Blepharitis improves with age; cataracts and detached retina may occur. Decreased bone density is observed, with occasional fractures. One quarter have leg length discrepancy and 39% scoliosis. Most females have delayed or irregular menses but normal gynecologic exams and pap smears. Benign prostatic hypertrophy occurred in one male prior to 40 years. The phenotype is variable, but there is a distinct pattern of facial changes with aging. Premature gray hair is frequent; two patients had cutis verticis gyrata. Behavioral issues and specific psychiatric diagnoses, including self-injury, anxiety, attention-deficit disorder, autistic features, depression, and obsessive-compulsive behavior, often worsen with age. This work presents some evidence for accelerated aging in CdLS. Of 53% with mutation analysis, 55% demonstrate a detectable mutation in NIPBL or SMC1A. Although no specific genotype-phenotype correlations have been firmly established, individuals with missense mutations in NIPBL and SMC1A appear milder than those with other mutations. Based on these observations, recommendations for clinical management of adults with CdLS are made.
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PMID:Natural history of aging in Cornelia de Lange syndrome. 1764 42

Gastric volvulus was first described by Berti in 1966. Whereas acute gastric volvulus is very rare, chronic gastric volvulus on the other hand is being diagnosed with increasing frequency. This is attributed to the liberal use of barium meal for the evaluation of infants and children with repeated attacks of vomiting and recurrent chest infection. This report describes our experience in the management of 36 infants and children with acute and chronic gastric volvulus. Their medical records were retrospectively reviewed for: age at diagnosis, sex, symptomatology, diagnosis, treatment and outcome. There were 22 males and 14 females. Their ages at presentation ranged from 1 week to 2.5 years (mean 6.7 months). Their symptomatology included repeated attacks of vomiting (30 patients), recurrent chest infection and asthma like symptoms (6 patients), failure to thrive (6 patients), chocking with feeds (3 patients), loose bowel motion (3 patients) and apnoea attack (1 patient). Two presented acutely with intrathoracic gastric volvulus. One of them had recurrent left diaphragmatic hernia while the other had a large paraesophageal hernia. The remaining patients had chronic intraabdominal gastric volvulus. Radiologically, all had organo-axial gastric volvulus except one who had mesenterico-axial gastric volvulus and 33 (97%) of them had demonstrable gastroesophageal reflux. Eleven were treated conservatively because their symptoms were mild to moderate and settled. The two patients with intrathoracic gastric volvulus underwent reduction of the contents, repair of the defect and anterior gastropexy. The remaining patients underwent gastropexy, both fundal and anterior. Intraoperatively, two were found to have diaphragmatic hernia, nine had mobile (non-fixed) spleen, and eight showed mobile stomach with lax ligaments. Post-operatively, all did well and showed good improvement with disappearance of their symptoms and increase in weight. Acute gastric volvulus is very rare. Prompt clinical suspicion and radiological assessment are essential to treat this life-threatening condition. Chronic gastric volvulus on the other hand is more common but under diagnosed. It should be included in the differential diagnosis of infants and children with repeated attacks of chest infection, vomiting and failure to thrive. Barium meal should form part of their investigations. The treatment of chronic gastric volvulus depends on their symptomatology. Those with mild to moderate symptoms should be treated conservatively, while those with persistent and severe symptoms should undergo anterior (to the abdominal wall) and fundal (to the diaphragm) gastropexy without fundoplication.
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PMID:Acute and chronic gastric volvulus in infants and children: who should be treated surgically? 1787 14

The laparoscopic management of the intrathoracic stomach is still controversial. Laparoscopic semifundoplication in gastroesophageal reflux disease results in effective long-term reflux control and is, as compared with 360 degrees Nissen fundoplication, associated with less frequent side effects such as dysphagia and gas bloat syndrome. The aim of our study was to evaluate the results of laparoscopic anterior semifundoplication in patients with intrathoracic stomach. Enrolled in this study are 19 patients (67.1 years of age; range, 37.5-83.7 years) with intrathoracic stomach undergoing laparoscopic anterior semifundoplication and a minimal follow up of 5 months postoperatively. The study covers the interval between August 1999 and March 2006. Including criterion was a minimum percentage of herniated intrathoracic stomach of 33 per cent. A standardized questionnaire was used for follow up and the modified symptomatic DeMeester score (0-9) was assessed. The median percentage of herniated stomach in the chest was 87.5 per cent (range, 33-100%). Seven patients revealed organo-axial volvulus of the stomach. Duration of preoperative symptoms was 24 months (range, 1-266 months) with a median follow up of 18 months (range, 5-76 months) postoperatively. The modified symptomatic DeMeester score was 0 (0-3). Thirteen of 19 patients were on no postoperative proton pump inhibitor medication. One patient had anatomic recurrence on late follow up at 27 months. The overall contentment with the surgical treatment on an analog scale from 0 to 10 was a median of 9. Although laparoscopic anterior semifundoplication yields satisfactory symptomatic results in patients with intrathoracic stomach, the incidence of failures and anatomical recurrences is higher than expected from subjective data. Prospective, randomized long-term studies are essential to gain further information about the "ideal" type of laparoscopic repair in large hiatal hernia with intrathoracic stomach.
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PMID:Laparoscopic anterior semifundoplication in patients with intrathoracic stomach. 1827 22

Nissen fundoplication is a generally accepted treatment for severe gastro-oesophageal reflux after conservative management has failed. The surgical techniques and the complications that may develop following the operation have been well described. However, necrosis of the spleen is a rare complication. We report here a patient with Down syndrome with a vanishing spleen after a Nissen fundoplication, who died of overwhelming pneumococcal septic shock 7 months after the operation. Vascular anomaly in Down syndrome, inadvertent ligation of the splenic artery or volvulus of the spleen may have caused a compromised splenic arterial circulation.Conclusion Nissen fundoplication may be associated with vanishing spleen and, consequently, with devastating consequences.
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PMID:Vanishing spleen after Nissen fundoplication: a case report. 1859 15

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

Gastric volvulus is a rare disease in the pediatric population. Its clinical presentation is exceedingly variable, and without a high index of suspicion, delayed or missed diagnosis is not uncommon as illustrated by this report of a 13-month-old boy with a puzzling presentation of chronic wheezing and cough for 1 year. There were no gastrointestinal symptoms. The symptoms were attributed to bronchiolitis, pneumonia, laryngomalacia, or reactive airway disease by several practicing physicians. A detailed history revealed that the wheezing got worse after large meals. This information prompted an upper gastrointestinal contrast study, which led to the identification of organoaxial gastric volvulus and coexisting gastroesophageal reflux. The respiratory symptoms resolved dramatically after antireflux medications and lifestyle modification for gastroesophageal reflux. This report highlights chronic gastric volvulus in the differential diagnosis of infantile wheezing, particularly when the wheezing is present very early in life and associated with feeding.
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PMID:Gastric volvulus manifesting as infantile wheezing: a puzzling presentation. 2182 83


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