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Query: UMLS:C0019270 (hernia)
 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Thirty patients underwent a defunctioning loop ileostomy. Elective ileostomy was performed in 23 patients to protect a potentially vulnerable colorectal anastomosis and in one patient as a permanent faecal diversion for colonic atony. Six emergency loop ileostomies were performed; in four patients after colonic perforations and in two patients as a primary treatment secondary to colonic anastomotic leakage. Peri-operatively, none of the patients with an elective operation died. Four patients with an emergency operation, however, all died of irreversible peritoneal sepsis. Complications were a diversion colitis and an abdominal sepsis after anastomotic leakage in a second patient who required a re-operation. During follow-up (up to four years) one patient suffered from an episode of severe dehydration six months after operation. The ileal continuity was, without mortality, restored in 23 patients. Two patients had a wound infection with, in one of them, a late cicatricial hernia. In our experience, a defunctioning loop ileostomy is a relatively safe procedure and is, in our opinion, preferable to loop colostomy for temporary faecal diversion. The high mortality following emergency loop ileostomy reflects the bad prognosis of these patients and indicates the need for resection of the primary disease.
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PMID:A future role for loop ileostomy in colorectal surgery? 178 8

Late onset congenital diaphragmatic hernia is a rare condition that is difficult to diagnose. Complications such as intestinal obstruction and digestive perforation may occur. A previously healthy three year-old girl was admitted to hospital with dehydration, shock, and ketoacidosis. A chest X-ray film showed a left hydropneumothorax with an indefinable left diaphragm, that was confirmed by ultrasonography. Hexabrix introduced through a nasogastric tube showed opacification of the left hemithorax attributed to an intrathoracic gastric perforation. She recovered after surgery. Gastrointestinal complications of delayed congenital diaphragmatic hernia must be promptly recognized since surgery should not be delayed.
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PMID:[Delayed appearance of left Bochdalek hernia disclosed by intrathoracic gastric perforation]. 196 33

Six cases of abdominal wall hernias involving the stomach are reported. Three of the hernias were incisional, 2 were epigastric, and 1 was umbilical. All the patients were middle-aged or elderly women. In 2 cases, the gastric herniation produced gastric outlet obstruction with resulting severe dehydration and electrolyte disturbances. Radiographically, the abnormality involved deformity of the stomach with shortening in the frontal views. Lateral profile views were essential in demonstrating the cause of this deformity. In 5 cases, there was mesenteroaxial torsion of the herniated stomach so that the efferent limb of the hernia was superior to the afferent limb. Two of these were associated with obstruction which developed at the neck of the efferent limb.
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PMID:Gastric involvement in abdominal wall hernias. 650 Feb 41

Twenty-three children from 8-60 months (mean age 21.13 months) admitted with neuromuscular manifestations of diarrhea related hypokalemia were studied. Forty four per cent cases were suffering from diarrhea at the time of admission but in majority of cases (56%), the diarrheal episode had already terminated. Mild hypokalemia was seen in 17.4%, moderate in 43.5% and severe in 39.1%. Neck flop was the commonest (100%) neuromuscular manifestations followed by diminished bowel sounds (82.6%), truncal weakness (52.2%), weakness of limbs (52.2%), lethargy (43. 5%), abdominal distension (43.5%), respiratory involvement (4.3%) and phantom hernia (4.3%). Two cases (8.7%) had flaccid paralysis of both the lower limbs. Severe hypokalemia was more frequently observed in children below 24 months of age and those who had received i.v. fluids or salt sugar solution before reporting in the hospital. A significant correlation was noticed between severity of hypokalemia and frequency of stools (p < 0.05), degree of dehydration (p < 0.01), severity of nutrition (p < 0.01) and extent of neuromuscular involvement (p < 0.01). Our results highlights the importance of diarrhea related hypokalemia particularly in young malnourished children who are rehydrated with solutions inadequate in potassium. Early diagnosis and appropriate treatment can promptly reverse these manifestations within 48-72 hours.
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PMID:Neuromuscular manifestations of diarrhea related hypokalemia. 863 3

In order to define current issues and outcomes of living kidney donation, 100 consecutive living donors operated on between July 1996 and March 2001 were evaluated. The 64 women and 36 men ranged in age from 19 to 72 yr (mean 42.5 yr), and 65 were related to the recipient while 35 were unrelated donors. Hospital admission the morning of surgery and use of a minimal open approach to the donor kidney were standard, as were post-operative epidural pain control and plans for short hospital stay. The 100 donors were hospitalized for 2 (25), 3 (48), 4 (18), 5 (8), or 6 (1) days, with an average length of stay of 3.12 d (range 2-6 d). The mean charge for kidney donor hospitalization was 14,470 dollars (range 9671-22,808 dollars). There were no major intra or immediate post-operative complications. Six rehospitalizations occurred for post-donation nausea, vomiting, dehydration (n = 2); spinal headache; pneumonia and wound haematoma; and late wound reexploration (one hernia and one nerve entrapment). All donors returned to pre-operative functional status within 6 d to 6 wk of donation. All kidneys functioned immediately in the 100 recipients (50 women, 50 men) who averaged 46.6 yr of age (range 17-69 yr); recipient length of stay averaged 3.81 d (range 2-15 d). All donors survived in excellent health; recipient graft and patient survival, respectively, are 87 and 90% through the entire 5-yr period. Excellent long-term outcomes for living kidney donors may be accomplished using minimal open surgical technique, post-operative epidural pain control and plans for a brief hospitalization. Expansion of living donor resources in renal transplant programs may grow as unrelated kidney donation and non-directed donation as well as minimally invasive (open and laparoscopic) techniques evolve.
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PMID:One hundred consecutive living kidney donors: modern issues and outcomes. 1237 47

Non-operative management by pressure reduction is now the preferred treatment for uncomplicated intussusception in children. However, in many developing countries, laparotomy is routinely performed for such cases. This is a retrospective anlaysis of 24 children who had operative reduction of intussusception. The age range was 3 months--10 years (median 7 months) and duration of symptoms 12 hours--7 days (median 2 days). The main features were abdominal pain, vomiting and rectal bleeding. Ten (42%) patients had varying degrees of dehydration, which were corrected. At laparotomy, the intussusceptions were reduced without difficulty. Thirteen (54%) patients developed 15 procedure related complications including wound infection 6(25%), ileus 2(8%), stitch sinus 2(8%), incisional hernia 2(8%), intestinal obstruction from adhesions resulting in intestinal gangrene 2(8%) and aspiration pneumonia 1 (4%). Mortality was 2( 8%) from aspiration pneumonia and overwhelming infection due to intestinal gangrene from adhesive intestinal obstruction respectively. Laparotomy for uncomplicated intussusception in children is attended by significant morbidity and mortality. Many of such intususceptions, may be successfully managed by pressure reduction and children should not be denied the benefits of this form of treatment.
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PMID:The morbidity and mortality of laparotomy for uncomplicated intussusception in children. 1240 31

Benign multicystic peritoneal mesothelioma (BMPM) is a rare tumor that occurs mainly in women in their reproductive age. The pathogenesis of BMPM is unclear and a controversy regarding its neoplastic and reactive nature exists. The biological behavior of BMPM is characterized by its slowly progressive process and high rate of recurrence after surgical resection. In addition this lesion does not present a strong tendency to transform into malignancy. Today approximately 130 cases have been reported. We here report a 62-year-old woman who had diffuse abdominal pain, nausea and vomiting. Physical examination revealed a painful mass in her upper abdomen. She reported a mild dehydration, but the vital signs were normal. Peristaltic rushes, gurgles and high-pitched tinkles were audible. Upright plain abdominal film revealed small bowel loops with air-fluid levels. She was diagnosed having an incarcerated incisional hernia that resulted in intestinal obstruction. The patient underwent surgery during which a cystic mass of the right ovary measuring 6 cm multiply 5 cm multiply 4 cm, four small cysts of the small bowel (1 cm in diameter) and a cyst at the retroperitoneum measuring 11 cm multiply 10 cm multiply 3 cm were found. Complete resection of the lesion was performed. The patient had an uneventful recovery and had no recurrence two years after surgery.
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PMID:Benign multicystic peritoneal mesothelioma: a case report and review of the literature. 1700 34

Wobenzim, a drug for systemic enzyme therapy, was used in 26 children with lower orbital wall fractures as monotherapy in early periods (on days 1 to 7) after brain injury to improve healing conditions and to minimize the formation of scar tissues in the fractural area. A control group comprised 24 patients who received systemic dehydration and vessel-strengthening therapy. Systemic enzyme therapy with Wobenzim could reduce the attenuation time of inflammatory manifestations of injury, prevent complications, such as strangulation of the musculus rectus inferior in the fractural area and development of strangulated orbital soft tissue hernia, and substantially decrease the number of patients having indications for surgical plastic repair of the orbital wall, as compared with the control group.
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PMID:[Systemic enzyme therapy in the treatment of children with lower orbital wall fractures]. 1721 96

Housing calves in large groups is associated with a higher risk of respiratory disease and with increased difficulties in identifying diseased animals compared with single housing. The aim of the present study was to investigate the effect of clinical disease on some behaviors recorded by automatic milk feeders in pre-weaned dairy calves. The experiment included 27 calves from a Danish research farm and 41 calves from a Swedish research farm. The calves were fed restrictively from a computer-controlled milk feeder, and all calves were subjected to daily clinical examinations for 3 to 26 d, with information gathered on general condition, nasal discharge, lung auscultation findings, coughing, signs of dehydration, naval status, rectal temperature, fecal consistency, and presence of chin abscess, arthritis, umbilical hernia, poor body condition, and poor hair coat. Calves suffering from diarrhea, respiratory disease, fever, or unspecific decreased general condition for more than 2 d were considered to be diseased and were declared to have recovered when they had been free of clinical signs of the disease for at least 2 d. The effects of clinical status (healthy, diseased) on the number of rewarded and unrewarded visits to the calf feeder and drinking rate, respectively, were analyzed by variance component analysis using a mixed model. Milk consumption on diseased and nondiseased days within calves was compared using a Wilcoxon signed rank test. In total, 53 of the calves were diagnosed as diseased during the study period. All cases of diseases were mild and were associated with an unaffected or only mildly affected general condition. Diarrhea was diagnosed in 51 calves, 6 of which also had respiratory disease. In 2 calves, respiratory disease was the only diagnosis. Eleven calves had an unspecific decreased general condition. The number of unrewarded visits was significantly reduced when calves were diseased. In Swedish calves, there was also a tendency for rewarded visits to be reduced during diseased days. Drinking rate and number of rewarded visits increased with increasing age. No effect of clinical status on milk consumption was detected. The number of unrewarded visits was the most sensitive of the 4 feeding behaviors monitored to indicate clinical disease in calves fed restricted milk volumes.
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PMID:Short communication: Identification of diseased calves by use of data from automatic milk feeders. 1723 77

Treatment options for morbidly obese patients with complications from large paraesophageal hernias (PEH) are limited. Simple repair of the PEH has a high recurrence rate and may be associated with poor gastric function. We compared a series of patients who underwent repair of large PEH plus gastrostomy tube gastropexy (PEH-GT) with PEH plus sleeve gastrectomy (PEH-SG). Retrospective review of patients undergoing PEH-SG and patients with PEH-GT was performed. We assessed symptoms of delayed gastric emptying and reflux postoperatively. In selected patients, gastric-emptying studies and upper gastrointestinal contrast studies were also obtained. All patients with large PEH were repaired laparoscopically with sac resection, primary crural closure using pledgeted sutures, and biologic patch onlay. SG for patients undergoing concomitant weight loss surgery (PEH-SG) was performed with linear endoscopic staplers and staple line reinforcement. Patients undergoing PEH repair alone had a gastrostomy tube gastropexy (PEH-GT). Patients had intraoperative endoscopic evaluation and postoperative contrast swallow studies. In a 12-month period, five patients underwent laparoscopic PEH-SG; two of five had previous antireflux surgery and one of five with a previous diagnosis of delayed gastric emptying. Postoperatively, two patients undergoing PEH-SG had readmission for dehydration and odynophagia. Six-month follow-up body mass index was 32 kg/m2 for the PEH-SG group with no hernia recurrence and complete resolution of gastroesophageal reflux disorder symptoms. Six patients underwent PEH-GT, one for acute incarceration and anemia and four with previous antireflux surgery. Follow up at 8 months demonstrated one recurrence, four of six had severe delayed gastric emptying and reflux, three of six had additional hospitalization for poor oral intake, and three of six underwent reoperation for delayed gastric emptying. There were no perforations, leaks, or deaths in either group. Combined laparoscopic PEH-SG is a clinically reasonable option for patients with morbid obesity with minimal additional risks and decreased incidence of delayed gastric emptying, reflux, and reoperation.
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PMID:Comparison between laparoscopic paraesophageal hernia repair with sleeve gastrectomy and paraesophageal hernia repair alone in morbidly obese patients. 1965 9


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