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

We successfully treated surgically an elderly patient, a 80-year-old woman, with Bochdalek diaphragmatic hernia. She had intermittent episodes of intestinal obstruction. A preoperative chest roentgenograph revealed a loop of gas-filled bowel in the left chest and elevation of the left diaphragm. CT scanning of the thorax revealed the bowels filled with gastrografin in the left thoracic cavity. She was treated surgically, through transabdominal and then transthoracic approaches. The herniated large bowel was reduced from the thoracic cavity and the hernial sac was excised. The posterolateral defect of the diaphragm, 5 x 6 cm in size was closed with interrupted mattress sutures. The patient has been well without any symptoms 6 months after the surgery. Bochdalek diaphragmatic hernia is the most common problem in infants with risky respiratory distress and high mortality, however it is preferable to carry out surgical treatment for adult patients because of good postoperative results. As a surgical route in the management of Bochdalek diaphragmatic hernia in adults, a transthoracic approach is preferable since it provides easy separation and reduction of herniated bowels from the thoracic cavity and easy closure of the diaphragmatic defect, furthermore there are no other serious gastrointestinal complications which are required specific repair.
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PMID:[Bochdalek diaphragmatic hernia in the elderly: a case report]. 150 9

Twenty one surgically documented cases of Meckel's diverticulum in children treated at Kasturba Hospital, Manipal since 1981 are reviewed. Of them, 14 presented with intestinal obstruction, 2 with pain abdomen, 2 with Littre's hernia and 2 were found incidentally. Only one patient presented with gastrointestinal bleeding. The clinical profile of these patients is analyzed.
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PMID:Meckel's diverticulum in children. 151 19

Intestinal malrotation may be complicated by volvulus and intestinal necrosis. One hundred two children (64 male, 38 female) undergoing surgical abdominal exploration from 1977 to 1987 had malrotation. Fifty-two patients were less than 7 days of age, 13 from 8 to 30 days, 26 from 31 to 365 days, and 11 were older than 1 year of age. Of infants, 39 of 65 had 40-week gestations, 18 of 65 had 36- to 39-week gestations, and 8 of 65 had less than 36-week gestations. Chief symptomatology included: bilious emesis (47), intestinal obstruction (19), abdominal pain (11), and bloody stools (7). Seventy patients had congenital anomalies (50 single, 20 multiple). Diagnostic evaluations included 56 upper gastrointestinal series and 27 barium enemas. Each patient underwent correction of malrotation and appendectomy, and correction of congenital anomalies (omphalocele-9, gastroschisis-6, diaphragmatic hernia-7). Complications included short gut (2), sepsis (5), feeding difficulties (2), pneumonia (3), small bowel obstruction (2), and other (15). Nine patients (8.8%) died (trisomy 18-1, trisomy 13-1, intestinal necrosis-3, hepatic failure-1, prematurity-1, other sepsis-2). Two hundred sixteen children with intestinal malrotation have been treated from 1937 to 1987. Mortality rate has improved from 23% to 2.9%.
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PMID:Malrotation of the intestine in children. 154 4

Prostheses of expanded polytetrafluoroethylene (e-PTFE) were used to repair 89 abdominal wall defects in which primary closure would produce undue tension on tissue. Over a 52-month period (median follow-up: 24 months), we observed three wound infections, one in a clean wound, and four hernia recurrences. No other complications were noted. Twenty-one e-PTFE grafts were placed directly over intraperitoneal viscera without clinical evidence of adhesions leading to intestinal obstruction. In grafts inspected postoperatively, no apparent evidence of fatigue or fragmentation was observed. Histologic findings concurred with experimental data obtained during animal trials revealing the creation of a new mesothelial lining. These results encourage the use of e-PTFE prostheses for the repair of abdominal wall hernias, particularly when the parietal peritoneum is absent.
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PMID:Hernia repair with expanded polytetrafluoroethylene. 155 82

An 88 year old woman presented with a painful, irreducible right femoral hernia and small intestinal obstruction. At laparotomy, some distal small intestine was found to have twisted around an uninflamed appendix which was acting as a 'band', with its tip fixed in the femoral hernia sac. Although the association between the appendix and femoral hernia is well recognized, the production of small intestinal obstruction by this particular mechanism has not been previously reported.
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PMID:Femoral hernia appendix causing small intestinal obstruction. 158 85

We have presented a case of internal herniation of small bowel through the sigmoid mesocolon in a pregnant woman. In patients with symptoms suggestive of bowel obstruction, even without a history of previous abdominal surgery, internal hernia must be included in the differential diagnosis.
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PMID:Transmesosigmoid hernia during pregnancy. 160 96

The complications arising from 100 consecutive retroperitoneal lymphadenectomies done for nonseminomatous germ-cell tumours of the testis were reviewed. Thirty procedures were performed with sparing of sympathetic nerve fibres. There were no operative deaths. Complications were not stage-related, and the sympathetic nerve-sparing procedure did not alter their frequency. Long-term follow-up in the same cancer centre allowed documentation of all early and delayed complications as a measure of burden of surgical therapy. Median follow-up for survivors was 44 months. Complications that resulted in delayed hospital discharge or further operative intervention at any time were defined as major; all others, resulting in minimal morbidity to the patient, were documented as minor. Injury to renal vessels occurred in four patients intraoperatively. Delayed complications included small-bowel obstruction requiring laparotomy (six patients), incisional hernia requiring repair (two patients) and urethral stricture requiring urethroplasty (one patient). There were 49 complications (14 major, 35 minor) in 35 patients. The authors conclude that the majority of complications after retroperitoneal lymphadenectomy are minor and cause little morbidity. This information is useful when comparing surgery to alternative therapy with similar outcomes. The overall burden of treatment becomes all-important in the selection of optimal therapy.
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PMID:Early and late complications of retroperitoneal lymphadenectomy in testis cancer. 165 Nov 54

Elective repair of simple (uncomplicated) inguinal and femoral hernias avoids incarceration and bowel obstruction (complicated presentations). To identify factors that perturb this strategy, we analyzed the records of 1,859 consecutive nonpediatric patients with groin hernias. Incarceration or bowel obstruction prompted operation in 22 of 77 (29%) women and in 15 of 34 (44%) patients with femoral hernia. Patients presenting with bowel obstruction were significantly older than those with incarceration only and/or uncomplicated presentation, and 13 of 25 (52%) required resection of necrotic bowel. Mortality was limited to five patients of advanced age with groin hernia and bowel obstruction. Four of the five patients had undergone resection of necrotic bowel. Complicated presentations of groin hernias are associated with a higher proportion of women and patients with femoral hernias. Gangrenous bowel was encountered only in those patients with groin hernia and bowel obstruction. Early diagnosis and elective repair of uncomplicated hernias should remain our strategy in patients of all ages.
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PMID:Complicated presentations of groin hernias. 167 Feb 26

A case of recurrent strangulated obturator hernia is presented. The difficulty in diagnosing obturator hernia and the high mortality associated with strangulation are highlighted from a literature review. A high index of suspicion in older patients presenting with intestinal obstruction without an obvious cause, possibly combined with CT scanning of the pelvic region, may lead to earlier diagnosis and operation and a more favourable outcome in such cases.
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PMID:Recurrent strangulated obturator hernia. 175 5

Eighteen patients were examined; they were suffering from small bowel obstruction due to adhesions (7 cases), hernia (3 cases), carcinoma (2 cases), metastasis from melanoma (1 case), radiation enteritis (2 cases), intramural hematoma (2 cases), and peritoneal carcinosis (1 case). CT capabilities in showing the site and the cause of obstruction were evaluated. CT was performed after conventional radiology in 13 cases, while in 5 cases it was the first exam and demonstrated the condition as an occasional finding. In all cases i.v. contrast agents were administered. Filling of the intestinal loop by oral contrast agent was never performed since the hypodense fluid present in the distended intestinal loops allowed good evaluation of intestinal walls. CT always showed the level of the obstruction thanks to the presence of the distended loops (phi: 4-8 cm) above the condition and of collapsed loops below. In 8/18 cases (44%) it was possible to show the cause of the obstruction. Those due to neoplasms, herniae and intramural hematomas were correctly diagnosed. On the contrary, it was not possible to identify the cause of the obstructions due to adhesions, radiation enteritis and peritoneal metastases because of the absence, in such cases, of specific parietal alterations. According to our results, CT is suitable in patients suffering from small bowel obstruction because it allows: to always show the site of the obstruction and, in some cases, its cause; to diagnose closed loop obstructions; to obtain a simultaneous staging in neoplastic patients.
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PMID:[The potentials of computed tomography in the study of mechanical ileus of the small intestine]. 178 Apr 62


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