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

Obturator hernias are relatively rare. In the past 15 years at the Mayo Clinic, eight patients underwent nine operations for repair of 11 obturator hernias, which represented 0.073 per cent (11 of 15,098) of all hernias repaired at this institution. Elderly women with chronic disease were most frequently affected. Symptoms were usually intermittent; mechanical small intestinal obstruction was the most common presenting condition, followed by pain in the thigh or groin area. The Howship-Romberg sign was found in only two patients, and a correct preoperative diagnosis was made in only one patient. Midline abdominal incisions were made in all patients. Incarcerated ileum was the most frequently encountered organ in the hernia sac. Surprisingly, foci of endometriosis in the obturator defect accounted for symptoms in two patients with three obturator hernias. Right-sided obturator hernias outnumbered left, and bilateral obturator hernias were found synchronously in two instances and metachronously in one instance. The often debilitated state of the patients with obturator hernia and the frequent delay of diagnosis combined to produce significant operative morbidity and mortality rates.
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PMID:Obturator hernia. 341 51

Retrosternal (Morgagni) hernias in children are usually asymptomatic or may be associated with mild respiratory distress or gastrointestinal symptoms. Incarceration of bowel in a retrosternal hernia is unusual with only four reported cases, all in adult patients. This report details an unusual case of complete small bowel obstruction in which the Morgagni hernia sac itself contained the defect through which a portion of small bowel incarcerated as a Richter's hernia.
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PMID:Retrosternal (Morgagni) hernia with small bowel obstruction secondary to a Richter's incarceration. 343 Mar 23

Intestinal malrotation has received, so far, little attention in the Spanish medical literature. This is probably due to the fact that is variable forms of clinical presentation may be overlooked during infancy and childhood and be present or not later in adult life. This is a report on 33 patients between 1 week and 8 years old operated upon, from 1965 to 1985, at the Clinica Infantil "La Paz", Madrid, with pre or postoperative diagnoses of intestinal malrotation (patients with Bochdalek's hernia, omphalocele and gastrosschisis are excluded). Midgut volvulus has been the most frequent preoperative complication and has occurred in 50% of patients. Intestinal obstruction was the most frequent clinical presentation, specially in patients under one week of age. There was a 30% figure of associated malformations, mostly of the duodenojejunal area (atresia, diaphragm, anular pancreas). All 5 deceased patients had other associated malformations. Long term survival was 85%.
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PMID:[Intestinal malrotation in children]. 343 61

Living related donor (LRD) nephrectomies are controversial due to the risks to the donor and improved cadaveric graft survival using cyclosporine A. Between December 22, 1970, and December 31, 1984, 1096 renal transplants were performed at a single institution, 314 (28.6%) from LRD. The average age was 34.3 years (range: 18-67); none had preoperative hypertension. All nephrectomies were performed transabdominally. Major perioperative complications occurred in 22 (7.0%). These include wound infections (3.5%), pancreatitis (1.0%), injuries to spleen (1.0%) or adrenal gland (0.3%) requiring removal, pneumonitis (0.6%), ulnar nerve palsy (0.6%), femoral artery thrombosis after arteriogram (0.3%), pulmonary embolus (0.3%), and upper pole infarct of contralateral kidney (0.3%). There are six known deaths in this series, none of which were related to the operation. Major late complications were seen in 50 (20.0%) of 250 patients followed for 6 to 175 months (mean 53.1 months). These included definite hypertension (5.6%), suture granuloma (4.4%), incisional hernia (3.6%), proteinuria (2.4%), bowel obstruction (2.0%), nephrolithiasis (1.2%), wound infection (0.4%), scrotal hydrocele (0.4%), and chronic pancreatitis (0.4%). While the risk of hypertension appears to increase as the interval from donation increases, no cases of renal failure after donation have been noted, and negligible proteinuria among those followed long-term has been seen in this series. It is felt that living related kidney donation is justified when the relative is sincerely motivated and well informed prior to donation.
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PMID:Living related kidney donors. A 14-year experience. 352 9

A radiological diagnosis of gastric volvulus (GV) was made in 11 of 576 consecutive upper gastrointestinal series at the University of Benin Teaching Hospital, Nigeria, over a two-year period. The clinical symptoms were thoracico-abdominal in three and abdominal in eight; these cases were evaluated as acute in three, acute upon chronic in two, and chronic in six. There was a significant delay in the diagnosis in all cases (except a neonate in the series), and no case was diagnosed on clinical grounds alone.THE PREDISPOSING FACTORS (EXCEPT THE CLINICAL MISDIAGNOSIS OF THE NEONATE) IN SIX OF THE SEVEN CASES THAT CAME TO SURGERY WERE: diaphragmatic hernia and perigastritis (left lung abscess, thoracic empyema), arteriomesenteric compression of the duodenum in pregnancy (peptic ulcer), splenomegaly (hepatosplenomegaly, ascites, esophageal varices), previous gastrojejunostomy (stomal ulcer, left subphrenic abscess) and two cases of intestinal malrotation with mesenteric abnormalities (small bowel obstruction in one and duodenal atresia in the other). In one idiopathic case, gastric outlet obstruction was clinically suspected prior to surgery. Thus, the putative rarity of GV in black Africans is not supported by this experience.Gastric volvulus is a clinico-radiologic entity that may present with a confusing thoracico-abdominal symptom complex. A greater awareness of the radiologic features is quintessential to an expeditious and usually successful surgical management that will avoid potentially serious complications. Negative surgical findings do not exclude GV as the underlying cause of acute abdomens necessitating emergency laparotomies.
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PMID:Volvulus of the stomach: an African series and a review. 356 Feb 44

Internal hernias of a developmental nature are an uncommon cause of intestinal obstruction. Among the rarest of internal hernia is that which involves a defect in the broad ligament of the uterus. The case report of an elderly lady who had herniation of small bowel through a defect in the left broad ligament is presented.
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PMID:Internal herniation through a defect in the broad ligament. 357 36

The object of this study is to focus attention on the causes of intestinal obstruction in Libya. In this study, spread over 30 months and involving 114 patients, the most common cause was the entrapment of bowel in an external hernia. Postoperative adhesions accounted for obstruction in a third of our patients, and 59 per cent of them followed appendicectomy. Biliary lithiasis is the most common surgical disease in Libya, yet there was only one instance of gallstone ileus in this series. Sigmoid volvulus and intestinal lymphoma were also rare, and tubercular stricture and Crohn's disease were remarkable by their absence. There were no cases of idiopathic intussusception during or immediately following Ramadan.
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PMID:Major causes of intestinal obstruction in Libya. 358 Aug 11

A review of 52 consecutive cases of congenital diaphragmatic hernia composed of 36 cases of Bochdalek hernia (B.H.) 13 of diaphragmatic eventration (D.E.), and 3 of diaphragmatic agenesis (D.A.) is reviewed critically. The operative mortality rate in Bochdalek hernia was 8.3% but became 20% with reference to the 15 infants with B.H. operated in the first 24 hrs. of life and 31.5% with reference to all 19 infants requiring repair of the diaphragmatic defect during the first day after birth. The operative mortality in D.A. was 100% and was nil in D.E. The mortality appeared related directly to prematurity, early age at operation, preoperative hypoxemia (PaO2 less than or equal to 60), hypercarbia, (PaCO2 greater than or equal to 60), and acidosis (pH less than or equal to 7.0), association with life-threatening anomalies affecting the lungs and its vessels, the heart, the size of the diaphragmatic defect and of the celomic cavity, the postoperative development of NEC and of obstructing intestinal adhesions. Eight of the 33 survivors (24%) with B.H. developed intestinal obstruction secondary to adhesions 2 months to 14 years after operation, of whom 7 required surgical intervention, and 3 bowel resections. The total mortality rate in B.H. was 14% and the rate in this series of combined defects was 15%.
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PMID:Congenital diaphragmatic hernia and eventration. 361 33

A 22-year-old man with an incarcerated left paraduodenal hernia is described. Symptoms included nausea, vomiting, cramp-like abdominal pain and obstipation. A clinical diagnosis of mechanical small-intestinal obstruction was made on the history, examination, and abdominal radiographic findings. At laparotomy successful manual reduction was achieved, resection was not required and the patient made an uneventful recovery.
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PMID:Left paraduodenal hernia with acute abdominal symptoms. A case report. 373 64

Fourteen cases of small bowel obstruction caused by congenital or postoperative internal herniation of bowel and treated at the University and Veterans Administration Medical Centers, Jackson, Mississippi between 1970 and 1983 were reviewed retrospectively. Of the total, eight were congenital (three transomental, two paraduodenal, one foramen of Winslow, one ileocecal transmesenteric, and one paracecal) and six acquired (three transmesenteric, one behind a Roux-Y esophagojejunostomy, one behind a Roux-Y pancreaticojejunostomy, and one between limbs of an end colostomy mucous fistula). Gangrenous bowel was present at exploration in nine cases (64 percent, five congenital and four acquired). In no case was a correct preoperative diagnosis of incarcerated or strangulated internal hernia made. In each patient, except for one who died before celiotomy could be performed, reduction of the hernia contents, resection of necrotic bowel, primary anastomosis or, on occasion, enterostomy, and correction of the anatomic defect leading to the herniation were performed. Postoperative mortality was 31 percent (four patients). Each of the four patients had presented initially with gangrenous bowel. The clinical features and management of congenital and acquired internal hernias have been reviewed and correlated with therapeutic outcome. In addition, the difficulties in diagnosis and the features of various types of these hernias have been discussed with comments made regarding prevention of the acquired forms of these rare hernias, along with the embryologic background and methods of management of the various congenital defects.
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PMID:Congenital and acquired internal hernias: unusual causes of small bowel obstruction. 375 77


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