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

Colonic pseudo-obstruction (Ogilvie's syndrome) may occur in surgical patients, particularly those who have had orthopedic or blunt trauma, have uremia or diabetes, have complex metabolic or cardiac failure, have metastatic cancer involving the lymph nodes and neural tissue, or are addicted to narcotics. Although a single true cause has not been identified by fulfilling Koch's postulates, the clinical pattern has been recognized in a variety of surgical patients, and this pattern must be distinguished from true obstruction of the colon. Tumor or internal hernia may constitute an obstruction, but the important differential diagnosis of cecal volvulus must be excluded. Ischemic colitis may be confused with Ogilvie's syndrome or may follow it. Gangrene, infarction, and perforation may ensue as colon diameter increases and particularly if cecal distention reaches above 14 cm. This arbitrary number for cecal dilatation should not be awaited before treatment is instituted if signs of devitalization of the gut or peritoneal signs have developed in the patient. Treatment has changed recently with the widespread application of colonoscopy. Endoscopy is helpful in relieving distention but may also be dangerous in the patient with a massively distended colon, particularly at the level of the thin-walled cecum. Colonoscopy also appears to be associated with a high rate of treatment failure and recurrence. Surgical decompression may take the form of cecostomy or may require exteriorization or resection of the colon if infarction has occurred. A series of 12 patients has been presented. The patients were all referred to a single surgeon in a university medical center over a 4 1/2 year period with clinical patterns not suggestive of a common cause but a similar clinical evolution of Ogilvie's syndrome. The prognosis for such patients in whom the complication is recognized early and in whom decompression is performed endoscopically or surgically is encouraging. If recognition is late and particularly if perforation and gangrene result, mortality is nearly 50 percent.
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PMID:Colonic pseudo-obstruction in surgical patients. 397 Mar 26

This retrospective analysis of 140 continuous ambulatory peritoneal dialysis patients followed during a 4 year period revealed a 5 percent incidence of abdominal wall hernias. Inguinal hernias were frequently manifested as unilateral scrotal swelling. Hernias too small to be appreciated by physical examination were easily demonstrable with intraperitoneal instillation of technetium 99m sulfur colloid through the continuous ambulatory peritoneal dialysis catheter. This procedure was also useful when differentiating dialysate leaks from inguinal hernia in the early and late postoperative periods. Recurrences developed in 27 percent of the herniorrhaphies. Factors contributing to the development of abdominal wall hernias in continuous ambulatory peritoneal dialysis patients include uremia, obesity, anemia, and chronically elevated intraperitoneal pressures.
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PMID:Abdominal wall and inguinal hernias in continuous ambulatory peritoneal dialysis patients. 403 96

Urethral stricture in the tropics may be a serious public health problem; the majority of cases are caused by the gonococcus. The pathology is varied, and many advanced cases with complications are seen. Most strictures are seen in the posterior urethra, where fibrosis and narrowing may extend from a short length of under 5 mm to well over 10 cm. A wide variety of complications occurs. Diagnosis is easy when the patient presents in acute retention or with a history of difficult micturition, but more difficult when stricture is the underlying cause of perianal abscess, gangrene of the scrotum caused by extravasation, uremia or hypertension, hernia or rectal prolapse, urinary infection, or elephantiasis of scrotum with multiple fistulae. A careful history is helpful, paricularly if previous gonorrhea is involved. Physical examination varies according to mode of presentation and complications; a rectal examination and neurological examination should be included. Definitive investigation to prove the presence of a stricture includes urethrography and urethroscopy, if facilities are available. Indirect methods of diagnosis include tests for hemoglobin, blood urea, plain X-ray of the whole urinary tract, urinalysis, and others. It is preferable to leave instrumentation until last in diagnostic cases, to avoid infection, but a diagnostic bougie may be passed under strict aseptic conditions prior to treatment. The mainstay of treatment is regular bouginage for life, which is best done in a bougie clinic held at regular intervals. Equipment for bouginage, in order of desirability, includes soft plastic bougies, straight metal bougies, or curved metal bougies in larger sizes, a large stainless steel instrument tray, a basin for sterile water, and lubricant. Care should be taken during bouginage not to pass bougies into acutely inflamed strictures, and not to overstretch the urethra. Plastic bougies are preferable, until a stable situation has been reached. Surgery is indicated for a persistently impassable stricutre, for 1 requiring difficult bouginage at frequent intervals with many failures, for an established false passage, and for complications, especially bladder neck stenosis. Instructions for intravenous pyelograms and for urethrography from below and above, and diagrams of urethrograms indicating various pathological states and a diagnostic schema for urethral stricture are included.
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PMID:Urethral stricture. 469 33

Home peritoneal dialysis has recently become an important addition to the therapy of chronic renal failure. Abdominal wall hernias have become more apparent as complications of this mode of dialysis, with isolated instances of incarcerations and one fatality. Results of our review of 276 patients receiving peritoneal dialysis revealed seven with hernias, an incidence of 2.5 per cent. Six patients with hernias were receiving c.a.p.d.; one patient was receiving c.c.p.d., and none was receiving i.p.d., for incidences of 17, 5 and zero per cent, respectively. All hernias found at presentation occurred within two to 20 months after peritoneal catheter placement. Most were ventral or umbilical, and all were repaired electively without serious complications. All patients with hernias had associated problems with leaks, peritonitis or predialysis hernias. In two of four patients with predialysis hernias, herniorrhaphy without catheter removal resulted in two recurrences. Abdominal wall hernias are a more frequent complication of c.a.p.d. and c.c.p.d., modalities which require large volumes of peritoneal dialysate during ambulatory hours. Review of the literature reveals that wound tensile strength and healing are decreased in those patients having renal disease with uremia, anemia and malnutrition. However, these factors do not increase the over-all incidence of hernias. Patients should be screened for hernias, and hernias should be repaired prior to catheter placement. Hernias presenting during dialysis are best treated by herniorrhaphy and hemodialysis postoperatively or low volume peritoneal dialysis to optimize the metabolic state.
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PMID:Abdominal wall hernias as a complication of peritoneal dialysis. 664 75

A case is presented in which a giant scrotal hernia contained intestines together with the whole bladder, prostate, urethra and both ureters. Their compression by intestines caused uremia. After reconstruction of the normal anatomy the renal function improved and the man became able to work.
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PMID:[Uremia caused by giant scrotal hernia and bladder herniation (author's transl)]. 719 24

Controversy still exists as to whether peritoneal dialysis (PD) treatment can be safely continued after herniotomy. Many nephrologists withhold PD treatment for several weeks after herniotomy for fear of dialysate leakage and hernia recurrence. Here, we report on 9 patients (2 women, 7 men) in whom herniotomy was performed for umbilical (n = 3), inguinal (n = 5), or cicatricial hernia (n = 2), or for open processus vaginalis (n = 2). Surgery was performed according to the Lichtenstein method with insertion of a polypropylene mesh and ligation of the hernia sac. In all patients, PD treatment was paused for the day of surgery and for 1-3 days postoperatively, depending on residual renal function. Over the next several days, low-volume (1.0-1.5 L), high-frequency (6 per day) exchanges were started. The patient's original PD regimen was gradually reinstated over the next 2-4 weeks. All patients recovered rapidly, with no uremia or dialysis-related complications. Particularly, no leakage and no hernia recurrence could be observed 3 months thereafter. None of the patients had to be hemodialyzed intercurrently. In conclusion, continuing a modified regimen of CAPD treatment after herniotomy seems to be safe, with excellent patient comfort.
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PMID:Sustaining continuous ambulatory peritoneal dialysis after herniotomy. 1151 Mar 4

There is still controversy as to whether PD-treatment can be safely continued after herniotomy (HT). Many nephrologists withhold PD-treatment for several weeks after HT in fear of dialysate leakage and/or hernia recurrence. We report on 12 patients (2 women, 10 men) in whom HT was performed either for umbilical (n = 6), inguinal (n = 6) or open processus vaginalis (n = 3). Surgery was performed according to the Lichtenstein method with insertion of a Marlex-mesh and ligation of the hernia sac. In all patients PD treatment was paused for the day of surgery and 1 to 3 days postoperatively, depending on RRF. Low volume (1.0 to 1.5 l) and high frequency exchanges (6 exchanges per day) were started for several days with a gradual reinstitution of the former PD-regimen within the next 2 to 4 weeks. All patients did well rapidly with no uraemia-or dialysis-related complications. No leakage and no hernia recurrence could be observed 3 months thereafter. None of the patients had to be haemodialysed intercurrently. In conclusion, continuing a modified regimen of PD-treatment after HT seems to be safe and comfortable for the patient.
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PMID:Continuing CAPD after herniotomy. 1263 31

We successfully used argon plasma coagulation (APC) to treat two cases of dialysis patients with hemorrhagic gastric angiodysplasia. Gastric angiodysplasia is recognized as an important cause of gastrointestinal bleeding. Angiodysplastic lesion confined to the gastric antrum was first described in 1953 and named gastric antral vascular ectasia (GAVE). The condition is characterized as submucosal capillary dilatation and fibromuscular hyperplasia. The typical finding of GAVE is the so-called watermelon stomach, attributable to vasodilatation. In case 1, a 69-year-old man was introduced continuous ambulatory peritoneal dialysis (CAPD) in July 1997 because of chronic renal failure due to nephrosclerosis. He was hospitalized for severe anemia in December 1997. Gastrointestinal fiberscopy (GIF) showed oozing in the antrum, and gastritis and esophagitis with sliding hernia. Famotidine was started and recombinant human erythropoietin (rHuEPO) was used for anemia. However, the severe anemia did not improve. The patient was hospitalized again for severe anemia and hematemesis. Another GIF showed typical watermelon stomach, which corresponded with GAVE. An APC was performed without complications. Three months later, the anemia was improved, and the dose of rHuEPO was reduced. In case 2, a 57-year-old woman was introduced to hemodialysis in 1998 for uremia due to nephrosclerosis. In October 2000, she was hospitalized for rHuEPO-resistant anemia. A GIF showed oozing in the antrum with diffuse vasodilation in the antrum; GAVE was diagnosed. An APC was carried out without complications. Three months later, anemia was improved. Recently, gastric angiodysplasia was reported to be an important complication in dialysis patients and was recognized as an important cause of rHuEPO-resistant anemia. Argon plasma coagulation is an effective treatment for gastric angiodysplasia in patients on dialysis.
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PMID:Gastric angiodysplasia in patients undergoing maintenance dialysis. 1476 50

Surgical treatment of giant abdominal hernias includes reduction of the hernia content and tension-free closure of the abdominal wall. Initial laparoscopy simulates the postoperative abdominal wall tension. Recognizing the need for a preoperative pneumoperitoneum in cases of chronic eventration may help to avoid "abdominal catastrophes" including bowel resection, abdominal compartment, and extended abdominal wall reconstruction. We report a 66-year-old man with an asymptomatic long-standing giant scrotal hernia who was admitted with sepsis and uremia caused by intestinal obstruction.
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PMID:[Pneumoperitoneum in surgical management of giant scrotal hernias]. 1639 76

Management of patients undergoing dialysis after inguinal hernia surgery has not been standardized. This report presents the results of 9 patients with inguinal hernias (11 hernias) who were undergoing continuous ambulatory peritoneal dialysis (CAPD). All patients treated in this hospital since 2007 have returned to CAPD within 3 days after surgery without switching to hemodialysis (HD). The mean durations for resuming CAPD after surgery were 7.6 days from 1998 through 2007 and 2.3 days since 2008. The surgical procedure was performed with a polypropylene mesh in all cases. Local anesthesia was utilized for one patient with low cardiac function. All patients recovered rapidly, with no uremia or dialysis-related complications. No leakage or hernia recurrence was observed over the subsequent observation period (56.2 months). This experience suggests the possibility that interim HD can therefore be skipped in patients undergoing CAPD if the hernia sacs are closed tightly. Local anesthesia seems to be safe for high-risk hernia patients undergoing CAPD.
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PMID:Perioperative management of continuous ambulatory peritoneal dialysis patients undergoing inguinal hernia surgery. 2126 73


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