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

Neonatal infants who require total parenteral nutrition (TPN) after major operations are susceptible to total parenteral nutrition-associated cholestasis (TPNAC). A therapeutic dilemma ensues if cholestasis does not resolve after the institution of full enteral nutrition. The authors report the reversal of TPN-associated cholestasis by intravenous cholecystokinin in eight infants who had undergone major surgery during the neonatal period. The indications for surgery were necrotizing enterocolitis in three patients, midgut volvulus in one, gastroschisis in one, diaphragmatic hernia in one, necrosis of the stomach in one, and cardiac anomaly in one. Four of the infants were premature. Median duration of TPN was 25 days (range, 20 to 150 days). Seven patients were weaned from TPN before treatment with cholecystokinin was instituted Mean duration of pretreatment full enteral nutrition in these seven patients was 35 days (range, 20 to 55 days). One girl with short gut syndrome tolerated only 10% of her caloric needs via the enteral route. All patients had alcoholic stools, conjugated hyperbilirubinemia, no excretion of Technetium-labeled HIDA to the biliary tree or duodenum (six patients), and significantly elevated liver enzyme values. In three patients, echography showed biliary sludge or stones in the gall bladder. Porcine cholecystokinin (2 IDU/kg) was administered intravenously for 3 to 5 days. If the stool color did not normalize, cholecystokinin injections were repeated using a larger dose (4 IDU/kg). In seven patients, including the girl with short gut syndrome, the clinical jaundice and conjugated hyperbilirubinemia completely resolved within 1 to six weeks. No biliary sludge or stones were seen in the posttreatment echography in any of the patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Total parenteral nutrition-associated cholestasis in surgical neonates may be reversed by intravenous cholecystokinin: a preliminary report. 766 17

Stabilization and delayed operation for patients with congenital diaphragmatic hernia (CDH) is now widely accepted. When preoperative extracorporeal membrane oxygenation (ECMO) is needed, most centers have CDH repaired on ECMO to minimize the risk of postoperative deterioration. The authors adopted a policy of weaning from ECMO before repair in an effort to avoid hemorrhagic risks. They reviewed their experience with CDH patients who required ECMO for stabilization before repair but for whom post-ECMO repair was planned. The records of all high-risk CDH patients with a gestational age of at least 34 weeks were reviewed. Eighteen patients were identified. None of the eight who were stabilized and operated on without ECMO required bypass postoperatively; all survived. Ten were placed on bypass, nine for stabilization before repair. Of the nine, seven (78%) were weaned from ECMO to conventional ventilation. Repair of the diaphragmatic defect was performed an average of 3.8 days later; none of these patients had severe pulmonary hypertension postoperatively, and all survived. Two could not be weaned before repair, one of whom had a complex congenital heart defect. This patient died. The other patient had repair on ECMO because of intrathoracic gastric volvulus. Severe blood loss prompted decannulation, and the patient died. One patient who was placed on bypass was transferred 10 days after having had repair elsewhere (at 4 hours of age). Pulmonary hypertension did not resolve, and the postmortem examination showed alveolar capillary dysplasia, with focal misalignment of the pulmonary vessels.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Repair of congenital diaphragmatic hernia after weaning from extracorporeal membrane oxygenation. 773 64

Abdominal hernias are a common clinical problem. The main types of abdominal hernias are external or abdominal wall hernias, which involve protrusion of abdominal contents through a defect in the abdominal wall; internal hernias, which involve protrusion of viscera through the peritoneum or mesentery and into a compartment in the abdominal cavity; and diaphragmatic hernias, which involve protrusion of abdominal contents into the chest. Clinical diagnosis of abdominal hernias can be difficult. However, plain radiography, radiography performed after administration of barium, and computed tomography allow evaluation of suspected abdominal hernias and detection of those that are clinically occult. The anatomic location of the hernia, the contents, and complications such as incarceration, bowel obstruction, volvulus, and strangulation can be demonstrated with radiologic examination. Occasionally, complications such as neoplasms or inflammatory conditions can be identified in the hernial contents. With abdominal imaging modalities, a variety of abdominal hernias can be confidently diagnosed.
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PMID:Imaging of abdominal hernias. 776 39

A case of gastric volvulus resulting from the migration of the stomach and the transverse colon into the right thorax via the Larrey or Morgagni foramen is reported. The anatomy of the Morgagni foramen and a brief description of the resulting hernias is presented. This rare hernia is usually occurs as a complication or during examinations. Surgical treatment is relatively simple via the abdominal route.
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PMID:[Gastric volvulus disclosing diaphragmatic hernia]. 776 29

Malrotation in the neonate is an anomaly for which there are clear indications for surgery. However, the management of the older patient with this entity is not well defined. At Arkansas Children's Hospital, we reviewed our patients who were older than two years of age with malrotation. Between 1978 and 1993, 22 cases ages 2-23 years were identified. The most common presenting symptoms were vomiting 15 (68%), colicky abdominal pain 12 (55%), and diarrhea 2 (9%). Other symptoms were hematemesis 1 (5%), and constipation 1 (5%). The duration of symptoms averaged 28 months, range 2-96 months. All diagnoses were made by upper gastrointestinal (UGI) series, except for one that was recognized during an exploratory laparotomy for an intestinal duplication. A Ladd's procedure with appendectomy was performed in all cases. A significant number of patients in our series (41%) were found to have either a volvulus or internal hernia at exploration that was not clearly demonstrated by the diagnostic studies. Intestinal resection was performed in two patients for ischemic bowel. There were no perioperative deaths. Postoperative complications consisted of a wound infection in one patient. Total relief of symptoms occurred in 64% of patients. All patients with volvulus or internal hernia had resolution of symptoms, and all patients reported partial relief of their chronic symptoms. Surgical therapy eliminates the possibility of loss of bowel from volvulus or internal hernia, which is not always evident on diagnostic radiographic examination. Surgery is also highly effective in alleviating the chronic symptoms in these children. We believe, therefore, that surgical treatment is clearly indicated in the older child with proven malrotation.
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PMID:Malrotation in the older child: surgical management, treatment, and outcome. 785 73

Conduit volvulus is a very rare complication of ileal loop diversion. To date it has not been described in association with parastomal herniae. We report two such cases. Antegrade nephrostogram established the diagnosis and nephrostomy drainage facilitated spontaneous resolution of the volvulus with return to baseline renal function in both patients. Percutaneous drainage was the only intervention required in one case. For the second patient, percutaneous decompression permitted elective surgical refashioning of the conduit following clinical stabilization. Conduit volvulus in association with a parastomal hernia is a potentially reversible cause of renal impairment in patients with urinary diversions. The diagnosis depends on accurate radiological evaluation. The initial treatment of choice is percutaneous drainage with elective surgery when the patient's clinical status has improved.
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PMID:Ileal loop conduit volvulus: a rare but reversible cause of bilateral ureteric obstruction. 788 10

The article deals with experience in surgical treatment of 375 patients with various diseases of the small intestine, rare diseases (tuberculosis, enterolithiasis, tumors, etc.) among others. These diseases were usually manifested clinically in the late stages by ileus, peritonitis or bleeding into the gastrointestinal tract. Most patients with surgical diseases of the small intestine were subjected to operation for emergency indications. Such instrumental methods as laparoscopy, selective endoscopic radiocontrast study of the small intestine, angiography, etc. are important in the diagnosis of the diseases. The authors emphasize the high diagnostic efficacy of a special method of selective endoscopic radiocontrast study, especially in tumors of the small intestine. According to the authors, general mortality rate in diseases of the small intestine is high (13%) and is mainly due to such diseases as disorders of mesenteric blood circulation, incarceration of the intestine in a hernia, adhesive obstruction, volvulus, etc. The authors claim that mortality in diseases of the small intestine can be reduced if early diagnosis, early hospitalization, and adequate surgical interventions are ensured. Among the factors contributing to increase of the efficacy of surgical operations the authors indicate efficacy of surgical operations the authors indicate precision techniques of intestinal suture application with atraumatic suture material, the use of complex biological protection of the anastomosis including treatment with low-frequency ultrasound and subsequent application of collagenic films in which antibacterial agents are deposited, and measures for stimulating reparative regeneration.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Surgical treatment of diseases of the small intestine]. 808 66

A massive incarcerated hiatal hernia is a frequent finding in elderly people. The aim of this report has been to review from 1987 to 1992 the clinical aspects, therapeutic options and results of surgical treatment in a series of twenty-eight patients (23 females and 5 males) with a large incarcerated hiatal hernia. Age averaged 66 +/- 10 years; thirteen patients (46.5%) had a sliding type of hernia, 8 (28.5%) a mixed one, and 7 (25%) a paraesophageal hernia. In 9 patients (32%) there was a chronic volvulus of the incarcerated stomach. Twenty-seven patients underwent elective repair; one patient developed a perforated gastric ulcer into the pericardial sac with pneumopericardium and died before surgery. The surgical technique included reduction of the hernia, closure of the hiatus and an antireflux procedure (Nissen 25, Toupet 1 and Dor 1). There was no mortality and the morbidity (18%) was not directly related to the surgical procedure. In our series there were no cases of acute volvulus requiring emergency surgery. Our results suggest that surgical correction of massively incarcerated hiatal hernias is well tolerated in the elderly, it relieves symptoms, and avoids potential serious complications.
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PMID:[Incarcerated giant hiatal hernia]. 812 90

Acute gastric volvulus occurred in nine infants and one older child during the past 19 years; all patients had an associated left diaphragmatic anomaly. There were seven examples of eventration of the diaphragm, two of giant hiatal hernia and one Bochdalek hernia. Nine of the ten patients presented with vomiting and one with acute respiratory distress. The gastric volvulus was mesenteroaxial in eight patients and organoaxial in two. Operative treatment consisted of repair of the diaphragmatic anomaly and gastric fixation in eight patients. Gastric fixation alone was performed in one patient. A single patient died preoperatively and had gastric necrosis at postmortem examination. Of the nine patients treated operatively, all remain alive and well without recurrence. Acute gastric volvulus should be considered in any infant presenting with unexplained vomiting in association with a left diaphragm anomaly, and once diagnosed, immediate operation is mandatory.
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PMID:The pediatric diaphragm in acute gastric volvulus. 814 14

This is the report of a newborn girl who was treated by "trial of life" before surgical repair of her left-sided diaphragmatic hernia. Surgery was performed 60 hours after birth, at which time she was found to have an organo-axial volvulus of the stomach. Her postoperative course was complicated by a jejunal perforation on the fourth postoperative day, necessitating another laparotomy.
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PMID:Potential danger of 'trial of life' approach to congenital diaphragmatic hernia. 820 7


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