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

Identifying patients with small bowel obstruction who need operative intervention and those who will fail nonoperative management is a challenge. Without indications for urgent intervention, a computed tomography scan with/without intravenous contrast should be obtained to identify location, grade, and etiology of the obstruction. Most small bowel obstructions resolve with nonoperative management. Open and laparoscopic operative management are acceptable approaches. Malnutrition needs to be identified early and managed, especially if the patient is to undergo operative management. Confounding conditions include age greater than 65, post Roux-en-Y gastric bypass, inflammatory bowel disease, malignancy, virgin abdomen, pregnancy, hernia, and early postoperative state.
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PMID:Small Bowel Obstruction. 3024 55

An 84-year-old woman with a history of weight loss, anorexia and episodic vomiting was admitted to hospital where she died soon afterwards. Her diagnosis was acute renal injury due to dehydration and malnutrition. At autopsy the body was cachectic with a small intestinal obstruction due to herniation through a defect at the anterolateral aspect of the obturator foramen. A poorly differentiated adenocarcinoma of the gastroesophageal junction was also identified with small peripheral pulmonary thromboemboli. Death was due to small bowel obstruction from a left obturator hernia with scattered peripheral pulmonary thromboemboli complicating cachexia due to gastroesophageal adenocarcinoma. Obturator hernias are called the "little old lady's hernia" and occur mainly in elderly, multiparous and malnourished women. The broader female pelvis and wider obturator canal with laxity of ligaments and loss of preperitoneal adipose tissue padding around the canal predispose to herniation. This rare hernia is often first identified at autopsy.
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PMID:Obturator hernia and the elderly. 3039 70

Lung hypoplasia and pulmonary hypertension (PH) in association with congenital diaphragmatic hernia (CDH) may cause fatal respiratory failure. Lung transplantation (Ltx) may represent an option for CDH-related end-stage pulmonary failure. The aim of this study is to report a patient with CDH who underwent Ltx or combined heart-lung transplantation (H-Ltx). Our patient was born at 33 weeks of gestation, with a prenatally diagnosed isolated left CDH. Twenty-four hours after birth, she underwent surgical repair of a type D defect (according to the CDH Study Group staging system). Postoperative course was unexpectedly uneventful, and she was discharged home at 58 days of life. Echocardiography before discharge was unremarkable. Periodic follow-up revealed gastroesophageal reflux (GER) and initial scoliosis. At the age of 10, she was readmitted for severe PH. Lung function progressively deteriorated, and at the age of 14, she underwent H-Ltx due to end-stage respiratory failure. After discharge, she developed recurrent respiratory tract infections, severe malnutrition, and drug-induced diabetes. Scoliosis and GER progressed, requiring posterior vertebral arthrodesis and antireflux surgery, respectively. Bronchiolitis obliterans further impaired her respiratory function, and though she had a second Ltx, she died at the age of 18, 4 and 1.5 years after the first and the second Ltx, respectively. Late-onset PH is an ominous complication of CDH. From our patient and the six further cases collected from the literature, Ltx may be considered as a last-resource treatment in CDH patients with irreversible and fatal respiratory failure, although its prognosis seems unfair.
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PMID:Lung Transplantation for Late-Onset Pulmonary Hypertension in a Patient with Congenital Diaphragmatic Hernia. 3059 54

Spontaneous evisceration is a rare complication that becomes life-threatening in direct inguinal hernia. A female at the age of 44, weighing 50 kg looked cachectic and was suffering from swelling on the left groin for the last several years. The evisceration of the small intestine as separated from the mesenterium transpired in the subsequent stage of a spontaneous rupture in the left inguinal region after severe coughing. The region ruptured was sealed after small intestine resection carried out through the incision perforated; mesh herniorrhaphy was implemented at the end of the 3rd month. The spontaneous rupture may transpire depending on malnutrition and cachexia not only after the complications by hernia, such as incarceration, strangulation but also after factors increasing intra-abdominal pressure. Elective surgical treatment must be implemented in hernia regardless of its kind. Complications likely to transpire in cases where intervention is conducted too late may threaten the patient's life.
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PMID:Spontaneous direct inguinal hernia rupture and intestinal mesenteric separation: A case report. 3258 35


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