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

The authors report a rare complication observed after transhiatal esophagus extirpation performed for esophageal cancer. In this case the transverse colon herniated into the pleural cavity through the esophageal hiatus. Herniation completed on the 6.th. postoperative day and caused mechanical ileus. In the first few postoperative days, radiology pointed to a basal pulmonal infiltrate, later it resembled relaxation of the diaphragm, which was rather misleading. Recognition of the real situation was possible only on the 6.th.postoperative day. The patient was reoperated and the pathological state could be reversed. The esophageal hiatus was reconstructed. In the opinion of the authors the complication may have developed partly due to the opening of the left pleural cavity in the course of extrathoracal esophagectomy, and partly to the fact that the spleen was removed during operation. The outcome after reoperation was uneventful. The authors consider this as a rather rare and instructive case.
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PMID:[A case of unusual complication of diaphragmatic herniation of transverse colon following transhiatal esophagectomy]. 941 24

The aim of this study was to investigate the relative accuracy of megavoltage photon-beam dose calculations employing either 5 bulk densities or independent voxel densities determined by calibration of the CT Houndsfield number. Full-resolution CT and bulk density treatment plans were generated for 70 lung or esophageal cancer tumors (66 cases) using a commercial treatment planning system with an adaptive convolution dose calculation algorithm (Pinnacle3, Philips Medicals Systems). Bulk densities were applied to segmented regions. Individual and population average densities were compared to the full-resolution plan for each case. Monitor units were kept constant and no normalizations were employed. Dose volume histograms (DVH) and dose difference distributions were examined for all cases. The average densities of the segmented air, lung, fat, soft tissue, and bone for the entire set were found to be 0.14, 0.26, 0.89, 1.02, and 1.12 g/cc, respectively. In all cases, the normal tissue DVH agreed to better than 2% in dose. In 62 of 70 target DVHs, agreement to better than 3% in dose was observed. Six cases demonstrated emphysema, one with bullous formations and one with a hiatus hernia having a large volume of gas. They required the additional assignment of density to the emphysemic lung and inflammatory changes to the lung, the regions of collapsed lung, the bullous formations, and the hernia gas. Bulk tissue density dose calculation provides an accurate method of heterogeneous dose calculation. However, patients with advanced emphysema may require high-resolution CT studies for accurate treatment planning.
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PMID:Accurate heterogeneous dose calculation for lung cancer patients without high-resolution CT densities. 1945 88

Gastroesophageal reflux disease (GERD) is the most common gastrointestinal diagnosis recorded during visits to outpatient clinics in west countries. The prevalence of symptom-defined GERD in China is as high as 3% to 5%. Asa dysfunction, GERD is characterized by reflux and heartburn. The pathophysiologic process of GERD is very complicated and subtle. The spectrum of injury from long-term reflux of acid or bile includes damage mucosa, Barrett's esophagus, dysplasia, and esophageal cancer. Therefore, the therapies of GERD should focus on controlling symptom,treating complications, and surveillance the possibility of oncologic transform. As with therapy with proton-pump inhibitors (PPI), modifying lifestyle is another most important modality for most GERD. The window of surgical treatment for GERD is narrow. Surgical therapy is alternative management approach to the patients with PPI failure, complications, or huge hernia. The laparoscopic minimally invasive procedure improves the acceptance of patients to surgical therapy, but the long-term complication and drawbacks of anti-reflux surgery cannot be ignored, and which is even more common than open procedures. The limitations of current therapy for GERD have encouraged a search for more effective treatment.The Linx sphincter augmentation device has been developed to address this gap with improvement of the barrier function of LES and reversible design if necessary.
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PMID:[Treatment of gastroesophageal reflux disease: comments from thoracic surgeon]. 2315 37

A retrocardiac lung hernia is an extremely rare complication after esophagectomy. A 56-year-old man was admitted to our hospital with advanced middle thoracic esophageal cancer and a giant bulla at the apical portion of the right lung. Since it appeared that dissection of the upper mediastinum would most likely require resection of the right bulla, a two-stage operation for esophageal cancer was planned. During the first-stage operation, thoracic esophagectomy and resection of the right giant bulla were performed. Fourteen days after the first-stage operation, the patient underwent laparotomy as the second-stage operation to reconstruct a narrow gastric tube via a retrosternal route. After the second-stage operation, the inflammatory reaction was prolonged. Therefore, a thoracoabdominal computed tomography scan was performed, showing retrocardiac pulmonary atelectasis. The patient was diagnosed with a retrocardiac left lung hernia in which the left lower lobe was displaced into the right thoracic cavity. Because the inflammatory reaction was due to effects of the lung hernia, a repair operation was performed via a left seventh intercostal thoracotomy. At thoracotomy, the left basal segment of the lung was atelectatic and reddish and had herniated into the right thoracic cavity through an opening between the aorta and pericardium. The herniated lung tip adhered strongly to the subcarina, and synechiotomy was performed. We believe that simultaneous removal of the right giant bulla with esophagectomy was the important cause of this complication.
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PMID:Retrocardiac lung hernia after thoracic esophagectomy: report of a rare case. 2636 55

Diaphragmatic hernia was found in a patient who had undergone transhiatal esophagectomy for early esophageal cancer. Chest X-ray was not helpful, but abdominal or chest computed tomography was useful for accurate diagnosis. Primary repair through thoracotomy was performed and was found to be feasible and effective. However, long-term follow-up is required because hernia recurrence is common.
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PMID:Diaphragmatic Hernia after Transhiatal Esophagectomy for Esophageal Cancer. 2752 43

Postoperative diaphragmatic hernia (PDH) is an increasingly reported complication of esophageal cancer surgery. PDH occurs more frequently when minimally invasive techniques are employed, but very little is known about its pathogenesis. Currently, no consensus exists concerning preventive measures and its management. A 71-year-old man underwent minimally invasive esophagectomy for esophageal cancer. Three months later, he developed a giant PDH, which was repaired by direct suture via laparoscopic approach. A hypertensive pneumothorax occurred during surgery. This complication was managed by the anaesthesiologist through a high fraction of inspired O2 and several recruitment manoeuvres. The patient remained free of hernia recurrence until he died of neoplastic cachexia 5 months later. Laparoscopic repair of PDH may be safe and effective even in the acute setting and in the case of massive herniation. However, surgeons and anaesthesiologists should be aware of the risk of intraoperative pneumothorax and be prepared to treat it promptly.
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PMID:Emergency Laparoscopic Repair of Giant Left Diaphragmatic Hernia following Minimally Invasive Esophagectomy: Description of a Case and Review of the Literature. 3029 14

Postoperative diaphragmatic hernia (PDH) is an increasingly reported complication of esophageal cancer surgery. It occurs more frequently with minimally invasive techniques and very little is known about its pathogenesis. Currently, no consensus exists concerning preventive measures and its management. A 36 years old male underwent minimally invasive esophagectomy and presented with chest pain and dyspnoea in the emergency department 8 months after the procedure. He was started on acute coronary syndrome treatment protocol but was later diagnosed on CT scan to have diaphragmatic hernia through a defect in the oesophageal hiatus. As he was already loaded with dual anti platelet therapy it led to qualitative defect of the platelet which resulted in bleeding post procedure and the patient needed resuscitation with blood products. Dual anti-platelet therapy is an integral component of early management strategy in acute coronary syndrome. Chest X-ray was not helpful, but abdominal or chest computed tomography was useful for accurate diagnosis.
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PMID:Massive Haemorrhage In Patient After Repair Of Post Esophagectomy Diaphragmatic Hernia And A Loading Dose Of Clopidogrel. 3063 49

We report the case of a 69-year-old man with a history of esophagogastric junction cancer (Barrett's esophageal cancer; pT1b [SM], N0, M0, pStage IA) that was surgically resected 2 years prior to the present episode. Recurrence was not observed during follow-up. Following complaints of dysphagia and abdominal pain, computed tomography revealed signs of internal hernia. Thus, laparoscopic exploration was performed. Intraoperatively, accumulation of chylous ascites accompanying the internal hernia through the jejunojejunostomy mesenteric defect was observed, which was successfully treated with laparoscopic hernia reduction and defect closure by sutures without intestinal resection. Here, we discuss the case and report that along with previous studies, our study suggests that chylous ascites might be a reliable sign of intestinal viability for herniated intestines.
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PMID:Chylous Ascites Accompanying Internal Hernia after Total Gastrectomy with Roux-en-Y Reconstruction. 3182 37