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

Objective: A simplified method of cesarean delivery aimed at minimizing postoperative morbidity is illustrated.Methods: Two hundred consecutive cesarean deliveries were performed by the authors' simplified cesarean technique. Mean patient age was 27 years (range 17-46), and mean weight was 169 pounds (range 112-414). Indications for cesarean delivery included dystocia or failure to progress in labor (38%), repeat cesarean (32%), malpresentation (11.5%), fetal distress (9.5%), and other (9%).Results: Simplified cesarean delivery was successfully completed in all cases. Mean operating time was 16 minutes (range 9-33), mean blood loss was 460 mL (range 100-1150), and mean postsurgical hospitalization time was 72 hours (range 36-120). No bowel, bladder, or vascular injuries occurred. Postoperative febrile morbidity occurred in one patient (0.5%), ileus occurred in one patient (0.5%), and blood transfusion was administered to one patient (0.5%). No cases of wound infection, wound dehiscence, hematoma, or incisional hernia occurred. All patients were ambulatory on the first postoperative day. All but one patient (99.5%) tolerated a regular diet on the first postoperative day.Conclusions: The authors' technique of cesarean section appears to be a safe and efficient method for cesarean delivery associated with minimal postoperative infectious morbidity and rapid resumption of bowel and ambulatory function.
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PMID:Simplified cesarean section: a strategic surgical approach to minimize postoperative infectious morbidity. 1083 69

We report the case of a 6-month-old female infant who developed post-operative bowel obstruction due to an incarcerated hernia through a 5-mm laparoscopic wound. The patient underwent laparoscopic Nissen fundoplication for gastroesophageal reflux. On day 6, she showed symptoms of ileus, and the diagnosis of a trocar wound hernia was made on day 13. The herniated intestine was reduced and the defective peritoneum and fascia were closed under relaparoscopic guidance, thus avoiding full-scale laparotomy. A trocar wound hernia causing early postoperative bowel obstruction is a rare complication, especially at 5-mm trocar puncture sites. Intraoperative dislodgment and reinsertion of working trocars may create fascial defects larger than the actual size of the trocar. All laparoscopic puncture wounds, even those <10 mm in size, should be closed at the fascial level in infants. Revision laparoscopy is considered preferable to manage trocar site complications in children.
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PMID:Revision laparoscopy for incarcerated hernia at a 5-mm trocar site following pediatric laparoscopic surgery. 1087 Nov 81

The herniation of small bowel through Winslow's foramen is a rare type of internal hernia which can cause ileus; however, a hernia traversing the lesser sac is even more unusual. To the best of our knowledge, only 25 cases of herniation through Winslow's foramen and 10 cases of lesser sac hernia have been reported in the Japanese literature. We describe herein the case of a 33-year-old man who presented to our hospital complaining of abdominal pain in whom a plain abdominal radiograph revealed small bowel gas with air-fluid levels, suggesting ileus. Following admission, an ileus tube was inserted, but the intestinal shadow did not improve and surgery was performed based on suspicion of an internal hernia. Approximately 100 cm of ileum was found to have herniated through a defect in the lesser omentum after passing through Winslow's foramen. Since the herniated bowel was viable, manual reduction without resection was performed. The patient had a satisfactory postoperative course, and was discharged on postoperative day 11. There are many unknown aspects surrounding the etiology of Winslow's foramen hernia and lesser sac hernia, and although internal hernia is a rare cause of ileus, its possibility should be kept in mind.
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PMID:Herniation through both Winslow's foramen and a lesser omental defect: report of a case. 1088 69

We report herein the case of a 6-year-old boy in whom a strangulated ileus was caused by a traumatic transmesenteric hernia. The boy had fallen from his bicycle and suffered a severe blow to the abdomen. Abdominal pain and vomiting developed 10 h after the accident and he was admitted to our hospital. Abdominal ultrasonogram and computed tomogram demonstrated ascites, intestinal wall thickening with fluid, and an engorged radiating mesenteric vasculature. Thus, an emergency laparotomy was performed which revealed bloody ascites, a strangulated ileus, and torsion with a transmesenteric hernia. The necrotic intestine was resected and an anastomosis was performed. Macroscopic and microscopic findings revealed a traumatic mesenteric rent. The unusual presentation of this case is discussed.
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PMID:The occurrence of a strangulated ileus due to a traumatic transmesenteric hernia: report of a case. 1088 70

We report the case of a 54-year-old woman who developed epigastralgia and vomit. Because of the abnormal gas in the epigastrium on abdominal X-ray, ileus due to foramen of Winslow hernia or left paraduodenal hernia was suspected. However, abdominal CT and barium study revealed the gas in the epigastrium to be the air in the transverse colon interposed between the stomach and pancreatic body. This anomalous interposition of the transverse colon is called retrogastric colon. The ileus was due to non-specific inflammatory duodenal stenosis. It is important to prevent misdiagnosis of retrogastric colon as lesser sac pathologic condition such as abscess, bowel perforation and internal hernia.
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PMID:[Retrogastric colon mimicking foramen of Winslow hernia or left paraduodenal hernia: case report]. 1096 51

We report herein the case of a 65-year-old woman who was referred to our department with prolonged ileus symptoms despite conservative therapy. A plain abdominal radiograph showed intestinal gas shadows with an air-fluid level in the lesser curvature of the stomach. As no improvement was achieved by the insertion of a short tube, a long tube was inserted. A loop formation of the long tube in the subphrenic region was detected on an abdominal radiograph, and an enterogram showed an interruption in the ileum in the lower abdomen. The patient was diagnosed as having an adhesional ileus and a strangulated ileus due to a lesser sac hernia. A laparotomy was performed which revealed that the small intestine had herniated into the lesser sac space through a hiatus of Treitz' fossa and a hiatus in the transverse mesocolon. Furthermore, part of the small intestine had herniated through an omental hiatus. The herniated intestine was manually reduced and the hiatus was closed. However, as the right ovary was found to have adhered to the ileum and stenosis was seen, we were forced to perform partial resection of the ileum. Considering that this patient had no history of laparotomy in the upper abdomen, abdominal injury, or acute abdomen, it was surmised that the three abnormal hiatuses were congenital.
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PMID:Internal hernia with triple hiatus of congenital origin: report of a case. 1105 42

Recently, laparoscopically assisted bowel resections have been shown to be less morbid than the traditional laparotomy, especially for benign conditions such as Crohn's disease. While reports describing laparoscopically assisted bowel resections use a small midline or right transverse incision, we describe a novel laparoscopically assisted approach employing a Pfannenstiel incision for Crohn's patients. We attempted the Pfannenstiel incision since it is well known to be associated with less postoperative pain, decreased ileus and hospital stay, and low rates of wound infection and incisional hernia, compared with midline or right transverse incisions. Furthermore, we found that the Pfannenstiel incision offers additional advantages that may be uniquely suited for Crohn's patients. First, the cosmetic position of the incision is particularly attractive to the young population affected by Crohn's. Second, the Pfannenstiel incision preserves fresh tissue in the midline, right, and left lower quadrants in the event that reoperation or stoma placement are required in the future owing to recurrent disease. We describe our technique in 10 consecutive patients undergoing ileocolectomy for Crohn's disease. Our patients experienced minimal morbidity and were pleased with the cosmetic results of their incisions.
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PMID:Laparoscopically assisted ileocolectomy for Crohn's disease through a pfannenstiel incision. 1108 38

Intestinal obstruction caused by internal hernia due to Meckel diverticulum is a rare disease. The condition is seldom diagnosed preoperatively. In this paper, we present a 10-month-old boy who suffered from abdominal pain, persistent vomiting, and mild fever for 2 days. Abdominal sonography, plain abdomen X-ray, and computed tomography merely showed mechanical ileus and partial malrotation. However, exploratory laparotomy revealed a Meckel diverticulum through which the small bowel had herniated. We introduce the Meckel diverticulum and internal hernia and discuss intestinal obstructions.
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PMID:Internal hernia caused by Meckel diverticulum in an infant: report of one case. 1135 62

Most umbilical hernias in children close spontaneously. Complications associated with umbilical hernias are rarely observed during follow-up. We report herein a 5-month-old girl with a strangulated umbilical hernia. Her umbilicus was hard, reddish, and irreducible. Plain radiography of the abdomen showed signs of mechanical ileus. The patient was thus diagnosed to have a strangulated umbilical hernia. A 5-cm section of the ascending colon and a 5-cm section of the terminal ileum, as well as the cecum and appendix, were congested, edematous, and erythematous, and together were enclosed by a firm hernial ring. A closure of the fascial defect and umbilicoplasty were performed. The postoperative course was uneventful. In patients with infantile umbilical hernias, strangulation may occur as the fascial defect decreases in size.
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PMID:Strangulated umbilical hernia in a child: report of a case. 1142 12

We report a case of internal hernia of the small intestine in a 13-year-old boy with presentation of partial intestinal obstruction. The patient suffered from recurrent abdominal pain and chronic constipation over the past few years. An abdominal mass was suspected from clinical manifestations and images derived from abdominal echography. Upper gastrointestinal contrast study revealed poor motility at the distal jejunum with barium stasis. Follow-up film on the next day delineated medially and downwardly displaced splenic flexure and proximal descending colon. At operation, total herniation of small intestine into a retroperitoneal space through a defect on left mesocolon was noted. A left paraduodenal (mesocolic) hernia was diagnosed. The patient made an uneventful recovery after the hernia was repaired. This report provides unusual image clues of internal hernias of the small intestine presenting as ileus. Though rare, paraduodenal hernia should be taken into account in a differential diagnosis of intestinal obstruction. Early surgical intervention allows uneventful recovery to occur and also prevents the possible complication of gangrenous bowels.
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PMID:Left paraduodenal hernia presenting as intestinal obstruction: report of one case. 1143 65


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