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

Small bowel obstruction is caused by postoperative adhesions in most patients. The traditional surgical treatment has been laparotomy with adhesiolysis and possible resection of the ischaemic intestine. The laparoscopic approach has proved feasible but not without risks. We analysed our experience in the management of acute small bowel obstruction and then reviewed the literature in an attempt to identify the real role of laparoscopy. From January 2003 to June 2008, 19 patients operated on for small bowel obstruction were identified. We evaluated our performance in terms of the aetiology of the obstruction, operative time, length of postoperative hospital stay, conversion rate, and major morbidity and mortality. Postoperative adhesions were responsible for the occlusion in 13 cases; a single band was identified in 47% of patients (9 cases). Neoplastic disease (3 cases), a gallstone ileus, Crohn's disease and an internal hernia were the remaining cases. Laparoscopic treatment was only possible in 7 patients with single adhesions (77%), and a conversion was carried out in the remaining 12 cases (63%), including "laparoscopy-assisted" cases (6 cases). The duration of the intervention (89 +/- 21 min vs 135 +/- 27.5 min) and postoperative hospitalisation (3.6 +/- 1 days vs 6.25 +/- 1.6 days) were in favour of the completely laparoscopic group as compared to the laparoscopy-assisted group. A case of postoperative peritonitis due to bowel perforation required a second intervention. With an appropriate selection of patients, confirming the high incidence of the single adhesions responsible for the occlusion and the resulting high success rate of laparoscopy, we believe that only an initial laparoscopic approach can help identify such favourable situations.
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PMID:[Role of laparoscopy in acute obstruction of the small bowel: personal experience and analysis of the literature]. 1939 38

CT scan is the gold standard for follow-up after abdominal surgery and diagnosis of postoperative complications. During the immediate postoperative period, asymptomatic and rapidly regressing peritoneal collections of fluid and gas are often present. Transient ileus is classically present as well. The diagnosis of postoperative peritonitis is difficult on imaging; fluid collections are frequent and easily detected. The main postoperative peritoneal complication is small bowel obstruction, either early and due to inflammatory changes, or delayed and due to adhesions or less frequently to other causes, including transmesenteric hernia. Other rare complications include desmoid tumors and gossypiboma. Wall complications, after laparotomy as well as laparoscopic surgery, are mainly hematoma, infections and wound hernia.
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PMID:[Postoperative imaging of the peritoneum and abdominal wall]. 1975 34

Obturator hernia repair has traditionally been performed via an intra-abdominal approach, although laparoscopy is also emerging as a feasible alternative. On the other hand, the Kugel method is a minimally invasive and effective form of repair of groin hernia, but there have been few reports on its use for an incarcerated obturator hernia. We describe how we used the Kugel method to repair an obturator hernia in two patients. Both patients presented with acute intestinal obstruction, necessitating emergency surgery. Via a preperitoneal approach, the impacted obturator hernia was carefully released and the obturator canal defect was repaired with a Kugel patch. One patient recommenced oral intake on postoperative day (POD) 1, and was discharged on POD 5. The other patient's postoperative course was complicated by ileus, prolonging the hospital stay to 14 days. There has been no sign of recurrent disease for 6 and 21 months, respectively. The Kugel method offers several advantages, such as a short operative time (76-82 min), small scar (3 cm), and early postoperative ambulation (POD 1), thus minimizing the hospital stay. Further study is needed to confirm the usefulness of this procedure for an incarcerated obturator hernia.
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PMID:Impacted obturator hernia treated successfully with a Kugel repair: report of two cases. 1977 83

Early diagnosis of diaphragmatic rupture after traumas may be difficult, and delayed diagnosis may result in increased morbidity and mortality. This paper describes the case of a 32-year-old man who experienced a traffic accident and had diagnosis of traumatic diaphragmatic hernia nearly four months later. The patient was referred to our emergency room suffering from ileus symptoms. Physical examination demonstrated an apparent abdominal distention, tenderness at the upper abdominal quadrants, rebound, and defense. Thoraco-abdominal X-rays and computerized tomography imaging demonstrated intestinal segments with air-fluid levels in thorax. Laparotomy was performed after a preoperative diagnosis of a strangulated-diaphragmatic hernia. At abdominal exploration, it was found that transverse colon and omentum entered into thorax through diaphragmatic defect located at the left diaphragm. Herniating colon segment was complicated with ischemic necrosis and perforation. In conclusion, colon necrosis and perforation may develop when early diagnosis of diaphragmatic ruptures are missed.
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PMID:Delayed diagnosis of traumatic diaphragmatic hernia may cause colonic perforation: a case report. 1991 52

This paper refers to 50 unusual cases of 542 consecutive adult patients who underwent surgery because of acute intestinal obstruction. Of the 38 small bowel cases, 5 were caused by hernias in anomalous recesses (1 prevesical, 2 left paraduodenal, and 2 paracecal hernias), 6 by a gallstone ileus, 14 to the presence of a bezoar or foreign body, 8 to extended postradiation perivisceritis, 3 to Meckel diverticulum volvulus, 1 to transepiploic hernia, and 1 to ileus-Meckel hematoma during anticoagulation treatment. The 12 large bowel cases included 3 diaphragmatic hernias (1 late post-trauma), 3 cases of colo-colic intussusception, 1 case of obstructive cholecystitis, and 5 cases of Ogilvie's syndrome. Major technical problems have to be immediately solved in the case of left paraduodenal, prevesical, or diaphragmatic hernias; however, during laparotomy, there may also be some difficult and unpredictable problems caused by widespread postradiation perivisceritis.
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PMID:Unusual causes of acute intestinal obstruction in adults. 2010 11

We report a rare case of internal hernia through an abnormal defect in the broad ligament of the uterus. A 49-year-old woman, without any previous surgery, was admitted because of vomiting and lower abdominal pain. Three days after admission a small amount of small intestinal gas was pointed out on her plain abdominal X-ray film. An enema examination by ileus tube revealed a pooling of gastrografin on the left side of the pelvic cavity, showing an obstruction of the ileum. Therefore, an emergency operation was performed, whereupon we found an abnormal defect in the left broad ligament of the uterus. This case describes an internal hernia through an abnormal defect in a female ileus patient without a history of surgery.
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PMID:[A case report of internal hernia through an abnormal defect in the broad ligament of the uterus]. 2037 96

Eleven hundred patients who underwent laparoscopic primary hernioplasty from 2002 to 2007 at our hernia center are included in our prospective study. A modified transabdominal preperitoneal (TAPP) prosthetic technique was applied in 1100 cases of hernioplastic operations. The modified technique consisted of using the needle with thread and needle-hook to close the hernia ring and partial preperitoneal dissecting to place the mesh. A self-made mesh is used. The lift-insert technique is applied to fix the mesh. There were 882 indirect and 218 direct hernias. Mean operative time is 20 minutes for 1-sided hernia and 35 minutes for two-sided hernia. A total of 1002 (95%) patients were discharged within 48 hours. No mesh infection or migration has been reported. No postoperative adhesive ileus has been reported. Ten patients have been treated with analgesic medication. There are 9 recurrences (0.9%) reported with a 98% follow-up over 1-6 years. We find that the modified laparoscopic transabdominal preperitoneal hernioplasty is a safe and efficacious treatment option for primary inguinal hernia.
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PMID:The application of modified transabdominal preperitoneal prosthetic laparoscopic hernioplasty. 2039 21

Plain radiographs of an 88-year-old woman who had experienced vomiting and abdominal distention for 3 days revealed a severely obstructed ileus, and abdominopelvic computed tomography revealed an incarcerated Morgagni hernia. The endoscope was passed through the constrictions from the diaphragmatic indentations and a thin catheter was placed for decompression. The obstructive ileus regressed markedly after the procedure; the patient underwent elective laparoscopic repair of the hernia 1 week later. This is believed to be the first case of endoscopic preoperative decompression for an incarcerated Morgagni hernia.
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PMID:Elective laparoscopic repair after colonoscopic decompression for incarcerated morgagni hernia. 2043 68

The authors present a study on rates and management of complications of gastric carcinoma surgeries. During a five-year period, a total of 149 patients with gastric carcinomas were operated in the Ist Surgical Clinic (Charles University Faculty Hospital). Radical resections were performed in 121 subjects. In 7 subjects, upper pole resections were performed. 21 subjects underwent paliative therapy or surgical exploration. In the authors' study group, no serious perioperative complications were recorded. The following postoperative complications were observed: fistulas in esophagojejunal anastomosis (8x), duodenal stub fistula (lx), subphrenic abscess (2x), adhesive ileus (1x). In two subjects, esophagojejunal stricture was diagnosed during the late postoperative period. Incisional hernia was diagnosed in two subjects. Two subjects exited- the first one from respiratory failure with ARDS syndrome in esophagojejunal dehiscence, the second subject died of hepatorenal failure in liver cirrhosis. Complications cannot be excluded in any surgical procedure. Should they occur, their timely diagnosis and adequate treatment is required.
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PMID:[Gastric carcinoma--rates and management of surgical treatment complications]. 2051 13

Loop ileostomy is an effective means of temporary fecal diversion. It is technically easy to create and manage. Moreover, ileostomy closure does not require a formal laparotomy. With the advent of laparoscopy, many of these loop ileostomies are being performed with laparoscopic assistance. Studies have proved the beneficial effects of laparoscopically created loop ileostomy for fecal diversion. Techniques for performing laparoscopic loop ileostomy have been described using two or more 10- to 12-mm ports with Hassan's technique at the umbilical site for pneumoperitoneum creation. We describe a modified technique, wherein pneumoperitoneum is created using a 10-mm port at the site of the future ileostomy, and a second 5-mm port is placed under vision at the umbilical site. This procedure requires minimal intervention and a reduced pneumoperitoneum time. Since the umbilical port site is 5 mm, it does not require closure, and it also reduces the chances of port-site hernia, formation, patient discomfort and scarring. Because intervention is minimally invasive, operative time is reduced, and there is less of chance postoperative ileus and adhesion formation.
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PMID:Laparoscopic loop ileostomy with a single-port stab incision technique. 2061 54


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