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

Elective surgical repair of an inguinal or femoral hernia is one of the most common surgical procedures. The treatment, however, presents several challenges regarding anaesthesia for the procedure, the postoperative analgesic therapy and convalescence, as well as planning of the procedure. Local, general, and regional anaesthesia are all used for hernia repair, but to different degrees, primarily depending on traditions and whether the institution has specific interest in hernia surgery. Thus, the use of local anaesthesia varies from a few percent in Sweden, 18% in Denmark and up to almost 100% in specialised institutions, dedicated to hernia surgery. The feasibility of local anaesthesia is high, as judged by the rate of conversion to general anaesthesia (< 1%), although intraoperative pain is quite common. The generally low rate of serious complications does not allow firm conclusions, but the rate of less serious complications is lower by local anaesthesia, compared to other anaesthetic techniques. Of special interest is, that the rate of urinary retention can be eliminated by the use of local anaesthesia. Local anaesthesia results, in comparative studies, in a higher degree of patient satisfaction than other anaesthetic techniques. Local anaesthesia also facilitates faster mobilisation and earlier discharge/fulfilment of discharge criteria from post anaesthetic care units than other anaesthetic techniques. Pain after hernia repair is more pronounced at mobilisation or coughing than during rest, and younger patients seem to have more pain than older patients. The pain ceases over time, and it is most pronounced the day after surgery, where two thirds have moderate or severe pain during activity, while one third still have moderate or severe pain after one week, and approximately 10% after 4 weeks. Pain after laparoscopic surgery is less pronounced than after open surgery, while different open repair techniques do not exhibit significant differences. Postoperative pain is best treated with a combination of local analgesia and peripherally acting agents (paracetamol, NSAID or their combination), while opioids should be avoided due to side effects, primarily nausea and sedation. Moderate or severe pain one year postoperatively is seen in 5-12% of patients. There seem to be no difference between different surgical or anaesthetic techniques, but the following factors have been related to a higher rate of chronic pain: previous or subsequent hernia surgery on the same side, young age, pain before surgery, high pain scores in the immediate postoperative period, and postoperative complications and prolonged convalescence. Patients should be informed about the risk of chronic pain, particularly if the hernia is asymptomatic. The duration of convalescence after hernia repair varies considerably, primarily due to variation in recommendations. No documentation is available to support that a prolonged convalescence reduces the risk of recurrence of the hernia, and most specialised institutions recommend immediate return to all usual activities. Pain seems to be the most important cause of prolonged convalescence. From all published consecutive materials with recommendations of short convalescence the mean or median duration is 6-8 days, in contrast to the two to four weeks often seen in randomised comparisons of different surgical techniques. Patients should be informed, that they can immediately resume all activity if pain permits, but also to expect that pain may limit function of activities of daily living during the first postoperative week. Hernia surgery, including treatment of recurrent hernias, can and ought to be performed as day case surgery, irrespective of the chosen anaesthetic technique, as there are no medical or surgical contraindications to this. Social causes may indicate, that overnight stay may be advisable or desirable, preferably in a patient hotel facility. Despite this, the fraction of patients operated in a day-case surgical set-up varies from 6% in France to 83% in US, and in Denmark 60% of patients have their hernia repair as a day-case procedure. A day-case hernia surgery service should be organised with standardised patient records, including descriptions of surgery performed as well as letters of discharge for the general practitioner. If clinical data are stored electronically, the basis is created for valuable clinical databases like the one behind the present thesis, and they can be used both for scientific purposes and for quality control and improvement.
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PMID:Inguinal hernia repair: anaesthesia, pain and convalescence. 1367 40

Congenital diaphragmatic hernia (CDH) is rare in adults. We report a 24 year old woman presenting with shortness of breath, chest pain and nausea after the birth of her first baby. Clinical examination, plain radiography and a CT scan revealed herniation of abdominal contents into her left chest. Via a midline laparotomy, the contents were reduced and the defect repaired, using a mesh. She remains symptom-free three years since her surgery and even after a second childbirth. A brief review of the literature reporting adult diaphragmatic hernia of congenital origin accompanies this case report. We conclude that symptomatic CDH in adults usually presents as an emergency with gastrointestinal and occasionally respiratory complications. Early diagnosis and repair is essential to avoid subsequent morbidity and mortality.
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PMID:Congenital diaphragmatic hernia in a post-partum woman. 1455 32

The primary radiologic evidence of intra-abdominal hernia is disturbance of normal small intestine arrangement. Loops of intestine are crowded together as if in a bag, giving the appearance of clumping or sacculation. Dilatation and loss of mobility may occur with varying degrees of stasis. Displacement of viscera or pressure deformity may be observed. Studies of the small bowel are necessary to demonstrate these conditions and must be made with the patient in the erect as well as the horizontal position. Repeated studies may be required, and the best time to make them is during an acute attack, as the hernia may be temporarily reduced during a remission. The clinical symptoms are sufficiently characteristic to suggest the diagnosis in most cases. The usual history is of repeated attacks of abdominal pain or discomfort, usually accompanied by distention, varying in periodicity and intensity, with or without nausea or vomiting, and not accompanied by laboratory data or clinical signs indicative of inflammatory disease. Similar or identical clinical and roentgenologic evidence may be produced by torsion of the small bowel or by peritoneal adhesions. The hernia or torsion may reduce spontaneously before or at the time of operation. Therefore, a careful search for abnormal fossae, mesenteric defects or adhesive bands is necessary if herniation or torsion is not found.
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PMID:Roentgen diagnosis of intra-abdominal hernia. 1479 74

Although supravesical hernias were described as early as 1804, there have been fewer than 100 cases reported in the literature. The supravesical fossa is a triangular area bounded laterally and above by median and medial umbilical ligaments, and below by the peritoneal reflection that passes from the anterior abdominal wall to the dome of the bladder. A hernia starting in this fossa usually protrudes through the abdominal wall as a direct inguinal hernia (external supravesical hernia). Less commonly, it remains within the abdomen, passing into spaces around the bladder (internal supravesical hernia). A 43-year-old mill worker presented with an enlarged painful mass in the left groin. He underwent a surgical repair of a direct inguinal hernia without addressing an unrecognized supravesicular component. Eight hours after his discharge next morning, he presented with acute abdomen, nausea, vomiting, and abdominal distention. The second surgery revealed the presence of a left lateral internal supravesical hernia with incarcerated small bowel. This was also repaired, and the patient was discharged in stable condition. This report aims to review and discuss the surgical anatomy of these rare supravesical hernias and calls attention to this type of hernia as an unusual cause of small bowel obstruction.
Hernia 2004 Dec
PMID:Inguinal mass due to an external supravesical hernia and acute abdomen due to an internal supravesical hernia: a case report and review of the literature. 1510 98

Herein, we present a case of primary liposarcoma of the omentum found in an incarcerated inguinal hernia in a 52-year-old male patient. The patient was admitted to our hospital in June 2000 with sudden onset of left-sided abdominal and groin pain of 12 hours' duration with a large, irreducible inguinal hernia. This was not associated with nausea or vomiting. An emergency operation was performed, and in the hernia sac the tumor, arising from the greater omentum, was found. After we opened the transversal fascia and peritoneum, the tumor was resected with a block of the greater omentum, and hernioplasty was performed using Shouldice's method. The histopathological diagnosis of resected tumor showed myxoid type liposarcoma. In the English medical literature, omental liposarcoma has never before been reported as the content of a hernia sac.
Hernia 2005 Mar
PMID:Primary omental liposarcoma presenting as an incarcerated inguinal hernia. 1518 28

Options for the repair of parastomal hernias include contralateral transposition or in situ repair. The latter can be accomplished either primarily or with prosthetic mesh. Concerns with mesh include possible gut erosion and infection. Recurrence rates in the literature are dismal regardless of technique. We retrospectively reviewed our experience with this problem focusing on in situ repairs. We identified 9 patients who underwent 10 in situ repairs. Of these, 6 were women, average age was 69.4 years, and stomas had been constructed for cancer in 6, inflammatory bowel disease in 2, and incontinence in 1. Eight patients had colostomies; one had an ileostomy. All patients were symptomatic from their hernias. Repairs were performed an average of 8 years after stoma construction. Hernia repair was performed transabdominally in four and through a parastomal incision in six. Complications included hematoma formation requiring evacuation in one and delayed resumption of oral intake secondary to nausea and cramps in three. Of the 9 initial repairs, 1 recurred (11%) and was repaired without subsequent failure. No mesh erosions or wound infections have occurred. This technique is safe and may be preferable to contralateral placement of the stoma.
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PMID:In situ mesh repair of parastomal hernias. 1532 4

The incidence of congenital diaphragmatic hernia (CDH) is about 4.8/10,000 live births. Its typical clinical presentation is respiratory distress occurring immediately after birth or in the first few hours or days of a child's life. It is characterized by a high mortality rate. Exceptionally, CDH can occur at an older age, its symptoms then frequently reflecting gastrointestinal obstruction or mild respiratory symptoms. In such cases CDH presents a far more complex diagnostic problem. The paper presents the cases of two girls without typical symptomatology, aged 5.5 and 10 years, in whom CDH was detected incidentally upon thorough physical examination and chest x-rays. Further radiographic evaluation, which included barium contrast study and spiral computed tomography, confirmed the suspicion of a left-sided posterolateral diaphragmatic hernia with associated intestinal malrotation. Surgical intervention conclusively confirmed a diaphragmatic defect at the site of Bochdalek's foramen in both cases. The vital capacity of the older girl, which was low before the surgery (VC 1.66 L; 69% of predicted), was significantly increased a month after the surgical treatment (VC 2.25 L; 92% of predicted). The generally expressed view that the clinical onset of CDH is rare after the neonatal period seems to be erroneous. Some papers report on the clinical presentation of CDH after the neonatal period in as many as 13%-14% of infants and young children suffering from CDH. Infants and young children with a delayed clinical occurrence of CDH can present with respiratory or gastrointestinal symptomatology. Children presenting with gastrointestinal symptoms have been shown to be significantly older than those presenting with respiratory symptoms. In older children and adolescents, the symptoms and signs of CDH, which include acute hernial incarceration, nausea, recurrent vomiting, diarrhea, obstipation, acute gastric dilatation, subcostal pain, failure to thrive and recurrent chest infections, habitually present a significant diagnostic problem. Diagnostic errors are mainly due to the fact that the possibility of CDH in that age is totally neglected. The most recurrent diagnostic misinterpretations in such cases are pneumonia or massive pleuropneumonia, empyema, pneumothorax, lung cysts and bullae, and gastric volvulus. Thus, whenever a child presents with uncommon respiratory or gastrointestinal symptoms and an anomalous chest x-ray, a differential diagnosis of CDH should be considered. Otherwise, an accurate diagnosis in both young and older children will most probably be only reached at autopsy. In conclusion, the presented cases corroborate the finding that CDH in older children may present with scarce symptoms, mostly gastrointestinal, or may be altogether asymptomatic and unrecognized until as late as adolescence. However, when a diagnosis of CDH has been established, albeit asymptomatic, it must be promptly treated surgically in order to prevent complications, such as strangulation or bowel perforation, and thus avert a potentially fatal outcome. The size itself of the herniac foramen is unlikely to be a determining factor at the time of clinical presentation of CDH. Surgical occlusion of CDH may in older children result in an improved vital capacity, as such cases are rarely associated with major pulmonary hypoplasia. Complications resulting from surgical treatment of CDH in older children are more likely to occur in the gastrointestinal system, as a consequence of the associated bowel malrotation and inadequate bowel fixation. Finally, these two cases corroborate the diagnostic value of accurate history taking and thorough physical examination.
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PMID:[Congenital diaphragmatic hernia in older children]. 1550 87

We present the case of a 44-year-old man who presented with nausea, vomiting and acute pain in the right groin. On physical examination an irreducible mass was palpated in the right inguinal region. Ultrasound suggested an inguinal hernia sac with bowel contents. Subsequent right inguinal exploration revealed only unspecified necrotizing tissue, but no hernia sac or bowel contents were identified. Two days later laparotomy was required since the inguinal wound produced faecal discharge. The sigmoid appeared to be necrotic and perforated, and was subsequently resected. Histology revealed a perforated adenocarcinoma without lymph node involvement. Incarcerated inguinal hernias containing an adenocarcinoma of the colon are rare, but should be considered in patients presenting with an irreducible palpable mass in the inguinal region. Moreover, a carcinoma of the sigmoid may invade the right inguinal region. An intestinal perforation to skin-level in this population is even rarer and is associated with high morbidity and mortality rates.
Hernia 2006 Mar
PMID:Carcinoma of the sigmoid presenting as a right inguinal hernia. 1613 89

Internal hernia is an unusal cause of intestinal obstruction. Herniation related to epiploic appendix is a very rare entity. We herein report a case of internal herniation due to an adhesion between epiploic appendixes and the greater omentum. A 71-year-old woman complaining of abdominal pain and intermittent nausea was operated on with the pre-operative diagnosis of intestinal obstruction. Three epiploic appendixes of the left side of the transverse colon and the corresponding part of the greater omentum had created a tunnel and a loop of small bowel 25 cm in length was strangulated. No resection was required after releiving the strangulation. However, the patient died due to massive myocardial infarction in the postoperative period. Internal herniation must be included in the differential diagnosis of patients with acute abdomen or intestinal obstruction. A high index of suspicion with prompt surgical intervention may be the key to the reduction of morbidity and mortality.
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PMID:Internal herniation with fatal outcome: herniation through an unusual apertura between epiploic appendices and greater omentum. 1661 30

Paraduodenal hernias are the most common forms of intraabdominal hernias, accounting for 53% of all internal hernias. However, these account for only 0.2% to 0.9% of all small intestinal obstructions overall. Patients usually report vague abdominal pains and discomfort lasting for many years. Furthermore, in-patient diagnosis and management can last up to several weeks due to its rarity and unusual presentation. We report a case of a left paraduodenal hernia in an 18-year-old male who presented with abrupt onset of abdominal pain, nausea, and vomiting. He was subsequently managed by diagnostic laparoscopy and laparoscopic repair, which decreased the overall in-patient care to 2 days.
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PMID:Diagnostic laparoscopy and laparoscopic repair of a left paraduodenal hernia can shorten hospital stay. 1670 68


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