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

We have recently experienced two cases of traumatic diaphragmatic hernia which has been repaired by surgery. The first case was a 58-year-old man who had suffered left upper abdominal injury with a branch in his childhood. Although he had never symptoms, chest X-ray showed abnormal shadow in the left lower lung field. Radiologic studies indicated that the great omentum was escaped into the thoracic cavity. On patient request, we performed primary repair of the diaphragmatic hernia on thoracotomy. The second case was a 56-year-old woman who had undergone a left nephrectomy for the left renal abscess. Seven months after the operation, she began to feel nausea and vomiting, and the symptom aggravated with time. Chest X-ray showed air bubbles in the left lower lung field. It proved to be a projection of the stomach into the thoracic cavity through the iatrogenic diaphragmatic injury. We successfully performed a repairment of the diaphragm with a mesh.
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PMID:[Two cases of traumatic diaphragmatic hernia with atypical medical history]. 1071 18

A rare case of paraesophageal hernia with complete intrathoracic incarceration of the stomach after laparoscopic Nissen fundoplication is described. An 85-year-old woman who had undergone laparoscopic Nissen fundoplication for gastroesophageal reflux disease presented 14 months later with nausea and vomiting. Esophagogastroendoscopy showed obstruction of the esophagogastric junction and gastric mucosal necrosis. Emergency laparotomy showed the stomach to be entirely strangulated into the thorax, with areas of necrosis. Gastrotomy was followed by resection of the necrotic anterior wall of the stomach, closure of the hiatus, and suturing of the stomach to the diaphragm. Appropriate closure of crura and anchoring suture between the stomach and diaphragm are helpful to prevent recurrent hernia after laparoscopic Nissen fundoplication.
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PMID:Acute intrathoracic incarceration of the stomach after laparoscopic Nissen fundoplication. 1078 82

In France, ambulatory surgery is controlled by specific regulations which outline the organization of the facilities. It is practiced less in France than in other countries, but specific governmental incentive policies have been instituted. The characteristic feature of digestive surgery is the high occurrence of post-operative nausea and vomiting due to the peritoneal incision. New surgical procedures and anesthetic regimens allow ambulatory care in children and adults. But the choice of ambulatory care is based on the patient's characteristics more than on surgical procedure and follows well-known selection criteria. The procedures concerned in general surgery are groin hernia repair, proctologic surgery, and subcutaneous tissue surgery. Laparoscopic cholecystectomy and neck surgery in increasing numbers of patients on an ambulatory basis is the first step before expanding ambulatory surgical procedures toward major surgery. Physicians must have a thorough knowledge of ambulatory surgery as an organizational concept.
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PMID:[Contribution of ambulatory digestive surgery]. 1103 85

The case of an elderly, emaciated female patient with recurrent lower abdominal and hip pain associated with nausea and vomiting due to an incarcerated obturator hernia is described. The presence of a Howship-Romberg sign and a tender mass on digital rectal examination in this thin, elderly woman with a small bowel obstruction led to the rapid diagnosis of an obturator hernia by computed tomography (CT). The high mortality rate associated with this most lethal of all abdominal hernias requires a high index of suspicion to facilitate rapid diagnosis and surgical intervention if the survival rate is to be improved.
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PMID:Strangulated obturator hernia: still deadly. 1121 52

One hundred and fifty-five patients scheduled for inguinal hernia repair (IHR) were given the choice of either general anesthesia (GA) (n = 53) or spinal anesthesia (SP) (n = 47) or nerve stimulator guided paravertebral blockade (PVB) (n = 55). The incidence of postoperative nausea and vomiting (PONV), duration of hospital stay and need for postoperative analgesia were recorded. Apart from a difference in the age of patients in the GA group who were found to be slightly younger, all groups were found similar with regard to weight, height, duration of surgery, sex, type of hernia and ASA class. The incidence of PONV (0%) v/s 19% and 21% was significantly reduced in patients treated with the PVB compared to patients receiving SA and GA respectively. The length of hospital stay was also found to be shorter in the PVB group (mean 1.2 days) v/s SA (mean 2.4 days) and GA (mean 2.9 days). The need for supplemental postoperative analgesics was also found to be higher in both SA and GA when compared to PVB patients who were managed without any analgesics during the first 24 postoperative hours. The described technique appears to be an attractive alternative method to provide adequate anesthesia for IHR.
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PMID:Paravertebral blockade vs general anesthesia or spinal anesthesia for inguinal hernia repair. 1156 33

We report the case of a perforated duodenal ulcer and diffuse peritonitis associated with an incarcerated hiatal hernia. A 77-year-old woman with a 17-year history of rheumatoid arthritis treated with nonsteroidal anti-inflammatory drugs, who had also been receiving treatment for non-Hodgkin's lymphoma over 4 years, was referred to us for investigation of nausea and vomiting. An abdominal compute tomography (CT) scan showed an incarcerated hiatal hernia and free air in the hernia sac. Emergency laparotomy revealed an incarcerated hiatal hernia involving the stomach, transverse colon, and omentum. A perforated ulcer was also found in the posterior wall of the first portion of the duodenum. The combination of these disorders is thought to be rare in patients with a hiatal hernia and free air in its sac. As the reported mortality of perforated gastric ulcer associated with a hiatal hernia is high, early elective surgery should be performed in patients with a duodenal ulcer associated with a hiatal hernia.
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PMID:Perforated duodenal ulcer associated with an incarcerated hiatal hernia: report of a case. 1254 Oct 28

Richter's hernia can occur at trocar sites after laparoscopic procedures, and 10-mm or larger ports are the usual culprits. Most surgeons now routinely close the fascia of these sites to prevent herniation. The usual presentation is of crampy abdominal pain with nausea and vomiting. Treatment is reduction of the bowel that is incarcerated and then repair of the fascial defect. We describe four cases of Richter's hernia after laparoscopy, two that were repaired by open procedure and two that were repaired laparoscopically, and review the literature. A laparoscopic hernia repair is acceptable treatment at the time of diagnosis, especially in the obese patient, as long as the incarcerated bowel is not compromised or frankly ischemic.
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PMID:Richter's hernia in the laparoscopic era: four case reports and review of the literature. 1259 62

Choice of anesthesia for inguinal hernia repair remains a controversial topic. Local anesthesia has been described in the literature as the optimal technique, however general and spinal anesthesia are commonly used in practice despite well-known complications and side effects. The regional technique of paravertebral block has been successfully used at our institution for the operative treatment of breast cancer. Its attributes are prolonged sensory block with minimization of postoperative pain, reduction of nausea and vomiting, shortened hospital stay, patient satisfaction, and rapid return to normal activities. These features are desirable in the practice of ambulatory hernia surgery; hence we initiated the use of thoracic/lumbar paravertebral block for that surgical procedure. Paravertebral block anesthesia was performed on 30 consecutive patients. Block placement took an average of 12.3 minutes, in six cases repeat injection at one or two spinal levels was required due to incomplete blockade. Paravertebral block achieved effective anesthesia in 28 of 30 cases; conversion to general anesthesia was performed for two failed blocks. We are reporting postoperative data on the 28 completed blocks. Supplementation of intravenous sedation or injection of local anesthesia successfully treated transient intraoperative pain in 10 cases. Epidural extension of anesthesia resulting in lower limb numbness and motor weakness delayed the discharge of two patients. There were no other complications of anesthesia and no cases of urinary retention. TIme to onset of pain averaged 15 hours, while duration of sensory block was 13 hours. Patients were prescribed a standing order of naproxen 500 mg B.I.D. for 4 days regardless of pain; supplemental oral narcotic use during the 48 hours following surgery averaged 3.5 tablets, with 6 patients not requiring any narcotic. ninety-six percent of patients scheduled for ambulatory surgery were discharged from the postanesthesia care unit, with an average stay of 2.5 hours. Employed patients returned to work on day 5.5 (range 3-10 days); patients who were not employed returned to regular activities in 5.8 days (range 1-14 days). Eighty-two percent of patients reported being "very satisfied" with the anesthetic technique.
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PMID:Paravertebral block anesthesia for inguinal hernia repair. 1265 86

Mesenteric cysts are rare intra-abdominal lesions. They are usually diagnosed as an incidental laparotomy finding in adults but in childhood, they may present with acute abdomen. In this report, a 72-year old female was referred to our hospital, suffering from acute abdominal pain, several episodes of nausea and vomiting. Clinical abdominal examination revealed an irreducible recurrent umbilical hernia. The patient had both muscular defense and abdominal tenderness. Plain abdominal radiography showed multiple air-fluid levels. With these findings, a diagnosis of acute abdominal pathology was accepted and an urgent laparotomy was performed. A 5-cm-diameter mesenteric cyst was excised from the mesentery of the proximal jejunum and a prosthetic mesh was placed for incisional hernia. This is the first report of a strangulated umbilical hernia complicated with a mesenteric cyst.
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PMID:Strangulated umbilical hernia including a mesenteric cyst: a rare cause of acute abdomen. 1291 73

Pregnant women with an ostomy face many challenges during the prenatal period. Although these challenges may be present, pregnancy in the ostomate is presented as a continuum of health and wellness in this article. Collaborative care professionals, especially nurses and midwives, are often the most accessible professional sources for health care information, but current research and information on this topic is sparse. Ostomy-related problems that may occur during pregnancy, include: intestinal obstruction, peristomal hernia, pouching problems, including the effect of nausea and vomiting on pouch hydration, stomal retraction, stenosis, or laceration, and stomal prolapse. Three types of ostomies are discussed: continent ileostomies, urostomies and colostomies. A description of the normal characteristic appearance of each is also included. Collaborative care from pre-conception through the post partum period is described with emphasis on teaching self-help techniques such as: special nutritional considerations, how to recognize potential problems, and how to fit and adapt appliances to the changing body form of the patient as the pregnancy progresses. Phenomenologic information about the pregnant ostomate's perceptions about her pregnancy experience is also presented. Psycho-prophylaxis methods of complementary therapy alternatives alleviating nausea and vomiting within pregnancy, as well as the pain of childbirth are also presented. Although nursing/midwifery management of a pregnant ostomy patient is a challenge, those challenges are surmountable and outcomes resemble those found in the general population.
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PMID:Collaborative care management for a pregnant woman with an ostomy. 1474 1


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