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

We present a case of delay in diagnosis of diaphragmatic rupture and herniation in a pregnant 25-year-old woman. The diaphragmatic rupture was secondary to trauma sustained five months prior to presentation. Subsequent to her accident, she was provided medical care on multiple occasions for symptoms of intractable nausea, vomiting, and weight loss that were probably related to an expanding uterus and diaphragmatic herniation of abdominal contents. At the time she presented to us the herniation had progressed and she was experiencing severe respiratory difficulty. A nasogastric tube was placed for diagnosis and decompression. A chest radiograph provided the diagnosis of herniation of gastrointestinal contents through the left hemidiaphragm. A healthy 5-lb boy was delivered vaginally and subsequently a left thoracotomy was performed for decompression and repair of the diaphragm. The patient's hospital course after hernia repair was uneventful.
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PMID:Delayed diagnosis of traumatic diaphragmatic hernia during pregnancy. 335 40

A case of an infradiaphragmatic bronchogenic cyst in an adult patient presenting with nausea, vomiting, and epigastric discomfort is reported. An upper gastrointestinal series showed a multiloculated cyst communicating with the stomach via a patent fistulous tract. At laparotomy the cyst was found to be connected to and communicating with the posterolateral portion of the stomach. The cyst was completely below the diaphragm and received its blood supply from a branch of the abdominal aorta. Histologically, the cyst was composed of smooth muscle, respiratory epithelium, cartilage, and submucous glands. A review of the literature reveals that this case of bronchogenic cyst was unique in that it was located entirely beneath the diaphragm, was not associated with a diaphragmatic hernia or other congenital anomaly, and maintained a patent communication with a portion of the gastrointestinal tract, ie, the stomach, reminiscent of its embryological development.
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PMID:Subdiaphragmatic bronchogenic cyst with communication to the stomach: a case report. 340 77

During the years 1981-85, 163 patients were treated with gastric banding for morbid obesity. Mean preoperative body weight (+/- s.e.m.) was 121.3 kg +/- 1.4, and mean overweight was 71.5% +/- 1.6 according to Broca's formula. Twenty-four patients had postoperative complications during the first 30 days, mostly minor. Four required reoperation and one of these died. Seventeen patients had late complications, six persistent vomiting necessitating reoperation, eight incisional hernia and three penetration of gastric wall by band. The weight loss was rapid during the first 6 months, and thereafter levelled off. After 2 years the weight loss was 33.4 kg +/- 2.4, corresponding to a mean weight loss of 27.6 percent +/- 1.9 of preoperative weight. There was no significant difference in weight loss expressed as a percentage of preoperative weight between patients operated with an outlet of 12 mm (45 patients) or 15 mm (118 patients), nor between males (37 patients) or females (126 patients). We conclude that our technique of gastric banding seems to be a relatively safe and reliable surgical treatment for morbid obesity. But our follow-up period has been limited to 2 years or less, and a longer follow-up is necessary before the method can be fully evaluated.
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PMID:Gastric banding for morbid obesity: early results. 366 69

A 22-year-old man with an incarcerated left paraduodenal hernia is described. Symptoms included nausea, vomiting, cramp-like abdominal pain and obstipation. A clinical diagnosis of mechanical small-intestinal obstruction was made on the history, examination, and abdominal radiographic findings. At laparotomy successful manual reduction was achieved, resection was not required and the patient made an uneventful recovery.
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PMID:Left paraduodenal hernia with acute abdominal symptoms. A case report. 373 64

Fifty-five operations for paraesophageal hiatus hernia were performed at the Lahey Clinic, Burlington, Mass, between January 1970 and October 1985. Pain was present in 35 of 51 patients. Other less common symptoms were anemia and vomiting. Reflux symptoms were rare. Esophageal manometry disclosed a mean lower esophageal sphincter pressure of 18.2 mm Hg and a length of 3.5 cm. An anterior crural repair (Collis procedure) was employed in all patients. In 22 patients Stamm gastrostomies were also performed. In two patients, a Nissen fundoplication was also carried out because of coexisting gastroesophageal reflux. One patient died postoperatively of a pulmonary embolus. Of the patients, 88.4% benefited from the operation. Of the five poor results, four were due to hernial recurrence and only one was due to severe reflux symptoms. Gastroesophageal reflux is rare in patients with paraesophageal hiatus hernia. An antireflux procedure should be added to surgical correction of the anatomic defect only if evidence of a hypotensive lower esophageal sphincter is clearly present preoperatively or intraoperatively. The addition of gastrostomy to the procedure protects against recurrence of hernia.
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PMID:Paraesophageal hiatus hernia. 395 87

At the University of Minnesota under the supervision of one staff surgeon both jejunoileal bypass (JIB) and gastric bypass (GIB) operations have been performed for weight reduction in morbidly obese individuals. During the last 14 years 727 patients underwent end-to-end (40 to 4 cm) JIB and more than 570 patients underwent GIB. This report is based on a comparison of 205 JIBs performed between July 1975 and July 1979, 106 Alden-loop type GIBs (GIB-loop) performed between July 1975 and July 1979, 53 loop GIBs with enteroenterostomies between the limbs of the loop (GIB-EE) performed between May 1980 and May 1981, and 57 Roux-en-Y GIBs (GIB-Roux) performed between May 1981 and May 1982. Adequate weight loss occurred in 80% of the patients who returned for follow-up in all groups. The percentage of excess body weight loss was similar for the first year (65% for JIB, 62% for GIB-loop, 69% for GIB-EE, and 71% for GIB-Roux). The operative mortality and the immediate morbidity rates were uniformly low. The long-term complications for JIB were 37.7% arthralgia, 7.1% oxalate urolithiasis, 5.6% incisional hernia, and 1.4% liver failure. The complications for GIB-loop were 10.2% nausea/vomiting, 1.9% bile reflux gastritis, and 2.8% anastomotic problems; for GIB-EE 23% nausea/vomiting, 7% bile gastritis, 4.6% incisional hernia, and 3.7% anastomotic problems; and for GIB-Roux 16% nausea/vomiting and 1.7% anastomotic problems. The anastomotic problems consisted of afferent loop obstructions and stomal stenosis; there were no leaks. At 1 year plasma cholesterol reduction for JIB averaged 42% (p less than 0.001), GIB-loop 14% (p less than 0.001), GIB-EE 7% (NS), and GIB-Roux 17% (p less than 0.001). One year after operation 49% of 88 JIB patients showed progression of liver disease on sequential biopsy specimens and 20% improvement. In the 78 GIB patients with sequential biopsies, liver disease progressed in 8% and improved in 65%. In summary, comparable therapeutic weight reduction occurred with all the assessed procedures; however, the GIB-Roux was associated with far fewer serious long-term complications. At this time the GIB-Roux procedure is the weight reduction operation we recommend.
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PMID:Searching for the best weight reduction operation. 648 6

The author presents the results of a new surgical technique for the reconstruction of the gastrointestinal tract after gastrectomy. It was utilized in 36 patients (ten with total, 16 with subtotal and seven with minimal radical gastrectomy and also three cases of post-gastrectomy syndrome). The initial methodology, using the lost tie (group striction (GST)) to the duodenojejunal reservoir was not successful since it showed recanalization and consequent refluxing esophagitis (55,5%). For that reason, we changed to a complete section of the intestinal loop (group section (GS)). The follow up period ranged from one to 49 months. The following complications were observed: incisional hernia, one case (GST); early postoperative period death (19th day), one case (GS); dumping syndrome, one case (GST); bilious vomiting, two cases (GS); diarrhea, four cases (one GST and three GS). Clinically, in the late follow up of patients without recurrency of neoplasia, 17 of them have gained weight, four have lost weight and two were unaltered. Laboratory tests such as amilasemia, hematologic, proteins and glycemia were favorable to the method. Postoperative function, studied roentgenologically, showed that the average time emptying of the remmant stomach was 115 minutes in the subtotal resections and 82 minutes in total resections. The filling of the reservoir by the barium solution ranged from 40 to 60%; this variation depended on whether the duodenum was in peristalsis or antiperistalsis. Late death occurred in 13 patients, none because of the proposed technique.
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PMID:[An antiperistaltic duodenojejunal pouch in the reconstruction of digestive transit after subtotal and total gastrectomy and in the postgastrectomy syndrome. Results]. 653 56

One case of a para-oesophageal hernia and ten cases of gasto-oesophageal reflux with or without hiatal hernia are reviewed. Vomiting commenced from the first week of life and in three children progressed to stricture formation. Pulmonary manifestations of gastro-oesophagela reflux were intractable asthma and attacks of bronchiolitis. A surgical operation performed through the abdomen was successful in controlling the reflux in all cases. Follow-up barium studies in all cases showed no hernia recurrences. A conservative approach to fibrous reflux strictures has been adopted and it is found that these can be cured by dilatations once the reflux has been controlled.
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PMID:Gastro-oesophageal reflux and hiatal hernia in children. 693 48

Incarcerated congenital diaphragmatic hernias are a rare cause of bowel obstruction in children. In the past 3 yr, we have treated three such diaphragmatic hernias: the first incarcerated and strangulated requiring bowel resection while the other two were incarcerated only. The difficulty in diagnosing this condition in illustrated by these cases. In all children with the triad of upper respiratory illness (URI) or infiltrate on chest x-ray, vomiting, and x-ray evidence of bowel obstruction, the diagnosis of congenital diaphragmatic hernia (CDH) with incarceration and bowel obstruction should be entertained.
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PMID:Incarcerated congenital diaphragmatic hernias with bowel obstruction (Bochdalek). 717 42

The clinical presentation, treatment, and results of 405 patients with mechanical small intestinal obstruction admitted to the Montefiore Hospital and North Central Bronx Hospitals were reviewed. The etiology of obstruction was adhesions 74%, malignancy 8.6%, hernia 8.1%, inflammatory bowel disease 5.2%, and miscellaneous causes 4.1%. The overall mortality rate for the series was 6.7%, and the incidence of bowel strangulation was 10.1%. Strangulation occurred in 33.3% of the hernia group, 9.0% of the adhesions group, and 2.8% of the malignancy group. The largest single cause of death was related to malignant disease--12 cases (44.4%). Six deaths (22.2%) were caused by bowel strangulation. Of the patients who received more than 24 hours of nonoperative therapy, 46% had relief of obstruction. There was no statistically significant difference in successful results between patients managed with long tubes compared to patients managed with nasogastric tubes. Conservative therapy for malignant obstruction was not successful in 85% of cases. The presence of bowel strangulation shows a positive correlation with age (greater than 70 years), feculant vomiting, peristaltic sounds, and a white blood cell count higher than 18,000/mm3. It shows no correlation with onset, localization or type of pain, duration of symptoms, temperature, tachycardia, or x-ray findings. The results of the study indicate that accurate criteria for small bowel obstruction therapy have not been clearly defined except in patients with incarcerated hernias. Nonoperative management is successful in a significnt percentage of patients.
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PMID:Small bowel obstruction: the role of nonoperative treatment in simple intestinal obstruction and predictive criteria for strangulation obstruction. 720 87


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