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

Intussusception of the distal esophagus into a reducible hiatus hernia is described in nine female and three male patients. The main radiographic feature is demonstration of a lobulated fundal mass of changeable size and configuration surrounding the narrowed distal esophageal segment. This pseudotumor is produced by inversion of the hiatus hernia into the stomach, and may be mistaken for a neoplasm. Disinvagination invariably occurs when maneuvers directed toward demonstration of a sliding hernia are utilized during upper gastrointestinal fluoroscopy. It is emphasized that esophago-gastric invagination frequently accounts for masses shown in the cardia of older women with intermittent dysphagia and crampy epigastric pain.
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PMID:Esophago-gastric invagination in patients with sliding hiatus hernia. 105 68

Gastric volvulus is a rare disease. We recently encountered a gastric volvulus associated with Bochdalek hernia and severe hypopotassemia. A 32-year-old woman experienced epigastric pain and recurrent vomiting. The changes of the electrocardiogram in this patient (K1.8mEq/l) were inverted T wave and ST depression. She was diagnosed as having gastric volvulus associated with Bochdalek hernia by chest X-ray films, contrast radiography of the upper digestive tract and thoraco-abdominal CT scans. Symptoms did not disappear with the administration of conservative therapy. At laparotomy, the stomach was rotated around its mesenteric axis in the sagittal plane. After operative repair, symptoms disappeared, and serum potassium level returned to normal. Gastric volvulus is rather easily diagnosed if its existence is kept in mind.
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PMID:[A case of Bochdalek hernia in an adult with volvulus of the stomach and hypopotassemia]. 189 66

During a 25-year period, 40 patients with paraoesophageal hiatus hernia were operated on by narrowing of the hiatus and gastropexy. The main symptoms were: epigastric pain (40%), reflux symptoms (25%), cardiac symptoms (20%), dysphagia (20%) and dyspnea (8%). Six patients were free of symptoms. Anaemia was present in 33%, gastric ulcer in 15%. Six patients (18%) had to be operated on as emergencies because of gastric ulcer complications in 4 (3 perforations, 1 severe bleeding) and incarceration in 2 patients. Considering the important risk of acute complications in paraoesophageal hernia an elective gastropexy seems generally advisible--also in patients with few or no symptoms, provided there are no contraindications.
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PMID:[Paraesophageal hiatal hernia--risks and surgical indications]. 277 98

A twenty-seven-year-old 25 weeks gestation female was admitted with recurrent symptoms of nausea, vomiting and epigastric pain. She was diagnosed as left diaphragmatic hernia by chest X-ray film, CT and esophago-gastrography. During operation, a left central tendon defect was observed, and was 3.5 cm in diameter. The margin of the defect was smooth and round. It was associated with diaphragmatic eventration. The small intestine and transverse colon were herniated into the left thoracic cavity. The central tendon defect was closed with direct mattress sutures and was reinforced by overlap-technique of the diaphragm. To our knowledge, this type of defect has not been described previously in Japan. Diaphragmatic hernia in pregnancy is very rare, and presents abdominal pain, vomiting and dyspnea. Usually the diagnosis is achieved by chest X-ray film. However, esophago-gastrography should be added, if the diagnosis could not be confirmed by chest X-ray film. Conservative management is reported to bring high mortality, therefore, prompt surgical repair is advisable.
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PMID:[A case of congenital diaphragmatic hernia due to left central tendon defect in pregnancy]. 279 5

Case 1, a 9-year-old woman, was admitted to our hospital because of nausea, vomiting, and epigastralgia. Diagnosis of Bochdalek hernia was made by the unusual course of naso-gastric tube. At surgery through the left posterorateral thoracotomy, the herniation of the stomach, small intestine, and colon to the thoracic cavity through the dorsolateral defect of the diaphragm were revealed. Case 2, a 35-year-old man, was admitted to our hospital because of dyspnea. Similar diagnosis was made by the examination of upper G1 series and barium enema, which demonstrated the presence of multiple loops of the small intestine and colon in the left thoracic cavity. Their postoperative courses were uneventful. Most of Bochdalek hernia is observed in infancy, and adolescent or adult case is is rarely reported (approximately 10% of all cases). Since this often misdiagnosed as pleuritis or pulmonary tuberculosis, a cautious examination is necessary for the establishment of the correct diagnosis.
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PMID:[Two cases of the congenital posterolateral diaphragmatic hernia were reported]. 899 51

Twenty-seven patients underwent consecutive elective laparoscopic repair of paraesophageal hiatal hernia between October 1992 and June 1997. There were 24 females and 3 males. The average age was 68 years (range, 46-86) and average weight was 173 pounds (range, 122-243 lb.). Presenting symptoms were: postprandial epigastric pain or pressure in 19 patients, postprandial dyspnea in 7 patients, anemia in 5 patients, postprandial vomiting of food in 5 patients, and 1 patient had postprandial palpitation. Heartburn was present in 9 patients. Five patients had a history of symptoms of intermittent volvulus. History of hiatal hernia was present in 19 patients ranging from 6 months to 38 years in duration. The operative procedure included a laparoscopic reduction of the herniated stomach, excision of the hernia sac, and closure of the diaphragmatic defect with placement of mesh graft. Anterior gastropexy was performed on all patients except two who had a Nissen fundoplication due to severe reflux symptoms. Seven patients had laparoscopic cholecystectomy at the same time and one patient had an excision of a small benign gastric leiomyoma of the fundus. The average operative time was 2:54 hours (range, 1:35-4:05 hrs.). The average hospital stay was 3.8 days (range, 2-8 days). One patient had a postoperative stroke and recovered quickly. Follow-up of 1 to 56 months showed no recurrence of the hernia. Two patients complained of some epigastric pain and six patients had occasional mild reflux that was easily controlled medically. Laparoscopic repair of paraesophageal hernia is a safe procedure with a short hospital stay and recovery time. Using mesh graft decreases the risk of developing an iatrogenic parahiatal hernia. The addition of Nissen fundoplication is not necessary unless the patient has objective findings of reflux.
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PMID:Laparoscopic repair of paraesophageal hiatal hernia. 969 97

A 63-year-old male with a previously documented paraesophageal hernia presented with acute severe epigastric pain and bloating. He was taken urgently to the operating room for laparoscopic exploration. The hernia sac was reduced with difficulty owing to extensive adhesions and the incarcerated portion of the stomach was mottled and blue. After 10 min of observation the stomach began to resume a normal appearance. The anterior crura were approximated and an anterior gastropexy was performed. The patient was discharged on the 3rd postoperative day and has been asymptomatic since. Paraesophageal hernias with evidence of impending gastric necrosis can be approached laparoscopically as long as basic principles are observed.
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PMID:Emergency laparoscopic repair of a paraesophageal hernia. 986 95

Internal hernia, herniation of the internal organs through defects in the intraabdominal cavity, is rare. Due to the rarity of this pathology and lack of the specific symptoms and signs, early diagnosis and treatment are always stressful to the clinician and misdiagnoses may occur in the emergency room. The prognosis of a patient with uncomplicated internal hernia is excellent. We report a 21-year-old Chinese man with internal herniation through a defect of mesocolon, presented as an impalpable abdominal mass which was shown only on imaging studies. In addition to the typical whirlpool pattern, a huge solid mass between the pancreatic tail and stomach was found under computed tomography (CT) scan. The major symptoms were intermittent epigastralgia and abdominal fullness that had bothered him for years. Physical examination results showed only mild epigastric tenderness. Computed tomography scans and exploratory laparotomy of the abdomen played vital roles during diagnosis. The herniated organ was a portion of jejunum with partial small intestinal obstruction.
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PMID:Descending mesocolon defect herniation: case report. 1041 23

BACKGROUND: Although unusual, but not rare, obstruction in the vicinity of the jejunojejunostomy in Roux-Y gastric bypass (RYGBP) can progress in a very short period of time to a life-threatening situation. METHODS: Over a 10-year period in 1,174 RYGBPs, we have seen seven instances of acute and subacute partial to complete small bowel obstructions in the vicinity of the jejunojejunostomy, which can lead to acute gastric dilatation due to obstruction of the bilio-pancreatic limb. Signs and symptoms of the obstruction may include tachycardia, oliguria, hypotension, severe epigastric pain with or without a palpable mass in the epigastrium, chronic bile regurgitation and bilious vomiting, and a possible increase in serum amylase. Laboratory data otherwise has not been helpful, and although a palpable abdominal mass may be diagnostic, the best tools have been radiologic, i.e. the acute abdomen series, limited upper GI series in the patients that appear to be only partially obstructed, abdominal ultrasound and probably most importantly, CT of the abdomen. RESULTS: In the seven cases presented, diagnoses included internal hernia, adhesions, an idiopathic spontaneous hematoma of the bowel wall and retrograde intussusception at the jejunojejunostomy. CONCLUSIONS: Since many surgeons who perform bariatric surgery are alone in their community, they should train their non-bariatric surgical colleagues and associates to be aware of these potential deadly problems.
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PMID:Biliopancreatic Limb Obstruction in Gastric Bypass at or Proximal to the Jejunojejunostomy: A Potentially Deadly, Catastrophic Event. 1072 97

Diaphragmatic hernias of the Bochdalek type are rare in adults. The diagnosis may be made with radiography of the chest in an asymptomatic person or in a person with respiratory and/or gastrointestinal symptoms. It has been mistaken for pleural effusion, empyema, lung cysts, and pneumothorax. A 38-year-old woman presented with epigastric pain and a persistent cough of 2 months' duration. A chest radiograph showed bowel loops in the left side of the chest. On laparoscopy, two defects, measuring 10 and 4 cm, respectively, were seen in the left hemidiaphragm. The herniated fundus of the stomach was reduced and the defect repaired with Gore-Tex mesh (W. L. Gore & Associates, Inc., Flagstaff, AZ, U.S.A.). The patient had an uneventful recovery. Laparoscopic repair of the rare Bochdalek hernia is feasible.
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PMID:Laparoscopic repair of Bochdalek hernia in an adult. 1087 27


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