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Query: UMLS:C0019270 (hernia)
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Paraduodenal hernia is a rare situation, less than 400 cases being published in literature. This condition is difficult to explore, diagnose appear within an occlusive syndrome. The etiopathology involves perturbation of intestinal rotation during the intrauterine life, producing paraduodenal fossa, which generates conditions for internal hernias and occlusive situations. We present the case of a 36 years old woman with chronic epigastric pain, diagnosed as duodenal ulcer, later as acute pancreatitis and in the end as high occlusion syndrome. Open laparotomy was performed, uncovering a strangulated left paraduodenal hernia, with severe pathologic lesions of the intestinal loops. Kelotomy and pure-string suture of parietal defect was performed. Post-operative evolution has been difficult with hepatic failure with coagulopathy and diffuse intestinal hemorrhage, threatening the patient's life. Intensive care lead eventually to a favorable condition. The rarity of this disease, difficulty of diagnosis and the particular evolution were the reasons to present this rare case.
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PMID:[Left paraduodenal hernia with particular evolution]. 1871 86

Practically, hiatal hernias are divided into sliding hiatal hernias (type I) and PEH (types II, III, or IV). Patients with PEH are usually symptomatic with GERD or obstructive symptoms, such as dysphagia. Rarely, patients present with acute symptoms of hernia incarceration, such as severe epigastric pain and retching. A thorough evaluation includes a complete history and physical examination, chest radiograph, UGI series, esophagogastroscopy, and manometry. These investigations define the patient's anatomy, rule out other disease processes, and confirm the diagnosis. Operable symptomatic patients with PEH should be repaired. The underlying surgical principles for successful repair include reduction of hernia contents, removal of the hernia sac, closure of the hiatal defect, and an antireflux procedure. Debate remains whether a transthoracic, transabdominal, or laparoscopic approach is best with good surgical outcomes being reported with all three techniques. Placement of mesh to buttress the hiatal closure is reported to reduce hernia recurrence. Long-term follow-up is required to determine whether the laparoscopic approach with mesh hiatoplasty becomes the procedure of choice.
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PMID:Paraesophageal hernia: clinical presentation, evaluation, and management controversies. 2011 30

Gastric diverticula are rare disorders which present usually with vague upper abdominal symptoms. The diagnosis is based on endoscopic and radiologic findings, but it may remain uncertain until the operation. Herein we report the case of a 46-year-old woman with a diverticulum of the posterior aspect of the upper part of the gastric fundus, referred to our attention for epigastric pain. The preoperative work out evidenced a pouch of the gastric fundus which was misinterpreted as a paraesophageal or a diaphragmatic hernia. The operation was performed by laparoscopy with a 4-port technique and the diverticulum was resected by an endoscopic stapler. The patient is well and symptom-free more than two months after the operation.
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PMID:Laparoscopic treatment of a gastric diverticulum. 2032 72

We describe a case of a young woman with acute epigastric pain. Extensive diagnostic workup suggested a hernia through the foramen of Winslow. A laparoscopic exploration of the abdomen revealed an internal herniation of the cecum and ascending colon behind the hepatoduodenal ligament into the lesser sac. Successful management requires prompt diagnosis and surgical treatment. In our case the internal herniation was uncomplicated and could be reduced laparoscopically. To our knowledge, this is the first documented case of a laparoscopically treated Winslow hernia.
Hernia 2011 Aug
PMID:Herniation through the foramen of Winslow: a laparoscopic approach. 2046 68

Bochdalek hernias (BHs) arise due to congenital diaphragmatic defect and can result in gross displacement of abdominal tissues into the thorax. Although they are uncommon in occurrence, they usually present as serious respiratory distress in infants. In the adult population, they are asymptomatic and only detected incidentally. In this report, we present the case of a 26-year-old male who acutely presented with severe epigastric pain radiating to the back and deranged vital signs as a result of incorrect previous diagnoses. A large left diaphragmatic hernia containing his pancreatic tail, spleen, stomach and other intra-abdominal organs was confirmed by CT scan, together occupying a third of the hemithorax. Although not common, diagnostics of BHs should be considered in patients presenting with acute abdomen. A plain chest X-ray displaying diminished left diaphragmatic outline or signs of mediastinal shift should raise suspicion. Previous normal chest X-ray can be deceptive and does not rule out a diaphragmatic hernia. Herein, we also review the literature for previously reported acute presentation of 11 similar cases in adults and highlight the value of including BH as one of the differential diagnoses.
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PMID:Recurrent indigestion in a young adult. 2132 83

Diaphragmatic hernia complicating pregnancy is rare and results in a high mortality rate, if early surgical intervention is not undertaken. We report a case of a woman at 32 week's gestation who was admitted to our hospital due to severe epigastralgia. Diaphragmatic relaxation had been pointed out since her birth. The patient was initially diagnosed with acute gastritis, but she developed acute respiratory insufficiency on day 3 of hospitalization. Chest X-ray and computed tomography showed niveau in the left pleural cavity. She was treated with chest tube drainage and an emergency caesarean was performed. The next day, gastric fiberscope demonstrated perforation of gastric ulcer in the left hemithorax. She was diagnosed as having diaphragmatic hernia complicated by a perforated stomach. Emergency thoracotomy was carried out and primary repair of both stomach and diaphragma was performed.
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PMID:[Diaphragmatic hernia complicated with perforated stomach during pregnancy]. 2168 48

Diaphragmatic hernia is a rare complication in pregnancy which due to misdiagnosis or management delays may be life-threatening. We report a case of a woman in the third trimester of pregnancy who presented with sudden onset of severe epigastric and thoracic pain radiating to the back. Earlier in the index pregnancy, she had undergone laparoscopic antireflux surgery (ARS) for a hiatus hernia because of severe gastro-oesophageal reflux. Owing to increasing epigastric pain a CT scan was carried out which diagnosed wrap disruption with gastric herniation into the thoracic cavity and threatened incarceration. This is, to our knowledge, the first report of severe adverse outcome after ARS during pregnancy, with acute intrathoracic gastric herniation. We recommend the avoidance of ARS in pregnancy, and the need to advise women undergoing ARS of the postoperative risks if pregnancy occurs within a few years of ARS.
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PMID:Acute gastric incarceration from thoracic herniation in pregnancy following laparoscopic antireflux surgery. 2337 56

Internal hernias through the foramen of Winslow are extremely rare. Prompt diagnosis and early surgical reduction are vital to prevent bowel gangrene and avoid resection. We report a case of ileal hernia through the foramen of Winslow in a 48-year-old woman. She presented to the emergency department with acute epigastric pain, and rapid and definitive pre-operative diagnosis of internal hernia of ileum through the foramen of Winslow without ischaemia was made by means of multi-detector computed tomography. Emergency laparoscopic bowel reduction was performed. The postoperative course was uneventful, and the patient recovered rapidly.
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PMID:Rapid pre-operative diagnosis of ileal hernia through the foramen of Winslow with multi-detector computed tomography, enabling successful laparoscopic reduction. 2347 52

An otherwise healthy 17-year-old boy presented to the paediatric emergency department with acute severe epigastric pain. An admission abdominal radiograph demonstrated gastric dilation, associated with an elevated left hemidiaphragm. Subsequent barium contrast imaging confirmed the diagnosis of organoaxial acute gastric volvulus (AGV). Emergent exploratory laparoscopy revealed AGV with migration of the stomach, spleen, pancreatic tail, splenic flexure, left kidney and adrenal through a left-sided Bochdalek diaphragmatic hernia. Following careful mobilisation of the displaced structures, a mesh closure of the diaphragmatic defect was performed. The patient's postoperative chest radiograph was unremarkable, and he was discharged on the sixth postoperative day after an uneventful recovery. At 2 months the patient was well and asymptomatic, with normal barium contrast imaging results.
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PMID:Laparoscopic repair of a late-presenting Bochdalek diaphragmatic hernia with acute gastric volvulus. 2351 14

A 53-year-old lady presented to A&E with a 3-day history of severe epigastric pain and vomiting. This was preceded by a 3-month history of generalised abdominal discomfort, early satiety and increasing shortness of breath. A CT scan showed a left-sided posterior diaphragmatic defect. Urgent repair of the hernia showed herniation of three-quarter of the stomach, half of the transverse colon, the 13 cm spleen and the pancreas in the chest. There were no postoperative complications. Traumatic diaphragmatic hernias are known to be a complication of major trauma. However, the patient in this case report presented acutely, after mild physical trauma related to using a rowing machine. This exercise, when not performed correctly can raise intra-abdominal pressure. It is plausible that this trauma, although mild, was sufficient in causing the lady's diaphragmatic hernia. This case would suggest that the trauma required to cause a diaphragmatic hernia need not be as severe as originally thought.
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PMID:Diaphragmatic hernia: an unusual presentation. 2361 19


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