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

Internal herniation is a well-described complication after a gastric bypass, particularly when performed laparoscopically, although it is rarely described following a total gastrectomy. A 55-year-old lady presented with a 24-hour history of vomiting and rigors 10 months after a radical total gastrectomy with Roux-en-Y reconstruction for a gastric adenocarcinoma. Computed tomography (CT) showed a complete small bowel obstruction and a mesenteric swirl sign, indicating a possible internal hernia. The entire small bowel was found at laparotomy to have migrated through the mesenteric defect adjacent to the site of the previous jejunojejunostomy and was dark purple and aperistaltic. The small bowel was reduced through the defect. At a second laparotomy, the small bowel looked healthy and the defect was repaired. Postoperative recovery was unremarkable. Of numerous signs described, the mesenteric swirl sign is considered the best indicator on CT of an internal hernia following Roux-en-Y reconstruction in gastric bypass surgery. A swirl sign on CT in a patient with abdominal pain should always raise the suspicion of an internal hernia.
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PMID:Internal hernia following total gastrectomy with Roux-en-Y reconstruction. 2192 89

The Fetal Treatment Center founded by Michael Harrison is credited as the birthplace of fetal surgery. His trainees in pediatric surgery subsequently founded fetal centers throughout the United States. In Europe, the advent of minimally invasive fetal surgical techniques led to the establishment of treatment centers led predominantly by perinatologists. More recently, perinatologists in North America have begun to play a greater role in the field of fetal intervention.Intrauterine transfusion for the treatment of hemolytic disease of the fetus/newborn was the first successful fetal intervention. Although not subjected to the rigors of clinical trials, this treatment has withstood the test of time. Interventions for other fetal disease states such as twin-twin transfusion and repair of fetal myelomeningocele were investigated in animal models followed by randomized clinical trials before widespread adoption. Tracheal occlusion for diaphragmatic hernia is still currently being investigated as the next promising step in fetal intervention.
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PMID:The history of fetal therapy. 2457 Jan 68