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

The average length of the umbilical cord is 50-60 cm in the normal full term newborn infant. The length of the cord is an index of foetal activity and is dependent on the tension caused by the freely moving foetus, primarily during the second trimester. The short cord is associated with foetal akinesis or maldevelopment of the central nervous system and is a significant early marker of developmental abnormalities including Down syndrome. Abnormal girth of the cord should make one suspicious of a patent urachus or an umbilical hernia and caution should be used before clamping. The importance of the twist is that, if not present, one should suspect congenital anomalies. The twist should be to the left or counter clockwise. The cord stump separates from the baby at about two weeks of age at present in the era of triple dye care with a large variability due to multiple factors.
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PMID:The umbilical cord: normal parameters. 194 74

This is a case report of extravaginal twisting of the spermatic cord in a neonate (third pregnancy, without prenatal care, obtained through iterative cesarean section), which occurred during the prenatal (in uterus) period since it was present at birth. Clinically found were: an enlargement of the right hemiscrotum, color changes (violet), induration, absence of the cremasteric reflex and no translumination. Ultrasonography showed homogeneous opaqueness of the right scrotal pouch. Right radical orchiectomy was carried out after finding testicular necrosis. The differential diagnosis includes: tumor, hematocele, testicular twist of the epidydimus appendexes, incarcerated hernia, scrotal abscess, supradrenal gland or ectopic spleen and the twisting of the spermatic cord. All of these conditions require immediate surgical exploration through the inguinal region in order to obtain a correct diagnosis and give prompt treatment. If there is twisting, contralateral fixation is necessary.
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PMID:[Prenatal testicular torsion. Presentation of a case and review of the literature]. 205 84

The frequency of bariatric operations has increased in Germany. Primary operations are usually performed at specialised centres. However, late complications may develop months or even years after the operation, and every general and visceral surgeon may be confronted with them, regardless of the size and specialisation of their clinics. The laparoscopic Roux-Y gastric bypass is the most frequently performed bariatric operation worldwide. During this procedure, the alimentary loop is lifted up in front of the colon to form a pouch, which creates a mesenteric space, also called the Petersen space, dorsal to the alimentary loop and below the transverse colon. Both here and around the mesenteric space of the Roux anastomosis, an internal hernia may develop, i.e. the small intestine can twist on its own axis. Abdominal discomfort due to intestinal obstruction is unspecific, but very pronounced. Clinically, patients either present with an acute abdomen or with intermittent unspecific abdominal pain with nausea, and rarely also with vomiting. Clinical examinations and lab chemistry tests usually do not reveal any indicative findings. In cases of doubt, therefore, contrast-enhanced computed tomography of the abdomen is the diagnostic imaging procedure of choice. A diagnostic laparoscopy should be performed in every patient with a clinical suspicion of an internal hernia, even if the CT scan is unremarkable. This should be done by a surgeon who is well-versed in laparoscopy and experienced in bariatric surgery, since classification of the intestinal loops is very difficult without knowledge of the hernial orifices. First, an inframesocolic view is obtained with the transverse colon being lifted. From here, the open Petersen space offers a direct view of the ligament of Treitz from the right side. If small intestine is found to the right of the ligament, there is a Petersen hernia. After the inframesocolic view, the gastroenterostomy should be located and the alimentary loop should be followed in distal direction towards the jejunojejunostomy, where the second possible space may be found. Once both spaces have been located and a hernia has been reduced as appropriate, the spaces should be closed with non-absorbable suture.
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PMID:[Internal Hernia Following Laparoscopic Roux-Y Gastric Bypass - a Challenge not only for the General Surgeon]. 2730 May 88

Midgut volvulus in adults is a rare entity that may present with intermittent colicky abdominal pain mixed with completely asymptomatic episodes. This small bowel twist may result in complications of obstruction, ischemia, hemorrhage, or perforation. With a midgut volvulus, complications may be life-threatening, and emergent surgical intervention is the mainstay of treatment. This current case involves an 80-year-old woman with intermittent abdominal pain with increasing severity and decreasing interval of time to presentation. A CAT scan revealed mesenteric swirling with possible internal hernia. A diagnostic laparoscopy followed by laparotomy revealed a midgut volvulus, extensive adhesions involving the root of the mesentery, and a large jejunal diverticulum. The adhesions were lysed enabling untwisting of the bowel, allowing placement of the small bowel in the correct anatomic position and resection of the jejunal diverticulum. This is a rare case of midgut volvulus with intermittent abdominal pain, associated with jejunal diverticulum managed successfully. A midgut volvulus should be considered in the differential diagnosis of a patient who present with a small bowel obstruction secondary to an internal hernia, especially when a swirl sign is present on the CAT scan.
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PMID:A Case of Midgut Volvulus Associated with a Jejunal Diverticulum. 2941 Sep 29

BACKGROUND The upper stomach can be involved in 1 type of esophageal hiatal hernia in which the degree of stomach insertion is considerable and accompanied by a twist in the shaft of the stomach. The diagnostic accuracy of upper endoscopy or barium meal examination decreases in patients with upside-down stomach, thus making diagnosis of stomach lesions very difficult. No previous reports have described scirrhous gastric cancer in a patient with upside-down stomach. CASE REPORT An 85-year-old woman presented with loss of appetite and vomiting after eating oxalic acid-containing food 2 months previously. Computed tomography revealed an upside-down stomach, and upper endoscopy revealed loss of distensibility and superficial gastritis of the entire stomach. Upside-down stomach was diagnosed; accordingly, laparoscopic hernia repair was planned. Laparoscopic exploration revealed retention of serous fluid (i.e., ascites) containing gastric carcinoma cells (pathologically identified intraoperatively) and induration of the entire stomach. After converting to laparotomy, induration of the stomach was confirmed, continuing to the adjacent 4 cm of the distal esophagus. The patient was diagnosed with scirrhous gastric cancer. Esophageal hiatus hernia repair was performed due to the patient's age and the risks associated with esophagojejunostomy. Preoperative complaints of symptoms disappeared. The patient was transferred to the medical hospital on postoperative day 52 with no complications. CONCLUSIONS Specific symptoms of gastric cancer can mimic those of esophageal hiatal hernia in patients with hernia. In cases of upside-down stomach with loss of distensibility and increased wall thickness, physicians should be aware of the possibility of scirrhous gastric cancer.
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PMID:Difficult Diagnosis and Surgical Procedure for Scirrhous Gastric Cancer Complicated by Upside-Down Stomach: A Case Report. 3297 80