scholarly journals Hiatal Hernia as a Total Gastrectomy Complication

2016 ◽  
Vol 9 (1) ◽  
pp. 100-105 ◽  
Author(s):  
Bruna do Nascimento Santos ◽  
Marcos Belotto de Oliveira ◽  
Renata D'Alpino Peixoto
Keyword(s):  
Hiatal Hernia ◽  
Gastric Adenocarcinoma ◽  
Epigastric Pain ◽  
Abdominal Cavity ◽  
Esophageal Hiatus ◽  
The Third ◽  
Esophageal Anastomosis ◽  
Folfox Chemotherapy ◽  
Laparoscopic Assisted ◽  
Severe Epigastric Pain

Introduction: According to the Brazilian National Institute of Cancer, gastric cancer is the third leading cause of death among men and the fifth among women in Brazil. Surgical resection is the only potentially curative treatment. The most serious complications associated with surgery are fistulas and dehiscence of the jejunal-esophageal anastomosis. Hiatal hernia refers to herniation of elements of the abdominal cavity through the esophageal hiatus of the diaphragm, though this occurrence is rarely reported as a complication in gastrectomy. Case Report: A 76-year-old man was diagnosed with intestinal-type gastric adenocarcinoma. He underwent a total laparoscopic-assisted gastrectomy and D2 lymphadenectomy on May 19, 2015. The pathology revealed a pT4pN3 gastric adenocarcinoma. The patient became clinically stable and was discharged 10 days after surgery. He was subsequently started on adjuvant FOLFOX chemotherapy; however, 9 days after the second cycle, he was brought to the emergency room with nausea and severe epigastric pain. A CT scan revealed a hiatal hernia with signs of strangulation. The patient underwent emergent repair of the hernia and suffered no postoperative complications. He was discharged from the hospital 9 days after surgery. Conclusion: Hiatal hernia is not well documented, and its occurrence in the context of gastrectomy is an infrequent complication.

Surgical Management of Hiatal Hernia in Children with Asplenia Syndrome

2016 ◽  
Vol 27 (03) ◽  
pp. 274-279
Author(s):  
Koji Fukumoto ◽  
Masaya Yamoto ◽  
Hiroshi Nouso ◽  
Masakatsu Kaneshiro ◽  
Mariko Koyama ◽  
...  
Keyword(s):  
Hiatal Hernia ◽  
Duodenal Obstruction ◽  
Abdominal Cavity ◽  
The Other ◽  
Esophageal Hiatus ◽  
Thoracic Cavity ◽  
Toupet Fundoplication ◽  
Cavity Volume ◽  
Upper Gastrointestinal ◽  
Asplenia Syndrome

Purpose Patients with asplenia syndrome (AS) are likely to have upper gastrointestinal tract malformations such as hiatal hernia. This report discusses the treatment of such conditions. Methods Seventy-five patients with AS underwent initial palliation in our institution between 1997 and 2013. Of these, 10 patients had hiatal hernia. Of the patients with hiatal hernia, 6 had brachyesophagus and 7 had microgastria. Results Of the 10 patients with hiatal hernia, 9 underwent surgery in infancy (7 before Glenn operation, 2 after Glenn operation). Two underwent typical Toupet fundoplication, and the other 7 underwent atypical repair including reduction of the stomach. Two patients with atypical repair showed recurrence of hernia and required reoperation. Three patients required reoperation due to duodenal obstruction. Duodenal obstruction occurred due to preduodenal portal vein or abnormal vessels compressing the duodenum. Obstructive symptoms were not seen in any cases preoperatively. Conclusions In patients with hiatal hernia, typical fundoplication is often difficult because most have concomitant brachyesophagus, microgastria, and hypoplasia of the esophageal hiatus. However, we should at least reduce the stomach to the abdominal cavity as early as possible to increase thoracic cavity volume and allow good feeding. Increasing the volume of the thoracic cavity thus makes Glenn and Fontan circulations more stable. Duodenal obstruction secondary to vascular anomalies is also common, so the anatomy in the area near the duodenum should be evaluated pre- and intraoperatively.

scholarly journals Esophageal Hiatus Hernia

2020 ◽  
Vol I (1) ◽  
pp. 26-26
Author(s):  
Wei Liu
Keyword(s):  
Physical Examination ◽  
Hiatus Hernia ◽  
Epigastric Pain ◽  
Treatment Options ◽  
Abdominal Cavity ◽  
Antireflux Procedure ◽  
Esophageal Hiatus ◽  
Her Family ◽  
Breath Sounds ◽  
Esophageal Hiatus Hernia

A 83-year-old women presented to the emergency department with epigastric pain and vomiting that had progressively worsened over a period of 1 year. Her medical history was notable for type 2 diabetes and hypertension. A physical examination revealed that breath sounds were weakened. Her abdomen was soft, with moderate epigastric tenderness and normal bowel sounds. The rest of the physical examination was unremarkable. A radiograph of the chest confirmed compression of both lungs for unknown reasons (Figure 1A). Computed tomography (CT) of the chest revealed a large hiatus hernia containing almost the entire stomach (Figure 1B). A diagnosis of esophageal hiatus hernia was made. Hiatus hernia refers to a disease status involving herniation of the contents of the abdominal cavity, especially the stomach, through esophageal hiatus of the diaphragm into the mediastinum. It is accepted that the prevalence of hiatus hernia increases with age and body mass index. The typical symptom of hiatus hernia is gastroesophageal reflux and less common symptoms are epigastric or chest pain and dysphagia. It is necessary to make a critical risk-benefit assessment mandatory before complicated and surgical treatment of hiatus hernia, usually coupled with an antireflux procedure.8,9 After a well-informed discussion of treatment options with the patient and her family, the decision was made to pursue surgery. After the procedure, she clinically improved and was discharged home with outpatient follow-up.

scholarly journals Metronidazole-Induced Pancreatitis

HPB Surgery ◽  
2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
E. O'Halloran ◽  
A. Hogan ◽  
K. Mealy
Keyword(s):  
Emergency Department ◽  
Epigastric Pain ◽  
Acute Onset ◽  
Antibiotic Agent ◽  
The Third ◽  
Case Summary ◽  
Successful Recovery ◽  
History Of ◽  
Severe Epigastric Pain ◽  
Similar Episode

Case Summary. A 25-year-old caucasian lady presented to the Accident & Emergency department complaining of acute onset severe epigastric pain radiating through to the back with associated nausea and vomiting. A diagnosis of acute pancreatitis was made. Symptoms commenced after the third dose of Metronidazole therapy prescribed for a recurrent periodontal abscess. The patient described a similar episode 10 months previously. On neither occasion were any other medications being taken, there was no history of alcohol abuse and no other gastro-intestinal aetiology could be identified on imaging. Symptoms resolved quickly upon discontinuation of the antibiotic agent. We conclude therefore that Metronidazole can reasonably be identified as the only potential causative agent. Discussion. The proportion of cases of pancreatitis caused by drugs is estimated to be around 2% in the general population. The exact mechanism of action of Metronidazole induced pancreatitis is unclear but a trigger role for the drug seems likely. Conclusion. This case provides the eighth report of Metronidazole induced pancreatitis. All of the cases were reported in females and ran a benign course.Early diagnosis, discontinuation of the drug and supportive care will lead to a successful recovery in the majority of cases.

scholarly journals Inflammatory Pseudotumor of Omentum Containing Gas Misdiagnosed as Perforation of Hollow Organs

2021 ◽  
Author(s):  
Shiwen Nie ◽  
Yadong He ◽  
Shuo Zhang ◽  
Fenghong Cao
Keyword(s):  
Inflammatory Pseudotumor ◽  
Epigastric Pain ◽  
Treatment Plan ◽  
Abdominal Cavity ◽  
White Blood Cells ◽  
Previous History ◽  
Clinical Manifestations ◽  
Emergency Operation ◽  
Good Prognosis ◽  
Pathological Examination

Abstract BackgroundInflammatory pseudotumors that grow on the omentum are relatively rare, and inflammatory pseudotumor most often involves the lung. As far as we know, the inflammatory pseudotumor of omentum, which is in the shape of beaded vesicles and contains gas, has never been reported in the literature. Case presentationwe report a 45-year-old Chinese woman who complained of epigastric pain with hematemesis for 9 hours, physical examination showed subxiphoid tenderness, previous history of gastric ulcer and repair of gastric perforation, laboratory examination showed slight increase of white blood cells and decrease of hemoglobin. Computed tomography showed dotted free gas in the abdominal cavity, and the perforation of the hollow organs was considered. The pathological results after emergency operation showed that histiocyte aggregation with multinucleated giant cell reaction could be seen in the omental tissue. Immunohistochemistry :ER (-), PR (-), PAX-8 (-), CK (mesothelial+), MC (mesothelial+), CR (mesothelial+), CD68 (histiocyte+), SMA (smooth muscle+). The abdominal pain was relieved after surgical resection of the tumor, and recovered well after symptomatic treatment.ConclusionInflammatory pseudotumor of omentum containing gas is easily diagnosed as perforation of hollow organs, with few clinical manifestations of acute abdomen, mostly non-specific, and a good prognosis. Understanding its clinicopathological features and pathological examination methods are helpful to diagnose the disease, so as to choose an appropriate treatment plan, and whether surgical treatment is better than conservative treatment remains to be further studied. The disease should be distinguished from perforation of hollow organs, but the source of gas is unknown. It may have something to do with past medical history.

scholarly journals Low-dose combined spinal-epidural anesthesia for a patient with a giant hiatal hernia who underwent urological surgery

2018 ◽  
Vol 46 (10) ◽  
pp. 4354-4359 ◽  
Author(s):  
Mi Kyeong Kim ◽  
Junoik Shin ◽  
Jeong-Hyun Choi ◽  
Hee Yong Kang
Keyword(s):  
Hiatal Hernia ◽  
Epidural Catheter ◽  
Epidural Anesthesia ◽  
Low Dose ◽  
Intrathecal Injection ◽  
Vital Signs ◽  
Esophageal Hiatus ◽  
Urological Surgery ◽  
Gastrointestinal Problems ◽  
Giant Hiatal Hernia

A hiatal hernia refers to herniation of the abdominal organs through the esophageal hiatus of the diaphragm. A giant hiatal hernia affects digestive and cardiopulmonary function by compressing the organs. We report a patient who had low-dose combined spinal and epidural anesthesia (CSEA) for safe and effective anesthesia for conservative treatment of a giant hiatal hernia. An 84-year-old woman who had a giant hiatal hernia was scheduled for ureteroscopic removal of a ureteral stone. CSEA was performed at the L4 to L5 lumbar interspace and an epidural catheter tip was placed 5 cm cephalad from the inserted level. The T12 block was checked after 10 minutes of intrathecal injection of 6 mg of 0.5% bupivacaine. The T10 block was checked after additional injection of 80 mg of 2% lidocaine through the epidural catheter. During anesthesia and surgery, the patient's vital signs remained stable and the operation was completed within 1 hour without any problems. In conclusion, low-dose CSEA may be safely used without any cardiopulmonary and gastrointestinal problems in patients with a giant hiatal hernia undergoing urological surgery.

scholarly journals Acute Gastric Volvulus on Hiatal Hernia

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Abdessamad EL KAOUKABI ◽  
Mohamed MENFAA ◽  
Samir HASBI ◽  
Fouad SAKIT ◽  
Abdelkrim CHOHO
Keyword(s):  
Hiatal Hernia ◽  
Gastrointestinal Endoscopy ◽  
Epigastric Pain ◽  
Gastric Volvulus ◽  
Upper Gastrointestinal Endoscopy ◽  
Rare Entity ◽  
Midline Laparotomy ◽  
Acute Gastric Volvulus ◽  
Upper Abdominal ◽  
Upper Gastrointestinal

The gastric volvulus is defined as an abnormal rotation of all or part of the stomach around one of its axes, creating the conditions of an upper abdominal obstruction with gastric dilation and risk of strangulation. It is a rare entity that requires a surgical treatment, and its diagnosis is often delayed due to frequently aspecific symptoms. We will describe the observation of a 62 year old patient who presented to the emergency department for acute epigastric pain with dyspnea. The thoracoabdominal CT has demonstrated a stasis stomach on pyloric obstacle evoking a gastric torsion. An upper gastrointestinal endoscopy (EGD) and an upper gastrointestinal contrast made it possible to diagnose an acute gastric volvulus on hiatal hernia. A midline laparotomy was performed with detorsion of the stomach and repair of the hiatal hernia. The patient recovered gradually and was discharged on the sixth postoperative day. Three months after the operation, the patient remained asymptomatic.

Gastric Adenocarcinoma: An Update on Genomics, Immune System Modulations, and Targeted Therapy

2016 ◽  
pp. 104-111 ◽  
Author(s):  
Jeeyun Lee ◽  
Adam J. Bass ◽  
Jaffer A. Ajani
Keyword(s):  
Immune System ◽  
Gastric Adenocarcinoma ◽  
Median Overall Survival ◽  
Therapeutic Agents ◽  
The Novel ◽  
The Third ◽  
Genomic Knowledge ◽  
Genomic Analyses ◽  
Novel Targets ◽  
Related Mortality

Gastric adenocarcinoma (GAC) is a global health burden on all societies, and it was the third-leading cause of cancer-related mortality in 2012, causing 723,000 deaths worldwide. The prognosis of patients with metastatic GAC remains poor, with a median overall survival of less than 1 year in patients treated with currently available therapies. A limited number of therapeutic agents is currently available. Recent additions to the armamentarium include trastuzumab and ramucirumab, which have shown some survival advantage when added to cytotoxic(s). Genomic analyses have defined various genotypes of GACs. The novel genomic knowledge can lead to discovery of novel targets and novel therapeutic agents. In this update, we focus on the current genomic data, targeted therapies including immune system modulators, and expand on HER2/neu testing and the use of agents against this target. Several other facets of GAC and its therapy are not to be included in this review but have been discussed elsewhere.

scholarly journals Postpartum Spontaneous Subcapsular Hepatic Hematoma Related to Preeclampsia

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Dimitrios Anyfantakis ◽  
Miltiades Kastanakis ◽  
Georgios Fragiadakis ◽  
Paraskevi Karona ◽  
Nikolaos Katsougris ◽  
...  
Keyword(s):  
Epigastric Pain ◽  
Emergency Caesarean Section ◽  
Maternity Ward ◽  
Hepatic Hematoma ◽  
Pregnancy And Postpartum ◽  
Life Threatening ◽  
Clinical Phenomenon ◽  
Diagnostic Work ◽  
Work Up ◽  
Severe Epigastric Pain

Subcapsular hematoma of the liver represents an unusual clinical phenomenon in the pregnancy and postpartum period with serious complications in terms of fetal and maternal mortality. Here we report a case of a 32-year-old primiparous female at 36 weeks of gestation, admitted to a maternity ward of a private clinic for preeclampsia. The woman underwent an emergency caesarean section with the extraction of an alive foetus. A few hours after delivery, she was transferred to the emergency department of our institution complaining of severe epigastric pain. Diagnostic work-up was suggestive of a subcapsular right lob hepatic hematoma which was successfully managed conservatively. Timely diagnosis is necessary for the prevention of life-threatening events in mother and fetus. For this reason acute care physicians have to be vigilant of the condition and consider this in the differential diagnosis of epigastric pain during pregnancy and postpartum.

Acute Pancreatitis in Pregnancy: Maternal and Fetal Outcomes

2017 ◽  
Vol 9 (2) ◽  
pp. 106-109
Author(s):  
Asha Swarup ◽  
GS Jyothi ◽  
Shruti R Bhoosanoor
Keyword(s):  
Acute Pancreatitis ◽  
Epigastric Pain ◽  
Treatment Options ◽  
Abdominal Cavity ◽  
Age At Onset ◽  
Initial Assessment ◽  
Fetal Mortality ◽  
Fetal Outcomes ◽  
Mortality And Morbidity ◽  
In Pregnancy

ABSTRACT Aim and objective To evaluate the maternal and fetal outcomes in patients with acute pancreatitis. Materials and methods It is a retrospective observational study. A total of three patients were admitted with acute pancreatitis complicating pregnancy between January 2013 and June 2015 in the Department of Obstetrics and Gynaecology, M. S. Ramaiah Medical College and Hospital, Bengaluru, India, and were followed up until after delivery. Results Incidence of acute pancreatitis in our study was 1 in 1,620. Mean age was 24 years, and 33.3% were multiparous. Mean gestational age at onset was 33 weeks. One patient (33.3%) in our study had hypertriglyceridemia (870 mg/dL), and 66.7% of patients were idiopathic. The most common complaint was epigastric pain radiating to back. All patients showed leukocytosis and elevated amylase and lipase levels. Ultrasound showed [1] enlarged pancreas with decreased peripancreatic echogenicity and [2] pelvic and abdominal cavity effusions, in all the patients. All patients were managed conservatively in the intensive care unit. Mean duration of hospital stay was 7 days; 33.3% patients developed acute respiratory distress syndrome; 33.3% patients went into preterm spontaneous vaginal delivery. Cesarean section rate was 66.7%. Perinatal mortality was 33.3%. Conclusion Acute pancreatitis in pregnancy remains a challenging clinical problem to manage. The initial assessment, severity, and the initial management of the patient are of great importance in order to support the function and to prevent maternal and fetal mortality and morbidity. Clinical significance Acute pancreatitis either in its mild or its severe form causes maternal and fetal morbidity. However, these rates are declining due to early diagnosis and greater treatment options. Multidisciplinary approach leads to good maternal and fetal outcomes. How to cite this article Jyothi GS, Bhoosanoor SR, Swarup A. Acute Pancreatitis in Pregnancy: Maternal and Fetal Outcomes. J South Asian Feder Obst Gynae 2017;9(2):100-103.

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