Cases of retrograde infringement in a "sliding" hernia

The concept of retrograde infringement is understood as infringement of one or more loops of the intestines, in which an eating disorder involves not only the parts in the hernial sac into suffering, but also, and to a greater extent, especially the part located in the free abdominal cavity. This, rare, form of infringement by Bendel was given the name Hernie en W, since in typical cases there are two loops in the hernial sac outward from the restraining ring, and inwardly from it in the abdominal cavity one connecting with a more severe eating disorder, depending on its bending mesentery or twisting of the entire loop. It is extremely rare that the median loop is little changed in comparison with the two in the hernial sac (the case of Nevsky).

204 ENDOSCOPIC EVIDENCE OF BILE REFLUX IS A STRONG INDEPENDENT FACTOR ASSOCIATED WITH THE PRESENCE OF BARRETT’S ESOPHAGUS

Several basic researches have indicated that there is a significant relationship between bile reflux and the pathogenesis of Barrett’s esophagus (BE). However, only few clinical studies have been reported regarding the endoscopic finding of bile reflux and Barrett’s esophagus. Our objective is to evaluate whether the endoscopic evidence of bile reflux is an independent factor associated with the presence of BE. Methods We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive Japanese patients who underwent screening gastroscopy. Endoscopic findings of BE, reflux esophagitis, atrophic gastritis and sliding hernia were recorded. Evaluation of a BE was based on the Prague criteria. Endoscopic evidence of bile reflux was defined as the presence of yellow or green juice observed by white light image or red juice by narrow band image (NBI) in the gastric fundus. Univariate and multivariate analyses were performed to identify factors that differed significantly between patients with or without BE. Results A total of 454 patients were enrolled; 124 (27%) had BE and 126 (28%) had endoscopic evidence of bile reflux. Compared to patients without BE, patients with BE were more likely to be old, male and to have sliding hernia and endoscopic evidence of bile reflux on univariate analysis. On multivariate analysis, endoscopic evidence of bile reflux was a stronger independent factor associated with BE (odds ratio(OR) 11.3, 95% confidence interval(CI) 6.56–19.4) compared to the presence of sliding hernia (OR 3.58, 95%CI 2.14–6.0). Conclusion Endoscopic evidence of bile reflux identified by white light or NBI is a strong independent factor associated with the presence of BE, implying that this finding should be considered as an important parameter to determine the surveillance strategy for gastroesophageal reflux disease patients same as the presence of sliding hernia.

High Resolution Manometry Guidance During Laparoscopic Fundoplication in Pediatric Surgically “Fragile” Patients: Preliminary Report

Background: High resolution manometry (HRM), has been recently introduced in clinical practice to detect esophageal intraluminal pressure and esophageal motor function. We evaluated the feasibility and usefulness of intraoperative esophageal HRM during antireflux laparoscopic procedures in pediatric cases with neurological impairment (NI) or esophageal atresia (EA). Methods: From January to November 2019, seven children (5 NI, 2 EA) with gastroesophageal reflux (GER) were enrolled. Data on intraoperative pressure changes of the esophagogastric junction (EGJ) and postoperative follow-up data were collected. Results: Average preoperative LES pressures were not significantly different from postoperative pressures. A sliding hernia was detected in all patients as evidenced by EGJ double peak pressures. Hernia correction after esophageal traction was complete in 71.4% of the patients, and residual hernia (<2 cm) was detected in 28.6%. Postoperative EGJ pressures were higher compared to preoperative sphincteric pressures (p < 0.001); in NI patients, higher postoperative values were noted compared to EA (p = 0.05). No sliding hernia and/or GER relapses were recorded. Two patients reported dysphagia postoperatively. Conclusions: Intraoperative HRM may optimize esophageal pressure changes during laparoscopic fundoplication. Further studies are needed to confirm the usefulness of a tailored surgical approach to reduce postoperative complications.

Strangulated Morgagni hernia and sliding hiatal hernia: A rare association.

Morgagni hernias are congenital diaphragmatic hernias accounting for 3 to 5% of all diaphragmatic hernias. The association with hiatal hernia is rarely reported in the literature. We report another case of a right Morgagni hernia revealed by an acute intestinal obstruction associated with a sliding hernia hiatal. The aim is to discusses the clinical presentation and to highlight the management characteristics.

Familial sliding hiatus hernia in four siblings with uncommon features: a case series report

This case report shows a very rare case series of one family with four children who had severe congenital sliding hiatus hernia (HH) with uncommon presentations, and they had one parent with sliding hernia and the other with reflux symptoms. It is rarely described in the literature a direct link to a familial type that might refer to a common genetic factor. Hiatus hernia is protrusion of abdominal viscera through the oesophagus opening in the diaphragm into the thoracic cavity with sliding hernia being the most common. It can be either asymptomatic or accompanied by a variety of symptoms. We present a case series of one family in which four siblings had congenital sliding diaphragmatic hernia with atypical symptoms and gastro-oesophageal reflux disease (GORD). It is a rare case that suggests a common factor that can cause such a common disease. All four had uncommon presentations which all required surgical repair. Few cases reported on the medical literature, and they were discussed and compared with our case. However, we need further studies in families that might have this phenomenon.