1/289. Paraoesophageal hernia in children: familial occurrence and review of the literature. Paraoesophageal hernia (PH) in children is a rare entity, and most reported cases refer to adult patients. Its etiology is not precisely known, but the hypothesis of its congenital origin is widely accepted. Similarly to other congenital diaphragmatic defects, PH follows a sporadic pattern of incidence in most cases. Familial occurrence of sliding hiatal herniae has been reported in more than 20 cases, but only one family with two members affected by PH was described in the literature. We present two pairs of siblings with the paraoesophageal type of hiatus hernia and discuss the clinical presentation of this anomaly in children. ( info) |
2/289. Right-sided hiatal hernia of the oesophagus. At chest radiography performed for recurrent pneumonia in a 3-month-old boy, an air-fluid level in the right cardiophrenic angle was found and initially perceived as a lung abscess. upper gastrointestinal tract radiographs, however, revealed a congenital diaphragmatic hernia, which was successfully repaired. ( info) |
3/289. Intrathoracic omental herniation through the esophageal hiatus: report of a case. We report herein an extremely rare case of intrathoracic omental herniation through the esophageal hiatus. In fact, according to our review of the literature, only eight other cases have been reported, most of which were misdiagnosed as mediastinal lipoma after being identified as an intrathoracic mass. We report herein the ninth case of intrathoracic omental herniation through the esophageal hiatus. A 54-year-old obese woman was admitted to our hospital for investigation of a chest roentgenographic abnormality. She was asymptomatic, and her physical examination and laboratory data were all within normal limits. Her chest X-ray demonstrated a large, sharply-defined mass, and a computed tomography scan of the thorax indicated a large mediastinal mass with fat density. A thoracotomy was performed under the diagnosis of a mediastinal lipoma which revealed an encapsulated fatty mass, 10x7.5x6 cm in size, that proved to be an omental herniation through the esophageal hiatus. There was no herniation of the stomach or intestines into the thorax. The esophageal hiatus was repaired after the omental mass and hernia sac had been resected. This case report serves to demonstrate that whenever a mass of fat density is recognized in the lower thorax, an omental herniation should be borne in mind as a possible differential diagnosis. ( info) |
4/289. Radiologic differential diagnosis. Radiologic pattern: solitary cavity. The differential diagnosis of a left lower lobe cavity in this young patient with a history of productive cough should include hiatal hernia, pulmonary abscess, bronchiectatic cyst and bronchopulmonary sequestration. Hiatal hernia should be ruled out by barium swallow; acute pulmonary abscess by the lack of a history suggestive of a necrotizing pneumonia; bronchiectasis by bronchogram; and intralobar bronchopulmonary sequestration should be confirmed by aortography. ( info) |
| OBJECTIVE: To describe a case of esophageal ulcer associated with the use of alendronate. CASE REPORT: This is the fifth case ever described in the literature according to our bibliographic review. In our patient, the association between the drug and the esophageal lesions was masked by the presence of a hiatal hernia, potentially a cause of the esophageal lesion. The persistence of the lesions despite high doses of anti-reflux therapy called attention to the possibility of the relationship. The esophageal lesion healed soon after suspension of alendronate. DISCUSSION: The authors present a review of the literature and point to the need for diagnostic investigation, to suspend such a drug from patients who experience dyspeptic symptoms while using it. ( info) |
| Approximately 20% of the 100,000 patients in the united states currently undergoing dialysis therapy for end-stage renal disease use the technique of peritoneal dialysis. We present a patient on peritoneal dialysis who developed a large posterior mediastinal mass, which on surgical exploration was found to be a paraesophageal hernia sac filled with omentum and dialysis fluid. We use this case as an introduction to review the thoracic complications of peritoneal dialysis. ( info) |
7/289. Simultaneous pyloric and colonic obstruction associated with hiatus hernia in a weightlifter: a case report. Hiatus hernia is usually attributed to conditions that cause a chronic increase in intra-abdominal pressure such as multiple pregnancies and obesity. A 30-year-old man, a weightlifter, had a massive hiatus hernia causing both high and low gastrointestinal obstruction but no involvement of the gastroesophageal junction or fundus. The onset of the obstruction is attributed to an extreme increase in intra-abdominal pressure caused by the action of lifting weights. ( info) |
8/289. pulmonary embolism following laparoscopic antireflux surgery: a case report and review of the literature. Deep venous thrombosis and pulmonary embolism are concerning causes of morbidity and mortality in patients undergoing general surgical procedures. Laparoscopic surgery has gained rapid acceptance in the past several years and is now a commonly performed procedure by most general surgeons. Multiple anecdotal reports of pulmonary embolism following laparoscopic cholecystectomy have been reported, but the true incidence of deep venous thrombosis and pulmonary embolism in patients undergoing laparoscopic surgery is not known. We present a case of pulmonary embolism following laparoscopic repair of paraesophageal hernia. The literature is then reviewed regarding the incidence of pulmonary embolism following laparoscopic surgery, the mechanism of deep venous thrombosis formation, and the recommendations for deep venous thrombosis prophylaxis in patients undergoing laparoscopic procedures. ( info) |
9/289. Intrathoracic stomach presenting as acute tension gastrothorax. Total intrathoracic stomach creating pulmonary and hemodynamic compromise is a rare life-threatening complication in patients with hiatal hernia. The presentation and clinical course of this condition are discussed. physicians should consider this entity in patients presenting with apparent tension pneumothorax without history or other evidence of trauma or positive pressure ventilation who do not respond to standard interventions. ( info) |
10/289. Transient left vocal cord paralysis during laparoscopic surgery for an oesophageal hiatus hernia. A 45-year-old male, with symptoms of many years standing of gastro-oesophageal reflux disease, was subjected, under general anaesthesia, to laparoscopic fundoplication. Tracheal intubation yielded no problems but great difficulties were encountered during tube insertion into the oesophagus. After surgery, aphonia developed. Laryngological examination demonstrated paralysis of the left vocal cord. voice strength returned to the pre-operative status after 3 months, and laryngological examination confirmed normal mobility of both cords. The possible cause of the complication was damage to the left recurrent laryngeal nerve which occurred during insertion of the tube into the oesophagus. Gastro-oesophageal reflux disease causing 'acid laryngitis' can create conditions favouring this type of complication. ( info) |