1/30. 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.- - - - - - - - - - ranking = 1keywords = herniation (Clic here for more details about this article) |
2/30. Paraesophageal omental hernia mimics pleural lipomatous tumor.Paraesophageal omental herniation (POH) is uncommon. CT scan and MRI are complementary in diagnosis. We present a posterior mediastinal mass in a 43 year old male with a history of myxoid liposarcoma raising the suspicion of latent secondary tumor. Subsequently, at thoracotomy he was found to have a POH. Differential diagnosis, work-up and surgical approach are discussed.- - - - - - - - - - ranking = 0.11111111111111keywords = herniation (Clic here for more details about this article) |
3/30. hernia at 5-mm laparoscopic port site presenting as early postoperative small bowel obstruction.A decade has passed since laparoscopy became a popular tool in general surgery. New technologies continue to surface, and surgeons are still trying to expand the applications of this technique. Parallel to the development of new techniques, we are also measuring the presentation of new complications. Incisional hernias are not new complications. Although their avoidance has been one of the proposed benefits of laparoscopy, several cases of port-site hernias have been reported. Current surgical wisdom suggests closure of 10-mm or larger port sites to avoid herniation. Most surgeons do not routinely close 5-mm port sites, believing that such fascial defects are not large enough to create a significant risk of hernia formation, thus not justifying the extra time and effort needed to close them. Although this practice may be reasonable for most cases, it should be reconsidered in lengthy procedures, particularly if the port has been used for active operative instruments. Under these circumstances, the repetitive motions in different directions may cause the 5-mm defect to enlarge significantly, allowing a hernia of considerable size to develop, with the obvious clinical implications of such a complication. We present a case of a hernia through a 5-mm port site presenting as small-bowel obstruction in the early postoperative period after a laparoscopic paraesophageal hernia repair.- - - - - - - - - - ranking = 0.11111111111111keywords = herniation (Clic here for more details about this article) |
4/30. Fatal cardiac tamponade after emergency tension-free repair of a large paraesophageal hernia.Paraesophageal hernia is an unusual disorder of the esophageal hiatus that may be associated with life-threatening mechanical problems. We report a case of a large paraesophageal hernia that presented with acute thoracic herniation and incarceration of the stomach. The patient underwent laparoscopic operation, including reduction of an intrathoracic stomach, hernial sac removal, and tension-free repair of the hiatus with polytetrafluoroethylene (PTFE) mesh. The mesh was fixed with a straight hernia stapler. Postoperatively the patient developed a fatal cardiac tamponade secondary to a coronary vein laceration due to fixation of the mesh with the stapler. Different operative techniques and possibilities for prevention of the complication are discussed.- - - - - - - - - - ranking = 0.11111111111111keywords = herniation (Clic here for more details about this article) |
5/30. Intrathoracic omental herniation through the esophageal hiatus: a case report.A case of paraesophageal omental herniation in a 74-year-old man is reported. Although computed tomography (CT) and magnetic resonance imaging (MRI) depicted a retrocardiac fatty mass that resembled omental herniation, residual concern remained regarding lipomatous tumor. Angiography provided decisive evidence of a mass containing omental vessels passing through the esophageal hiatus, which led to the final diagnosis. The patient underwent a strict course of observation, because he had no symptoms or abnormal physical or laboratory findings. Paraesophageal omental herniation mimics lipomatous tumors, such as lipoma or well-differentiated liposarcoma, extending to both sides of the diaphragm. Correct diagnosis of omental herniation requires the evidence of omental fat accompanied with omental vessels passing through the esophageal hiatus. Since angiography is an invasive diagnostic procedure, we would recommend dynamic MRI or reconstructed 3D MR angiography as alternatives to angiography.- - - - - - - - - - ranking = 0.88888888888889keywords = herniation (Clic here for more details about this article) |
6/30. Laparoscopic repair of an extrahiatal hernia caused by congenital dysplasia: a case report.A 40-year-old woman with complaints of relapse in the upper abdomen and dysphagia was referred for laparascopic hiatal hernia repair. Chest radiograph, barium-swallow, and upper endoscopy revealed a paraesophageal hernia. Esophageal manometry and 24-h-pH study showed no pathological findings. A laparoscopic gastropexy was planned. Intraoperatively, in contradiction to the preoperative findings, an extrahiatal hernia containing most of the stomach was found. After resection of the hernia sac, the beating heart without covering pericardium was seen. These findings were confirmed by an additional thoracoscopy at the end of the operation. The defect was closed by direct suturing. The postoperative course and 2-month follow-up were uneventful. The resected parts of the hernia sac showed an embryonic and dysgenetic etiology. This rare malformation has been reported in combination with complex syndromes, which appear with serious clinical and morphological signs in the neonatal period. In adults, the pericardial aplasia can be observed during diagnostic or surgical interventions. In these patients, complaints are usually not caused by the malformation but may be due to the occasional herniation of abdominal organs. We consider laparoscopic repair to be a gentle and safe procedure for the treatment of extrahiatal hernias.- - - - - - - - - - ranking = 0.11111111111111keywords = herniation (Clic here for more details about this article) |
7/30. Asymptomatic diaphragmatic hiatal herniation of the pancreas.Herniation of the pancreas into a diaphragmatic hiatal hernia is a rare condition reported in only three cases; all were symptomatic. We present a CT diagnosis of hiatal hernia containing the body and tail of a normal pancreas in an asymptomatic patient.- - - - - - - - - - ranking = 0.44444444444444keywords = herniation (Clic here for more details about this article) |
8/30. Isolated trans-hiatal colonic herniation.Isolated herniation of the colon through congenital or traumatic diaphragmatic defects are well documented. However, trans-hiatal herniation of the colon in the absence of an intrathoracic stomach has been reported only once. A 67-year-old man presented with intragastric abdominal pain and a chest x-ray film documenting a posterior mediastinal air-fluid level. Computed tomography showed gastrointestinal contents within the thorax. The findings on an upper gastrointestinal film with small bowel follow-through were normal. Finally, a barium enema identified transverse colon within the thoracic cavity. At laparoscopy, the entire transverse colon was reduced with the hernia sac. The crural defect was repaired, and a Toupet fundoplication was performed. A gastropexy was also added. The patient was discharged on postoperative day 2 able to tolerate a regular diet, and he has been asymptomatic for 5 months. This defect most likely represents a congenital deformity of the diaphragm with intact posterior gastric attachments, including the posterior phrenoesophageal ligament. An intact gastric mesentery enabled isolated colonic herniation with retention of the stomach its normal anatomic position. An antireflux procedure was performed in addition to the crural repair because of the circumferential dissection of the esophagus. This article is the second report of an isolated trans-hiatal herniation of the colon and the first report of laparoscopic repair of this entity.- - - - - - - - - - ranking = 0.88888888888889keywords = herniation (Clic here for more details about this article) |
9/30. Parahiatal hernia with gastric obstruction in a child.Parahiatal hernia refers to herniation of abdominal viscera into the chest adjacent to an intact hiatus. Spontaneously occurring parahiatal herniae are extremely rare. We report a 4-year-old boy who presented with intermittent vomiting and had such a hernia, where the herniated stomach had undergone partial volvulus. He was symptom-free after surgical repair.- - - - - - - - - - ranking = 0.11111111111111keywords = herniation (Clic here for more details about this article) |
10/30. Pancreatic herniation through the gastroesophageal hiatus: magnetic resonance imaging, magnetic resonance cholangiopancreatography, and computed tomography evaluation.A rare case of pancreatic herniation through the gastroesophageal hiatus is presented, including magnetic resonance evaluation with magnetic resonance cholangiopancreatography and magnetic resonance angiography images unique to the published literature.- - - - - - - - - - ranking = 0.55555555555556keywords = herniation (Clic here for more details about this article) |
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