1/15. 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.- - - - - - - - - - ranking = 1keywords = pressure (Clic here for more details about this article) |
2/15. 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.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
3/15. Outpatient laparoscopic Nissen fundoplication.gastroesophageal reflux disease affects more than 40% of Americans, causing heartburn and reflux of gastric contents into the esophagus when bending or lying down. Lifestyle modification, such as weight loss and a diet rich in protein and low in fat and glucose, should increase the patient's resting lower esophageal sphincter pressure. Avoiding exacerbating substances, such as mint, chocolate, alcohol, and tobacco, also may reduce symptoms. Medications may be prescribed to reduce persistent symptoms, although no medication currently available cures the disease process. patients who need antireflux medication regularly for four to six weeks or more may be candidates for laparoscopic Nissen fundoplication. patients who do not want to take antireflux medication for the rest of their lives, cannot afford the medication for an extended period of time, or suffer significant side effects from the medication also are candidates. This article describes performing Nissen fundoplication laparoscopically on an outpatient basis. The average length of hospital stay has been decreased to two to three hours when performed laparoscopically on an outpatient basis from 10 days for the open procedure and two to three days when performed laparoscopically on an inpatient basis. The incidence of recurrent heartburn is less than 2% when the procedure is performed laparoscopically and does not appear to be clinically significant.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
4/15. Giant gastrointestinal stromal tumor, associated with esophageal hiatus hernia.An 85-year-old woman was admitted to our hospital because of vomiting. An upper gastrointestinal series what showed a large esophageal hiatus hernia, suggesting an association with extrinsic pressure in the middle portion of the stomach. An upper gastrointestinal endoscopic examination showed severe esophagitis and a prominent narrowing in the middle portion of the stomach, however, it showed normal gastric mucosa findings. CT and MRI revealed a large tumor extending from the region of the lower chest to the upper abdomen. From these findings, the tumor was diagnosed as gastrointestinal stromal tumor (GIST), which arose from the gastric wall and complicated with an esophageal hiatus hernia. We performed a laparotomy, however, the tumor showed severe invasion to the circumferential organs. Therefore, we abandoned the excision of the tumor. Histologically, the tumor was composed of spindle shaped cells with marked nuclear atypia and prominent mitosis. The tumor cells were strongly positive for CD34 and c-kit by immunohistochemical examination. From these findings, the tumor was definitely diagnosed as a malignant GIST. As palliative treatment, we implanted a self-expandable metallic stent in the narrow segment of the stomach. The patient could eat solid food and was discharged. In the treatment of esophageal hiatus hernia, the rare association of GIST should be considered.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
5/15. Anesthetic management for repair of adult Bochdalek hernia by laparoscopic surgery.This report describes anesthetic management of a case (a 64-year-old man) who was originally diagnosed as paraesophageal hernia before surgery and later diagnosed as Bochdalek hernia during laparoscopic surgery. anesthesia was started with oxygen, nitrous oxide, and sevoflurane, and respiration was managed using controlled mechanical ventilation. Although left pneumothorax was noticed during laparoscopic surgery (aeroperitonia pressure: 10 cmH2O), the surgery was performed using the same anesthesia procedure, because hardly any changes were observed on the monitor and vital signs were stable. The surgery was completed without incident. However, postoperative chest x-rays revealed the residual large pneumothorax. A chest drain tube was inserted immediately, after which the pneumothorax was improved. pneumothorax is considered to be inevitable in cases of laparoscopic repair of Bochdalek hernia. To prevent exacerbation of pneumothorax, anesthetic management should consist of discontinuing the use of nitrous oxide and lowering the aeroperitonia pressure concomitently with the use of positive airway pressure.- - - - - - - - - - ranking = 1.5keywords = pressure (Clic here for more details about this article) |
6/15. Recurrent acute heart failure caused by sliding hiatus hernia.The case is reported of a 75 year old woman who presented with recurrent nocturnal episodes of acute pulmonary oedema. The cause was uncertain as she had normal cardiothoracic ratio on chest radiography and normal left ventricular systolic and diastolic function by transthoracic echocardiogram. Another transthoracic echocardiogram was repeated when she was recumbent for an hour and had a full stomach. It showed a striking finding of severe left atrial compression by an external structure. Computed tomography of the thorax showed an intrathoracic mass behind the left atrium causing external compression of the left atrium suggestive of a sliding hiatus hernia. Cardiac catheterisation confirmed the diagnosis by showing a pronounced rise of pulmonary capillary wedge pressure in the recumbent position compared with the sitting up position.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
7/15. Familial Barrett's oesophagus?Two sisters presenting with Barrett's oesophagus both at the age of 66, are described. The endoscopic appearances revealed striking similarities in terms of severity and extent of the lesion and the presence of a hiatus hernia. At oesophageal manometry low lower oesophageal sphincter pressures were recorded in each case. These observations raise the possibility that familial factors may influence the development of this condition, and likely mechanisms are discussed.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
8/15. Simultaneous cineradiographic-manometric study of the distal esophagus: small hiatal hernias and rings.Manometric features were correlated with roentgen configurations of the esophagogastric region in subjects with hiatal hernias and with rings by simultaneous cineradiographic and manometric study. The supradiaphragmatic pouch in small hiatal hernias was shown to have two functionally distinct components. Its upper portion (vestibule) had sequential contractile motor activity in response to swallowing. The lower portion was inactive and represented the true hernial sac. A weblike ring (Schatzki) or notches were often identified at the junction of these two segments. There was no peristaltic activity at or below this type of ring. A broad ring with contractile radiological behavior at the upper margin of the vestibule showed resting high pressure which fell on swallowing. This differed from the resting high pressure zone of normals in being shorter in length and showing an abrupt rather than gradual transition to contiguous pressures. Retrograde barium flow from hernial sac into the tubular esophagus was not seen when such a contractile A-ring was evident. Retrograde barium flow into the esophagus from the hernial sac occurred in those subjects not having a resting high pressure zone. Such reflux was delayed as long as the peristaltic wave persisted in the vestibular segment above the hernial sac. A constriction above the hernial sac during retrograde flow presumably represents a residual manifestation of the peristaltic wave, is transient, and is not associated with elevated resting pressure. The pressure inversion point was inconstant in its location in hiatal hernia subjects. It was often located at the site of the upwardly displaced high pressure zone, although a second pressure inversion point could be identified at the hiatal level on deep inspiration.- - - - - - - - - - ranking = 4keywords = pressure (Clic here for more details about this article) |
9/15. Acute hiatal hernia with oesophageal perforation following Heller's operation.The unusual complication of acute hiatal hernia with oesophageal rupture following transthoracic oesophagomyotomy is described in 2 cases. Inadvertent disruption and widening of the oesophageal hiatus at the time of surgery coupled with increased intragastric and intra-abdominal pressure were the probable causes. The hiatus should be carefully inspected on completion of the myotomy and anatomical restoration performed if necessary in order to avoid this complication. Urgent surgical intervention, gastric fundal serosal patch repair and intravenous alimentation proved successful in the management of these patients.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
10/15. Multiple surgical problems in two patients with ehlers-danlos syndrome.ehlers-danlos syndrome is a genetically determined disorder of connective tissue, the internal manifestations of which carry significant morbidity and mortality rates. During the past 14 years, we have treated multiple life-threatening surgical complications of this disease in two patients. The difficulties encountered at operation require modification of anesthetic and surgical techniques to accommodate the sometimes surrealistic situations that develop with alarming suddenness in patients with the ehlers-danlos syndrome. These techniques include handling the extremely friable tissues, dissecting and ligating vessels that disintegrate under the pressure of a hemostat, stemming spontaneous arterial hemorrhage, and special care in harvesting and placing split-thickness skin grafts.- - - - - - - - - - ranking = 0.5keywords = pressure (Clic here for more details about this article) |
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