1/7. 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 = physical (Clic here for more details about this article) |
2/7. Paraesophageal hernia in an elderly woman with vomiting.We describe the case of a 79-year-old woman who presented with resolved episodes of vomiting and was found to have a paraesophageal hernia. Her initial evaluation was unremarkable, and the diagnosis was established only by the use of screening chest radiography. Once the diagnosis was confirmed, the patient required urgent surgical repair. Paraesophageal hernia is a rare clinical entity with the potential for life-threatening complications, making the diagnosis itself an indication for surgery. This case illustrates the fact that significant pathology may be present with few, if any, physical findings in the elderly patient, and thorough evaluations are required for the diagnosis of such occult pathology.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/7. 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 = 1keywords = physical (Clic here for more details about this article) |
4/7. Esophageal hernia in dementia: surgeon's role for mixed-type esophageal hernia in an elderly woman with dementia.The mixed-type esophageal hernia is an indication for operation to prevent stomach volvulus and perforation. However, preventive operation is meaningful depending on the physical status. We encountered an 84-year-old, demented, bed-ridden woman of mixed-type esophageal hernia complicated with severe reflux esophagitis. First, the patient was conservatively treated by intravenous hyperalimentation and H2 blocker but, with onset of delirium, she removed the venous route twice. Subsequently, she was tightly restrained to the bed to avoid removing the line. Ethical deliberation for the patient tightly fixed to the bed and intravenous alimentation for her life prompted us to reconsider hernia operation after discussion with surrogate decision makers. The patient recovered uneventfully after operation, and movement without intravenous route or without any restraints was maintained by oral feeding assisted by gastrostomy feeding. In the coming decade, when senior patients are expected to increase, such operations can be forwarded to respect the patients' quality of life.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/7. A thrilling case of hiatus hernia.A 65 year old woman was found to have a left parasternal heave and a systolic murmur associated with a thrill. A chest radiograph, echocardiogram and gastrograffin swallow demonstrated a massive obstructed hiatus hernia which displaced the heart anteriorly. Aspiration of the contents of the hernia led to complete resolution of the physical signs. Possible mechanisms for their production are discussed.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/7. A case of profound iron deficiency anemia owing to corrosive esophagitis in a 20-year-old developmentally delayed male.The level of severe compensated iron deficiency anemia incompatible with life is not defined in the pediatric or adolescent literature. A hemoglobin of 1.5 gm/dl in an older adolescent with few physical symptoms is distinctly unusual. A case of profound iron deficiency anemia in a 20-year-old developmentally delayed male is the subject of this brief report. There were only subtle physical findings in spite of this severe anemia. The anemia was the result of corrosive esophagitis associated with a hiatal hernia and reflux. physicians dealing with developmentally delayed adolescents should be aware of the fact that a severe anemia may develop, and such individuals should be periodically screened for anemia, melena, hematochezia, and hematemesis.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
7/7. Laparoscopic Nissen fundoplication complicated by late gastroesophageal herniation and intrathoracic perforation: a case report with review of the literature.We report the case of a 38-year-old man who, 2 weeks after a laparoscopic Nissen fundoplication, was referred to our Unit because of acute wrap herniation and intrathoracic gastric perforation. Although both of these complications have already been described, this is the first case in which they have occurred simultaneously and not as an immediate consequence of the operation. Intraoperative findings suggested that diaphragmatic crura had not been reapproximated and that the gastric wrap had not been fixed to them. This observation and the fact that immediately after hospital discharge the patient had sustained intense physical efforts can explain acute wrap herniation. Placement of full-thickness sutures may account for gastric perforation. These pathogenetic determinants and their preventive measures are discussed in the light of a review of the literature.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |